Health Effects Related to Harmful Presentation Title Algal Bloom - PowerPoint PPT Presentation

Health Effects Related to Harmful Presentation Title Algal Bloom Exposure Sarah Koske, D.V.M., M.P.H. CDC/CSTE Applied Epidemiology Fellow - Waterborne Diseases Wisconsin Department of Health Services, Division of Public Health Lake Wisconsin Alliance Meeting, July 9, 2015, Okee, WI

Wisconsin Division of Public Health (DPH), Harmful Algal Bloom (HAB) Surveillance Program � Established in 2009. � Surveillance for health effects related to HAB exposure. � Investigate reports of human and animal illnesses. � Coordinate water sampling and analysis. � Coordinate health advisories with local public health ������������������������������������ agencies. � Provide education and outreach. 2

HAB-Associated Illness Reporting � Reporting pathways: � Online case reporting tool on DPH Blue-Green Algae website. � Direct contact with staff (email, phone). � Dept. of Natural Resources (DNR), local health depts., lake association referrals. � Wisconsin Poison Center. 3

Harmful Algal Blooms (HABs) � How are people exposed? � Swimming � Water skiing � Boating � Wading � Using lake water for drinking ������������ or irrigation � Routes of exposure determine clinical signs/symptoms � Ingestion of water or algal scum material � Skin contact with bloom material � Inhalation of toxins or gases from decaying bloom mats � Fish consumption may be a valid exposure pathway 4

Routes of Exposure and Symptoms � Skin Contact � Rash, hives, or skin blisters (especially in areas under swimsuits) � Ingestion � Abdominal pain � Diarrhea � Vomiting � Nausea � Numb lips, tingling fingers and toes, or dizziness � Inhalation � Influenza-like illness � Respiratory irritation (e.g., runny eyes, nose, sore throat) � Asthma-like symptoms 5

Harmful Algal Blooms (HABs) � How are animals exposed? � Dogs are common victims. � Eating scum material, drinking lake water, licking algae from coat. ���������������������� ��� 6

Algal Toxins and Animal Health � Symptoms in Animals � Lethargy � Vomiting, drooling � Diarrhea � Difficulty breathing � Weakness � Seizures ���������������������������������� 7

HAB-Related Illness Complaints in Wisconsin Health Complaints Overview 2009-2014 # of Health Complaints Year 2009 37 2010 27 2011 36 2012 33 2013 13 2014 27 Total 173 Symptom Profile (2009-2013)** # of Reports Gastrointestinal Distress 56 **Many cases included multiple Cold/Flu-like Illness 37 symptom profiles, thus total number of Dermal Rash 31 symptoms exceeds total number of Respiratory Irritation 24 reports. 8

Frequency of Reported Primary Human and Animal Health Complaints, Wisconsin, 2009-2013 (n=121) Number of complaints 0 5 10 15 20 25 30 35 Diarrhea Rash Sore Throat Nausea Headache Vomiting Primary complaint Fever Shortness of Breath Fatigue Anorexia Chest Tightness Cough Malaise Muscle Pain Seizure Wheezing Itchy eyes Stomach ache 9

HAB-Related Illness in Wisconsin Incubation Period of Primary Health Duration of Primary Health Complaint, 2009-2013 (n=108) Complaint, 2009-2013 (n=110) 40 45 40 35 Number of complainants Number of complainants 35 30 30 25 25 20 20 15 15 10 10 5 5 0 0 <1 hr 1-6 6-24 1-7 Don't hrs hrs days know Incubation period Duration 10

Public Health Importance � Emerging public health problem worldwide. � Ability to affect large numbers of people when drinking water is involved. � Projected increases in severity and magnitude. � Health impacts still poorly understood. 11

Public Health Importance � The number of HAB-related illnesses is likely underestimated. � Under-reporting of cases to the HAB Surveillance Program due to: � Voluntary reporting. � Variable knowledge of symptoms and ability to associate illness with HAB exposure. � Challenging diagnosis. � Non-specific symptoms that mimic other common illnesses (e.g., food poisoning, swimmer’s itch, seasonal allergies). � Most ill individuals do not seek medical attention. � Variable case recognition among doctors and veterinarians. � No clinical diagnostic test to confirm exposure. 12

What does a case of HAB-related illness sound like? 13

HAB Case Study 1: Lake Kegonsa, Dane County � On July 15, 2009, a 31 year old male awoke at 2AM with symptoms of nausea, diarrhea and vomiting. � Later that day, the patient developed burn- like lesions on his lower left arm. � The previous evening, he ����������������������������� had caught and eaten fish from Lake Kegonsa. 14

HAB Case Study 1: Lake Kegonsa, Dane County � Patient reported: � Lake water was green and cloudy with a strong manure- like odor. � Heavy algal mat present. � Left arm was exposed to algal material up to his elbow when he reached into the lake. � While cleaning the fish, he accidentally severed the liver, possibly contaminating the fillet with algal toxins that can be concentrated in the bile. � Water sample collected two days later showed: � Two cyanobacteria species � Microcystin-LR present 15

HAB Case Study 2: Lake Tomahawk, Oneida County � August 14, 2009 � A 15 lb. rat terrier collapsed 30 minutes after swimming and playing fetch near a beach on Lake Tomahawk. � The dog’s owner immediately took it to a local veterinarian. � On admission, the dog was comatose, with dilated pupils, blue-gray mucous membranes ��������������������������������� and a heart rate of 180-200 beats per minute. 16

HAB Case Study 2: Lake Tomahawk, Oneida County � Dog died within 90 minutes of onset. � Inspection of the water at this beach conducted August 17 (three days later) found no visible evidence of an algal bloom. � Water samples contained two cyanobacteria species at concentrations considered low risk for adult humans. � Toxin analysis was not conducted. � The presumptive cause of death was exposure to blue-green algae. 17

HAB Case Study 3: Lakes Mendota and Monona, Dane County � 25 year-old female developed a rash on her chest and abdomen within one hour of tubing over 4 th of July weekend, 2009. � Within 12 hours she http://msbonnersinil.blogspot.com / developed severe nasal congestion, earache, sore throat, conjunctivitis, headache, and malaise. 18

HAB Case Study 3: Lakes Mendota and Monona, Dane County � Routine monitoring of beaches by County Health Department detected four toxin-producing species of cyanobacteria at four different beaches. � Samples from Lake Mendota contained several microcystin variants at high risk concentrations as well as cylindrospermopsin. 19

How Can I Help? � Become familiar with the signs and symptoms and relevant water conditions. � DHS, DNR, CDC websites � Educate others. � Posters, pamphlets, materials available for download � Report suspected illnesses to the WI Division of Public Health HAB Surveillance Program. � Encourage others to report suspected illnesses. � Report suspected blooms to your local health department. 20

Contact Information Gina LaLiberte Wisconsin Dept. of Natural Resources Gina.LaLiberte@wisconsin.gov Sarah Koske, DVM, MPH Wisconsin Division of Public Health Sarah.Koske@dhs.wi.gov TO REPORT A HAB-RELATED ILLNESS: Online report form: https://www.dhs.wisconsin.gov/water/bg- algae/index.htm Visit www.dhs.wisconsin.gov and search for “blue-green algae” By phone: (608) 266-1120 21