Natural-and-man-made-disasters by wuyunyi

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									Water Borne Disasters: Complex
   Hydrocarbons, Complex
          Pathogens
           Jonathan A. Bernstein, M.D.
              Professor of Medicine
             University of Cincinnati
         Department of Internal Medicine
     Division of Immunology/Allergy Section
Water World 2000

                         70% of earth is covered with water

                         97.5% is in the oceans and seas

                         2.5% is freshwater:
                              • 1.6% is polar ice caps
                              • 0.36% is present underground

                         6 billion people on earth expected to
                         Increase to 7.3-8.3 billion by 2025

                         There is no shortage of water; it is just
                         poorly distributed around the earth




     Environ Health Perspect. 2000 February; 108(2): A69–A73.
Issues pertaining to water
 Accessto potable water
 Adequate sanitation
   Water borne illnesses (cholera, malaria,
    dysentery, tetanus, diphtheria…)
   Technology to improve water quality

 Contamination      from natural and man-
 made sources
     Infectious, respiratory and allergic
      diseases
Definition of Natural Disaster
   A natural disaster is the effect of a natural
    hazard leading to financial, environmental
    or human losses
      Loss depends on the vulnerability of a
       population to resist the hazard
      Natural hazards never result in a natural
       disaster in areas without vulnerability

                                   Bankoff, G, et.al. 2003.
Classification of Natural Disasters
 Geological (avalanches, earthquakes, volcanic
  eruptions)
 Hydrological (floods, limnic eruptions,
  tsunamis)
 Meterological (blizzards, cyclonic storms
  [hurricanes, typhoons], droughts, hailstorms,
  heat waves, tornados)
 Fires
 Health (epidemics, famines)
 Space (impact events, solar flares)
Man Made Disasters
 10. Gulf of Mexico Dead Zone
  9. Great Pacific Garbage Patch
  8. West Virginia/Kentucky Coal Sludge
     Spill
  7. Anniston, Alabama PCB Poisoning
  6. Picher, Oklahoma Lead Contamination
  5. Three Mile Island Nuclear Meltdown
  4. Love Canal Toxic Dump
  3. Libby, Montana Asbestos Contamination
  2. Exxon-Valdez Oil Spill
  1. Tennessee Coal Ash Spill
Man Made Disasters
 10. Gulf of Mexico Dead Zone
  9. Great Pacific Garbage Patch
  8. West Virginia/Kentucky Coal Sludge
     Spill
  7. Anniston, Alabama PCB Poisoning
  6. Picher, Oklahoma Lead Contamination
  5. Three Mile Island Nuclear Meltdown
  4. Love Canal Toxic Dump
  3. Libby, Montana Asbestos Contamination
  2. Exxon-Valdez Oil Spill
  1. Tennessee Coal Ash Spill
#9   1) A huge swirling mess of plastic in the North Central
     Pacific Ocean estimated by some to be the size of the
     United States.
     2) 80% of the garbage comes from land-based sources
     3) Ends up in the digestive systems of sea creatures
Man Made Disasters
 10. Gulf of Mexico Dead Zone
  9. Great Pacific Garbage Patch
  8. West Virginia/Kentucky Coal Sludge
     Spill
  7. Anniston, Alabama PCB Poisoning
  6. Picher, Oklahoma Lead Contamination
  5. Three Mile Island Nuclear Meltdown
  4. Love Canal Toxic Dump
  3. Libby, Montana Asbestos Contamination
  2. Exxon-Valdez Oil Spill
  1. Tennessee Coal Ash Spill
#8   October 2000, 300 million gallons of
     mercury- and arsenic-laced coal slurry
     flooded land, polluted rivers and destroyed
     property in Eastern Kentucky and West
     Virginia
Man Made Disasters
 10. Gulf of Mexico Dead Zone
  9. Great Pacific Garbage Patch
  8. West Virginia/Kentucky Coal Sludge
     Spill
  7. Anniston, Alabama PCB Poisoning
  6. Picher, Oklahoma Lead Contamination
  5. Three Mile Island Nuclear Meltdown
  4. Love Canal Toxic Dump
  3. Libby, Montana Asbestos Contamination
  2. Exxon-Valdez Oil Spill
  1. Tennessee Coal Ash Spill
#2   1) The Exxon Valdez spill of 1989 resulted in 10.8
     million gallons of crude oil into Prince William Sound
     2) Covered 11,000 miles of ocean killing massive numbers
     of wild life and destroying ecosystems
Man Made Disasters
 10. Gulf of Mexico Dead Zone
  9. Great Pacific Garbage Patch
  8. West Virginia/Kentucky Coal Sludge
     Spill
  7. Anniston, Alabama PCB Poisoning
  6. Picher, Oklahoma Lead Contamination
  5. Three Mile Island Nuclear Meltdown
  4. Love Canal Toxic Dump
  3. Libby, Montana Asbestos Contamination
  2. Exxon-Valdez Oil Spill
  1. Tennessee Coal Ash Spill
     Sources of Water Contamination:
     Examples
   Industrial waste discharged into rivers or streams or
    in landfills or dumps which seeps into shallow water
    tables connected to lakes, streams and aquifers
       In developing countries 80-90% of sewage dumped directly
        into rivers and streams used for drinking, bathing and
        washing
   Climate change
       Intensifying the hydrological cycle drawing more moisture
        into the atmosphere
       Alters patterns of precipitation
       Massive flooding contaminates wells and water treatment
        facilities
                             Water world 2000. Environ Health Perspect 2000;108:A69-A73.
          Environmental Disasters:
        Effects on Respiratory Health
       Natural                 Man-made
   Hurricanes              Global warming/Climate
   Red tide                 change
   Algal blooms            Oil spills
                            Terrorism?
Natural Disasters: Hurricanes
   Floyd, Dennis and Irene in 1999
    successfully flooded North Carolina
      Farm-waste lagoons were breached by the
       flooding requiring farmers to pump large
       volumes of diluted waste onto saturated fields
      Floodwaters polluted wells, broke water mains
       and threatened water supplies with bacteria
       (Aeromonas hydrophila), viruses and parasites
      Increased risk of soft tissue, respiratory,

       diarrheal and vector-borne infectious diseases
       among survivors and responders
Katrina/Rita: Respiratory Health Effects
      Katrina (August 29) and Rita (September 24,
       2005)
           Flooding for weeks led to extensive mold growth in
            buildings; CDC determined that 46% of inspected
            homes had visible mold
           EPA continuously analyzed floodwaters finding
            dozens of contaminants, 8 of which exceeded EPA
            minimal risk levels for drinking
           Concerns about health effects of sediment left
            behind after floodwaters receded (dust related air
            toxics, mold spores…) especially among clean-up
            workers
Floodwater Exposure and the Related Health Symptoms
Among Firefighters in New Orleans, Louisiana 2005: Tak
SW, et.al. Am J Ind Med 2007; 50:377-383
   Background: Concerns over increased symptoms among
    NO firefighters related to floodwater exposure
   Methods: A cross sectional survey to assess health of
    these workers; multivariate analysis adjusting for age,
    gender and smoking
   Results: 525 firefighters completed the questionnaire
      201 reported one or more new onset respiratory
       symptoms (sinus congestion, throat irritation, cough)
      258 reported skin rash

   Conclusions: Firefighters who had floodwater contact
    compared to those non-exposed had an increased rate of
    new onset upper respiratory symptoms (PR 1.9; CI 1.1,
    3.1) and rash (PR 2.1; CI 1.4, 3.2)
Children’s respiratory health and mold levels in New
Orleans after Katrina: A Preliminary Look. Rabito FA,
et.al. J Allergy Clin Immunol 2008; 121:622-5.
   Background: Due to Katrina, 134,000 homes flooded and as
    repopulation and revitalization activities continued mold exposure has
    emerged as a major concern
   Objective: To determine the respiratory health effects in a sample of
    children who returned to live in New Orleans post-Katrina
   Methods: Children were recruited from a private primary school and
    respiratory health questionnaires and spirometry were collected in
    children aged 7-14; mold air sampling was performed at baseline and
    after two months
   Conclusions: A decrease in mold levels was observed over the study
    period; indoor mold levels remained low despite hurricane damage
      No significant difference in respiratory symptoms or spirometry
                           Red Tides
   Result from blooms of the marine dinoflagellate
    Karenia brevis
       Produce potent natural polyether toxins called
        brevetoxins that are known to cause:
            Reversible upper and lower respiratory tract irritation after
             inhalation of red tide aerosols; asthmatics more susceptible
            Acute gastroenteritis with neurologic symptoms after ingestion
             of contaminated shellfish
       In asthmatic sheep, instillation of picogram doses of
        brevotoxin caused significant and rapid bronchospasm
        blocked by atropine, albuterol, cromolyn sodium and
        chlorpheniramine
                                 Fleming LE, et.al. 2005; Abraham, et.al. 2003, 2005;
                                 Baden et.al. 2005; Benson et.al. 2005; Singer et.al. 1998
Fleming LE, et.al. Evaluation of Florida Red Tide Toxins in
Asthmatics. Environ Health Perspect 2005; 113:650-657.
Red Tide: Conclusions
 Changes in respiratory symptoms and lung
  function occur secondary to exposure to
  aerosolized Florida red-tide toxins in
  asthmatic subjects especially among those
  requiring regular asthma therapy
 Further investigation is required to
  determine whether these effects are irritant
  induced or mast cell mediated
                       Algal Blooms
                                               Blue Green Algae
          Green Algae                          (Cyanobacteria)
   Kingdom: Plantae                     Kingdom: Monera (Bacteria)
   6,000 species                       1,500 species
   Chloroplasts                         Autotrophs – derive their
       Contain chlorophylls, β-          energy from photosynthesis
        carotene, mitochondria,          Contain thick walled
        flagella
                                          heterocysts (nitrogen fixation);
   Eukaryotic                            chlorophyll and β-carotene; no
       Reproduce by alternation of       organelles
        generations
                                         Prokaryotic
   Exist as single cells,
                                             Reproduce by fission
    colonies, long filaments or
    macroscopic seaweeds                 Exist as colonies, filaments and
                                          sometimes as single cells
Green Algae as Allergens
   Bernstein IL, Safferman RS.
       Sensitivity of skin and bronchial mucosa to green algae. J Allergy 1966; 38:166-73.
       Immunologic responses of experimental animals to green algae. J Allergy 1969;
        43:191-9.
       Viable algae in house dust. Nature 1970; 227:851-2.
       Clinical sensitivity to green algae demonstrated by nasal challenge and in vitro tests
        of immediate hypersensitivity. J Allergy Clin Immunol 1973; 51:22-8.

   Tiberg E et.al. Allergy to green algae (Chlorella) among
    children. JACI 1995; 96:257-9.
       Higher sensitization in atopic mold-sensitized children
       Confirmed that Chlorella is a relevant allergen in certain groups of
        patients
   Algae powders used in therapeutic preparations induce
    occupational asthma
       Boulet LP. Algae induced occupational asthma in a thalassotherapist. Occup Med
        2006;282-3.
Algae warnings posted at 3 Ohio state park lakes
 COLUMBUS, Ohio -- Officials have now issued warnings about three
 Ohio state park lakes because of toxic, blue-green algae seen in the water.

 Signs were posted in recent days advising visitors not to touch the water or
 go boating on Cutler Lake at Blue Rock State Park in eastern Ohio's
 Muskingum County. Associated Press; August 10th, 2010
Polluted Ohio lake linked to at least 6 illnesses
ST. MARYS, Ohio -- Ohio health officials say at least six illnesses are likely related
to polluted water at the state's largest inland lake.

The Ohio Department of Health says five other reports of water-related illnesses
from this summer are still under investigation near Grand Lake St. Marys in western
Ohio.

Toxic algae found in the lake has led state officials to warn people to avoid direct
contact with the water in the lake, which sits between Toledo and Dayton. Associated
Press; Sept 8th, 2010
Approximately 40 species produce toxins that can
be lethal to animals and humans:
Anatoxin-a, anatoxin as, aplysiatoxin,
cylindrospermopsin, domoic acid, microcystin LR,
nodularin R, saxitoxin
Health benefits of cyanobacteria?
   Spirulina (Arthrospira platensis) – a non-toxic specie of blue
    green algae produced as a dietary supplement
   Kim HM, et.al. Inhibitory effect of mast cell-mediated
    immediated type allergic reactions in rats by spirulina.
    Biochem Pharmacol 1998; 55:1071-6.
   Mao TK, et.al. J Med Food 2005; 8:27-30)
        Randomized double blinded cross over study vs. placebo
        Allergic and non-allergic subjects fed spirulina for 12 weeks
        PBMCs stimulated with PHA pre- and post-treatment
        IL-4 reduced by PBMCs from atopic subjects
   Cingi C, et.al. The effects of spirulina on allergic rhinitis.
    Eur Arch Otorhinolaryngol 2008; 265:1219-23.
        DBPC found that spirulina improved nasal discharge and congestion,
         sneezing, itching vs. placebo (p<.001)
    Are cyanobacteria allergenic?
   Heise HA. Symptoms of hay fever caused by algae. II. Microcystic,
    another form of algae producing allergenic reactions. Ann Allergy 1951;
    9:100-1.
   Mittal A, et.al. Respiratory allergy to algae: clinical aspects. Ann Allergy
    1979; 42:253-6.
        Demonstrated specific IgE skin test responses to toxic strains; didn’t remove
         toxic components.
   Bernstein JA, et.al. Cyanobacteria: An unrecognized ubiquitous
    sensitizing allergen? Allergy, Asthma Proc (in press)
        Removal of exotoxins from nine species found in freshwater blooms, soil and
         air samples
        Preparation of skin test reagents; testing of non-allergic individuals to
         identify irritant threshold responses
        Skin prick testing of chronic rhinitis patients

                          Bernstein JA, et.al. Allergy, Asthma Proc (in press)
Table 1. Frequency and Percentage of Gender, Race, Atopy and Cyanobacteria Skin Prick
Testing for 259 Patients *SPT=skin prick testing; 64 positive to Microcystis aeruginosa,
9 positive to Aphanizomenon-flos aquae, 3 positive to Synchocystis, 1 positive to Lyngbya
          Demographics                    n              %
            Gender
Male                                     101            39.0%
Female                                   158            61.0%
               Race
Caucasian                                209            80.7%
AA/Asian                                 50             19.3%
              Atopy
Yes                                      190            73.4%
No                                       69             26.6%
      Cyanobacteria SPT*
Positive                                 74             28.6%
Negative                                 185            71.4%
Table 2. Frequency Table for Atopy and Algae Positive SPT for 259 Patients
P-value is Testing the Association between Atopy and Algal Positive SPT*
*P<0.001; P-value is Testing the Association between Atopy and Algal Positive SPT
 Cyanobacteria              Atopy
                      Yes           No          Total
Positive               68            6           74
Negative              122           63          185
Total                 190           69          259
                                  Bernstein JA, et.al. Allergy, Asthma Proc (in press)
Other notable findings
   Cyanobacteria sensitization was more prevalent
    among patients with allergic rhinitis vs. non-
    allergic rhinitis and mixed rhinitis
      7/71 patients with NAR sensitized to

       cyanobacteria
   The prevalence of cyanobacteria sensitization was
    increased in patients with greater numbers of
    positive skin prick tests to aeroallergens
   There was an inverse correlation between
    cyanobacteria sensitization and smoking
                Bernstein JA, et.al. Allergy, Asthma Proc (in press)
Man Made Disasters: Oil Spills



   Tasman Spirit oil spill – Karachi, Pakistan
       July 27, 2003 a ship carrying crude oil ran aground releasing
        37,000 tons of oil into the sea
       Study comparing acute health effects of households living on the
        shoreline (exposed) compared to those living 2 km (Group A) and
        20km (Group B) away from the sea
       400 subjects interviewed (Exposed n=216; Group A n=83; Group
        B n=101) regarding respiratory and non-respiratory health effects
       Statistically significant associations between exposure and
        symptoms
                                   Janjua NZ, et.al. BMC Public Health 2006; 6:84.
    Prestige Oil Spill
    Zock J-P et.al. Am J Resp Crit Care Med 2007; 176:610-616.




     November 19, 2002 the oil tanker Prestige sank 200 km of the coast of
      northwestern Spain releasing 67,000 tons of “Bunker C oil” into the
      Atlantic ocean.
          Objective: Evaluate the prevalence of respiratory health effects in local
           fisherman involved in the clean-up process one year after the spill
          Methods: Questionnaire surveys assessing the relationship of respiratory
           symptoms and exposure; multiple logistic regression analysis adjusted for
           age, gender and smoking
          Results: 6,780 fisherman completed surveys; 63% participated in clean-up
           activities; lower respiratory symptoms more prevalent in clean-up workers
           which increased with the number of exposed days, hours of exposure per
           day and number of clean-up activities
          Conclusion: Participating in clean-up activities associated with old spills
           can lead to prolonged respiratory symptoms 1-2 years later
Climate Change
   Rising temperatures on earth responsible for increased in
    anthropogenic (man-made) greenhouse gases leading to
    respiratory health effects
   Link between thunderstorms and epidemics of rhinitis and
    asthma exacerbations
       Late spring and summer when high levels of airborne pollen grains
       Worse in subjects with allergic rhinitis and improperly treated
        asthmatics
   Diseases transmitted by mosquitoes (malaria, dengue
    fever, yellow fever and encephalitis) increase because
    these vectors are very sensitive to meteorological changes
       Floods and drought resulting from global warming trigger
        outbreaks by creating breeding grounds for insects whose
        desiccated eggs remain viable and hatch in still water
                                        D’Amato, et.al. Clin Exp Allergy 2008; 38:1264-74.
                                        Epstein PR. Sci Am 2000; 283:50-7.
Terrorism?
   Potential for water as a vehicle for causing mass casualties
    is the 1993 outbreak of Cryptosporidiosis in Milwaukee
    where 403,000 people developed disease, 4,400 were
    hospitalized and 54 died
       C. parvum oocysts got through the treatment system
       Some individuals may have developed infection after exposure to
        only one oocyst
   Contamination of city water supplies , recreational pools
    and lakes with infectious agents are other likely targets
       Toxins are odorless, colorless and tasteless
       2 oz of Botulinum toxin A is sufficient to kill everyone in the US
       Current water surveillance programs in the US are insensitive
   Bottled water
       Reverse osmosis is the most effective barrier against toxins and
        microbial contaminants
Conclusions
   Natural and man-made disasters have a broad impact on
    health
       Infectious
       Carcinogenic
       Toxic
       Allergenic
   Exposure can occur through ingestion, dermal and
    inhalation routes
       Better methods for accurately establishing exposure levels with
        health related effects are needed
   Increased water safety surveillance and response activities
    are the best hope to prevent natural or man-made diseases
    including bioterrorism

								
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