Prospective study of acute health effects in relation to exposure to cyanobacteria.

We conducted a study to investigate the relationship between exposure to cyanobacteria and microcystins and the incidence of symptoms in humans living in close proximity to lakes affected by cyanobacteria. The design was a prospective study of residents living around three lakes (Canada), one of which has a water treatment plant supplying potable water to local residents. Participants had to keep a daily journal of symptoms and record contact (full or limited) with the water body. Samples were collected to document cyanobacteria and microcystin concentrations. Symptoms potentially associated with cyanobacteria (gastrointestinal: 2 indices (GI1: diarrhea or abdominal pain or nausea or vomiting; GI2: diarrhea or vomiting or [nausea and fever] or [abdominal cramps and fever]); upper and lower respiratory tract; eye; ear; skin; muscle pain; headaches; mouth ulcers) were examined in relation with exposure to cyanobacteria and microcystin by using Poisson regression. Only gastrointestinal symptoms were associated with recreational contact. Globally, there was a significant increase in adjusted relative risk (RR) with higher cyanobacterial cell counts for GI2 (<20,000 cells/mL: RR=1.52, 95% CI=0.65-3.51; 20,000-100,000 cells/mL: RR=2.71, 95% CI=1.02-7.16; >100,000 cells/mL: RR=3.28, 95% CI=1.69-6.37, p-trend=0.001). In participants who received their drinking water supply from a plant whose source was contaminated by cyanobacteria, an increase in muscle pain (RR=5.16; 95% CI=2.93-9.07) and gastrointestinal (GI1: RR=3.87; 95% CI=1.62-9.21; GI2: RR=2.84; 95% CI=0.82-9.79), skin (RR=2.65; 95% CI=1.09-6.44) and ear symptoms (RR=6.10; 95% CI=2.48-15.03) was observed. The population should be made aware of the risks of gastrointestinal symptoms associated with contact (full or limited) with cyanobacteria. A risk management plan is needed for water treatment plants that draw their water from a source contaminated with cyanobacteria.

[1]  F. Speizer,et al.  Surveillance techniques for respiratory illness. , 1976, Archives of environmental health.

[2]  K. Dietz,et al.  A Randomized Controlled Trial Assessing Infectious Disease Risks from Bathing in Fresh Recreational Waters in Relation to the Concentration of Escherichia coli, Intestinal Enterococci, Clostridium perfringens, and Somatic Coliphages , 2005, Environmental health perspectives.

[3]  W. Carmichael,et al.  Human Fatalities from Cyanobacteria: Chemical and Biological Evidence for Cyanotoxins , 2001 .

[4]  Priscilla Robinson,et al.  Health effects of exposure to cyanobacteria (blue–green algae) during recreational water–related activities , 1977, Australian and New Zealand journal of public health.

[5]  Ward Wm,et al.  Guidelines for Canadian recreational water quality. , 1984 .

[6]  B. Kirkpatrick,et al.  Recreational Exposure to Low Concentrations of Microcystins During an Algal Bloom in a Small Lake , 2008, Marine drugs.

[7]  Paul B. Hamilton,et al.  The occurrence of the cyanobacterium Cylindrospermopsis raciborskii in Constance Lake: an exotic cyanoprokaryote new to Canada , 2005 .

[8]  S. Sauvé,et al.  Toxic cyanobacterial breakthrough and accumulation in a drinking water plant: a monitoring and treatment challenge. , 2012, Water research.

[9]  S. Zeger,et al.  Longitudinal data analysis using generalized linear models , 1986 .

[10]  Edwin C. Lippy,et al.  Gastrointestinal Illness at Sewickley, Pa. , 1976 .

[11]  A. Humpage.  Toxin types, toxicokinetics and toxicodynamics. , 2008, Advances in experimental medicine and biology.

[12]  K. Sivonen,et al.  Virulence genes of Aeromonas isolates, bacterial endotoxins and cyanobacterial toxins from recreational water samples associated with human health symptoms. , 2011, Journal of water and health.

[13]  M. Sinclair,et al.  Sporadic gastroenteritis and recreational swimming in a longitudinal community cohort study in Melbourne, Australia. , 2009, American journal of epidemiology.

[14]  D. Kleinbaum,et al.  Applied Regression Analysis and Other Multivariate Methods , 1978 .

[15]  I. Falconer,et al.  Severe hepatotoxicity caused by the tropical cyanobacterium (blue-green alga) Cylindrospermopsis raciborskii (Woloszynska) Seenaya and Subba Raju isolated from a domestic water supply reservoir , 1985, Applied and environmental microbiology.

[16]  W. Mcnab,et al.  Magnitude and distribution of acute, self-reported gastrointestinal illness in a Canadian community , 2004, Epidemiology and Infection.

[17]  L. Backer,et al.  The epidemiology of recreational exposure to freshwater cyanobacteria - an international prospective cohort study , 2002 .

[18]  M. V. Veldee.  An Epidemiological Study of Suspected Water-borne Gastroenteritis. , 1931, American journal of public health and the nation's health.

[19]  P. Turner,et al.  Pneumonia associated with contact with cyanobacteria. , 1990, BMJ.

[20]  Andrew R. Humpage,et al.  Health Risk Assessment of Cyanobacterial (Blue-green Algal) Toxins in Drinking Water , 2005, International journal of environmental research and public health.

[21]  A. Esterman,et al.  Murray River water, raised cyanobacterial cell counts, and gastrointestinal and dermatological symptoms , 1995, The Medical journal of Australia.

[22]  Jamie Bartram,et al.  Toxic Cyanobacteria in Water: a Guide to Their Public Health Consequences, Monitoring and Management Chapter 2. Cyanobacteria in the Environment 2.1 Nature and Diversity 2.1.1 Systematics , 2022 .

[23]  V. Stanghellini.  Three-month prevalence rates of gastrointestinal symptoms and the influence of demographic factors: results from the Domestic/International Gastroenterology Surveillance Study (DIGEST). , 1999, Scandinavian journal of gastroenterology. Supplement.

[24]  H. Dillenberg,et al.  Toxic waterbloom in Saskatchewan, 1959. , 1960, Canadian Medical Association journal.

[25]  Ian Stewart,et al.  Cyanobacterial lipopolysaccharides and human health – a review , 2006, Environmental health : a global access science source.

[26]  D. Hryhorczuk,et al.  Health Risks of Limited-Contact Water Recreation , 2011, Environmental health perspectives.

[27]  D. Bird,et al.  Seasonal changes in composition of the cyanobacterial community and the occurrence of hepatotoxic blooms in the eastern townships, Québec, Canada , 2005 .

[28]  M. D. G. Teixeira,et al.  Gastroenteritis epidemic in the area of the Itaparica Dam, Bahia, Brazil. , 1993, Bulletin of the Pan American Health Organization.

[29]  D. Mash,et al.  Cyanobacterial neurotoxin BMAA in ALS and Alzheimer’s disease , 2009, Acta neurologica Scandinavica.

[30]  J. Kaufman,et al.  Evaluating the evidence for models of life course socioeconomic factors and cardiovascular outcomes: a systematic review , 2005, BMC public health.