Complex Challenges to
S t i bl Water
Sustainable
W t
Resources: Public Health
Issues
Lora E Fleming MD PhD MPH MSc
University of Miami
Water Uses
•
•
•
•
•
•
•
•
Drinking
Hygiene
Food preparation
Irrigation
R
Recreation
ti
Industry
Waste Disposal
Ecosystem Health
Aquatic Toxins
•
•
•
•
•
•
•
Harmful Algal Blooms
Routes of Exposures
Di
Diseases
Populations
Prevention
Surveillance
Outreach & Education
Harmful Algal Blooms
Harmful Algal Blooms (HABs)
Definition:
• “Red/Brown/Yellow/etc Tides”
• Proliferation of microscopic organisms
• Marine,
Marine fresh & estuarine waters
•1
Potential danger to:
– Environment
– Wildlife
– Humans
Florida Red Tide
C
Causes
off HAB
HABs?
?
DEPENDS on Individual Organism!!!!
• Environmental/Biological
g
factors
– Currents, temperature, wind
• ?Anthropogenic
t opoge c Factors
acto s
– ?Human Interactions
– ?Pollution & Nutrients
– ?Global Change
Causes of HABs
• Blooms of Microscopic
organisms
g
– Dinoflagellates, diatoms, blue
green algae
g
g (cyanobacteria)
( y
)
• “Harm” =
– Oxygen deprivation
– Natural Toxin-production
Florida Red Tide
Karenia brevis
((formerlyy Gymnodinium
y
breve,, Ptychodiscus
y
brevis))
Whole (live) Cell
Intra-cellular Toxins
Lysed (ruptured) Cell
Extra-cellular Toxins
HAB Toxins
• Natural
N t
l Toxins
T i
– Harmful in minute (picogram) doses
• Can NOT be
– detected
• No taste or smell
– eliminated
• Heat and acid stable
g, storage,
g , cooking
g
• Cleaning,
• Work at cellular level
Brevetoxins
HO
H3C
OA
CH 3
CH 3
O
O
D
B C O E
O JO
I
H3C
O HO
F G
O
R2
O
PbTx Type-2
PbTx-2:
PbTx-3:
PbTx-5:
PbTx-6:
R1
H
H
CH3CO
H
PbTx-8: H
PbTx-9: H
R2
R1
CH2C(=CH2)CHO
PbTx-1: H
(
CH2C(=CH
PbTx-7: H
2))CH2OH
CH2C(=CH2)CHO
CH2C(=CH2)CHO
27,28 peroxide
CH2C(=CH2)COCH2Cl
CH2CH(CH3)CH2OH PbTx-10: H
PbTx Type-1
R2
CH2CH(CH=CH2)CHO
(
CH2CH(CH=CH
2))CH2OH
CH2CH(CH3)CH2OH
Brevetoxin Effects on the Sodium
Channel in Nerve Cells
Brevetoxin
Nerve Cell
Harmful
H
f l Algal
Al l Blooms
Bl
in Florida
Florida Red Tide
Positive Samples,
Samples 1954 to Present
Florida Blue Green Algae
S
Sampling:
li
Surface
S f
Water
W t
Seafood Consumption
?Brevetoxin Fish Poisoning
Flewelling et al. Nature 2005
Air ((Aerosol)) & Water Exposure
p
Natural Forces and Exposures
Birds
UV
Rain
Wind
p
People
Air--Sea
Air
Marine Mammals
Fish
Recreational Exposure
Occupational Exposure
Red Tides & Fish Kills
Endangered Florida Manatee
Florida Red Tide
Environmental Impact
Economic Costs of HABs
1987-1992:
1987
1992:
> $449,291,987
$449 291 987
– Public Health
– Commercial Fisheries
– Recreation & Tourism
– Monitoring & Management
– Anderson & Hoagland et al (2000/2002)
Clinical Epidemiology
• Onset:
– Minutes to hours (<24)
• Attack Rate = # Ill/# Exposed:
– ??100%
• Symptoms:
S
t
– Gastrointestinal; Neurologic; Respiratory; Dermatologic
• ?F
?Fatality:
t lit Yes
Y
• ?Chronic Disease
– Ciguatera;
Ci
t
?A
?Aerosolized
li d Fl
Florida
id R
Red
d Tid
Tide; ?C
?Carcinogenicity
i
i it
• Treatment
– Mostly
M tl supportive;
ti
IV Mannitol;
M
it l ?Brevenal
?B
l
• Other
Marine & Freshwater Toxin
Shellfish Human Diseases
•
•
•
•
•
Paralytic Shellfish Poisoning (PSP)
Neurotoxic Shellfish Poisoning (NSP)
Diarrheic Shellfish Poisoning (DSP)
Amnesiac Shellfish Poisoning (ASP)
Azaspiracid Shellfish Poisoning (AZP)
Marine & Freshwater Toxin
Fish Human Diseases
• Pufferfish “Fugu”
(Tetrodotoxin)/(Saxitoxin)
• Ciguatera Fish Poisoning
• ?Brevetoxin Fish
Poisoning
Assessment of Saxitoxin in
Puffer Fish and other Biota
Florida Marine Research
Institute (FMRI)
Marine & Freshwater Toxin
Water/Aerosol Human Diseases
• Blue Green
Algae/Cyanobacteria
• Aerosolized
A
li d
(Brevetoxin) Red Tide
• ?Pfiesteria
Cyanobacteria
Microcystis
bloom
Anabaena circinalis
June 2000
Photos by John Burns
GIS Methods:
HCC Cases & Surface Water Treatment
Plants
Who are the potentially
susceptible populations?
yUnderlying lung disease
yAsthma & COPD
yElderly
Eld l
yPregnant
g
women
y?Underlying neurologic disease
y?Immunosuppressed
y?Children
yPets
P t
Marine & Freshwater Toxin
Diseases: Current “Prevention”
Prevention
Disease
PSP
NSP
DSP
ASP
AZP
Ci
Ciguatera
t
Fugu (Tetrodotoxin/Saxitoxin)
?Brevetoxin Fish
(Brevetoxin) Red Tide
ue G
Green
ee Algae
gae
Blue
?Pfiesteria/PEAS
Transvector
Organism/Toxin
S
Shellfish
f
Bed
Monitoring
?Fi h Monitoring
?Fish
M it i
?Water/Air Monitoring
??Nutrient Restrictions?
Sarasota CHD
Florida Poison Information
Center
Aquatic Toxins Hotline
• Toll Free: 888 232 8635
• 24/7 in English & Spanish
• Automated Menu of Information
– Florida Red Tide
– Other HABs
• Speak with Trained Poison Information
Specialist
– Information
– Report cases to Fl Dept of Health & CDC
Florida Dept of Health Medical Fact Sheets
Posters
Hotels,
Restaurants,
Restaurants
Tourist Venues
Outreach Activities: Information,
Education and Communication
9 Brochures
9 Trinkets
9 Web Site
Development
9 PSAs for Hotels
Hotels,
Public Access
C a es
Channels
9 Exhibits
9 Professional
Enrichment
Presentations
Sarasota County Beach Conditions Report
NOAA HAB Bulletins
Forecast
Infrared
Satellite
Imagery
(Chlorophyll a)
Detailed
Analysis
Wind Speed Graph
Acknowledgements
• Florida Dept of Health Aquatic Toxins
Program
• CDC
• Florida Poison Information Center
• NSF NIEHS Oceans and Human Health
Center
• NIEHS Florida Red Tide PO1
ollfree 24/7 Aquatic Toxins Hotline: 1
1-888-232-86
888 232 86
•www.doh.state.fl.us/environment/community/aquatic/
•http://coastwatch noaa gov/hab/bulletins ns htm
•http://coastwatch.noaa.gov/hab/bulletins_ns.htm
• www.Floridamarine.org/
• www.mote.org/
g
• www.start1.com/
• www.rsmas.miami.edu/groups/ohh/