Sarah Koske Presentation - Lake Wisconsin Alliance

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
Lake Kegonsa, Dane County, June 2009
2
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.
HAB-Associated Illness Reporting
Reporting pathways:
3
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.
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
4
www2.epa.gov
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
Routes of Exposure and Symptoms
Skin Contact
Ingestion
Abdominal pain
Diarrhea
Vomiting
Nausea
Numb lips, tingling fingers and toes, or dizziness
Inhalation
5
Rash, hives, or skin blisters (especially in areas under swimsuits)
Influenza-like illness
Respiratory irritation (e.g., runny eyes, nose, sore throat)
Asthma-like symptoms
Harmful Algal Blooms (HABs)
How are animals exposed?
Dogs are common victims.
Eating scum material, drinking lake water, licking algae from coat.
CDC
6
www.organic-center.org
Algal Toxins and Animal Health
Symptoms in Animals
https://aesrd.files.wordpress.com/
7
Lethargy
Vomiting, drooling
Diarrhea
Difficulty breathing
Weakness
Seizures
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
Symptom Profile (2009-2013)**
8
173
# of Reports
Gastrointestinal Distress
56
Cold/Flu-like Illness
37
Dermal Rash
31
Respiratory Irritation
24
**Many cases
included multiple
symptom profiles,
thus total number of
symptoms exceeds
total number of
reports.
Frequency of Reported Primary Human and Animal
Health Complaints, Wisconsin, 2009-2013 (n=121)
Number of complaints
Primary complaint
0
9
Diarrhea
Rash
Sore Throat
Nausea
Headache
Vomiting
Fever
Shortness of Breath
Fatigue
Anorexia
Chest Tightness
Cough
Malaise
Muscle Pain
Seizure
Wheezing
Itchy eyes
Stomach ache
5
10
15
20
25
30
35
HAB-Related Illness in Wisconsin
Duration of Primary Health
Complaint, 2009-2013 (n=110)
45
40
40
35
Number of complainants
Number of complainants
Incubation Period of Primary Health
Complaint, 2009-2013 (n=108)
35
30
25
20
15
10
5
30
25
20
15
10
5
0
0
<1 hr 1-6 6-24 1-7 Don't
hrs hrs days know
Incubation period
10
Duration
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
14
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 burnlike lesions on his lower
left arm.
The previous evening, he
had caught and eaten fish
from Lake Kegonsa.
www.floridawatercoalition.org
HAB Case Study 1:
Lake Kegonsa, Dane County
Patient reported:
Water sample collected two days later showed:
15
Lake water was green and cloudy with a strong manurelike 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.
Two cyanobacteria species
Microcystin-LR present
HAB Case Study 2:
Lake Tomahawk, Oneida County
16
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.
http://msh.mashoid.netdna-cdn.com
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
18
25 year-old female
developed a rash on her
chest and abdomen
within one hour of tubing
over 4th of July weekend,
2009.
Within 12 hours she
developed severe nasal
congestion, earache, sore
throat, conjunctivitis,
headache, and malaise.
http://msbonnersinil.blogspot.com/
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/bgalgae/index.htm
Visit www.dhs.wisconsin.gov and search
for “blue-green algae”
By phone: (608) 266-1120
21