Cyanobacteria have adapted to survive in a variety of environments and have been found globally. Toxin-producing cyanobacterial harmful algal blooms (CHABs) have been increasing in frequency worldwide and pose a threat to drinking and recreational water. In this study, the prevalence, impact of CHABs and mitigation efforts were reviewed, focusing on the Lake Erie region and Ohio’s inland lakes that have been impacted heavily as an example so that the findings can be transferrable to other parts of the world that face the similar problems due to the CHABs in their freshwater environments. This paper provides a basic introduction to CHABs and their toxins as well as an overview of public health implications including exposure routes, health effects, and drinking water issues, algal bloom advisory practices in Ohio, toxin measurements results in Ohio public water supplies, and mitigation efforts.

A recent ecological study demonstrated a significant association between an increased risk of nonalcoholic liver disease mortality and freshwater cyanobacterial blooms. Moreover, previous epidemiology studies highlighted a relationship between cyanotoxins in drinking water with liver cancer and damage and colorectal cancer. These associations identified cyanobacterial blooms as a global public health and environmental problem, affecting freshwater bodies that are important sources for drinking water, agriculture, and aquafarms. Furthermore, as a result of climate change, it is expected that our freshwater environments will become more favorable for producing harmful blooms that produce various cyanotoxins. Food is an important source of cyanotoxin exposure to humans, but it has been less addressed. This paper synthesizes information from the studies that have investigated cyanotoxins in freshwater and food on a global scale. We also review and summarize the health effects and exposure routes of cyanotoxins and candidates for cyanotoxin treatment methods that can be applied to food.

Harmful cyanobacterial blooms present a global threat to human health. There is evidence suggesting that cyanobacterial toxins can cause liver damage and cancer. However, because there is little epidemiologic research on the effects of these toxins in humans, the excess risk of liver disease remains uncertain. The purpose of this study is to estimate the spatial distribution of cyanobacterial blooms in the United States and to conduct a Bayesian statistical analysis to test the hypothesis that contamination from cyanobacterial blooms is a potential risk factor for non-alcoholic liver disease. An ecological study design was employed, in which county-specific gender and age standardized mortality rates (SMR) of non-alcoholic liver disease in the United States were computed between 1999 and 2010. Bloom coverage maps were produced based on estimated phycocyanin levels from MERIS (Medium Resolution Imaging Spectrometer) water color imageries from 08/01/2005 to 09/30/2005. A scan statistical tool was used to identify significant clusters of death from non-alcoholic liver disease. A map of local indicator of spatial association (LISA) clusters and a Bayesian spatial regression model were used to analyze the relationship between cyanobacterial bloom coverage and death from non-alcoholic liver disease. Cyanobacterial blooms were found to be widely spread in the United States, including coastal areas; 62% of the counties (1949 out of 3109) showed signs of cyanobacterial blooms measured with MERIS. Significant clusters of deaths attributable to non-alcoholic liver disease were identified in the coastal areas impacted by cyanobacterial blooms. Bayesian regression analysis showed that bloom coverage was significantly related to the risk of non-alcoholic liver disease death. The risk from non-alcoholic liver disease increased by 0.3% (95% CI, 0.1% to 0.5%) with each 1% increase in bloom coverage in the affected county after adjusting for age, gender, educational level, and race. At the population level, there is a statistically significant association between cyanobacterial blooms and non-alcoholic liver disease in the contiguous United States. Remote sensing-based water monitoring provides a useful tool for assessing health hazards, but additional studies are needed to establish a specific association between cyanobacterial blooms and liver disease.