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

Kenneth D. Haddad

Executive Director

The 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 population 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.

The 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

James F. Quinn, Jr., Science Editor

Judith 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 Abbott1*

Jan H. Landsberg1

Andrew R. Reich2

Karen A. Steidinger 1,3

Sharon Ketchen2

Carina Blackmore2

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

Tallahassee, 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

For more information on living resource health

in relation to Harmful Algal Blooms, please contact

Jan H. Landsberg

Florida Fish and Wildlife Conservation Commission

Fish and Wildlife Research Institute

Fish and Wildlife Health Program

Jan.Landsberg@MyFWC.com, 727-896-8626

For 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

This document was composed in Microsoft Word® and produced using QuarkXPress® on Apple Macintosh®

computers.The headline font is Adobe® Avant Garde, the text font is Adobe® Palatino, and the cover headline

is Adobe® Gill Sans.

The 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 Protection, conceived and created the Florida Harmful Algal Bloom Task Force (FHABTF) as an ad hoc

group to identify gaps in information on harmful

algal blooms (HABs) in Florida, particularly Karenia 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. Recommendations 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, economic, 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

Wildlife 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

The remaining task (F.S. Ch. 379.2271 [2][c])

was to “develop recommendations that can be implemented by state and local governments to develop 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

Technical Panel. In the same year, FWC–FWRI received 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 recommendations for an integrated public health environmental 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 Program administered by FWC–FWRI. However,

legislative budget cuts that began in 2008 threaten

the program’s future.

The 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

were conducted at FWC–FWRI in St. Petersburg.

The first workshop titled “Florida Public Health

Meeting on Harmful Algal Blooms and their Effects”was held 27–28 September 2005.The second

workshop titled “Florida Harmful Algal Bloom

Public Health Agenda: Information for Developing Local Response Capacity”was held 9–10 August 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, environmental, natural resource, agriculture, and research

professionals from state agencies, universities,

and private laboratories (see Acknowledgement

of Participants).

This document is an extension of the activities

performed by the Public Health Technical Panel,

and addresses in part tasks directed by the legislatively created FHABTF.The final phase is the actual development of public health response plans,

and this will be done by local county health departments assisted by the FDOH Aquatic Toxins

Program.
v

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Table of Contents

PREFACE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii

ACKNOWLEDGMENT OF PARTICIPANTS. . . . . . . . . . . . . . . . . . . . . . . . . vii

ACKNOWLEDGMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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

OTHER POTENTIAL HAB PROBLEMS. . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Chapter 2 Agency Responsibility Matrices . . . . . . . . . . . . . . . . . . . . . . 22

AQUATIC 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 WATER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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

MITIGATION ACTIVITIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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 Maps of Specific Areas of Florida at High Risk for HAB Exposures (by County) . . . . . . . . 90

B Medical 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® Web 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

Tables

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

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Acknowledgment of Participants

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

was 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 brainstorming 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

Faconti,Victor – FDOH

Flanery, Mike – FDOH

Fleming, Lora – U of M

Flewelling, Leanne – FWC

Friedman, 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

Jackow, George – FDOH

Jerez, Eva – PCC

Kent, Steve – FDEP

Ketchen, Sharon – FDOH

King, Joe – FDEP

Kirkpatrick, Barb – MML

Koerner, David – FDOH

Kowal, 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

Patch, Sonal – FDOH

Pawlowicz, Marek – FDOH

Pettit, Karen – MCWTP

Pfeuffer, Richard – SFWMD

Pink, Jack – FDOH

Polk, David – FDOH

Pouso, David – FDOH

Prager, Ellen – Earth2Ocean, Inc.

Rakestraw, Richard – FDEP

Reed, Gale – FDOH

Reich, Andy – FDOH

Reinhold,Todd – FDOH

Riskowitz, Kevin – City of St.

Petersburg

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

Terzagian, Robin – FDOH

Thornton, Pete – FDOH

Traynor, Sharleen – FDOH

Waldron, Jennifer – FDOH

Watford, Kim – FDOH

Weisman, Richard – U of M

Whiting, David – FDEP

Williams, Chris – GWL

Wilson, Emily – FDOH

Wilson,Yvette – FDOH

Windham, Donald – FDOH

Winn, Sarah – FDOH

Zager, Hunter – FDOH

Zaheer, Saad – FDOH

Zorros,Tim – FDOH
viii

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Acknowledgments

The FHABTF Public Health Technical Panel was convened specifically to provide guidance and recommendations 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 Earth2Ocean, 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 environment, 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 concern over an increasing public health risk.

The FHABTF was charged with investigating HABs

and assessing their potential effects on living aquatic

resources and public health.This charge included investigating HAB events such as red tides and newly

emerging issues such as the potential for the fishkilling dinoflagellate Pfiesteria piscicida to become a

threat in Florida. In addition, the FHABTF was to evaluate critical HAB issues and make recommendations

for action. A Technical Advisory Group (TAG) was

also appointed to assist the task force. The TAG developed a resource document,“Harmful Algal Blooms

in Florida,” that identified major Florida HABs; discussed the history and economic, natural-resource, and

public health effects of HABs; and made recommendations 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

was created in response to F.S. Ch. 379.2271 section

2(c), “Develop recommendations that can be implemented by state and local governments to develop a response 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 facilitate the development of local public health HAB

response plans.

This technical manual has two major components.

The first provides background information for guiding

development of local response plans and quick-reference guides for public health HAB response.The second presents a methodology for developing flowcharts

and further technical information related to public

health HAB response. The major topics include the

following:

• review of current literature on HABs significant to

public health in Florida

• identification of present federal, state, and local governmental authority over, and responsibility for, response activities related to HABs

• available monitoring and surveillance databases

• current human health and animal surveillance

systems

• public health regulatory guidelines (state, national,

and international)

• available outreach resources

• current management strategies for mitigation of

HABs in Florida

• priority research and policy needs

• examples of generic response flowcharts for environmental and case investigations

• maps identifying specific areas of Florida at high

risk for HAB exposures

• medical fact sheets, clinical case definitions and reporting requirements for HAB-related human illnesses, 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 neither always red nor even visible to the unaided human

eye 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

events 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 ecological community structure. For example, animal mortalities associated with HABs can result from indirect

effects such as the formation of toxic sulfides or increased 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

avoidance of an area, and reduced feeding (Landsberg, 2002). Mass marine mortalities may result in

piles of decomposing organisms on the beaches, adversely 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 researched.“Algal” usually refers to microscopic algae,

which include phytoplankton that can cause these

harmful effects. Globally, an increasing number of microalgae such as dinoflagellates and cyanobacteria

have been found to produce toxins.“Bloom”means that

the microalgae are present at high enough concentrations 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 pigments. A bloom of these pigmented algae can color the

water in many hues including red, brown, green, yellow, 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.

With more than 50 marine and 20 freshwater harmful algal species present, Florida’s HABs have the potential to affect public health, cause economic losses,

and affect living marine, freshwater, and terrestrial

resources (Fleming et al., 1998; Steidinger et al., 1999;

Williams et al., 2001; Backer et al., 2003a; Kirkpatrick et

al., 2004; Landsberg et al., 2006).The most significant toxins produced by HABs in Florida include saxitoxins

(STXs), brevetoxins (PbTXs), ciguatoxins (CTXs) in marine waters, and cyanotoxins, e.g., microcystins, cylindrospermopsins, and lyngbyatoxins, in fresh water.

Elsewhere, STXs are produced by multiple dinoflagellate species and are typically associated with paralytic shellfish poisoning (PSP). In Florida, STX-caused

illnesses have only been from saxitoxin puffer fish poisoning (SPFP). STX is produced by the dinoflagellate

Pyrodinium bahamense. Brevetoxins are produced by

the dinoflagellate K. brevis and cause neurotoxic shellfish 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 and

their 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).

The following is an overview of the current HABs in Florida, their related toxins, and associated illnesses.These include brevetoxins and neurotoxic shellfish poisoning, saxitoxins and saxitoxin puffer fish poisoning, ciguatoxins and ciguatera fish poisoning, 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 prioritize regional HAB issues in the design of response plans.
Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 3

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1 | Background on Harmful Algal Blooms

lyse cells and release the toxins, which become airborne

in jet spray and create a red tide aerosol. Ciguatoxins

(CTXs) produced by the benthic dinoflagellate Gambierdiscus toxicus cause the tropical and subtropical

poisoning known as ciguatera fish poisoning (CFP).

Cyanotoxins and their corresponding algal genera include microcystins,Microcystis; lyngbyatoxins, Lyngbya;

anatoxins, Anabaena; and cylindrospermopsin, Cylindrospermopsis. However, many other species are also

known to produce cyanotoxins and some may produce multiple toxins. Some cyanotoxins have been

found in the surface layer of freshwater during blooms

and ingestion of affected raw water has been associated with human illness elsewhere and death of livestock 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.

These include the domoic-acid–producing diatom,

Pseudo-nitzschia, which is associated with amnesic

shellfish poisoning (ASP); and the dinoflagellates Dinophysis and Prorocentrum, which produce okadaic acid

(OA). This toxin causes the illness diarrheic shellfish

poisoning (DSP). However, neither of these illnesses has

yet been documented in Florida.

Equally important, HABs negatively impact living 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 fishery implications in Florida. These toxins are not currently known to be public health risks.

Harmful macroalgal blooms in Florida coastal and

estuarine waters can also affect reefs and benthic communities. 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 environments 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 million dollars (using year 2000 dollars).This is a conservative 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-related 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 include “trash fish”of no commercial value. Costs to the

recreation and tourism industries are vast, including

losses from hotels, restaurants, and recreational fisheries affected by HAB events.Various agencies are involved with regular water quality and shellfish

monitoring, but all of them have other related management 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 neritic 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 entrained 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, affect humans and a wide diversity of aquatic organisms.

The 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”

was later determined to be particulates in sea spray that

irritated the respiratory passages and eyes (Woodcock, 1948). Today we know that brevetoxins are lowmolecular-weight, lipid-soluble, polyether toxins that

can be associated with cell fragments or particles in seawater. Because K. brevis cells are unarmored and fragile, 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).
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4 FWRI Technical Report TR-14

Public Health Response to HABs 1 | Background on Harmful Algal Blooms Abbott et al.

Seafoam can be more than 100 times higher in toxicity than seawater itself.

Other Karenia species found in the Gulf are K. mikimotoi,K.papilionacea,K.selliformis,K.longicanalis, and Karenia 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 selliformisproduces gymnodimine (Seki

et al., 1995; Haywood et al., 2004),whereas Karlodiniumproduces 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

work is done on harmful algae, more potentially harmful species are being described.

Ecology

Karenia brevis red tides have been documented in almost all years since funding was initiated for surveillance 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 physical and oceanographic circulation features and a range

of nutrient sources. Karenia brevis populations do not

demonstrate explosive growth as the population increases 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 movement 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 levels such as fish, dolphins, manatees, and birds. Adverse

effects on these species may be seen for weeks postbloom (Flewelling et al., 2005; Landsberg et al., 2009).

Although Florida red tide blooms are natural

events that start offshore, questions remain as to

whether land-based anthropogenic sources may influence their longevity and persistence once they come

inshore. Several factors, particularly salinity and nutrient levels (Landsberg and Steidinger, 1998; Mulholland et al., 2004), are often considered influential, but

the issue of nutrients is complex. Karenia brevis requires 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., waters low

in nutrients and biomass). It may be stimulated by

blooms of the blue-green algae Trichodesmium (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 nutrients from benthic diatom blooms, and a very significant 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 brevetoxins.There have been no known human fatalities associated with exposure to brevetoxins. (This contrasts

with other HAB-related toxins such as STXs, ciguatoxins, cyanotoxins, and domoic acid which have caused fatalities 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 derivatives has been studied, the effects of brevetoxin

metabolites are still not well understood. One confounding 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 effects 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 periodic 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;

vomiting; 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 misdiagnosis and undetected milder clinical cases. While no
Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 5

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1 | Background on Harmful Algal Blooms

human mortalities have been reported from brevetoxicosis, there have been four separate incidents in

which patients (one less than five years old, two

teenagers, and one adult with other underlying medical 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®, unpublished data).

There are fewer than 100 documented case histories of NSP. About 50 of these illnesses were documented 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 Carolina coast transported the bloom inshore to estuaries

which then resulted in toxic shellfish beds (Fowler and

Tester, 1989; Morris et al., 1991). Many of the other documented 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 shellfish, e.g., Chione clams and fragile surf clams,Mactroma

fragilis, although in some instances the implicated

species has been another commonly harvested shellfish or is unknown (Steidinger et al., 1998; Poli et al., 2000;

Terzagian, 2006; Watkins et al., 2008; FWC–FWRI, unpublished data). As with the other marine toxins, brevetoxins 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, nonproductive 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 comprehensive epidemiological studies on chronic exposures

during a Florida red tide event or on lingering symptoms post-exposure. People with a history of respiratory 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 (Kirkpatrick et al., 2006, 2008). The FDOH, in collaboration

Florida red tide fish kill, July 2005.

FWC image
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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 Marine Laboratory (MML), and other partners, are conducting investigations on human risks associated with

exposure to this toxic aerosol (Backer et al., 2005; Benson et al., 2005; Fleming et al., 2005a,b). These include

studies on trans-placental transport of brevetoxins,

chronic effects of exposure, and emergency room admission rates for respiratory illness. For additional discussions 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 Environmental Health Perspectives, Mini-Monograph: Brevetoxins, 113(5): 618–657 (May 2005).

Rare cases of other health effects include anecdotal 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 associated with the consumption of fish during Florida red

tide blooms.

Effects on Living Resources 

Historically, of all the HABs in Florida, brevetoxinproducing 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 mammals, sea turtles, and birds (Gunter et al., 1948; Rounsefell and Nelson, 1966; Steidinger et al., 1973;

Landsberg, 2002; Flewelling, 2008).

There 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 transferred 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 complex phenomenon, one that is far more complicated

than originally conceived (Flewelling et al., 2005; Landsberg et al., 2009).

Investigations of toxic fish are ongoing. Brevetoxins 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 levels 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, analyses of more than 2,500 fish have not indicated a risk to

human health from consumption of the fillet (FWC, unpublished 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 thousands of deaths of different species of marine mammals, turtles, seabirds, fish, and invertebrates.The 2005

event 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 brevetoxins 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

were admitted to local veterinary clinics after being reportedly affected by exposure to brevetoxins during a

highly concentrated Florida red tide event (Landsberg

et al., 2003). Birds are also affected by brevetoxins, especially those that consume toxic shellfish or fish. Substantial 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 

Two 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 community recreational activities are adversely affected

by K. brevis red tides (e.g., Longboat Key, from

1 | Background on Harmful Algal Blooms
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Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 7

1994–1996; Boesch et al., 1997), but current data documenting 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 combined monthly losses of nearly $6.5 million for businesses such as restaurants and hotels. Another study

(Morgan et al., 2007), in which coastal managers were

surveyed to determine associated costs of red tide

events to public beaches, four counties (Pinellas, Sarasota, 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 primarily for beach cleanup (including labor, equipment, supplies, and vendor fees) and were paid for by

tourism tax dollars.

The difficulty in calculating economic effects is

due to the variety of direct adverse effects on a particular area, ranging from public health and management 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

Woods 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 offshore.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 samples 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 supplemented by event-response-targeted monitoring, offshore 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 cooperation with other state regulatory agencies, e.g., Florida

Department of Agriculture and Consumer Services

(FDACS), FDOH, and Florida Department of Environmental Protection (FDEP); a volunteer network

of boaters, charter boat captains, fishermen, and other

citizens; and MML. All analyses involve in situ testing, onboard testing, or onshore laboratory testing. Results are posted weekly on the FWC–FWRI Web site,

http://research.myFWC.com, and include data from a

variety of sources. In addition, there is a toll-free number, 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 methodologies. The results reported in the National Oceanic

and Atmospheric Administration (NOAA) HAB Bulletin use satellite imagery, which detects chlorophyll

a concentrations.This determination is not organismspecific, and the chlorophyll a may come from a number of sources including blue-green algae, macroalgae,

or K. brevis.This 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

chlorophyll a concentrations and the local wind field

to predict potential bloom events. Additional information on this methodology is available on the NOAA

HAB Web site, http://coastwatch.noaa.gov/hab/bulletins_ms.htm.The Center for Prediction of Red Tides

collaboration between the FWC–FWRI and the University of South Florida College of Marine Science has

begun testing the application of algorithms that detect

Karenia and Trichodesmium specifically using the unique

reflectance signatures of chlorophyll a for these specific organisms. Combined with model forecasts based

upon ocean current observations and wind measurements, this technology holds promise for species-specific monitoring by satellites of Karenia blooms and

forecasting daily bloom movements and their potential effects.

Toxin concentrations in seawater are quantified by

various laboratory methods, including the ELISA test,

a receptor binding assay (RBA), or liquid chromatography–mass spectrometry (LC–MS). Tests are being

done to evaluate whether a relationship exists between

toxin concentrations and cell counts of K. brevis.Water

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 conversion 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 identification 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 Blooms
PUBLIC 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 bioassay (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 background 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 turnaround 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 approved for regulatory decision-making activities.

Shellfish can depurate toxins within two to six

weeks after counts of K. brevis cells have returned to

background levels in an area. However, there is one report that indicates the edible clam,Chione cancellata, retained toxicity for one year after exposure (Steidinger

et al., 1998). This suggests that under certain conditions, 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 unapproved 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 recreational harvesting from closed areas. Foreign and outof-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 harvesting guidelines and regulations.

AEROSOL

There 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 Collier, Lee, Manatee, Pinellas, and Sarasota have implemented a real-time Beach Condition Reporting System.

Beach conditions, including water color, chance of respiratory irritation, and presence of dead fish are reported 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/beachconditions/. Because blooms, once onshore, can be

extremely variable, this system allows beach goers to

make informed decisions on which beach to visit to experience 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 information on bloom conditions.

These sources are usually adequate for local residents 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. Unfortunately, conditions that favor dispersal of the respiratory irritant, such as onshore winds, can change

dramatically and shift direction within hours. Since

the toxins are associated with marine particulates, exposure can be reduced by use of a particle mask commonly available in hardware or drug stores.

Antihistamines are also somewhat effective for reducing the effects; however, this over-the-counter medication should be taken only following labeled directions

and/or on the advice of a physician.

FISH

No monitoring or regulatory programs exist for fish exposed to brevetoxins. Although fish can concentrate

brevetoxins in their viscera, levels in the fillet of livecaught fish have not suggested a human health risk.

Saxitoxin, Puffer Fish Poisoning, 

and Saxitoxin Puffer Fish Poisoning

Background

Poisoning from consumption of puffer fish (also known

as “blowfish”) is usually associated with tetrodotoxin

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8 FWRI Technical Report TR-14

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1 | Background on Harmful Algal Blooms
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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 usually been associated with imported puffer fish (Marcus et al., 2002); fatalities have rarely occurred after

the consumption of indigenous puffer fish. However,

in Hawaii, white-spotted puffer fish,Arothron hispidus,

were 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 consuming the toxic liver of a checkered puffer fish (Sphoeroides testudineus) (Benson, 1956).The toxins involved

in the previous Florida PFP cases were not characterized, 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 Morton, 1971), but again, the specific toxins were not determined. (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.) 

From January 2002 to May 2004, 28 cases of poisoning 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 demonstrated 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 levels over that period were similar to those observed since

2002; no fish poisoning incidents were reported or documented 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 revealed STXs (Quilliam et al., 2004), not TTXs, a distinction 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 associated with puffer fish poisonings in the USA.

The 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

challenge for Florida. STX is a complex molecule that

interferes with the voltage-sensitive sodium (Na+)

channel in neuron membranes. STXs can selectively

bind to neural cell Na+ channels blocking these molecules from entering or exiting the cell. Lack of Na+ inside the cell blocks its action potential, inhibiting

transmission of neural impulses and resulting in impairment of bodily functions. Globally, STXs are usually associated with paralytic shellfish poisoning (PSP),

an acute intoxication occurring in humans after the consumption of toxic shellfish, such filter-feeding shellfish

consume microalgae and retain STXs in their tissue.

Human consumption of these shellfish can cause severe 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 dinoflagellate Pyrodinium bahamense implicated as the putative

toxin source. STXs were confirmed in IRL southern,

checkered, and bandtail puffer fish, with toxins detected 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 southern 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 documented globally (Rodrigue et al., 1990). Landsberg et al.

(2006) proposed characterizing this food poisoning

syndrome as SPFP to distinguish it from PFP traditionally 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 waAbbott et al. 1 | Background on Harmful Algal Blooms Public Health Response to HABs
.

Public Health Response to HABs Abbott et al.

10 FWRI Technical Report TR-14

ters of the Pacific (e.g., Malaysia, the Philippines, and

Papua New Guinea).Toxic strains are also known from

Pacific 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 outbreaks of SPFP in 2002, there was no indication that this

variety 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)

were 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 accumulate high toxin concentrations in the muscle tissue, 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 permanent ban on their harvest in the IRL (Landsberg et al.,

2006; Abbott et al., 2009).

Symptoms of SPFP may include tingling or numbness 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, respiratory paralysis and death may occur. STX is heat- and

acid-stable and is not detoxified or destroyed by freezing 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 required 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; Landsberg et al., 2005). Marine mammals are exposed to STXs

primarily through their diet, consuming toxins vectored through the food chain. For example, during a fiveweek 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 viscera, 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 standard bioassay, and the mice showed classic signs of

STX poisoning (Geraci et al., 1989). STXs were a key suspect in the mortality of more than 100 highly endangered 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

Far East, mortalities of dolphins and other animals

were reported (Maclean and White, 1985), but no follow-up investigation was conducted. In conjunction

with several PSP incidents in Central America in 2006,

fish kills and dead turtles were associated with P. bahamense blooms (Licea-Duran et al., 2008; Flewelling and

Landsberg, FWC–FWRI, unpublished data).

In the past few years, the northern IRL has experienced 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

There has been little assessment of the economic effects of STXs in the IRL. However, puffer fish are not

considered to be a significant recreational or commercial resource, and there has been minimal feedback

from the public indicating any adverse economic effects.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 industry are possible. Highly lethal STXs have the potential

to have significant economic effects on fishery industries and to threaten marine mammals, birds, and

other aquatic organisms.

Existing Monitoring Operations

In Florida’s marine waters, STXs have only been associated 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 originating from the northern Indian River and the Banana River on Florida’s east coast. All the puffer fish

were caught recreationally, except for one case in which

puffer fish were commercially harvested and reached

a New Jersey fish market (Bodager, 2002).With the advent of the Florida SPFP cases, state (FDOH, FDACS)

and federal (FDA, CDC) officials issued health advisories 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 program to determine concentrations of STXs in various

puffer fish species and in other biota, including shellfish. Puffer fish regularly monitored for toxicity include

striped burrfish together with bandtail, checkered,

and southern puffer fish. Pyrodinium bahamense concentrations are determined from monthly water samples at fixed stations throughout the IRL, funded by

SJRWMD, FWC, and FDACS.

The FDACS and the FWC–FWRI are monitoring

target shellfish species, particularly hard clams, Mercenaria spp., in the IRL because bioaccumulation of

STXs in shellfish can pose a risk to consumers.The FDA

has established national regulatory standards for acceptable limits of STXs in seafood. In Florida, only

puffer fish have consistently exceeded the limit for acceptable 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 collected 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_statusmap.htm. Shellfish beds in the northern IRL have

been closed on a few occasions (2003, 2005) as a precautionary measure when toxin levels in bivalves as determined 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

Possibly 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

weighing 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 unknown.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 described (Holmes, 1998; Chinain et al., 1999). CFP has continued 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, ciguatoxin, 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

changed biochemically as they are transmitted up the

food chain, resulting in a variable complex of ciguatoxins in herbivorous fish. Because the top-level carnivorous fish may have consumed a variety of

herbivorous fish species over their lifetime, the complex of ciguatoxins that have been biotransformed,

bioaccumulated, and deposited in the muscle of a fish

may be present in different proportions and combinations. 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 herbivorous 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 acquired 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

dynamite 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.toxicusincreased, but the species did not appear in the newly exposed 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).

There are only a limited number of places in the

continental United States where indigenous ciguatera

phytoplankton species are found (either on algal substrates 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

Tortugas Banks; and in Texas, the Flower Gardens

(Bomber et al., 1989; de Sylva, 1994). Confirmed ciguatera 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 ciguateric dinoflagellates (Villareal et al., 2006).

Since the 1980s, there have finally been major advances and intensive chemical studies of the organisms

and toxins causing this illness. Although other toxic dinoflagellates (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 concentrated up the food chain from primary consumers

that have been exposed to Gambierdiscus cells or toxins

through herbivorous fish that browse on affected substrates to finally accumulate in the muscles of the carnivorous 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 implicated in CFP (Halstead, 1967), the most common

being tropical fish such as groupers, barracudas, hogfish, 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, perspiration, tearing, and giddiness (Swift and Swift, 1993;

Backer et al., 2003a) (see Appendix B, Medical Fact

Sheets and Case Definitions). Gastrointestinal symptoms usually persist for only a few days, whereas neurological symptoms may persist for several months or

years. 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 consciousness, and death. In sublethal cases, symptoms

may continue for weeks to months until the acute

phase abates. In some instances, symptoms have continued or recurred years later. Ingestion of fish or alcohol 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 freezing and can currently be confirmed only by specific

chemical analyses exclusively available through the

FDA.Toxin identification by chemical analysis is challenging 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 variety of symptoms and effects on humans diagnosed

with CFP.The presence of different groupings of ciguatoxins in ciguateric fish from the Caribbean Sea and the

Pacific Ocean probably underlies the clinical differences

in the ciguatera syndrome as reported in the two regions (Vernoux and Lewis, 1997).

More than 175 symptoms of CFP have been reported (Swift and Swift, 1993). CFP probably also includes 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. Palytoxin has been implicated in ciguatera-like symptoms

in humans who ate smoked mackerel (Decapterus macrosoma) (Kodama et al., 1989). Both lipid- and water-soluble 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

west 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 subclinical cases that do not reach health-care providers,

misdiagnosis, difficulty in diagnosis and case confirmation, and failure by treating physicians to make a report (despite the fact the ciguatera is a reportable

disease in Florida) (Freidman et al., 2008).The FDOH reportable-disease network, Merlin®, indicates that there

were 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

were reported.

Twenty cases of CFP from consumption of amberjack were reported to FDOH during August and

September 1991 (Hammond et al., 1993). Eight persons 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 restaurant 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. Because of the unique symptomatology and the common

denominator of amberjack consumption, investigators suspected either scombroid or ciguatera poisoning.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 Alabama 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 difficulties 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 become 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 barracuda, the most common source of affected commercial 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 eliminated 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 either orally or by intraperitoneal injection (Davin et al.,

1986, 1988; Lewis, 1992). Experimentally exposed fish

behave abnormally, exhibiting erratic movement, disorientation, 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 severely affected fish could contribute to the low incidence of human fatalities associated with CFP.To date,

there is minimal but compelling evidence that ciguatoxins can affect fish health and under certain circumstances, 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 economic 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 estimated to exceed $10 million (Hoagland et al., 2002).

Anderson et al. (2000) suggested that a conservative estimate for the economic effects of CFP in the U.S.

would 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 dependent areas of Marshall Islands, Palau, and Micronesia. In the U.S. and Canada, annual costs for time

lost from work and hospitalization expenses are estimated 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 considered to be responsible for ciguatera transmission

even 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 64D3, 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 investigations 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 medical professionals recognize CFP. Use of ciguatera

posters in emergency rooms has helped raise the awareness of both physicians and the public and encouraged 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) resulted in the number of ciguatera cases reported in

Dade County increasing 2.7 times over the previous

three months (Fleming et al., 1998).

The dinoflagellates that cause CFP are known to

occur in Florida waters, but potential ciguateric areas

have not been mapped. Fish are not routinely collected to monitor for ciguatoxin; however, there are

research initiatives in place (CDC, FDOH, FWC, University of North Carolina at Wilmington) to investigate

the distribution of ciguatoxin (and brevetoxin) in fish

from known endemic ciguateric areas in the Florida

Keys and on the west coast of Florida.

Cyanobacteria (Blue-Green

Algae) and Cyanotoxin Poisoning

Background

Florida’s diverse freshwater, brackish, and marine environments support a wide variety of cyanobacteria

(blue-green algae) blooms. Like other HABs, cyanobacteria 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 estuaries (Williams et al., 2001, 2006, 2007a; Burns et al., 2002;

Phlips et al., 2002; Paerl et al., 2005; Aubel et al., 2006;

Burns, 2008).

There are about 20 taxa or species of bloom-forming cyanobacteria that are toxic or potentially toxic in

Florida fresh waters, including Microcystis aeruginosa,

Anabaena circinalis, A. flos-aquae, Aphanizomenon flosaquae, Cylindrospermopsis raciborskii, Oscillatoria spp.,

Lyngbya wollei, and Lyngbya 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 associated toxins.) 

In the United States, Europe, Asia, and Australia,

a significant percentage of water samples analyzed

for cyanobacteria test positive for cyanotoxins. Because

cyanotoxins can be retained in source water, their contamination of drinking-water reservoirs is an important public health concern. The first nationwide

drinking water survey in the United States revealed that

80% of 677 samples analyzed (from 45 utility companies) contained microcystins. These are potent hepatotoxins 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 microcystin (Carmichael, 2001). In Florida, water-treatment

Public Health Response to HABs 1 | Background on Harmful Algal Blooms Abbott et al.
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Abbott et al. Public Health Response to HABs

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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).

The American Water Works Association (AWWA) is

evaluating the effectiveness of various water treatment methods.

Ecology

Unlike the more open marine systems, land-use activities are particularly important factors in stimulating and

maintaining cyanobacterial blooms in enclosed freshwater ponds, rivers, and smaller water bodies. Usually

found close to urban areas, the highly visible bluegreen discolorations caused by cyanobacteria blooms

often generate public concern and a demand for attention 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 (Sivonent et al., 1989; Humpage et al., 1994).Microcystis aeruginosa strains are known to produce 37 of the 52

microcystins that occur in lakes Okeechobee and Istokpoga (Carmichael, 1992).

Aphanizomenon flos-aquae is also common throughout Florida (Williams et al., 2001, 2006). Anatoxin-a and

two neurotoxic alkaloids resembling STX and neosaxitoxin 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.

Johns River, Wekiva River, Newnans Lake, Lake Dora,

Lake Eustis, Lake Griffin, Lake George, Lake Okeechobee, Lake Wauberg, and Lake Disston, but its disSampling 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 hypereutrophic Lake Griffin have been observed to extend over the entire lake for periods in excess of a year

(Phlips et al., 2002).

Lyngbya wollei has become increasingly prominent in Florida’s freshwater systems. Lyngbya wollei

has been reported to produce decarbomoylsaxitoxin,

decarbomoyl-gonyautoxin, lyngbyawolleitoxin, cylindrospermopsin, 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 toxicity reported in Florida. Ongoing sampling and testing

may provide additional information on the ecology

and toxin production of various freshwater Lyngbya

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, consumption of contaminated food, and even from kidney dialysis using contaminated water (Jochimsen et

al., 1998; Pouria et al., 1998; Falconer, 1999, 2005; Chorus et al., 2000). Occupational exposures for fishermen,

watermen, and scientists, as well as recreational exposures for the general public, are all possible. However, there are relatively few case reports and even

fewer epidemiologic studies of the effects of bluegreen algal toxins on human health.

Seasonal gastroenteritis has been reported worldwide and may be related to the consumption of

cyanobacterial-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 gastrointestinal (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 estimate the number of Floridians who have been adversely affected by such exposure.

Cyanotoxins belong to one of three groups: neurotoxins, hepatotoxins, and dermatotoxins. Each toxin

is defined by the symptoms it produces in animals.

NEUROTOXINS

The cyanotoxic neurotoxins include anatoxin-a, anatoxin-a(s), and STX. STX is also produced by dinoflagellates 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; anatoxin-a(s) binds to acetylcholinesterase acting as a

natural organophosphate; and STXs are sodium-channel 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

The cyanotoxic hepatotoxins include cylindrospermopsins, nodularins, and microcystins. These toxins

damage the liver by altering the cytoskeletal architecture of the hepatocytes (Carmichael, 1994). Cylindrospermopsin 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 nodularins and microcystins inhibit Type 1 and 2 protein phosphatase 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; Fleming and Stephan, 2001).

Humans exposed to microcystins through contaminated 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 reservoir became contaminated on Palm Island, northeastern Australia.The majority (139) of cases (148) were in

children.The liver was enlarged in all cases, and the initial 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).

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16 FWRI Technical Report TR-14

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1 | Background on Harmful Algal Blooms
DERMATOTOXINS

The cyanotoxic dermatotoxins include aplysiatoxins

and lyngbyatoxins and are often reported from marine

cyanobacterial blooms, including those of Lyngbya majuscula. These 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; Fleming 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.

Testing 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 decarbamoylsaxitoxin (dcSTX) and decarbamoylgonyautoxin-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 reactions (both dermatologic and respiratory) with continued 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

Lyngbya majuscula from tropical marine areas

(Osbourne et al., 2001). Type I hypersensitivity to

cyanobacteria (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, livestock, and wildlife that drink contaminated surface

water as well as aquatic animals that are directly

exposed to toxins throughout the water column (Falconer, 2005).

Persistent and decaying blooms, with their accompanying odor, are aesthetically displeasing. However, 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, including foul odor and the proliferation of undesirable

microorganisms.The release of cyanotoxins, a reduction of light availability in the water column, and the

alteration or disruption of food webs are also potential 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.

The mat-forming filamentous alga Lyngbya wollei

can grow to bloom proportions in freshwater littoral

zones in Florida, degrading nearshore areas and preventing light from reaching submerged aquatic vegetation (Joyner et al., 2008). An extensive marine Lyngbya

bloom, primarily comprising L. confervoides and L. polychroa, on the reef tract offshore of Broward County,

Florida, was first noted in 2002. Blooms continue to

cause extensive problems as they smother and ultimately kill octocorals and other invertebrates, negatively 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

were inconclusive, but analysis of tissues by ELISA

revealed the presence of small quantities of microcystin 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 platyrhynchos 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 levels 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, unpublished data). The epiphytic cyanobacterium (family

Stigonematales) primarily responsible for avian vacuolar myelinopathy, a neurological disease affecting

water 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 ecological and aesthetic problems and potentially affect

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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 issues in Florida, and following the work conducted

under the FHABTF, Florida state agencies have developed an interagency working group to address the response 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 diversity 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 microcystin accumulation in fish and monitoring water

for the presence of cyanobacteria and/or toxicity by

ELISA as part of ongoing, routine, water-quality projects conducted or funded by the Water Management

Districts, the FDEP, universities (e.g., UF), or volunteer groups (e.g., UF Lakewatch). The FDEP is conducting an inter-laboratory study to develop standard

operating procedures for collecting and analyzing

samples of natural cyanobacterial blooms.

Emerging HAB Threats 

to Public Health

Approximately 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 geographic 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 produce toxins in Florida as well as elsewhere but without 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 polyedrum, and Gonyaulax spinifera, dinoflagellates that

produce yessotoxins (Rhodes et al., 2005; Bowden,

2006). However, no incidents of toxicity from these organisms have been documented in either humans or

wildlife in Florida.

Several species of Coolia and Ostreopsis, both benthic dinoflagellates, also occur in Florida waters. Coolia monotis can produce polyether toxins and Ostreopsis

species can produce palyotoxin-like bioactive compounds. 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 produced per cell by some HAB species varies. It is not

known whether apparently nontoxic strains have the

genes to produce toxins. However, environmental conditions such as temperature, nutrient levels, and light

intensity can affect the production of toxins even

though the species population contains toxin-producing genes. With emerging HAB problems it is important to know if and what environmental regulators

influence toxicity.This information would be critical to

prepare response plans and develop effective management strategies.

Diarrheic Shellfish Poisoning

DSP is associated with the aquatic toxin OA, which is

produced by the dinoflagellate Prorocentrum lima (Murakami 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). Although the HAB species associated with DSP occur in

Florida coastal waters and estuaries, there have been

no known cases of DSP from harvested shellfish.

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1 | Background on Harmful Algal Blooms
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Amnesic Shellfish Poisoning

ASP, caused by the toxin domoic acid, has a history similar to that of DSP in Florida. Although no cases of

ASP are known to have occurred from shellfish harvested from Florida coastal or estuarine waters, domoic

acid-producing strains of the diatom Pseudo-nitzschia

spp. are known to bloom there.

Tumor 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, aplysiatoxins, debromoaplysiatoxin, and lyngbyatoxin-a have

all been demonstrated experimentally to be tumorigenic in small mammals or cell assays (Fujiki and Suganuma, 1993; Falconer and Humpage, 1996; Sueoka

and Fujiki, 1998). Although the potential role of microalgal toxins in tumor development in marine animals has been postulated (Landsberg, 1995, 1996;

Landsberg et al., 1999; Arthur et al., 2006), clearly linked

evidence is still lacking.

In addition to the involvement of OA in acute

human shellfish poisoning events (DSP), there is an increasing awareness of the potential role of OA and its

derivatives as tumor promoters. In two-stage carcinogenesis experiments, OA has been shown to induce skin

papillomas and carcinomas in mice and adenomatous

hyperplasia 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 debilitating neoplastic disease that has reached epizootic

levels worldwide. The etiology of FP is unknown, but

it has been linked to oncogenic viruses (Herbst, 1994).

Toxic benthic dinoflagellates (Prorocentrum spp.) are

not typically considered tumorigenic agents, but they

do have a worldwide distribution and produce tumorpromoting OA (Fujiki and Suganuma, 1993). Benthic

Prorocentrum spp. are epiphytic on the macroalgae and

seagrasses that are normal components of green turtle 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 promote tumor growth through the activation of protein

kinase C, not through protein phosphatase inhibition

(Fujiki and Suganuma, 1996). Like benthic Prorocentrum, Lyngbya majuscula grows epiphytically on seagrass and macroalgae, which also form the basis of the

diet of the herbivorous green turtle (Chelonia mydas). In

Australia, Arthur et al. (2006) demonstrated that green

turtles are exposed to, and assimilate, tumor-promoting compounds produced by Lyngbya, thus providing

a potential for these compounds to be involved in FP.

The potential for these tumor promoters to be involved

in turtle FP in Florida should also be investigated.

Other Potential HAB Problems

Potential 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 behavior of aquatic animals, and other clues, e.g., respiratory irritation associated with a body of water. FDOH

and FWC, together with other state agencies, universities, and private laboratories, use various hotlines

and participate in an integrated program for notification 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 appropriate 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,

Takayama pulchella, Karenia mikimotoi, Karenia selliformis, 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, photosynthetic 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.

The 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 present, is available on the internet at http://research.

myfwc.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 dinoflagellates were discovered in fish aquaria and in

North Carolina rivers and estuaries. These organisms

were 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 photosynthetic; 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 PfiPublic Health Response to HABs Abbott et al.

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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 Conservation.

FWC image
esteria-like dinoflagellates (e.g., Cryptoperidiniopsis brodyi

and Luciella spp.) have also been characterized and described 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.

The toxic mechanism for P. shumwayae activity

has been proposed (Moeller et al., 2007) after a decade

of concerted research efforts to elucidate the production of bioactive compounds. Although the compounds 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 pathogenic 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 lowsalinity areas.

Although Pfiesteria were 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 Pseudopfiesteria 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 was 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-Atlantic state waters. They discussed several controversial topics: fish death through physical contact with

Pfiesteria cells, the implications of a life cycle without

many stages, fish biotoxicity assays with differing results, and the use of various detection techniques.

More importantly they presented evidence that a cooccurring ichthyotoxic dinoflagellate,Karlodinium veneficum, 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 Pseudopfiesteria shumwayae were found in less than 4% of

Florida sites statewide, with no evidence of Pfiesteriaassociated fish kills or disease problems. No recorded

blooms of these species or the closely related Pfiesteria-like genera (Landsberg et al., FWC–FWRI, unpublished 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 estuarine fish, the fungus A. invadans does not present a

public health risk.

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

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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.

The 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 

Weisman 

Jacksonville PCC: Jay Schauben

Tampa 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

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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

Tampa Bay NEP: Holly Greening 

Sarasota Bay Project: Mark Alderson

NOAA X X X Biotoxin Program, Charleston Laboratory: Tod Leighfield,

Fran Van Dolah 

Pacific 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 Division 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 

Tallahassee 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 

Jacksonville PCC: Jay Schauben

Tampa 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. 2 | Agency Responsibility Matrices Public Health Response to HABs
Public 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:

Jan Landsberg

Molluscan Fisheries: Steve Geiger

CHD 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.
Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 25

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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

Tampa PCC: Cynthia Lewis-Younger, MD 

Jacksonville 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

Available Resources and Databases

Purpose To identify existing resources and databases containing historic and present information for

physiographic, environmental, animal, and human monitoring and surveillance.

The 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.

Timely and accurate information can be used by natural resource managers, researchers, public health officials, and legislators to respond to events that may be of urgent public-health consequence such as to design disease prevention and mitigation 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

water 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

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FWRI Technical Report TR-14 27

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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.

water-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

Turtle FWC– Distribution, seasonality, Statewide 2004– http://ocean.florida

Nesting FWRI and abundance of nesting current marine.org/mrgis/

sea turtles viewer.htm

Turtle 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

Wildlife 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. 3 | Available Resources and Databases Public Health Response to HABs
Public Health Response to HABs Abbott et al.

28 FWRI Technical Report TR-14

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3 | Available 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_

Tutorial.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,

vehicles 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

OTC 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

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3 | Available 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, regardless of age, gender, lifestyle, ethnic background, or socioeconomic 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 continually changes due to the regular influx of visitors,

seasonal workers, and new residents. It is the responsibility of the CHD epidemiology programs to be on

the front lines of disease prevention and control within

this unique population. Although technology will always help by improving methods and tools, the epidemiologist 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 toxins from HABs such as NSP. In addition to the reportable diseases, there are new potential health threats

from aquatic toxins.These threats are related to the appearance of novel toxins and/or the increased presence

of toxin-producing organisms. Current research on

aquatic toxin distribution in Florida ecosystems, together with studies on the uptake, distribution, and retention of toxic compounds in laboratory animals, have

shown the potential for additional routes of exposure

and effects on human health. Describing newly emerging aquatic-toxin-related illnesses will be especially

challenging 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 immunological suppression and genotoxic outcomes.

SURVEILLANCE

Surveillance is a core public health function and is defined 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 “information for action.”Surveillance is done for many reasons, 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 hypotheses for the causes of emerging diseases.The basic

elements to be addressed when initiating surveillance

are system design and purpose, data collection, analysis, information dissemination, and system evaluation.

Surveillance systems fall into two categories—active and passive. Active surveillance consists of searching 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 traditional reportable disease surveillance, vital statistics,

and disease registries. Passive surveillance relies almost entirely upon regular disease reporting by hospitals, physicians, and laboratories to CHDs or the state

health office. Electronic reporting systems allow passive reporting to become more rapid and complete.To

assure completeness of reporting, an effective surveillance 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 emerging illnesses or rare diseases that are not well recognized

30 FWRI Technical Report TR-14

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Chapter 4

Surveillance Networks and Systems

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

The 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.

The uncertainty in identifying “cases” of HABrelated illnesses has resulted in the lack of an epidemiological surveillance tool for documenting

nonreportable diseases. Efforts to improve this situation by the CDC and a number of participating states

including Florida resulted in the design of a HAB-related reporting tool, Harmful Algal Bloom-related Illness Surveillance System (HABISS).

DATA COLLECTION 

There are several laws, rules, and regulations that govern the collection of data for the purposes of protecting 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 Administrative Code is a compilation of rules that state agencies 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. Conducting disease surveillance does not end with the list

of notifiable conditions.

Communicable disease data collection for surveillance purposes may be accomplished in many ways

due to advances in technology such as Web-based surveys and wireless devices. For outbreak purposes, surveillance data are generally collected by questionnaire

or by medical chart review and then entered into a database. It is important that a standard data set be collected

during any type of surveillance activity to ensure reliable analysis over time and across geographic regions. In Florida, the flow of data collection starts at the

community level with reports from the general public, healthcare providers, or clinical laboratories to the

CHD. If the data meets the case definition for surveillance, 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 animal and environmental surveillance networks managed 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 surveillance because it relies on timely data obtained from

provider reports and laboratory results. Disease reporting represents only a part of the communicabledisease surveillance picture that also includes any

active or passive method for uncovering clusters of

disease, monitoring disease burden in the community, and evaluating prevention methods. The importance 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 crucial step in controlling and preventing diseases. However, there is always room to improve the quality of

reportable-disease surveillance data by improving relationships with community providers.

The legal basis for surveillance of reportable diseases is supported by Florida statute and administrative 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 transmission, 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 epidemiologic 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 licensed under part I of chapter 395; or any laboratory licensed 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 infectious 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 section 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. 4 | Surveillance Networks and Systems Public Health Response to HABs
of public health significance described in subsection (2).

The 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 reported 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-related information, notwithstanding any other law to

the contrary. Release of medical records and medical-related 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 subject to criminal penalties for providing patient records

to the department as authorized by this section.

(6) The department may adopt rules related to reporting 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 required follow-up activities by the department which

are necessary to protect public health.”

The 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 information 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

Weekly Report (MMWR) at http://www.cdc.gov/

mmwr/preview/mmwrhtml/su5201a1.htm).

Reportable diseases caused by aquatic toxins include SPFP, CFP, NSP, and PSP. The FDOH Bureau of

Epidemiology and the Division of Environmental

Health rely on CHDs, healthcare providers, laboratories, 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 system 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 professionals and those public health partners who are

key 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 disaster or a public health emergency. Several specific needs

were identified, all of which were designed to provide

centralized and uniform practices within the FDOH itself, 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 parties. 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.

The creation of FDENS was not intended to replace

existing localized procedures for collecting contact information nor was it intended to replace well-established emergency procedures already in place. By

augmenting the current procedures of all participants

and providing an umbrella of support, FDENS ensures an ongoing, consistent flow of information while

providing for backup and redundancy.

BENEFITS AND CAPABILITIES OF FDENS

• Web access 

• A centralized user registry 

• A multi-device alerting function

• A password-protected Web site

• Required confirmation of receipt of the alert notification

• Confirmation tracking to ensure that the appropriate people have been notified

• Reduction in duplicate messaging

• Establishment of a collaborative work environment

so that sensitive disaster-planning and response information may be securely shared between local

and state health agencies

• Licensing 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

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4 | Surveillance Networks and Systems
Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 33

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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, Division of Disease Control, Bureau of Epidemiology.

EpiCom allows for immediate real-time exchange of information for health care practitioners and other partners on disease outbreaks or other incidents, such as

red tide blooms, flu vaccination shortages, or hurricane

response. EpiCom users include healthcare practitioners 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 ensure it is added to the correct topic and does not contain personally identifiable information.The EpiCom

system is composed of three main components: EpiCom Exchange, EpiCom Alert, and ER Surveillance.

EpiCom Exchange is a secure, Web-based anecdotal public health surveillance system designed to solicit 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 Division of Environmental Health. Messages are sent

through the EpiCom system via e-mail to affected

groups, making the FDOH responsible for recognizing 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 numbers 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 Surveillance can provide graphs to track census trends, including anomalous variations.

EpiCom has a number of “forums” that are currently 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 investigations in the Waterborne Illness Program Food and

Waterborne Disease forum. A newly created Aquatic

Toxins forum contains postings of environmental conditions such as red tide blooms that have high potential 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 represent an excellent tool and an opportunity for gaining 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/Attachments/FDENS_Tutorial.htm

Once logged on, there is a screen showing the numerous 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 Webbased system for reporting, managing, and performing epidemiological analysis of communicable-disease

Public Health Response to HABs Abbott et al.

34 FWRI Technical Report TR-14

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4 | Surveillance Networks and Systems

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

FWRI Technical Report TR-14 35

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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 Tallahassee and is accessed through Microsoft® Internet Explorer®. 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 always 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 definition for surveillance. Merlin® enables counties to report 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.

The Merlin® morbidity database is a dynamic database. Counties report and update many cases every

week. 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 Morbidity and Mortality Weekly Report (see www.cdc.

gov/mmwr).

BENEFITS AND CAPABILITIES OF MERLIN®

• Ability to electronically review and analyze county

and statewide disease trends 

• Ability to export disease information for more sophisticated analysis 

• Quick and easy data entry 

• Availability of printable reports and documents 

• Receipt and processing of electronic laboratory data 

• Potential for more timely reporting

• Detection of potential disease outbreaks and clusters 

• Availability of a Helpdesk for submitting questions

and requesting assistance 

• Ability to manage, investigate and analyze information from a variety of outbreak/cluster types, including: reportable and nonreportable diseases,

symptoms/syndromes and other events of public

health importance

The Merlin® Training site can be accessed at http://

merlintraining.isf.com/MerlinNet/start/Login.aspx

(Figure 4.2).

Florida Poison Information Center

The three Florida Poison Information Centers (FPIC)

were created in 1989 by an act of the Florida Legislature (F.S. 395.038).The centers provide an invaluable service to the citizen community, health care professionals, visitors, and the FDOH. Calls to the FPICs are

handled by specially trained nurses, pharmacists, physician assistants, physicians, and on-call board-certified

toxicologists who have computerized access to the latest in-depth health and safety assessment tools. The

FPICs are located in Miami,Tampa, and Jacksonville and

serve all Florida counties and beyond, operating tollfree 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

Jackson 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 Sciences (NIEHS) Marine and Freshwater Biomedical

Sciences Center, the FPIC/Miami established an additional free hotline dedicated to providing information concerning aquatic health issues (1-888-232-8635).

The “Aquatic Toxins Hotline”allows users to access information 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 [coastwatch.noaa.gov/hab/bulletins_ ns.htm], updated twice

weekly). They can also obtain information about marine 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 including ciguatoxin, STX, and those associated with

cyanobacteria.

The 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

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all FPICs and currently provides the only way for the

public to receive the NOAA HAB Bulletin in a convenient audio format. Callers are also provided with a

Web 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 research in the field.The FWC–FWRI also generates biweekly reports of current statewide red tide status,

available on its Web site as well as in audio format.

Food, Water and Vector-borne 

Surveillance System

The Web-based Food, Water and Vector-borne Surveillance System (FWVSS) (Figure 4.3) was created to

manage data generated by the Food and Waterborne

Disease Program and the Arbovirus Surveillance Program and enhances the ability to monitor for—and respond quickly to—food-, water-, and vector-related

disease outbreaks.The Food and Waterborne Disease

Program data include summary data, including geographic elements, on food and waterborne disease outbreaks from 1994 to the present, as well as food- and

water-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 searchable by multiple fields, including county of outbreak,

outbreak type, investigation and summary dates, vehicles of transmission, implicated pathogen, and contributing factors (contamination, proliferation, survival,

method of cooking).The FWVSS generates user-specified 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

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4 | Surveillance Networks and Systems

Syndromic Surveillance Systems 

The CDC applies the term “syndromic surveillance”to

surveillance using health-related data that precede actual diagnosis and signal the probability of a case or an

outbreak of sufficient seriousness to warrant a further

public health response. Historically syndromic surveillance has been used to target the investigation of potential 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 Notification of Community-Based Epidemics (ESSENCE) is a

Web-based syndromic surveillance system available

24 hours a day, 7 days a week. It was originally developed by the Department of Defense and Johns Hopkins

University for Military Treatment Facilities in the National Capital Region but is currently available in 37 hospitals 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 algorithms for temporal and spatial detection based on

Emergency Department chief complaints. ESSENCE

uses the information gathered to make statistical models for syndromic surveillance and alert detection.This

includes making predictions based on previous several

weeks of data, detecting irregularities in public health

surveillance data, and identifying geographic clusters

(Kite-Powell, 2007).

Data collected from emergency rooms and analyzed 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 collection 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 illness, rash, gastrointestinal illness, and respiratory illness. 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 illness is properly categorized.

Generally, ESSENCE monitors syndromic surveillance using the following steps:

• Each morning hospitals transmit Emergency Department 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

• Updated detection algorithms

• Expandability to other data sources

• Designed 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 Environmental Health in Atlanta has developed HABISS.

The HABISS is a unique surveillance system that includes both human and animal health data as well as

environmental data about HABs themselves. Data collection is organized in a modular format that can be expanded 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 activities to be in place, not only in response to reports of

human or animal illnesses, but also in advance of anticipated public health problems.

HABISS is a surveillance system that can be accessed online through the Web and offline through

Windows®-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, specifically for survey-design and data-collection purposes.

Protected by approved access and password, statebased 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:

• Point of contact with the system
• Identifying information for the case

• Case demographics

• Environmental information

• Exposure information

• Signs and symptoms

• Medical review (including laboratory analysis)

• Case assessment and follow-up 

• Parallel modules for animal events

Users are requested to report the following data

elements on algal blooms:

• Water-sample and collection information

• Geographic coordinates via GoogleTM Maps

• Toxin identification

Human illness reports can be easily linked to data

collected on algal blooms.It is intended to synthesize information not only on regional algal blooms across multiple 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 monitoring, 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

The FWC–FWRI produces biweekly reports of current

statewide red tide status. Reports include map of sampling results and regional status reports.Reports are generated 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 

Volunteer nearshore and offshore sampling of estuarine 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, retirees, divers, and researchers as well as private institutes 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 actions 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/

The Center for Prediction of Red Tides is a collaborative effort between the USF College of Marine Science

and FWC to develop USF red tide research monitoring

tools. Satellite imagery, physical oceanography monitoring buoys, physical ocean models, and red tide predictive models are all tools being evaluated for use in

FWC statewide red tide monitoring efforts. The Center for Prediction of Red Tides Web site includes an experimental 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

The HAB bulletin generated by NOAA and the National 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,

chlorophyll levels, and potential or actual bloom events

and are sent twice a week via e-mail to registered

users with natural-resource management responsibilities to alert subscribers of developing blooms and

changes in the location and extent of existing blooms.

Bulletins can be accessed online 48 hours following email distribution.

Reports are generated from a variety of information sources including the NOAA HAB Forecasting

System (http://www.csc.noaa.gov/crs/habf/), which supplies 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 forecasting system relies on satellite imagery, field observations, 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

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4 | Surveillance Networks and Systems
Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 39

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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 processing plants, and shellfish-harvesting areas to protect 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

• Western 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 

Violations, unlawful possession, or harvesting of cultured 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 coliform bacteria or on emergency conditions such as red

tide blooms, hurricanes, or tropical storms. Shellfish

areas are reopened for harvest when sampling demonstrates that stringent water-quality criteria are met to

ensure that shellfish are wholesome. Shellfish bed closures 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

The 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. Reports 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

The 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, diseased 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. Although the hotline is primarily a resource regarding

marine fish kills, calls are regularly received about mortalities 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

The FWC’s Wildlife Alert Hotline is a 24-hour public

hotline for reporting animal injury or death or suspected 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/

The FWC provides an online reporting system for surveillance of wild bird die-offs that aids in the monitoring of Avian Influenza, West Nile Virus, and bird

electrocutions from power lines.

FDACS: Division of Animal Industry

The 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 infectious and communicable diseases exists to eradicate them from livestock and other domestic animals.

Information on HAB-related illnesses is lacking and they

are not reportable, but the Kissimmee Animal Diagnostic Lab (KADL) is working with FWC to develop response and analytical capabilities for addressing

potential livestock kills that are due to exposure to

cyanobacteria in freshwater ponds, lakes, and reservoirs.

If any unusual animal disease or pest that might

indicate a possible newly emerging disease with the potential 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 policies targeted illnesses resulting from the consumption 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.

The National Shellfish Sanitation Program (NSSP)

was first developed based on the public health principles and controls formulated at the 1925 conference.

The public health control procedures later established

by the NSSP Manual of Operations were dependent

on the cooperative and voluntary efforts of state regulatory 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 implementing mandatory NSSP regulations. To establish

standard national guidelines for shellfish, state regulatory officials along with the National Marine Fisheries 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 Memorandum 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 manner. The FDA is responsible for the annual review of

each states’ shellfish-control program to assure conformity 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-harvesting areas to ensure that shellfish are grown, harvested,

and processed in a safe and sanitary manner. Harvesting areas are classified as Approved, Conditionally

Approved, Restricted, Conditionally Restricted, Prohibited, and Unclassified.Waters that are not classified

are considered to be unapproved for all molluscan

shellfish harvesting (Heil, 2009).

The FDACS also oversees the operation and maintenance of 1,200 bacteriological sampling stations to

routinely monitor fecal coliform and water-quality parameters 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 response to an event, sample results must meet the appropriate 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 penalties, apply to both commercial and recreational shellfish 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 concen40 FWRI Technical Report TR-14

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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.

This 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

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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 monitoring. FDACS collects monthly samples of water and

hard clams, Mercenaria sp., from three representative

shellfish harvesting areas in the IRL. FWC–FWRI analyzes water and shellfish for P. bahamense and STXs, respectively. Following NSSP guidelines and FDA action

levels, FDACS closes shellfish-harvesting areas when

STX levels in shellfish exceed 80 μg STX eq./100 g tissue (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 numerous cases of severe neurological illnesses associated 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). Symptoms were consistent with PSP, which in the U.S. has

generally been associated with the consumption of

molluscan shellfish from the northeastern and northwestern coastal regions of the country. Subsequent

laboratory tests of puffer fillet samples confirmed

that STX was the causative agent in the reported illnesses (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, Brevard,Indian River, and St. Lucie county waters. Species

of puffer fish covered by the harvest prohibition included 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

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

checkered (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. Because tests showed that puffer fish in these areas continued 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.

Therefore, 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 knowledge of this fact in both the Caribbean and other tropical island communities has influenced fishing behavior

and eating customs. However, there are only limited

examples of regulatory restrictions on harvesting.

These have been reported to include American Samoa;

Queensland, Australia; French Polynesia; Fiji; Hawaii,

and Miami (De Fouw et al., 2001).The report of a prohibition on the harvesting of barracuda in Miami,

Dade County, though referenced (Lawrence et al.,

1980), has not been confirmed.

Drinking Water

The 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 participants, representing 36 countries, reported data suggesting a high frequency of cyanotoxin occurrence in

drinking water in concentrations that may be hazardous to human health.

Worldwide, the leading route of human exposure

to cyanobacteria is through the consumption of drinking water (Gupta, 1998). Urban drinking-water systems have been implicated in most suspected cases of

cyanobacterial 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 intake (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

water and the average daily drinking-water consumption in liters (L).The resulting formula is as follows: 

Guideline value = TDI × bw × P

L

In their addendum to the second edition of Guidelines for Drinking-Water Quality (1998b), the WHO published 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

average 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 differences 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

water containing 10 μg/L of MC-LR or less would result 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 alternative HAL values could be justifiably proposed. The

WHO concluded that insufficient data were available

upon which to derive guideline values for any other

cyanobacterial toxins, including anatoxins, STXs, and

cylindrospermopsin.

After the release of the WHO provisional drinking

water guidelines, many countries adopted the value directly or derived slight variations. Despite limited data,

some countries also developed guidance values for

other cyanotoxins, such as cylindrospermopsins, anatoxins, 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 standards to protect against both naturally occurring and

man-made contaminants that may be found in drinking water. Although the EPA has developed and implemented regulations for more than 90 drinking water

contaminants, it has yet to create regulations or guidelines addressing cyanobacteria in drinking-water supplies. Awareness of toxic cyanobacterial blooms in the

U.S. has increased in recent years, but the substantial

gaps that remain in the recognition and understanding of the risks posed by cyanobacterial cells and their

toxins have hindered development of appropriate public health guidelines. These include limited data on

5 | Regulatory Guidelines
Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 43

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5 | Regulatory Guidelines

Table 5.1 Examples of drinking water guidelines for cyanotoxins.a

Toxin 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

France 1 μg/L of MC-LR

New Zealand Provisional MAC of 0.001 mg/L (= 1 μg/L) MC-LR toxicity equivalents

Poland 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 Contaminant Candidate List (CCL), includes contaminants

about which critical information is lacking for regulatory

decisions to be made. Such information can be provided by the Unregulated Contaminant Monitoring

Regulation (UCMR) program, which directs select public-drinking water systems to screen for unregulated

contaminants to provide insights into their occurrence

and concentrations in public water supplies.

The 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 plausibility of modeling quantitative structural-activity relationships (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

cyanobacteria 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. However, the public health effect of these exposures is

poorly understood as a result of limited surveillance

and human-health studies.

Australia has had recreational guidelines for

cyanobacteria exposure in place since 1993. These

guidelines were developed on the basis of reports that

established links between skin contact with cyanobacteria and adverse health effects, especially among sensitive individuals.

In 2005,the WHO published suggested safety guidelines associated with incremental severity and probability of health effects resulting from exposure to

cyanobacteria 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

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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 bluegreen algae. As in the case of the provisional drinking

water 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

cyanobacterial blooms in recreational waters. Waterquality criteria for recreational waters was first established 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 microbiological suitability of recreational water. The Healthy

Beaches Act of 2000, amendment 303i to the Clean

5 | Regulatory Guidelines

Table 5.2 WHO guidelines for cyanobacterial exposure in recreational waters.a

Risk Level Guidance Level How Level Derived Health Risks Typical Actionsb

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.

cyanobacteria. 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.

cyanobacteria. cyanotoxins.c Short-term adverse Discourage

health outcomes swimming and

(e.g., skin irritations, further

gastrointestinal investigate

illness). hazard.

Post 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 wateroutcomes (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,Table 8.3, Guidelines for Safe Practice in Managing Recreational

Waters, 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 The 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

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5 | Regulatory Guidelines

Table 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 Environmental Quality (ADEQ), Arizona Game and Fish Department, and

the University of Arizona in cooperation with the Tonto National 

Forest 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 Monitoring 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 were issued at levels >15 ppb. Nebraska officials found that the twotier 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 Environmental 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 advisory 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

water 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

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5 | Regulatory Guidelines

Lake Harris

Water Act, and the November 16, 2004 federal rule

change, mandated E. coli or enterococci as indicator organisms for freshwater beaches in the Great Lakes

and enterococci only in marine waters (EPA, 2004).

The 2005 International Symposium on Cyanobacterial

Harmful Algal Blooms (ISOC–HAB) sponsored by federal agencies (http://www.epa.gov/cyano_habs_symposium/monograph.html) reviewed the current status

regarding cyanobacteria, and the EPA is actively addressing 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 Cyanobacterial 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 supplements were introduced into the U.S. in 1979 and

marketed for a wide range of health benefits, including 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.

The two primary blue-green algae species found

in supplements are Spirulina spp. and Aphanizomenon

flos-aquae. With no U.S. guidelines in place to monitor 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 aeruginosa, a hepatotoxic species, are a regular occurrence.

In response to these concerns, the Oregon Health Division and the Oregon Department of Agriculture imposed 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 dissemination of information, provision for education, and

communication outreach. IEC is an all-encompassing

expression commonly used in the health field to describe efforts to increase public awareness about a

specific topic and change potentially harmful behaviors

while reinforcing health-promoting practices. Critical factors to consider when initiating any IEC activity 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 available (e.g., financial or staffing), and quality. Outreach

materials should be pretested for best outcomes.

While there are a variety of reasons for conducting any outreach or health communication activity,

most HAB outreach efforts focus on prevention, mitigation, 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 awareness about possible human-health effects, and (4) to

prevent unnecessary contact with potentially harmful

substances or environmental components. When selecting 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, including the level of the potential HAB threat and stakeholder attitudes.

A target audience is the group, community, or

population identified as the most appropriate recipient 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

owners, 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 potentially affected by HABs access the information.

A wide variety of materials are being used to raise

awareness 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 scientific journal;

• presentations or training materials—slide presentation, poster presentation, bulletin board, curriculum or lesson plan, speech, guidelines, manual, text,

or reference book;

• multimedia—public service announcement or interview 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.

The FDOH provides a number of downloadable education 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

The 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 

Tracking Program

http://www.cdc.gov/nceh/tracking/resources_data.htm

FWRI Technical Report TR-14 47

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Chapter 6

Outreach Resources

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

The 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 available. 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

• National 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.

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6 | Outreach Resources

START image

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

FWRI Technical Report TR-14 49

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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

• The 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/environconcerns/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

This site provides links to UNESCO’s publication of

international news and activities concerning HABs.

• The Intergovernmental Oceanographic Commission Harmful Algal Bloom Program

http://ioc.unesco.org/hab/

This site includes databases on HABs and health experts, IOC activities, and IOC services.

• International Atomic Energy Agency

http://www.iaea.org/NewsCenter/Features/AlgalBloom/index.html

This site provides information and IAEA staff reports

on international HAB situations—what is afflicting

other countries and how they are managing.

• International Society for the Study of Harmful

Algae 

http://www.issha.org/

This 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

This 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.

• United Nations Educational, Scientific and

Cultural Organization: Intergovernmental

Oceanic Commission’s Global Ecology and

Oceanography of Harmful Algal Blooms 

http://www.ioc-unesco.org/hab/

This site provides information about UNESCO’s HABrelated activities, research, databases, and partners.

• World Health Organization, Water-Related Diseases

http://www.who.int/water_sanitation_health/diseases/

cyanobacteria/en/

This site offers detailed information on cyanobacterial toxins, their effects on humans, and their global distribution.

Federal HAB Links

• Bigelow Laboratory for Ocean Sciences

http://www.bigelow.org/hab/organism.html

This site provides a comprehensive overview of several types of HABs toxins and related human and animal illnesses, including toxicology and US locations

of HAB species.

• CDC, Environmental Hazards and Health Effects

Program (HABs)

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

This site includes information on various HABs and

their human-health threats.

• EPA, Environmental Monitoring for Public Access

and Community Tracking Program

http://cfpub.epa.gov/si/si_public_record_Report.cfm?di

rEntryID=29117

This site provides EPA’s assessment of an automated

biological monitoring system that measured toxicity

caused by HABs in the Chicamacomico River, a tributary of Chesapeake Bay.

• Harmful Algae Management and Mitigation 2001

Conference

http://www.cfsan.fda.gov/~frf/sfhamm.html

This site offers the conference proceedings and information on related research.

• National Institute of Environmental Health

Sciences

http://www.niehs.nih.gov/ 

This site offers a variety of resources including community outreach and education materials and updates

on current HAB health research projects.

• NOAA, Center for Coastal Environmental Health

and Biomolecular Research, Marine Biotoxins

Program

http://www.chbr.noaa.gov/default.aspx?category=mb&

pageName=biotoxin

This site describes NOAA’s cooperative programs,

which conduct research into marine biotoxins. It includes links to federal partners, a description of research projects, and a list of publications.

• NOAA, Center for Coastal Fisheries and Habitat

Research

http://www.ccfhr.noaa.gov

This site describes NOAA’s CCFHR program, which

studies the effects of coastal-habitat change on living marine resources, including the effects of algal

toxins.
Public Health Response to HABs Abbott et al.

50 FWRI Technical Report TR-14

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• NOAA, 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

This site includes information about the program’s

HAB-related research activities, grants, projects, publications 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.

• NOAA, Integrated Ocean Observing System

http://ioos.noaa.gov/

This site describes the multidisciplinary system designed to support research and inform decision-making enhancing the ability to collect, deliver, and use

ocean information in formats, rates, and scales required by scientists, managers, businesses, governments, and the public.

• Northwest Fisheries Science Center, HAB 

Program

http://www.nwfsc.noaa.gov/hab/ 

This site describes HAB, biotoxin, and NWFSC research, 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 

This site provides information about EPA’s list of contaminants 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, Center for Food Safety and Applied Nutrition

http://vm.cfsan.fda.gov/~mow/chap37.html 

This site provides detailed information on shellfishassociated toxins.

• Woods Hole Oceanographic Institution, National

Office for Harmful Algal Blooms,The Harmful

Algae Page

http://www.whoi.edu/redtide/

This site provides facts about HABs, maps of HAB distribution 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/ 

This site describes a five-year project, funded by NOAA

and directed by several universities in the Pacific Northwest, to study the physiology, toxicology, ecology, and

oceanography of toxic Pseudo-nitzschia species off the

Pacific Northwest coast.

• Gulf of Mexico Coastal Observing System

http://www-ocean.tamu.edu/GCOOS/

This site promotes establishment of a sustained observation system for the Gulf of Mexico.

• Mid-Atlantic Sea Grant Programs

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

This 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

This site provides information on Pfiesteria and bluegreen algae.

• Purdue University, Indiana: “Cyanosite”

http://www-cyanosite.bio.purdue.edu/

This site is a purely scientific site focused on cyanobacterial taxonomy and biochemistry, but it is also an excellent source for referencing and research links.

• Wisconsin Department of Natural Resources

http://dnr.wi.gov/lakes/bluegreenalgae/

This 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

• FDEP, Bureau of Laboratories

http://www.floridadep.org/labs/hab_info.htm

The FDEP protects, conserves, and manages Florida’s

natural resources and enforces the state’s environmental laws.This site provides information on standard

operating procedures for the collection and analysis of

cyanobacterial samples.

• FDOH, Aquatic Toxins Program

http://www.doh.state.fl.us/environment/community/aq

uatic/index.html 

The FDOH ATP aims to protect Florida’s citizens and visitors from HAB exposure or illness.This site includes information 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

The 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/default.aspx

The FDOH performs water monitoring in coastal communities to limit threats to human health from exposure 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 technical knowledge.This site offers information on HABs in

Florida including basic facts, current research, bloom

events, 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 research such as developing new technology for monitoring 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.

• START, Red Tide

http://www.start1.com

START is a non-profit organization dedicated to promoting efforts for control and mitigation of red tide in

an environmentally responsible manner and committed 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 

This site offers information on medical and ocean research 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 

The purpose of a press release is to distribute consistently

accurate information about an event that affects or interests the public.This assists the public in making informed decisions regarding their health and way of life.

When the public believes that an event (e.g., a red

tide or hurricane) threatens them, they want immediate 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 respond with as much information as is available. By

providing transparent, factual information, your agency

can be a valuable resource for the public. First impressions 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 contacts.When an emergency situation occurs, the predesignated 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, communication formats and other regional contacts. Tell

the first inquirers that you are aware of the situation,

your agency is considering how to proceed, and by

a certain time a spokesperson will have information available. Always return calls and provide information—it is important to establish credibility

with reporters. Even if you do not have all the information you would like, make the contact and explain what you do know at that time.

• Investigative team leaders should meet with the

spokesperson and decide on guidelines about information distribution.This step will vary with the event;

Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 51

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6 | Outreach Resources

FDOH image

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

52 FWRI Technical Report TR-14

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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 person who currently has complete and accurate information. It is crucial that the reporter be given the

most reliable information. If your team is well coordinated, the spokesperson is the person with the

most reliable information. A great deal of time and

energy is wasted on refuting inaccurate (but usually

well-intentioned) information. A disorganized effort 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

well-informed and available spokesperson will enhance the effectiveness of the research team because the team will have more time to focus on the

scientific investigation.

On-Going Events

The first few days are often characterized by numerous inquiries about the status of the event; the

spokesperson will probably spend a great deal of time

responding to these inquiries and receiving new information. However, after the initial deluge of information requests, the spokesperson is often more

effective as someone who summarizes incoming information and disperses it to a number of interested

parties, who then redistribute it as needed. For example, the spokesperson can e-mail a daily status report

to other government agencies, regulatory commissions, government officials, or media sources. Timely

Web 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 investigating 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.

The obvious disadvantage to this type of arrangement is that some incorrect information may be introduced. However, the advantages of providing useful

information and generating goodwill with partner

agencies generally outweigh the disadvantages of occasional misinformation.

Employees should always refer callers to the contact listed on the status report, especially if they cannot answer specific questions. Agency managers must

emphasize to their employees that information should

only be provided when the information has been confirmed; if the employee is not certain, the inquiry

should be referred to someone who has relevant information. Other useful communication tools include

the following: 

• Frequently Asked Questions (FAQs) sheets for anyone who answers incoming calls (see http://www.

myfloridaeh.com, under Aquatic Toxins; see Figure 6.5).

• Brochures 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).

• Fact Sheets that can be easily generated in-house via

desktop publishing systems to meet unexpected or

rapidly changing needs (see http://www.myfloridaeh.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 organizations to announce new initiatives, research results, and

status reports that are newsworthy, they may not be effective for unusual, on-going events like HABs. Their

overall effectiveness in these situations is debatable. Possible reasons for this argument include the following.

• Within governmental agencies, it often requires

hours (sometimes as many as 24–48 hours) to prepare 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.

The 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 various 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.

They 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-harvesting areas along the entire southwest coast of Florida

until further notice.

HOW CAN THIS RELEASE BE 

MORE EFFECTIVE?

• Always 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 morning, hundreds of dead mullet and catfish washed

ashore on St. Pete Beach. FWC researchers responded

to investigate the cause of the fish kill.

• Identify 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 contaminated seafood, respiratory irritation, aesthetics of

dead fish and smell) should be clearly identified.

• Avoid alarmist and irrelevant information. Stick to

the facts about this occurrence. Provide common

sense, nonalarmist information.

• Provide only necessary, uncontroversial and welldocumented information. Be prepared to provide

historical, supplementary information for those reporters who do in-depth or human-interest articles.

• Avoid 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.

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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 Services (FDACS) to close local shellfish harvesting areas

as researchers from the Florida Fish and Wildlife Conservation Commission’s (FWC) Fish and Wildlife Research Institute (FWRI) pointed to Florida’s red tide as

the cause.

“Laboratory tests on the St. Pete Beach water samples we took showed that cell counts of the red tide organism were much higher than normal and were high

enough to cause fish kills,”said [insert name], [insert title].

The 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-thannormal concentrations, a red tide occurs.

The shellfish harvesting ban from Tarpon Springs

to Charlotte Harbor means you should not eat regulated 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 respiratory problems are also urged to stay away from

beaches in these areas because respiratory discomfort may be associated with red tides.

It is too early to tell how this red tide event compares 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 laboratory tests show that the shellfish are safe to eat, [insert name] said.

For 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.
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6 | Outreach Resources

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

The 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 Karenia brevis, or K. brevis.

“Even when the algae is in very low concentrations, it can still contaminate the shellfish, which concentrate the toxins in their bodies,”she said.

Pigott said the bureau is distributing the health department’s notice and hoteliers are sharing the information 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.

The 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 quality 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.
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6 | Outreach Resources

Figure 6.2 Example 2—Sample health advisory/press release.
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6 | Outreach Resources

Figure 6.3 Example 3—Sample health advisory/press release.
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6 | Outreach Resources

Figure 6.4 Example 4—Sample health advisory/press release.
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6 | Outreach Resources

Figure 6.5 Example 5—Frequently asked questions about Florida red tide and their toxins.

(continued next page)
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Figure 6.5 Example 5—Frequently asked questions about Florida red tide and their toxins. (continued)

6 | Outreach Resources
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6 | Outreach Resources

Red Tide Alliance image

Figure 6.6 Example of red tide facts handout, side 1.
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Abbott et al. 6 | Outreach Resources Public Health Response to HABs Red Tide Alliance image

Figure 6.6 Example of red tide facts handout, side 2.
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Mitigation Activities

Mitigation can be defined as “...minimizing HAB impacts on human health, living resources, and coastal

economies when they do occur...”(NOAA, 2001).These

activities can take place before, during, or after an

event. Specific measures designed to address each

stage of a HAB event should be identified and combined with ongoing actions or “preparedness.”CHDs

should identify a local focal person to coordinate work

with various statewide agencies conducting mitigation activities.

Various 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 strategies are used to avoid the occurrence of, or minimize

exposure to, HABs. Presently, strategies for preventing

“events” are limited. Research is focused on determining the technological feasibility of enhancing HAB

prevention capabilities statewide. Additional prevention activities include regulating nutrient inputs from

human land-based activities to minimize bloom growth

and regulating ballast water releases to reduce HAB introductions or global expansion. HAB control strategies include activities to reduce or contain the bloom

populations or their effects, and involve direct interventions during HAB events for the purpose of eliminating 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 mechanical, chemical, and biological control methods. Examples 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

warning 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 monitored, the public can plan ahead, and regulatory agencies, local governments, and businesses can

implement contingency plans (Heil, 2009). Monitoring 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 effective mitigation method to date. HAB education is

crucial for raising awareness about the health risks associated with shellfish consumption and beach-going,

and on the environmental effects of blooms on aquatic

ecosystems.

The FDOH, through CHDs, issues health advisories based on local needs. Press releases are the

mechanism through which most CHDs disseminate information on health risks related to current HAB

events. 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. Restoration 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 rehaChapter 7

Management Strategies 

for Mitigation of HABs

Purpose To describe management strategies for mitigating HABs in Florida.

The 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

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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 strategies to remove and safely dispose of dead fish and

other species is necessary because recreational activities are dependent on aesthetically clean beaches and

a healthy coastline environment.

The 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 general 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 million award from NOAA’s ECOHAB program to investigate 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 implementing “a program designed to increase the knowledge 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 undertaking successful efforts to control and mitigate the effects 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 monitoring and responding to the development and movement of harmful algal blooms in Florida marine and

estuarine waters.”

Of the appropriated funds, $1,000,000 was designated 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; controlling or reducing the toxicity of K. brevis; and minimizing 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 researchers, including government entities, universities,

and other organizations involved with HAB research

on the economic, social, environmental, naturalresource, and public-health effects of red tides. However, legislative budget cuts that began in 2008

threaten the program’s future.

FWC image

Abbott et al. 7 | Management Strategies for Mitigation of HABs Public Health Response to HABs

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

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Florida HAB Public Health 

Research Needs

Clinical

There 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.

• Develop tools for clinical diagnostic support including 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 HABassociated cases from a variety of sources, including hospitals, emergency departments, stand-alone clinics,

general practitioners, and entities other than traditional health care providers.This effort will include the

partnering of the FDOH Central Office and local CHDs

with health care providers, other agencies with community contacts, and specific ethnic entities that are outside of the usual public health lines of communication.

The use of animals as sentinel systems is also relevant

and has a number of public health precedents in outbreak response and mitigation.

• Provide reportable disease training to health care

providers that includes NSP, PSP, SPFP, and CFP.

• Develop early-warning systems and identify sentinel 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

The ability to assess ecological conditions associated

with the development and persistence of HABs is essential to gaining a better understanding of their potential 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 epidemiological and environmental studies and through

predictive modeling.

• Improve monitoring, detection, and documentation

of the occurrence of cyanotoxins in drinking and

recreational waters.

• Determine 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 effects on aquatic habitats.

• Conduct research on possible adverse effects of current water treatment methods and control measures

for cyanobacterial HABs (e.g., variability in toxin

production and possible toxin production from

spraying chemical treatment).

• Develop 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.

There 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 distribution 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.

The 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

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° 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 recreational 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 methodologies for studying the environment. Automated instrumentation, simplified molecular probes, and

establishment of consistent detection and quantitation limits have resulted in the determination of environmental concentrations of toxins, identification of

HAB organisms implicated in toxin production, and

analysis of how the affected biota can further affect public health. Further refinement of existing technologies,

together with the development of innovative new procedures, will enable faster detection of HABs and their

toxins and lead to better response capability.

• Incorporate validated and rapid field and/or laboratory detection methods for the following:

° Cyanotoxins: enzyme-linked immunosorbent

assay (ELISA) tests dramatically increased the

ability of laboratories to detect cyanotoxins. However, these are not universally available for all important cyanotoxins. Standardized methods and

interlaboratory calibration procedures are needed

to ensure the reliability and validity of results.

° Saxitoxins: Although rapid methods for STX analyses 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

evaluation 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 further 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.

• Develop automated methods for organism identification: 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 instruments to assess environmental samples remotely.

Public Health Policy Needs, 

Applications for HAB Research

• Develop action levels for the presence of algal toxins and incorporate them into water-quality standards for both drinking and recreational waters.

• Develop county-specific response plans addressing

pertinent HABs to protect public health.

• Develop effective outreach and education efforts to

increase public awareness of and medical proficiency 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 National Research Agenda.Woods Hole Oceanographic

Institution, Woods Hole, Massachusetts. 66 p.

• BAUER, 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,

Woods 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. WHITLEDGE. 1997. Harmful algal blooms in coastal waters: options for prevention, control, and mitigation.

Special joint report with the National Fish and

Wildlife 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 Research, Development, Demonstration and Technology Transfer: A National Workshop Report. Woods

8 | Research Needs
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Hole Oceanographic Institution, Woods Hole, MA.

Available at http://www.whoi.edu/fileserver.do?id

=43464&pt=10&p=19132

• HEIL, D. 2009. Karenia brevis monitoring, management, 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

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

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Definition

A flowchart is a graphical representation of a process;

it is designed to show the possible actions and outcomes involved. It should serve as a roadmap, ensuring 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 developing preparedness plans. During the initial planning, 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

• determine 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

• develop a common understanding about a process.

Benefits of Flowcharts

• They promote understanding of the process by explaining steps pictorially.

• They provide a tool for training employees.

• They identify problem areas and opportunities for

improvement and/or ways to streamline activities.

Pre-flowchart Steps

• Identify the right people to develop the chart.

• Determine 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 improved (limits or how far you want to go into the

process).

Tips

• Observe the current process (start with the process

as it is, then focus on how the process “should be”).

• Draw 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.

The 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

The FDOH provides technical assistance to counties interested 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 operations flowchart shown in Figure 9.1. These include

investigations of HAB-related illnesses from consumption 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.

The FDOH, alongside other interagency response efforts, is working with CHDs to develop standard investigation methods for blue-green algae or cyanobacterial 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

Visually 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

water for source water have instituted a testing program

based on their historical experience in dealing with

cyanobacteria. At times, the testing is initiated in response to complaints of bad odor or taste; others use

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Figure 9.1 Foodborne illness flowchart, Florida Department of Health investigation methods.

9 | Activity Flowcharts
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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).
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9 | Activity Flowcharts

visual monitoring of the surface water body to identify a pending bloom and start analyses when scums

start to form. There are no required or regulationdirected protocols in place at this time.

STEP 2

Sample raw or treated water for toxins and algal identification. For high-risk areas, this step may be conducted 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 procedures for sampling for cyanobacteria can be found at

ftp://ftp.dep.state.fl.us/pub/labs/biology/hab/cyanobacteria_sop.pdf

STEP 3

Send raw or treated water samples for cyanotoxin analyses to a recognized analytical laboratory for confirmatory 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 regardless of test results. The information will be used

to assist with statewide surveillance efforts and contribute 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

ATP Coordinator initiates the call-down phone and/or

email list for blue-green algae bloom response consultation. 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

valuable step to identify additional resources to support local efforts and determine roles and responsibilities of agencies involved.

ACTIVATION

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 organism 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. Deactivation 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 Public Health Technical Panel, various examples of previous

HAB case-history event responses were described. Figures 9.3 through 9.6 on the following pages summarize

notification and response flow charts to these events as

well as identify some of the challenges and difficulties

that were encountered.

Notification groups could include the regional epidemiologist, FDACS, FDEP, FDOH–ATP, FWC,WMDs,

health care workers, the media, and related industries

(see Chapter 2, Agency Responsibility Matrices, and

Appendix I for interagency contacts).
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9 | Activity Flowcharts

Figure 9.3 Neurotoxic shellfish poisoning event in 2006.
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9 | Activity Flowcharts

Figure 9.4 Aerosol brevetoxin, red tide event.
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9 | Activity Flowcharts

Figure 9.5 Shellfish poisoning event (general).
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9 | Activity Flowcharts

Figure 9.6 Saxitoxin puffer fish poisoning event 2002.
ABBOTT, J. P., L. J. FLEWELLING, and J. H. LANDSBERG. 2009. Saxitoxin monitoring of three species of

Florida puffer fish. Harmful Algae 8(2): 343–348.

ADACHI, R., and Y. FUKUYO. 1979. The thecal structure of the marine toxic dinoflagellate Gambierdiscus toxicus gen. et sp. nov. collected in the ciguatera-endemic

area. Bulletin of the Japanese Society of Scientific Fisheries 45: 67–71.

AHMED, F. E., ed. 1991. Seafood Safety. National Academy Press, Washington, DC. 432 p.

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

and Oceanography of Harmful Algal Blooms: A National 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 harmful algal blooms in the United States. Woods Hole

Oceanographic Institution Technical Report, WHOI2000-11. 97 p.

ARTHUR, K. E., C. J. LIMPUS, C. M. ROELFSEMA, J.

W.UDY, and G. R. SHAW. 2006. A bloom of Lyngbya majuscula in Shoalwater Bay, Queensland, Australia: an important feeding ground for the green turtle (Chelonia

mydas). Harmful Algae 5: 251–265.

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APPENDICES
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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).
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Appendix A
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Appendix B

Medical Fact Sheets 

and Case Definitions

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Appendix B

Version 3 – 07/07/08

CAUSATIVE 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, originate 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, mackerel, and triggerfish.

SIGNS/SYMPTOMS: Initial complaints typically include abdominal pain, nausea, vomiting, and diarrhea accompanied 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 (reversal of hot and cold sensation), metallic taste, tooth pain, headache, vertigo, arrhythmia, bradycardia or tachycardia, 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 development of additional symptoms in 1–2 days. The illness often subsides within several days. However, in severe 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 evaluation. 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 individuals 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: Avoid eating barracuda and other large predatory reef fish. Contaminated shellfish are not detectable by taste or odor. It cannot be removed by cooking, freezing or other storage or preparation 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 pursuant to Section 381.0031 (1), Florida Statutes.

ADDITIONAL INFORMATION 

Aquatic Toxins Hotline (24/7 medical information): 1-888-232-8635

The Florida Department of Health’s Aquatic Toxins Program at www.myfloridaeh.com
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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 

Comment 

Even 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

June 2003

Additional Information

Florida Department of Health: www.myfloridaeh.com under Food and Waterborne Surveillance

Program; Aquatic Toxins Program
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Appendix B

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CAUSATIVE 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 aeruginosa, Anabena circinalis, Anabena flos-aquae, Aphanizomenon flos-aquae, Cylindrospermopsis raciborskii, Lyngbya wollei and Oscillatoria. 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 dermal contact with surface water. The cyanotoxins belong to diverse groups of chemical substances with specific toxic mechanisms including neurotoxins (anatoxin-a, anatoxin-a(s), saxitoxin, neosaxitoxin), hepatotoxins (microcystins, nodularins,

cylindrospermopsin), tumor promoters (microcystins) and dermatotoxins (include aplysiatoxins and lyngbyatoxin, (also potent 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

eyes and nose, a sore throat, asthma-like symptoms, or allergic reactions. Ingestion can cause acute, severe gastroenteritis (including diarrhea, vomiting); liver toxicity (nausea, vomiting and acute liver failure); kidney toxicity, and neurologic effects such

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: With exposure to neurotoxic cyanotoxins, symptoms can appear within minutes to few hours of exposure, 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 treatment after complete removal from exposure. If the exposure was oral, administration of activated carbon to decrease gut absorption 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: Avoid 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

Toxin 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

The 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 99

.

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

Possible case: Confirmed exposure (ingestion OR immersion) to water with confirmed bloom

of cyanobacterial species capable of microcystin production AND clinical evidence of hepatic

dysfunction (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

Possible 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)

• GI 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 Program
Public Health Response to HABs Abbott et al.

100 FWRI Technical Report TR-14

.

Appendix B

Version 3 – 07/07/2008

CAUSATIVE AGENT: Neurotoxic shellfish poisoning (NSP) is caused by the consumption of molluscan shellfish (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 accompanied 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 understanding of chronic exposures and long term health impacts

ONSET/DURATION: Onset of symptoms occurs within minutes to hours, definitely within 24 hours, of consuming 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 confirm 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 generally 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 supportive and symptom-driven.

RISK GROUPS: All persons are susceptible to NSP. However, young children, the elderly and those individuals with underlying neurologic disease may be at increased risk. Effects on pregnancy and fetal health are unknown.

PREVENTATIVE MEASURES: Contaminated shellfish are not detectable by taste or odor. It cannot be removed 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 department 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

FWRI Technical Report TR-14 101

.

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

by diarrhea, 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

June 2003

Additional Information

Florida Department of Health: www.myfloridaeh.com under Food and Waterborne Surveillance

Program; Aquatic Toxins Program
Public Health Response to HABs Abbott et al.

102 FWRI Technical Report TR-14

.

Appendix B

Version 3 – 07/07/2008

CAUSATIVE 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 paralytic shellfish poisoning or PSP). However in Florida saxitoxin poisoning has been associated with the consumption 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: The onset of symptoms is rapid, generally occurring within 15 minutes to 10 hours following 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 testing 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

ventilatory 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: The 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 preparation 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 department pursuant to Section 381.0031 (1), Florida Statutes.

ADDITIONAL INFORMATION

Aquatic Toxins Hotline (24/7 medical information): 1-888-232-8635

The 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

June 2003

Additional Information

Florida Department of Health: www.myfloridaeh.com under Food and Waterborne Surveillance

Program; Aquatic Toxins Program
Public Health Response to HABs Abbott et al.

104 FWRI Technical Report TR-14

.

Appendix B

Version 3 – 07/07/2008

CAUSATIVE 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. 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 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, nonproductive cough, and bronchoconstriction. Wheezing, shortness of breath, and chest tightness are also common, 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 individuals symptoms reportedly subside quickly once exposure to aerosolized brevetoxins ceases. However, symptoms 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 conjunction 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 alleviated. 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 Program 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-14 105
Public Health Response to HABs Abbott et al.

106 FWRI Technical Report TR-14

.

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 

Lyngbya 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 conShellfish (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 radioimmunoassay (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) vomiting, 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 

myalgia, 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

vomiting, 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- eye irritation, asthma has not been fully 

green described for U.S.

algae) exposures to multiple 

cyanobacteria 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) chione 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, organophosphates); not reported 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., carbamates, organophosphates) 

* 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* Diagnosis
Abbott 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,

vomiting, 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 Treatment
110 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 [LD50 i.p. mouse] is 250 μg/kg)

Cyanobacteria

Potential for wildlife Anabaena circinalis Freshwater, 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 Freshwater, 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 LD50 i.p. mouse] is 140–200 μg/kg)

Dinoflagellates

Potential 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 [LD50 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 [LD50 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 [LD50 i.p. mouse] 24 hr = 2.1 mg/kg, 5–6 d = 200 μg/kg)

Cyanobacteria

Unknown Aphanizomenon Freshwater, 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 Freshwater, FL Blooms occurred during alligator,

and turtle kills? raciborskii planktonic bird, and fish fills in Lake Griffin, FL

Domoic acid (DA) (acute toxicity [LD50 i.p. mouse] is 3.6 mg/kg)

Diatoms

Potential 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

Potential for ASP Pseudo-nitzschia Benthic, Gulf-wide Low levels of DA detected in lab tests

delicatissima tychoplanktonic of FL field samples; no human 

shellfish toxicity cases in FL

Potential 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

Potential for ASP Pseudo-nitzschia Benthic, Gulf-wide Low levels of DA detected in lab tests

pseudodelicatissima tychoplanktonic of FL field samples; no human 

shellfish toxicity cases in FL

Goniodomin A (acute toxicity [LD50 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 Toxic in field and lab studies; known 

and in fish farm ponds planktonic to kill fish at very high cell 

concentrations (>104 cells/mL)

Microcystins (acute toxicity [LD50 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

Potential for wildlife Anabaena flos-aquae Freshwater, 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

Potential for animal Geitlerinema sp. Marine, benthic FL Keys Implicated in black disease of corals

health problems

Potential for animal Leptolyngbya sp. Marine, benthic FL Keys Implicated in black disease of corals

health problems

Potential for wildlife Microcystis aeruginosa Freshwater, 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 Freshwater, FL, likely found Implicated in poisoning event; 

planktonic throughout US blooms not analyzed for toxin in FL

Impact Species Habitat Distribution Comments
Okadaic acid and derivatives (acute toxicity [LD50 i.p. mouse] is 210 μg/kg)

Dinoflagellates

Potential for Prorocentrum Benthic South FL No toxic events reported or blooms 

Diarrheic Shellfish belizeanum analyzed for toxin in FL; field and lab 

Poisoning (DSP); studies on strains from other regions 

tumor promotion? have shown toxicity

Potential 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

Potential 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

Potential for DSP; Prorocentrum Benthic Gulf-wide, No toxic events reported or blooms

tumor promotion marinum Atlantic coast FL analyzed for toxin in FL

Potential 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

Potential 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

Potential 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

Potential 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

Potential for DSP; Dinophysis tripos Coastal Gulf-wide No toxic events reported or blooms 

tumor promotion? planktonic analyzed for toxin in FL

Palytoxins (acute toxicity [LD50 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 

waters

Unknown Ostreopsis lenticularis Benthic South FL Co-occurs with ciguatera species; no 

known toxic events in Gulf or FL 

waters; toxic in lab studies 

Unknown Ostreopsis siamensis Benthic FL Co-occurs with ciguatera species; no 

known toxic events in Gulf or FL 

waters 

Saxitoxins (acute toxicity [LD50 i.p. mouse] is 10 μg/kg) 

Cyanobacteria

Potential for wildlife Anabaena circinalis Freshwater, 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

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Appendix D

Impact Species Habitat Distribution Comments
Potential for wildlife Aphanizomenon Freshwater, FL No toxic events reported or blooms 

and fish kills, loss of flos-aquae planktonic analyzed for toxin in FL

habitat, human health 

concerns

Potential for wildlife Cylindrospermopsis Freshwater, 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

Yessotoxins (acute toxicity [LD50 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)

Potential for shellfish Lingulodinium Estuarine, coastal, Gulf-wide No toxic events reported or blooms

poisoning incidents polyedrum planktonic, benthic analyzed for toxin in FL

Potential 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

Potential for coral Lyngbya cf. Marine, benthic FL Implicated in sea fan mortalities

reef impacts confervoides

Potential for marine Lyngbya majuscula Marine, benthic, Gulf-wide, Lyngbyatoxin, debromoaplysiatoxin 

animal disease and tychoplanktonic Atlantic coast FL (known tumor promoter),

human health concerns aplysiatoxin 

Potential for coral Lyngbya polychroa Marine, benthic FL Implicated in sea fan mortalities

reef impacts

Potential for wildlife Lyngbya wollei Freshwater, 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 Freshwater, FL No toxic events reported or blooms

planktonic analyzed for toxin in FL

Unknown Aphanocapsa incerta Freshwater, 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

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Appendix D

Impact Species Habitat Distribution Comments
Unknown Coelosphaerium Freshwater, 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 Freshwater, ? No toxic events reported or blooms

estuarine, analyzed for toxin in FL

planktonic 

Unknown Microcystis wesenbergii Freshwater, FL No toxic events reported or blooms 

planktonic analyzed for toxin in FL

Potential 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 Freshwater pools, FL No toxic events reported or blooms

rivers and on moist analyzed for toxin in FL

soil; planktonic,

tychoplanktonic 

Unknown Planktothrix rubescens Freshwater, 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 

events reported or blooms analyzed 

for toxin in FL

Animal kills? Trichodesmium Offshore, coastal,

Ciguatera? erythraeum planktonic Coastal FL No toxicity found in FL studies; 

implicated in fish kills and coral 

mortality in Australia

Animal kills? Trichodesmium 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 

waters

Public Health Response to HABs Abbott et al.

114 FWRI Technical Report TR-14

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Appendix D

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

FWRI Technical Report TR-14 115

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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

Potential for DSP? Phalacroma mitra Coastal Gulf-wide No toxic events reported or blooms

planktonic analyzed for toxin in FL

Potential 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 implicated in fish kill events in FL

Fish kills, Takayama 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) planktonic

Fish kills? Fibrocapsa 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

Force 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 D
116 FWRI Technical Report TR-14

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Appendix E

Examples of Guidelines for 

Cyanobacteria in Recreational Watersa

Country Guideline

Australia Guidelines are designated for cyanobacteria and algae in fresh waters and coastal and estuarine

waters, and corresponding management actions including alert levels and staged response have

been outlined.

Fresh 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 equivalent of ≥4 mm3

/L for the combined total of all cyanobacteria where a known toxin producer is

dominant in the total biovolume; or

Level 2: ≥10 mm3

/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 Lyngbya 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.

Warning or alert categorization system adopted via ordinance of National Health Institute (Methodical 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.

France Three levels of management responses are identified depending on the concentration of cyanobacteria:

Level 1: At <20,000 cells/mL ± 20%, the majority of which are cyanobacteria, recreational activities are allowed to continue and users are informed by posters on site.There is, however, no standardized 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 MCLR–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

water bodies with persistently high algal concentrations, based on visual and microscopic observations, a stricter monitoring system is implemented.
Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 117

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Appendix E

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

Visible 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 temporary closure of the bathing area.

The 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, warnings 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

Values 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 assuming that a swimmer ingests 100 mL of water (and bathes 365 days per year—more likely this

would be less than 35 days), an exposure limit of 20 μg MC-LR per liter of bathing water is derived.

Poland 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 Perspectives, Mini-Monograph: Brevetoxins, 113(5): 618–657

(May 2005)

NAAR, 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.

WATKINS, 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. BOTTEIN, L. BACKER, R. AYYAR, R. WEISMAN, S.

WATKINS, R. GRANADE, and A. REICH. 2008. Ciguatera fish poisoning: treatment, prevention and management. 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.Advances in Experimental Medicine and Biology 619: 127–37.

CARMICHAEL,W.W. 1997.The cyanotoxins. Advances

in Botanical Research 7: 211–256.

DEPARTMENT OF HEALTH AND HUMAN SERVICES, CENTERS FOR DISEASE CONTROL AND

PREVENTION. (Undated) Facts about cyanobacteria &

cyanobacterial harmful algal blooms. Brochure. Available 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

hypersensitivity reactions to freshwater cyanobacteria

—human volunteer studies. BMC Dermatology 6: 6.

STEWART, I., P. M.WEBB, P. J. SCHULTER, L. E. FLEMING, 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. Occupational exposure to Pfiesteria species in estuarine waters is not a risk factor for illness. Environmental Health

Perspectives 114: 1038–1043.

Saxitoxin Puffer Fish Poisoning

BODAGER, D. 2002. Outbreak of saxitoxin illness following consumption of Florida pufferfish. Florida Journal 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.

VAN 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 Literature
FWRI Technical Report TR-14 119

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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 commercial 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

chemosynthesis

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 commercially; 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., oyster 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

chloroplast the cellular organelle in which photosynthesis takes place

ciguatera fish poisoning (CFP) a human disease caused by eating certain tropical fish that contain ciguatoxin and its derivatives; the toxins originate in dinoflagellates; more than

400 tropical fish species are implicated; affects the gastrointestinal and neurological systems; the characteristic symptom is hot–cold reversal

Appendix G

Glossary
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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 various small marine and freshwater crustaceans of the order

Copepoda

CUSUM a method 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 barnacles 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 photosynthesis

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

cycle); cells can be armored or unarmored; approximately half photosynthesize; Class Dinophyceae, Phylum Pyrrophyta, Division Dinoflagellata

dinophysistoxin toxins produced by Dinophysis or some Prorocentrum species

domoic acid toxin produced by Pseudo-nitzschia and Nitzschia species

dysesthesia 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 organism 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

gymnodinioid 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

heterotroph an organism that ingests and absorbs organic materials for carbon source

and energy
Abbott et al. Public Health Response to HABs

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high performance liquid an analytical laboratory technique using chemical

chromatography (HPLC) interactions to identify, separate, purify, or quantify specific compounds 

hypoxia 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 detection of toxins such as brevetoxin

LD50 lethal or life dose; dose required to kill 50 percent of the exposed organism 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., oysters, clams,

and gastropods)

mouse bioassay (MBA) laboratory technique used to determine total toxicity of samples.

Note: does not determine the causative agent, toxin, or group of toxins

myalgia 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 continental 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 numbness 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 maintenance 

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 G
Public Health Response to HABs Abbott et al.

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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., water

ppm parts per million; the concentration of a substance per million units in

which it is being measured; e.g., water

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 dinoflagellates

pruritus itchiness

red tide 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

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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 G
124 FWRI Technical Report TR-14

.

ACHA 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

AWWA 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 Commission of Hillsborough County

EWMA exponentially weighted moving 

average

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

Force 

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 Abbreviations
Abbott 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 

chromatography 

HPLC/MS high performance liquid chromatography/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

Wilmington

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 H
FWRI 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

Tel (770) 488-3426

Fax (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

Tel (321) 697-1400

Fax (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

Tel (321) 984-4890

beadleh@doacs.state.fl.us

Chris Brooks

Division of Aquaculture

1203 Governors Square Blvd., 5th Floor

Tallahassee, FL 32301

Tel (850) 488-4033

Fax (850) 410-0893

brooksc@doacs.state.fl.us

John Fruin

Division of Food Safety

3125 Conner Blvd., Suite D

Tallahassee, FL 32399-1650

Tel (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

Tallahassee, FL 32301

Tel (850) 488-5471

Fax (850) 410-0893

heild@doacs.state.fl.us

Alan Pierce

Bureau of Aquaculture Environmental Services

1203 Governors Square Blvd., 5th Floor

Tallahassee, FL 32301

Tel (850) 488-5471

Fax (850) 410-0893

piercea@doacs.state.fl.us

Florida Department of Environmental Protection

Tim Fitzpatrick

Bureau of Laboratories

Chemistry

2600 Blairstone Road, MS6510

Tallahassee, FL 32399-2400

Tel (850) 245-8083

Fax (850) 245-8082

Timothy.Fitzpatrick@dep.state.fl.us

Russ Frydenborg

Bureau of Laboratories

Environmental Assessment Section

2600 Blairstone Road, MS6511

Talllahassee, FL 32399-2400

Tel (850) 245-8063

Fax (850) 245-8082

Russel.Frydenborg@dep.state.fl.us

David Whiting

Bureau of Laboratories

Biology

2600 Blairstone Rd, MS6515

Tallahassee, FL 32399

Tel (850) 245-8191

Fax (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

Tallahassee, FL 32399-1712

Appendix I

Agency Contacts, Scientists, and Managers
Tel (850) 245-4732

Fax (850) 922-8473

Carina_Blackmore@doh.state.fl.us

Ming S. Chan

Bureau of Laboratories

Chief of Laboratory Services

Jacksonville Central Laboratory

1217 Pearl Street

Jacksonville, FL 32202

Tel (904) 791-1550

Fax (904) 791-1567

Ming_Chan@doh.state.fl.us

Frederic Ciner

Bureau of Laboratories

Microbiology

Jacksonville Central Laboratory

1217 Pearl Street

Jacksonville, FL 32202

Tel (904) 791-1792

Fax (904) 791-1520

Frederic_Ciner@doh.state.fl.us

Roberta Hammond

Division of Environmental Health

Food & Waterborne Disease

4052 Bald Cypress Way, Bin #A08

Tallahassee, FL 32399-1712

Tel (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

Tallahassee, FL 32399-1742

Tel (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

Tallahassee, FL 32399-1742

Tel (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

Tallahassee, FL 32399-1742

Tel (850) 245-4444

Fax (850) 922-8473

Danielle_Stanek@doh.state.fl.us

Bob Vincent

Bureau of Water Programs

Healthy Beaches, Environment

Tel (850) 245-4578

Fax (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

Tallahassee, FL 32399-1742

Tel (850) 245-4240

Fax (850) 921-0298

Sharon_Watkins@doh.state.fl.us

Dean E. Willis

Bureau of Laboratories

Chief of Microbiology

Jacksonville Central Laboratory

1217 Pearl Street

Jacksonville, FL 32202

Tel (904) 791-1557

Fax (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

Tel (727) 896-8626 

Meghan.Abbott@MyFWC.com

Theresa Cody

Fish and Wildlife Health, Aquatic

Fish and Wildlife Research Institute

100 Eighth Avenue SE

St. Petersburg, FL 33701-5095

Tel (727) 896-8626 

Fax (727) 893-9840

Theresa.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 I
Abbott et al. Public Health Response to HABs

FWRI Technical Report TR-14 129

.

Appendix I

4005 South Main Street

Gainesville, FL 32601

Tel (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

Tel (727) 896-8626 

Fax (727) 550-4222

Leanne.Flewelling@MyFWC.com

Allen Foley

Marine Turtle Research

Fish and Wildlife Research Institute

Jacksonville Field Laboratory

6134 Authority Avenue

Jacksonville, FL 32221

Tel (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

Tel (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

Tel (727) 896-8626 

Fax (727) 550-4222

Cindy.Heil@MyFWC.com

Col. Julie Jones

Director

Division of Law Enforcement

620 South Meridian Street

Tallahassee, FL 32399-6988

Tel (850) 488-6251 

Julie.Jones@MyFWC.com

Yasu Kiryu

Fish and Wildlife Health

Fish and Wildlife Research Institute

100 Eighth Avenue SE

St. Petersburg, FL 33701-5095

Tel (727) 896-8626 

Fax (727) 893-9840

Yasu.Kiryu@MyFWC.com

Jan Landsberg

Fish and Wildlife Health

Fish and Wildlife Research Institute

100 Eighth Avenue SE

St. Petersburg, FL 33701-5095

Tel (727) 896-8626 

Fax (727) 893-9840

Jan.Landsberg@MyFWC.com

Leslie Ward

Marine Mammal Research

Fish and Wildlife Research Institute

100 Eighth Avenue SE

St. Petersburg, FL 33701-5095

Tel (727) 896-8626 

Fax (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

Tel (352) 955-2230 

Fax (352) 955-2183

Dan.Wolf@MyFWC.com

National Estuary Program

Mark Alderson

Sarasota Bay Project

111 South Orange Avenue, Suite 200W

Sarasota, FL 34236

Tel (941) 955-8085

Fax (941) 955-8081

mark@sarasotabay.org

Lisa Beever

Charlotte Harbor NEP

1926 Victoria Ave

Fort Myers, FL 33901

Tel (239) 338-2556 ext. 235

Fax (239) 338-2560

lbeever@swfrpc.org

Holly Greening

Tampa Bay National Estuary Project

100 Eighth Avenue, SE
St. Petersburg, FL 33701

Tel (813) 893-2765

tbnep@tampabayrcp.org

Troy Rice

Indian River Lagoon Program

525 Community College Parkway, SE

Palm Bay, FL 32909

Tel (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

Tel (305) 361-4200

Blair.Mase@noaa.gov

Pacific Northwest National Laboratory (US DOE)

P.O. Box 999

902 Battelle Blvd.

Richland, WA 99352

Tel 1-888-375-PNNL (7665)

inquiry@pnl.gov

Teri 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

Tel (301) 713-2322

Fax (301) 427-2522

Teri.Rowles@noaa.gov

Barbara Schroeder

National Marine Fisheries Service

Office of Protected Resources

1315 East-West Highway, Room 13657

Silver Spring, MD 20910

Tel (301) 713–1401

Barbara.Schroeder@noaa.gov

Vera Trainer

Northwest Fisheries Science Center

Harmful Algal Blooms

2725 Montlake Blvd. East

Seattle, WA 98112-2097

Tel (206) 860-6788 

Fax (206) 860-3217

Vera.Trainer@noaa.gov

Fran Van Dolah

Marine Biotoxins Program

Center for Coastal Environmental Health and 

Biomolecular Research

National Ocean Service

Charleston, SC 29412

Tel (843) 762-8631 

Fax (843) 762-8700

Fran.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

Tel (305) 585-5250

Fax (305) 545-9762

ejerez@med.miami.edu

Cynthia Lewis-Younger

Tampa Poison Information Center

Tampa General Hospital

P.O. Box 1289

Tampa, FL 33601

Tel (813) 844-7044

Fax (813) 844-4443

Jay Schauben

Jacksonville Poison Information Center

655 West Eighth Street

Jacksonville, FL 32209

Tel (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

Tel (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 I
Abbott 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

Tel (301) 619-4801

Mark_Poli@amedd.army.mil

U.S. Department of Agriculture

Terence Evens

U.S. Horticultural Research Laboratory

2001 South Rock Road

Fort Pierce, FL 34945-3030

Tel (772) 462-5941

Fax (772) 462-5986

Terence.Evens@ars.usda.gov

Kathleen Hartman

APHIS

1408-24 Street SE

Ruskin, FL 33570

Tel (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

Tel (404) 562-9383

Fax (404) 562-9224

decker.ed@epa.gov

Jack Fournie

One Sabine Island Drive

Gulf Breeze, FL 32561

Tel (850) 934-9272

Fax (850) 934-9201

fournie.john@epa.gov

U.S. Fish and Wildlife Service 

Todd Hopkins

1339 – 20th Street

Vero Beach, FL 32960

Tel (772) 562-3909 ext.316

Todd_Hopkins@fws.gov

Dawn Jennings

7915 Baymeadows Way, Suite 200

Jacksonville, FL 32256

Tel (904) 731-3103

Dawn_Jennings@fws.gov

Jim Valade

North Florida Field Office

Endangered Species

6620 Southpoint Drive South, Suite 310

Jacksonville, FL 32216-0958

Tel (904) 232-2580

Fax (904) 232-2404

Jim_Valade@fws.gov

U.S. Food and Drug Administration

Jon Deeds

Center for Food Safety and Applied Nutrition

Microbiology

HFS-707

5100 Paint Branch Parkway

College Park, MD 20740

Tel (301) 436-1474

Fax (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

Tel (251) 690-3368

Fax (251) 694-4477

rdickey@cfsan.fda.gov

Stacey Etheridge

Center for Food Safety and Applied Nutrition

Biology

HFS-707

5100 Paint Branch Parkway

College Park, MD 20740

Tel (301) 436-1470

Fax (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

Tel (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

Tel (608) 270-2445
Fax (608) 270-2415 

aballmann@usgs.gov

Barry Rosen

Florida Integrated Science Center

12703 Research Parkway

Orlando, FL 32806

Tel (407) 803-5508

Fax (407) 803-5501

brosen@usgs.gov

Scott D. Wright

Branch Chief, Disease Investigation

National Wildlife Health Center

6006 Schroeder Road

Madison, WI 53711-6223

Tel (608) 270-2445

Fax (608) 270-2415 

swright@usgs.gov

Water Management Districts

Northwest Florida Water Management District

Graham Lewis

81 Water Management Drive

Havana, FL 32333

Tel (850) 539-5999

Fax (850) 539-2777

Graham.Lewis@nwfwmd.state.fl.us

South Florida Water Management District

Richard Pfeuffer

Water Quality Assessment Division

3301 Gun Club Road

West Palm Beach, FL 33406

Tel (561) 682-6806

Fax (561) 682-6442

rpfeuff@sfwmd.gov

St. Johns River Water Management District

Dean Campbell

Environmental Sciences Division

P.O. Box 1429

Palatka, FL 32178-1429

Tel (386) 329-4360

Fax (386) 329-4103

dcampbell@sjrwmd.com

St. Johns River Water Management District

John Hendrickson

Environmental Sciences Division

P.O. Box 1429

Palatka, FL 32178-1429

Tel (386) 329-4370

Fax (386) 329-4103

jhendrickson@sjrwmd.com

Southwest Florida Water Management District

Veronica Craw

2379 Broad Street

Brooksville, FL 34606-6899

Tel (352) 796-7211

veronica.craw@swfwmd.state.fl.us

Suwannee River Water Management District

Robbie McKinney

9225 CR 49

Live Oak, FL 32060

Tel (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 

Poison 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

Technical 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

Technical Report TR-1. iv + 37 p. + appendices.

TR-2 Witherington, 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 Witherington, 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 Conservation 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

Population 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 Weigle, 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 Wakeford, 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

(Trichechus 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.