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The National Poison Data System (NPDS) comprises self-reported information from people who call US poison center hotlines. NPDS data have proven to be important in identifying emerging public health threats. We used NPDS to examine records of people who had self-reported exposure to harmful algal blooms (HABs). Participating poison centers then contacted people who had called their centers from May through October 2019 about their HAB exposure to ask about exposure route, symptoms, health care follow-up, and awareness of possible risks of exposure. Of 55 callers who agreed to participate, 47 (85%) reported exposure to HABs while swimming or bathing in HAB-contaminated water. Nine callers reported health symptoms from being near waters contaminated with HABs, suggesting potential exposure via aerosolized toxins. Symptoms varied by the reported routes of exposure; the most commonly reported symptoms were gastrointestinal and respiratory. More public and health care provider education and outreach are needed to improve the understanding of HAB-related risks, to address ways to prevent HAB-related illnesses, and to describe appropriate support when exposures occur. [ABSTRACT FROM AUTHOR]

Harmful algal and cyanobacterial blooms (harmful algal blooms) are large colonies of algae or cyanobacteria that can harm humans, animals, and the environment (1-3). The number of algal blooms has been increasing in the United States, augmented by increasing water temperatures and nutrients in water from industry and agricultural run-off (4,5). The extent to which harmful algal bloom exposures cause human illness or long-term health effects is unknown. As the number of blooms increases annually, the likelihood of negative health outcomes (e.g., respiratory or gastrointestinal illness) from exposure also increases (4,5). To explore the utility of syndromic surveillance data for studying health effects from harmful algal bloom exposures, CDC queried emergency department (ED) visit data from the National Syndromic Surveillance Program (NSSP) for harmful algal bloom exposure-associated administrative discharge diagnosis codes and chief complaint text terms related to harmful algal bloom exposure (6). A total of 321 harmful algal bloom-associated ED visits were identified during January 1, 2017-December 31, 2019. An increase in harmful algal bloom-associated ED visits occurred during warmer months (June-October), consistent with seasonal fluctuations of blooms and recent publications (6,7). Although syndromic surveillance data are helpful for understanding harmful algal bloom-associated ED visits in the United States, exposures were documented infrequently with discharge diagnosis codes; 67% of harmful algal bloom-associated ED visits were identified through querying chief complaint text. Improving the documentation of harmful algal bloom exposures in medical records would further benefit future health studies. [ABSTRACT FROM AUTHOR]

Algae and cyanobacteria are present in all aquatic environments. We do not have a good sense of the extent of human and animal exposures to cyanobacteria or their toxins, nor do we understand the public health impacts from acute exposures associated with recreational activities or chronic exposures associated with drinking water. We describe the Harmful Algal Bloom-related Illness Surveillance System (HABISS) and summarize the collected reports describing bloom events and associated adverse human and animal health events. For the period of 2007-2011, Departments of Health and/or Environment from 11 states funded by the National Center for Environmental Health (NCEH), Centers for Disease Control and Prevention contributed reports for 4534 events. For 2007, states contributed 173 reports from historical data. The states participating in the HABISS program built response capacity through targeted public outreach and prevention activities, including supporting routine cyanobacteria monitoring for public recreation waters. During 2007-2010, states used monitoring data to support196 public health advisories or beach closures. The information recorded in HABISS and the application of these data to develop a wide range of public health prevention and response activities indicate that cyanobacteria and algae blooms are an environmental public health issue that needs continuing attention. [ABSTRACT FROM AUTHOR]

The article presents a report summarizing the characteristics of recreational water-associated disease outbreaks in the U.S. from 2009-2010. The outbreaks were caused by infectious pathogens or chemical agents in treated recreational water venues or untreated recreational water venues. A total of 81 recreational water-associated outbreaks were reported by public health officials from U.S. states. It has found that over half of the 57 outbreaks were associated with hotel or waterpark settings.

In the United States, the proportion of foodborne illness outbreaks associated with consumption of contaminated domestic and imported fresh fruits and vegetables (produce) has increased over the past several decades. To address this public health concern, the goal of this work was to identify and quantify factors associated with microbial contamination of produce in pre-and postharvest phases of the farm-to-fork continuum. From 2000 to 2003, we collected 923 samples of 14 types of produce (grown in the southern United States or in the northern border states of Mexico) front 15 farms and eight packing sheds located in the southern United States. To assess microbial quality, samples were enumerated for Escherichia coli, total aerobic bacteria, total coliforms, and total Enterococcus. Most produce types had significantly higher microbial concentrations when sampled at the packing shed than when sampled at the farm. In addition, we observed seasonal differences in the microbial concentrations on samples grown in the United States, with higher mean indicator concentrations detected in the fall (September, October, and November). We developed a predictive, multivariate logistic regression model to identify and quantify factors that were associated with detectable concentrations of E. coli contamination on produce. These factors included produce type (specifically, cabbage or cantaloupe), season of collection (harvested in the fall), and packing step (bin, box, conveyor belt, or turntable). These results can be used to identify specific mechanisms of produce contamination and propose interventions that may decrease the likelihood of produce-associated illness. [ABSTRACT FROM AUTHOR]

In this review we present an update on maternal exposure to nitrates in drinking water in relation to possible adverse reproductive and developmental effects, and also discuss nitrates in drinking water in the United States. The current standard for nitrates in drinking water is based on retrospective studies and approximates a level that protects infants from methemoglobinemia, but no safety factor is built into the standard. The current standard applies only to public water systems. Drinking water source was related to nitrate exposure (i.e., private systems water was more likely than community system water to have nitrate levels above the maximum contaminant limit). Animal studies have found adverse reproductive effects resulting from higher doses of nitrate or nitrite. The epidemiologic evidence of a direct exposure-response relationship between drinking water nitrate level and adverse reproductive effect is still not clear. However, some reports have suggested an association between exposure to nitrates in drinking water and spontaneous abortions, intrauterine growth restriction, and various birth defects. Uncertainties in epidemiologic studies include the lack of individual exposure assessment that would rule out confounding of the exposure with some other cause. Nitrates may be just one of the contaminants in drinking water contributing to adverse outcomes. We conclude that the current literature does not provide sufficient evidence of a causal relationship between exposure to nitrates in drinking water and adverse reproductive effects. Future studies incorporating individual exposure assessment about users of private wells—the population most at risk—should be considered. [ABSTRACT FROM AUTHOR]

The article offers insights on the unregulated drinking water initiative in the U.S. for environmental protection and safeguarding public health. The authors stress the need to assess and protect the drinking water in the country. They suggest adding resources allocation and identifying information available on unregulated drinking water sources.

Prenatal exposure to drinking water with arsenic concentrations >50 μg/L is associated with adverse birth outcomes, with inconclusive evidence for concentrations ≤50 μg/L. In a collaborative effort by public health experts, hydrologists, and geologists, we used published machine learning model estimates to characterize arsenic concentrations in private wells—federally unregulated for drinking water contaminants—and evaluated associations with birth outcomes throughout the conterminous U.S. Using several machine learning models, including boosted regression trees (BRT) and random forest classification (RFC), developed from measured groundwater arsenic concentrations of ∼20,000 private wells, we characterized the probability that arsenic concentrations occurred within specific ranges in groundwater. Probabilistic model estimates and private well usage data were linked by county to all live birth certificates from 2016 (n = 3.6 million). We evaluated associations with gestational age and term birth weight using mixed-effects models, adjusted for potential confounders and incorporated random intercepts for spatial clustering. We generally observed inverse associations with term birth weight. For instance, when using BRT estimates, a 10-percentage point increase in the probability that private well arsenic concentrations exceeded 5 μg/L was associated with a −1.83 g (95% CI: −3.30, −0.38) lower term birth weight after adjusting for covariates. Similarly, a 10-percentage point increase in the probability that private well arsenic concentrations exceeded 10 μg/L was associated with a −2.79 g (95% CI: −4.99, −0.58) lower term birth weight. Associations with gestational age were null. In this largest epidemiologic study of arsenic and birth outcomes to date, we did not observe associations of modeled arsenic estimates in private wells with gestational age and found modest inverse associations with term birth weight. Study limitations may have obscured true associations, including measurement error stemming from a lack of individual-level information on primary water sources, water arsenic concentrations, and water consumption patterns. [ABSTRACT FROM AUTHOR]

Arsenic from geologic sources is widespread in groundwater within the United States (U.S.). In several areas, groundwater arsenic concentrations exceed the U.S. Environmental Protection Agency maximum contaminant level of 10 μg per liter (μg/L). However, this standard applies only to public-supply drinking water and not to private-supply, which is not federally regulated and is rarely monitored. As a result, arsenic exposure from private wells is a potentially substantial, but largely hidden, public health concern. Machine learning models using boosted regression trees (BRT) and random forest classification (RFC) techniques were developed to estimate probabilities and concentration ranges of arsenic in private wells throughout the conterminous U.S. Three BRT models were fit separately to estimate the probability of private well arsenic concentrations exceeding 1, 5, or 10 μg/L whereas the RFC model estimates the most probable category (≤5, >5 to ≤10, or >10 μg/L). Overall, the models perform best at identifying areas with low concentrations of arsenic in private wells. The BRT 10 μg/L model estimates for testing data have an overall accuracy of 91.2%, sensitivity of 33.9%, and specificity of 98.2%. Influential variables identified across all models included average annual precipitation and soil geochemistry. Models were developed in collaboration with public health experts to support U.S.-based studies focused on health effects from arsenic exposure.

We measured microcystins in blood from people at risk for swallowing water or inhaling spray while swimming, water skiing, jet skiing, or boating during an algal bloom. We monitored water samples from a small lake as a Microcystis aeruginosa bloom developed. We recruited 97 people planning recreational activities in that lake and seven others who volunteered to recreate in a nearby bloom-free lake. We conducted our field study within a week of finding a 10-microg/L microcystin concentration. We analyzed water, air, and human blood samples for water quality, potential human pathogens, algal taxonomy, and microcystin concentrations. We interviewed study participants for demographic and current health symptom information. Water samples were assayed for potential respiratory viruses (adenoviruses and enteroviruses), but none were detected. We did find low concentrations of Escherichia coli, indicating fecal contamination. We found low levels of microcystins (2 microg/L to 5 microg/L) in the water and (<0.1 ng/m(3)) in the aerosol samples. Blood levels of microcystins for all participants were below the limit of detection (0.147 microg/L). Given this low exposure level, study participants reported no symptom increases following recreational exposure to microcystins. This is the first study to report that water-based recreational activities can expose people to very low concentrations of aerosol-borne microcystins; we recently conducted another field study to assess exposures to higher concentrations of these algal toxins.