### FWRI Technical Report TR-14 2009 

# TECHNICAL REPORTS

Florida Fish and Wildlife Conservation Commission Resource Guide for Public Health Response to Harmful Algal Blooms in Florida

Based on Recommendations of the Florida Harmful Algal Bloom Task Force Public Health Technical Panel 

# FISH AND WILDLIFE RESEARCH INSTITUTE 

# TECHNICAL REPORTS ISSN 1930-1448

### Charlie Crist **Governor of Florida**



## Florida Fish and Wildlife Conservation Commission

**K enneth D. Haddad** 

**E xecutive Director** 

**T he Fish and Wildlife Research Institute (FWRI) is a division of the Florida Fish and Wildlife**  **Conservation Commission (FWC). The FWC is “managing fish and wildlife resources for their long-term well-being and the benefit of people.” The FWRI conducts applied research**  **pertinent to managing fishery resources and species of special concern in Florida.**

**Programs at FWRI focus on obtaining the data and information that managers of fish, wildlife, and ecosystem resources need to sustain Florida's natural resources. Topics include managing**  **recreationally and commercially important fish and wildlife species; preserving, managing, and restoring terrestrial, freshwater, and marine habitats; collecting information related to popula**  **tion status, habitat requirements, life history, and recovery needs of upland and aquatic species; synthesizing ecological, habitat, and socioeconomic information; and developing educational**  **and outreach programs for classroom educators, civic organizations, and the public.**

**T he FWRI publishes three series:**  **Memoirs of the Hourglass Cruises, Florida Marine Research Publications,**  **and FWRI Technical Reports. FWRI Technical Reports**  **contain information relevant to immediate resource-management needs.** 

**Gil McRae, FWRI Director** 
**J ames F. Quinn, Jr.,**  **Science Editor**
**J udith G. Colvocoresses,**  **Copy Editor Llyn C. French,**  **Publications Production .**  

# Resource Guide for Public Health Response to Harmful Algal Blooms in Florida

Based on Recommendations of the Florida Harmful Algal Bloom Task Force Public Health Technical Panel



# G. Meghan Abbott 1*



# Jan H. Landsberg 1



# Andrew R. Reich 2 

# Karen A. Steidinger 1,3 

# Sharon Ketchen 2 

# Carina Blackmore 2

1 

### Florida Fish and Wildlife Conservation Commission Fish and Wildlife Research Institute 100 Eighth Avenue Southeast St. Petersburg, Florida 33701 USA

2 

### Florida Department of Health Division of Environmental Health 4052 Bald Cypress Way T

allahassee, Florida 32399 USA

3 

### University of South Florida Florida Institute of Oceanography 830 First Street South St. Petersburg, Florida 33701 USA

*Present address follows Acknowledgments



# Florida Fish and Wildlife Conservation Commission FWRI Technical Report TR-14

2009**.** 

### Cover Photographs

**Center: Mercenaria mercenaria hard clams**  **(Florida Fish and Wildlife Conservation Commission). Clockwise from upper left:**  **Saxitoxin puffer fish poisoning warning sign in the Indian River Lagoon, Florida**  **(Florida Department of Health). Cyanobacteria bloom in Crescent Lake outflow into Coffee Pot**  **Bayou, Florida (Florida Fish and Wildlife Conservation Commission).**  **Red tide aerosol studies ( Mote Marine**  **Laboratory ). Florida red tide fish kill, July 2005 (**  **Florida Fish and Wildlife Conservation Commission )** 

**.**



### Copies of this document may be obtained from **http://research.MyFWC.com Florida Fish and Wildlife Conservation Commission**  **Fish and Wildlife Research Institute 100 Eighth Avenue SE**  **St. Petersburg, FL 33701-5020 USA Attn: Librarian** 

**F or more information on living resource health**  **in relation to Harmful Algal Blooms, please contact J**  **an H. Landsberg Florida Fish and Wildlife Conservation Commission**  **Fish and Wildlife Research Institute**

**Fish and Wildlife Health Program J**  **an.Landsberg@MyFWC.com, 727-896-8626**

**F or more information on public health in**  **relation to Harmful Algal Blooms, please contact Andrew R. Reich**  **Florida Department of Health, Aquatic Toxins Program Andy_Reich@doh.state.fl.us, 850-245-4299** 



### Document Citation **Abbott, G. M., J. H. Landsberg, A. R. Reich, K. A. Steidinger, S. Ketchen, and C. Blackmore. 2009. Resource guide for public health response to harmful algal blooms in Florida. Fish and Wildlife**  **Research Institute Technical Report TR-14. viii + 132 p.**



### Document Production

**T**

**his document was composed in Microsoft Word ®**  **and produced using QuarkXPress ®**  **on Apple Macintosh ®**  **computers.The headline font is Adobe ®**  **Av ant Garde, the text font is Adobe**  **® P**  **alatino, and the cover headline is Adobe**  **® Gill Sans.** 

**T he cover and text papers used in this publication meet the minimum requirements of the American**  **National Standard for Permanence of Paper for Printed Library Materials Z39.48—1992. .**  iii **In October 1997,Virginia Wetherell, then Secretary of the Florida Department of Environmental Pro** **tection, conceived and created the Florida Harm ful Algal Bloom Task Force (FHABTF) as an**  **ad hoc group to identify gaps in information on harmful**  **algal blooms (HABs) in Florida, particularly Kare**  **nia brevis red tides and potential**  **Pfiesteria fish kills.**  **Secretary Wetherell invited Dr. James Howell, then Secretary of the Florida Department of Health**  **(FDOH), to co-chair the ad hoc**  **task force. The FHABTF received a legislative mandate in July**  **1999, Florida Statute (F.S.) Chapter (Ch.) 370.06092 (now F.S. Ch. 379.2271).**  **One product of the FHABTF, “Harmful Algal Blooms in Florida”(Steidinger**  **et al., 1999), was an**  **unpublished technical report presented to the Florida legislature in October 1999. Recommenda**  **tions from this report contributed to the drafting of F** **.S. Ch. 370.06092 (now F.S. Ch. 379.2271), which assigned four tasks for the FHABTF. As of 2003,**  **only three had been completed:**

**“(a) Review the status and adequacy of information for monitoring physical, chemical, biological, eco**  **nomic, and public health factors affecting harmful algal blooms in Florida;**  **“(b) Develop research and monitoring priorities for harmful algal blooms in Florida, including detection,**  **prediction, mitigation and control; ...and “(d) Make recommendations to the Florida Fish and**  **W**

**ildlife Research Institute for research, detection, monitoring, prediction, mitigation, and control of**  **harmful algal blooms in Florida.”**
**F.S. Ch. 379.2271** 

# Preface**FWC image**

**Dinoflagellate bloom in Bayboro Harbor, St. Petersburg, Florida .**  iv **T he remaining task (F.S. Ch. 379.2271 [2][c])** 

**w as to “develop recommendations that can be im** **plemented by state and local governments to de**

**v elop a response plan and to predict, mitigate, and**  **control the effects of harmful algal blooms.” In 2003, the Florida Fish and Wildlife Conservation**  **Commission (FWC) Fish and Wildlife Research Institute (FWRI) created the FHABTF Public Health**  **Tec hnical Panel. In the same year, FWC–FWRI re**  **ceived funds from the FDOH (made available by the Centers for Disease Control and Prevention**  **Grant U50-CCU423360-01) for support of this initiative to assist in the development of recom** **mendations for an integrated public health envi ronmental monitoring response plan.The portion**  **of the statute on “predict, mitigate, and control the effects of harmful algal blooms”was addressed in** **part by the Red Tide Control and Mitigation Pro gram administered by FWC–FWRI. However,**  **legislative budget cuts that began in 2008 threaten the program’s future.**  **T he Public Health Technical Panel first met in**  **October 2004 to discuss a framework for local public health response plans. In the next phase,**  **two workshops on informational needs for the development of local public health response plans**  **w ere conducted at FWC–FWRI in St. Petersburg.**  **T he first workshop titled “Florida Public Health** **Meeting on Harmful Algal Blooms and their Ef fects”was held 27–28 September 2005.The second** 

**wo rkshop titled “Florida Harmful Algal Bloom** **Public Health Agenda: Information for Develop ing Local Response Capacity”was held 9–10 Au**  **gust 2006. At the second workshop specific recommendations were made by participants on**  **informational materials needed for a user-friendly guide to address county public health response to**  **HABs.The two workshops were co-chaired by Jan Landsberg (FWC) and Andrew Reich (FDOH)** **and were attended by public health, environ mental, natural resource, agriculture, and research**  **professionals from state agencies, universities, and private laboratories (see Acknowledgement**  **of Participants). T** **his document is an extension of the activities performed by the Public Health Technical Panel,** **and addresses in part tasks directed by the leg islatively created FHABTF.The final phase is the ac**  **tual development of public health response plans, and this will be done by local county health de**  **partments assisted by the FDOH Aquatic Toxins Program.** v

**.** 

# Ta ble of Contents

**PREFACE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii**  **A CKNOWLEDGMENT OF PARTICIPANTS**  **. . . . . . . . . . . . . . . . . . . . . . . . . vii A** **CKNOWLEDGMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii**  **EXECUTIVE SUMMARY ................................. 1**  

### Chapter 1 Background on Harmful Algal Blooms **.................. 2 INTRODUCTION**  **.................................... 2 BREVETOXINS AND NEUROTOXIC SHELLFISH POISONING**  **............... 3 SAXITOXIN, PUFFER FISH POISONING, AND SAXITOXIN PUFFER FISH POISONING**  **.... 8 CIGUATOXIN AND CIGUATERA FISH POISONING**  **. . . . . . . . . . . . . . . . . . . . 11 CYANOBACTERIA (BLUE–GREEN ALGAE) AND CYANOTOXIN POISONING**  **. . . . . . . . 14 EMERGING HAB THREATS TO PUBLIC HEALTH**  **. . . . . . . . . . . . . . . . . . . . . 18 O**  **THER POTENTIAL HAB PROBLEMS . . . . . . . . . . . . . . . . . . . . . . . . . . . 19**  

### Chapter 2 Agency Responsibility Matrices **. . . . . . . . . . . . . . . . . . . . . . 22 AQ**  **UA TIC ANIMAL MORTALITY RESPONSIBILITY AND/OR AUTHORITY**  **. . . . . . . . . 22 ENVIRONMENTAL SAMPLING RESPONSIBILITY AND/OR AUTHORITY**  **. . . . . . . . . . 23 SHELLFISH RESPONSIBILITY AND/OR AUTHORITY**  **. . . . . . . . . . . . . . . . . . . 24 HUMAN SURVEILLANCE RESPONSIBILITY AND/OR AUTHORITY**  **. . . . . . . . . . . . . 25** 

### Chapter 3 Available Resources and Databases **. . . . . . . . . . . . . . . . . . . 26 ENVIRONMENTAL MONITORING DATA**  **. . . . . . . . . . . . . . . . . . . . . . . . . 26 ANIMAL SURVEILLANCE DATA**  **. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 HUMAN SURVEILLANCE DATA**  **. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 PHYSIOGRAPHIC DATA**  **. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29** 

### Chapter 4 Surveillance Networks and Systems **. . . . . . . . . . . . . . . . . . . . 30 HUMAN SURVEILLANCE NETWORKS**  **. . . . . . . . . . . . . . . . . . . . . . . . . . 30 SURVEILLANCE SYSTEMS USED BY FDOH**  **. . . . . . . . . . . . . . . . . . . . . . . . 32 SURVEILLANCE SYSTEMS MAINTAINED BY OTHER AGENCIES**  **. . . . . . . . . . . . . . 38** 

### Chapter 5 Regulatory Guidelines **. . . . . . . . . . . . . . . . . . . . . . . . . . . 40 SHELLFISH**  **. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 FISH**  **. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 DRINKING**  **WA TER**  **. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 RECREATIONAL WATERS**  **. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 BLUE–GREEN ALGAE DIETARY SUPPLEMENTS**  **. . . . . . . . . . . . . . . . . . . . . . 46** 

### Chapter 6 Outreach Resources **. . . . . . . . . . . . . . . . . . . . . . . . . . . 47 INFORMATION, EDUCATION, AND COMMUNICATION**  **. . . . . . . . . . . . . . . . . . 47 ONLINE RESOURCES**  **. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 RESPONDING TO THE PRESS AND PUBLIC**  **. . . . . . . . . . . . . . . . . . . . . . . . 51 DEVELOPING AN EFFECTIVE PRESS RELEASE**  **. . . . . . . . . . . . . . . . . . . . . . 52** 

### Chapter 7 Management Strategies for Mitigation of HABs **. . . . . . . . . . . . . . 62 MITIGATIO**  **N A CTIVITIES**  **. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 THE RED TIDE CONTROL AND MITIGATION PROGRAM**  **. . . . . . . . . . . . . . . . . 63**vi

**.** 

### Chapter 8 Research Needs **. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 FLORIDA HAB PUBLIC HEALTH RESEARCH NEEDS**  **. . . . . . . . . . . . . . . . . . . . 64 PUBLIC HEALTH POLICY NEEDS, APPLICATIONS FOR HAB RESEARCH**  **. . . . . . . . . . 65 IDENTIFIED RESOURCES**  **. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65** 

### Chapter 9 Activity Flowcharts **. . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 DEFINITION**  **. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 PURPOSE OF FLOWCHARTS**  **. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 SAMPLE FLOWCHARTS**  **. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 EXAMPLES OF CASE–HISTORY EVENT RESPONSES**  **. . . . . . . . . . . . . . . . . . . . 70** 

### Chapter 10 Literature Cited **. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75** 

### Appendices **. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 A M**  **aps of Specific Areas of Florida at High Risk for HAB Exposures (by County) . . . . . . . . 90**  **B M edical Fact Sheets and Case Definitions**  **. . . . . . . . . . . . . . . . . . . . . . . . . 95 C**  **Human Health Threats from Harmful Algal Bloom Species . . . . . . . . . . . . . . . . . 105**  **D Known or Potentially Toxic or Harmful Algal Species in Florida**  **. . . . . . . . . . . . . . . 110 E**  **Examples of Guidelines for Cyanobacteria in Recreational Waters . . . . . . . . . . . . . . 116**  **F Bibliography of Significant Literature**  **. . . . . . . . . . . . . . . . . . . . . . . . . . 118 G**  **Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119**  **H Acronyms and Abbreviations**  **. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 I**  **Agency Contacts, Scientists, and Managers . . . . . . . . . . . . . . . . . . . . . . . . 127**  

### Figures **4.1 EpiCom Web site forums screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33**  **4.2 Merlin ®**  **W eb site home page**  **. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 4.3 Food, Water and Vector-borne Surveillance System (FWVSS) Web site home page**  **. . . . . . 36 5.1 Example of an FWC–FWRI red tide status report map,**  **Karenia brevis counts**  **. . . . . . . . . 41 6.1 Example 1—Sample news release**  **. . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 6.2 Example 2—Sample health advisory/press release**  **. . . . . . . . . . . . . . . . . . . . 55 6.3 Example 3—Sample health advisory/press release**  **. . . . . . . . . . . . . . . . . . . . 56 6.4 Example 4—Sample health advisory/press release**  **. . . . . . . . . . . . . . . . . . . . 57 6.5 Example 5—Frequently asked questions about Florida red tide and their toxins**  **. . . . . . . 58 6.6 Example of red tide facts handout**  **. . . . . . . . . . . . . . . . . . . . . . . . . . . 60 9.1 Foodborne illness flowchart, Florida Department of Health investigation methods**  **. . . . . . 68 9.2 Flowchart for blue-green algae or cyanobacterial bloom response for water treatment plants**  **and water bodies in Florida (recreational and other) . . . . . . . . . . . . . . . . . . . 69**  **9.3 Neurotoxic shellfish poisoning event in 2006 . . . . . . . . . . . . . . . . . . . . . . . 71**  **9.4 Aerosol brevetoxin, red tide event . . . . . . . . . . . . . . . . . . . . . . . . . . . 72**  **9.5 Shellfish poisoning event (general) . . . . . . . . . . . . . . . . . . . . . . . . . . . 73**  **9.6 Saxitoxin puffer fish poisoning event 2002 . . . . . . . . . . . . . . . . . . . . . . . . 74** 


### T

ables **5.1 Examples of drinking water guidelines for cyanotoxins . . . . . . . . . . . . . . . . . . 43**  **5.2 WHO guidelines for cyanobacterial exposure in recreational waters . . . . . . . . . . . . 44**  **5.3 Examples of state guidelines for cyanobacteria in recreational waters . . . . . . . . . . . . 45** vii

**.** 

# Acknowledgment of Participants

**T he FHABTF Public Health Technical Panel met in 2004, 2005, and 2006 at the FWC–FWRI.The purpose** 

**w as threefold: to familiarize county health personnel with the different HABs in Florida, to identify the**  **public health and environmental effects of a particular bloom, and to identify the resources needed for developing public health response plans at the county level. The meetings were in part a review of** **currently known harmful algae and the consequences of their presence in Florida waters, and in part brain storming on the issues,**  **e.g., monitoring, research, agency coordination, public health information,**  **education, and communication. Participants included the following public health, environmental, natural resource, agriculture, and research professionals from state agencies, universities, and private laboratories.**  **We thank the following for their participation and continued interest in this joint FWC–FDOH**  **project in cooperation with other federal and state agencies, laboratories, and universities.**

**Abbott (Shone), Meghan – FWC Alaimo, Antoinette – FDOH**  **Backer, Lorraine – CDC Bigsby, Patricia – FDOH**  **Blackmore, Carina – FDOH Bodager, Dean – FDOH**  **Boler, Richard – EPCHC Bolestra, Rob – FDOH**  **Borroto-Ponce, Rene – FDOH Bryan, Scott – FDOH**  **Campbell, Dean – SJRWMD Degenaro, Stephanie – FDOH**  **DeThomasis, JoEllen – FDOH Dobberfuhl, Dean – SJRWMD**  **Donnelly, Maria – FDOH Downing, Brandy – FDOH**  **Drake, Judy – FDOH Drew, Richard – FDEP**  **F aconti,Victor – FDOH**  **Flanery, Mike – FDOH Fleming, Lora – U of M**  **Flewelling, Leanne – FWC F** **riedman, Mike – FDOH Fugitt, Marian – FDEP**  **Fulton, Jason – FDOH Girardin, David – SJRWMD**  **Grant,Val – FDOH Halscott, Kenneth – FDOH**  **Hammond, Roberta – FDOH Harvey, Richard – EPA**  **Heil, Cindy – FWC Heil, David – FDACS**  **Higman, John – SJRWMD Hutchinson, Richard – FDOH**  **Jac kow,**  **George – FDOH J**  **erez, Eva – PCC K** **ent, Steve – FDEP K** **etchen, Sharon – FDOH King, Joe – FDEP**  **Kirkpatrick, Barb – MML K** **oerner, David – FDOH Kow** **al, Laura – FDOH Lander, Mark – FDOH**  **Landsberg, Jan – FWC Lazensky, Becky – FDOH**  **Luce, Christie – FDOH Maier, Gary – FDOH**  **Melling, Russ – FDOH Nelson, Jennifer – FDEP**  **Nelson, Sascha – FDOH Odongo, George – FDOH**  **O’Reilly, Andrew – USGS P** 

**atch, Sonal – FDOH Pa** **wlowicz, Marek – FDOH P** 

**ettit, Karen – MCWTP Pfeuffer, Richard – SFWMD**  **Pink, Jack – FDOH P** 

**olk, David – FDOH P** 

**ouso, David – FDOH Prager, Ellen – Earth**  **2 Ocean, Inc.**  **Rakestraw, Richard – FDEP Reed, Gale – FDOH**  **Reich, Andy – FDOH Reinhold,Todd – FDOH**  **Riskowitz, Kevin – City of St.**

**Pe tersburg**  **Scheidt, Dan – EPA Schelble, Chip – FDOH**  **Seay, Briana – FWC Shapiro, Jerne – FDOH**  **South, Robert – FDOH Stanek, Paul – FDOH**  **Steidinger, Karen – USF Stephan, Wendy – U of M**  **Stripling,Terri – FDOH T** 

**erzagian, Robin – FDOH T** **hornton, Pete – FDOH Tra** **ynor, Sharleen – FDOH W**  **aldron, Jennifer – FDOH W**  **atford, Kim – FDOH W**  **eisman, Richard – U of M Wh**  **iting, David – FDEP W**  **illiams, Chris – GWL W**  **ilson, Emily – FDOH W**  **ilson,Yvette – FDOH W**  **indham, Donald – FDOH W**  **inn, Sarah – FDOH Zager, Hunter – FDOH**  **Zaheer, Saad – FDOH Zorros,Tim – FDOH** viii

**.** 

# Acknowledgments

**T he FHABTF Public Health Technical Panel was convened specifically to provide guidance and recom**  **mendations on materials needed to develop plans for local public health response to HABs. Many thanks to FDOH staff JoEllen DeThomasis and Sharon Watkins, as well as FWC–FWRI staff Leanne Flewelling,**  **Llyn French, Craig Harmak, Cindy Heil, James Quinn, Jr., and Ruth Reese for their various review and graphics contributions to this Guide, and to Dr. Ellen Prager of Earth**  **2 Ocean, Inc., for facilitating the 2006**  **FHABTF Public Health Technical Panel meeting.**
**Funding was provided by the Florida Department of Health, the Florida Fish and Wildlife Conservation Commission, and the Florida Department of Health Grant Award, U50-CCU423360-01, U.S. Centers for**  **Disease Control and Prevention.**

Author’s present address **G. Meghan Abbott, 8207-98 Avenue, Edmonton, Alberta, Canada T6A 0B6** **. Harmful algal blooms adversely affect Florida’s envi**  **ronment, economy, and human health. In recent years, more HAB species and toxins have been identified, and**  **toxins have appeared unexpectedly in algae that were once presumed to be nontoxic. HABs are increasing in** **frequency and geographic range, causing global con cern over an increasing public health risk.**  **T**

**he FHABTF was charged with investigating HABs and assessing their potential effects on living aquatic** **resources and public health.This charge included in**

**v estigating HAB events such as red tides and newly** **emerging issues such as the potential for the fish killing dinoflagellate**  **Pfiesteria piscicida to become a** **threat in Florida. In addition, the FHABTF was to eval uate critical HAB issues and make recommendations**  **for action. A Technical Advisory Group (TAG) was also appointed to assist the task force. The TAG de** 

**v eloped a resource document,“Harmful Algal Blooms** **in Florida,” that identified major Florida HABs; dis cussed the history and economic, natural-resource, and** **public health effects of HABs; and made recommen dations for action.This document was reviewed by the**  **Florida legislature which passed Florida Statutes (F.S.) Ch. 379.2271 and Ch. 379.2272 (formerly Ch. 370.06092**  **and Ch. 310.06093) in 1999, charging the task force with identifying gaps in research and information**  **and developing strategies and recommendations for response.**  **In 2003, the FHABTF Public Health Technical Panel**

**w as created in response to F.S. Ch. 379.2271 section** **2(c), “Develop recommendations that can be imple mented by state and local governments to develop a re**  **sponse plan and to predict, mitigate, and control the effects of harmful algal blooms.”This document is the** **resulting guide for state and local governments to fa cilitate the development of local public health HAB**  **response plans. T** **his technical manual has two major components. T** **he first provides background information for guiding development of local response plans and quick-refer** **ence guides for public health HAB response.The sec ond presents a methodology for developing flowcharts**  **and further technical information related to public health HAB response. The major topics include the**  **following:**

**• re view of current literature on HABs significant to** 

**public health in Florida**

**• identification of present federal, state, and local gov** 

**ernmental authority over, and responsibility for, re sponse activities related to HABs** 

**• av ailable monitoring and surveillance databases** 

**• current human health and animal surveillance** 

**systems**

**• public health regulatory guidelines (state, national,** 

**and international)**

**• a va**  **ilable outreach resources**

**• current management strategies for mitigation of** 

**HABs in Florida**

**• priority research and policy needs** 

**• examples of generic response flowcharts for envi** 

**ronmental and case investigations**

**• m aps identifying specific areas of Florida at high** 

**risk for HAB exposures**

**• medical fact sheets, clinical case definitions and re** 

**porting requirements for HAB-related human ill nesses, including neurotoxic shellfish poisoning,**  **brevetoxin-associated respiratory syndrome (also known as red tide cough), ciguatera fish poisoning,**  **saxitoxin puffer fish poisoning, and blue-green algae toxin (cyanotoxin) poisoning and illness, with a quick**  **reference guide to all**

**• extensive overview of toxins associated with HAB** 

**species in Florida**

**• guidelines for cyanobacteria in recreational waters** 

**• other significant literature related to the effects of** 

**HABs on humans**

**• list of important agency contacts, scientists, and** 

**managers**

FWRI Technical Report TR-14 1 

# Executive Summary**.** 2 FWRI Technical Report TR-14 

## Introduction
**Harmful algal blooms are global phenomena occuring in almost all aquatic environments from open seas to**  **freshwater lakes. In the marine environment, they are sometimes known as red tides. However, they are nei**  **ther always red nor even visible to the unaided human ey**  **e and are not necessarily associated with tides.The term “red tide” is a misnomer and its replacement**  **“harmful algal blooms” is more descriptive of the**

**ev ents that occur (Anderson, 1995).**  **“Harmful”describes the algae usually associated with toxic events during which animals and humans**  **sicken or even die; however, even nontoxic algae can also impact humans, animals, and the entire ecologi** **cal community structure. For example, animal mor talities associated with HABs can result from indirect** **effects such as the formation of toxic sulfides or in creased nitrogenous byproducts in the water. As cells**  **in a bloom multiply, die, and decompose, they use so much oxygen that other organisms in the water may**  **not be able to survive. Declining water quality can lead to chronic animal disease or mortalities, species** 

**av oidance of an area, and reduced feeding (Lands**  **berg, 2002). Mass marine mortalities may result in piles of decomposing organisms on the beaches, ad** 

**v ersely affecting beach quality and ultimately human**  **use of these areas. Decomposing organisms may also contribute to bacteria-associated beach and water** **quality degradation although this issue is not well re searched.“Algal” usually refers to microscopic algae,**  **which include phytoplankton that can cause these harmful effects. Globally, an increasing number of mi**  **croalgae such as dinoflagellates and cyanobacteria have been found to produce toxins.“Bloom”means that** **the microalgae are present at high enough concentra tions in the water to have an effect—whether it is**  **human illness, sick or dead animals, or change in the ecological community structure of a particular habitat.** **Most HAB microalgae have photosynthetic pig ments. A bloom of these pigmented algae can color the** 

**w ater in many hues including red, brown, green, yel**  **low, and white.There are more than 100 reported toxic or harmful microalgae species (about 2% of the world’s**  **phytoplankton) (Landsberg, 2002); over 70% of those are dinoflagellates.**  **W**

**ith more than 50 marine and 20 freshwater harm ful algal species present, Florida’s HABs have the po**  **tential to affect public health, cause economic losses, and affect living marine, freshwater, and terrestrial**  **resources (Fleming et al.,**  **1998; Steidinger et al.,**  **1999; W**  **illiams et al.,**  **2001; Backer et al.,**  **2003a; Kirkpatrick et**  **al., 2004; Landsberg**  **et al., 2006).The most significant tox**  **ins produced by HABs in Florida include saxitoxins (STXs), brevetoxins (PbTXs), ciguatoxins (CTXs) in ma**  **rine waters, and cyanotoxins, e.g.,**  **microcystins, cylin drospermopsins, and lyngbyatoxins, in fresh water.** **Elsewhere, STXs are produced by multiple dinofla gellate species and are typically associated with par**  **alytic shellfish poisoning (PSP). In Florida, STX-caused illnesses have only been from saxitoxin puffer fish poi**  **soning (SPFP). STX is produced by the dinoflagellate Pyrodinium bahamense.**  **Brevetoxins are produced by the dinoflagellate**  **K. brevis and cause neurotoxic shell**  **fish poisoning (NSP); brevetoxicosis also results in widescale animal mortalities. Brevetoxin-associated**  **respiratory illness occurs after inhalation of marine aerosols containing the toxin.Wind and wave action can**  

# Chapter 1 Background on Harmful Algal Blooms

Purpose To identify existing HABs and their related toxins; to review their backgrounds and ecologies andtheir effects on public health, living resources, and the economy; and to review existing monitoring operations. To update and expand on information originally printed in the FHABTF white paper, “Harmful Algal Blooms in Florida” (Steidinger et al., 1999).

**T**

**he following is an overview of the current HABs in Florida, their related toxins, and associated illnesses.These include breve toxins and neurotoxic shellfish poisoning, saxitoxins and saxitoxin puffer fish poisoning, ciguatoxins and ciguatera fish poi**  **soning, as well as cyanotoxins and/or cyanobacterial exposures and their associated health concerns. Sections are included on the background, ecology, human health effects, living-resource effects, economic effects, and the existing operations for**  **monitoring and responding to each HAB. Additional sections address emerging or potential HAB threats to public health, including fish kills, diarrheic shellfish poisoning, amnesic shellfish poisoning, and HAB toxins as tumor promotors. Other**  **HABs of interest include Pfiesteria**  **and Pfiesteria**  **-like species.This information may be used as a background guide to pri oritize regional HAB issues in the design of response plans.** Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 3

**.** 1 | Background on Harmful Algal Blooms

**ly se cells and release the toxins, which become airborne**  **in jet spray and create a red tide aerosol. Ciguatoxins (CTXs) produced by the benthic dinoflagellate**  **Gam bierdiscus toxicus**  **cause the tropical and subtropical poisoning known as ciguatera fish poisoning (CFP).** **Cyanotoxins and their corresponding algal genera in clude microcystins,**  **Microcystis; l**  **yngbyatoxins, L**  **yngbya; anatoxins,**  **Anabaena; and cylindrospermopsin,**  **Cylin drospermopsis.**  **However, many other species are also known to produce cyanotoxins and some may pro**  **duce multiple toxins. Some cyanotoxins have been found in the surface layer of freshwater during blooms** **and ingestion of affected raw water has been associ ated with human illness elsewhere and death of live**  **stock or pets. There are also anecdotal reports of dermatitis and skin irritation after exposure to red**  **tide and cyanobacterial blooms. Other toxic algae have also been found in Florida.**  **T hese include the domoic-acid–producing diatom,**  **Pseudo-nitzschia, which is associated with amnesic**  **shellfish poisoning (ASP); and the dinoflagellates Dino**  **physis and**  **Prorocentrum, which produce okadaic acid**  **(OA). This toxin causes the illness diarrheic shellfish poisoning (DSP). However, neither of these illnesses has**  **y et been documented in Florida.** **Equally important, HABs negatively impact liv ing resources and ecosystem health. For example, at**  **least 12 species of HABs are known to be ichthyotoxic, contributing to many fish-kills, and hence have fish** **ery implications in Florida. These toxins are not cur rently known to be public health risks.**  **Harmful macroalgal blooms in Florida coastal and estuarine waters can also affect reefs and benthic com**  **munities. Macroalgal blooms, such as red drift algae common to Florida’s southwest coast, can alter marine**  **habitats by smothering benthic communities, reducing species diversity and abundances,and leading to animal**  **disease (Landsberg,1995; Lapointe et al.,**  **2005).Beach en vironments can be degraded by dead fish from kills or**  **large amounts of macroalgae washing ashore. However, these blooms are not known to affect human health.**  **Economic impacts from HABs are often difficult to assess, but one report (Hoagland**  **et al., 2002) estimated**  **that between 1987 and 1992, the average annual loss of revenue from all HABs in the United States was 50 mil** **lion dollars (using year 2000 dollars).This is a conser**

**v ative estimate. A breakdown of the estimated costs**  **suggested 45% for impacts to public health, 37% for commercial fisheries, 13% for recreation and tourism,**  **and 4% for monitoring and management. Public health effects include the costs of illness-re**  **lated loss of wages and productivity and the costs of medical treatment and event investigation.The losses**  **incurred by commercial fisheries include those in aquaculture facilities due to contamination from toxic**  **HAB blooms as well as a reduction in public demand due to reported human illnesses or poisonings. Losses**  **to the wild harvest are harder to measure because identifying the exact cause of many fish and shellfish**  **kills is not possible and quantifying the effect on the fishery is complicated by the fact that kills always in**  **clude “trash fish”of no commercial value. Costs to the recreation and tourism industries are vast, including** **losses from hotels, restaurants, and recreational fish eries affected by HAB events.Various agencies are in** 

**vo lved with regular water quality and shellfish** **monitoring, but all of them have other related man agement activities, making it difficult to separate the**  **costs of HAB-specific events (Hoagland et al.,**  **2002).**



## Brevetoxins and Neurotoxic Shellfish Poisoning
Background

**Karenia brevis (also known as Florida red tide) is a ner**  **itic dinoflagellate found in open and nearshore areas of the Gulf of Mexico and southeastern U.S.A. Blooms of**  **K. brevis have been recorded from off the west coast of**  **Florida to the Mexican Yucatan peninsula. Although the majority of**  **K. brevis blooms occur on the west coast** **of Florida, these red tides occasionally become en trained in circulation features along southwestern**  **Florida and are transported into the Gulf Stream via the Florida Current and up the east coast of the United**  **States.The toxins produced by K. brevis,**  **brevetoxins, af fect humans and a wide diversity of aquatic organisms.**  **T he first documented report of fish kills along**  **Florida’s west coast attributed to red tide occurred in 1844, with the first reported case of human illness from**  **eating “tainted” shellfish occurring in 1880 (Walker, 1884). Mrs. Charles Hoy experienced symptoms of**  **NSP after consuming toxic shellfish from Tampa Bay. During that same event, dead fish and sick and dying**  **seabirds were also reported.Taylor (1917) reported the occurrence of a toxic “gas”during the 1916 red tide that**  **caused essentially the same symptoms that would be described today for aerosolized brevetoxins.The “gas”** 

**w as later determined to be particulates in sea spray that** **irritated the respiratory passages and eyes (Wood cock, 1948). Today we know that brevetoxins are low**  **molecular-weight, lipid-soluble, polyether toxins that can be associated with cell fragments or particles in sea** 

**w ater. Because**  **K. brevis cells are unarmored and frag**  **ile, their lysis at the sea surface can release brevetoxins that become aerosolized and highly toxic above the**  **air–water interface (Pierce, 1986; Pierce et al.,**  **1990). .**  4 FWRI Technical Report TR-14 Public Health Response to HABs Abbott et al. 1 | Background on Harmful Algal Blooms

**Seafoam can be more than 100 times higher in toxic ity than seawater itself.**  **Other Karenia**  **species found in the Gulf are K. miki**  **motoi,K.papilionacea,K.selliformis,K.longicanalis, and**  **Kare nia**  **spp., along with a related species Karlodinium**  **veneficum (Haywood**  **et al., 2004). Some of these species**  **are toxic but are not known to produce brevetoxin. For example,**  **Karenia selliformis produces gymnodimine (Seki**  **et al., 1995; Haywood**  **et al., 2004),whereas**  **Karlodinium pro**  **duces karlotoxins (Deeds et al.,**  **2002). There have been no reported cases of human illnesses in Florida caused**  **by toxic exposures from these latter species. As more** 

**w ork is done on harmful algae, more potentially harm**  **ful species are being described.** 

### Ecology

**Karenia brevis red tides have been documented in al** **most all years since funding was initiated for surveil lance and research in the 1960s (Steidinger, 2009; FWC,**  **unpublished data). Karenia brevis**  **blooms are most common in the fall and least common in February and**  **March, but they can occur in any month. Blooms do not survive well in seawater with salinity less than 24 psu,**  **but the species is well adapted to the west Florida shelf environment and is influenced by specific phys**  **ical and oceanographic circulation features and a range of nutrient sources.**  **Karenia brevis populations do not** **demonstrate explosive growth as the population in creases but the population can double every 3 days.The**  **successive stages of a bloom are initiation, growth, maintenance, and termination or transport away from**  **the area. The initial appearance of K. brevis**  **occurs on the outer or mid-shelf region of the Gulf of Mexico with** **growth in the mid-shelf region, followed by move ment inshore. It often concentrates at a frontal system**  **and is then transported by winds and currents up and down Florida’s Gulf coast.**  **Exposures to toxins are coincident with the bloom or may continue well after the event subsides. Toxins**  **move up through the food web from filter feeders, such as shellfish, to organisms at higher trophic lev**  **els such as fish, dolphins, manatees, and birds. Adverse effects on these species may be seen for weeks post**  **bloom (Flewelling et al.,**  **2005; Landsberg et al.,**  **2009). Although Florida red tide blooms are natural** 

**ev ents that start offshore, questions remain as to** **whether land-based anthropogenic sources may in fluence their longevity and persistence once they come** **inshore. Several factors, particularly salinity and nu trient levels (Landsberg and Steidinger, 1998; Mul**  **holland et al.,**  **2004), are often considered influential, but the issue of nutrients is complex.**  **Karenia brevis re**  **quires nitrogen, phosphorus, trace metals, and other major and minor nutrients for basic growth and is**  **able to use organics efficiently. Offshore, K. brevis**  **is adapted to an oligotrophic environment (**  **i.e., w** **aters low in nutrients and biomass). It may be stimulated by**  **blooms of the blue-green algae T**  **richodesmium (Walsh**  **and Steidinger, 2001), which release nutrients during growth and senescence.These nutrients (**  **e.g., organic**  **nitrogen) have been shown to be taken up by K. brevis**  **(Mulholland et al.,**  **2004, 2006). However, there are other sources of nutrients:**  **e.g., rich marine and terrestrial** **phosphate deposits, estuarine flux, regenerated nu trients from benthic diatom blooms, and a very sig**  **nificant self-generating source—the dead fish caused by**  **a Karenia**  **bloom (Vargo, 2009; Walsh et al.,**  **2009).**


### Effects on Human Health

**Karenia brevis produces a suite of neurotoxins, chemicals** **that affect nerve conduction,collectively known as breve toxins.There have been no known human fatalities as**  **sociated with exposure to brevetoxins. (This contrasts with other HAB-related toxins such as STXs, ciguatox** **ins, cyanotoxins, and domoic acid which have caused fa talities in other regions; however, no fatalities have been**  **reported originating from blooms in the Gulf of Mexico). Although the activity of the parent toxins and their de**  **rivatives has been studied, the effects of brevetoxin metabolites are still not well understood. One con**  **founding factor in potency is the coproduction by K.**  **brevis of a toxin antagonist,known as brevenal (Bourdelais**  **et al., 2004). The ability of brevenal to modulate the ef**  **fects of brevetoxins and metabolites is not understood. Brevetoxins can affect people through several**  **routes of exposure. Brevetoxin-related illnesses are typically due to acute exposure such as ingestion of**  **toxic shellfish or through inhalation of toxic aerosol. However, there is no information on the effects of pe**  **riodic chronic exposure to low levels of brevetoxin or brevetoxin metabolites.**  **NSP occurs from ingestion of edible bivalves that have accumulated brevetoxins from**  **K. brevis cells.**  **Symptoms of NSP include numbness and tingling sensations in the lips, mouth, and extremities; nausea;** 

**v omiting; diarrhea; slurred speech; muscle weakness;**  **and ataxia.Vertigo, hot–cold reversals, pupil dilation, respiratory distress, and partial paralysis have also**  **been reported. Full recovery typically takes two to three days (see Appendix B, Medical Fact Sheets and**  **Case Definitions). Although NSP is known to cause moderate symptoms, a significant portion of cases**  **require hospitalization for brief periods. NSP is a reportable disease in Florida although it** **is probably underreported due partially to misdiag nosis and undetected milder clinical cases. While no** Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 5

**.** 1 | Background on Harmful Algal Blooms

**human mortalities have been reported from breve toxicosis, there have been four separate incidents in**  **which patients (one less than five years old, two teenagers, and one adult with other underlying med**  **ical conditions) required breathing support (Steidinger et al.,**  **1998; Poli et al.,**  **2000; Watkins et al.,**  **2008). In 2005, four cases of NSP were reported in Florida and more**  **than 20 in 2006 (Terzagian, 2006; Watkins et al.,**  **2008; Florida Department of Health [FDOH] Merlin**  **® , un**  **published data). T** **here are fewer than 100 documented case histo ries of NSP. About 50 of these illnesses were docu**  **mented in North Carolina in 1987 when a K. brevis**  **bloom was transported from the west coast to the east coast of Florida and up to the Carolinas via the Gulf** **Stream. A Gulf Stream intrusion off the North Car olina coast transported the bloom inshore to estuaries**  **which then resulted in toxic shellfish beds (Fowler and T** 

**ester, 1989; Morris et al.,**  **1991). Many of the other doc umented cases have occurred in Florida. There have**  **been repeated outbreaks of NSP off Florida’s southwest coast during the years 1995, 1996, 2001, 2005, and 2006**  **and most frequently in Lee County. All of these have been associated with recreationally harvested shell**  **fish, e.g., Chione**  **clams and fragile surf clams, Mactroma**  **fragilis, although in some instances the implicated**  **species has been another commonly harvested shell fish or is unknown (Steidinger**  **et al., 1998; Poli**  **et al., 2000;**  **T**

**erzagian, 2006; Watkins et al.,**  **2008; FWC–FWRI, un published data). As**  **with the other marine toxins, breve toxins are not altered by cooking or freezing and cannot**  **be detected by taste or smell, all factors that increase the potential for human health impacts.**  **A second exposure route is through inhalation of marine aerosols containing brevetoxin originating from**  **ruptured K. brevis**  **cells via bubble-mediated transport (Pierce**  **et al., 1990, 2003). Brevetoxins and cell fragments**  **from K. brevis**  **can cause upper and lower respiratory symptoms. Humans can experience eye irritation, non**  **productive cough, and broncho-constriction (Baden et**  **al., 1995; Backer**  **et al., 2003b, 2005; Kirkpatrick**  **et al., 2004; Fleming**  **et al., 2007) from exposure to the toxic**  **aerosol.These symptoms are reversible upon removal of the irritant source; however, there are no compre**  **hensive epidemiological studies on chronic exposures during a Florida red tide event or on lingering symp** **toms post-exposure. People with a history of respira tory illness such as asthma, bronchitis, or chronic**  **obstructive pulmonary disease (COPD) may be at risk for longer-term effects. In asthmatics, effects have been** **shown to last up to 5 days after a beach exposure (Kirk patrick**  **et al., 2006, 2008). The FDOH, in collaboration**  **Florida red tide fish kill, July 2005. FWC image** **.** Public Health Response to HABs Abbott et al.

6 FWRI Technical Report TR-14 **with the University of Miami (U of M), the Centers for Disease Control and Prevention (CDC), the Mote Ma** **rine Laboratory (MML), and other partners, are con ducting investigations on human risks associated with**  **exposure to this toxic aerosol (Backer et al.,**  **2005; Ben**

**son et al.,**  **2005; Fleming et al.,**  **2005a,b). These include studies on trans-placental transport of brevetoxins,** 

**c hronic effects of exposure, and emergency room ad** **mission rates for respiratory illness. For additional dis cussions on human health effects, see Backer**  **et al., 2003b, Kirkpatrick**  **et al., 2004. A comprehensive review**  **of the public health aspects of red tide appears in En**  **vironmental Health Perspectives, Mini-Monograph: Breve**  **toxins, 113(5): 618–657 (May 2005). Rare cases of other health effects include anecdo**  **tal reports of contact dermatitis from exposure to Florida red tide blooms and instances of puncture wounds**  **from contact with spines of beached dead fish. There have been no documented cases of human illness as**  **sociated with the consumption of fish during Florida red tide blooms.**  

### Effects on Living Resources

**Historically, of all the HABs in Florida, brevetoxin producing**  **K. brevis red tides have caused the most**  **significant problems, with sustained threats from NSP, aerosolized toxins, and annual mass mortalities of**  **thousands of fish and invertebrates and frequent mass mortalities of hundreds of endangered marine mam**  **mals, sea turtles, and birds (Gunter et al.,**  **1948; Roun sefell and Nelson, 1966; Steidinger**  **et al., 1973;**  **Landsberg, 2002; Flewelling, 2008). T** **here is a long history of marine mammal die-offs during Florida’s red tide blooms, including events in**  **1947–1948 (Gunter et al.,**  **1948; Rounsefell and Nelson, 1966); 1963 and 1982 (Layne,1965; O’Shea**  **et al., 1991); and**  **1987–1988 (Geraci, 1989). Large-scale mass mortalities of manatees occurred in Florida in 1996, 2002, 2003, 2005,**  **2006, and 2007 (Bossart et al.,**  **1998, 2002; Landsberg and Steidinger, 1998; Flewelling**  **et al., 2005; Landsberg**  **et al., 2009; FWC–FWRI, unpublished data); and of bottlenose**  **dolphins in 1999–2000 and 2004 (Flewelling et al.,**  **2005; Landsberg**  **et al., 2009; B. Mase and T. Leighfield, NOAA,** **personal communications). Brevetoxins can be trans ferred through the food chain and are accumulated in**  **or transferred by biota at many trophic levels. The trophic transfer of brevetoxins in the food web is a com**  **plex phenomenon, one that is far more complicated than originally conceived (Flewelling**  **et al., 2005; Lands**  **berg et al.,**  **2009). Investigations of toxic fish are ongoing. Brevetox**  **ins and derivatives have been found in tissues of red tide-exposed fish, including muscle, liver, kidney, and**  **other body parts, as well as in stomach contents (Naar et al.,**  **2007).The highest toxin concentrations reported have been in planktivorous fishes that can feed on red** **tide (Flewelling, 2008).These fish concentrate high lev els of brevetoxins in their viscera and become toxic to**  **higher predators including such marine mammals as dolphins, because these predators eat whole fish. In**  **omnivorous and carnivorous fishes, the highest levels of brevetoxins and their metabolites (as determined by**  **enzyme linked immunosorbent assay [ELISA]) typically occur in liver tissue, and if fishermen gut their fish**  **and eat only the muscle, they should not become sick. To**  **date, in an ongoing study measuring brevetoxin concentrations in the tissues of live-caught fish, analy**  **ses of more than 2,500 fish have not indicated a risk to human health from consumption of the fillet (FWC, un**  **published data). In addition, toxins in the muscle are quickly depurated or cleared by normal metabolic**  **processes (Naar et al.,**  **2007). In 2005, a persistent**  **K. brevis bloom off the west** **coast of Florida was responsible for hundreds of thou sands of deaths of different species of marine mam**  **mals, turtles, seabirds, fish, and invertebrates.The 2005**

**ev ent even contributed to a benthic mortality off Tampa**  **Bay (Landsberg et al.,**  **2009), partly attributable to low dissolved oxygen associated with the large biomass of** **dead and dying organic material and from brevetox ins that settled to the bottom, similar to a 1971 event**  **(Smith, 1975). In 2003, at least eight domestic dogs from the beach**  **area of Little Gasparilla Island in southwestern Florida**

**w ere admitted to local veterinary clinics after being re**  **portedly affected by exposure to brevetoxins during a highly concentrated Florida red tide event (Landsberg**  **et al., 2003). Birds are also affected by brevetoxins, es** **pecially those that consume toxic shellfish or fish. Sub stantial numbers of sick and dying cormorants have**  **occurred with red tide outbreaks along the west Florida coast since 1995 (Kreuder**  **et al., 2002; Landsberg**  **et al., 2007; FWC, unpublished data) and were documented**  **in the 1880 red tide.**


### Economic Effects

**Tw o 3- to 5-month red tide blooms off Florida caused**  **$15–$20 million in losses to local communities in the 1970s (Habas and Gilbert, 1974, 1975). In 1987, Florida**  **red tide transported from Florida by the Gulf Stream resulted in closures of shellfish-harvesting areas in**  **North Carolina with an economic loss of $25 million (Tester and Fowler, 1990).Those who live and work on** **the beach note that businesses, tourism, and com munity recreational activities are adversely affected**  **by K. brevis**  **red tides ( e.g.,**  **Longboat Key, from** 1 | Background on Harmful Algal Blooms**.** Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 7 **1994–1996; Boesch et al.,**  **1997), but current data doc umenting actual losses is limited. Morgan and Larkin**  **(2006) reported that Florida red tide impacts between 1995 and 2000 in the Fort Walton Beach and Destin** **areas of Okaloosa County alone resulted in com bined monthly losses of nearly $6.5 million for busi**  **nesses such as restaurants and hotels. Another study (Morgan**  **et al., 2007), in which coastal managers were**  **surveyed to determine associated costs of red tide**

**ev ents to public beaches, four counties (Pinellas, Sara**  **sota, Lee, and Collier) and two cities (Longboat Key and Naples) gave actual figures for the period of 2004** **through 2007. These total costs of $653,890 were pri marily for beach cleanup (including labor, equip**  **ment, supplies, and vendor fees) and were paid for by tourism tax dollars.**  **T he difficulty in calculating economic effects is** **due to the variety of direct adverse effects on a par ticular area, ranging from public health and manage**  **ment costs to the displacement of certain activities such as tourism and fisheries to the benefit of other**  **areas ( Backer, 2009). Protocols for collecting such data are being evaluated by economists at the University of**  **Florida (C. Adams, personal communication), and through a collaborative study between MML and**  **W**

**oods Hole Oceanographic Institution (WHOI) (B. Kirkpatrick, personal communication).**  

### Existing Monitoring Operations

**Regular monitoring of Gulf waters can help predict the movement of red tides to inshore areas from off**  **shore.The forecast helps to predict potential risks of human exposure to brevetoxins—either through the**  **consumption of toxic shellfish or through inhalation of aerosolized toxic particles. One method used to**  **monitor K. brevis**  **blooms is to collect seawater sam ples and examine these samples microscopically for**  **the presence of toxic species. Although the majority of**  **K. brevis monitoring information is collected from** **inshore land-based samples, this is often supple mented by event-response-targeted monitoring, off**  **shore samples provided by a volunteer sampling program, or preplanned cruises with research vessels**  **on transects out to 80 km or more offshore. The FWC–FWRI monitors west coast waters in coopera**  **tion with other state regulatory agencies, e.g.,**  **Florida Department of Agriculture and Consumer Services** **(FDACS), FDOH, and Florida Department of Envi ronmental Protection (FDEP); a volunteer network**  **of boaters, charter boat captains, fishermen, and other citizens; and MML. All analyses involve**  **in situ test** **ing, onboard testing, or onshore laboratory testing. Re sults are posted weekly on the FWC–FWRI Web site,**  **http://research.myFWC.com, and include data from a** 

**va riety of sources. In addition, there is a toll-free num**  **ber, 1-866-300-9399, to access current Florida red tide monitoring information (Heil and Steidinger, 2009).**  **Another source of monitoring data is from remote sensing devices, which use several different method**  **ologies. The results reported in the National Oceanic and Atmospheric Administration (NOAA) HAB Bul**  **letin use satellite imagery, which detects chlorophyll**

**a concentrations.This determination is not organism**  **specific, and the chlorophyll a**  **may come from a num ber of sources including blue-green algae, macroalgae,** 

**or K. brevis.**  **T his method requires verification by direct**  **bloom sampling and microscopic identification during all bloom stages. Potential bloom areas are identified**  **using an algorithm which uses the weekly changes in**

**c hlorophyll**  **a concentrations and the local wind field** **to predict potential bloom events. Additional infor mation on this methodology is available on the NOAA** **HAB Web site, http://coastwatch.noaa.gov/hab/bul letins_ms.htm.The Center for Prediction of Red Tides** **collaboration between the FWC–FWRI and the Uni**

**v ersity of South Florida College of Marine Science has**  **begun testing the application of algorithms that detect Karenia**  **and T**  **richodesmium specifically using the unique**  **reflectance signatures of chlorophyll a**  **for these spe cific organisms. Combined with model forecasts based** **upon ocean current observations and wind measure ments, this technology holds promise for species-spe**  **cific monitoring by satellites of Karenia**  **blooms and forecasting daily bloom movements and their poten**  **tial effects. T** 

**oxin concentrations in seawater are quantified by**

**v arious laboratory methods, including the ELISA test,** **a receptor binding assay (RBA), or liquid chromatog raphy–mass spectrometry (LC–MS). Tests are being**  **done to evaluate whether a relationship exists between toxin concentrations and cell counts of**  **K. brevis. W**  **ater concentrations of toxins vary because of cell lyses and**  **photo-oxidation, particularly inshore after a bloom fully develops.The toxin antagonist brevenal may also**  **play a role in water toxin concentration. Preliminary data suggest that it is not realistic to compare cell counts with**  **toxin levels or potency because both the physiological state of the bloom and the seawater temperature can** **affect production of toxins, their potency, and the con**

**v ersion of specific toxins to less potent metabolites.**  **In-water testing is time- and personnel-intensive, but scientists are moving toward new technologies for rapid** **assessments that will allow near-real-time identifica tion and quantification of species and toxins. Blooms**  **can then be monitored, and the information acquired can be used to forecast movement or to initialize 3-D**  **mathematical models.** 1 | Background on Harmful Algal BloomsPUBLIC HEALTH **SHELLFISH To**  **protect public health during bloom events, shellfish areas are closed to harvesting by FDACS Division of**  **Aquaculture when K. brevis**  **cell counts are above 5,000 cells per liter.They are re-opened when mouse bioas**  **say (MBA) test results provided by FWC–FWRI are acceptable (less than 20 mouse units [MU] per 100 g** **of shellfish meats), and cell counts return to back ground levels, less than 1,000 cells per liter. FDACS**  **maintains a Web site that lists shellfish area closures (http://www.floridaaquaculture.com/SEAS/SEAS_mng**  **mt.htm).This protocol is in compliance with Florida’s Marine Biotoxin Control Plan (FDACS, 2007).The MBA** **is a slow and labor-intensive method with a turn around time of two to three days. Alternative, more**  **rapid chemical analyses have been developed, e.g.,**  **an ELISA method (Naar**  **et al., 2002). However, although** **being evaluated, this method has not yet been ap proved for regulatory decision-making activities.**  **Shellfish can depurate toxins within two to six**

**w eeks after counts of**  **K. brevis cells have returned to** **background levels in an area. However, there is one re port that indicates the edible clam,**  **Chione cancellata, re**  **tained toxicity for one year after exposure (Steidinger et al.,**  **1998). This suggests that under certain condi tions, a reservoir of toxic biota may persist in bottom**  **communities and prolong the risks to public health long after a red tide has dissipated. Research continues on**  **brevetoxin retention times in different shellfish species (**  **e.g., Plakas**  **et al., 2002) and may require managers to**  **update monitoring and regulatory activities and species-specific guidelines.**  **Over the past 40 years, cases of NSP in Florida have only occurred when shellfish were harvested illegally** **from state-regulated closed shellfish beds or unap proved areas (Steidinger**  **et al., 1998; Poli**  **et al., 2000; Heil,**  **2009). In 2006, for example, more than a dozen cases of NSP occurred in the Sanibel area when multiple clam**  **species were recreationally harvested from unapproved areas adjacent to the beach area during or just after a red**  **tide event (Terzagian, 2006; Watkins et al.,**  **2008). Florida continues to have cases of NSP associated with recre** **ational harvesting from closed areas. Foreign and out of-state tourists are particularly vulnerable because they**  **have no knowledge of the permissible harvesting areas or the health risks associated with such activity.There is**  **also a lack of awareness of local resources that provide information on red tide events along with shellfish har** 

**v esting guidelines and regulations.** 

**AEROSOL T** **here is no specific proactive outreach mechanism to inform residents and visitors that a red tide is in an area**  **and that the aerosol is a potential public health risk. In most instances, this information is picked up by**  **local media outlets, such as television, newspapers, and radio, although some counties are implementing** **proactive measures. MML and counties such as Col lier, Lee, Manatee, Pinellas, and Sarasota have imple**  **mented a real-time Beach Condition Reporting System. Beach conditions, including water color, chance of res** **piratory irritation, and presence of dead fish are re ported twice daily at various beach sites. Reports can**  **be accessed by the public directly via a hotline (941- BEACHES) or at http://coolgate.mote.org/beachcon**  **ditions/. Because blooms, once onshore, can be extremely variable, this system allows beach goers to** **make informed decisions on which beach to visit to ex perience minimal exposure to toxins. People can also**  **log onto various other Web sites, such as FWRI’s http://research.MyFWC.com/, or call the FDOH** **Aquatic Toxins Hotline (1-888-232-8635) for more in formation on bloom conditions.**  **T hese sources are usually adequate for local resi**  **dents who are keeping informed. Tourists, especially those who are only visiting for a few days or those for**  **whom English is not their primary language, are a much harder audience to reach. Ideally, residents and**  **tourists are made aware that a red tide that has come inshore and is present along the beach or in near shore**  **coastal waters and that people with asthma and other respiratory problems should avoid certain areas. Un** **fortunately, conditions that favor dispersal of the res piratory irritant, such as onshore winds, can change**  **dramatically and shift direction within hours. Since the toxins are associated with marine particulates, ex** **posure can be reduced by use of a particle mask com monly available in hardware or drug stores.** **Antihistamines are also somewhat effective for reduc ing the effects; however, this over-the-counter med**  **ication should be taken only following labeled directions and/or on the advice of a physician.** 

**FISH No monitoring or regulatory programs exist for fish ex**  **posed to brevetoxins. Although fish can concentrate brevetoxins in their viscera, levels in the fillet of live**  **caught fish have not suggested a human health risk.** 

## Saxitoxin, Puffer Fish Poisoning, and Saxitoxin Puffer Fish Poisoning
Background

**Po isoning from consumption of**  **puffer fish (also known as “blowfish”) is usually associated with tetrodotoxin**  Public Health Response to HABs Abbott et al.

8 FWRI Technical Report TR-14

**.** 1 | Background on Harmful Algal Blooms**.** FWRI Technical Report TR-14 9 **(TTX) found in fish viscera.These poisonings are more common in Asia and are associated with the cultural**  **practice of eating puffer fish (fugu) prepared by specially trained chefs as a delicacy. In the U.S.A., PFP has usu** **ally been associated with imported puffer fish (Mar**

**cus et al.,**  **2002); fatalities have rarely occurred after the consumption of indigenous puffer fish. However,**  **in Hawaii, white-spotted puffer fish, Arothron hispidus,** 

**w ere implicated in seven deaths (Ahmed, 1991). Until**  **1974, only seven PFP cases caused by the consumption of locally caught “blowfish” or puffer fish had been**  **documented in Florida (Benson, 1956; Hemmert, 1974; Mosher and Fuhrmann, 1984; Ahmed, 1991; Bigler,**  **1999). These cases included three fatalities, one of which was a woman who died 45 minutes after con**  **suming the toxic liver of a checkered puffer fish ( Spho**  **eroides testudineus ) (Benson, 1956).The toxins involved** **in the previous Florida PFP cases were not character ized, but because PFP is usually associated with TTX,**  **investigators likely assumed that TTX was the cause (Benson, 1956; Hemmert, 1974; Bigler, 1999). Tissues**  **from Florida bandtail ( S. spengleri**  **), checkered, and southern (**  **S. nephelus ) puffer fish were found to be**  **lethal in MBA (Lalone et al.,**  **1963; Burklew and Mor ton, 1971), but again, the specific toxins were not de**  **termined. (Note: MBA is a nonspecific test that only assesses lethality of the tissue composite and does not**  **identify the causative agent, toxin, or group of toxins.) F** **rom January 2002 to May 2004, 28 cases of poison ing from puffer fish in Florida, New Jersey, Virginia,**  **and New York were linked to fish originating from the Indian River Lagoon (IRL) in Florida (Bodager, 2002;**  **Landsberg et al.,**  **2006). In a 1960s toxicity study, extracts of tissues from IRL southern puffer fish were demon**  **strated to be toxic to mice by intraperitoneal injection (Lalone**  **et al., 1963). Muscle tissue was the most lethal**  **to mice, as it is currently. However, the toxins in these puffer fish samples were not characterized.Although this**  **anecdotal evidence suggests that southern puffer fish may have been mildly toxic from STXs in the IRL for the** **past 45 years, there has been no indication that toxin lev els over that period were similar to those observed since** **2002; no fish poisoning incidents were reported or doc umented from this area prior to 2002. Initial analyses of**  **toxins from unidentified puffer fish fillet remnants from one of the early 2002 poisoning cases in New Jersey re** 

**v ealed STXs (Quilliam**  **et al., 2004), not TTXs, a distinc**  **tion that could not be made solely on the basis of consumer symptoms or traditional screening methods**  **( i.e.,**  **MBA).This was the first time that STX had been as sociated with puffer fish poisonings in the USA.**  **T he sudden appearance of STXs at potentially**  **lethal concentrations in an area previously not known to have such toxins signaled an unprecedented and**  **emerging public health threat and natural-resource**

**c hallenge for Florida. STX is a complex molecule that**  **interferes with the voltage-sensitive sodium (Na +**  **)**

**c hannel in neuron membranes. STXs can selectively**  **bind to neural cell Na +**  **c hannels blocking these mol**  **ecules from entering or exiting the cell. Lack of Na +**  **in side the cell blocks its action potential, inhibiting** **transmission of neural impulses and resulting in im pairment of bodily functions. Globally, STXs are usu**  **ally associated with paralytic shellfish poisoning (PSP), an acute intoxication occurring in humans after the con**  **sumption of toxic shellfish, such filter-feeding shellfish consume microalgae and retain STXs in their tissue.** **Human consumption of these shellfish can cause se**

**ve re and potentially lethal cases of PSP.**  **Because STXs had never been identified in Florida’s marine waters and their distribution and origin were**  **unknown, an intensive survey of biota in the IRL was initiated in April 2002 to determine the concentration**  **and distribution of this toxin (Landsberg et al.,**  **2006). Puffer fish were confirmed as a hazardous reservoir of** **STXs in Florida’s marine waters, with the dinoflagel late**  **Pyrodinium bahamense implicated as the putative**  **toxin source. STXs were confirmed in IRL southern,**

**c heckered, and bandtail puffer fish, with toxins de**  **tected in skin, muscle, and viscera in concentrations of up to 20,106 μg STX eq./100 g tissue in muscle (the Food**  **and Drug Administration [FDA] action level for STX in edible tissue is 80 μg STX eq./100 g) (Wekell**  **et al., 2004; Abbott**  **et al., 2009). TTX has also been found in** **IRL puffer fish, but compared to STX, nearly all south ern puffer tissues tested had only trace amounts of TTX.**  **Both checkered and bandtail puffers from the central and southern IRL had higher concentrations of TTX**  **than of STX in all tissues, checkered puffer livers being the most toxic (Deeds**  **et al., 2008). Regardless of toxin,**  **puffer fish in the IRL are extremely dangerous to eat. Pyrodinium bahamense**  **represents an emerging public health threat in Florida; it has been associated**  **with fatal PSP in the Pacific but was not known to be toxic in the western Atlantic. Human fatalities from STX**  **produced by P.**  **bahamense blooms have been docu**  **mented globally (Rodrigue et al.,**  **1990). Landsberg et al.**  **(2006) proposed characterizing this food poisoning syndrome as SPFP to distinguish it from PFP tradi**  **tionally associated with TTX and from PSP caused by STXs in shellfish (see Appendix B, Medical Fact Sheets**  **and Case Definitions). As of January 2009, there have been no cases of PSP in Florida.**  

### Ecology

**STXs and PSP associated with Pyrodinium bahamense** **are best known from the tropical and subtropical wa** Abbott et al. Public Health Response to HABs 1 | Background on Harmful Algal Blooms**.** Public Health Response to HABs Abbott et al.

10 FWRI Technical Report TR-14 **ters of the Pacific ( e.g.,**  **Malaysia, the Philippines, and P** 

**apua New Guinea).Toxic strains are also known from P** 

**acific waters off Central America where blooms have been associated with PSP in shellfish (Vargas-Montero**  **and Freer, 2004). Blooms of**  **Pyrodinium bahamense are now common**  **in the IRL and have been documented for several years (Badylak**  **et al., 2004; Phlips**  **et al., 2004), but until the out**  **breaks of SPFP in 2002, there was no indication that this**

**v ariety was toxic (Landsberg**  **et al., 2006). Puffer fish**  **can retain the toxin for months and even years and therefore may be toxic even when a**  **Pyrodinium bloom**  **is not present. Pyrodinium**  **in Florida is P.**  **bahamense var.**  **bahamense, and it produces STX. Prior to the 2002 event,**  **all Atlantic Pyrodinium**  **( i.e., P. bahamense**  **var. bahamense**  **)**

**w ere thought to be non-toxic and only**  **P. bahamense** 

**var. compressum,**  **which occurs in the Pacific, were thought to produce STX and its derivatives (Badylak**  **et al.,**  **2004; Phlips et al.,**  **2004; Landsberg et al.,**  **2006). In this report, both varieties will be referred to as**  **P. bahamense.** 


### Effects on Human Health

**Because they are immune to STXs, puffer fish can ac cumulate high toxin concentrations in the muscle tis**  **sue, making them a significant threat to consumers.The extreme toxicity of these puffer fish fillets, well above**  **the FDA action level, emphasizes the public health danger posed by these fish and supports the perma**  **nent ban on their harvest in the IRL (Landsberg et al.,**  **2006; Abbott et al.,**  **2009). Symptoms of SPFP may include tingling or numb**  **ness in the mouth and/or lips, paresthesia in the face and/or extremities, ataxia, nausea, vomiting, drowsiness,**  **incoherent speech, and muscle weakness (Hammond et al.,**  **2002; Quilliam et al.,**  **2004). In severe cases, respi ratory paralysis and death may occur. STX is heat- and** **acid-stable and is not detoxified or destroyed by freez ing or cooking.The onset of symptoms is usually rapid**  **as soon as 30 minutes to 2 hours after ingestion, to as long as 8 hours.The duration of illness may range from**  **12 hours to, in severe cases, 45 days. In the Florida cases, almost half of the victims required emergency** **room services and nearly half of those individuals re quired hospital admission. Long term neurologic effects**  **have not been studied (see Appendix B, Medical Fact Sheets and Case Definitions).**  

### Effects on Living Resources

**In addition to their effects on human health, STXs are responsible for aquatic animal mortalities (Landsberg,**  **2002; Shumway et al.,**  **2003; Van Dolah et al.,**  **2003; Lands berg**  **et al., 2005). Marine mammals are exposed to STXs**  **primarily through their diet, consuming toxins vec tored through the food chain. For example, during a five** 

**w eek period beginning in late November 1987, 14**  **humpback whales, Megaptera novaeangliae,**  **died in New England after ingesting Atlantic mackerel,**  **Scomber scombrus,**  **containing STXs. STXs were present in the vis cera, especially the liver, of mackerel caught where the**  **whales had been feeding. Extracts of whale kidney, liver, and stomach contents were lethal to mice by stan**  **dard bioassay, and the mice showed classic signs of STX poisoning (Geraci**  **et al., 1989). STXs were a key sus** **pect in the mortality of more than 100 highly endan gered Mediterranean monk seals,**  **Monachus monachus, on the coast of West Africa during May and June 1997**  **(Reyero et al.,**  **1999). During a Pyrodinium**  **bloom in the F**  **ar East, mortalities of dolphins and other animals**

**w ere reported (Maclean and White, 1985), but no fol**  **low-up investigation was conducted. In conjunction with several PSP incidents in Central America in 2006,**  **fish kills and dead turtles were associated with P.**  **ba hamense**  **blooms (Licea-Duran et al.,**  **2008; Flewelling and Landsberg, FWC–FWRI, unpublished data).** **In the past few years, the northern IRL has expe rienced a number of unusual events: dolphin, manatee,**  **fish, and horseshoe crab mortalities; increased tumor incidence in hard clams (** **Mercenaria spp.); diseased**  **shrimp; and both reductions in the natural recruitment of hard clams and increases in hatchery losses of these**  **commercially important species (Bossart et al.,**  **2003; Landsberg and Kiryu, 2005; Landsberg**  **et al., 2006).**  **However, to what extent, if at all, these events are linked to the emerging issue of toxic**  **P. bahamense**  **blooms and STXs in the IRL remains undetermined.** 


### Economic Effects

**T here has been little assessment of the economic ef**  **fects of STXs in the IRL. However, puffer fish are not considered to be a significant recreational or com**  **mercial resource, and there has been minimal feedback from the public indicating any adverse economic ef**  **fects.The puffer fish ban does not appear to have had any significant effect on the tourist and sport fishing** **industries. Potential impacts on the hard clam indus try are possible. Highly lethal STXs have the potential** **to have significant economic effects on fishery indus tries and to threaten marine mammals, birds, and**  **other aquatic organisms.** 

### Existing Monitoring Operations

**In Florida’s marine waters, STXs have only been as sociated with**  **P. bahamense,**  **extensive blooms of which appeared in the IRL in 2002. During 2002–2004, all the**  1 | Background on Harmful Algal Blooms**.** Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 11 1 | Background on Harmful Algal Blooms

**Florida SPFP cases were linked to puffer fish origi nating from the northern Indian River and the Ba**  **nana River on Florida’s east coast. All the puffer fish**

**w ere caught recreationally, except for one case in which**  **puffer fish were commercially harvested and reached a New Jersey fish market (Bodager, 2002).With the ad** 

**v ent of the Florida SPFP cases, state (FDOH, FDACS)** **and federal (FDA, CDC) officials issued health advi sories on 15 April 2002, and the FWC placed a ban on**  **puffer fish harvesting in the IRL that remains in effect today. Funded by the CDC, FDOH, and NOAA, the** **FWC initiated an intensive statewide monitoring pro gram to determine concentrations of STXs in various** **puffer fish species and in other biota, including shell fish. Puffer fish regularly monitored for toxicity include**  **striped burrfish together with bandtail, checkered, and southern puffer fish.**  **Pyrodinium bahamense con** **centrations are determined from monthly water sam ples at fixed stations throughout the IRL, funded by**  **SJRWMD, FWC, and FDACS. T** **he FDACS and the FWC–FWRI are monitoring target shellfish species, particularly hard clams,**  **Mer cenaria**  **spp., in the IRL because bioaccumulation of STXs in shellfish can pose a risk to consumers.The FDA** **has established national regulatory standards for ac ceptable limits of STXs in seafood. In Florida, only** **puffer fish have consistently exceeded the limit for ac ceptable STX levels of 80 μg STX eq./100 g, data that**  **support continuation of the puffer-fishing ban in the IRL (Abbott**  **et al., 2009). Samples of hard clams are col**  **lected monthly by FDACS throughout the IRL. Clam tissues are tested for toxicity by FWC–FWRI using the**  **MBA. If warranted, FDACS implements shellfish bed closures and posts this information on their Web site** **http://www.floridaaquaculture.com/seas/seas_sta tusmap.htm. Shellfish beds in the northern IRL have** **been closed on a few occasions (2003, 2005) as a pre cautionary measure when toxin levels in bivalves as de**  **termined by MBA minimally exceeded the FDA action limit. In 2006, shellfish beds were closed by FDACS for**  **more extensive periods during the summer and fall when**  **P. bahamense**  **blooms extended throughout the IRL and persisted.**  

## Ciguatoxin and Ciguatera Fish Poisoning
Background

**P**

**ossibly the oldest report of seafood intoxication in the Americas was made by Peter Martyr (1457–1526) in**  **the West Indies (Halstead, 1967). An illness now known as CFP was first noted (Gruder, 1930) and later recorded**  **in the 1600s and 1700s (Withers, 1982). In the early 1800s, a Cuban ichthyologist described an ordinance**  **prohibiting the sale of ciguatera-contaminated fish**

**w eighing more than three pounds. He noted that in the**  **Caribbean, toxic fish were unevenly distributed: fish on one side of an island were toxic while those on the**  **other side were nontoxic (Gordon, 1977).The origin or causative agent was unkno** **wn.The organism that causes ciguatera was eventually identified as**  **Gambierdiscus toxicus**  **(Yasumoto et al.,**  **1977; Adachi and Fukuyo, 1979) ,**  **a toxic dinoflagellate that normally inhabits reefs and seaweeds in subtropical and tropical regions. Several**  **other toxic Gambierdiscus**  **species have now been de scribed (Holmes, 1998; Chinain**  **et al., 1999). CFP has con**  **tinued to occur and is prevalent in subtropical and tropical regions, including the Indo-Pacific, Hawaiian**  **Islands, and Caribbean Sea. Randall (1958) first suggested that the toxin, cigua**  **toxin, is accumulated through the food chain into the top predators including large, reef-dwelling piscivorous**  **fish such as grouper.**  **Ciguatoxins are lipid-soluble molecules that are absorbed directly in the viscera**  **and accumulate in muscle tissue either intact or with some biochemical modification. Ciguatoxins are often** 

**c hanged biochemically as they are transmitted up the** **food chain, resulting in a variable complex of cigua toxins in herbivorous fish. Because the top-level car**  **nivorous fish may have consumed a variety of herbivorous fish species over their lifetime, the com**  **plex of ciguatoxins that have been biotransformed, bioaccumulated, and deposited in the muscle of a fish** **may be present in different proportions and combi nations. Only a few of the toxins have been identified**  **or characterized from ciguateric fish. However, more than 20 precursor gambiertoxins and ciguatoxins have**  **been identified from the algae G.**  **toxicus and from her**  **bivorous and carnivorous fish tissue (Lehane and Lewis, 2000). Evidence also suggests that when reef fish**  **become toxic, they can remain so for a long period of time either because of the slow depuration of the ac**  **quired toxin or from continued exposure to more ciguatoxins. Because many of these fish are permanent**  **reef dwellers, they remain exposed to sources of toxin (Banner**  **et al., 1966).**  

### Ecology

**Ciguatera outbreaks are sometimes associated with reef disturbances from hurricanes such as Andrew and**  **Gilbert (Bohnsack et al.,**  **1994), coral bleaching (Kohler and Kohler, 1992), dredging (Bagnis**  **et al., 1990; Tebana,**  **1992), use of destructive methods such as rotenone and d** 

**ynamite for the commercial harvesting of fish or corals, and by other anthropogenic alterations (South Pacific** **.** Public Health Response to HABs Abbott et al.

12 FWRI Technical Report TR-14 1 | Background on Harmful Algal Blooms

**Commission, 1990). However, when boat channels were blasted from coral, existing populations of**  **G. toxicus**  **in creased, but the species did not appear in the newly ex**  **posed areas (Kaly and Jones, 1994). Increases in G.**  **toxicus populations can also accompany an increased**  **abundance of macroalgae, particularly filamentous red algae (Bomber**  **et al., 1989; Lehane and Lewis, 2000).**  **Several other species of Gambierdiscus**  **in Florida are being described (Litaker, unpublished data).**  **T here are only a limited number of places in the**  **continental United States where indigenous ciguatera phytoplankton species are found (either on algal sub**  **strates or on reefs) and where verified toxicities have been confirmed in local fish. In Florida, these include**  **the Florida Keys, Florida Bay, the Dry Tortugas, and the T** 

**ortugas Banks; and in Texas, the Flower Gardens (Bomber**  **et al., 1989; de Sylva, 1994). Confirmed ciguat**  **era cases in Texas were associated with fish captured near an oil platform 30 miles from Matagorda. Oil**  **platforms and their attached flora may provide good substrate for colonization by**  **G. toxicus**  **and other cigua teric dinoflagellates (Villareal**  **et al., 2006).** **Since the 1980s, there have finally been major ad**

**va nces and intensive chemical studies of the organisms** **and toxins causing this illness. Although other toxic di noflagellates (**  **e.g., Prorocentrum, Ostreopsis ) have been**  **suspected in CFP, Gambierdiscus**  **is the only genus that has been definitively implicated (Lewis and Holmes,**  **1993). Ciguatoxins originating from G.**  **toxicus are con**  **centrated up the food chain from primary consumers that have been exposed to**  **Gambierdiscus cells or toxins** **through herbivorous fish that browse on affected sub strates to finally accumulate in the muscles of the car**  **nivorous fish at the top of the food-chain. As the toxin concentration in these fish increases, they pose a risk**  **to human consumers (Lewis and Holmes, 1993; Swift and Swift, 1993). At least 400 fish species have been im**  **plicated in CFP (Halstead, 1967), the most common being tropical fish such as groupers, barracudas, hog**  **fish, snappers, jacks, triggerfish, kingfish, parrotfish, and surgeonfish (Backer**  **et al., 2003a).** 


### Effects on Human Health

**In humans, consumption of ciguatoxic herbivorous fish is usually associated with gastrointestinal illness**  **or neurological symptoms, whereas toxic carnivorous fish are more often associated with cardiovascular and**  **neurological disorders (Bagnis, 1968). Symptoms begin 1 to 12 hours after ingestion of contaminated fish and**  **include sensory disturbances such as paresthesias, arthralgia, myalgia, diarrhea, asthenia, chills, headache,** **nausea, pruritus, abdominal pain, vomiting, perspi ration, tearing, and giddiness (Swift and Swift, 1993;**  **Backer et al.,**  **2003a) (see Appendix B, Medical Fact Sheets and Case Definitions). Gastrointestinal symp** **toms usually persist for only a few days, whereas neu rological symptoms may persist for several months or**  **y ears. In the Pacific, for example, chronic neurological**  **symptoms have been reported to last for up to 25 years after the initial exposure (Backer**  **et al., 2003a). Extreme** **cases, which are rare, result in paralysis, loss of con sciousness, and death. In sublethal cases, symptoms**  **may continue for weeks to months until the acute phase abates. In some instances, symptoms have con** **tinued or recurred years later. Ingestion of fish or al cohol may cause symptoms to recur long after the**  **original intoxication event. Administering intravenous mannitol within 24 hours of intoxication has helped to**  **reduce brain swelling and diminish the most irritating symptoms (Palafox**  **et al., 1988; Blythe**  **et al., 1994). No**  **permanent cure is currently available. Ciguatoxins are not affected by cooking or freez**  **ing and can currently be confirmed only by specific**

**c hemical analyses exclusively available through the** **FDA.Toxin identification by chemical analysis is chal lenging because pure ciguatoxin is not available for**  **comparison and because human illness can be caused by**  **low concentrations of toxins in fish muscle. The broad suite of ciguatoxins contributes to the wide va**  **riety of symptoms and effects on humans diagnosed with CFP.The presence of different groupings of cigua**  **toxins in ciguateric fish from the Caribbean Sea and the P** 

**acific Ocean probably underlies the clinical differences in the ciguatera syndrome as reported in the two re**  **gions (Vernoux and Lewis, 1997). More than 175 symptoms of CFP have been re** **ported (Swift and Swift, 1993). CFP probably also in cludes several other reported food-poisoning**  **syndromes associated with different toxins originating from microalgae. Scaritoxin, a lipid-soluble toxin from**  **parrotfish, and maitotoxin, a water-soluble toxin from surgeonfish, have also been associated with CFP. Pa**  **l ytoxin has been implicated in ciguatera-like symptoms**  **in humans who ate smoked mackerel ( Decapterus macro** 

**soma ) (Kodama**  **et al., 1989). Both lipid- and water-sol**  **uble compounds interfere with neural conduction by acting on either the calcium or the sodium channel**  **(Baden et al.,**  **1990). Ciguatoxic barracuda have been found off Florida’s** 

**w est coast (Morton and Burklew, 1970; Tomas, 1996)**  **and the Florida Keys, including the Dry Tortugas (Tomas and Baden, unpublished data). In the late**  **1970s, the threat of ciguatera caused the prohibition of barracuda sales in Miami, Florida (Lawrence**  **et al., 1980). During the late 1980s, ciguatera intoxications on**  **the east and west coasts of Florida caused further alarm. The frequency and extent of these intoxica-** **.** Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 13 1 | Background on Harmful Algal Blooms

**tions and the species of ciguatoxic fish involved were documented by de Sylva (1994).**  **In Florida, ciguatera is a larger public health risk than NSP (McKee**  **et al., 2001).Worldwide, an estimated**  **50,000 victims suffer from CFP each year, and some estimate 1,300 cases per annum occur in Florida alone**  **(de Sylva, 1994).The gross underreporting of ciguatera to the FDOH stems from several problems: mild sub**  **clinical cases that do not reach health-care providers, misdiagnosis, difficulty in diagnosis and case confir** **mation, and failure by treating physicians to make a re port (despite the fact the ciguatera is a reportable**  **disease in Florida) (Freidman et al.,**  **2008).The FDOH re portable-disease network, Merlin**  **® , i**  **ndicates that there**

**w ere 4 reported, confirmed cases in 2005 and 16 in**  **2006. However, the FDOH notes that the number of ciguatera outbreak-related cases in 2005 and 2006 were**  **8 and 44, respectively, and in 2007 and 2008, 34 and 51**

**w ere reported.**  **Tw enty cases of CFP from consumption of am**  **berjack were reported to FDOH during August and September 1991 (Hammond**  **et al., 1993). Eight per**  **sons developed one or more of the following symptoms: cramps, nausea, vomiting, diarrhea, or chills and sweats,** **all within 3–9 hours after eating amberjack at a restau rant on August 7 or 8. Symptoms lasted 12 to 24 hours**  **after onset; three persons were hospitalized. By August 12, patients began to report pruritus of hands and feet,**  **paresthesia, dysesthesia, and muscle weakness. Based on the initial food histories, amberjack was suspected**  **as the source of illness. On August 14, three additional persons with similar symptoms were identified; they** **had also eaten amberjack at the same restaurant. Be cause of the unique symptomatology and the common** **denominator of amberjack consumption, investiga tors suspected either scombroid or ciguatera poison**  **ing.The shipment of amberjack was traced to a seafood dealer in Key West, Florida, who had distributed the**  **fish through a dealer in north Florida. The second dealer subsequently had sold the fish to the restaurant**  **in question, another restaurant in Alabama, and to a third dealer who sold the fish to two grocery stores, one**  **in Alabama and the other in north Florida.The FDOH received reports of additional suspected cases of CFP** **among persons who had bought amberjack at the Al abama grocery store (six persons) and at the north**  **Florida grocery store (three). The FDA evaluated 19 amberjack samples believed to have originated from**  **a single lot from the Key West dealer and obtained samples from the restaurants and grocery stores in**  **Florida and Alabama. Forty percent of the specimens tested by MBA were positive for ciguatera-related** **biotoxins. This outbreak highlights some of the diffi culties in tracing suspected fish, case identification,**  **and the numerous vendors and agencies that must be involved in a successful investigation.** **It might be expected that CFP events would be come more common if there are increased levels of**  **ciguatoxins in the environment. However, not all of these events may be identified because (1) sale of bar** **racuda, the most common source of affected com mercial fish, is prohibited in Miami; (2) many, if not**  **most, ciguatera cases go unreported; (3) it is difficult to determine the source of ciguatera toxicity in fish; and**  **(4) CFP is difficult to diagnosis after the first few days of illness because conflicting diagnoses must be elim**  **inated and a complete food history obtained before ciguatera can be confirmed (Lawrence**  **et al., 1980; de**  **Sylva, 1994; Freidman et al.,**  **2008).** 

### Effects on Living Resources

**Although ciguatoxins have not been reported to have any acute effect on fish in the wild (Banner**  **et al., 1966;**  **Swift and Swift, 1993; Naar et al.,**  **2007), experiments have shown that ciguatoxins can be lethal to fish when** **dissolved in aquarium water or when administered ei ther orally or by intraperitoneal injection (Davin**  **et al., 1986, 1988; Lewis, 1992). Experimentally exposed fish** **behave abnormally, exhibiting erratic movement, dis orientation, inactivity, and loss of equilibrium; signs of**  **physiological distress include blanching or darkening of the skin, changes in opercular movement patterns,**  **and loss of appetite (Kelly et al.,**  **1992; Lewis, 1992). In 1993 through 1994 ciguatoxins were thought to play a**  **role in the large-scale die-off of tropical fish in Florida and the Caribbean (Landsberg, 1995).**  **Because ciguatoxins can be highly toxic and lethal to fish, Lewis (1992) suggested that there may be an**  **upper limit to tissue concentrations of ciguatoxin that fish can tolerate. Fish can retain these toxins for long**  **periods of time; toxic fish remained so for up to 30 months, even when maintained in nontoxic water and**  **fed nontoxic diets (Banner et al.,**  **1966). A die-off of se**

**v erely affected fish could contribute to the low inci**  **dence of human fatalities associated with CFP.To date, there is minimal but compelling evidence that cigua** **toxins can affect fish health and under certain cir cumstances, may be responsible for fish mortalities**  **(Landsberg, 1995).**


### Economic Effects

**Because ciguatera cases are underreported by up to 90%, it is difficult to make accurate estimates of the eco**  **nomic effects on Florida’s economy (Fleming et al.,**  **1998; McKee et al.,**  **2001).These effects include not only lost tourism revenue, restaurant liabilities, treatment** **.** 14 FWRI Technical Report TR-14 **of patients, and hospitalizations, but also the time off from work and medical costs incurred by people who**  **experience recurrent symptoms months or years after the initial poisoning.** **Economic effects of CFP in the Caribbean are es timated to exceed $10 million (Hoagland**  **et al., 2002).**  **Anderson et al.**  **(2000) suggested that a conservative es timate for the economic effects of CFP in the U.S.** 

**w ould average $21.19 million annually (using year**  **2000 dollars); this estimate included Florida, Hawaii, Puerto Rico, the Virgin Islands, Guam, America Samoa,** **Northern Mariana Islands, and the economically de pendent areas of Marshall Islands, Palau, and Mi**  **cronesia. In the U.S. and Canada, annual costs for time lost from work and hospitalization expenses are esti**  **mated at $20 million (de Sylva, 1994). Because we lack an effective screening procedure, the only reliable**  **method of preventing poisoning is to prohibit sales of fish from known ciguatoxic areas as they do in Tahiti**  **(Bagnis et al.,**  **1990).This prohibition causes significant economic losses to the fishing industry in these regions**  **(de Sylva and Higman, 1980). In Florida, while the sale of barracuda is banned in Miami (Lawrence**  **et al., 1980), the effect on the economy from loss in sales is**  **unknown. Liability for damages due to exposure to toxic fish has fallen on seafood sellers.They have been con**  **sidered to be responsible for ciguatera transmission**

**ev en if due care is exercised in preparation and sale of**  **the product (Sturm, 1991). Persons affected have also successfully sued restaurant operators to recover**  **ciguatera-related damages (Nellis and Barnard, 1986).** 

### Existing Monitoring Operations
**CFP is a reportable disease in Florida (Chapter 64D 3, Florida Administrative Code). Physicians and other**  **health care professionals in Florida are required to report all cases to the local county health department**  **(CHD). These reports are then entered into Merlin ®** 

**. State epidemiologists conduct follow-up investiga**  **tions to confirm these cases. However, the amount of underreporting is estimated to be high, up to 90% of**  **cases (Fleming et al.,**  **1998; McKee et al.,**  **2001). Outreach attempts have been made to help med**  **ical professionals recognize CFP. Use of ciguatera posters in emergency rooms has helped raise the aware** **ness of both physicians and the public and encour aged the reporting of CFP cases. In 1997, a three-month**  **collaborative outreach project by the U of M and the South Florida Poison Information Center (FPIC) re**  **sulted in the number of ciguatera cases reported in Dade County increasing 2.7 times over the previous**  **three months (Fleming et al.,**  **1998). T** **he dinoflagellates that cause CFP are known to occur in Florida waters, but potential ciguateric areas** **have not been mapped. Fish are not routinely col lected to monitor for ciguatoxin; however, there are** **research initiatives in place (CDC, FDOH, FWC, Uni**

**v ersity of North Carolina at Wilmington) to investigate**  **the distribution of ciguatoxin (and brevetoxin) in fish from known endemic ciguateric areas in the Florida**  **Ke ys and on the west coast of Florida.** 


## Cyanobacteria (Blue-Green Algae) and Cyanotoxin Poisoning
Background

**Florida’s diverse freshwater, brackish, and marine en vironments support a wide variety of cyanobacteria** **(blue-green algae) blooms. Like other HABs, cyanobac teria can affect water quality, and more importantly,**  **those that produce cyanotoxins can pose a threat to public health. Cyanobacteria can also adversely affect**  **natural resources and the environment. Many of Florida’s largest and most important aquatic systems**  **have been affected by persistent cyanobacterial blooms, including Lake Okeechobee; the Harris chain of lakes**  **(Apopka, Griffin, Eustis, and Harris); and the St. Johns, St. Lucie, and Caloosahatchee rivers and their estuar**  **ies (Williams et al.,**  **2001, 2006, 2007a; Burns et al.,**  **2002; Phlips**  **et al., 2002; Paerl**  **et al., 2005; Aubel**  **et al., 2006;**  **Burns, 2008). T** **here are about 20 taxa or species of bloom-form ing cyanobacteria that are toxic or potentially toxic in**  **Florida fresh waters, including Microcystis aeruginosa,** **Anabaena circinalis, A. flos-aquae, Aphanizomenon flos aquae, Cylindrospermopsis raciborskii, Oscillatoria**  **spp., L** 

**yngbya wollei, and**  **L yngbya**  **sp. (Chapman and Schelske, 1997; Williams**  **et al., 2001, 2006, 2007a; Phlips**  **et al., 2002; Burns, 2008; Joyner**  **et al., 2008; Yilmaz**  **et al., 2008).** **(See Appendix E for a table of species and their asso ciated toxins.)**  **In the United States, Europe, Asia, and Australia, a significant percentage of water samples analyzed**  **for cyanobacteria test positive for cyanotoxins. Because cy** **anotoxins can be retained in source water, their con tamination of drinking-water reservoirs is an impor**  **tant public health concern. The first nationwide drinking water survey in the United States revealed that** **80% of 677 samples analyzed (from 45 utility compa nies) contained microcystins. These are potent hepa**  **totoxins produced by certain species of cyanobacteria (**  **e.g., Microcystis aeruginosa ); 4% of the positive samples**  **exceeded the World Health Organization’s (WHO) safe drinking water guideline of 1μg/L for total mi**  **crocystin (Carmichael, 2001). In Florida, water-treatment** Public Health Response to HABs Abbott et al. 1 | Background on Harmful Algal Blooms**.** Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 15 1 | Background on Harmful Algal Blooms

**systems have some ability to reduce toxin levels (Drew, 2002). However, it is not known to what extent, if at all,**  **these toxic compounds are making their way through existing treatment processes (Williams**  **et al., 2006).**  **T he American Water Works Association (AWWA) is** 

**ev aluating the effectiveness of various water treat**  **ment methods.** 

### Ecology
**Unlike the more open marine systems, land-use activ ities are particularly important factors in stimulating and** **maintaining cyanobacterial blooms in enclosed fresh**

**w ater ponds, rivers, and smaller water bodies. Usually** **found close to urban areas, the highly visible blue green discolorations caused by cyanobacteria blooms** **often generate public concern and a demand for at tention even in the apparent absence of toxic species.**  **Anabaena circinalis and**  **Microcystis aeruginosa are**  **two of the most widely distributed species in Florida (Williams**  **et al., 2001, 2006; Burns**  **et al., 2002). Being**  **planktonic, they often form extensive surface blooms and scums in eutrophic waters during warm weather**  **and calm winds. Toxic Anabaena**  **and Microcystis**  **have occurred in lakes Okeechobee and Istokpoga**  **(Carmichael, 1992; Phlips et al.,**  **2002). Elsewhere, A.**  **circinalis strains have been reported to produce the** **neurotoxins anatoxin-a, STX, and neosaxitoxin (Sivo nent**  **et al., 1989; Humpage**  **et al., 1994).**  **Microcystis aerug inosa**  **strains are known to produce 37 of the 52 microcystins that occur in lakes Okeechobee and Is**  **tokpoga (Carmichael, 1992). Aphanizomenon flos-aquae**  **is also common through out Florida (Williams**  **et al., 2001, 2006). Anatoxin-a and** **two neurotoxic alkaloids resembling STX and neosax itoxin have been isolated from**  **A. flos-aquae. Cylindrospermopsis raciborskii**  **in Florida is known to produce cylindrospermopsin (hepatotoxin) (Burns**  **et al., 2002) and is found principally in tropical and**  **subtropical regions. It forms subsurface blooms and has been reported throughout Florida, including the St.**  **J ohns River, Wekiva River, Newnans Lake, Lake Dora,** **Lake Eustis, Lake Griffin, Lake George, Lake Okee**

**c hobee, Lake Wauberg, and Lake Disston, but its dis**  **Sampling plants and water in Lake Harris, 2007. FWC image** **tribution appears to be increasing (Chapman and Schelske, 1997; Williams**  **et al., 2001; Phlips**  **et al., 2002).**  **Bloom concentrations of Cylindrospermopsis**  **in the hy pereutrophic Lake Griffin have been observed to ex**  **tend over the entire lake for periods in excess of a year (Phlips**  **et al., 2002).**  **L**

**yngbya wollei has become increasingly promi**  **nent in Florida’s freshwater systems. L**  **yngbya wollei has been reported to produce decarbomoylsaxitoxin,** **decarbomoyl-gonyautoxin, lyngbyawolleitoxin, cylin drospermopsin, and deoxy-cylindrospermopsin in**  **freshwater environments in Australia and the U.S.A. (Carmichael**  **et al., 1997; Seifert**  **et al., 2007).**  **Lyngbya wollei**  **has been identified as a complex that probably comprises at least two species (Joyner**  **et al., 2008) that** **potentially account for observed differences in toxic ity reported in Florida. Ongoing sampling and testing**  **may provide additional information on the ecology and toxin production of various freshwater**  **L yngbya**  **species in Florida.**


### Effects on Human Health

**Humans can be exposed to cyanobacteria and their toxins (cyanotoxins) through direct skin contact or**  **by drinking contaminated waters; other possible** **routes of exposure include inhalation of aerosol, con sumption of contaminated food, and even from kid**  **ney dialysis using contaminated water (Jochimsen et**  **al., 1998; Pouria**  **et al., 1998; Falconer, 1999, 2005; Cho** 

**rus et al.,**  **2000). Occupational exposures for fishermen,**

**wa termen, and scientists, as well as recreational ex** **posures for the general public, are all possible. How**

**ev er, there are relatively few case reports and even** **fewer epidemiologic studies of the effects of blue green algal toxins on human health.** **Seasonal gastroenteritis has been reported world wide and may be related to the consumption of**  **cy anobacterial-toxin-contaminated drinking water or**  **recreational exposures (El Saadi et al.,**  **1995; Fleming and Stephan, 2001). Reports of two cases of pneumonia** **and 16 other complaints of a variety of gastrointesti nal (hepatoenteritis), dermatologic, and respiratory**  **ailments in previously healthy army recruits were likely linked to exposure with a blue-green algal bloom**  **of Microcystis aeruginosa**  **(Turner et al.,**  **1990; Fleming and Stephan, 2001; Stewart**  **et al., 2006a).**  **In Florida, health effects associated with exposure to cyanobacteria are a very important issue (Johnson**  **and Harbison, 2002), but they are not considered to be a reportable disease at this time. It is not possible to es** **timate the number of Floridians who have been ad**

**v ersely affected by such exposure.** **Cyanotoxins belong to one of three groups: neu rotoxins, hepatotoxins, and dermatotoxins. Each toxin**  **is defined by the symptoms it produces in animals.**

**NEUROTOXINS T** **he cyanotoxic neurotoxins include anatoxin-a, ana toxin-a(s), and STX. STX is also produced by dinofla**  **gellates and is associated with SPFP in Florida’s marine systems (Landsberg**  **et al., 2006). Anatoxin-a mimics the**  **neurotransmitter acetylcholine, but the toxin cannot be degraded by the enzyme acetylchoinesterase; ana**  **toxin-a(s) binds to acetylcholinesterase acting as a natural organophosphate; and STXs are sodium-chan**  **nel blockers (Carmichael, 1992; Fleming and Stephan, 2001). These toxins can cause death within minutes,**  **secondary to effects on respiratory muscles, causing paralysis, convulsions, and suffocation (Carmichael**  **et al.,**  **1979; Fleming and Stephan, 2001; Stewart et al.,**  **2006a).**

**HEPATOTOXINS T** **he cyanotoxic hepatotoxins include cylindrosper mopsins, nodularins, and microcystins. These toxins** **damage the liver by altering the cytoskeletal architec ture of the hepatocytes (Carmichael, 1994). Cylindros**  **permopsin is a protein synthesis inhibitor, resulting in widespread necrosis of the tissues in many organs**  **(Terao et al.,**  **1994; Froscio et al.,**  **2003). The nodularins and microcystins are protein phosphatase inhibitors**  **and are potent tumor promoters in animals (Carmichael, 1992; Falconer and Humpage, 1996). Both**  **in vivo and**  **in vitro studies indicate that both nodular** **ins and microcystins inhibit Type 1 and 2 protein phos phatase activities, which causes the cytoskeletal**  **structure to collapse, thus leading to a loss of liver cell function and eventually cell death (Honkanen**  **et al., 1990, 1991). At lower doses, enteritis and hepatitis are**  **seen shortly after ingestion of microcystins, which at higher doses can cause liver necrosis that leads to**  **death within hours or days (Falconer et al.,**  **1981; Flem ing and Stephan, 2001).** **Humans exposed to microcystins through conta minated drinking water supplies are also potentially**  **at risk of primary liver cancer (Yu, 1991). An outbreak of human hepatoenteritis was associated with a bloom**  **of C.**  **racbiorskii after a domestic drinking-water reser** 

**v oir became contaminated on Palm Island, northeast**  **ern Australia.The majority (139) of cases (148) were in**

**c hildren.The liver was enlarged in all cases, and the ini**  **tial symptoms resembled hepatitis accompanied by abdominal pain. Kidney malfunction and profuse**  **bloody diarrhea followed. Symptoms occurred after copper sulfate was applied to a dense algal bloom in**  **the water supply (Bourke et al.,**  **1983; Hawkins et al.,**  **1985, 1997).** Public Health Response to HABs Abbott et al.

16 FWRI Technical Report TR-14

**.** 1 | Background on Harmful Algal Blooms**DERMATOTOXINS T** **he cyanotoxic dermatotoxins include aplysiatoxins and lyngbyatoxins and are often reported from marine**  **cy anobacterial blooms, including those of**  **L yngbya ma**  **juscula. T** **hese toxins are potent tumor promoters and protein kinase C activators (Fujiki and Suganuma,**  **1996).They can cause severe dermatitis with only skin contact and can cause gastrointestinal inflammation if**  **ingested; however, there is no direct evidence for a cause–effect relationship in Florida (WHO, 1999; Flem**  **ing and Stephan, 2001). In freshwater, the FDOH Aquatic Toxins Program (ATP) has been investigating**  **reports of skin irritation and rashes from a number of state-owned Florida parks with spring-fed streams.**  **T**

**esting of L. wollei**  **found in Florida springs during the summer of 2006 did not detect dermal toxins; however,**  **STX-like compounds were identified by ELISA tests and receptor-binding assay, and the PSP toxins de** **carbamoylsaxitoxin (dcSTX) and decarbamoylgo ny** **autoxin-2 and -3 (dcGTX-2/3) were identified by HPLC (PBS&J Corporation, 2007; Flewelling, FWC–**  **FWRI, unpublished data). Elsewhere, there are individual case reports of**  **persons exposed by swimming through blue-green algal blooms, resulting in skin irritation and allergic re** **actions (both dermatologic and respiratory) with con tinued sensitivity to skin testing post-exposure (Stewart**  **et al., 2006b). In particular, urticaria (hives), blistering,**  **and even deep desquamation (shedding) of skin in sensitive areas such as the lips and under swim suits**  **have been reported, especially related to contact with L** **yngbya majuscula from tropical marine areas**  **(Osbourne et al.,**  **2001). Type I hypersensitivity to cy** **anobacteria (as detected via skin-patch testing and bronchial-provocation testing) has also been reported**  **with exposure to contaminated recreational water (Stewart**  **et al., 2006a).**  

### Effects on Living Resources

**Cyanobacterial blooms can kill domestic pets, live stock, and wildlife that drink contaminated surface** 

**w ater as well as aquatic animals that are directly** **exposed to toxins throughout the water column (Fal coner, 2005).**  **P ersistent and decaying blooms, with their ac** **companying odor, are aesthetically displeasing. How**

**ev er, bloom conditions may create hypoxic (low**  **dissolved oxygen) conditions leading to fish kills and environmental degradation. When the oxygen supply**  **is depleted, oxygen-reliant organisms die, which leads to other cascading environmental problems, includ**  **ing foul odor and the proliferation of undesirable microorganisms.The release of cyanotoxins, a reduc**  **tion of light availability in the water column, and the alteration or disruption of food webs are also poten**  **tial effects of cyanobacterial blooms. Large blooms and mats of cyanobacteria can hinder or eliminate**  **the growth of native species and upset the ecological balance by changing the number and type of species**  **present in a given area. T** **he mat-forming filamentous alga L**  **yngbya wollei can grow to bloom proportions in freshwater littoral** **zones in Florida, degrading nearshore areas and pre**

**v enting light from reaching submerged aquatic vege**  **tation (Joyner et al.,**  **2008). An extensive marine L**  **yngbya bloom, primarily comprising**  **L. confervoides and**  **L. poly**

**c hroa,**  **on the reef tract offshore of Broward County, Florida, was first noted in 2002. Blooms continue to** **cause extensive problems as they smother and ulti mately kill octocorals and other invertebrates, nega**  **tively affecting these reefs (Paul et al.,**  **2005). Cylindrospermopsis raciborskii**  **has been implicated as a possible cause of the late-1990s mass mortality and**  **reproductive failure of American alligators ( Alligator**  **mississippiensis ) in Lake Griffin in the Oklawaha River**  **system in central Florida. Necropsies of four alligators**

**w ere inconclusive, but analysis of tissues by ELISA** **revealed the presence of small quantities of micro**

**c ystin toxin, a known tumor promoter (Carmichael,**  **1992; Richey et al.,**  **2001). Other proposed causes include a thiamine (vitamin B1) deficiency in the alligator’s**  **diet (Sepulveda et al.,**  **2004). A 2007 Cylindrospermopsis**  **bloom occurred with a mallard duck ( Anas platyrhyn** 

**c hos**  **and mallard hybrids) die-off and led to an intense investigation to determine whether the cause was not**  **a single factor but a multi-factorial association of a number of etiological factors, including cyanotoxins and**  **botulism. STXs have been detected at low concentrations in**  **blue crabs ( Callinectes sapidus**  **) surveyed from freshwater and low-salinity areas with chronic cyanobacterial** **blooms. A study funded by CDC/FDOH to assess lev els of microcystins in four species of freshwater fish**  **from each of four lakes has confirmed microcystins in the livers of gizzard shad (**  **Dorosoma cepedianum ) and**  **bluegill ( Lepomis macrochirus**  **) (FWC–FWRI, unpub lished data). The epiphytic cyanobacterium (family** **Stigonematales) primarily responsible for avian vac uolar myelinopathy, a neurological disease affecting** 

**w ater birds (Williams**  **et al., 2007b), has been confirmed**  **by PCR for the first time in Florida on several substrate**  **species (Williams et al.,**  **2009).**


### Economic Effects

**Although cyanobacterial blooms cause significant eco logical and aesthetic problems and potentially affect**  Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 17

**.** 1 | Background on Harmful Algal Blooms**the operation of drinking-water facilities, economic costs associated with these blooms in Florida have not**  **been assessed.**


### Existing Monitoring Operations

**Recognizing the need to address cyanobacterial is sues in Florida, and following the work conducted** **under the FHABTF, Florida state agencies have devel oped an interagency working group to address the re**  **sponse to cyanobacteria bloom events. Surveys, such as the projects coordinated by the**  **FHABTF (see http://www.floridamarine.org/features/ view_article.asp?id=26908), have highlighted the di** 

**v ersity of harmful or toxic cyanobacterial species in**  **Florida (Williams et al.,**  **2001). As some cyanobacterial species can have both toxic and nontoxic strains, it is**  **important to determine the status of the various species and strains in Florida’s waters because management**  **strategies will vary accordingly. Most studies done to date have not been broad**  **monitoring programs but rather have been specific research projects to address particular cyanobacterial**  **species or toxins. These include, for example, an FDOH/FWC project to determine the potential for mi**  **crocystin accumulation in fish and monitoring water for the presence of cyanobacteria and/or toxicity by** **ELISA as part of ongoing, routine, water-quality pro jects conducted or funded by the Water Management**  **Districts, the FDEP, universities ( e.g.,**  **UF), or volun teer groups (**  **e.g., UF Lakewatch). The FDEP is con**  **ducting an inter-laboratory study to develop standard operating procedures for collecting and analyzing**  **samples of natural cyanobacterial blooms.**


## Emerging HAB Threats to Public Health

**A pproximately 70 of the over 100 potentially toxic**  **HAB species occur in Florida waters (Steidinger et al.,**  **1999; see Appendix E for a table of species and their associated toxins).Therefore, proactive sampling and**  **testing for toxicity is desirable, particularly because certain species can produce both nontoxic and toxic**  **strains. With all these emerging HAB-related threats to public health, it is important that blooms, animal**  **mortalities, and shellfish toxicity be investigated. Many state agencies and other institutions currently**  **collect and evaluate water samples for presence of HAB species and toxins, although much more needs**  **to be done. HAB cells are isolated from field blooms, cultures are established, and the toxicity of various ge**  **ographic strains is determined. Other biota are also tested for specific toxins in parallel with known HAB**  **species.These evaluations determine whether a bloom is producing toxins that could affect public health or**  **living resources. Some HAB organisms present in Florida are**  **known to produce toxins in other parts of the world, including the Gulf of Mexico, but to date have not**  **been shown to cause human health problems in Florida (**  **e.g., DSP and**  **Prorocentrum or**  **Dinophysis species). Other organisms have been shown to pro** **duce toxins in Florida as well as elsewhere but with out any resultant negative impacts or human illnesses**  **( e.g.,**  **domoic acid and Pseudo-nitzschia**  **). Other toxic HAB species that occur and bloom in Florida waters**  **include Protoceratium reticulatum, Lingulodinium poly**  **edrum, and**  **Gonyaulax spinifera, dinoflagellates that**  **produce yessotoxins (Rhodes et al.,**  **2005; Bowden, 2006). However, no incidents of toxicity from these or**  **ganisms have been documented in either humans or wildlife in Florida.**  **Several species of Coolia**  **and Ostreopsis,**  **both ben thic dinoflagellates, also occur in Florida waters.**  **Coo lia monotis**  **can produce polyether toxins and Ostreopsis** **species can produce palyotoxin-like bioactive com pounds. However, the Florida strains have not been**  **tested for toxins, and no known human illnesses have occurred from large concentrations or blooms.** **In culture conditions, the amount of toxins pro duced per cell by some HAB species varies. It is not**  **known whether apparently nontoxic strains have the genes to produce toxins. However, environmental con**  **ditions such as temperature, nutrient levels, and light intensity can affect the production of toxins even** **though the species population contains toxin-pro ducing genes. With emerging HAB problems it is im**  **portant to know if and what environmental regulators influence toxicity.This information would be critical to** **prepare response plans and develop effective man agement strategies.**  

### Diarrheic Shellfish Poisoning

**DSP is associated with the aquatic toxin OA, which is produced by the dinoflagellate**  **Prorocentrum lima (Mu**  **rakami et al.,**  **1982), other benthic Prorocentrum**  **species (Dickey**  **et al., 1990), and**  **Dinophysis species (Yasumoto**  **et al., 1984).This toxin has been detected in shellfish and**  **phytoplankton from the Gulf of Mexico (Dickey et al.,**  **1992). In 2008,Texas closed shellfish beds because of a toxic**  **Dinophysis bloom (Campbell**  **et al., 2008). Al**  **though the HAB species associated with DSP occur in Florida coastal waters and estuaries, there have been**  **no known cases of DSP from harvested shellfish.** Public Health Response to HABs Abbott et al.

18 FWRI Technical Report TR-14

**.** 1 | Background on Harmful Algal BloomsAbbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 19

**.** 

### Amnesic Shellfish Poisoning

**ASP, caused by the toxin domoic acid, has a history sim ilar to that of DSP in Florida. Although no cases of** **ASP are known to have occurred from shellfish har**

**v ested from Florida coastal or estuarine waters, domoic**  **acid-producing strains of the diatom Pseudo-nitzschia**  **spp. are known to bloom there.**


### T umor Promoters
**Several groups of toxins produced by dinoflagellates and cyanobacteria have been shown to have a variety**  **of short-term effects causing intoxication, but these same toxins can be tumor promoters in the long term.** **Microcystins, nodularins, OA, dinophysistoxin-1, aplysi atoxins, debromoaplysiatoxin, and lyngbyatoxin-a have** **all been demonstrated experimentally to be tumori genic in small mammals or cell assays (Fujiki and Sug**  **anuma, 1993; Falconer and Humpage, 1996; Sueoka and Fujiki, 1998). Although the potential role of mi** **croalgal toxins in tumor development in marine ani mals has been postulated (Landsberg, 1995, 1996;**  **Landsberg et al.,**  **1999; Arthur et al.,**  **2006), clearly linked**

**e vidence is still lacking.**  **In addition to the involvement of OA in acute human shellfish poisoning events (DSP), there is an in**  **creasing awareness of the potential role of OA and its derivatives as tumor promoters. In two-stage carcino**  **genesis experiments, OA has been shown to induce skin papillomas and carcinomas in mice and adenomatous**  **h**

**yperplasia and adenocarcinomas in the glandular stomach of rats (Suganuma**  **et al., 1988, 1990; Fujiki**  **et al., 1989; Sakai and Fujiki, 1991; Fujiki and Suganuma,**  **1993). Dinophysistoxin, an OA derivative, has also been shown to induce tumors in mice (Fujiki**  **et al., 1988). An**  **epidemiological study of digestive-tract cancer mortality of DSP (from OA or dinophysistoxins) was conducted**  **in relation to its distribution. Although there appeared to be a very tentative positive association between the**  **two, Cordier et al.**  **(2000) recognized the need for more extensive surveys and in-depth research before any**  **link can be definitively proven. Fibropapillomatosis (FP) in green turtles is a de**  **bilitating neoplastic disease that has reached epizootic levels worldwide. The etiology of FP is unknown, but**  **it has been linked to oncogenic viruses (Herbst, 1994). T** 

**oxic benthic dinoflagellates ( Prorocentrum**  **spp.) are not typically considered tumorigenic agents, but they** **do have a worldwide distribution and produce tumor promoting OA (Fujiki and Suganuma, 1993). Benthic**  **Prorocentrum spp. are epiphytic on the macroalgae and** **seagrasses that are normal components of green tur tle diets. In the Hawaiian Islands, green turtles consume**  **Prorocentrum, and high-risk FP areas are linked to areas**  **where P.**  **lima and**  **P. concavum**  **are both widespread and abundant. The presence of OA in the tissues of**  **Hawaiian green turtles indicates exposure and that this tumor-promoter may have a potential role in the**  **etiology of FP (Landsberg et al.,**  **1999). Like OA, lyngbyatoxin-a has been experimentally**  **demonstrated to induce papillomas in two-stage mouse carcinogenesis experiments (Fujiki**  **et al., 1984). Unlike**  **OA, nodularins, and microcystins, lyngbyatoxins pro**  **mote tumor growth through the activation of protein kinase C, not through protein phosphatase inhibition**  **(Fujiki and Suganuma, 1996). Like benthic Prorocen**  **trum, Lyngbya majuscula grows epiphytically on sea**  **grass and macroalgae, which also form the basis of the diet of the herbivorous green turtle (**  **Chelonia mydas ). In**  **Au stralia, Arthur**  **et al. (2006) demonstrated that green** **turtles are exposed to, and assimilate, tumor-promot ing compounds produced by**  **L yngbya,**  **thus providing a potential for these compounds to be involved in FP.**  **T he potential for these tumor promoters to be involved**  **in turtle FP in Florida should also be investigated.**



## Other Potential HAB Problems

**P**

**otential HAB problems in Florida need to be treated in the same manner as are the already emerging HAB**  **threats.This includes statewide monitoring for species and testing for toxins. Event response by FWC covers**  **the entire state. It is triggered by discolored water, dead or dying animals, toxic shellfish, unusual be**  **havior of aquatic animals, and other clues, e.g.,**  **respi ratory irritation associated with a body of water. FDOH** **and FWC, together with other state agencies, univer sities, and private laboratories, use various hotlines** **and participate in an integrated program for notifica tion and response.This network should be recognized,**  **formalized, and actively maintained. Local CHDs and their personnel should be part of this network and** **have action or response plans in place to facilitate ap propriate and effective activities in the event of a HAB**  **outbreak.**


### Fish Kills
**At least twelve fish-killing (ichthyotoxic) HAB species occur in Florida, including**  **Alexandrium monilatum, T** 

**akayama pulchella, Karenia mikimotoi, Karenia selli formis, Karlodinium veneficum, Prymnesium parvum,**  **and Chattonella**  **spp. (Steidinger et al.,**  **1999; Landsberg, 2002; see Appendix E for a table of species and their**  **associated toxins). These species have the ability to produce toxins, but often blooms can occur and not be**  1 | Background on Harmful Algal Blooms**toxic, particularly those of Chattonella**  **and Prymnesium.**  **Many fish kills, particularly those occuring in the early-morning hours, are due to low dissolved oxygen**  **levels in the water associated with algal blooms and are not necessarily the result of toxins. During the day, pho**  **tosynthetic activity of phytoplankton and other aquatic plants produces net oxygen. At night, in the dark,**  **plants use oxygen and this can decrease the levels of dissolved oxygen in restricted systems.**  **T he FWC responds to discolored water, fish kills,**  **and other mortality or disease events to determine whether the cause is environmental or anthropogenic.**  **A statewide fish kill hotline (1-800-636-0511) has been in operation for more than a decade. Access to the fish**  **kill database, which contains information on fish kills in Florida reported to the FWC from 1972 to the pre**  **sent, is available on the internet at http://research.**

**m yfwc.com/fishkill/. New fish-kill reports can also be**  **submitted through the Web site.** 

### Pfiesteria and Pfiesteria -Like Species

**In the late 1980s and early 1990s, small benthic di noflagellates were discovered in fish aquaria and in**  **North Carolina rivers and estuaries. These organisms**

**w ere blamed for numerous fish kills that had been**  **previously attributed to low dissolved oxygen (Noga et**  **al., 1993; Burkholder**  **et al., 1995, 1999, 2001; Burkholder**  **and Glasgow, 1997).These dinoflagellates were unlike some other HAB species in that they were not photo**  **synthetic; they were heterotrophic and preyed upon other microalgae as a food source.**  **Pfiesteria could also**  **feed on the epidermis of fish. Pfiesteria piscicida**  **and Pseudopfiesteria shumwayae**  **(previously Pfiesteria**  **shumwayae ) (Litaker**  **et al., 2005; Marshall**  **et al., 2006) were**  **considered responsible for a large number of fish kills in North Carolina, and were thought to pose public**  **health risks (Noga et al.,**  **1993; Burkholder et al.,**  **1995, 1999, 2001; Burkholder and Glasgow, 1997). Other**  **Pfi** Public Health Response to HABs Abbott et al.

20 FWRI Technical Report TR-14

**.** 1 | Background on Harmful Algal Blooms

**Florida red tide fish kill investigation,Venice Airport Beach, October 1959, Agent M. P. Courtney, Florida State Board of Conservatio n.** **FWC image esteria**  **-like dinoflagellates ( e.g., Cryptoperidiniopsis brodyi**  **and Luciella**  **spp.) have also been characterized and de scribed based on morphology and genetics (Steidinger**  **et al., 2001, 2006; Mason**  **et al., 2007), but their potential**  **threats to human health appear to be negligible. T** **he toxic mechanism for P.**  **shumwayae activity**  **has been proposed (Moeller et al.,**  **2007) after a decade of concerted research efforts to elucidate the pro** **duction of bioactive compounds. Although the com pounds are ichthyotoxic, it is still unclear whether**  **this group of dinoflagellates pose a public health threat. Mortality of fish in tanks with**  **Pfiesteria or**  **Pseudopfiesteria is in part due to micropredation on fish**  **epidermal cells by the heterotrophic dinoflagellates (Vogelbein**  **et al., 2001). Definitive studies have shown**  **that fish ulcers and ulcerative mycosis (UM), once attributed by some researchers to**  **Pfiesteria and related** **dinoflagellates, are caused instead by a primary path ogenic fungal oomycete,**  **Aphanomyces invadans (Blazer**  **et al. ,**  **1999, 2002; Vogelbein et al.,**  **2001; Kiryu et al.,**  **2003; Sosa**  **et al., 2007a,b) found in fresh water and low**  **salinity areas. Although**  **Pfiesteria w** **ere considered to represent a risk to public health (Glasgow**  **et al., 1995; Grattan**  **et al., 1998; Haselow**  **et al., 2001; Morris, 2001), a study by**  **Morris et al.**  **(2006) concluded that repetitive low-level exposure to waters where**  **Pfiesteria and**  **Pseudopfieste ria**  **have been found does not present a significant human health risk through occupational exposure to**  **such estuarine environments. The identification of areas with**  **Pfiesteria and**  **Pseudopfiesteria w** **as done by PCR analyses of over 3,500 water samples.The authors**  **did not rule out the possiblity that outbreaks resulting from high level concentrations of these species could**  **affect public health. Place et al.**  **(2008) reviewed the history and current status of**  **Pfiesteria piscicida and its** **natural resource and human health effects in mid-At lantic state waters. They discussed several controver**  **sial topics: fish death through physical contact with Pfiesteria**  **cells, the implications of a life cycle without many stages, fish biotoxicity assays with differing re**  **sults, and the use of various detection techniques. More importantly they presented evidence that a co**  **occurring ichthyotoxic dinoflagellate, Karlodinium venefi** 
**cum, produces known water-soluble toxins that have**  **been isolated and characterized. These toxins were detected in**  **K. veneficum cultures as well as at the sites**  **of fish kills, raising the question, how many of the mid-Atlantic and Carolinean fish kills were actually**  **caused by Karlodinium**  **rather than Pfiesteria? Pfiesteria**  **piscicida, Pseudopfiesteria shumwayae, and**  **Karlodinium also co-occur in Florida waters. Public health risks**  **from these genera are considered minimal. In surveys conducted by FWC, low and essentially**  **benign concentrations of Pfiesteria piscicida**  **and Pseudop**  **fiesteria shumwayae w**  **ere found in less than 4% of Florida sites statewide, with no evidence of**  **Pfiesteria**

  ** associated fish kills or disease problems. No recorded** **blooms of these species or the closely related Pfieste**  **ria -like genera (Landsberg**  **et al., FWC–FWRI, unpub**  **lished data) have been reported in Florida. Aphanomyces**  **invadans has been confirmed in more than eight species**  **of estuarine fish with UM in Florida’s waters (Sosa et**  **al., 2007a,b). Although associated with skin ulcers in es**  **tuarine fish, the fungus A. invadans**  **does not present a public health risk.**  Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 21

**.** 1 | Background on Harmful Algal Blooms22 FWRI Technical Report TR-14

**.** Purpose To identify federal, state, and local agencies with authority over, and responsibility for, response to harmful algal blooms and to facilitate their communication and coordination.

**T**

**he following charts present federal, state, and local governmental authority over and responsibility for response activities related to harmful algal blooms. These charts should help clarify the appropriate collaboration and coordination between**  **these entities. In addition to the agencies shown here, interaction with academia, the public, and nongovernmental organizations such as veterinarians and rehabilitation centers ensures a comprehensive and integrated research effort.**  

# Chapter 2 Agency Responsibility Matrices

Aquatic Animal Mortality Responsibility and/or Authority Aquatic Aquatic Animal Animal Aquatic Mortality Mortality Animal Illness/Disease Illness/Disease Mortality Agency* Reporting Investigations Monitoring Contacts **NOAA Xa,d Xa,d Xa,d NMFS: Melody Baran, Blair Mase,Teri Rowles, Barbara Schroeder**  **USFWS X X X North Florida Field Office: Jim Valade**
**USDA X X X APHIS: Kathleen Hartman**
**USGS X X X National Wildlife Health Center: Anne Ballmann**
**FDOH Xb Xb Xb Division of Environmental Health: Carina Blackmore, Andrew Reich, Sharon Watkins,**  **Danielle Stanek FDACS X X X Kissimmee Animal Diagnostic Laboratory (KADL),**  **Live Oak Laboratory FWC Xa,b, Xa,b, Xa,b, Fish and Wildlife Research Institute:** 

**c ,d,e c,d,e c,d,e Xa: Leslie Ward**  **Xb: Mark Cunningham, Dan Wolf Xa,c,e: Jan Landsberg,Theresa Cody,Yasu Kiryu**  **Xd: Allen Foley PCC X Miami PCC and Aquatic Toxins Hotline: Richard**  **W eisman**  **Jac ksonville PCC: Jay Schauben**  **T**

**ampa PCC: Cynthia Lewis-Younger CHD Xb Xb Xb Epidemiology Programs**  **Environmental Health Programs County specific,** 

**http://www.doh.state.fl.us/chdsitelist.htm County Environmental Agency County specific, must be identified locally**  **County Emergency Response Agency http://floridadisaster.org** 

***** **Agencies are listed in descending order: federal, state, local. a: marine mammals; b: birds, rabies-associated mammals; c: fish kills; d: turtles; e: invertebrates (**  **e.g., crustacea, mollusks)** FWRI Technical Report TR-14 23

**.** Environmental Sampling Responsibility and/or Authority Fresh- Brackish Marine Analytical Agency* water Water Water Support Contacts
**CDC X Health Studies Branch: Lorraine Backer** 

**FDA X X Office of Seafood Safety and Nutrition: Stacey Etheridge,**  **Jon Deeds** 

**EPA X X National Health and Environmental Effects Research Laboratory,**  **Neurotoxicology Division Region 4: Ed Decker** 

**NEP X X**  **Charlotte Harbor NEP: Lisa Beever IRL NEP: Troy Rice**  **Ta mpa Bay NEP: Holly Greening**  **Sarasota Bay Project: Mark Alderson**
**NOAA X X X Biotoxin Program, Charleston Laboratory: Tod Leighfield,**  **F ran Van Dolah**  **P**

**acific Northwest Laboratory: Vera Trainer**
**USDA X X Terence Evens** 
**USFWS X X X Todd Hopkins, Dawn Jennings** 
**USGS X X X Barry Rosen**  **FDOH Xa,b,c Xa,c Xa X Di vision of Environmental Health: Andrew Reich, Sharon Watkins**  **Bureau of Water Programs, Healthy Beaches Monitoring:**

**Bob Vincent, David Polk Bureau of Laboratories: Ming Chan, Dean Willis**  **FDEP Xb, Xb, X Division of Water: Russ Frydenborg**  **e,f e,f Laboratory Services: David Whiting,Tim Fitzpatrick,** 
**FDACS Xe X Palm Bay Office: Howard Beadle**  **T**

**allahassee Office: Chris Brooks, David Heil, Alan Pierce FWC Xc Xc, Xc,d, X Harmful Algal Blooms: Cindy Heil, Leanne Flewelling**  **d,f e,f Fish and Wildlife Health: Jan Landsberg**  **WMD Xb, Xb, SFWMD: Richard Pfeuffer**  **e,f e,f SJRWMD: Dean Campbell, John Hendrickson**  **SWFWMD: Veronica Craw Suwannee WMD: Robbie McKinney**  **NWFWMD: Graham Lewis**
**PCC Miami PCC and Aquatic Toxins Hotline: Richard Weisman**  **Jac ksonville PCC: Jay Schauben**  **T**

**ampa PCC: Cynthia Lewis-Younger CHD Xa,b,c Xa,c Xa X County-specific, http://www.doh.state.fl.us/chdsitelist.htm**  **County Environmental Agencies County-specific, must be identified locally**  **County Emergency Response Agency http://floridadisaster.org Primary Care Facilities**  **http://www.floridahealthfinder.gov/**

***** **Agencies are listed in descending order: federal, state, local. a: microbiology; b: inorganic and organic parameters; c: cyanotoxins; d: marine toxins; e: cell counts; f: identification**  Abbott et al. Public Health Response to HABs 2 | Agency Responsibility MatricesPublic Health Response to HABs Abbott et al.

24 FWRI Technical Report TR-14

**.** 2 | Agency Responsibility Matrices

Shellfish Responsibility and/or Authority

Shellfish Laboratory Shellfish Retail Shellfish Support (based Shellfish Bed Sales Bed on capabilities/ Agency* Regulation Permitting Inspection Monitoring capacity) Contacts

**FDA X X Dauphin Island Laboratory:**  **Robert Dickey Office of Seafood Safety Laboratory:** 

**Sherwood Hall, Stacey Etheridge, Jon Deeds** 
**FDOH X**  **X Division of Environmental Health: Carina Blackmore, Sharon Watkins,**  **Roberta Hammond, Regional Environmental Epidemiologists** 
**FDACS X X X X X Aquaculture Program:**  **David Heil, Chris Brooks Bureau of Food Safety: John Fruin** 
**FWC X**  **X Harmful Algal Blooms: Leanne Flewelling**  **Fish and Wildlife Health:**

**J an Landsberg**  **Molluscan Fisheries: Steve Geiger**
**CH D C**  **ounty-specific, http://www.doh. state.fl.us/chdsitelist.htm**  **County Environmental Agency County specific, must be identified**  **locally County Emergency Response Agency**  **http://floridadisaster.org**

***** **Agencies are listed in descending order: federal, state, local.**Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 25

**.** 2 | Agency Responsibility Matrices

Human Surveillance Responsibility and/or Authority

Human Human Human Morbidity Morbidity Morbidity

and/or and/or and/or Mortality Mortality Mortality Agency* Reporting Investigations Monitoring Contacts

**CDC X X**  **X Health Studies Branch: Lorraine Backer**
**USAMRIID Mark Poli** 

**FDA X**  **Dauphin Island Laboratory: Robert Dickey Office of Seafood Safety: Sherwood Hall, Jon Deeds,** 

**Stacey Etheridge**
**FDOH X X**  **X Epidemiology Program: Julia Gill Division of Environmental Health: Roberta Hammond,** 

**Carina Blackmore, Andrew Reich, Sharon Watkins**
**FWC X**  **Division of Law Enforcement: Col. Julie Jones**
**PCC X X Miami PCC: Richard Weisman, Eva Jerez**  **T**

**ampa PCC: Cynthia Lewis-Younger, MD Jac**  **ksonville PCC: Jay Schauben**
**CHD X X**  **X County specific, http://www.doh.state.fl.us/chdsitelist.htm County Environmental Agency**  **County specific, must be identified locally County Emergency Response Agency**  **http://floridadisaster.org Physicians Xa**  **http://www.floridahealthfinder.gov/**

***** **Agencies are listed in descending order: federal, state, local. a: reportable disease** 

# Chapter 3 A vailable Resources and Databases

Purpose To identify existing resources and databases containing historic and present information for physiographic, environmental, animal, and human monitoring and surveillance.

**T**

**he following tables identify existing resources for physiographic, environmental monitoring, and both animal and human surveillance data. These tables can be used to identify historic trends within a region or to find accurate current information**  **that may help identify the possible cause of an illness or outbreak, or determine a probable direction for further investigation**

**. T** 

**imely and accurate information can be used by natural resource managers, researchers, public health officials, and legisla tors to respond to events that may be of urgent public-health consequence such as to design disease prevention and mitiga**  **tion strategies; to address interconnections between human, domestic animal, and wildlife disease; and to assist in identification of “normal**  **’ disease issues versus biosecurity concerns.** 

Environmental Monitoring Data Data Base Source Description Region Date Web Link **Florida UF/IFAS Report of Statewide 1986– http://lakewatch.ifas.ufl.edu/**  **Lakewatch limnological data**  **2001 data2001.htm Program**  **from 1,235 inland**

**w ater bodies and**  **river/creek stations and 269 saline stations**  **Florida UF/IFAS Report of Statewide 2004 http://lakewatch.ifas.ufl.edu/**  **Lakewatch limnological data**  **data2004.htm Program**  **from 607 lakes, 127 river/creek**  **stations, 4 springs, and 142 saline stations**  **Healthy FDOH Beach water FL coastal 2001– http://esetappsdoh.doh.state.**  **Beaches sampling for**  **counties current fl.us/irm00beachwater/ enterococci and**  **default.aspx fecal coliform analysis** 
**HAB Events FWC– Results of K. brevis**  **Gulf Coast 1954–**  **http://ocean.floridamarine.org/ FWRI sampling activities**  **current mrgis/viewer.htm Shellfish FDACS Open/Closed Statewide current http://www.floridaaquaculture**  **Harvesting Division of status of shellfish com/SEAS/seas_**  **Area Status Aquaculture harvesting areas statusmap.htm**  **STORET EPA Office Historical water National up to http://www.epa.gov/storpubl/ Legacy Data of Water quality data archives**  **1998 legacy/gateway.htm Center**  **STORET FDEP/EPA Comprehensive National 1999– http://dep.state.fl.us/water/ Office repository of**  **current monitoring/data.htm of Water water quality and**  **http://www.epa.gov/storet/ biological and**  **physical data**

26 FWRI Technical Report TR-14

**.**FWRI Technical Report TR-14 27

**.** Animal Surveillance Data Data Base Source Description Region Date Web Link **Bird FWC Access for reporting Statewide 2000–**  **http://myfwc.com/bird/ Mortality**  **wild bird die-offs only current**  **Fish Kill FWC– Reported kills to FWRI Statewide 1972– http://research.myfwc.**  **FWRI identified by date, location, current com/fishkill/**  **animal category, probable kill cause, water body, and**  **specimen count Florida UF/IFAS Summary report of 35 lake**  **Statewide 1998– http://lakewatch.ifas. Lakewatch**  **sampling sites for age and 2003 ufl.edu**  **/FishData2003. Program**  **abundance assessment of htm**  **fish; includes comparative data of trophic status and aquatic**  **macrophyte abundance FWVSS FDOH Manages data on food- and Statewide 2004– http://florida.state.** 

**w ater-borne disease outbreaks**  **current gegov.com/web related to complaints including**  **admin/login.cfm? geographic elements, vehicles**  **attempt=index.cfm of transmission, and implicated** 

**causes Manatee FWC– Synoptic count**  **Statewide 1991– http://ocean.florida Counts FWRI data of manatee population**  **2006 marine.org/mrgis/ estimates from aerial surveys**  **viewer.htm**
**Manatee FWC– Historic records of Statewide 1974– http://ocean.florida**  **Mortality FWRI manatee mortalities 2005 marine.org/mrgis/**  **viewer.htm**

**T**

**urtle FWC– Distribution, seasonality, Statewide 2004– http://ocean.florida**  **Nesting FWRI and abundance of nesting current marine.org/mrgis/**  **sea turtles viewer.htm** 

**T**

**urtle FWC– Records of turtle strandings Statewide 1980– http://ocean.florida Strandings FWRI to monitor marine turtle**  **2005 marine.org/mrgis/ mortalities and identify**  **viewer.htm mortality factors** 

**W ildlife USGS Documents wildlife mortality National 1995– http**  **://www.nwhc.usgs. Mortality**  **events including locations, species, current gov/publications/**  **and causes of death quarterly_reports/**  Abbott et al. Public Health Response to HABs 3 | A vailable Resources and DatabasesPublic Health Response to HABs Abbott et al.

28 FWRI Technical Report TR-14

**.** 3 | A vailable Resources and Databases

Human Surveillance Data Data Base Source Description Region Date Web Link **Asthma AHCA Summary of Statewide**  **http://ahca.myflorida.com/ hospitalization**  **Inside_AHCA/index.shtml and ER charges**  **Emergency AHCA Summary of Statewide**  **http://ahca.myflorida.com/ Room**  **hospitalization Inside_AHCA/index.shtml**  **and ER charges FDENS/ FDOH Information system that Statewide 2003– http://www.fdens.com**  **EpiCom supports 24 hrs a day, 365**  **current Tutorial available at days a year, notification**  **http://www.flhan.com/ and alert within the**  **or public health emergency**  **https://epicomfl.com/ response system**  **Attachments/FDENS_ T** 

**utorial.htm FPIC FPIC Summary report of Nationwide, 2002– http://www.fpicn.org/**  **Network calls to FPIC including biased current**  **calls related to toward**  **aquatic toxins Florida**  **FWVSS FDOH Manages data on food- Statewide 2004 http://florida.state.gegov.com/ and water-borne disease**  **current webadmin/login.cfm? outbreaks related to**  **attempt=index.cfm complaints including**  **geographic elements,**

**v ehicles of transmission,**  **and implicated causes HABISS CDC Collects data on human and Nationwide 2007– http://www.cdc.gov/hab/**  **animal health and on the current surveillance.htm#about**  **environmental effects of HABs; modular format**  **allows data collection to be expanded to suit the**  **needs of state and local health and environmental**  **protection agencies**
**Merlin ®**  **FDOH Electronic communicable Statewide http://merlintraining.isf.com/**  **disease reporting system, MerlinNet/start/Login.aspx**  **access by FDOH approval only** 
**O TC Drug NRDM Summary report of Nationwide, 2003– http://rods.health.pitt.edu/**  **Use over-the-counter (OTC) Florida well current NRDM.htm**  **drug sales by category represented**Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 29

**.** 3 | A vailable Resources and Databases

Physiographic Data Data Base Source Description Region Date Web Link **Florida UF/IFAS Bathymetric Statewide Current http://lakewatch.ifas.ufl.edu/**  **Lakewatch maps for all**  **MapList.htm Program**  **Florida lakes Gulf of FWC– Depth contours Gulf**  **of 1997– http://ocean.floridamarine.org/ Mexico FWRI of offshore areas Mexico current mrgis/viewer.htm**  **Bathymetry of Gulf of Mexico,**  **South Atlantic Bight, and northern**  **Caribbean; see NOAA Nautical**  **Chart 411 Nearshore FWC– Compilation Statewide**  **1992– http://ocean.floridamarine.org/ Bathymetry FWRI of nearshore**  **current mrgis/viewer.htm bathymetry** 

## Human Surveillance Networks
Background **Adapted from FDOH Bureau of Epidemiology “CHD Guide”Version 1 Final, March 10, 2005** 
**Diseases are a persistent threat to all people, regard less of age, gender, lifestyle, ethnic background, or so**  **cioeconomic status. Although some diseases have been controlled by modern medical or technical advances,**  **new disease conditions are constantly emerging. Florida has a large and unique population that con**  **tinually changes due to the regular influx of visitors, seasonal workers, and new residents. It is the respon**  **sibility of the CHD epidemiology programs to be on the front lines of disease prevention and control within** **this unique population. Although technology will al**

**wa ys help by improving methods and tools, the epi**  **demiologist will always be essential for identifying, preventing, and controlling disease in the community.**  **Each CHD must investigate all cases of “reportable” diseases, including those associated with aquatic tox** **ins from HABs such as NSP. In addition to the re portable diseases, there are new potential health threats** **from aquatic toxins.These threats are related to the ap pearance of novel toxins and/or the increased presence**  **of toxin-producing organisms. Current research on aquatic toxin distribution in Florida ecosystems, to** **gether with studies on the uptake, distribution, and re tention of toxic compounds in laboratory animals, have**  **shown the potential for additional routes of exposure and effects on human health. Describing newly emerg**  **ing aquatic-toxin-related illnesses will be especially ch**  **allenging for epidemiologists, environmental health scientists, and other public health researchers due to**  **the lack of information on symptomology, undefined case definitions, the sporadic nature of exposures, and**  **the wide variation in susceptibility. In addition, the effects of chronic exposures are unknown and there is** **the potential for long term consequences such as im munological suppression and genotoxic outcomes.**  SURVEILLANCE**Surveillance is a core public health function and is de fined as the regular collection, meaningful analysis,**  **and routine dissemination of relevant data to provide opportunities to prevent and control disease through** **public health action. Surveillance can be considered “in formation for action.”Surveillance is done for many rea**  **sons, such as identifying cases of diseases like meningitis that pose immediate risk to communities;**  **detecting clusters and monitoring trends in disease occurence that may represent outbreaks; evaluating** **prevention and control measures; and developing hy potheses for the causes of emerging diseases.The basic**  **elements to be addressed when initiating surveillance are system design and purpose, data collection, analy**  **sis, information dissemination, and system evaluation. Surveillance systems fall into two categories—ac** **tive and passive. Active surveillance consists of search ing for cases by calling or visiting hospitals, schools, or**  **other institutions where large numbers of people are closely associated proactively using specific methods to**  **obtain an accurate disease picture. Active surveillance is often conducted within an epidemiological study,**  **with the discovery of a new disease, when an outbreak is detected, or when circumstances prompt public**  **health officials to suspect potential bioterrorism around a high-profile event. Passive surveillance includes tra**  **ditional reportable disease surveillance, vital statistics, and disease registries. Passive surveillance relies al** **most entirely upon regular disease reporting by hos pitals, physicians, and laboratories to CHDs or the state** **health office. Electronic reporting systems allow pas sive reporting to become more rapid and complete.To** **assure completeness of reporting, an effective surveil lance program manager should make periodic visits, at**  **least annually, to all laboratories and infection control practitioners at health care facilities in the county. Such**  **visits permit the CHD to provide facilities with current lists of reportable diseases and develop professional**  **connections. This is especially important when trying to accumulate and disseminate information on emerg**  **ing illnesses or rare diseases that are not well recognized**

30 FWRI Technical Report TR-14

**.** 

# Chapter 4 Surveillance Networks and Systems

Purpose To identify current human, animal, and environmental surveillance systems and networks

**T**

**he following summary identifies existing human health surveillance networks, including sources of information, reporting requirements, and procedures for identification, confirmation, and follow up on reported cases; included also is a summary**  **of current state surveillance systems to monitor animals and the environment for disease.**FWRI Technical Report TR-14 31

**. or understood in traditional health care facilities.**  **T he uncertainty in identifying “cases” of HAB** **related illnesses has resulted in the lack of an epi demiological surveillance tool for documenting** **nonreportable diseases. Efforts to improve this situa tion by the CDC and a number of participating states** **including Florida resulted in the design of a HAB-re lated reporting tool, Harmful Algal Bloom-related Ill**  **ness Surveillance System (HABISS).**

DA TA COLLECTION **T here are several laws, rules, and regulations that gov** **ern the collection of data for the purposes of protect ing the public’s health.The legal basis for collecting case**  **and laboratory result data for surveillance is found in section 381.0031(1) of the Florida Statutes (F.S.).The list**  **of notifiable diseases is contained in Rule 64D-3.002, Florida Administrative Code. The Florida Adminis** **trative Code is a compilation of rules that state agen cies use to govern their operations pursuant to the**  **Administrative Procedures Act, Chapter 120, F.S.This allows the FDOH the flexibility to periodically change**  **the list of notifiable diseases without a legislative act, allowing it to conduct surveillance on any unforeseen**  **condition or situation of public health significance that would pose a risk to the population of Florida. Con**  **ducting disease surveillance does not end with the list of notifiable conditions.** **Communicable disease data collection for sur**

**v eillance purposes may be accomplished in many ways** **due to advances in technology such as Web-based sur**

**ve ys and wireless devices. For outbreak purposes, sur** 

**v eillance data are generally collected by questionnaire** **or by medical chart review and then entered into a data base. It is important that a standard data set be collected** **during any type of surveillance activity to ensure re liable analysis over time and across geographic re**  **gions. In Florida, the flow of data collection starts at the community level with reports from the general pub**  **lic, healthcare providers, or clinical laboratories to the CHD. If the data meets the case definition for surveil**  **lance, then it moves from the CHD to the state health office and subsequently to the CDC.**  **Many automated information systems are available in Florida and are used by FDOH for human disease** **surveillance. Such systems are supported by various an imal and environmental surveillance networks man**  **aged by other agencies. For effective notification and response, all systems must communicate to identify and**  **address potential public-health threats from HABs.**

DISEASE REPORTING**Disease reporting is an example of passive surveil lance because it relies on timely data obtained from**  **provider reports and laboratory results. Disease re porting represents only a part of the communicable**  **disease surveillance picture that also includes any active or passive method for uncovering clusters of** **disease, monitoring disease burden in the commu nity, and evaluating prevention methods. The impor**  **tance of timely reporting cannot be overemphasized because late reporting can distort trends, prevent early**  **recognition of outbreaks, and possibly have an effect on prevention measures and program funding. Even**  **with these limitations, reportable-disease surveillance is vital to the health of Floridians because it is a cru** **cial step in controlling and preventing diseases. How**

**ev er, there is always room to improve the quality of** **reportable-disease surveillance data by improving re lationships with community providers.**  **T he legal basis for surveillance of reportable dis** **eases is supported by Florida statute and administra tive rule. Section 381.0011, F.S. states, in part:** 

**“Duties and powers of the Department of Health.—It is the duty of the Department of Health to:**  **“...(7) Provide for a thorough investigation and study of the incidence, causes, modes of propagation and trans**  **mission, and means of prevention, control, and cure of diseases, illnesses, and hazards to human health. ...”**  **Section 381.0031, providing specific authority for designating notifiable diseases and for public health** **agency access to medical records as part of epidemi ologic investigations, reads as follows:** 

**“Report of diseases of public health significance to department.—**  **(1) Any practitioner licensed in this state to practice medicine, osteopathic medicine, chiropractic medicine,** **naturopathy, or veterinary medicine; any hospital li censed under part I of chapter 395; or any laboratory li**  **censed under chapter 483 that diagnoses or suspects the existence of a disease of public health significance shall**  **immediately report the fact to the Department of Health. (2) Periodically the department shall issue a list of in**  **fectious or noninfectious diseases determined by it to be a threat to public health and therefore of significance to**  **public health and shall furnish a copy of the list to the practitioners listed in subsection (1).**  **(3) Reports required by this section must be in accordance with methods specified by rule of the department.** **(4) Information submitted in reports required by this sec tion is confidential, exempt from the provisions of s.**  **119.07(1), and is to be made public only when necessary to public health. A report so submitted is not a violation**  **of the confidential relationship between practitioner and patient.**  **(5) The department may obtain and inspect copies of medical records, records of laboratory tests, and other**  **medical-related information for reported cases of diseases** Abbott et al. Public Health Response to HABs 4 | Surveillance Networks and Systems**of public health significance described in subsection (2). T** 

**he department shall examine the records of a person who has a disease of public health significance only for**  **purposes of preventing and eliminating outbreaks of disease and making epidemiological investigations of re**  **ported cases of diseases of public health significance, notwithstanding any other law to the contrary. Health**  **care practitioners, licensed health care facilities, and laboratories shall allow the department to inspect and** **obtain copies of such medical records and medical-re lated information, notwithstanding any other law to** **the contrary. Release of medical records and medical-re lated information to the department by a health care**  **practitioner, licensed health care facility, or laboratory, or by an authorized employee or agent thereof, does not**  **constitute a violation of the confidentiality of patient records. A health care practitioner, health care facility,**  **or laboratory, or any employee or agent thereof, may not be held liable in any manner for damages and is not sub**  **ject to criminal penalties for providing patient records to the department as authorized by this section.** **(6) The department may adopt rules related to report ing diseases of significance to public health, which must**  **specify the information to be included in the report, who is required to report, the method and time period** **for reporting, requirements for enforcement, and re quired follow-up activities by the department which**  **are necessary to protect public health.”**

**T**

**he Privacy Rule of the Health Insurance Portability and Accountability Act (HIPAA) protects personal**  **health information, but does not restrict the ability of county and state health departments to obtain such in**  **formation when its collection is authorized by state law. A full discussion of the public health dimensions of**  **HIPAA is available in the Morbidity and Mortality W** **eekly Report (MMWR) at http://www.cdc.gov/ mmwr/preview/mmwrhtml/su5201a1.htm).** **Reportable diseases caused by aquatic toxins in clude SPFP, CFP, NSP, and PSP. The FDOH Bureau of**  **Epidemiology and the Division of Environmental Health rely on CHDs, healthcare providers, laborato**  **ries, PCCs, and other public health personnel to report the occurrence of these poisonings.** 


## Surveillance Systems Used by FDOH
Florida Department of Health Emergency Notification System **www.fdens.com**

**CDC guidelines define the intended purpose of a Health Alert Network (HAN) as an information sys**  **tem to identify public health emergency events 24 hours a day, every day of the year, provide relevant and** **timely information, and alert both public health pro fessionals and those public health partners who are**  **ke y to a successful response.The Florida Department**  **of Health Emergency Notification System (FDENS) is Florida’s HAN.**  **In 2004, the FDOH recognized that national, statewide, and multicounty events had drawn attention**  **to the need for large public service organizations to more effectively coordinate efforts across geographic** **and regional boundaries when responding to a disas ter or a public health emergency. Several specific needs** 

**w ere identified, all of which were designed to provide** **centralized and uniform practices within the FDOH it self, as well as in their public health partners.The first**  **need was to create a centralized and uniform method to collect and organize contact information from all par**  **ties. Next, there had to be a consistent and centralized method for issuing emergency alerts and information,**  **including confirmation from the recipient entity. Finally, there was a need for all parties to have updated and**  **uniform communication devices, such as land-line, cellular, and satellite phones; fax capability; and more**  **sophisticated e-mail and internet connections. T** 

**he creation of FDENS was not intended to replace existing localized procedures for collecting contact in** **formation nor was it intended to replace well-estab lished emergency procedures already in place. By**  **augmenting the current procedures of all participants and providing an umbrella of support, FDENS en**  **sures an ongoing, consistent flow of information while providing for backup and redundancy.** 

BENEFITS AND CAPABILITIES OF FDENS **• W eb access**  **• A centralized user registry**  **• A multi-device alerting function**  **• A password-protected Web site** 

**• Required confirmation of receipt of the alert notifi** 

**cation**

**• Confirmation tracking to ensure that the appropri** 

**ate people have been notified**

**• Reduction in duplicate messaging**  **• E stablishment of a collaborative work environment** 

**so that sensitive disaster-planning and response in formation may be securely shared between local**  **and state health agencies • L**  **icensing and permission levels for access to specific**

**information**

**• Integration of the EpiCom system into FDENS**  **An FDENS tutorial is available online at http:// www.flhan.com/ or https://epicomfl.com/Attachments**  **/FDENS_Tutorial.htm** Public Health Response to HABs Abbott et al.

32 FWRI Technical Report TR-14

**.** 4 | Surveillance Networks and SystemsAbbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 33

**.** 4 | Surveillance Networks and Systems



### EpiCom **Adapted from FDENS/EpiCom Web site EpiCom is the Web-based surveillance portion of** **FDENS developed and maintained by the FDOH, Di vision of Disease Control, Bureau of Epidemiology.** **EpiCom allows for immediate real-time exchange of in formation for health care practitioners and other part**  **ners on disease outbreaks or other incidents, such as red tide blooms, flu vaccination shortages, or hurricane** **response. EpiCom users include healthcare practi tioners throughout Florida, such as physicians, CHD**  **staff, and other Florida state agencies. All FDENS users have access to EpiCom and can submit information on**  **a specific topic. All information submitted by FDENS users is reviewed by a moderator who is approved**  **and trained by the FDOH. A moderator’s function is to review the information posted to EpiCom to en**  **sure it is added to the correct topic and does not con tain personally identifiable information.The EpiCom** **system is composed of three main components: Epi Com Exchange, EpiCom Alert, and ER Surveillance.** **EpiCom Exchange is a secure, Web-based anec dotal public health surveillance system designed to so**  **licit public health information from a variety of sources and to share that information with other users across**  **the state. Confirmed or potential cases are reported through “postings”and approved and categorized by** **Bureau of Epidemiology staff and moderators in the Di vision of Environmental Health. Messages are sent**  **through the EpiCom system via e-mail to affected groups, making the FDOH responsible for recogniz**  **ing public health threats in the shortest time possible. Once a threat is identified, EpiCom Alert is employed**  **to issue emergency notification to selected EpiCom users. Users are alerted via registration information that**  Figure 4.1 **EpiCom Web site forums screen. includes office, home, and cellular telephone num**  **bers as well as e-mail addresses.The ER Surveillance tool is used by hospitals to enter daily emergency room** **registration counts. Once data is entered, ER Surveil lance can provide graphs to track census trends, in**  **cluding anomalous variations. EpiCom has a number of “forums” that are cur**  **rently being used for HAB-related surveillance and for timely dissemination of information. These include**  **ongoing reports of shellfish poisonings and related issues, such as ciguatera and STX-associated investi**  **gations in the Waterborne Illness Program Food and W**  **aterborne Disease forum. A newly created Aquatic T** 

**oxins forum contains postings of environmental con ditions such as red tide blooms that have high poten**  **tial for affecting gulf coastal communities, NOAA Bulletins with anticipated bloom movements derived**  **from satellite imagery, FWC–FWRI status updates, and reports of cyanobacterial blooms and conditions** **in major freshwater bodies in Florida.The forums rep resent an excellent tool and an opportunity for gain**  **ing insights and generating peer-reviewed discussions on aquatic toxin-related subjects.**  **An EpiCom tutorial is available online at http:// www.flhan.com/ or https://epicomfl.com/Attach**  **ments/FDENS_Tutorial.htm Once logged on, there is a screen showing the nu**  **merous forums available to registered users (Figure 4.1).**


### Merlin ®

### : Florida Reportable Disease System **Adapted from the Merlin ®**  **User Manual**

**Merlin ®**  **is the FDOH Bureau of Epidemiology’s Web based system for reporting, managing, and perform**  **ing epidemiological analysis of communicable-disease** Public Health Response to HABs Abbott et al.

34 FWRI Technical Report TR-14

**.** 4 | Surveillance Networks and Systems

Figure 4.2 **Merlin ®**  **W eb site home page.** Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 35

**.** 4 | Surveillance Networks and Systems

**information. It is the primary reporting tool for all CHDs and is also utilized by all the various bureaus and**  **divisions within the FDOH.The Web-based application runs from a central FDOH intranet server in Tallahas**  **see and is accessed through Microsoft ®**  **Internet Ex plorer**  **®**

**. Merlin**  **® is a thin client application, which**  **eliminates the need to load any software or updates onto the user’s terminal.**  **All disease conditions have separate clinical and surveillance case definitions; a given case may not al** 

**wa ys be reportable. A case of hepatitis A may meet the**  **clinical case definition but not have a confirming lab result. Clinically, this is a case of hepatitis, but it would** **not be reportable because it does not meet the case de finition for surveillance. Merlin**  **® enables counties to re**  **port cases to the FDOH in real time; the FDOH Bureau of Epidemiology then reports to the CDC in Atlanta on**  **a weekly basis. Information on the required reportable diseases involving aquatic toxins (NSP, CFP, SPFP, and**  **PSP) can be found in Appendix B, Medical Fact Sheets and Case Definitions.**  **T**

**he Merlin ®**  **morbidity database is a dynamic data base. Counties report and update many cases every** 

**w eek. The CDC accepts all new cases and updates**  **during the course of a morbidity year and publishes all morbidity counts, by reporting week, in the Mor**  **bidity and Mortality Weekly Report (see www.cdc. gov/mmwr).** 

BENEFITS AND CAPABILITIES OF MERLIN ® **• A bility to electronically review and analyze county** 

**and statewide disease trends**

**• Ability to export disease information for more so** 

**phisticated analysis**

**• Quick and easy data entry**  **• Av ailability of printable reports and documents** 

**• Receipt and processing of electronic laboratory data**  **• P otential for more timely reporting** 

**• Detection of potential disease outbreaks and clusters**  **• Av ailability of a Helpdesk for submitting questions** 

**and requesting assistance**

**• Ability to manage, investigate and analyze infor** 

**mation from a variety of outbreak/cluster types, in cluding: reportable and nonreportable diseases,**  **symptoms/syndromes and other events of public health importance** 

**T he Merlin**  **® T**  **raining site can be accessed at http:// merlintraining.isf.com/MerlinNet/start/Login.aspx**  **(Figure 4.2).**


### Florida Poison Information Center

**T he three Florida Poison Information Centers (FPIC)** 

**w ere created in 1989 by an act of the Florida Legisla**  **ture (F.S. 395.038).The centers provide an invaluable ser vice to the citizen community, health care profession**  **als, visitors, and the FDOH. Calls to the FPICs are handled by specially trained nurses, pharmacists, physi**  **cian assistants, physicians, and on-call board-certified toxicologists who have computerized access to the lat**  **est in-depth health and safety assessment tools. The FPICs are located in Miami,Tampa, and Jacksonville and** **serve all Florida counties and beyond, operating toll free and in all major languages 24 hours a day, 7 days**  **a week, 365 days a year.The FPIC/Miami, located at the University of Miami Miller School of Medicine and**  **Ja ck** **son Health Systems, in particular has rapidly grown into a cost-effective model for poison center systems.**  **In 1997, with funding from the FDOH, the CDC, and the National Institute of Environmental Health Sci**  **ences (NIEHS) Marine and Freshwater Biomedical Sciences Center, the FPIC/Miami established an ad** **ditional free hotline dedicated to providing informa tion concerning aquatic health issues (1-888-232-8635).**  **T he “Aquatic Toxins Hotline”allows users to access in**  **formation using an automated call-processing menu system. Callers can listen to prerecorded information**  **about possible health effects and locations of red tide blooms (including the NOAA HAB Bulletin [coast** 

**wa tch.noaa.gov/hab/bulletins_ ns.htm], updated twice** 

**w eekly). They can also obtain information about ma**  **rine toxin issues in general, and have the opportunity to speak to a Specialist in Poison Information (SPI).The**  **hotline also provides callers with accurate, timely, and understandable information on other aquatic toxins in**  **cluding ciguatoxin, STX, and those associated with cy** **anobacteria. T** **he Aquatic Toxins Hotline has been expanded to Florida Poison Information Center, Miami** **FPIC image**Public Health Response to HABs Abbott et al.

36 FWRI Technical Report TR-14

**. all FPICs and currently provides the only way for the** **public to receive the NOAA HAB Bulletin in a conve nient audio format. Callers are also provided with a**  **W eb site that displays the NOAA HAB Bulletin and**  **information in the form of a detailed map, as well as the Web site for FWC–FWRI with further information** **about red tide, its causative organism, and ongoing re search in the field.The FWC–FWRI also generates bi** 

**w eekly reports of current statewide red tide status,** 

**av ailable on its Web site as well as in audio format.** 



### Food, Water and Vector-borne Surveillance System

**T he Web-based Food, Water and Vector-borne Sur** 

**v eillance System (FWVSS) (Figure 4.3) was created to**  **manage data generated by the Food and Waterborne Disease Program and the Arbovirus Surveillance Pro** **gram and enhances the ability to monitor for—and re spond quickly to—food-, water-, and vector-related**  **disease outbreaks.The Food and Waterborne Disease Program data include summary data, including geo** **graphic elements, on food and waterborne disease out breaks from 1994 to the present, as well as food- and** 

**w ater-related complaints. Data includes HAB-related**  **illnesses such as NSP, SPFP, and CFP. (Single case data for reportable diseases [notifiable per Florida Statutes**  **Chapter 64D-3, F.A.C.] are entered in and maintained by**  **the Merlin ®**  **surveillance system.) FWVSS is search able by multiple fields, including county of outbreak,** **outbreak type, investigation and summary dates, ve hicles of transmission, implicated pathogen, and con**  **tributing factors (contamination, proliferation, survival, method of cooking).The FWVSS generates user-spec**  **ified reports automatically or by user-determined fields.** 4 | Surveillance Networks and Systems

Figure 4.3 **Food, Water and Vector-borne Surveillance System (FWVSS) Web site home page.**Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 37

**.** 4 | Surveillance Networks and Systems



### Syndromic Surveillance Systems

**T he CDC applies the term “syndromic surveillance”to** **surveillance using health-related data that precede ac tual diagnosis and signal the probability of a case or an**  **outbreak of sufficient seriousness to warrant a further public health response. Historically syndromic sur** 

**v eillance has been used to target the investigation of po**  **tential cases; its utility for detecting outbreaks associated with HABs is being explored by the FDOH ATP.**  

### Electronic Surveillance System for the Early Notification of Community-Based Epidemics
**Electronic Surveillance System for the Early Notifica tion of Community-Based Epidemics (E**  **SSENCE) is a W**  **eb-based syndromic surveillance system available 24 hours a day, 7 days a week. It was originally devel**  **oped by the Department of Defense and Johns Hopkins University for Military Treatment Facilities in the Na** **tional Capital Region but is currently available in 37 hos pitals in five Florida counties: Volusia (2), Palm Beach**  **(4), Monroe (2), Miami-Dade (14), and Broward (15).The ESSENCE system performs automated electronic data** **collection and analysis of health information using al gorithms for temporal and spatial detection based on**  **Emergency Department chief complaints. ESSENCE uses the information gathered to make statistical mod**  **els for syndromic surveillance and alert detection.This includes making predictions based on previous several** 

**we eks of data, detecting irregularities in public health**  **surveillance data, and identifying geographic clusters (Kite-Powell, 2007).** **Data collected from emergency rooms and ana l** **yzed using various methods includes the following: date and time of visit, the hospital name and region,**  **patient county of residence, age, sex, chief complaint, discharge diagnosis, and admission status. Data col**  **lection options in ESSENCE include different record formats and collection frequency.**  **Syndrome categories used for surveillance include 102 established categories that include the following:** **botulism-like illness, neurological, hemorrhagic ill ness, rash, gastrointestinal illness, and respiratory ill**  **ness. Other categories established using the chief complaint query mechanism include the following:**  **dialysis, animal bite, rabies, diarrhea or vomiting, and asthma. Syndrome definitions are used be sure the ill**  **ness is properly categorized. Generally, ESSENCE monitors syndromic sur** 

**v eillance using the following steps:** 

**• Each morning hospitals transmit Emergency De** 

**partment chief complaint data •**  **System monitoring and review process**



## ° **Evaluation of the alert list and time series data by**

■ **Date of visit, time of visit, age, gender, zip code,**

**hospital**

■ **Clustering of chief complaints**

**• If further investigation is warranted, data reviewed** 

**by the medical epidemiologist** 

**• If necessary, hospital infection control practitioner** 

**(ICP) is contacted for chart review**

BENEFITS AND CAPABILITIES OF ESSENCE

**• Geographic Information Systems component for** 

**spatial cluster detection**

**• Syndrome definitions** 

**• Subsyndrome categories**  **• U pdated detection algorithms** 

**• Expandability to other data sources**  **• D esigned to capture naturally occurring infectious** 

**disease and bioterrorism data**


### HABISS: CDC’s Multi-State HAB Surveillance System

**In response to the need to support public health decision-making, the CDC National Center for Envi**  **ronmental Health in Atlanta has developed HABISS. T** **he HABISS is a unique surveillance system that in cludes both human and animal health data as well as** **environmental data about HABs themselves. Data col lection is organized in a modular format that can be ex**  **panded to suit the needs of state and local health and environmental protection agencies. In the future, data**  **collected and stored in HABISS will be used to assist in predicting local HABs, thus allowing state public** **health and environmental health prevention activi ties to be in place, not only in response to reports of** **human or animal illnesses, but also in advance of an ticipated public health problems.** **HABISS is a surveillance system that can be ac cessed online through the Web and offline through**  **W indows**  **® -based or hand-held devices. It operates on**  **top of a secure platform, the Rapid Data Collector (RDC). The RDC tool was designed in-house, specifi**  **cally for survey-design and data-collection purposes. Protected by approved access and password, state**  **based users can choose to enter, edit, and save data for subsequent sessions. Users may also choose to export**  **data to Access, Excel, or XML. The HABISS requires users to input several key indicators (**  **e.g., dates, agency**  **contact information, state codes, route of exposure, patient’s chief complaint). If data are available, HABISS**  **also prompts users to include the following elements for a suspected human illness report:**  **• P oint of contact with the system** **• Identifying information for the case** 

**• Case demographics**  **• En vironmental information** 

**• Exposure information** 

**• Signs and symptoms**  **• M edical review (including laboratory analysis)**  **• C ase assessment and follow-up**  **• P arallel modules for animal events**  **Users are requested to report the following data elements on algal blooms:**  **• W ater-sample and collection information** 

**• Geographic coordinates via Google**  **TM Maps**  **• T oxin identification**  **Human illness reports can be easily linked to data collected on algal blooms.It is intended to synthesize in** **formation not only on regional algal blooms across mul tiple sites,but also on active blooms in residential ponds,**  **reservoirs, natural springs, and other water bodies.** 

## Surveillance Systems Maintained by Other Agencies

**HABs negatively affect environmental and animal health in addition to potentially threatening human** **health. Surveillance systems designed for health mon itoring, response, and reporting in any of these areas**  **can serve as indicators for HAB-related illness threats.** 

### FWC–FWRI: Red Tide Status Report **http://research.myfwc.com/features/view_article.asp?id=9670 1-866-300-9399 inside Florida, 727-552-2448 outside Florida** 

**T he FWC–FWRI produces biweekly reports of current** **statewide red tide status. Reports include map of sam pling results and regional status reports.Reports are gen**  **erated by the FWC–FWRI’s coordinated year-round statewide comprehensive red tide monitoring program.**  **Scientists investigate and monitor red tide and other HABs in coastal and estuarine waters around the state.** 



### FWC–FWRI: Volunteer Monitoring Program **http://myfwri.com/features/view_article.asp?id=24851 or contact the FWC–FWRI HAB Group 727-896-8626** 

**Vo lunteer nearshore and offshore sampling of estuar**  **ine and marine waters is coordinated by FWC–FWRI to assist with monitoring HABs in Florida, increase**  **coverage of the Gulf of Mexico, create early warning of offshore blooms, and develop partnerships with the**  **marine business and research community.Volunteers consisting of FWC scientists, other state agencies,** **stakeholder groups, charter and fishing captains, re tirees, divers, and researchers as well as private insti**  **tutes collect up to 200 water samples with greater than 70 HAB species weekly. The FWC scientists perform**  **sample analysis for HAB species, note data in the HAB Historical Database, and ensure that appropriate ac**  **tions and reporting, such as shellfish bed closures by FDACS and weekly HAB bulletins from FWC–FWRI**  **and NOAA, follow detection.**



### USF–FWC Center for Prediction of Red Tides **http://ocgmod1.marine.usf.edu/pyocean-Web/**

**T he Center for Prediction of Red Tides is a collabora**  **tive effort between the USF College of Marine Science and FWC to develop USF red tide research monitoring** **tools. Satellite imagery, physical oceanography moni toring buoys, physical ocean models, and red tide pre**  **dictive models are all tools being evaluated for use in FWC statewide red tide monitoring efforts. The Cen** **ter for Prediction of Red Tides Web site includes an ex perimental forecasting product which predicts daily**  **bloom movements based on current FWC red tide cell counts and USF current speed and direction data.** 



### NOAA HAB Bulletin and Forecasting System **http://coastwatch.noaa.gov/hab/bulletins_ns.htm or contact hab@noaa.gov** 

**T he HAB bulletin generated by NOAA and the Na**  **tional Environmental Satellite Data and Information Service for the Gulf of Mexico provides notification of**  **bloom conditions to state and local coastal managers. Bulletins include information on wind conditions,** 

**c hlorophyll levels, and potential or actual bloom events**  **and are sent twice a week via e-mail to registered users with natural-resource management responsi**  **bilities to alert subscribers of developing blooms and**

**c hanges in the location and extent of existing blooms.** **Bulletins can be accessed online 48 hours following e mail distribution.** **Reports are generated from a variety of informa tion sources including the NOAA HAB Forecasting**  **System ( http://www.csc.noaa.gov/crs/habf/),**  **which sup plies information on the location, extent, and potential**  **for development or movement of HABs in the Gulf of Mexico, and for advance warning of potential events** **(posted twice weekly during HAB season). The fore casting system relies on satellite imagery, field obser** 

**v ations, and buoy data to provide the large spatial**  **scale and high frequency of observations required to assess bloom location and movements.**  Public Health Response to HABs Abbott et al.

38 FWRI Technical Report TR-14

**.** 4 | Surveillance Networks and SystemsAbbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 39

**.** 4 | Surveillance Networks and Systems



### FDACS Division of Aquaculture: Shellfish Harvesting Management **http://www.floridaaquaculture.com/SEAS/SEAS_mngmt.htm FDACS regulates aquaculture facilities, shellfish pro** **cessing plants, and shellfish-harvesting areas to pro tect human health. Current open/closed status and**  **maps of shellfish area classifications can be obtained 24 hours a day from the Shellfish Environmental**  **Assessment Section (SEAS) Web site or by contacting one of the following FDACS field offices:** 

**• Headquarters,Tallahassee 850-488-5471**  **• W estern Gulf, Panama City 850-236-2200** 

**• Central Gulf, Apalachicola 850-653-8317** 

**• Big Bend Gulf, Cedar Key 352-543-5181** 

**• South Gulf, Punta Gorda 941-255-2552** 

**• Atlantic, Palm Bay 407-984-4890**  **V**

**iolations, unlawful possession, or harvesting of cul tured shellfish from closed areas can be reported to 1-**  **800-DIAL-869. FDACS offices provide information on areas closed for shellfish harvesting due to threats that**  **the shellfish are unsafe for consumption. Closures may be based on harmful levels of enteroccoci or fecal col**  **iform bacteria or on emergency conditions such as red tide blooms, hurricanes, or tropical storms. Shellfish** **areas are reopened for harvest when sampling demon strates that stringent water-quality criteria are met to** **ensure that shellfish are wholesome. Shellfish bed clo sures caused by red tide are based on**  **K. brevis cell**  **counts of 5,000 cells per liter of seawater or greater and confirmation of brevetoxin toxicity by MBA.** 


### MML: Beach Conditions Reporting Program **http://coolgate.mote.org/beachconditions/ 1-941-BEACHES** 

**T he MML Beach Conditions Report provides several**  **types of information about beach conditions during red tide events: presence of dead fish, respiratory irritation** **among beachgoers, water color, and wind direction. Re ports are provided by county lifeguards and updated**  **at 10 a.m. and 3 p.m. daily. Information gathered also contributes to the NOAA HAB Bulletin.** 


### FWC: The Florida Fish-Kill Hotline **http://research.myfwc.com/fishkill/submit.asp 1-800-636-0511** 

**T he Fish-Kill Hotline is a tool by which researchers**  **monitor fish disease and mortalities throughout the state. The hotline provides a means for governmental** **agencies and the public to directly report fish kills, dis eased fish, or fish with other abnormalities. The**  **FWC–FWRI’s Fish and Wildlife Health Group may then respond with an investigation of the kill either directly** **or through its network of more than 350 contacts. Al though the hotline is primarily a resource regarding** **marine fish kills, calls are regularly received about mor talities of freshwater fish, and of birds and other wildlife,**  **which are then referred to the appropriate department, agency, or organization. Historical records regarding**  **fish kills and disease events may also be accessed by the public at http://research.MyFWC.com/fishkill/.** 



### FWC: Wildlife Alert Hotline **1-888-404-FWCC (3922), cell phone users** ***** **FWC or #FWC**

**T he FWC’s Wildlife Alert Hotline is a 24-hour public** **hotline for reporting animal injury or death or sus pected wildlife law violation. The hotline aids in the**  **monitoring of sick, dead, injured, or tagged manatees; dead or injured marine turtles; right whale sightings;**  **illegal hunting, killing, or capturing of protected species; fishing by illegal methods; and boating under**  **the influence.**


### FWC: Wild Bird Die-Offs **http://myfwc.com/bird/**

**T he FWC provides an online reporting system for sur** 

**v eillance of wild bird die-offs that aids in the moni**  **toring of Avian Influenza, West Nile Virus, and bird electrocutions from power lines.**  

### FDACS: Division of Animal Industry

**T he FDACS Bureau of Animal Disease Control and**  **Bureau of Diagnostic Laboratories enforce animal health regulations to protect Florida from animal pests**  **and diseases that have a major economic and public health consequence. Mandatory reporting of specific in** **fectious and communicable diseases exists to eradi cate them from livestock and other domestic animals.**  **Information on HAB-related illnesses is lacking and they are not reportable, but the Kissimmee Animal Diag** **nostic Lab (KADL) is working with FWC to develop re sponse and analytical capabilities for addressing**  **potential livestock kills that are due to exposure to cy** 

**anobacteria in freshwater ponds, lakes, and reservoirs.**

**If any unusual animal disease or pest that might indicate a possible newly emerging disease with the po**  **tential to cause human disease, economic damage, or an animal mortality event in unusually high numbers**  **is discovered in the state, a report should immediately be made to the State Veterinarian: office hours, 850-410-**  **0900; fax, 850-410-0915; after hours, 1-800-342-5869; e-mail, rad@doacs.state.fl.us).** 

## Shellfish
**Historically, algal biotoxin-related public health poli cies targeted illnesses resulting from the consump**  **tion of contaminated molluscan shellfish. Public health controls of shellfish became a national concern in the**  **U .S. in the late nineteenth and early twentieth centuries**  **when public health authorities noted a large number of illnesses associated with consuming raw oysters,**  **clams, and mussels. In 1925, the Surgeon General of the U**  **.S. Public Health Service convened a conference on shellfish sanitation in response to requests from local**  **and state public health officials for assistance. T** **he National Shellfish Sanitation Program (NSSP)**

**w as first developed based on the public health prin**  **ciples and controls formulated at the 1925 conference. Th**  **e public health control procedures later established by**  **the NSSP Manual of Operations were dependent on the cooperative and voluntary efforts of state reg**  **ulatory agencies and the voluntary participation of the shellfish industry. In 1975, the FDA decided that NSSP**  **goals would best be met by making periodic revisions to the Manual of Operations rather than by imple**  **menting mandatory NSSP regulations. To establish standard national guidelines for shellfish, state regu** **latory officials along with the National Marine Fish eries Service (NMFS), the Environmental Protection**  **Agency (EPA), and the shellfish industry organized the Interstate Shellfish Sanitation Conference (ISSC) in** **1982. In 1984, the ISSC entered into a formal Memo randum of Understanding with the FDA to promote**  **shellfish sanitation through the NSSP. Under this agreement, ISSC members are required to adopt laws**  **and regulations to ensure that shellfish are grown, harvested, and processed in a safe and sanitary man**  **ner. The FDA is responsible for the annual review of each states’ shellfish-control program to assure con**  **formity with the NSSP standards and guidelines.The FDA also established action levels for four of the five**  **recognized shellfish poisoning syndromes in the U.S.: PSP: 0.8 ppm (80 μg/100 g) saxitoxin equivalent;**  **NSP: 0.8 ppm (20 MU/100 g) brevetoxin-2 equivalent; DSP: 0.2 ppm**  **okadaic acid plus 35-methyl okadaic acid (dinophysistoxin-1); and**  **ASP: 20 ppm domoic acid, except in the viscera of**  **Dungeness crab, where 30 ppm is permitted. As a member of the ISSC, Florida formalized a**  **federally approved marine biotoxin contingency plan. Under the state’s Comprehensive Shellfish Control**  **Code, Chapter 5L-1, F.A.C., FDACS is responsible for classification and management of shellfish-harvest**  **ing areas to ensure that shellfish are grown, harvested, and processed in a safe and sanitary manner. Har** 

**ve sting areas are classified as Approved, Conditionally**  **A pproved, Restricted, Conditionally Restricted, Pro**  **hibited, and Unclassified.Waters that are not classified are considered to be unapproved for all molluscan**  **shellfish harvesting (Heil, 2009). T** **he FDACS also oversees the operation and main tenance of 1,200 bacteriological sampling stations to** **routinely monitor fecal coliform and water-quality pa rameters in each of Florida’s shellfish-harvesting areas.**  **Harvesting areas can be temporarily closed in response to pollution events, such as sewage spills, hurricanes, or** **toxic algal blooms. If a harvesting area is closed in re sponse to an event, sample results must meet the ap**  **propriate NSSP standard and adequate time must elapse for shellfish to purify themselves before the area can be**  **reopened. Classification and open and/or closed status of shellfish harvesting areas, along with violation penal** **ties, apply to both commercial and recreational shell fish harvest. It is a criminal violation to harvest any**  **species of oysters, clams, or mussels from any area that is not classified as “open”or during “closed”status.**  **To address the threat of NSP, guidelines are in**  **place under Chapter 5L-1.003(8), F.A.C. for monitoring and closing shellfish areas when**  **K. brevis cell concen** 

40 FWRI Technical Report TR-14

**.** 

# Chapter 5 Regulatory Guidelines

Purpose To identify existing and developing regulatory guidelines and public health policies intended to protect human health from exposures to harmful algae and their toxins.

**T**

**his section provides an overview of public health policies concerning the effect of harmful algae and their toxins on human health. Included are existing policies, the historical background on their development, and what future regulations may be**  **needed. It includes sections regarding shellfish, fish, and both drinking and recreational waters, with supplemental regulatory guidelines concerning blue-green algae. This is not a comprehensive review of all policies affecting Florida; there are**  **additional local, state, and federal laws that may apply to related activities.**Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 41

**.** 5 | Regulatory Guidelines

**trations reach dangerous levels. Background levels of K. brevis**  **in Florida are usually 1,000 cells or fewer per liter of seawater.When cell concentrations exceed 5,000**  **cells per liter, affected shellfish-harvesting areas are temporarily closed. Harvesting areas are reopened**  **when K. brevis**  **cell counts fall below 5,000 cells per liter and MBA tests verify that bivalves are safe to consume**  **(<20 MU/100 g shellfish tissue) (Heil, 2009) (Figure 5.1).**  **In 2003, following the 2002 outbreaks of SPFP in the IRL, FDACS collaborated with FWC and was initially**  **assisted by the FDA to implement an STX contingency shellfish monitoring program to protect the public** **from PSP, similar to the FDACS program for NSP mon itoring. FDACS collects monthly samples of water and**  **hard clams, Mercenaria**  **sp., from three representative shellfish harvesting areas in the IRL. FWC–FWRI an**  **alyzes water and shellfish for P.**  **bahamense and STXs, re**  **spectively. Following NSSP guidelines and FDA action levels, FDACS closes shellfish-harvesting areas when** **STX levels in shellfish exceed 80 μg STX eq./100 g tis sue (edible portion) and reopens them only when STX**  **concentrations fall below the action level.** 

## Fish Saxitoxin Puffer Fish Poisoning

**In 2002, Florida health officials were notified of nu merous cases of severe neurological illnesses associ**  **ated with the consumption of puffer fish harvested from the Titusville area of Florida (Bodager**  **et al., 2002; Hammond**  **et al., 2002; Marcus**  **et al., 2002). Symp**  **toms were consistent with PSP, which in the U.S. has generally been associated with the consumption of** **molluscan shellfish from the northeastern and north**

**w estern coastal regions of the country. Subsequent**  **laboratory tests of puffer fillet samples confirmed that STX was the causative agent in the reported ill**  **nesses (Quilliam et al.,**  **2004; Landsberg et al.,**  **2006). In response to the puffer fish poisoning cases, the**  **FWC issued an executive order in April 2002 placing a 90-day ban on puffer fish harvest from Volusia, Bre** 

**va rd,**  **Indian River, and St. Lucie county waters. Species of puffer fish covered by the harvest prohibition in**  **cluded southern ( Sphoeroides nephelus**  **), northern ( S.**  Figure 5.1 **Example of an FWC–FWRI red tide status report map, Karenia brevis**  **counts. FWC image** Public Health Response to HABs Abbott et al.

42 FWRI Technical Report TR-14

**. maculatus**  **), marbled ( S. dorsalis**  **), bandtail ( S. spengleri**  **),**

**c heckered (**  **S. testudineus ), and least (**  **S. parvus ) puffer**  **fish. A second executive order was issued in July 2002, which extended the ban an additional 90 days and** **added Martin County to the list of affected areas. Be cause tests showed that puffer fish in these areas con**  **tinued to be toxic, FWC issued two consecutive one-year bans, effective through October 22, 2004.**  **FWC finally concluded that because STX levels in puffer fish were remaining far above the FDA action**  **limits, a long-term ban on their harvest was necessary. T** **herefore, Chapter 68B-3.007, F.A.C., which extended indefinitely the puffer fish harvesting ban in these**  **areas, was passed in July 2004.** 

### Ciguatera Fish Poisoning
**In many parts of the world, tropical reef fish are known to be highly likely vectors for ciguatera. Local knowl** **edge of this fact in both the Caribbean and other trop ical island communities has influenced fishing behavior**  **and eating customs. However, there are only limited examples of regulatory restrictions on harvesting.**  **Th ese have been reported to include American Samoa;**  **Queensland, Australia; French Polynesia; Fiji; Hawaii, and Miami (De Fouw**  **et al., 2001).The report of a pro**  **hibition on the harvesting of barracuda in Miami, Dade County, though referenced (Lawrence**  **et al., 1980), has not been confirmed.**  

## Drinking Water

**T he need for regulatory approaches to reduce human**  **exposures to cyanotoxins was underscored at the 6th International Conference on Toxic Cyanobacteria, held** **in Bergen, Norway, in June 2004. Many of the 190 par ticipants, representing 36 countries, reported data sug**  **gesting a high frequency of cyanotoxin occurrence in drinking water in concentrations that may be haz**  **ardous to human health. W** 

**orldwide, the leading route of human exposure to cyanobacteria is through the consumption of drink** **ing water (Gupta, 1998). Urban drinking-water sys tems have been implicated in most suspected cases of**  **cy anobacterial poisoning in communities in which the**  **reservoir had a recorded cyanobacteria bloom and, in several instances, had been treated with copper sulfate**  **(Carmichael and Falconer, 1993; Falconer, 1996). Guidelines for the total daily intake over a lifetime**  **of a chemical compound in drinking water is typically calculated by applying the derived tolerable daily in**  **take (TDI) to typical daily consumption in liters by an individual of a given body weight (bw) while taking into**  **consideration the proportion (P) of the total daily intake of the compound that is ingested through drinking** 

**w ater and the average daily drinking-water consump**  **tion in liters (L).The resulting formula is as follows:**

**Guideline value = TDI**  × **bw** × **P L** 
**In their addendum to the second edition of Guide**  **lines for Drinking-Water Quality (1998b), the WHO pub**  **lished a provisional health-based drinking-water guideline value of 1.0 μg/L for the total daily intake of**  **microcystin-LR (MC-LR) (free plus cell-bound) for an**

**av erage adult assuming TDI = 0.04 μg/kg, bw = 60 kg,**  **P = 0.8, and L = 2. The WHO based the guidelines on studies reporting a lowest observable adverse effect**  **level (LOAEL) on the toxicity of MC-LR in mice or rats exposed to contaminated drinking water (Fawell**  **et al., 1994; Heinze, 1999). Discrepancies in the data derived** **from the studies suggest a potential for substantial dif ferences in LOAEL between different strains of rats**  **and/or mice. An intermediate exposure value cannot be determined because the current data available on the**  **toxicity of MC-LR is not adequate. Available data does not show whether intermediate exposure to drinking** 

**w ater containing 10 μg/L of MC-LR or less would re**  **sult in adverse effects on human health (Burch, 2008). A health advisory level (HAL) presented as 10 μg/L/day**  **is based on many assumptions because the database for the toxicity of microcystins is very limited and alter**  **native HAL values could be justifiably proposed. The WHO concluded that insufficient data were available**  **upon which to derive guideline values for any other cya**  **nobacterial toxins, including anatoxins, STXs, and**

**c ylindrospermopsin.**  **After the release of the WHO provisional drinking**

**w ater guidelines, many countries adopted the value di**  **rectly or derived slight variations. Despite limited data, some countries also developed guidance values for** **other cyanotoxins, such as cylindrospermopsins, ana toxins, and STXs (see Table 5.1). Currently, Florida**  **does not recognize any regulatory guidelines. In the U.S., the Safe Drinking Water Act (SDWA)** **authorizes the EPA to set national health-based stan dards to protect against both naturally occurring and** **man-made contaminants that may be found in drink ing water. Although the EPA has developed and im**  **plemented regulations for more than 90 drinking water contaminants, it has yet to create regulations or guide** **lines addressing cyanobacteria in drinking-water sup plies. Awareness of toxic cyanobacterial blooms in the**  **U .S. has increased in recent years, but the substantial** **gaps that remain in the recognition and understand ing of the risks posed by cyanobacterial cells and their** **toxins have hindered development of appropriate pub lic health guidelines. These include limited data on**  5 | Regulatory GuidelinesAbbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 43

**.** 5 | Regulatory Guidelines

T able 5.1 **Examples of drinking water guidelines for cyanotoxins. a** 

T oxin Country Guideline for Daily Intake **Microcystins Australia 1.3 μg/L expressed as MC-LR toxicity equivalents Brazil 1 μg/L (variant not specified)**  **Canada Maximum Acceptable Concentration (MAC) of 1.5 μg/L per day for MC-LR Czech Republic 1 μg/L MC-LR**  **F rance 1 μg/L of MC-LR**  **New Zealand Provisional MAC of 0.001 mg/L (= 1 μg/L) MC-LR toxicity equivalents P** 

**oland 1 μg/L microcystin-LR South Africa Target Water Quality Range (TWQR) of 0–0.8 μg/L deemed desirable, and**  **concentrations in excess of 1 μg/L deemed as posing a possible acute risk of hepatotoxicosis**  **Spain 1 μg/L Cylindro- Australia No official guideline; however, 1 μg/L used in some areas**  **spermopsins Brazil No mandatory guideline; 15 μg/L recommended value New Zealand Provisional MAC of 0.001 mg/L (= 1 μg/L)**  **Anatoxins New Zealand Provisional MAC: Anatoxin 0.006 mg/L (= 6 μg/L); Anatoxin-a(s) 0.001 mg/L (= 1 μg/L)**  **Saxitoxins Australia No officially adopted guideline; “health alert”of 3 μg/L for acute exposure sometimes used for guidance**  **Brazil No mandatory guideline; 3 μg/L recommended value**  **New Zealand Provisional MAC for Saxitoxins (as STX eq) 0.003 mg/L (= 3 μg/L)**

**a Adapted from Burch, 2008.** 
**the occurrence, frequency, and distribution of blooms and the lack of reliable analytical methods, proven**  **prevention and mitigation technologies, and human health-risk studies (Donohue**  **et al., 2008).**  **Every five years the EPA is required to select a group of known or potential drinking-water contaminants for** **regulatory consideration.This list, known as the Cont aminant Candidate List (CCL), includes contaminants**  **about which critical information is lacking for regulatory decisions to be made. Such information can be pro**  **vided by the Unregulated Contaminant Monitoring Regulation (UCMR) program, which directs select pub**  **lic-drinking water systems to screen for unregulated contaminants to provide insights into their occurrence**  **and concentrations in public water supplies. Th**  **e EPA included cyanobacteria and their toxins in their first CCL published in 1998. With more than**  **80 variants reported, the 1998 CCL did not specify which of the cyanotoxins should be targeted for study.**  **In February 2005, the EPA published the second CCL of 51 contaminants, again including cyanobacteria and**  **their toxins.The EPA is currently assessing the risk of exposure to cyanotoxins: microcystins LR, RR,YR, and** **LA; cylindrospermopsin; and anatoxin-a and the plau sibility of modeling quantitative structural-activity re**  **lationships (QSARs) for cyanotoxins. Analytical methods for cyanotoxin detection and quantification**  **are being developed to facilitate UCMR monitoring. In the meantime, the EPA is examining the efficacy of**  **conventional water-treatment processes for removing cy** **anobacteria cells and toxins from drinking-water supplies as well as exploring advanced oxidation and**  **sonolysis techniques (Donohue et al.,**  **2008).**


## Recreational Waters
**Recreational exposure to cyanobacteria can occur through direct skin contact or inadvertent ingestion or** **aspiration of algae cells or contaminated water. How**

**ev er, the public health effect of these exposures is**  **poorly understood as a result of limited surveillance and human-health studies.**  **A ustralia has had recreational guidelines for**  **cya nobacteria exposure in place since 1993. These**  **guidelines were developed on the basis of reports that established links between skin contact with cyanobac** **teria and adverse health effects, especially among sen sitive individuals.** **In 2005,the WHO published suggested safety guide lines associated with incremental severity and proba**  **bility of health effects resulting from exposure to cy** **anobacteria and their toxins (see Table 5.2). However, determining the acceptable concentration of blue-green**  **algae in recreational water is more complicated. The**Public Health Response to HABs Abbott et al.

44 FWRI Technical Report TR-14

**. concentrations of MC-LR, any other microcystin, or the**  **neurotoxic compounds found in blue-green algae are not currently correlated with the skin irritation and skin** **sensitization known to occur with exposure to blue green algae. As in the case of the provisional drinking** 

**w**

**ater guidelines,however,some countries have adopted the WHO guidelines for recreational exposure directly**  **or with slight variations (see Appendix E). At present there are no U.S. federal guidelines for**  **cy anobacterial blooms in recreational waters. Water** **quality criteria for recreational waters was first estab lished in 1968 by the Department of the Interior’s**  **National Technical Advisory Committee (NTAC, 1968) and were later upheld by the EPA in 1976 and 1986**  **(EPA, 1986).The EPA uses fecal coliforms or enterococci as the indicator organism for evaluating the microbi**  **ological suitability of recreational water. The Healthy Beaches Act of 2000, amendment 303i to the Clean**  5 | Regulatory Guidelines

T able 5.2 **WHO guidelines for cyanobacterial exposure in recreational waters. a** 

Risk Level Guidance Level How Level Derived Health Risks Typical Actions b **Relatively low 20,000 cyanobacterial Human bathing Short-term adverse Post on-site risk probability of cells/mL or 10 μg epidemiological health outcomes, advisory signs.**  **adverse health chlorophyll a**  **per L with study. e.g.,**  **skin irritations, Inform relevant effects**  **a dominance of gastrointestinal authorities.**  **cy anobacteria.**  **illness.**
**Moderate 100,000 cyanobacteria Provisional drinking Potential for long- Watch for scums probability of cells/mL or 50 μg water guideline value term illness with or conditions**  **adverse health chlorophyll a**  **per L for MC-LR and data some cyanobacterial conducive to effects**  **with dominance of concerning other species. scums.**  **cy anobacteria.**  **cyanotoxins. c**  **Short-term adverse Discourage health outcomes swimming and**  **( e.g.,**  **skin irritations, further gastrointestinal investigate**  **illness). hazard. P** 

**ost on-site risk advisory signs.**  **Inform relevant authorities.** 
**High probability Cyanobacterial scum Inference from oral Potential for acute Immediate action**  **of adverse formation in areas animal lethal poisoning.**  **to control contact**  **health effects where whole-body poisonings. Potential for long- with scums;**  **contact and/or risk Actual human-illness term illness with possible of ingestion or**  **case histories. some cyanobacterial prohibition of aspiration occur.**  **species. swimming and** **Short-term adverse other water outcomes (**  **e.g., skin contact activities.**  **irritations, Public health**  **gastrointestinal follow-up illness).**  **investigation. Inform public**  **and relevant authorities.** 

**a Excerpt from**  **Guidelines for Safe Recreational Water Environments, T**  **able 8.3, Guidelines for Safe Practice in Managing Recreational**  **W**

**aters, p.**  **150. (WHO, 2003).**

**b Actual action taken should be determined in light of the extent of use and a public health assessment of hazard.** 

**c T** **he provisional daily drinking-water guideline value for microcystin-LR is 1 μg/L (WHO, 1998a).**Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 45

**.** 5 | Regulatory Guidelines

T able 5.3 **Examples of state guidelines for cyanobacteria in recreational waters.**

State Guideline Control Measures
**Arizona None found Combined monitoring efforts by Arizona Department of Environ**  **mental Quality (ADEQ), Arizona Game and Fish Department, and the University of Arizona in cooperation with the Tonto National**  **F orest and the Arizona Department of Health Services. Monitoring**  **includes “valley”reservoirs used for drinking water and other select water bodies. ADEQ issues press releases as deemed**  **necessary. California Reference WHO guidelines Monitori**  **ng appears to be regional with multiple agencies involved. based on cell counts and a CHDs issue press releases as deemed appropriate.**  **toxin level of 20 μg/L Iowa 20 ppb cyanotoxin benchmark Iowa State University monitors water quality in 132 lakes.The Iowa**  **for issuing health alerts Department of Natural Resources (IDNR) and Public Health (IDPH)**  **(based on Nebraska) issue joint press releases. IDNR posts health alerts on their Web site.**  **Maryland None found Maryland Department of Natural Resources issues press releases**  **and posts notices along water bodies as deemed necessary.The Bay Safety and Environmental Hotline was created for reporting**  **blooms and illnesses. Illnesses associated with HABs are now reportable diseases.**  **Nebraska 20 ppb benchmark for In 2004, health advisories were issued for levels of 2–15 ppb, and alerts**  **issuing health alerts w** **ere issued at levels >15 ppb. Nebraska officials found that the two tier system confused the public. In 2005, the state dropped the**  **health advisories and raised the threshold for health alerts to match WHO recommendations.The Nebraska Department of Environ**  **mental Quality issues press releases and does Web-postings; e-mail notifications are sent to interested agencies; signs are posted at**  **affected water bodies; and beaches are closed at unsafe levels.**
**New None found Post signs at affected water body when deemed appropriate.**  **Hampshire North Currently developing Monitoring animal deaths since 1990; two confirmed reports to**  **Carolina guidelines date. Established canine surveillance program in 2005.** 
**Minnesota None found Interagency workgroup (DOH, DNR, PCA,Veterinary Medical**  **Association) formed after several dog deaths occurred in 2004.**
**Montana None found Department of Environmental Quality issues press releases as**  **deemed necessary. Oregon Established mandatory Oregon Department of Health Services (ODHS) issues health**  **guidance value of 1 μg/L for ad visory press releases and posts health advisories on their Web site.**  **food supplements. ODHS also offers a subscription service for health advisories.**  **Generally follow WHO Signs are posted at affected water bodies. guidelines for recreational**  **exposure but advise against**

**w ater contact when visible**  **algae or blue or blue-green color present. Samples >15,000**  **cells/mL are tested for toxins.**Public Health Response to HABs Abbott et al.

46 FWRI Technical Report TR-14

**.** 5 | Regulatory Guidelines

**Lake Harris**

**W ater Act, and the November 16, 2004 federal rule** 

**c hange, mandated**  **E. coli or enterococci as indicator or**  **ganisms for freshwater beaches in the Great Lakes and enterococci only in marine waters (EPA, 2004).**  **T he 2005 International Symposium on Cyanobacterial** **Harmful Algal Blooms (ISOC–HAB) sponsored by fed eral agencies (http://www.epa.gov/cyano_habs_sym**  **posium/monograph.html) reviewed the current status regarding cyanobacteria, and the EPA is actively ad**  **dressing the issue. In the absence of federal guidelines, some states have developed policies or taken other**  **control measures to address recreational exposures to cyanobacteria and their toxins (see Table 5.3).**  

## Blue-Green Algae Dietary Supplements

**During the 2005 International Symposium on Cyano bacterial Harmful Algal Blooms, EPA officials expressed**  **a growing concern about the potential for human exposure to cyanotoxins through the consumption of** **dietary supplements. Blue-green algae dietary sup plements were introduced into the U.S. in 1979 and** **marketed for a wide range of health benefits, includ ing weight loss, improved mental clarity, and increased**  **energy. Blue-green algae supplements are believed to be widely used, with more than one million consumers**  **in the U.S. and Canada. T** **he two primary blue-green algae species found in supplements are**  **Spirulina spp. and**  **Aphanizomenon flos-aquae**  **. W ith no U.S. guidelines in place to moni**  **tor the safety of these products, Oregon health officials became concerned about the practice of supplement**  **manufacturers harvesting A. flos-aquae**  **from Upper Klamath Lake, where blooms of**  **Microcystis aerugi**
**nosa, a hepatotoxic species, are a regular occurrence.** **In response to these concerns, the Oregon Health Di vision and the Oregon Department of Agriculture im**  **posed a regulatory limit of 1 μg/L for microcystin content in products that contain blue-green algae**  **(Gilroy et al.,**  **2000). FWC image** 

## Information, Education, and Communication

**Outreach activities related to HABs include dissemi nation of information, provision for education, and**  **communication outreach. IEC is an all-encompassing expression commonly used in the health field to de**  **scribe efforts to increase public awareness about a specific topic and change potentially harmful behaviors** **while reinforcing health-promoting practices. Criti cal factors to consider when initiating any IEC activ**  **ity are timing ( e.g.,**  **season), gauging the readiness of the target audience for such a message, accessibility**  **( e.g.,**  **language or medium used), appropriateness ( e.g.,** **cultural or literacy issues), relevance, resources avail able (**  **e.g., financial or staffing), and quality. Outreach**  **materials should be pretested for best outcomes. W** **hile there are a variety of reasons for conduct ing any outreach or health communication activity,** **most HAB outreach efforts focus on prevention, miti gation, and control or restoration. HAB outreach is**  **generally done (1) to inform the public of an event in a timely manner, (2) to provide reassurance to the** **public that monitoring is occurring, (3) to raise aware ness about possible human-health effects, and (4) to**  **prevent unnecessary contact with potentially harmful substances or environmental components. When se**  **lecting which IEC activities to conduct in your area, it is best to first conduct a needs assessment to determine** **the most relevant activities given the local situation, in cluding the level of the potential HAB threat and stake**  **holder attitudes. A target audience is the group, community, or** **population identified as the most appropriate recipi ent of a particular health campaign or message. Most**  **often the target audience for HAB information falls into one of the following categories: children, adolescents,**  **health care providers (public and private), business**

**o wners, fishermen, life guards, the general public,**  **tourists, and sensitive populations such as persons with respiratory conditions.The most important aspects**  **of any outreach activity are to ensure all those poten tially affected by HABs access the information.**  **A wide variety of materials are being used to raise**

**aw areness about HABs in Florida. For example,** 

**• print materials—brochure, leaflet, poster, sign or** 

**billboard, fact sheet, newsletter, press kit (media package), column in newspaper, magazine, or sci**  **entific journal;**

**• presentations or training materials—slide presen** 

**tation, poster presentation, bulletin board, curricu lum or lesson plan, speech, guidelines, manual, text,**  **or reference book;**

**• m ultimedia—public service announcement or in** 

**terview on TV or radio, video, CD–ROM, DVD, GIS update, hotline, Web site; and** 

**• promotional materials/events—button, T-shirt,** 

**sticker, magnet, frisbee, pen or pencil, health fair display, museum display.** 

**Many IEC materials are available on the Internet. T** **he FDOH provides a number of downloadable edu cation and outreach materials on their ATP Web site**  **(http://www.doh.state.fl.us/environment/community/ aquatic/Education_and_Outreach_Materials.htm).**  **Other information resources and key HAB Web sites are listed in the following sections.** 



## Online Resources

**T**

**he following list of online HAB resources is not meant to be exhaustive; however, it should serve to direct the**  **user to key information sites from which to conduct a more comprehensive search.** 


### Environmental and Public Health Data Sources

**• Centers for Disease Control and Prevention** 

**http://www.cdc.gov/hab/default.htm**



## ° **CDC National Environmental Public Health**

**T**

**racking Program http://www.cdc.gov/nceh/tracking/resources_data.htm** 

FWRI Technical Report TR-14 47

**.** 

# Chapter 6 Outreach Resources

Purpose To identify resources available to conduct outreach about HABs affecting Florida through information dissemination, education, and communication activities.

**T**

**he following contains general information for creating an effective information, education, and communication (IEC) HAB activity. Information includes describing the need for IEC activities, common methods used, and materials and resources avail**  **able. An additional tutorial is included on responding to media and developing an effective press release. •**  **Florida Department of Health, Aquatic Toxins Program**  **http://www.doh.state.fl.us/environment/community/ aquatic/index.html** 

**• Florida Fish and Wildlife Conservation** 

**Commission, Fish and Wildlife Research Institute**  **http://research.myfwc.com/**

**• Mote Marine Laboratory** 

**http://www.mote.org**

**• N ational Oceanic and Atmospheric** 

**Administration http://coastwatch.noaa.gov/hab/bulletins_ns.htm**  **http://www.science-house.org/nesdis/algae/ background.html** 

**• Solutions To Avoid Red Tide** 

**http://www.start1.com/** 

### Links to Manuals, Powerpoint Presentations, Etc.

**• Harmful Algal Research and Response: A Human** 

**Dimensions Strategy http://www.coastalscience.noaa.gov/stressors/extreme**  **events/hab/HDstrategy.pdf**

**• HARRNESS: The National Plan for Algal Toxins** 

**and Harmful Algal Blooms http://www.esa.org/HARRNESS/harrnessReport**  **10032005.pdf**

**• Prevention, Control, and Mitigation of Harmful** 

**Algal Blooms: A Research Plan, September 2001 (submitted to Congress by NOAA, 2001)**  **http://www.whoi.edu/science/B/redtide/pertinentinfo/ PCM_HAB_Research_Plan**  Public Health Response to HABs Abbott et al.

48 FWRI Technical Report TR-14

**.** 6 | Outreach Resources**START image**

**Red tide awareness sign**Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 49

**.** 6 | Outreach Resources

**• Queensland Harmful Algal Bloom Response Plan,** 

**December 2002 http://www.nrm.qld.gov.au/water/blue_green/pdf/**  **multiagency_hab_plan_v1.pdf**

**• T he Texas Harmful Algal Bloom Response Plan** 

**Copy must be requested via meridith.byrd@tpwd.state.tx.us** **http://www.tpwd.state.tx.us/landwater/water/environ concerns/hab/** 

**• WHO Guidelines for Drinking-Water Quality** 

**http://www.who.int/water_sanitation_health/dwq/gdw q2v1/en/index2.html** 


### International HAB Links

**• Harmful Algae News** 

**http://ioc.unesco.org/hab/news.htm T** **his site provides links to UNESCO’s publication of international news and activities concerning HABs.** 

**• T he Intergovernmental Oceanographic Commis** 

**sion Harmful Algal Bloom Program http://ioc.unesco.org/hab/**  **T his site includes databases on HABs and health ex**  **perts, IOC activities, and IOC services.**

**• International Atomic Energy Agency** 

**http://www.iaea.org/NewsCenter/Features/Algal Bloom/index.html**  **T his site provides information and IAEA staff reports**  **on international HAB situations—what is afflicting other countries and how they are managing.** 

**• I nternational Society for the Study of Harmful** 

**Algae http://www.issha.org/**  **T**

**his site provides information on HAB conferences and meetings, related proceedings and publications, and**  **links to a variety of other HAB resources.**

**• State of Queensland, Australia** 

**http://www.nrm.qld.gov.au/water/blue_green/index.html T** **his site describes the state’s plans and procedures for multiagency response to HABs.The site also includes**  **multiple fact sheets related to HABs and human health.**

**• U nited Nations Educational, Scientific and** 

**Cultural Organization: Intergovernmental Oceanic Commission’s Global Ecology and**  **Oceanography of Harmful Algal Blooms http://www.ioc-unesco.org/hab/**  **T his site provides information about UNESCO’s HAB**  **related activities, research, databases, and partners.**

**• W orld Health Organization, Water-Related Diseases**  **http://www.who.int/water_sanitation_health/diseases/ cy** **anobacteria/en/ T** **his site offers detailed information on cyanobacter ial toxins, their effects on humans, and their global dis**  **tribution.**


### Federal HAB Links

**• Bigelow Laboratory for Ocean Sciences** 

**http://www.bigelow.org/hab/organism.html T** **his site provides a comprehensive overview of sev eral types of HABs toxins and related human and an**  **imal illnesses, including toxicology and US locations of HAB species.** 

**• CDC, Environmental Hazards and Health Effects** 

**Program (HABs) http://www.cdc.gov/hab/default.htm**  **T his site includes information on various HABs and**  **their human-health threats.**

**• E PA**  **, En vironmental Monitoring for Public Access**  **and Community Tracking Program http://cfpub.epa.gov/si/si_public_record_Report.cfm?di**  **rEntryID=29117 T** **his site provides EPA’s assessment of an automated biological monitoring system that measured toxicity** **caused by HABs in the Chicamacomico River, a trib utary of Chesapeake Bay.** 

**• Harmful Algae Management and Mitigation 2001** 

**Conference http://www.cfsan.fda.gov/~frf/sfhamm.html**  **T his site offers the conference proceedings and infor**  **mation on related research.**

**• National Institute of Environmental Health** 

**Sciences http://www.niehs.nih.gov/**  **T his site offers a variety of resources including com**  **munity outreach and education materials and updates on current HAB health research projects.** 
**• NO AA, Center for Coastal Environmental Health**  **and Biomolecular Research, Marine Biotoxins Program**  **http://www.chbr.noaa.gov/default.aspx?category=mb& pageName=biotoxin**  **T his site describes NOAA’s cooperative programs,** **which conduct research into marine biotoxins. It in cludes links to federal partners, a description of re**  **search projects, and a list of publications.**
**• NO AA, Center for Coastal Fisheries and Habitat**  **Research http://www.ccfhr.noaa.gov**  **Th is site describes NOAA’s CCFHR program, which** **studies the effects of coastal-habitat change on liv ing marine resources, including the effects of algal**  **toxins.**Public Health Response to HABs Abbott et al.

50 FWRI Technical Report TR-14

**. • NO**  **AA, Center for Sponsored Coastal Ocean Research, HABs**  **http://www.cop.noaa.gov/stressors/extremeevents/hab/ welcome.html**  **http://www.cop.noaa.gov/products/factsheets.html T** **his site includes information about the program’s HAB-related research activities, grants, projects, pub**  **lications and partners, as well as available fact sheets. A link to NOAA’s congressional mandate to establish**  **a HAB task force and facilitate HAB investigations (HABHRCA) are found here.** 
**• NO AA, Integrated Ocean Observing System**  **http://ioos.noaa.gov/ T** **his site describes the multidisciplinary system de signed to support research and inform decision-mak**  **ing enhancing the ability to collect, deliver, and use ocean information in formats, rates, and scales re** **quired by scientists, managers, businesses, govern ments, and the public.** 

**• Northwest Fisheries Science Center, HAB** 

**Program http://www.nwfsc.noaa.gov/hab/**  **T his site describes HAB, biotoxin, and NWFSC re**  **search, and provides links to HAB newsletters and outreach materials.** 

**• United States Environmental Protection Agency,** 

**Drinking Water Contaminant Candidate List http://www.epa.gov/safewater/ccl/index.html**  **T his site provides information about EPA’s list of con**  **taminants that are not regulated, occur in public water systems, and may require regulation under the Safe**  **Drinking Water Act. Algae that can be harmful are on this list.** 

**• United States Food and Drug Administration, Cen** 

**ter for Food Safety and Applied Nutrition http://vm.cfsan.fda.gov/~mow/chap37.html**  **T his site provides detailed information on shellfish**  **associated toxins.**

**• W oods Hole Oceanographic Institution, National**  **Office for Harmful Algal Blooms,The Harmful Algae Page**  **http://www.whoi.edu/redtide/ T** **his site provides facts about HABs, maps of HAB dis tribution across the U.S., links to information about the**  **institution’s HAB research, and PDFs of management documents.** 


### State HAB Links

**• ECOHAB Pacific Northwest** 

**http://www.ecohabpnw.org/ T** 

**his site describes a five-year project, funded by NOAA and directed by several universities in the Pacific North** 

**w est, to study the physiology, toxicology, ecology, and**  **oceanography of toxic Pseudo-nitzschia**  **species off the P** 

**acific Northwest coast.**

**• Gulf of Mexico Coastal Observing System** 

**http://www-ocean.tamu.edu/GCOOS/ T** **his site promotes establishment of a sustained ob servation system for the Gulf of Mexico.** 

**• M id-Atlantic Sea Grant Programs** 

**http://www.pfiesteria.seagrant.org/index.html T** 

**his site provides links to HAB-related projects funded by**  **WHOI in New York, New Jersey, Maryland, Delaware,Virginia, and North Carolina.** 

**• North Carolina Department of Health and Human** 

**Services, Occupational and Environmental Epidemiology program**  **http://www.epi.state.nc.us T** **his site provides information on Pfiesteria**  **and blue green algae.** 

**• Purdue University, Indiana: “Cyanosite”** 

**http://www-cyanosite.bio.purdue.edu/ Th**  **is site is a purely scientific site focused on cyanobac terial taxonomy and biochemistry, but it is also an ex**  **cellent source for referencing and research links.**

**• W isconsin Department of Natural Resources**  **http://dnr.wi.gov/lakes/bluegreenalgae/ T** 

**his site addresses blue-green algae and related public health concerns. It describes the findings of a two-year**  **monitoring program developed by the Wisconsin DNR.**


### Florida HAB Links

**• F DEP, Bureau of Laboratories**  **http://www.floridadep.org/labs/hab_info.htm T** **he FDEP protects, conserves, and manages Florida’s natural resources and enforces the state’s environ**  **mental laws.This site provides information on standard operating procedures for the collection and analysis of**  **cya nobacterial samples.** 

**• FDOH, Aquatic Toxins Program** 

**http://www.doh.state.fl.us/environment/community/aq uatic/index.html**  **T**

**he FDOH ATP aims to protect Florida’s citizens and vis itors from HAB exposure or illness.This site includes in**  **formation on HABs in Florida,health effects of exposure, current research, and toxins hotline number.** 

**• FDOH, Bureau of Community Environmental** 

**Health, Food and Waterborne Illness Program http://www.doh.state.fl.us/environment/community/**  **foodsurveillance/index.html T** **he FDOH is dedicated to prevention, monitoring and** 6 | Outreach Resources**surveillance, and investigative activities related to food and waterborne illnesses, including effects of algal**  **toxins.**

**• FDOH, Florida Healthy Beaches Program** 

**http://esetappsdoh.doh.state.fl.us/irm00beachwater/de f** 

**ault.aspx T** **he FDOH performs water monitoring in coastal com munities to limit threats to human health from expo**  **sure to harmful microorganisms.**

**• FWC–FWRI, Harmful Algal Blooms** 

**http://research.myfwc.com FWRI is FWC’s research division that is dedicated to**  **protecting, conserving, and managing Florida’s fish and wildlife resources by providing timely information** **and guidance through effective research and techni cal knowledge.This site offers information on HABs in**  **Florida including basic facts, current research, bloom**

**ev ents, red tide status, and archives.** 

**• MML, Red Tide** 

**http://www.mote.org MML is a private, nonprofit laboratory that aids in red** **tide monitoring and performs a variety of related re search such as developing new technology for moni**  **toring effects on human respiratory systems and marine-policy assessments. It also produces a report**  **of real-time beach conditions in regard to red tide along Florida’s west coast.** 
**• ST ART, Red Tide**  **http://www.start1.com START is a non-profit organization dedicated to pro**  **moting efforts for control and mitigation of red tide in an environmentally responsible manner and commit**  **ted to education outreach as its primary mitigation strategy.** 

**• University of Miami Rosenstiel School, Oceans** 

**and Human Health Center http://www.rsmas.miami.edu/groups/ohh/index.htm**  **T his site offers information on medical and ocean re**  **search conducted by U of M investigating the effects of humans on oceans and vice versa.The site provides**  **a list of the various research projects including those related to toxic HABs.** 



## Responding to the Press and Public **Adapted from U.S. EPA Gulf of Mexico Program report “Harmful Microalgae and Associated Public Health Risks**  **in the Gulf of Mexico”(Steidinger and Penta, 1999)** 

### Purpose

**T**

**he purpose of a press release is to distribute consistently accurate information about an event that affects or in** **terests the public.This assists the public in making in formed decisions regarding their health and way of life.**  **Wh en the public believes that an event (**  **e.g., a red** **tide or hurricane) threatens them, they want immedi ate information. All communications should address**  **• Who • What • When • Where • Why • How. If an event is unusual or unexpected, immediate** **information may not be available, but officials must re spond with as much information as is available. By**  **providing transparent, factual information, your agency can be a valuable resource for the public. First im**  **pressions are important. The following suggestions will help when you are involved in such an event.**  

### Preparation and Initial Response

**• Prior to an event, create a plan that identifies key con** 

**tacts.When an emergency situation occurs, the pre designated spokesperson should be provided with**  **all the relevant information. Announce the identity and function of the spokesperson to your agency**  **and to any relevant partner agencies.**

**• Expect media contacts before you are completely** 

**ready for them. Have an action plan that predefines communication networks, spokespersons, commu**  **nication formats and other regional contacts. Tell the first inquirers that you are aware of the situation,**  **y our agency is considering how to proceed, and by** **a certain time a spokesperson will have informa tion available. Always return calls and provide in**  **formation—it is important to establish credibility with reporters. Even if you do not have all the in** **formation you would like, make the contact and ex plain what you do know at that time.**  **• I nv**  **estigative team leaders should meet with the**

**spokesperson and decide on guidelines about infor mation distribution.This step will vary with the event;**  Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 51

**.** 6 | Outreach Resources**FDOH image**

**Refrigerator magnet for the Aquatic Toxins Hotline**Public Health Response to HABs Abbott et al.

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**.** 6 | Outreach Resources

**it includes answering anticipated questions, listing outside referral sources, outlining a timetable of the**  **immediate investigation, and assigning someone to research historical events of a similar nature. This**  **will enable team members to know what is needed and assist the spokesperson in explaining what is**  **happening to the news media and the public.**

**• Refer all contacts to the spokesperson. Explain to any** 

**reporter that, on a temporary basis, all contacts are going to [**  **insert name ] because (s)he is the only per** **son who currently has complete and accurate in formation. It is crucial that the reporter be given the** **most reliable information. If your team is well coor dinated, the spokesperson is the person with the**  **most reliable information. A great deal of time and energy is wasted on refuting inaccurate (but usually** 

**w ell-intentioned) information. A disorganized ef**  **fort benefits neither the agency nor the public—the agency loses credibility with the public, and the**  **public remains confused.**

**• Emphasize to all team members that information** 

**MUST be sent RAPIDLY to the spokesperson. A**

**w ell-informed and available spokesperson will en** **hance the effectiveness of the research team be cause the team will have more time to focus on the**  **scientific investigation.** 

### On-Going Events

**T he first few days are often characterized by numer**  **ous inquiries about the status of the event; the spokesperson will probably spend a great deal of time** **responding to these inquiries and receiving new in formation. However, after the initial deluge of infor**  **mation requests, the spokesperson is often more effective as someone who summarizes incoming in**  **formation and disperses it to a number of interested parties, who then redistribute it as needed. For exam**  **ple, the spokesperson can e-mail a daily status report to other government agencies, regulatory commis**  **sions, government officials, or media sources. Timely W**  **eb site updates can also be useful in disseminating crucial information.**  **Giving the public access to accurate information will relieve some of the burden for the initial investi**  **gating agency because questions can be answered by remote sources instead of being referred to the primary**  **agency and spokesperson. It also keeps misinformation to a minimum.**  **T he obvious disadvantage to this type of arrange** **ment is that some incorrect information may be in troduced. However, the advantages of providing useful**  **information and generating goodwill with partner agencies generally outweigh the disadvantages of oc**  **casional misinformation. Employees should always refer callers to the con** **tact listed on the status report, especially if they can not answer specific questions. Agency managers must**  **emphasize to their employees that information should only be provided when the information has been con**  **firmed; if the employee is not certain, the inquiry should be referred to someone who has relevant in**  **formation. Other useful communication tools include the following:**  **• F requently Asked Questions (FAQs) sheets for any** 

**one who answers incoming calls (see http://www. my** **floridaeh.com, under Aquatic Toxins; see Fig ure 6.5).**  **• B rochures that can be left at various locations (**  **e.g.,**

**piers, bait houses, hotels) or distributed to local agencies such as Chambers of Commerce (see**  **http:// www.myfloridaeh.com, under Aquatic Toxins; see**  **Figure 6.6). • F** **act Sheets that can be easily generated in-house via**

**desktop publishing systems to meet unexpected or rapidly changing needs (see http://www.myflori**  **daeh.com, under Aquatic Toxins).** 

## Developing an Effective Press Release

**News releases may be generated as needed. Although press releases are useful tools used by many organi**  **zations to announce new initiatives, research results, and status reports that are newsworthy, they may not be ef**  **fective for unusual, on-going events like HABs. Their**

**ov erall effectiveness in these situations is debatable. Pos**  **sible reasons for this argument include the following. • W**  **ithin governmental agencies, it often requires hours (sometimes as many as 24–48 hours) to pre**  **pare and process a release through the necessary managerial and scientific approvals. If any of these**  **approvals are bypassed for expediency, the release may suffer and convey inaccurate information.** 

**• Reporters rarely use only the release information;** 

**they usually make a personal contact. Staff time is required for both release preparation and follow-up**  **explanation.**

**T he following examples demonstrate how a poor**  **press release can be effectively improved using a few simple guidelines. Figures 6.1–6.4 are examples of var**  **ious types of HAB-related public health releases issued between 2003 and 2006, including new releases, press**  **releases, and health advisories.**

### Example of a Poor Press Release

PROPOSED PRESS RELEASE **Gulf coast beaches are currently being affected by a red tide. Red tides have occurred in Florida since the 1500s.**  **Th ey**  **cause fish kills and respiratory irritation and have been known to last as long as 18 months. Red tides**  **may occur in places other than Florida; in fact, those in New England and off California and Alaska have**  **been responsible for the deaths of marine animals and humans. The Florida Department of Agriculture** **and Consumer Services has closed shellfish-harvest ing areas along the entire southwest coast of Florida**  **until further notice.**
HOW CAN THIS RELEASE BE MORE EFFECTIVE? **• A lways answer who,what,when,where,why,and how.** 

**• Present specific information about the current event.** 

**Indicate what occurred (fish kills, water discoloration, respiratory irritation), where and when it occurred,** **and who is responding. Example: On Saturday morn ing, hundreds of dead mullet and catfish washed**  **ashore on St. Pete Beach. FWC researchers responded to investigate the cause of the fish kill.**  **• I dentify the effect on the public. Health effects are** 

**generally the public’s (and reporter’s) first concern. How humans are affected (**  **e.g., ingestion of conta**  **minated seafood, respiratory irritation, aesthetics of dead fish and smell) should be clearly identified.**  **• Av oid alarmist and irrelevant information. Stick to** 

**the facts about this occurrence. Provide common sense, nonalarmist information.** 

**• Provide only necessary, uncontroversial and well** 

**documented information. Be prepared to provide historical, supplementary information for those re**  **porters who do in-depth or human-interest articles. • Av** **oid speculation—it can be misleading.**

**• Press releases should always include the name and** 

**phone number of a contact person.**

**• Quotes are building blocks for news stories. Reporters** 

**prefer press releases that contain at least one quote by**  **a reliable source from the distributing agency.** Abbott et al. Public Health Response to HABs

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**.** 6 | Outreach Resources



### Example of a Good Press Release

**[ insert date** **] [**  **insert headline ]**  **Contact: [ insert name** **] [ insert phone number**  **]**
**Hundreds of dead mullet and catfish washed ashore on St. Pete Beach Monday morning, prompting the** **Florida Department of Agriculture and Consumer Ser vices (FDACS) to close local shellfish harvesting areas** **as researchers from the Florida Fish and Wildlife Con servation Commission’s (FWC) Fish and Wildlife Re**  **search Institute (FWRI) pointed to Florida’s red tide as the cause.** **“Laboratory tests on the St. Pete Beach water sam ples we took showed that cell counts of the red tide or**  **ganism were much higher than normal and were high enough to cause fish kills,”said [** **insert name ], [** **insert title ].**  **T he southwest Florida coast is no stranger to red**  **tides, a natural phenomenon caused by the tiny alga called**  **Karenia brevis (**  **K.brevis ).Florida red tides have been**  **reported for over 160 years and thought to date back to the 1500s.They usually start offshore, occur in the late**  **summer or fall, and last only a few months. K. brevis**  **is always present in Gulf waters in low concentrations, but** **when it blooms or grows in patches with higher-than normal concentrations, a red tide occurs.**  **Th e shellfish harvesting ban from Tarpon Springs** **to Charlotte Harbor means you should not eat regu lated shellfish (hard clams, oysters, coquinas) or other**  **mollusks from these areas. They accumulate red tide toxin (brevetoxin), which may cause various levels of**  **gastrointestinal and neurological distress in those who eat them. Asthma sufferers and those with other res**  **piratory problems are also urged to stay away from beaches in these areas because respiratory discom**  **fort may be associated with red tides. It is too early to tell how this red tide event com**  **pares to the other red tides Florida has experienced, FWC officials said Monday afternoon. FWC researchers**  **will continue monitoring offshore and inshore waters. FDACS will lift the harvesting ban when FWC labo**  **ratory tests show that the shellfish are safe to eat, [ in**  **sert name ] said.**  **F or more information about Florida red tide, visit**  **the Florida Department of Health Aquatic Toxins Web site at www.myfloridaEH.com or the FWRI Web site at**  **http://research.MyFWC.com.**Public Health Response to HABs Abbott et al.

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Figure 6.1 **Example 1—Sample news release.** 

# Lee issues advisory to avoid red-tide shellfish **By Michelle L. Start mstart@news-press.com**  **Originally posted on July 19, 2006**

**T he Lee County Health Department is warning people to stay away from red-tide contaminated shellfish**  **after 11 visitors became ill from eating clams they harvested this month. No local residents have become sick.**  **Officials said six of the people were so ill they were admitted to hospital intensive care units and the neurotoxic outbreak constitutes an epidemic.**  **Symptoms of the illness include numbness, tingling in the extremities, gastrointestinal symptoms and difficulty speaking and walking. People who experience these symptoms after ingesting contaminated**  **shellfish should seek medical care immediately. “These were people visiting here on vacation who were catching their own clams and cooking them,”**  **said Lee County Health Department Director Dr. Judith Hartner.“So far, they have only been harvesting and eating clams, but people should also avoid mussels, oysters and scallops if you can find them.”**  **Lee County Visitor and Convention Bureau Deputy Director Tamara Pigott said it is nearly impossible to measure the impact the outbreak will have on tourism.**  **Hartner said the neurotoxic outbreak can be traced to red tide, which is caused by the organism Kare**  **nia brevis, or**  **K. brevis. “Even when the algae is in very low concentrations, it can still contaminate the shellfish, which con**  **centrate the toxins in their bodies,”she said. Pigott said the bureau is distributing the health department’s notice and hoteliers are sharing the in**  **formation with guests. “Visitors are not educated about our waters,”she said.“Locally, we’re very aware of red tide. We don’t**  **harvest shellfish and we know we’re not supposed to eat them during red tide.” Eating shellfish at restaurants is safe, officials said.**  **Of the 11 people sickened, 10 became ill with clams gathered in Sanibel. Sanibel is delivering notices to every home, calling every listed telephone number, distributing fliers at**  **the bridge and giving out notices at the visitor center. T** **he other case was at Fort Myers Beach. Beach Seafood Market owner Dennis Henderson said he worried the outbreak could have an impact**  **on his business, although it shouldn’t.**

**“ All of the people we buy clams from and even the one outfit here in Pine Island are regulated by the** **state,”said Henderson, whose market is located on Shrimp Boat Lane in Fort Myers Beach.“They do qual ity checks on the beds every week.When there is red tide, they have other beds upstate and in the Panhandle**  **where they harvest. I know what we get is safe.” He said those looking to purchase shellfish should buy from a licensed vendor.** Abbott et al. Public Health Response to HABs

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**.** 6 | Outreach Resources

Figure 6.2 **Example 2—Sample health advisory/press release.**Public Health Response to HABs Abbott et al.

56 FWRI Technical Report TR-14

**.** 6 | Outreach Resources

Figure 6.3 **Example 3—Sample health advisory/press release.**Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 57

**.** 6 | Outreach Resources

Figure 6.4 **Example 4—Sample health advisory/press release.**Public Health Response to HABs Abbott et al.

58 FWRI Technical Report TR-14

**.** 6 | Outreach Resources

Figure 6.5 **Example 5—Frequently asked questions about Florida red tide and their toxins.** (continued next page)Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 59

**.** Figure 6.5 **Example 5—Frequently asked questions about Florida red tide and their toxins. (continued)** 6 | Outreach ResourcesPublic Health Response to HABs Abbott et al.

60 FWRI Technical Report TR-14

**.** 6 | Outreach Resources**Red Tide Alliance image**

Figure 6.6 **Example of red tide facts handout, side 1.**FWRI Technical Report TR-14 61

**.** Abbott et al. Public Health Response to HABs 6 | Outreach Resources**Red Tide Alliance image**

Figure 6.6 **Example of red tide facts handout, side 2.**62 FWRI Technical Report TR-14

**.** 

## Mitigation Activities
**Mitigation can be defined as “...minimizing HAB im pacts on human health, living resources, and coastal**  **economies when they do occur...”(NOAA, 2001).These activities can take place before, during, or after an** 

**ev ent. Specific measures designed to address each** **stage of a HAB event should be identified and com bined with ongoing actions or “preparedness.”CHDs**  **should identify a local focal person to coordinate work with various statewide agencies conducting mitiga**  **tion activities. V** 

**arious management strategies for the mitigation of HABs exist from activities aimed at preventing and**  **physically controlling blooms to activities focused on reducing the negative effects of HABs and their toxins** **on environmental and human health. Prevention strate gies are used to avoid the occurrence of, or minimize**  **exposure to, HABs. Presently, strategies for preventing “events” are limited. Research is focused on deter**  **mining the technological feasibility of enhancing HAB prevention capabilities statewide. Additional preven**  **tion activities include regulating nutrient inputs from human land-based activities to minimize bloom growth** **and regulating ballast water releases to reduce HAB in troductions or global expansion. HAB control strate**  **gies include activities to reduce or contain the bloom populations or their effects, and involve direct inter** 

**v entions during HAB events for the purpose of elim**  **inating toxic or harmful cells or inhibiting their growth. As with prevention strategies, many control strategies**  **are being tested for their effectiveness and their effects on the environment. Such strategies include mechan** **ical, chemical, and biological control methods. Exam ples of control methods to remove cells or toxins**  **include using pumps and filters, clay flocculation, or introducing natural predators such as parasites**  **(Sengco, 2009). Other HAB mitigation strategies being used focus**  **on monitoring, forecasting, and early detection or**

**w arning systems; analysis of hazard-related data;**  **and information dissemination (Heil and Steidinger, 2009). Mitigation emphasis is on the education of**  **government entities, private sector businesses, and the general public regarding measures they can all take**  **to reduce harmful effects. Modeling and forecasting are used to provide a system for predicting HABs**  **such as Florida red tides. With these predictions, shellfish harvesting areas can be selectively moni** **tored, the public can plan ahead, and regulatory agen cies, local governments, and businesses can** **implement contingency plans (Heil, 2009). Monitor ing beaches and harvesting areas to allow warning of**  **outbreaks such as red tide cough or food poisoning incidents promotes public safety and is the most ef**  **fective mitigation method to date. HAB education is crucial for raising awareness about the health risks as**  **sociated with shellfish consumption and beach-going, and on the environmental effects of blooms on aquatic**  **ecosystems. T** **he FDOH, through CHDs, issues health advi sories based on local needs. Press releases are the** **mechanism through which most CHDs disseminate in formation on health risks related to current HAB** 

**ev ents. Press releases are usually picked up by local**  **media outlets including television, newspapers, and radio. In some cases, national media has also used**  **these releases to report on conditions. In rare instances, the FDOH Central Office has issued press releases**  **(see Outreach Resources Chapter 6 for examples of health advisories and press releases).**  **Methods for restoring damaged aquatic resources after bloom dissipation are also being investigated as** **a final step in the mitigation of HAB events. Restora tion involves returning the site to its pre-bloom status.**  **Restoration activities include testing and reopening shellfish beds, cleaning up beaches by removing dead** **fish or other animal carcasses, or relocating and reha** 

# Chapter 7 Management Strategies for Mitigation of HABs

Purpose To describe management strategies for mitigating HABs in Florida.

**T**

**he following contains general background information describing HAB mitigation activities such as prevention and reduction of human exposures and reduction of bloom activity. Activities may include research aimed at bloom prevention or control**  **or mitigation through information dissemination such as issuing press releases or health advisories to increase public awareness of an event and reduce adverse human exposures.** FWRI Technical Report TR-14 63

**. bilitating affected animals. Currently, carcasses from**  **massive fish kills are relocated to landfills or buried under tons of sand with bulldozers; this is usually** **done by local governments.The development of strate gies to remove and safely dispose of dead fish and** **other species is necessary because recreational activ ities are dependent on aesthetically clean beaches and**  **a healthy coastline environment. T** **he FDACS has identified four possible mitigation strategies for managing shellfish harvesting areas**  **threatened by K. brevis**  **blooms, including reclassifying new areas for separate monitoring and management,**  **and periodic random brevetoxin testing of hard-clam processing facilities and lease areas for potentially**  **limited quarantine (Heil, 2009).**


## The Red Tide Control and Mitigation Program

**In 2006 the Florida Legislature provided a recurring gen eral revenue appropriation of $4,014,449 to FWC–FWRI**  **to support red tide research.The legislative funds were dedicated as supplementary funds following a $4.73 mil** **lion award from NOAA’s ECOHAB program to inves tigate the role of nutrients in bloom dynamics and**  **possible causes of red tide blooms.The Florida statute, 379.2272 (formerly 370.06093), charges FWRI with im** **plementing “a program designed to increase the knowl edge of factors that control harmful algal blooms,**  **including red tide, and to gain knowledge to be used for the early detection of factors precipitating harmful**  **algal blooms for accurate prediction of the extent and seriousness of harmful algal blooms and for under** **taking successful efforts to control and mitigate the ef fects of harmful algal blooms....The goal of this program**  **is to enable resource managers to assess the potential for public health damage and economic damage from**  **a given bloom and to undertake control and mitigation efforts through the development and application of an** **integrated detection and prediction network for mon itoring and responding to the development and move**  **ment of harmful algal blooms in Florida marine and estuarine waters.”** **Of the appropriated funds, $1,000,000 was desig nated directly to the Red Tide Control and Mitigation**  **Program. The majority of these funds are granted to research efforts directed towards environmentally**  **friendly techniques or technologies for controlling or reducing the spatial and temporal coverage of**  **Florida red tide blooms caused by K. brevis** **; control ling or reducing the toxicity of**  **K. brevis; and mini**  **mizing the effects of Florida red tide on public health, environmental health, and natural resources. Other**  **mitigation strategies focus on reducing the economic and social effects of Florida red tide blooms. These** **funds are disbursed annually to a variety of re searchers, including government entities, universities,**  **and other organizations involved with HAB research on the economic, social, environmental, natural** **resource, and public-health effects of red tides. How**

**ev er, legislative budget cuts that began in 2008**  **threaten the program’s future. FWC image**  Abbott et al. Public Health Response to HABs 7 | Management Strategies for Mitigation of HABs

**Beach cleanup of dead fish following a red tide**64 FWRI Technical Report TR-14

**.** 

## Florida HAB Public Health Research Needs
Clinical

**T here are few methodologies to document exposures**  **to HAB-related toxins.The need for the identification of human biomarkers related to dose and response are**  **just beginning to be recognized.There is a crucial need to determine the relationship between exposure dose**  **and adverse health outcomes and illness. • D**  **ev elop tools for clinical diagnostic support in** 

**cluding urine and blood tests.**

**• Assess the potential of algal toxin exposures to cause** 

**acute and long-term health effects.**


### Human and Animal Surveillance
**In order to assess public health impacts related to HABs, it is imperative to develop tools to identify HAB** **associated cases from a variety of sources, including hos pitals, emergency departments, stand-alone clinics,** **general practitioners, and entities other than tradi tional health care providers.This effort will include the**  **partnering of the FDOH Central Office and local CHDs with health care providers, other agencies with com** **munity contacts, and specific ethnic entities that are out side of the usual public health lines of communication.**  **T he use of animals as sentinel systems is also relevant** **and has a number of public health precedents in out break response and mitigation.** 

**• Provide reportable disease training to health care** 

**providers that includes NSP, PSP, SPFP, and CFP. • D**  **ev elop early-warning systems and identify sen** 

**tinel animal species that can be used to minimize human exposure to biotoxins.**  **• Assess community vulnerability to HAB-associated**  **public health risks.**

**• Improve data-sharing capabilities for identifying** 

**HAB-related disease outbreaks.**


### Environmental

**T he ability to assess ecological conditions associated** **with the development and persistence of HABs is es sential to gaining a better understanding of their po**  **tential to affect human health.The presence of toxins at very low levels is just beginning to be appreciated**  **for their potential chronic health effects. Methods to prevent and mitigate the effects of HABs and their** **toxins on humans can be greatly improved by epi demiological and environmental studies and through**  **predictive modeling.**

**• Improve monitoring, detection, and documentation** 

**of the occurrence of cyanotoxins in drinking and recreational waters.**  **• D etermine what environmental or genetic factors** 

**stimulate toxicity in HABs.**

**• Determine to what extent HAB toxins accumulate in** 

**the food chain.**

**• Determine whether aquatic animals and/or humans** 

**are at risk if exposed to cyanotoxins.**

**• Determine whether cyanotoxins have prolonged ef** 

**fects on aquatic habitats. • C**  **onduct research on possible adverse effects of cur**

**rent water treatment methods and control measures for cyanobacterial HABs (**  **e.g., v** **ariability in toxin production and possible toxin production from**  **spraying chemical treatment). • D**  **ev elop effective mitigation and control efforts for** 



## ° **the removal of toxins from drinking water sources**

**and recreational systems, and** 

# Chapter 8 Research Needs

Purpose To identify priority research and policy needs for HABs in Florida.

**T**

**here is a world-wide effort to monitor and assess the ecological and public health effects of HABs. Many countries and their governmental agencies, along with a multitude of research and development facilities, are developing analytical laboratory**  **methods and rapid field kits for phycotoxin detection, conducting epidemiological studies on the effects of HABs and their toxins on humans and natural resources, conducting ecological and molecular surveys to identify HABs and their toxin dis**  **tribution in biota, and performing in vivo and in vitro toxicology studies through biological assays. There are international and national perspectives regarding the focus on specific HAB species, but many of these efforts have direct application to**  **HABs occurring in Florida. T** 

**he following list (in no specific order) summarizes some priority public health research and policy needs for HABs in Florida as identified in the accompanying resources.** Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 65

**.** 

## ° **improved control and treatment methods for**

**affected waters.**

**• Assess the public health threat from other known** 

**(but minimally studied) HAB genera in Florida ( e.g.,**  **Cylindrospermopsis, Prorocentrum ).** 

**• Assess public health risks associated with the recre** 

**ational harvesting in closed areas of shellfish species that have become toxic from red tide and other Florida**  **HAB endemic species ( i.e., K. brevis, P. bahamense**  **).**



### Laboratory
**Our understanding of both the ecology and public health effects of HABs have been greatly enhanced due** **to improvements in analytical and molecular method ologies for studying the environment. Automated in**  **strumentation, simplified molecular probes, and establishment of consistent detection and quantita** **tion limits have resulted in the determination of envi ronmental concentrations of toxins, identification of**  **HAB organisms implicated in toxin production, and analysis of how the affected biota can further affect pub**  **lic health. Further refinement of existing technologies, together with the development of innovative new pro**  **cedures, will enable faster detection of HABs and their toxins and lead to better response capability.** 

**• Incorporate validated and rapid field and/or labo** 

**ratory detection methods for the following:**



## ° **Cyanotoxins: enzyme-linked immunosorbent**

**assay (ELISA) tests dramatically increased the ability of laboratories to detect cyanotoxins. How** 

**ev er, these are not universally available for all im**  **portant cyanotoxins. Standardized methods and interlaboratory calibration procedures are needed**  **to ensure the reliability and validity of results.**



## ° **Saxitoxins: Although rapid methods for STX analy**

**ses are available, few Florida laboratories have the sophisticated capabilities required for definitive**  **confirmation.Recent development of an easy-to-use molecular assay (ELISA) should allow increased** 

**ev aluation of both animal and plant tissue.** 



## ° **Brevetoxins: Currently, MBA is the only method**

**approved for detecting NSP toxins, and state and federal governments require this information in**  **order to regulate the closing and reopening of shellfish beds for harvest. The ELISA molecular** **technique for detecting these toxins needs fur ther development and documentation to support**  **its use as a rapid and more cost-effective tool for shellfish regulation and management.** 



## ° **Ciguatera: Currently only federal laboratories can**

**do confirmative testing; enhanced capabilities in state laboratories are desirable.This would allow**  **faster and better identification of ciguatoxic fish or reefs at risk and reduce the chance of affected fish**  **entering the food supply. • D**  **ev elop automated methods for organism identifi** 

**cation: the use of molecular probes would make identification of HAB species much easier. These**  **techniques, as well as automated toxin assays, may be possible to incorporate into automated instru**  **ments to assess environmental samples remotely.**


## Public Health Policy Needs, Applications for HAB Research

**• D ev**  **elop action levels for the presence of algal tox**

**ins and incorporate them into water-quality stan dards for both drinking and recreational waters.**  **• D ev**  **elop county-specific response plans addressing**

**pertinent HABs to protect public health. • D**  **ev elop effective outreach and education efforts to** 

**increase public awareness of and medical profi ciency in the treating of HAB-related illness.** 

**• Assess the need to distribute and ability to maintain** 

**proper and consistent signage to inform the public of HAB events.** 



## Identified Resources

**• ANDERSON, D. M., ed. 1995. ECOHAB,The Ecology** 

**and Oceanography of Harmful Algal Blooms: A Na tional Research Agenda.Woods Hole Oceanographic**  **Institution, Woods Hole, Massachusetts. 66 p.**
**• BA UER, M., ed. 2006. Harmful algal research and**  **response: A human dimensions strategy. National Office for Marine Biotoxins and Harmful Algal**  **Blooms, Woods Hole Oceanographic Institution, W**  **oods Hole, MA. 58 p. Available at http://www. coastalscience.noaa.gov/stressors/extremeevents/**  **hab/HDstrategy.pdf**

**• BOESCH, D. F., D. M. ANDERSON, R. A. HORNER,** 

**S. E. SHUMWAY, P. A. TESTER, and T. E. WHIT LEDGE. 1997. Harmful algal blooms in coastal wa**  **ters: options for prevention, control, and mitigation. Special joint report with the National Fish and**  **W ildlife Foundation. U.S. Department of Commerce,**  **National Oceanic and Atmospheric Administration, Coastal Ocean Office. NOAA Coastal Ocean Program**  **Decision Analysis Series No.10. 49 p.**

**• DORTCH, Q., D. ANDERSON, D. AYRES, and P.** 

**GLIBERT (eds.). 2008. Harmful Algal Bloom Re search, Development, Demonstration and Technol**  **ogy Transfer: A National Workshop Report. Woods** 8 | Research NeedsPublic Health Response to HABs Abbott et al.

66 FWRI Technical Report TR-14

**. Hole Oceanographic Institution, Woods Hole, MA.**  **Av ailable at http://www.whoi.edu/fileserver.do?id**  **=43464&pt=10&p=19132**

**• HEIL, D. 2009.**  **Karenia brevis monitoring, manage** 

**ment, and mitigation for Florida molluscan shellfish harvesting areas. Harmful Algae 8(4): 608–610.**  **• RAMSDELL, J. S., D. M. ANDERSON, and P. M.**  **GLIBERT (eds.). 2005. HARRNESS: Harmful Algal Research and Response: A National Environmental**  **Science Strategy 2005–2015. Ecological Society of America, Washington, D.C. iv + 89 p. Available at**  **http://www.esa.org/HARRNESS/harrnessReport 10032005.pdf**  8 | Research Needs**Image: Kevin McMahon, NOAA-CCMA**

**A vailable at http://www.coastalscience.noaa.gov/stressors/extremeevents/hab/HDstrategy.pdf** FWRI Technical Report TR-14 67

**.** 

## Definition
**A flowchart is a graphical representation of a process; it is designed to show the possible actions and out** **comes involved. It should serve as a roadmap, ensur ing that the process will be able to respond to every**  **possible outcome.** 

## Purpose of Flowcharts **Adapted from Flowchart Tutorial, EDraw Flowchart Software**
**Flowcharts are useful management tools when devel oping preparedness plans. During the initial plan**  **ning, finalizing the flowchart process may take up to one month; following initial design, charts should be**  **updated once a year or as necessary. Flowcharts can help to**  **• d etermine whether the steps in a process are logical;** 

**• uncover problems,gaps,bottlenecks,weak links,poorly** 

**defined steps, and possible miscommunications;**

**• define the boundaries of a process; and**  **• d ev**  **elop a common understanding about a process.**
**Benefits of Flowcharts • T** **hey promote understanding of the process by ex**

**plaining steps pictorially. • T** **hey provide a tool for training employees. • T** **hey identify problem areas and opportunities for**

**improvement and/or ways to streamline activities. Pre-flowchart Steps** 

**• Identify the right people to develop the chart.**  **• D etermine what you expect to get from the chart.** 

**• Identify who will use it and how.** 

**• Define the level of detail you want.** 

**• Establish the boundaries of the process to be im** 

**proved (limits or how far you want to go into the process).** 

**T**

**ips**

**• Observe the current process (start with the process** 

**as it is, then focus on how the process “should be”). • D**  **raw the flowchart after you have written the process**

**steps.** 

# Chapter 9 Activity Flowcharts

Purpose To present a methodology for developing flowcharts for responding to the various types of HAB events in Florida. To provide the user with sample flowcharts for modification and use at the local level.

**T**

**he following contains general information for developing flowcharts and provides both sample flowcharts of existing operations and case histories of event responses for guidance in developing response plans at the local level for HAB events.** 

## Sample Flowcharts

**T**

**he FDOH provides technical assistance to counties in terested in developing locally appropriate flowcharts.**  **Figures 9.1–9.6 are examples of existing operations and/or investigation methods that have been used in**  **response to events.The FDOH investigates food-borne illness outbreaks by using the epidemiological oper**  **ations flowchart shown in Figure 9.1. These include investigations of HAB-related illnesses from con**  **sumption of contaminated shellfish.** 

### Flowchart for Blue-Green Algae or Cyanobacterial Bloom Response (Figure 9.2) Step Description **Adapted from Proceedings of Health Effects of Exposure to Cyanobacteria Toxins: State of the Science,August 13–14,2002.** 

**T he FDOH, alongside other interagency response ef**  **forts, is working with CHDs to develop standard in**

**v estigation methods for blue-green algae or cyanobac**  **terial blooms.This includes investigation of blooms for preventive measures, such as beach closures, as well**  **as for illness from exposure to contaminated water.**

MONITORING **STEP 1 Vi**  **sually monitor water treatment plant and/or water body for blue-green algae or cyanobacterial bloom**  **development. Water bodies should be considered for monitoring based on susceptibility to algal blooms.**  **Monitoring activities may be increased during peak seasons. If a bloom develops, proceed to Step 2. Some**  **public water treatment plant facilities using surface**

**w**

**ater for source water have instituted a testing program based on their historical experience in dealing with**  **cy anobacteria. At times, the testing is initiated in re**  **sponse to complaints of bad odor or taste; others use** Public Health Response to HABs Abbott et al.

68 FWRI Technical Report TR-14

**.** Figure 9.1 **Foodborne illness flowchart, Florida Department of Health investigation methods.** 9 | Activity FlowchartsAbbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 69

**.** 9 | Activity Flowcharts

Figure 9.2 **Flowchart for blue-green algae or cyanobacterial bloom response for water treatment plants and water bodies in Florida (recreational and other).** Public Health Response to HABs Abbott et al.

70 FWRI Technical Report TR-14

**.** 9 | Activity Flowcharts

**visual monitoring of the surface water body to iden tify a pending bloom and start analyses when scums** **start to form. There are no required or regulation directed protocols in place at this time.** 

**STEP 2 Sample raw or treated water for toxins and algal iden** **tification. For high-risk areas, this step may be con ducted on a routine basis depending on the level of**  **concern and the available resources in the county. A field test kit (currently in development by a number of**  **research institutions) could be used as a screening tool to determine the presence or absence of toxins in** **the water supply. FDEP’s standard operating proce dures for sampling for cyanobacteria can be found at** **ftp://ftp.dep.state.fl.us/pub/labs/biology/hab/cyanobac teria_sop.pdf** 

**STEP 3 Send raw or treated water samples for cyanotoxin analy** **ses to a recognized analytical laboratory for confirma tory analysis.This step may be combined with Step 2.** 

**STEP 4 Laboratory provides results of sample testing to local**  **agency.**

**STEP 5 Local agency contacts FDOH’s ATP Coordinator re**  **gardless of test results. The information will be used to assist with statewide surveillance efforts and con**  **tribute to a better understanding of HABs. Based on results, the local agency, together with the ATP, will**  **make a decision on whether to proceed to the “alert” phase.** 

ALERT **STEP 6 A** 

**TP Coordinator initiates the call-down phone and/or email list for blue-green algae bloom response con**  **sultation. Members of the call-down phone and/or email list provide consultation and arrive at decision**  **concerning the type of action to be taken. This is a**

**v aluable step to identify additional resources to sup** **port local efforts and determine roles and responsi bilities of agencies involved.** 

A

CTIVATION **STEP 7 Both risk communication and corrective action may be**  **taken in Step 7. Decisions on which actions are to be taken will be determined through the consultation**  **process.**

**STEP 8 Resampling of water should be conducted to determine**  **whether response efforts to blue-green algae should remain activated. If no improvement in toxin or or**  **ganism levels is observed, efforts should continue back at Step 6.** 

DEACTIVATION **STEP 9 If results of resampling demonstrate an improvement** **in the levels, the effort should be deactivated. Deacti**

**v ation can include notification of improved conditions**  **( e.g.,**  **press release) or simply a return to Step 1.**


## Examples of Case-History Event Responses

**At the 2006 coordinating meeting of the FHABTF Pub lic Health Technical Panel, various examples of previous** **HAB case-history event responses were described. Fig ures 9.3 through 9.6 on the following pages summarize**  **notification and response flow charts to these events as**

**w ell as identify some of the challenges and difficulties**  **that were encountered. Notification groups could include the regional epi**  **demiologist, FDACS, FDEP, FDOH–ATP, FWC,WMDs, health care workers, the media, and related industries**  **(see Chapter 2, Agency Responsibility Matrices, and A** **ppendix I for interagency contacts).**Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 71

**.** 9 | Activity Flowcharts

Figure 9.3 **Neurotoxic shellfish poisoning event in 2006.**Public Health Response to HABs Abbott et al.

72 FWRI Technical Report TR-14

**.** 9 | Activity Flowcharts

Figure 9.4 **Aerosol brevetoxin, red tide event.**Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 73

**.** 9 | Activity Flowcharts

Figure 9.5 **Shellfish poisoning event (general).**Public Health Response to HABs Abbott et al.

74 FWRI Technical Report TR-14

**.** 9 | Activity Flowcharts

Figure 9.6 **Saxitoxin puffer fish poisoning event 2002. ABBOTT, J. P., L. J. FLEWELLING, and J. H. LANDS**  **BERG. 2009. Saxitoxin monitoring of three species of Florida puffer fish. Harmful Algae 8(2): 343–348.** **ADACHI, R., and Y. FUKUYO. 1979. The thecal struc ture of the marine toxic dinoflagellate**  **Gambierdiscus tox icus**  **gen. et sp. nov. collected in the ciguatera-endemic area. Bulletin of the Japanese Society of Scientific Fish**  **eries 45: 67–71. AHMED, F. E., ed. 1991. Seafood Safety. National Acad**  **emy Press, Washington, DC. 432 p. ANDERSON, D. M., ed. 1995. ECOHAB, The Ecology** **and Oceanography of Harmful Algal Blooms: A Na tional Research Agenda. Woods Hole Oceanographic**  **Institution, Woods Hole, Massachusetts. 66 p. ANDERSON, D. M., Y. KAORU, and A. W. WHITE.** **2000. Estimated annual economic impacts from harm ful algal blooms in the United States. Woods Hole** **Oceanographic Institution Technical Report, WHOI 2000-11. 97 p.**  **ARTHUR, K. E., C. J. LIMPUS, C. M. ROELFSEMA, J. W.**  **UDY, and G. R. SHAW. 2006. A bloom of L** **yngbya ma juscula**  **in Shoalwater Bay, Queensland, Australia: an im portant feeding ground for the green turtle (**  **Chelonia mydas**  **). Harmful Algae 5: 251–265.**

**A**

**UBEL, M., P. D’AIUTO, A. CHAPMAN, D. CASA MATTA, A. REICH, S. KETCHEN, and C. WILLIAMS.**  **2006. Blue-green algae in St. Johns River, FL. Lakeline Summer 2006: 40–45.** 

**BA CKER, L.C. 2009. Impacts of Florida red tides on**  **coastal communities. Harmful Algae 8: 618–622.**

**BA CKER, L. C., L. E. FLEMING, A. D. ROWAN, and D.**  **G. B ADEN. 2003a. Epidemiology, public health and**  **human illnesses associated with harmful marine algae. Pp. 723–750**  **in G.**  **M. Hallegraeff, D. M. Anderson, and A. D. Cembella, eds. Manual on Harmful Marine Mi** **croalgae. Intergovernmental Oceanographic Com mission of UNESCO, Paris, France.** 

**BA CKER, L. C., L. E. FLEMING, A. ROWAN, Y. S.**  **CHENG, J. BENSON, R. H. PIERCE, J. ZAIAS, J. BEAN, G.**  **D. BOSSART, D. JOHNSON, R. QUIMBO, and D. G.**  **B ADEN. 2003b. Recreational exposure to aerosolized**  **brevetoxins during Florida red tide events. Harmful Algae 2: 19–28.**  **BA CKER, L. C., B. KIRKPATRICK, L. E. FLEMING,Y. S.** **CHENG, R. PIERCE, J. A. BEAN, R. CLARK, D. JOHN SON, A. WANNER, R. TAMER, and D. G. BADEN.** **2005. Occupational exposure to aerosolized brevetox ins during Florida red tide events: Effects on a healthy** 

**w orker population. Environmental Health Perspec**  **tives 113: 644–649.**

**B ADEN, D. G., L. E. FLEMING, and J. A. BEAN. 1995.**  **Marine toxins. Pp. 141–175 in**  **F. A. de Wolff, ed. Hand** **book of Clinical Neurology. Intoxications of the Ner**

**v ous System Part II. Natural toxins and drugs. Elsevier**  **Press, Amsterdam, the Netherlands.**

**B ADEN, D. G., K. S. REIN, M. KINOSHITA, and R. E.** **GAWLEY. 1990. Computational modeling of the poly ether ladder toxins brevetoxins and ciguatoxin. Pp.**  **103–114 in**  **T. R. Tosteson, ed. Ciguatera. Polyscience**  **Publishing, Quebec.**

**BAD YLAK, S., K. KELLEY, and E. J. PHLIPS. 2004. A de**  **scription of Pyrodinium bahamense**  **(Dinophyceae) from the Indian River Lagoon, Florida, USA. Phycologia 43:**  **653–657.**

**BA GNIS, R. 1968. Clinical aspects of ciguatera (fish** **poisoning) in French Polynesia. Hawaii Medical Jour nal 28: 25–28.** 

**BA GNIS, R., A. M. LEGRAND, and A. INOUE. 1990. Fol**  **low-up of a bloom of the toxic dinoflagellate Gam**  **bierdiscus toxicus on a fringing reef in Tahiti. Pp. 98–103**  **in E. Granéli, B. Sundstrom, L. Edler, and D. M. An**  **derson, eds. Toxic Marine Phytoplankton. Elsevier Press, Amsterdam.** 

**B ANNER, A. H., P. HELFRICH, and T. PIYAKARN**  **CHANA. 1966. Retention of ciguatera toxin by red snapper (**  **Lutjanus bohar ). Copeia 2: 297–301.** **BENSON, J. 1956.Tetraodon (blowfish) poisoning: A re port of two fatalities. Journal of Forensic Science 1:**  **119–126. BENSON, J. M., F. F. HAHN, T. H. MARCH, J. D. Mc** **DONALD, A. P. GOMEZ, M. L. SOPORI, A. J. BOUR DELAIS, J. NAAR, J. ZAIAS, G. D. BOSSART, and D. G.**  **B ADEN. 2005. Inhalation toxicity of brevetoxin 3 in**  **rats exposed for twenty-two days. Environmental Health Perspectives 113: 626–631.**  **BIGLER, W. 1999. Florida past—bizarre tales about**

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**.** 

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# APPENDICES90 FWRI Technical Report TR-14

**.** 

# Appendix A Maps of Specific Areas of Florida at High Risk for HAB Exposures (by County)

These four maps of potentially toxic HAB events have been included to help identify areas of Florida where specific HAB toxicity events most frequently occur. However, CHDs, FDOH, and PICs can get reports of human illness in a county where the seafood product was NOT harvested. For example, ciguateric fish have been caught in the Bahamas and taken back to the east coast of Florida. The reverse can also happen, such as in the case of New Jersey SPFP, in which fish harvested from the Indian River Lagoon were frozen and taken to New Jersey, where the human toxicosis occurred. When recording or investigating a case of seafood-related illness, it is critical to know where the product was harvested. (See Medical Fact Sheets Appendix B and Chapter 9 for additional details to aid in flowchart development and event response and case investigations).Abbott et al. Public Health Response to HABs

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**.** Appendix APublic Health Response to HABs Abbott et al.

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**.** Appendix AAbbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 93

**.** Appendix APublic Health Response to HABs Abbott et al.

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**.** Appendix A**.** 

# Appendix B Medical Fact Sheets and Case Definitions

FWRI Technical Report TR-14 95Public Health Response to HABs Abbott et al.

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**.** Appendix B

**Ve rsion 3 – 07/07/08** 
CA USATIVE AGENT: **Ciguatera fish poisoning (Ciguatera) is caused by the consumption of certain tropical and subtropical marine finfish that have accumulated toxins through their diet.These toxins, called ciguatoxins, orig**  **inate from certain species of dinoflagellates (algae) that colonize coral reefs.The toxins accumulate in increasing concentration through the food chain starting from herbivorous fish ingesting the algae and ending with the top** **carnivore species. Fish most often implicated in ciguatera include the groupers, barracudas, snappers, jacks, mack erel, and triggerfish.** 
SIGNS/SYMPTOMS: **Initial complaints typically include abdominal pain, nausea, vomiting, and diarrhea ac companied by progressive paresthesia, which first affects the areas of the mouth and later the extremities. Other** **symptoms include arthralgia, myalgia, blurred vision, muscular weakness, paradoxical temperature sensation (re**

**v ersal of hot and cold sensation), metallic taste, tooth pain, headache, vertigo, arrhythmia, bradycardia or tachy**  **cardia, and hypotension.There is poor understanding of chronic exposures and long term health impacts.**
ONSET/DURATION: **Initial symptoms appear within 1–24 hours of consumption of ciguatoxic fish with the de**

**v elopment of additional symptoms in 1–2 days. The illness often subsides within several days. However, in se** 

**v ere cases neurological symptoms may persist from weeks to months or, in rare cases, even years. Some recovered**  **patients have experienced recurrence of neurological symptoms months or years after recovery. Such relapses are frequently associated with changes in dietary habits or with consumption of alcohol.** 
DIAGNOSIS: **Diagnosis is based on a clinical evaluation of symptoms and diet history. Laboratory tests are not presently available for the diagnosis of ciguatera fish poisoning in humans. Mouse bioassay is the generally accepted** **technique for testing fish samples. An enzyme immunoassay (EIA) method for testing fish samples is under eval uation. Potentially implicated fish samples should be frozen until pick up by county health department personnel.** 
TREATMENT: **No specific antitoxin is available. Gastrointestinal decontamination with activated charcoal may be of value if performed within 3–4 hours of ingestion. There is some evidence that intravenous administration**  **of Mannitol within 24 hours of exposure may reduce neurological symptoms and sequela.**
RISK GROUPS: **All persons are susceptible to Ciguatera. However, young children, the elderly and those individ uals with underlying neurologic disease may be at increased risk. Premature labor and spontaneous abortion have**  **been reported, as well as effects on the fetus and newborn child through placental and breast milk transmission.**
PREVENTATIVE MEASURES: **Av oid eating barracuda and other large predatory reef fish. Contaminated shell** **fish are not detectable by taste or odor. It cannot be removed by cooking, freezing or other storage or prepara tion methods. Reoccurrence of symptoms have been observed in some recovered patients with subsequent**  **ingestion of fish (regardless of type), alcohol, caffeine, and nuts so these items should be avoided for 3 to 6 months after recovery.**  REPORTING REQUIREMENTS: **Ciguatera cases** must **be reported to the local county health department pur suant to Section 381.0031 (1), Florida Statutes.** 
ADDITIONAL INFORMATION **Aquatic Toxins Hotline (24/7 medical information):** 1-888-232-8635 **T he Florida Department of Health’s Aquatic Toxins Program at www.myfloridaeh.com** Abbott et al. Public Health Response to HABs

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**.** Appendix B



# Ciguatera Case Definition

Reporting code = 98809 Case report forms: 1. CDC 52.13 (9/89) Investigation of a Foodborne Illness Outbreak 2. (5/98) Record of Ciguatera Intoxication
Clinical description Abdominal cramps, nausea, vomiting, diarrhea, numbness and paresthesia of lips and tongue, paresthesia of the extremities, metallic taste, arthralgia, myalgia, blurred vision and paradoxical temperature sensation. Associated with consumption of reef or bottom-dwelling fish such as barracuda and snapper

Case classification Confirmed: A clinically compatible illness in a patient with a history of fish consumption in the 24 hours before onset of symptoms
Laboratory criteria for diagnosis

• Detection of ciguatoxin in implicated fish helpful, but not necessary for case confirmation

CommentEven single sporadic cases should be reported on the CDC Investigation of a Foodborne Outbreak form and the Record of Ciguatera Intoxication. Testing for the toxin in implicated fishes is
available from the FDA. Contact your regional foodborne illness investigator for information.

From Surveillance Case Definitions for Select Reportable Diseases in Florida Bureau of Epidemiology Florida Department of Health J une 2003

Additional Information Florida Department of Health: www.myfloridaeh.com under Food and Waterborne Surveillance Program; Aquatic Toxins ProgramPublic Health Response to HABs Abbott et al.

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**.** Appendix B

**Version 3 – 07/07/2008** CA USATIVE AGENT: **Blue-green algae toxin (cyanotoxin) illness results from exposure to the toxins associated with organisms known as cyanobacteria.Their complexity, diversity and number of species involved makes the assessment of health impacts**  **an emerging research and medical issue. Species of blue-green algae that form HABs in fresh water include Microcystis aerug**  **inosa, Anabena circinalis, Anabena flos-aquae, Aphanizomenon flos-aquae, Cylindrospermopsis raciborskii, Lyngbya wollei and**  **Oscil latoria.**  **Exposure can occur through ingestion of contaminated drinking water, inadvertent ingestion via recreational water activities, use of contaminated dietary supplements and possibly from inhalation of aerosols containing cyanotoxins and der** **mal contact with surface water. The cyanotoxins belong to diverse groups of chemical substances with specific toxic mecha nisms including neurotoxins (anatoxin-a, anatoxin-a(s), saxitoxin, neosaxitoxin), hepatotoxins (microcystins, nodularins,** 

**c ylindrospermopsin), tumor promoters (microcystins) and dermatotoxins (include aplysiatoxins and lyngbyatoxin, (also po**  **tent tumor promoters and protein kinase C activators) and lipopolysaccharides, also known as LPS (also gastroenteritis and possibly causing dermatitis).**  SIGNS/SYMPTOMS: **Skin contact has been reported to produce rash, hives, or skin blisters (especially on the lips and under swimsuits). Inhaling water droplets from irrigation or water-related recreational activities have been reported to cause runny**  **ey es and nose, a sore throat, asthma-like symptoms, or allergic reactions. Ingestion can cause acute, severe gastroenteritis (in**  **cluding diarrhea, vomiting); liver toxicity (nausea, vomiting and acute liver failure); kidney toxicity, and neurologic effects su ch**  **as salivation, muscle cramps, twitching, paralysis and cardiac or respiratory failure (these are the symptoms most often seen in dogs who have been exposed to anatoxin).There is poor understanding of the health effects from chronic exposures.**  ONSET/DURATION: **W ith exposure to neurotoxic cyanotoxins, symptoms can appear within minutes to few hours of ex**  **posure, but may take up to 36 hours to manifest themselves. Hepatotoxin symptoms can appear rapidly within hours, but may occur as late as several days following exposure to high amounts of cyanotoxins.**  DIAGNOSIS: **Diagnosis is based on a clinical evaluation of symptoms and exposure history. Environmental samples should include assessment by microscopic identification of cyanobacteria and analytical testing by HPLC/MS and ELISA. Increased**  **serum levels of liver enzymes have been associated with hepatic injury after cyanotoxin ingestion. Clinical laboratory tests are not presently available for the diagnosis of cyanotoxin poisoning in humans. Research efforts are underway to assess the**  **potential to detect certain cyanotoxins in blood.** TREATMENT: **In general, the only treatment available for exposure to the blue green algal toxins is supportive medical treat ment after complete removal from exposure. If the exposure was oral, administration of activated carbon to decrease gut ab**  **sorption may be efficacious if given within hours of exposure. Artificial respiration with exposure to the neurotoxins (such as saxitoxin) should also be considered. Based on past outbreaks, monitoring of volume, electrolytes, liver and kidney function**  **should all be considered in the case of acute gastroenteritis associated with some of the blue green algal toxins.** RISK GROUPS: **All persons are susceptible to cyanobacteria. However, young children, the elderly and those individuals with underlying immunologic, neurologic, hepatic or kidney disease may be at increased risk. Effects on pregnancy and fetal**  **health are unknown. Animals drinking raw water contaminated with toxin-producing cyanobacteria are especially prone to acute poisonings.**  PREVENTATIVE MEASURES: **Av oid contact with water or algae if visibly present (foam, scum, or mats of algae). Restrict**  **swimming, boating and other activities in blooms. If exposed, rinse off with fresh water as soon as possible. Pets or livestock should not swim in or drink from areas where the water has. If pets (especially dogs) do swim in scummy water, rinse them**  **off immediately—do not let them lick the algae (and toxins) off their fur. Algaecides may temporarily increase the amount of toxins in the water.**  REPORTING REQUIREMENTS: **None. At present, cyanotoxin illness is not a reportable disease in Florida.To improve their surveillance of this illness, the Florida Department of Health asks health care providers to report suspect cases to the Aquatic**  **T**

**oxin Hotline at 1-888-232-8635 or the Aquatic Toxins Program at the Florida Department of Health.**
ADDITIONAL INFORMATION **Aquatic Toxins Hotline (24/7 medical information):** 1-888-232-8635 **T he Florida Department of Health’s Aquatic Toxins Program at www.myfloridaeh.com** Abbott et al. Public Health Response to HABs

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**.** Appendix B



# Cyanotoxin Case Definitions

Developed and Proposed by North Carolina Department of Health J. Newton MacCormack, MD, MPH Occupational & Environmental Epidemiology Branch

Microcystin Poisoning P ossible case: Confirmed exposure (ingestion OR immersion) to water with confirmed bloom of cyanobacterial species capable of microcystin production AND clinical evidence of hepaticdysfunction (e.g., painful hepatomegaly; aminotransferase [AST/ALT] level at least 2 times normal) developing within 48 hours of exposure AND other causes of hepatic dysfunction have been excluded. Probable case: Meets criteria for “possible case” AND there is laboratory documentation of microcystin toxin in water. Confirmed case: Meets criteria for “probable case” AND/OR positive assay for microcystin toxin in clinical specimen (blood or tissue)

Cylindrospermopsin Poisoning P ossible case: Confirmed exposure (ingestion OR immersion) to water with confirmed bloom of cyanobacterial species capable of cylindrospermopsin production AND development of at least one of the following within 48 hours:

• clinical evidence of hepatic dysfunction (e.g., painful hepatomegaly; aminotransferase [AST/ALT] level at least 2 times normal) • G I symptoms (e.g., nausea, vomiting, diarrhea, abdominal cramps)

• Proteinuria, hematuria, or other signs of acute renal damage. Probable case: Meets criteria for “possible case” AND laboratory documentation of cylindrospermopsin toxin in water. Confirmed case: Meets criteria for “probable case” AND positive assay for cylindrospermopsin toxin in clinical specimen (blood or tissue)

Additional Information Florida Department of Health: www.myfloridaeh.com under Food and Waterborne Surveillance Program; Aquatic Toxins ProgramPublic Health Response to HABs Abbott et al.

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**.** Appendix B

**Version 3 – 07/07/2008**
CA USATIVE AGENT: **Neurotoxic shellfish poisoning (NSP) is caused by the consumption of molluscan shell fish (e.g., clams, oysters, coquinas, mussels and other filter feeders) contaminated with brevetoxins, which are**  **produced by a marine dinoflagellate called Karenia brevis. K. brevis**  **is principally distributed throughout the Gulf of Mexico and occasionally along the mid- and south-Atlantic Coast. Commonly referred to as “Florida red**  **tides,”blooms of K. brevis**  **most often occur during late summer and fall but can be present any time of the year.**
SIGNS/SYMPTOMS: **Initial complaints typically include abdominal pain, nausea, vomiting, and diarrhea ac companied by progressive paresthesia, which first affects the areas of the mouth and later the extremities.**  **Other common symptoms include ataxia, myalgia, headache, and vertigo. Paradoxical temperature sensation (reversal of hot and cold sensations), as seen in ciguatera fish poisoning, has also been reported in NSP. In** **more severe cases of NSP, dilation of the pupils and bradycardia may also be observed.There is poor under standing of chronic exposures and long term health impacts** 
ONSET/DURATION: **Onset of symptoms occurs within minutes to hours, definitely within 24 hours, of con suming brevetoxin-contaminated shellfish. Duration of the illness is generally short, lasting from a few hours** **to several days. Urine analyses by specialty laboratories (such as Fish and Wildlife Research Institute) can con firm exposure with positive tests for brevetoxin. Samples should be preserved at –20°C and shipped on dry ice**  **with overnight delivery. Arrangements must be made with laboratory before submitting samples for analyses.**
DIAGNOSIS: **Diagnosis is generally based on a clinical evaluation of symptoms and recent food history.The use of an ELISA test for detecting brevetoxin in urine is experimental at this time. Mouse bioassay is the gener**  **ally accepted technique for testing shellfish, however brevetoxin ELISA and HPLC may also be helpful.**

TREATMENT: **No specific antitoxin is available. In general the illness is self-limiting and therapy is support ive**  **and symptom-driven.**
RISK GROUPS: **All persons are susceptible to NSP. However, young children, the elderly and those individu als with underlying neurologic disease may be at increased risk. Effects on pregnancy and fetal health are un**  **known.**
PREVENTATIVE MEASURES: **Contaminated shellfish are not detectable by taste or odor. It cannot be re moved by cooking, freezing or other storage or preparation methods.The Florida Department of Agriculture**  **and Consumer Services closes shellfish harvesting areas when K. brevis**  **cell counts exceed 5,000 cells per liter. In recent years most NSP cases have been the result of illegal harvesting of shellfish from closed areas. See**  **www.floridaaquaculture.com/seas/seas_statusmap.htm for shellfish harvesting area status.** REPORTING REQUIREMENTS: **NSP cases must be immediately reported to the local county health depart ment pursuant to Section 381.0031 (1), Florida Statutes.** 

ADDITIONAL INFORMATION **Aquatic Toxins Hotline (24/7 medical information):** 1-888-232-8635 **Florida Department of Health’s Aquatic Toxins Program at www.myfloridaeh.com**Abbott et al. Public Health Response to HABs

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**.** Appendix B



# Neurotoxic Shellfish Poisoning Case Definition

Reporting code = 98800 Case report form: CDC 52.13 (9/89) Investigation of Foodborne Illness

Clinical case definition Onset is within a few minutes to a few hours after consumption of epidemiologically implicated shellfish. Symptoms include tingling and numbness of lips, mouth, fingers, and toes; muscular aches; dizziness, reversal of hot and cold sensations; pupil dilation; and usually accompanied bydiarrhea, vomiting and ataxia. Illness is self-limited and milder than paralytic shellfish poisoning; paralysis has not been documented. Duration is from a few minutes to a few hours or a few days at most.
Laboratory criteria for diagnosis

• Detection of toxin in epidemiologically implicated shellfish

Case classification Confirmed: Clinically compatible illness that is associated with consumption of shellfish from areas where other toxic shellfish have been found.

From Surveillance Case Definitions for Select Reportable Diseases in Florida Bureau of Epidemiology Florida Department of Health J une 2003

Additional Information Florida Department of Health: www.myfloridaeh.com under Food and Waterborne Surveillance Program; Aquatic Toxins ProgramPublic Health Response to HABs Abbott et al.

102 FWRI Technical Report TR-14

**.** Appendix B

**Version 3 – 07/07/2008**
CA USATIVE AGENT: **Saxitoxins are a family of water-soluble neurotoxins that are produced by several species of marine algae known as dinoflagellates (**  **Pyrodinium, Gymnodinium and**  **Alexandrium ). In most parts of** **the United States, saxitoxin poisoning is generally associated with the consumption of shellfish (known as par alytic shellfish poisoning or PSP). However in Florida saxitoxin poisoning has been associated with the con**  **sumption of puffer fish (includng the fillet and tail portion) contaminated with saxitoxin and harvested from the Indian River Lagoon.** 
SIGNS/SYMPTOMS: **Symptoms of saxitoxin poisoning include: circumoral paresthesia, numbness or tingling of the face, arms, and legs, motor uncoordination, respiratory distress, headache, dizziness, weakness, nausea**  **and vomiting. In severe cases, acute muscle paralysis and respiratory failure can occur rapidly.There is poor understanding of chronic exposures and long term health impacts.** 
ONSET/DURATION: **T he onset of symptoms is rapid, generally occurring within 15 minutes to 10 hours fol**  **lowing consumption. In severe cases, death from respiratory failure can occur in 2 to 25 hours. Patients with appropriate supportive treatment reportedly recover fully although this has not been well researched.** 
DIAGNOSIS: **Diagnosis is generally based on a clinical evaluation of symptoms and recent food history. (Sometimes, it’s misdiagnosed as fugu poisoing.) Mouse bioassay is the generally accepted technique for test**  **ing food extract, but it cannot distinguish between tetrodotoxin and saxitoxin. Radioimmunoassay and indirect enzyme-linked immunoabsorbent assay (ELISA) have been developed for saxitoxin, but not all PSP toxins.**  **HPLC analysis method for all the PSP toxins has been developed with good correlation with mouse bioassay in terms of quantification.** 

TREATMENT: **No specific antitoxin is available. Supportive measures are the basis of treatment, especially**

**v entilatory support in severe cases.** 
RISK GROUPS: **All persons are susceptible to saxitoxin poisoning, but children and the elderly may be at greater risk. Effects on pregnancy and fetal health is unknown.** 
PREVENTATIVE MEASURES: **T he shellfish and fish reportedly taste delicious. Saxitoxin cannot be removed**  **by cleaning or cooking affected fish or shellfish. It cannot be removed by freezing or other storage or prepara**  **tion methods.The Florida Fish and Wildlife Conservation Commission has banned harvesting puffer fish from the waters of Volusia, Brevard, Indian River, St. Lucie, and Martin Counties.**  REPORTING REQUIREMENTS: **Saxitoxin Poisoning cases must be reported to the local county health de partment pursuant to Section 381.0031 (1), Florida Statutes.** 

ADDITIONAL INFORMATION **Aquatic Toxins Hotline (24/7 medical information):** 1-888-232-8635 **T he Florida Department of Health’s Aquatic Toxins Program at www.myfloridaeh.com** Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 103

**.** Appendix B



# Saxitoxin Poisoning Case Definition (including Paralytic Shellfish and Puffer Fish)

Reporting code = 98840 Case report form: NA
Clinical description A person with circumoral paresthesia, numbness or tingling of the face, arms, and legs, motor uncoordination, respiratory distress, headache, dizziness, weakness, nausea, and vomiting, 15 minutes to 10 hours following the consumption of puffer fish caught off the Florida coast or from the consumption of molluscan shellfish (from any source). In severe cases muscle paralysis and respiratory failure occur, with death occurring in 2 to 25 hours.

Case classification Confirmed: a clinically compatible case that is laboratory confirmed Suspect: a clinically compatible case that is not laboratory confirmed and has a demonstrated epidemiologic link
Laboratory criteria for diagnosis • Toxin detection in urine or epidemiology linked food specimen

From Surveillance Case Definitions for Select Reportable Diseases in Florida Bureau of Epidemiology Florida Department of Health J une 2003

Additional Information Florida Department of Health: www.myfloridaeh.com under Food and Waterborne Surveillance Program; Aquatic Toxins ProgramPublic Health Response to HABs Abbott et al.

104 FWRI Technical Report TR-14

**.** Appendix B

**Version 3 – 07/07/2008**
CA USATIVE AGENT: **Brevetoxin-associated Respiratory Syndrome is caused by the inhalation of aerosolized brevetoxins, which are produced by the marine algae known as dinoflagellates called**  **Karenia brevis. Com**  **monly referred to as “Florida red tides,”blooms of K. brevis**  **most often occur during late summer and fall, but can be present any time of the year in marine waters.**  **K. brevis is principally distributed throughout the Gulf of**  **Mexico and occasionally along the mid- and south-Atlantic Coast.**
SIGNS/SYMPTOMS: **Acute symptoms include conjunctival irritation, catarrhal exudates, rhinorrhea, non productive cough, and bronchoconstriction. Wheezing, shortness of breath, and chest tightness are also com**  **mon, especially among persons with underlying respiratory disease such as asthma. Other symptoms, such as dizziness, itchiness, and tinnitus, have also been reported.There is poor understanding of chronic exposures**  **and long term health impacts.**
ONSET/DURATION: **Onset of symptoms is rapid, typically within minutes of exposure. In healthy individu als symptoms reportedly subside quickly once exposure to aerosolized brevetoxins ceases. However, symp**  **toms may linger for hours or even days after prolonged exposure or in individuals with underlying respiratory disease.** 
DIAGNOSIS: **Diagnosis is generally based on a clinical evaluation of symptoms and exposure.**

TREATMENT: **No specific antitoxin is available. In experimental animals, treatment with bronchodilators (i.e., Albuterol) reversed the effects of inhaled brevetoxins. Inhaled steroids, antihistamines, bronchodilators, and**  **anticholinergics (i.e., Benedryl, Cromolyn, Albuterol, and Atropine) decreased the effects when taken prior to exposure.** 
RISK GROUPS: **All persons are susceptible. Persons with underlying respiratory disease may be at increased risk of asthma exacerbations, sinusitis, bronchitis, and pneumonia. Effects on pregnancy and fetal health are**  **unknown.**
PREVENTATIVE MEASURES: **Research suggests the greatest effects coincide with onshore winds in con junction with high organism and toxin levels in near-shore waters such as on beaches and boats. Nuisance**  **(dust) masks may decrease exposure to aerosolized brevetoxins. Anecdotal evidence suggests that once the person is removed from the exposure environment and goes into air conditioning, symptoms may be allevi**  **ated. Individuals with underlying respiratory disease should take precautions to avoid or minimize exposure.** REPORTING REQUIREMENTS: **At present, Brevetoxin-associated Respiratory Syndrome is not a reportable disease in Florida.To improve their surveillance of this illness, the Florida Department of Health asks health** **care providers to report suspect cases to the Aquatic Toxin Hotline at 1-888-232-8635 or the Aquatic Toxins Pro gram at the Florida Department of Health.** 
ADDITIONAL INFORMATION **Aquatic Toxins Hotline (24/7 medical information):** 1-888-232-8635 **Florida Department of Health Aquatic Toxin Program at www.myfloridaeh.com .**  

# Appendix C Human Health Threats from Harmful Algal Bloom Species

A quick reference guide to the Medical Fact Sheets. See Appendix B for complete information.

FWRI Technical Report TR-14 105Public Health Response to HABs Abbott et al.

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**.** Appendix C



### Quick Reference Guide—Part A
Factors Affecting Implicated Degree of Illness Species Toxin Toxicity* Diagnosis

Amnesic **Pseudo-nitzschia domoic acid amount of toxin**  **history of recent** Shellfish **species (diatom) and**  **ingested, rate of consumption**  Poisoning **e.g., P. multiseries and derivatives toxin elimination,**  **of seafood, symptoms,** (ASP) **P. calliantha**  **biotransformation of analyses of food**  **toxins, health of victim** Note: **not reported from Florida** 

Ciguatera **Gambierdiscus ciguatoxin, amount of toxin ingested, history of recent**  Fish **toxicus and other**  **maitotoxin rate of toxin elimination, consumption of seafood,**  Poisoning **Gambierdiscus spp.**  **repeated exposure, symptoms, analyses of**  (CFP) **health of victim food**  Note: **neurological symptoms may recur**  **for months or years**

Cyanotoxins **multiple species, e.g.,**  **multiple amount of toxin topical exposure to**  (blue-green **Microcystis aeruginosa, exposed to,**  **scummy waters,** algae) **Anabaena circinalis, health of victim**  **ingestion of L** 

**yngbya wollei, contaminated water,**  **Cylindrospermopsis spp.**  **or unintentional ingestion of raw water** 

Diarrheic **Dinophysis species, okadaic acid, amount of toxin ingested, history of recent**  Shellfish **e.g., D. cf**  **ovum; dinophysis rate of toxin elimination,**  **consumption of seafood,** Poisoning **Prorocentrum lima toxin**  **health of victim symptoms, analyses of**  (DSP) **food.** Note: **not reported from Florida** 

Neurotoxic **Karenia brevis brevetoxin amount of toxin ingested, history of recent con**  Shellfish **(formerly and**  **rate of toxin elimination, sumption of seafood,** Poisoning **Gymnodinium breve )**  **derivatives health of victim, bio- symptoms, analyses of**  (NSP) **transformation of toxin food; detection of metabolites via radio**  **immunoassay (RIA) of urine** 

(Part A continued on page 108)

* NOTE: **Symptoms are more severe in children, the elderly, and those with impaired immune systems. Adapted from multiple references; see Chapter 1, Overview of Harmful Algal Blooms Significant to Public Health.** Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 107

**.** Appendix C



### Quick Reference Guide—Part B

Symptoms Subsequent, Other, Route of Illness Acute or Severe Case Exposure Treatment
ASP (within 24 hrs) **v omiting, disorientation, memory seafood**  **symptomatic (gut emptying, abdominal cramps, loss, seizures, coma;**  **charcoal decontamination, diarrhea, nausea,**  **has been fatal in humans ventilators); atropine for**  **headache** Note: **memory loss can last bradycardia; dopamine or**  **for more than one year calcium gluconate for shock;**  **amitriptyline successful in relieving chronic symptoms**  **(fatigue, paraesthesias)**
CFP (1–12 hrs after ingestion) (12–18 hrs after ingestion) **generally associated symptomatic, no sensory disturbances,**  **e.g, headaches, itchy skin, with reef predators permanent cure,**  **paraesthesias, arthralgia, hot–cold reversal, abnormal including barracuda, mannitol if diagnosed my** **algia, asthenia, chills, tingling or burning of the skin grouper, snapper, within 24 hours headache, nausea; or extremities, muscle and amberjack, kingfish,**  **perspiration, tearing, joint pain, convulsions, mahi mahi; can also giddiness; pruritus; muscular paralysis,**  **affect some herbivores abdominal pain;**  **audiovisual hallucinations, such as parrotfish**

**v omiting, diarrhea vertigo, irregular pulse rate,**  **decreased blood pressure, sensitivity to certain foods**  **( e.g.,**  **caffeine and nuts) with reoccurrence of some**  **symptoms for up to 3–6 mos.** Note: **toxins interact with opiates and barbiturates,**  **causing hypertension**
Cyano- **skin rashes or irritations, this is an emerging issue, aerosol, water, food symptomatic** toxins **gastrointestinal distress, and the symptomatology** (blue- **ey e irritation, asthma has not been fully**  green **described for U.S.** algae) **exposures to multiple cy** **anobacteria species**

DSP (within 30 min–12 hrs, **seafood symptomatic,**  (within 3

average incubation is days) **complete clinical** 4 hrs) **nausea, vomiting, recovery, even in severe**  **diarrhea, abdominal cases pains, chills** 

NSP (within hours) **hot** (within 2–3 days) **c hione clams,**  **symptomatic; no known and/or cold sensation symptoms disappear**  **other clams, antidote; full recovery in**  **reversals, tingling, pins oysters, gastropods, humans usually within**  **and needles feeling in e.g.,**  **whelk several days**  **extremities, nausea, diarrhea, vertigo,**  **pupil dilation**

(Part B continued on page 109)

* NOTE: **Symptoms are more severe in children, the elderly, and those with impaired immune systems. Adapted from multiple references; see Chapter 1, Overview of Harmful Algal Blooms Significant to Public Health.** Public Health Response to HABs Abbott et al.

108 FWRI Technical Report TR-14

**.** Brevetoxin- **Karenia brevis brevetoxin amount of toxin inhaled, history of recent beach**  Associated **(formerly and**  **rate of toxin elimination, activity in vicinity of** Respiratory **Gymnodinium breve )**  **derivatives health of victim, marine waters with**  Syndrome **biotransformation of toxin known red tide bloom** (Red Tide Cough)

Paralytic **Pyrodinium bahamense saxitoxin amount of toxin ingested, history of recent**  Shellfish **and rate of toxin elimination, consumption of**  Poisoning **derivatives health of victim, seafood, symptoms,**  (PSP) **biotransformation of toxin detection in urine,**  **toxin analyses of food**  Note: **similar symptoms can come from exposure**  **to certain pesticides ( e.g.,** **carbamates, organo phosphates); not re**  **ported from Florida**

Saxitoxin **Pyrodinium bahamense saxitoxin amount of toxin ingested, history of recent**  Puffer Fish **and rate of toxin elimination,**  **consumption of seafood,** Poisoning **derivatives health of victim symptoms, toxin**  (SPFP) **detection in urine, analyses of food**  Note: **similar symptoms from exposure to certain**  **pesticides ( e.g.,**  **carba mates, organo**  **phosphates)**

* NOTE: **Symptoms are more severe in children, the elderly, and those with impaired immune systems. Adapted from multiple references; see Chapter 1, Overview of Harmful Algal Blooms Significant to Public Health.**  Appendix C



### Quick Reference Guide—Part A (continued)
Factors Affecting Implicated Degree of Illness Species Toxin Toxicity* DiagnosisAbbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 109

**.** BARS (within minutes) (within hours–days) **aerosol respiratory irritation**  (Red **wheezing, shortness of symptoms disappear usually ceases when**  Tide **breath, chest tightness,** Note: **effects from chronic individual leaves area**  Cough) **dizziness, itchiness, and exposures and long-term tinnitus**  **health impacts, particularly in individuals with asthma**  **or underlying respiratory disease, are unknown** 

PSP (30 min–3.5 hrs) (24 hrs) **severe cases may seafood symptomatic; no**  **abnormal tingling or lead to respiratory known antidote**  **burning of the skin or paralysis causing death extremities, loss of**  Note: **symptoms usually muscular coordination, disappear within a few**  **giddiness, staggering, days with no lasting drowsiness, dry throat effects**  **and skin, loss of speech or speech comprehension,**  **rash, fever, nausea,**

**v omiting, diarrhea.** 

SPFP (30 min–3.5 hrs) (24 hrs) **severe cases may pufferfish (primarily symptomatic abnormal tingling or lead to respiratory paralysis southern puffer fish)**  **burning of the skin or causing death extremities, loss of**  Note: **symptoms usually muscular coordination, disappear within a few**  **giddiness, staggering, days with no lasting drowsiness, dry throat effects**  **and skin, loss of speech or speech comprehension,**  **fever, nausea, vomiting**

* NOTE: **Symptoms are more severe in children, the elderly, and those with impaired immune systems. Adapted from multiple references; see Chapter 1, Overview of Harmful Algal Blooms Significant to Public Health.**  Appendix C



### Quick Reference Guide—Part B (continued)
Symptoms Subsequent, Other, Route of Illness Acute or Severe Case Exposure Treatment110 FWRI Technical Report TR-14

**.** 

# Appendix D Known or Potentially Toxic or Harmful Algal Species in Florida

Impact Species Habitat Distribution Comments Anatoxin-a (acute toxicity [LD 50 i.p. mouse] is 250 μg/kg) Cyanobacteria **P**

**otential for wildlife Anabaena circinalis**  **F reshwater, FL Blooms common throughout FL;**  **and fish kills, loss of estuarine,**  **Lake Istokpoga, September habitat, human**  **planktonic 1988—signs of poisoning in lab**  **health concerns mice indicated a neurotoxin;**  **implicated in fish kills in St. Johns River 1999**  **Unknown Anabaena spiroides**  **F reshwater, FL**  **planktonic Unknown**  **Microcystis sp. Freshwater, FL**  **Microcystis blooms common**  **estuarine, throughout FL; Lake Okeechobee,**  **planktonic August 1987—signs of poisoning in**  **lab mice indicated a hepatotoxin** Azaspiracid (acute toxicity [minimum LD 50 i.p. mouse] is 140–200 μg/kg) Dinoflagellates **P**

**otential for Protoperidinium**  **Coastal Gulf-wide Recently caused human shellfish Azaspiracid**  **crassipes planktonic**  **poisoning incidents in Europe; no shellfish**  **toxic events reported in FL poisoning (AZP)**  Brevetoxins (acute toxicity [LD 50 i.p. mouse] is 200 μg/kg) Dinoflagellates **Neurotoxic shellfish Karenia brevis**  **Oceanic, Gulf-wide, Documented ~60 times in the past**  **poisoning (NSP), (formerly coastal,**  **Atlantic coast FL 150 years; persistent in FL coastal aquatic animal**  **Gymnodinium brevis )**  **or estuarine waters over the past 50 years; from**  **mortalities, planktonic**  **1994–1996 ranged from Dry respiratory irritation**  **Tortugas to Pensacola and occurred in humans**  **with A. monilatum**  **in northwest FL and**  **K. mikimotoi in southwest FL;**  **NSP cases in FL from unregulated shellfish species or areas**  Ciguatoxins (acute toxicity [LD 50 i.p. mouse] is 350 μg/kg) Dinoflagellates **Ciguatera fish Gambierdiscus toxicus**  **Benthic South FL**  **Underreported illnesses; no blooms poisoning (CFP);**  **analyzed for toxin in FL human illness, fish**  **kills, fish disease?** Cylindrospermopsin (acute toxicity [LD 50 i.p. mouse] 24 hr = 2.1 mg/kg, 5–6 d = 200 μg/kg) Cyanobacteria **Unknown Aphanizomenon**  **F reshwater, FL**  **Known to be toxic in other regions; ovalisporum**  **estuarine, implicated in outbreak of severe**  **planktonic hepatoenteritis in Australia in 1970s** Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 111

**.** Appendix D

**Alligator, bird, fish, Cylindrospermopsis**  **F reshwater, FL**  **Blooms occurred during alligator, and turtle kills?**  **raciborskii planktonic**  **bird, and fish fills in Lake Griffin, FL** Domoic acid (DA) (acute toxicity [LD 50 i.p. mouse] is 3.6 mg/kg)

Diatoms **P**

**otential for Amnesic Pseudo-nitzschia**  **Benthic, FL, Indian River No DA detected in lab tests of FL Shellfish Poisoning**  **calliantha tychoplanktonic Lagoon**  **field samples; no human shellfish (ASP)**  **toxicity cases in FL Poten**  **tial for ASP Pseudo-nitzschia**  **Benthic, Gulf-wide Low lev** **els of DA detected in lab tests delicatissima**  **tychoplanktonic of FL field samples; no human**  **shellfish toxicity cases in FL Poten**  **tial for ASP Pseudo-nitzschia**  **Benthic, Gulf-wide No DA detected in lab tests of FL**  **multiseries tychoplanktonic**  **field samples; no human shellfish toxicity cases in FL**  **Poten tial for ASP**  **Pseudo-nitzschia Benthic,**  **Gulf-wide Low lev els of DA detected in lab tests**  **pseudodelicatissima tychoplanktonic**  **of FL field samples; no human shellfish toxicity cases in FL**  Goniodomin A (acute toxicity [LD 50 i.p. mouse] is 1.2 mg/kg) Dinoflagellates **Fish and Alexandrium**  **Estuarine, coastal, Gulf-wide, Caused marine animal mortality in invertebrate kills**  **monilatum planktonic east FL coast FL, MS, and TX; not implicated in**  **shellfish poisoning ( e.g.,**  **PSP)** Karlotoxins (not acutely toxic to mice up to 45 mg/kg) Dinoflagellates **Fish kills in nature Karlodinium veneficum**  **Estuarine, FL and TX T oxic in field and lab studies; known**  **and in fish farm ponds planktonic**  **to kill fish at very high cell concentrations (>10**  **4 cells/mL)**  Microcystins (acute toxicity [LD 50 i.p. mouse] 50–600 μg/kg) **Microcystins are inhibitors of protein phosphatases and are considered tumor promoters in laboratory mice; the provisional WHO standard for microcystin-LR in drinking water is 1 μg/L water.**  Cyanobacteria **P**

**otential for wildlife Anabaena flos-aquae**  **F reshwater, FL No toxic events reported or blooms**  **and fish kills, loss of planktonic**  **analyzed for toxin in FL; also shown habitat, potable water**  **to produce aphanotoxin in other supply problems, tumor**  **regions promoter in laboratory**  **mice, human health concerns, hepatotoxins**  **P**

**otential for animal Geitlerinema**  **sp. Marine, benthic FL Keys Implicated in black disease of corals**  **health problems P** 

**otential for animal Leptolyngbya**  **sp. Marine, benthic FL Keys Implicated in black disease of corals**  **health problems P** 

**otential for wildlife Microcystis aeruginosa**  **F reshwater, FL**  **Blooms common throughout FL; and fish kills, loss of**  **estuarine, Lake Okeechobee, August 1987—**  **habitat, potable water planktonic**  **signs of poisoning in lab mice supply problems,**  **indicated a hepatotoxin tumor promoter in**  **laboratory mice, human health concerns**  **Unknown Microcystis wesenbergii**  **F reshwater, FL, likely found Implicated in poisoning event;**  **planktonic throughout US blooms not analyzed for toxin in FL** Impact Species Habitat Distribution CommentsOkadaic acid and derivatives (acute toxicity [LD 50 i.p. mouse] is 210 μg/kg) Dinoflagellates **P**

**otential for Prorocentrum**  **Benthic South FL No toxic events reported or blooms Diarrheic Shellfish**  **belizeanum analyzed for toxin in FL; field and lab**  **P**

**oisoning (DSP); studies on strains from other regions**  **tumor promotion? have shown toxicity P** 

**otential for DSP; Prorocentrum**  **Benthic North and No toxic events reported or blooms tumor promotion**  **hoffmannianum southwest FL**  **analyzed for toxin in FL; field and lab studies on strains from other regions**  **have shown toxicity P** 

**otential for DSP; Prorocentrum lima**  **Benthic Gulf-wide, No toxic events reported or blooms**  **tumor promotion Atlantic coast FL**  **analyzed for toxin in FL; field and lab studies on strains from other regions**  **have shown toxicity P** 

**otential for DSP; Prorocentrum**  **Benthic Gulf-wide, No toxic events reported or blooms**  **tumor promotion marinum**  **Atlantic coast FL analyzed for toxin in FL P** 

**otential for DSP; Dinophysis acuminata**  **Coastal Gulf-wide No toxic events reported or blooms**  **tumor promotion planktonic**  **analyzed for toxin in FL; field and lab studies on strains from other regions**  **have shown toxicity P** 

**otential for DSP; Dinophysis caudata**  **Estuarine/coastal Gulf-wide, No toxic events reported or blooms tumor promotion**  **planktonic Atlantic coast FL analyzed for toxin in FL; field and lab**  **studies on strains from other regions have shown toxicity**  **P**

**otential for DSP; Dinophysis fortii**  **Coastal Gulf-wide No toxic events reported or blooms**  **tumor promotion planktonic**  **analyzed for toxin in FL; field and lab studies on strains from other regions**  **have shown toxicity P** 

**otential for DSP; Dinophysis**  **cf. ovum**  **Estuarine/coastal Gulf-wide No toxic events reported or blooms tumor promotion**  **planktonic analyzed for toxin in FL; field and lab**  **studies on strains from other regions (TX) have shown toxicity**  **P**

**otential for DSP; Dinophysis tripos**  **Coastal Gulf-wide No toxic events reported or blooms**  **tumor promotion? planktonic**  **analyzed for toxin in FL**

P

alytoxins (acute toxicity [LD 50 i.p. mouse] is 450 μg/kg) / Ostreotoxins Dinoflagellates **Unknown Ostreopsis heptagona**  **Benthic South FL**  **Co-occurs with ciguatera species; no known toxic events in Gulf or FL** 

**w aters**  **Unknown Ostreopsis lenticularis**  **Benthic South FL**  **Co-occurs with ciguatera species; no known toxic events in Gulf or FL** 

**w aters; toxic in lab studies**  **Unknown Ostreopsis siamensis**  **Benthic FL**  **Co-occurs with ciguatera species; no known toxic events in Gulf or FL** 

**w aters**  Saxitoxins (acute toxicity [LD 50 i.p. mouse] is 10 μg/kg) Cyanobacteria **P**

**otential for wildlife Anabaena circinalis**  **F reshwater, FL Lake Istokpoga, September 1988—**  **and fish kills, loss of estuarine,**  **signs of poisoning in lab mice habitat, human health**  **planktonic indicated a neurotoxin; implicated** 

**concerns in fish kills in St. Johns River 1999**  Public Health Response to HABs Abbott et al.

112 FWRI Technical Report TR-14

**.** Appendix D

Impact Species Habitat Distribution Comments**P otential for wildlife**  **Aphanizomenon F** **reshwater, FL No toxic events reported or blooms and fish kills, loss of**  **flos-aquae planktonic**  **analyzed for toxin in FL habitat, human health** 

**concerns P** 

**otential for wildlife Cylindrospermopsis**  **F reshwater, FL**  **Blooms have occurred during and fish kills, loss of**  **raciborskii planktonic**  **alligator, bird, and fish kills in lakes habitat, human health**  **in St. Johns River system**

**concerns** Dinoflagellates **Saxitoxin puffer fish Pyrodinium bahamense**  **Estuarine, coastal, FL Caused more than 25 SPFP**  **poisoning (SPFP) and planktonic,**  **incidents from 2002–2005, high risk potential for paralytic**  **benthic of PSP but managed by state**  **shellfish poisoning agencies; no human cases of PSP**  **(PSP) incidents reported in Florida** 

Y

essotoxins (acute toxicity [LD 50 i.p. mouse] is 100–700 μg/kg) Dinoflagellates **DSP-like, fish and Protoceratium**  **Estuarine, coastal, Gulf-wide No toxic events reported or blooms invertebrate kills?**  **reticulatum planktonic**  **analyzed for toxin in FL (=**  **Gonyaulax grindleyi )**  **P**

**otential for shellfish Lingulodinium**  **Estuarine, coastal, Gulf-wide No toxic events reported or blooms poisoning incidents**  **polyedrum planktonic, benthic**  **analyzed for toxin in FL P** 

**otential for shellfish Gonyaulax spinifera**  **Estuarine, coastal, Gulf-wide No toxic events reported or blooms poisoning incidents**  **planktonic, benthic analyzed for toxin in FL**  Multiple toxins Cyanobacteria **P**

**otential for coral L**  **yngbya cf.**  **Marine, benthic FL Implicated in sea fan mortalities**  **reef impacts confervoides**  **P**

**otential for marine L**  **yngbya majuscula Marine, benthic, Gulf-wide, L**  **yngbyatoxin, debromoaplysiatoxin animal disease and**  **tychoplanktonic Atlantic coast FL (known tumor promoter), human health concerns**  **aplysiatoxin P** 

**otential for coral L**  **yngbya polychroa Marine, benthic FL**  **Implicated in sea fan mortalities reef impacts**  **P**

**otential for wildlife L**  **yngbya wollei F** **reshwater, FL Lyngbyatoxin, saxitoxin; implicated**  **and fish kills, loss of estuarine; forms**  **in dermatitis in human incidents habitat, human health**  **benthic mats in FL** 

**concerns** Bioactive or potentially toxic Cyanobacteria **Unknown Anabaena solitaria**  **f. Freshwater, FL Implicated in a poisoning event;**  **planktonica planktonic**  **occurs as a minor component with other bloom-forming species; no**  **toxic events reported or blooms analyzed for toxin in FL**  **Unknown Anabaenaopsis milleri**  **F reshwater, FL**  **No toxic events reported or blooms planktonic**  **analyzed for toxin in FL Unknown**  **Aphanocapsa incerta F** **reshwater, FL No toxic events reported or blooms**  **(formerly Microcystis**  **planktonic analyzed for toxin in FL**  **incerta )**  Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 113

**.** Appendix D

Impact Species Habitat Distribution Comments**Unknown Coelosphaerium**  **F reshwater, FL**  **Implicated in a poisoning event; kuetzingianum**  **planktonic occurs as a minor component with**  **other bloom-forming species; no toxic events reported or blooms**  **analyzed for toxin in FL Unknown**  **Cylindrospermum sp. Freshwater, ?**  **No toxic events reported or blooms planktonic**  **analyzed for toxin in FL Unknown**  **Microcystis viridis F** **reshwater, ? No toxic events reported or blooms**  **estuarine, analyzed for toxin in FL**  **planktonic Unknown**  **Microcystis wesenbergii F** **reshwater, FL No toxic events reported or blooms**  **planktonic analyzed for toxin in FL**  **P**

**otential for wildlife Nodularia spumigena**  **Estuarine, FL No toxic events reported or blooms**  **and fish kills, loss of planktonic**  **analyzed for toxin in FL habitat, tumor promoter**  **in laboratory mice, human health concerns**  **Unknown Nostoc**  **spp. Freshwater, FL**  **Implicated in poisoning event; planktonic,**  **blooms not analyzed for toxin in FL benthic, moist soil**  **Unknown Oscillatoria**  **spp. Freshwater, FL No toxic events reported or blooms**  **planktonic analyzed for toxin in FL**  **Unknown Planktothrix agardhii**  **F reshwater pools, FL**  **No toxic events reported or blooms rivers and on moist**  **analyzed for toxin in FL soil; planktonic,**  **tychoplanktonic Unknown**  **Planktothrix rubescens F** **reshwater, FL No toxic events reported or blooms**  **tychoplanktonic analyzed for toxin in FL**  **Benthic animal kills?, Schizothrix calcicola**  **Estuarine/ FL Not acutely toxic in lab studies in**  **low dissolved oxygen? planktonic**  **other regions Suspected in SE U.S Unnamed species Freshwater, Central FL Uncharacterized neurotoxin**  **in Avian Vacuolar (Family epiphytic (on**  **Myelinopathy Stigonematales) submerged plants) Sponge mortality?**  **Synechococcus elongatus Coastal, estuarine, Florida Bay Mechanical damage or toxicity to**  **planktonic sponges**  **Unknown Synechocystis**  **sp. Freshwater, FL Hepatotoxins and possible**  **planktonic neurotoxins produced; no toxic** 

**ev ents reported or blooms analyzed**  **for toxin in FL Animal kills?**  **T richodesmium**  **Offshore, coastal, Ciguatera?**  **erythraeum planktonic Coastal FL No toxicity found in FL studies;**  **implicated in fish kills and coral mortality in Australia**  **Animal kills? T**  **richodesmium Offshore, coastal, Coastal FL No toxicity found in FL studies**  **thiebautii planktonic**  Dinoflagellates **Associated w/fish kills, Akashiwo sanguinea**  **Estuarine, coastal, Gulf-wide, No toxic events reported or blooms not tested for toxicity**  **planktonic Atlantic coast FL analyzed for toxin in FL PSP?**  **Alexandrium minutum Coastal,**  **Tampa Bay Produces saxitoxins elsewhere; no planktonic**  **toxic events reported or blooms analyzed for toxin in FL**  **Unknown Coolia monotis**  **Benthic Gulf-wide, Occurs with ciguatera species; no**  **Atlantic coast FL known toxic events in Gulf or FL**

**w aters**  Public Health Response to HABs Abbott et al.

114 FWRI Technical Report TR-14

**.** Appendix D

Impact Species Habitat Distribution CommentsAbbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 115

**. Unknown**  **Cryptoperidiniopsis Estuarine, plank- FL**  **No toxic events reported or blooms brodyi**  **tonic, benthic analyzed for toxin in FL**  **Fish kills? Karenia mikimotoi**  **Coastal, planktonic FL Known to be toxic in other regions**  **Fish kills? Karenia papillionacea**  **Coastal, Gulf-wide FL**  **Field and lab studies on strains from planktonic**  **other regions have shown toxicity Fish kills,**  **Karenia selliformis Coastal,**  **Gulf-wide, Field and lab studies on strains from**  **low dissolved oxygen planktonic Atlantic coast FL other regions have shown toxicity**  **Unknown Karenia**  **spp. Coastal, planktonic FL**  **Fish kills? Luciella masanensis**  **Estuarine, FL Confirmed at very low incidence;**  **planktonic, not currently implicated in fish kill**  **benthic or lesion events in FL**  **P**

**otential for DSP? Phalacroma mitra**  **Coastal Gulf-wide No toxic events reported or blooms**  **planktonic analyzed for toxin in FL**  **P**

**otential for DSP? Phalacroma rotundatum**  **Estuarine, coastal, Gulf-wide No toxic events reported or blooms planktonic**  **analyzed for toxin in FL Animal effects?**  **Prorocentrum Benthic**  **Gulf-wide No toxic events reported or blooms rhathymum**  **analyzed for toxin in FL (=**  **P. mexicanum**  **in part) Fish kills?**  **Prorocentrum minimum Coastal,**  **Gulf-wide, No toxic events reported or blooms Physiologically**  **estuarine, Atlantic coast FL analyzed for toxin in FL impaired shellfish**  **planktonic Fish kills?**  **Pfiesteria piscicida Estuarine, FL**  **Confirmed at very low incidence; planktonic, benthic**  **not implicated in fish kills in FL Fish kills in aquaria**  **Pfiesteria sp.**  **Benthic, ?**  **May be responsible for fish kills in planktonic**  **tropical saltwater aquaria Fish kills?**  **Pseudopfiesteria Estuarine, FL**  **Confirmed at very low incidence; shumwayae**  **planktonic, benthic not imp**  **licated in fish kill events in FL Fish kills,**  **T akayama pulchella**  **Estuarine, Southeast FL, Implicated in a 1996 fish kill low dissolved oxygen**  **planktonic Indian River Fish kills,**  **Takayama tasmanica Estuarine, Southeast FL, Implicated in a 2004 fish kill**  **low dissolved oxygen planktonic Indian River**  Prymnesiophytes **Fish kills? Chrysochromulina**  **spp. Coastal, planktonic Gulf-wide Cytolytic toxins? Fish kills**  **Prymnesium parvum Coastal, estuarine, Gulf-wide Fish kills in TX and FL, and known**  **planktonic toxic strains**  **Fish kills Prymnesium saltans**  **Coastal, estuarine, Gulf-wide Fish kills in FL, and known toxic planktonic**  **strains** Raphidophytes **Fish kills? Chattonella antigua**  **Coastal, FL**  **No toxic events reported or blooms planktonic**  **analyzed for toxin in FL Fish kills**  **Chattonella subsalsa Coastal,**  **FL Lab studies on strains from other**  **planktonic regions have shown toxicity**  **Fish kills Chloromorum toxicum**  **Coastal, FL**  **Lab studies on strains from other (formerly**  **Chattonella estuarine,**  **regions have shown toxicity cf**  **verruculosa ) pl**  **anktonic Fish kills?**  **F ibrocapsa japonica**  **Coastal, FL**  **Lab studies on strains from other planktonic**  **regions have shown toxicity Fish kills**  **Heterosigma akashiwo Coastal,**  **FL Lab studies on strains from other**  **planktonic regions have shown toxicity** 
**Reproduced from Harmful Algal Blooms in Florida.**  **Submitted to Florida’s Harmful Algal Bloom Task Force by the Harmful Algal Bloom Task F** **orce Technical Advisory Group and prepared by K. A. Steidinger, J. H. Landsberg, C. R. Tomas, and J. W. Burns, March 1999, 62 p. Updated by** **J. H. Landsberg, FWC–FWRI; K. A. Steidinger, FIO; and J. Wolny, FIO; February 2008**

**.** Impact Species Habitat Distribution Comments Appendix D116 FWRI Technical Report TR-14

**.** 

# Appendix E Examples of Guidelines for Cyanobacteria in Recreational Waters a

Country Guideline

**A ustralia Guidelines are designated for cyanobacteria and algae in fresh waters and coastal and estuarine** 

**w aters, and corresponding management actions including alert levels and staged response have**  **been outlined.**
**F resh recreational water bodies have multiple guideline values based on known risks associated**  **with toxins and health risk from exposure to cyanobacteria. Management Action Levels:**  **Level 1: Microcystin levels** ≥ **10 μg/L; toxic Microcystis aeruginosa**  ≥ **50,000 cells/mL; biovolume equiv alent of**  ≥ **4 mm 3**  **/L for the combined total of all cyanobacteria where a known toxin producer is dominant in the total biovolume; or** 
**Level 2:** ≥ **10 mm 3**  **/L total biovolume of all cyanobacteria where known toxins are not present; or Level 3: Cyanobacterial scums consistently present.** 
**Coastal and estuarine recreational water bodies should not contain** ≥ **10 cells/mL Karenia brevis**  **and/or have L**  **yngbya majuscula and/or**  **Pfiesteria present in high numbers.**  **In 2008, the National Health and Medical Research Council (NMHRC) released the document “Guidelines for Managing Risks in Recreational Waters,”addressing cyanobacteria and algae in**  **fresh, coastal, and estuarine waters.The document is available for download on NMHRC’s Web site, http://www.nhmrc.gov.au/publications/synopses/eh38.htm**  **Czech No requirements to analyze cyanotoxins.The responsibility to monitor water quality lies with Republic the owners or managers of the recreational sites.** 
**W arning or alert categorization system adopted via ordinance of National Health Institute (Me**  **thodical advice CSN 757712,TNV 757717). More than 20,000 cells/mL is considered the first warning level. If more than 100,000 cells/mL are**  **present, the reservoir should be closed for public recreation.**

**F rance T** **hree levels of management responses are identified depending on the concentration of cyanobac teria:** **Level 1: At <20,000 cells/mL ± 20%, the majority of which are cyanobacteria, recreational activi ties are allowed to continue and users are informed by posters on site.There is, however, no stan**  **dardized information. Monitoring is intensified to fortnightly sampling, counting, and species identification.** **Level 2: At 20,000–100,000 cells/mL: microcystins are analyzed. If the toxin concentration MC LR–equivalents is >25 μg/L, swimming is prohibited.The only watersports allowed are those like**  **rowing with minimum water contact. There are, however, no restrictions at all for professional athletes.**  **Level 3: When cyanobacterial scum appears in bathing areas, all activity in the water is prohibited. In 2003, following a recommendation by the public health service, a decision diagram was set up**  **to allow site managers and health services responsible for routine surveillance to collaborate. In**

**w ater bodies with persistently high algal concentrations, based on visual and microscopic ob**  **servations, a stricter monitoring system is implemented.**Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 117

**.** Appendix E

**Germany No mandatory guidelines.These are the recommended guidelines using a decision matrix:**
**V**

**isible scum, “greenish” streaks, or discoloration: publish warning notices (targeted to user groups) and discourage bathing; consider temporary closure of the bathing area.**  **Samples taken at secchi depth <1 m, total P > 20–40 μg/L, cyanobacteria dominant, chlorophyll a**  **>40 μg/L, and microcystin levels <10 μg/L: evaluate through routine monitoring;**  **microcystin levels >10 μg/L and <100 μg/L: publish warning notices (targeted to user groups) and discourage bathing; consider temporary closure of the bathing area;** **microcystin levels >100 μg/L: publish warning notices and discourage bathing; recommend tem porary closure of the bathing area.** 
**Th e guidelines also suggest that microcystin concentrations can be expected to be similar to those**  **found for chlorophyll a**  **when cyanobacteria are dominant. Therefore, in such situations, warn ings should be issued at >40 μg/L chlorophyll**  **a ,**  **or the site should be temporarily closed at >100 μg/L.**  **Hungary Cyanobacterial blooms are regulated based on the chlorophyll a**  **concentration.The proposed limit for chlorophyll**  **a is 25 μg/L and the still-acceptable limit is 75 μg/L. [273/2001(XII.21)**  **Governmental Ordinance on the Quality of Natural Bathing Waters] Italy**  **In 1998, the Ministry of Health provided a list of toxic algae and cyanobacteria of concern, analytical methodologies, and recommended a limit of 5,000,000 cells/L of toxic algal species as**  **a safe level for bathing activities. Netherlands No official guidance value, but recommend an exposure limit of 20 μg/L.These provisional**  **guidelines are used by many provinces: MC-LR >10 μg/L: issue warning**  **MC-LR >20 μg/L: issue warning and continue monitoring; if levels are persistently high, close bathing facility**  **Presence of scums: at least issue a warning and continue monitoring**
**V**

**alues based upon the tolerable daily intake in food (MC-LR <0.04 μg per kg bodyweight), from which the provisional WHO guideline for drinking water (MC-LR <1 μg/L) was derived, and as**  **suming that a swimmer ingests 100 mL of water (and bathes 365 days per year—more likely this**

**w ould be less than 35 days), an exposure limit of 20 μg MC-LR per liter of bathing water is de**  **rived.**

**P**

**oland In 2002, the Polish Ministry of Health added the presence of cyanobacteria to the requirements for monitoring bathing-water quality. The presence of cyanobacterial blooms is determined by**  **observation of water color, turbidity, and odor. Monitoring is done biweekly from April until the end of September. The required analysis does not include a determination of total phosphorus**  **and nitrogen (parameters that determine cyanobacterial growth) or the quantitative measurement of chlorophyll**  **a concentrations.**  Country Guideline

**a Adapted from Burch, 2008.** 118 FWRI Technical Report TR-14

**.** 

## Brevetoxins

**KIRKPATRICK, B., L. FLEMING, D. SQUICCIARINI, L. C. BACKER, R. CLARK,W. ABRAHAM, J. BENSON,**  **Y. S. CHENG, D. JOHNSON, R. PIERCE, J. ZAIAS, G.**  **BOSSART, and D. G. BADEN. 2004. Literature review of Florida Red Tide: Implications for human health**  **effects. Harmful Algae 3(2): 99–115. Multiple articles**  **in Environmental Health Perspec**  **tives, Mini-Monograph: Brevetoxins, 113(5): 618–657 (May 2005)** 
**N**

**AAR, J. P., L. J. FLEWELLING, A. LENZI, J. P. ABBOTT, A. GRANHOLM, H. M. JACOCKS, D. GANNON, M.**  **HENRY, R. PIERCE, D. G. BADEN, J. L. WOLNY, and J. L. LANDSBERG. 2007. Brevetoxins, like ciguatoxins,**  **are potent ichthyotoxic neurotoxins that accumulate in fish.Toxicon 50(5): 707–723.** 
**WA TKINS, S. M., A. REICH, L. E. FLEMING, and R.**  **HAMMOND. 2008. Neurotoxic shellfish poisoning. Marine Drugs 6: 431–455.**  

## Ciguatera

**FRIEDMAN, M. A., L. E. FLEMING, F. MERCEDES, P. BIENFAND, K. SCHRANK, R. DICKEY, M. Y. BOT**  **TEIN, L. BACKER, R. AYYAR, R. WEISMAN, S. WA** **TKINS, R. GRANADE, and A. REICH. 2008. Ciguat era fish poisoning: treatment, prevention and man**  **agement. Marine Drugs 6: 456–479. McKEE,D.B.,L.E.FLEMING,R.TAMER,R.WEISMAN,**  **and D.BLYTHE.2001.Physician diagnosis and reporting of ciguatera fish poisoning in an endemic area.Pp.451–453**  **in Harmful Algal Blooms 2000. Intergovernmental**  **Oceanographic Commission of UNESCO.** 

## Cyanobacteria

**BURNS,J.2008.Toxic cyanobacteria in Florida waters.Ad**

**v**

**ances in Experimental Medicine and Biology 619: 127–37.**
**C**

**ARMICHAEL,W.W. 1997.The cyanotoxins. Advances in Botanical Research 7: 211–256.**  **DEPARTMENT OF HEALTH AND HUMAN SER VICES, CENTERS FOR DISEASE CONTROL AND**  **PREVENTION. (Undated) Facts about cyanobacteria & cy** **anobacterial harmful algal blooms. Brochure. Avail able at http://www.cdc.gov/hab/cyanobacteria/facts.htm** 

**STEWART, I., I. M. ROBERTSON, P. M. WEBB, P. J. SCHLUTER, and G. R. SHAW. 2006. Cutaneous**  **h**

**ypersensitivity reactions to freshwater cyanobacteria —human volunteer studies. BMC Dermatology 6: 6.** **STEWART, I., P. M.WEBB, P. J. SCHULTER, L. E. FLEM ING, J.W. BURNS, JR., M. GANTAR, L. C. BACKER, and**  **G. R. SHAW. 2006. Epidemiology of recreational**  **exposure to freshwater cyanobacteria—an international prospective cohort study. BMC Public Health 6: 93.** 



## Pfiesteria

**MORRIS, J. G., JR., L. M. GRATTAN, L. A.WILSON,W. A. MEYER, R. McCARTER, H. A. BOWERS, J. R. HEBEL,**  **D. L. MATUSZAK, and D. W. OLDACH. 2006. Occu**  **pational exposure to Pfiesteria**  **species in estuarine wa ters is not a risk factor for illness. Environmental Health**  **P**

**erspectives 114: 1038–1043.** 

## Saxitoxin Puffer Fish Poisoning

**BODAGER, D. 2002. Outbreak of saxitoxin illness fol lowing consumption of Florida pufferfish. Florida Jour**  **nal of Environmental Health 179: 9–13. LANDSBERG, J. H., S. HALL, J. N. JOHANNESSEN, K.**  **D. WHITE, S. M. CONRAD, J. P. ABBOTT, L. J.**  **FLEWELLING, R. W. RICHARDSON, R. W. DICKEY, E. L. E. JESTER, S. M. ETHERIDGE, J. R. DEEDS, F. M.**  **VA N DOLAH, T. A. LEIGHFIELD, Y. ZOU, C. G.**  **BEAUDRY, R. A. BENNER, P. L. ROGERS, P. S. SCOTT, K. KAWABATA, J. L.WOLNY, and K. A. STEIDINGER.**  **2006. Saxitoxin puffer fish poisoning in the U.S.A. with the first report of**  **Pyrodinium bahamense as the putative**  **toxin source. Environmental Health Perspectives 114: 1502–1507. Available at http://www.ehponline.org/**  **members/2006/8998/8998.pdf** 

# Appendix F Bibliography of Significant LiteratureFWRI Technical Report TR-14 119

**. amnesic shellfish poisoning (ASP) illness caused by eating shellfish that have fed on diatoms producing the**  **toxin domoic acid; symptoms include a decreased reaction to pain and short-term memory loss; has caused deaths**  **anoxia absence of oxygen aphasia impairment or loss of speech or speech comprehension** **aquaculture the growth of freshwater and marine organisms for food on a commer cial scale in a confined area or volume of water** 
**armored refers to dinoflagellates that are covered with adjoining cellulose (or**  **other polysaccharide) plates (thecate); plate pattern is characteristic for armored genera**  **arthralgia joint pain asthenia absence or lack of energy or strength** 
**ataxia loss of muscular coordination autotroph an organism that makes**  **its own organic food via photosynthesis or**

**c hemosynthesis**  **ballast water water carried in a ship’s hold to give the craft stability, usually collected at one port and released at a second port**  **bathymetry the measurement of depth in bodies of water benthic pertaining to all undersea bottom terrain, regardless of water depth** **beta testing hardware or software testing of a new product before releasing com mercially; usually conducted by customers**  **biota the living portion of a given area including animals, plants, fungi, and microorganisms**  **biotoxin a biologically produced toxin bivalve mollusk (mollusc) an organism with a two-part shell (**  **e.g., o** **yster or clam) belonging to the Phylum Mollusca** 
**bloom a higher-than-normal population of phytoplankton or microalgae within**  **the water column**
**brackish water of less than normal oceanic salinity, usually ranging from 0.5 to 17**  **PSU but can have up to 32 PSU**
**brevetoxins a suite of neurotoxins reported (and verified) from**  **Karenia brevis**

**carcinomas malignant neoplasia derived from epithelial tissue** 

**c hloroplast**  **the cellular organelle in which photosynthesis takes place ciguatera fish poisoning (CFP) a human disease caused by eating certain tropical fish that contain cigua**  **toxin and its derivatives; the toxins originate in dinoflagellates; more than 400 tropical fish species are implicated; affects the gastrointestinal and neu**  **rological systems; the characteristic symptom is hot–cold reversal** 

# Appendix G GlossaryPublic Health Response to HABs Abbott et al.

120 FWRI Technical Report TR-14

**.** Appendix G

**ciguatoxin a toxin produced by the benthic dinoflagellate**  **Gambierdiscus toxicus control (of HABs, see mitigation) efforts to reduce or confine the size, intensity, or duration of a bloom**  **copepods any of v** **arious small marine and freshwater crustaceans of the order Copepoda** 
**CUSUM a m**  **ethod to graphically represent the cumulative sums of two related sets of data** 

**crustacean aquatic arthropods having segmented bodies, chitinous exoskeletons,** **and paired jointed limbs; including lobsters, crabs, shrimps, and barna cles of the order Crustacea**  **depuration the process of removing contaminants from seafood**  **desquamation shedding of skin** 
**diatom planktonic microalgal form with siliceous shell (shaped like a pillbox);** **occurs as a single cell or in a chain of connected shells; capable of pho tosynthesis**  **diarrheic shellfish poisoning (DSP) illness caused by eating shellfish that have fed on**  **Dinophysis or**  **Prorocentrum dinoflagellates, which produce a suite of toxins, including okadaic acid,**  **dinophysistoxins, and pectenotoxins; causes gastrointestinal disorders; not life-threatening**  **dinoflagellate unicellular microorganisms with two flagella (at some time during the life** 

**c ycle); cells can be armored or unarmored; approximately half photo** **synthesize; Class Dinophyceae, Phylum Pyrrophyta, Division Dinofla gellata**  **dinophysistoxin toxins produced by**  **Dinophysis or some**  **Prorocentrum species** 
**domoic acid toxin produced by**  **Pseudo-nitzschia and**  **Nitzschia species** 
**d**

**ysesthesia impairment of sensation from normal stimuli short of anesthesia** 
**ELISA enzyme-linked immunosorbent assay; a chemical method for detection**  **of toxins such as brevetoxin EpiCom**  **FDOH health information system epizootic**  **epidemic or outbreak of disease in a population of animals estuary**  **a semi-enclosed body of water that is connected to the open ocean, within**  **which freshwater from the land mixes with seawater etiological**  **relating to the causatory agents of a disease or illness eutrophic**  **a body of water that is rich in nutrients**
**filter feeder an or**  **ganism that obtains food by filtering particles from the water column; also called a suspension feeder**  **flagella (plural), flagellum (singular) a long, whip-like projection used for locomotion genotoxic**  **toxic or damaging to DNA**

**g**

**ymnodinioid a type of unarmored dinoflagellate (**  **e.g., Gymnodinium cells)**  **hemolysin a toxin that lyses or destroys red blood cells**  **hepatotoxin a toxin poisonous to the liver** 
**hetero tr**  **oph an organism that ingests and absorbs organic materials for carbon source**  **and energy**Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 121

**. high performance liquid**  **an analytical laboratory technique using chemical**

**c hromatography (HPLC)**  **interactions to identify, separate, purify, or quantify specific compounds**
**h**

**ypoxia decrease below normal levels of oxygen, short of anoxia**  **ichthyotoxin a toxin poisonous to fish**  **indigenous native; living or occurring naturally in a specific environment** 

**in situ in the natural or original place; site of origin** 
**LC–MS liquid chromatography–mass spectrometry; a chemical method for de**  **tection of toxins such as brevetoxin**

**LD 50**  **lethal or life dose; dose required to kill 50 percent of the exposed organ ism or population** 
**littoral the shore or region affected by high and low tides**  **macroalgae nonmicroscopic alga; observable to the eye** 

**maitotoxin a toxin produced by the benthic dinoflagellate**  **Gambierdiscus toxicus**
**Merlin ®**  **FDOH electronic communicable disease reporting system microalgae microscopic aquatic plants; can live free in the water column or attached**  **to sediments, plants, and even animals microcystin a hepatotoxin produced by certain cyanobacteria species**  **mitigation (of HABs, see Control) efforts to minimize or reduce the negative environmental, economic,**  **social, or public health impacts of HABs**
**molluscan shellfish type of shellfish that belong to the Phylum Mollusca (**  **e.g., o** **ysters, clams, and gastropods)**  **mouse bioassay (MBA) lab**  **oratory technique used to determine total toxicity of samples. Note:**  **does not determine the causative agent, toxin, or group of toxins**

**my algia**  **muscle pain or tenderness; may be chronic or temporary**

**nanogram one billionth of a gram** 

**neritic related to the ocean zone from the low tide line to the edge of the conti**  **nental shelf neurotoxic shellfish poisoning (NSP) illness caused by eating shellfish that have accumulated brevetoxin and** **its derivatives; not fatal; the main symptoms include tingling or numb ness of the lips, tongue, throat, hands, and feet** 

**neurotoxin a toxin that acts on nerve cells** 

**nutrient any substance required by an organism for normal growth and mainte** 

**nance**
**oceanic waters in the open ocean, beyond the continental shelf** 
**okadaic acid a toxin produced by**  **Prorocentrum and**  **Dinophysis species**  **oligotrophic waters that are low in nutrients and biomass**  **oomycete fungi that produce oospores for reproduction; nonphotosynthetic; resemble**  **algae papilloma**  **a benign epithelial tumor** Appendix GPublic Health Response to HABs Abbott et al.

122 FWRI Technical Report TR-14

**.** Appendix G

**paralytic shellfish poisoning (PSP) illness caused by eating shellfish containing toxic levels of saxitoxin and its derivatives; neurological symptoms include tingling, numbness, and**  **burning of lips and fingertips; in severe cases, respiratory paralysis can cause death within 24 hours**  **paresthesia abnormal sensation of the skin; e.g.,**  **tingling or burning Pfiesteria**  **species belongs to the genus**  **Pfiesteria Pfiesteria**  **-like morphologically similar to**  **Pfiesteria; can be associated with fish kills**  **phycotoxin algal toxin**  **physiographic the physical**  **features of a site; i.e.,**  **topography, soils, water resources, climate, and vegetative cover**  **phytoplankton small plant organisms that drift in the water column; they are too small**  **to resist currents planktonic**  **refers to those microscopic organisms that live floating or drifting, suspended in the water column**  **ppb parts per billion; the concentration of a substance per billion units in which**  **it is being measured; e.g.,**  **w ater** 

**ppm parts per million; the concentration of a substance per million units in**  **which it is being measured; e.g.,**  **w ater** 

**psu practical salinity units; the total amount of dissolved salts in water**  **determined by its electrical conductivity relative to a prescribed standard (**  Note: **Some authorities recommend no units) prorocentrolide**  **a toxin produced by Prorocentrum**  **species protista**  **diverse kingdom of simple organisms; includes diatoms and dinoflagel lates**  **pruritus itchiness** 

**r ed**  **tid e a**  **harmful algal bloom (HAB); refers to a bloom of toxic or harmful marine microorganisms that may color the water; toxins may also be released** 
**reef fish finfish living on or near a coral (or artificial) reef**  **saxitoxin (STX) highly toxic neurotoxin that causes PSP or SPFP; produced by the**  **dinoflagellate Pyrodinium bahamense**  **saxitoxin puffer fish poisoning (SPFP) illness caused by eating puffer fish containing toxic levels of saxitoxin and**  **its derivatives: neurological symptoms include tingling, numbness, and burning of lips and fingertips; in severe cases, respiratory paralysis can**  **cause death within 24 hours (no fatalities known in USA)**
**shellfish can refer to marine organisms belonging to the Phylum Mollusca (**  **e.g., clams and other bivalves) and the Subphylum Crustacea of the Phylum**  **Arthropoda ( e.g.,**  **crabs and lobsters); generally, shellfish refers to mollusks**
**siliceous containing silica**  **sonolysis the destruction or breakage of cells using high-frequency sound waves** 
**STORET (STOrage and RETrieval) EPA repository for water quality, biological,**  **and physical data.**

**strain a specific isolate of organisms within the same species** Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 123

**. taxa**  **classification for a grouping of organisms trophic**  **levels of the food chain tychoplanktonic**  **benthic organisms accidentally swept up into the water column**

**urticaria hives; raised itchy red areas of skin** 

**viscera the internal**  **organs particularly contained within the chest and abdomen; includes lung, heart, and digestive organs (**  **e.g., stomach, kidney)** 
**wind field the three-dimensional spatial pattern of winds**  **zooplankton animal component of the planktonic community**  Appendix G124 FWRI Technical Report TR-14

**. A** **CHA American College Health Association**  **ADEQ Arizona Department of Environmental Quality**  **AHCA Agency for Health Care Administration**  **APHIS Animal and Plant Health Inspection Service** 
**ASP amnesic shellfish poisoning**  **AST/ALT alanine aminotransferase/aspartate aminotransferase** 

**ATP Aquatic Toxins Program** 

**AW WA**  **American Water Works Association**

**BT bacterial** 
**CCFHR Center for Coastal Fisheries and Habitat Restoration (NOAA)** 
**CCL contaminant candidate list** 
**CDC Centers for Disease Control and Prevention** 
**CFP ciguatera fish poisoning (tropical**  **fish poisoning) CHD county health department**  **COPD chronic obstructive pulmonary disease** 
**CTX ciguatoxin** 
**DSP diarrheic shellfish poisoning**  **ECOHAB Ecology and Oceanography of Harmful Algal Blooms** 

**EIA enzyme immunoassay**  **ELISA enzyme-linked immunosorbent assay** 
**EPA Environmental Protection Agency** 
**EPCHC Environmental Protection Commis sion of Hillsborough County**  **EWMA exponentially weighted moving**

**av erage**  **F. A.C. Florida Administrative Code**  **FAQ frequently asked question** 

**FDA Food and Drug Administration**  **FDACS Florida Department of Agriculture and Consumer Services**  **FDENS FDOH Emergency Notification System**  **FDEP Florida Department of Environmental Protection**  **FDOH Florida Department of Health FHABTF Florida Harmful Algal Bloom Task**  **F orce** 
**FIO Florida Institute of Oceanography** 

**FP fibropapillomatosis** 
**FPIC Florida Poison Information Center**

**F .S.**  **Florida Statute FWVSS Food, Water and Vector-borne**  **Surveillance System**
**FWC Florida Fish and Wildlife Conservation Commission** 
**FWCLE Florida Fish and Wildlife Conservation Commission**  **Law Enforcement**
**FWRI Fish and Wildlife Research Institute**
**GoM Gulf of Mexico GEOHAB Global Ecology and Oceanography**  **of Harmful Algal Blooms**
**GWL GreenWater Laboratories / CyanoLabs**  **HAB harmful algal bloom HABISS Harmful Algal Bloom-related Illness**  **Surveillance System HABHRCA Harmful Algal Bloom and Hypoxia**  **Research Control Act HAL health advisory level**  

# Appendix H Acronyms and AbbreviationsAbbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 125

**. HARRNESS Harmful Algal Research and**  **Response National Environmental Science Strategy**  **HIPAA Health Insurance Portability and Accountability Act**  **HPLC high performance liquid**

**c hromatography** **HPLC/MS high performance liquid chromatog raphy/mass spectrometry** 
**ICP infection control practitioner**  **IDNR Iowa Department of National Resource**  **IDPH Iowa Department of Public Health IAEA International Atomic Energy Agency** 
**IEC information, education, and**  **communication IFAS Institute of Food and Agricultural**  **Sciences**
**IOC Intergovernmental Oceanographic**  **Commission**

**IRL Indian River Lagoon**  **ISSHA International Society for the Study of Harmful Algae** 
**ISSC Interstate Shellfish Sanitation Conference**  **KADL Kissimmee Animal Diagnostic Laboratory**  **LC–MS liquid chromatography–mass spectrometry** 
**LD50 lethal or life dose 50**
**LOAEL lowest observable adverse effect level**  **MAC maximum acceptable concentration MBA mouse bioassay**  **MC-LR microcystin-LR MCWTP Manatee County Water Treatment**  **Plant MML Mote Marine Laboratory**  **MMWR Morbidity and Mortality Weekly Report** 
**MU mouse units**  **NCEH National Center for Environmental Health** 

**NEP National Estuary Program** 
**NIEHS National Institute of Environmental Health Science** 
**NMFS National Marine Fisheries Service NOAA National Oceanic and Atmospheric**  **Administration**
**NRDM National Retail Data Monitor**
**NSF National Science Foundation** 
**NSP neurotoxic shellfish poisoning** 
**NSSP National Shellfish Sanitation Program**  **NTAC National Technical Advisory Committee** 
**NWFSC Northwest Fisheries Science Center**
**OA okadaic acid**  **ODHS Oregon Department of Health Services** 
**OTC over** **-the-counter**
**PbTx brevetoxin**
**PCA personal care assistance** 
**PCC Poison Control Center** 
**PCR polymerase chain reaction**  **PHTP public health technical panel**
**PLS Pfiesteria**  **-like species ppb**  **parts per billion**

**ppm parts per million** 

**PFP puffer fish poisoning** 
**PSP paralytic shellfish poisoning** 
**PSU practical salinity units (some**  **authorities recommend no units) QSAR quantitative structural activity**  **relationships RDC rapid data collector** 
**RSD red sore disease** 
**SAV submerged aquatic vegetation**  **SDWA Safe Drinking Water Act** Appendix H**SEAS Shellfish Environmental Assessment Section**  **SFWMD South Florida Water Management District**  **SJRWMD St. Johns River Water Management District**  **SPFP saxitoxin puffer fish poisoning SPI specialist in poison information**  **spp. species (plural)**
**START Solutions to Avoid Red Tide**
**STX saxitoxin**
**TAG technical advisory group** 

**TDI tolerable daily intake** 

**TTX tetrodotoxin**  **TWQR total water quality range UCMR unregulated contaminant**  **monitoring regulation**

**UF University of Florida**  **UM ulcerative mycosis**  **U of M University of Miami UNCW University of North Carolina at**  **W ilmington**  **UNESCO United Nations Educational, Scientific and Cultural Organization**  **USAMRIID United States Army Medical Research Institute for Infectious**  **Diseases USDOE United States Department of**  **Interior**
**USFWS United States Fish and Wildlife Service**  **USGS United States Geological Survey WHO World Health Organization**  **WHOI Woods Hole Oceanographic Institution**  **WMD Water Management District** Public Health Response to HABs Abbott et al.

126 FWRI Technical Report TR-14

**.** Appendix HFWRI Technical Report TR-14 127

**.** Center for Disease Control and Prevention
**Lorraine Backer National Center for Environmental Health**  **4770 Buford Highway NE MS F-46**  **Chamblee, GA 30341 Te**  **l (770) 488-3426 Fa**  **x (770) 488-3450 lbacker@cdc.gov** 
Florida Department of Agriculture and Consumer Services **Alice Agasan Kissimmee Animal Diagnostic Laboratory**  **2700 N. John Young Parkway Kissimmee, FL 34741**  **Te l (321) 697-1400**  **Fa x (321) 697-1467**  **agasana@doacs.state.fl.us**

**Howard Beadle Division of Aquaculture**  **Atlantic SEAS Office 1378 Malabar Road, Suite 1**  **Palm Bay, FL 32909 Te**  **l (321) 984-4890 beadleh@doacs.state.fl.us** 

**Chris Brooks Division of Aquaculture**  **1203 Governors Square Blvd., 5th Floor T** 

**allahassee, FL 32301 Te**  **l (850) 488-4033 Fa**  **x (850) 410-0893 brooksc@doacs.state.fl.us** 

**J ohn Fruin**  **Division of Food Safety 3125 Conner Blvd., Suite D**  **T**

**allahassee, FL 32399-1650 Te**  **l (850) 245-5520 Fax (850) 245-5553**  **fruinj@doacs.state.fl.us**

**David Heil Bureau of Aquaculture Environmental Services**  **1203 Governors Square Blvd., 5th Floor T**  **allahassee, FL 32301 Te**  **l (850) 488-5471 Fa**  **x (850) 410-0893 heild@doacs.state.fl.us** 

**Alan Pierce Bureau of Aquaculture Environmental Services**  **1203 Governors Square Blvd., 5th Floor T** 

**allahassee, FL 32301 Te**  **l (850) 488-5471 Fa**  **x (850) 410-0893 piercea@doacs.state.fl.us** 
Florida Department of Environmental Protection

**T**

**im Fitzpatrick Bureau of Laboratories**  **Chemistry 2600 Blairstone Road, MS6510**  **T**

**allahassee, FL 32399-2400 Te**  **l (850) 245-8083 Fa**  **x (850) 245-8082 Ti**  **mothy.Fitzpatrick@dep.state.fl.us**
**Russ Frydenborg Bureau of Laboratories**  **Environmental Assessment Section 2600 Blairstone Road, MS6511**  **Ta lllahassee, FL 32399-2400**  **Te l (850) 245-8063**  **Fa x (850) 245-8082**  **Russel.Frydenborg@dep.state.fl.us**
**David Whiting Bureau of Laboratories**  **Biology 2600 Blairstone Rd, MS6515**  **T**

**allahassee, FL 32399 Te**  **l (850) 245-8191 Fa**  **x (850) 245-8082 David.D.Whiting@dep.state.fl.us** 
Florida Department of Health
**Carina Blackmore State Public Health Veterinarian**  **Division of Environmental Health 4052 Bald Cypress Way, Bin #A08**  **T**

**allahassee, FL 32399-1712** 

# Appendix I Agency Contacts, Scientists, and Managers**Te l (850) 245-4732**  **Fax (850) 922-8473 Carina_Blackmore@doh.state.fl.us** 
**Ming S. Chan Bureau of Laboratories**  **Chief of Laboratory Services Jac**  **ksonville Central Laboratory 1217 Pearl Street**  **Jac ksonville, FL 32202**  **Te l (904) 791-1550**  **Fax (904) 791-1567 Ming_Chan@doh.state.fl.us** 

**F rederic Ciner**  **Bureau of Laboratories Microbiology**  **Jac ksonville Central Laboratory**  **1217 Pearl Street Jac**  **ksonville, FL 32202 Te**  **l (904) 791-1792 Fax (904) 791-1520**  **F rederic_Ciner@doh.state.fl.us** 

**Roberta Hammond Division of Environmental Health**  **F ood & Waterborne Disease**  **4052 Bald Cypress Way, Bin #A08 T** 

**allahassee, FL 32399-1712 Te**  **l (850) 245-4116 Fax (850) 922-8473**  **Roberta_Hammond@doh.state.fl.us**

**David Polk Bureau of Water Programs**  **Healthy Beaches: Bacterial Monitoring 4052 Bald Cypress Way, Bin #C-22**  **T**

**allahassee, FL 32399-1742 Te**  **l (850) 245-4240 Fax (850) 921-0298**  **David_Polk@doh.state.fl.us**

**Andrew Reich Division of Environmental Health**  **Aquatic Toxins Program 4052 Bald Cypress Way, Bin #C-22**  **T**

**allahassee, FL 32399-1742 T** 

**el (850) 245-4444 ext. 2295 Fax (850) 487-0864**  **Andy_Reich@doh.state.fl.us**

**Danielle Stanek Division of Environmental Health**  **4052 Bald Cypress Way, Bin #A08 T**  **allahassee, FL 32399-1742 Te**  **l (850) 245-4444 Fa**  **x (850) 922-8473 Danielle_Stanek@doh.state.fl.us** 

**Bob Vincent Bureau of Water Programs**  **Healthy Beaches, Environment Te**  **l (850) 245-4578 Fa**  **x (850) 921-0298 Bob_Vincent@doh.state.fl.us** 

**Sharon Watkins Division of Environmental Health**  **Aquatic Toxins Program 4052 Bald Cypress Way, Bin #C-22**  **T**

**allahassee, FL 32399-1742 Te**  **l (850) 245-4240 Fa**  **x (850) 921-0298 Sharon_Watkins@doh.state.fl.us** 

**Dean E. Willis Bureau of Laboratories**  **Chief of Microbiology Jac**  **ksonville Central Laboratory 1217 Pearl Street**  **Jac ksonville, FL 32202**  **Te l (904) 791-1557**  **Fa x (904) 791-1662**  **Dean_Willis@doh.state.fl.us**

Florida Fish and Wildlife Conservation Commission **Meghan Abbott Harmful Algal Blooms**  **Fish and Wildlife Research Institute 100 Eighth Avenue SE**  **St. Petersburg, FL 33701-5095 Te**  **l (727) 896-8626 Meghan.Abbott@MyFWC.com** 

**T heresa Cody**  **Fish and Wildlife Health, Aquatic Fish and Wildlife Research Institute**  **100 Eighth Avenue SE St. Petersburg, FL 33701-5095**  **Te l (727) 896-8626**  **Fa x (727) 893-9840**  **T heresa.Cody@MyFWC.com** 
**Mark Cunningham Fish and Wildlife Health,Terrestrial**  **Fish and Wildlife Research Institute Gainesville Wildlife Laboratory**  Public Health Response to HABs Abbott et al.

128 FWRI Technical Report TR-14

**.** Appendix IAbbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 129

**.** Appendix I

**4005 South Main Street Gainesville, FL 32601**  **Te l (352) 955-2230**  **Fax (352) 955-2183 Mark.Cunningham@MyFWC.com** 
**Leanne Flewelling Harmful Algal Blooms,Toxins**  **Fish and Wildlife Research Institute 100 Eighth Ave SE**  **St. Petersburg, FL 33701-5095 Te**  **l (727) 896-8626 Fax (727) 550-4222**  **Leanne.Flewelling@MyFWC.com**
**Allen Foley Marine Turtle Research**  **Fish and Wildlife Research Institute Jac**  **ksonville Field Laboratory 6134 Authority Avenue**  **Jac ksonville, FL 32221**  **Te l (904) 573-3930**  **Fax (904) 573-4982 Allen.Foley@MyFWC.com** 
**Steve Geiger Molluscan Fisheries**  **Fish and Wildlife Research Institute 100 Eighth Avenue SE**  **St. Petersburg, FL 33701-5095 Te**  **l (727) 896-8626 Fax (727) 893-1374**  **Steve.Geiger@MyFWC.com**
**Cindy Heil Harmful Algal Blooms**  **Fish and Wildlife Research Institute 100 Eighth Avenue SE**  **St. Petersburg, FL 33701-5095 Te**  **l (727) 896-8626 Fax (727) 550-4222**  **Cindy.Heil@MyFWC.com**

**Col. Julie Jones Director**  **Division of Law Enforcement 620 South Meridian Street**  **T**

**allahassee, FL 32399-6988 Te**  **l (850) 488-6251 Ju**  **lie.Jones@MyFWC.com**

**Y**

**asu Kiryu Fish and Wildlife Health**  **Fish and Wildlife Research Institute 100 Eighth Avenue SE**  **St. Petersburg, FL 33701-5095 Te**  **l (727) 896-8626 Fa**  **x (727) 893-9840 Y** 

**asu.Kiryu@MyFWC.com**

**J an Landsberg**  **Fish and Wildlife Health Fish and Wildlife Research Institute**  **100 Eighth Avenue SE St. Petersburg, FL 33701-5095**  **Te l (727) 896-8626**  **Fa x (727) 893-9840**  **J an.Landsberg@MyFWC.com** 

**Leslie Ward Marine Mammal Research**  **Fish and Wildlife Research Institute 100 Eighth Avenue SE**  **St. Petersburg, FL 33701-5095 Te**  **l (727) 896-8626 Fa**  **x (727) 893-9176 Leslie.Ward@MyFWC.com** 

**Dan Wolf Fish and Wildlife Health,Terrestrial**  **Fish and Wildlife Research Institute Gainesville Wildlife Laboratory**  **4005 South Main Street Gainesville, FL 32601**  **Te l (352) 955-2230**  **Fa x (352) 955-2183**  **Dan.Wolf@MyFWC.com**
National Estuary Program
**Mark Alderson Sarasota Bay Project**  **111 South Orange Avenue, Suite 200W Sarasota, FL 34236**  **Te l (941) 955-8085**  **Fa x (941) 955-8081**  **mark@sarasotabay.org**

**Lisa Beever Charlotte Harbor NEP**  **1926 Victoria Ave F** **ort Myers, FL 33901 T** 

**el (239) 338-2556 ext. 235 Fa**  **x (239) 338-2560 lbeever@swfrpc.org** 
**Holly Greening Ta**  **mpa Bay National Estuary Project 100 Eighth Avenue, SE** **St. Petersburg, FL 33701 Te**  **l (813) 893-2765 tbnep@tampabayrcp.org** 
**Troy Rice**  **Indian River Lagoon Program 525 Community College Parkway, SE**  **Palm Bay, FL 32909 Te**  **l (321) 984-4950 Fax (321) 984-4937**  **trice@sjrwmd.com**
National Oceanic & Atmospheric Administration
**Center for Coastal Environmental Health and Biomolecular Research**  **Biotoxin Program, Charleston Lab 219 Fort Johnson Road**  **Charleston, S.C. 29412-9110 Phone: (843) 762-8511**  **Fax: (843) 762-8700**

**Blair Mase-Guthrie National Marine Fisheries Service, Southeast**  **Fisheries Science Center (SEFSC) 75 Virginia Beach Drive**  **Miami, FL 33149 Te**  **l (305) 361-4200 Blair.Mase@noaa.gov** 

**P**

**acific Northwest National Laboratory (US DOE) P.**  **O. Box 999**  **902 Battelle Blvd. Richland, WA 99352**  **T**

**el 1-888-375-PNNL (7665) inquiry@pnl.gov** 

**T**

**eri Rowles National Marine Fisheries Service**  **Office of Protected Resources Marine Mammal and Sea Turtle Conservation**  **Division 1315 East-West Highway, F/PR2**  **Silver Spring, MD 20910 Te**  **l (301) 713-2322 Fax (301) 427-2522**  **T**

**eri.Rowles@noaa.gov**

**Barbara Schroeder National Marine Fisheries Service**  **Office of Protected Resources 1315 East-West Highway, Room 13657**  **Silver Spring, MD 20910 Te**  **l (301) 713–1401 Barbara.Schroeder@noaa.gov**  **V era Trainer**  **Northwest Fisheries Science Center Harmful Algal Blooms**  **2725 Montlake Blvd. East Seattle, WA 98112-2097**  **Te l (206) 860-6788**  **Fax (206) 860-3217 V** 

**era.Trainer@noaa.gov**

**F ran Van Dolah**  **Marine Biotoxins Program Center for Coastal Environmental Health and**  **Biomolecular Research National Ocean Service**  **Charleston, SC 29412 Te**  **l (843) 762-8631 Fax (843) 762-8700**  **F ran.Vandolah@noaa.gov** 

Poison Information Centers (PICs) **Eva Jerez Miami Poison Information Center**  **University of Miami, Dept of Pediatrics P.**  **O. Box 016960 (R-131)**  **Miami, FL 33101 Te**  **l (305) 585-5250 Fax (305) 545-9762**  **ejerez@med.miami.edu**
**Cynthia Lewis-Younger Ta**  **mpa Poison Information Center Ta**  **mpa General Hospital P.**  **O. Box 1289**  **Ta mpa, FL 33601**  **Te l (813) 844-7044**  **Fax (813) 844-4443**

**Ja y Schauben**  **Jac ksonville Poison Information Center**  **655 West Eighth Street Jac**  **ksonville, FL 32209 Te**  **l (904) 244-4465 Fax (904) 244-4063**  **schauben@poison.ufl.edu**

**Richard Weisman Miami Poison Information Center**  **University of Miami, Dept of Pediatrics P.**  **O. Box 016960 (R-131)**  **1611 NW 12th Avenue Miami, FL 33101**  **Te l (305) 585-5250**  **Fax (305) 545-9762 rweisman@med.miami.edu**  Public Health Response to HABs Abbott et al.

130 FWRI Technical Report TR-14

**.** Appendix IAbbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 131

**.** Appendix I

U.S. Army Medical Research Institute for Infectious Diseases
**Mark Poli 1425 Porter Street**  **Fort Detrick, MD 21702-5011 Te**  **l (301) 619-4801 Mark_Poli@amedd.army.mil** 
U.S. Department of Agriculture

**T**

**erence Evens U**  **.S. Horticultural Research Laboratory 2001 South Rock Road**  **Fort Pierce, FL 34945-3030 Te**  **l (772) 462-5941 Fax (772) 462-5986**  **T**

**erence.Evens@ars.usda.gov**

**Kathleen Hartman APHIS**  **1408-24 Street SE Ruskin, FL 33570**  **Te l (813) 671-5230**  **kathleen.h.hartman@aphis.usda.gov**
U.S. Environmental Protection Agency
**Ed Decker Region 4, Office of Science and Technology**  **Health and Ecological Criteria Division 61 Forsyth Street, SW**  **Atlanta, GA 30303-8960 Te**  **l (404) 562-9383 Fax (404) 562-9224**  **decker.ed@epa.gov**

**Ja ck**  **Fournie One Sabine Island Drive**  **Gulf Breeze, FL 32561 Te**  **l (850) 934-9272 Fax (850) 934-9201**  **fournie.john@epa.gov**

U.S. Fish and Wildlife Service

**T**

**odd Hopkins 1339 – 20th Street**  **V**

**ero Beach, FL 32960 Te**  **l (772) 562-3909 ext.316 T** 

**odd_Hopkins@fws.gov**
**Dawn Jennings 7915 Baymeadows Way, Suite 200**  **Jac ksonville, FL 32256**  **Te l (904) 731-3103**  **Dawn_Jennings@fws.gov Jim Valade**  **North Florida Field Office Endangered Species**  **6620 Southpoint Drive South, Suite 310 Jac**  **ksonville, FL 32216-0958 Te**  **l (904) 232-2580 Fa**  **x (904) 232-2404 Jim_Valade@fws.gov** 
U.S. Food and Drug Administration **Jo n Deeds**  **Center for Food Safety and Applied Nutrition Microbiology**  **HFS-707 5100 Paint Branch Parkway**  **College Park, MD 20740 Te**  **l (301) 436-1474 Fa**  **x (301) 210-0275 jonathan.deeds@fda.hhs.gov** 
**Robert Dickey Gulf Coast Seafood Laboratory**  **1 Iberville Street P.**  **O. Box 158**  **Dauphin Island, AL 36528 Te**  **l (251) 690-3368 Fa**  **x (251) 694-4477**

**r dickey@cfsan.fda.gov** 
**Stacey Etheridge Center for Food Safety and Applied Nutrition**  **Biology HFS-707**  **5100 Paint Branch Parkway College Park, MD 20740**  **Te l (301) 436-1470**  **Fa x (301) 436-2624**  **stacey.etheridge@fda.hhs.gov**

**Sherwood Hall Center for Food Safety and Applied Nutrition**  **Chemistry HFS-716**  **5100 Paint Branch Parkway College Park, MD 20740**  **Te l (301) 436-1653**  **sherwood.hall@fda.hhs.gov**
U.S. Geological Survey
**Anne Ballmann National Wildlife Health Center**  **6006 Schroeder Road Madison, WI 53711-6223**  **Te l (608) 270-2445** **Fax (608) 270-2415 aballmann@usgs.gov** 
**Barry Rosen Florida Integrated Science Center**  **12703 Research Parkway Orlando, FL 32806**  **Te l (407) 803-5508**  **Fa x (407) 803-5501**  **brosen@usgs.gov**
**Scott D. Wright Branch Chief, Disease Investigation**  **National Wildlife Health Center 6006 Schroeder Road**  **Madison, WI 53711-6223 Te**  **l (608) 270-2445 Fax (608) 270-2415**  **swright@usgs.gov**

W

ater Management Districts **Northwest Florida Water Management District Graham Lewis**  **81 Water Management Drive Havana, FL 32333**  **Te l (850) 539-5999**  **Fa x (850) 539-2777**  **Graham.Lewis@nwfwmd.state.fl.us**
**South Florida Water Management District Richard Pfeuffer**  **W ater Quality Assessment Division**  **3301 Gun Club Road W**  **est Palm Beach, FL 33406 Te**  **l (561) 682-6806 Fa**  **x (561) 682-6442 rpfeuff@sfwmd.gov** 
**St. Johns River Water Management District Dean Campbell**  **Environmental Sciences Division P.**  **O. Box 1429**  **P**

**alatka, FL 32178-1429 Te**  **l (386) 329-4360 Fax (386) 329-4103**  **dcampbell@sjrwmd.com**
**St. Johns River Water Management District J**  **ohn Hendrickson Environmental Sciences Division**  **P. O.**  **Box 1429 P** 

**alatka, FL 32178-1429 Te**  **l (386) 329-4370 Fax (386) 329-4103**  **jhendrickson@sjrwmd.com**
**Southwest Florida Water Management District V** 

**eronica Craw 2379 Broad Street**  **Brooksville, FL 34606-6899 Te**  **l (352) 796-7211**

**v eronica.craw@swfwmd.state.fl.us** 
**Suwannee River Water Management District Robbie McKinney**  **9225 CR 49 Live Oak, FL 32060**  **Te l (386) 362-1001** 

Hotlines **Aquatic Toxins 1-888-232-8635**  **http://www.doh.state.fl.us/environment/ community/aquatic/** 

**Fish Kill Hotline 1-800-636-0511**  **http://research.myfwc.com/fishkill/submit.asp**

**P**

**oison Control 1-888-222-1222**  **http://www.fpicn.org/** Public Health Response to HABs Abbott et al.

132 FWRI Technical Report TR-14

**.** Appendix I

# Fish and Wildlife Research Institute T

echnical Report Series

TR-1 **Sargent, F. J., T. J. Leary, D. W. Crewz, and C. R. Kruer. 1995. Scarring of Florida’s Seagrasses: Assessment and Management Options. Florida Marine Research Institute**  **Tec hnical Report TR-1. iv + 37 p. + appendices.** 
TR-2 **W itherington, B. E., and R. E. Martin. 2000. Understanding, Assessing, and Resolving**  **Light-Pollution Problems on Sea Turtle Nesting Beaches. Second Edition, revised. Florida Marine Research Institute Technical Report TR-2. vii + 73 p.** 
TR-2 **W itherington, B. E., and R. E. Martin. 2003. Entendiendo, evaluando y solucionando los**  **problemas de contaminación de luz en playas de anidamiento de tortugas marinas. Florida Marine Research Institute Technical Report TR-2, traducción de la Tercera Edición inglesa,**  **revisada. (In Spanish.) vii + 75 p.** 
TR-3 **Camp, D. K., W. G. Lyons, and T. H. Perkins. 1998. Checklists of Selected Shallow-Water Marine Invertebrates of Florida. Florida Marine Research Institute Technical Report**  **TR-3. xv + 238 p.**
TR-4 **National Oceanic and Atmospheric Administration, Florida Fish and Wildlife Conserva tion Commission, and Florida Keys National Marine Sanctuary. 2000. Benthic Habitats of**  **the Florida Keys. Florida Marine Research Institute Technical Report TR-4. v + 53 p.**
TR-5 **McBride, R. S. 2000. Florida’s Shad and River Herrings ( Alosa**  **species): A Review of P** 

**opulation and Fishery Characteristics. Florida Marine Research Institute Technical Report TR-5. iv + 18 p.** 
TR-6 **Adams, D. H., and R. H. McMichael. 2001. Mercury Levels in Marine and Estuarine Fishes of Florida. Florida Marine Research Institute Technical Report TR-6. ii + 35 p.** 
TR-7 **W eigle, B. L., I. E. Wright, M. Ross, and R. Flamm. 2001. Movements of Radio-Tagged**  **Manatees in Tampa Bay and Along Florida’s West Coast, 1991–1996. Florida Marine Research Institute Technical Report TR-7. ii + 156 p.** 
TR-8 **Wak eford, A. 2001. State of Florida Conservation Plan for Gulf Sturgeon (**  **Acipenser oxyrinchus desotoi**  **). Florida Marine Research Institute Technical Report TR-8. ii + 100 p.**
TR-9 **Adams, D. H., R. H. McMichael, Jr., and G. E. Henderson. 2003. Mercury Levels in Marine**  **and Estuarine Fishes of Florida 1989–2001. Second Edition, Revised. Florida Marine Research Institute Technical Report TR-9. ii + 57 p.**  TR-10 **McDonald, S. L., and R. O. Flamm. 2006. A Regional Assessment of Florida Manatees**  **( T** 

**richechus manatus latirostris ) and the Caloosahatchee River, Florida. Fish and Wildlife**  **Research Institute Technical Report TR-10. ii + 52 p.** TR-11 **Hunt, J. H., and W. Nuttle, eds. 2007. Florida Bay Science Program: A Synthesis of Research on Florida Bay. Fish and Wildlife Research Institute Technical Report TR-11.**  **iv + 148 p.**  TR-12 **Gerhart, S. D. 2007. A Review of the Biology and Management of Horseshoe Crabs, with Emphasis on Florida Populations. Fish and Wildlife Research Institute Technical Report**  **TR-12. ii + 24 p.** TR-13 **Swanson, K., D. Land, R. Kautz, and R. Kawula. 2008. Use of Least-Cost Pathways to Identify Key Road Segments for Florida Panther Conservation. Fish and Wildlife**  **Research Institute Technical Report TR-13. ii + 44 p.** TR-14 **Abbott, G. M., J. H. Landsberg, A. R. Reich, K. A. Steidinger, S. Ketchen, and C. Blackmore. 2009. Resource Guide for Public Health Response to Harmful Algal Blooms in Florida.**  **Fish and Wildlife Research Institute Technical Report TR-14. viii + 132 p.**