1. US EPA Drinking Water Health Advisories for Cyanotoxins
Lesley V. D’Anglada, Dr.P.H.
US Environmental Protection Agency
Office of Water/Office of Science and Technology
IAFP 2016
August 1st, 2016
St. Louis, Missouri

2. Presentation Overview
What are cyanobacterial harmful algal blooms
Routes of exposure and adverse health effects
Discuss the adverse effects in animals and plants
Overview of the current public health Federal and US States Regulations and Guidelines for cyanotoxins in drinking and recreational waters
Describe the EPA drinking water health advisories
Opportunity for Questions

3. Why are we talking about HABs?
The prevalence of HABs in freshwater is increasingly reported in the U.S. and worldwide
Algal blooms can cause:
Hypoxia, leading to fish kills
Taste and odor problems in treated drinking water
Toxins at levels that may be of concern for human health
Loss of drinking water, recreational/fishing uses, contributing to economic losses
Presence in source water and finished drinking water
2014: City of Toledo, OH (population ~500,000) issued a “do not drink” advisory, > 1 µg/L total microcystins detected in finished water in a drinking water system on western Lake Erie
2015: Ohio River HAB affected 3 States
2016: Florida issued a State of Emergency for four counties due to HABs in surface water

4. What are HABs and cyanoHABs?

5. Overview of Harmful Algal Blooms (HABs)
Algal blooms are natural components of marine and freshwater flora.
When an algae specie multiply and forms a bloom, they can affect aquatic life and water quality leading to scum formation, fish kills, and/or unpleasant odors. These are known as Harmful Algal Blooms (HABs).
HABs tend to occur in late summer and fall in temperate zones and potentially year-round in tropical and subtropical zones
Under the right conditions, all type of algae can cause harmful algal blooms.

6. Cyanobacterial Blooms
In freshwater, cyanobacteria or blue-green algae, are the most common “algae”, some of which produce highly potent cyanotoxins.
One species can make multiple toxins and different toxins can be produced by a number of different species making visual monitoring difficult.
Toxins can either reside inside the cell (intracellular) or be released into the water (extracellular).
Microcystins
Group of at least 100 variants
Primarily affect the liver (hepatotoxin)
Most studied and widespread cyanobacterial toxin (Microcystin-LR)
Freshwater Cyanotoxins
Type of Toxin
Causative Organism
Anatoxin-a
Neurotoxin
Anabaena spp.
Anatoxin-a (s)
Aphanizomenon spp.
Planktothrix spp.
Cylindrospermopsin
Hepatotoxin
Cylindrospermopsis raciborskii, Aphanizomenon ovalisporum
Lyngbyatoxin
Dermal Toxin
Lyngbya spp.
Microcystins
Microcystis aeruginosa
Saxitoxins
Anabaena circinalis
Lyngbya wollei

7. 2007 EPA National Lakes Assessment Microcystin Sampling
Microcystins were found throughout the United States especially in the upper Midwest.
32% overall detections (401/1238)
(Reference Lakes/Resampled lakes)
Source:
NLA link:

8. Adverse Effects to Humans and Animals

9. Exposure and Health Effects
Potential routes of exposure:
Consumption in drinking water and food
Ingestion during recreational activities
Dermal contact
Inhalation of aerosolized toxins
Health effects related to exposure to cyanotoxins:
Hepatotoxic (affects the liver)
Microcystins and Cylindrospermopsin
Neurotoxic (affects the nervous system)
Anatoxin-a and Saxitoxin
Dermatoxic (affects the skin)
Lipopolysaccharides and Lyngbyatoxin
Symptoms of acute exposure are irritation to eyes, ears, throat, rashes, and skin lesions.
Toxicity data (needed to determine thresholds) are not available for many cyanotoxins.

10. Effects of Cyanotoxins in Animals and Plants
Pets and livestock can be impacted by cyanotoxins
Animals are exposed by drinking water and/or eating algal biomass (surface mats or fur grooming)
Can have rapid onset of symptoms and mortality
Cyanobacterial cells and toxins can contaminate spray irrigation water and subsequently be associated with crop plants.
Low levels of cyanotoxins could be absorbed by roots, migrate to shoots, and then be translocated to grains and or fruits.
Cyanotoxins concentration in grains and fruits are very low.
Generally, roots accumulated more than the leaves.
Cyanotoxins inhibit plant growth causing visible toxic effects on the plant such as leaf discoloration.
Further investigation is needed to understand the uptake and fate of microcystins and other cyanobacterial toxins by food plants.

11. Cyanotoxins and Fish
Cyanotoxins levels in edible fish and shellfish are highly variable depending on trophic level and fish organ or tissues.
Concentrations are higher in liver > gut > kidneys and gonads > muscle tissue
Concentrations are higher >phytoplanktivorous > omnivorous > carnivorous fish
More research is needed to quantify the toxicity in fish caused by cyanotoxins and the bioaccumulation in aquatic food webs.
Rather than biomagnification, biodilution seems to occur in the foodweb with toxins being subject to degradation and excretion at every level.
One of research needs identified is the need to quantify the total toxicity in fish caused by MCs variants and other secondary metabolites.

12. Current Public Health Guidelines for Cyanotoxins in Drinking and Recreational Waters

13. Guidelines and Regulations in Drinking Water
No US Federal regulations for cyanobacteria or cyanotoxins in drinking water in the U.S.
Safe Drinking Water Act Requirements (SDWA Section 1412(b)(1))
Contaminant Candidate List
List of unregulated contaminants that are known or anticipated to occur in public water systems and may require a drinking water regulation.
EPA publishes the list every five years.
Cyanobacteria and their toxins included in CCL (1 , 2, 3 and draft 4)
Unregulated Contaminant Monitoring Rule (UCMR)
Collect data from selected public water systems.
EPA included 10 cyanotoxins in UCMR 4 for monitoring ( ).
Regulatory Determination (RD)
Determine whether or not to regulate; EPA publishes determinations every on a five year cycle.
RD 1, 2 and 3 – No Regulatory Decision - not sufficient information

14. Drinking Water Guidelines for Cyanotoxins
Authority/Country/State
Microcystins
CYL
Anatoxin-a
Saxitoxin
World Health Organization (WHO), 2003
1 μg/L MC-LR -
Health Canada, 2002
1.5 μg/L MCs (proposed)
Brazil, 2005
15 μg/L
3 μg/L
Australia, 2009
1.3 μg/L MC-LR TE
1 µg/L
Singapore, Poland, Norway, China, Netherlands, Korea, Japan, Italy, France, Germany, Finland, Czech Republic
1 µg/L MC-LR
Ohio, 2015
0.3 μg/L bottle-fed infants and pre- school age children
1.6 μg/L school- age children and adults
0.7 μg/L bottle-fed infants and pre- school age children
3 μg/L school-age children and adults
20 μg/L
0.2 μg/L
Oregon
0.3 μg/L
age 5 and younger
1.6 μg/L
age 6 and older
0.7 μg/L
Minnesota
0.1 µg/L MC-LR

15. Guidelines and Regulations in Recreational Water
No federal regulations for cyanobacteria or cyanotoxins in recreational water in the U.S.
World Health Organization (WHO) Guidelines:
Contained
Guidance values for recreational water have been adopted by many countries and some states based on WHO guidelines.

16. Recreational Water Guidance/Action Levels
State
Recreational Water Guidance/Action Levels
California
Microcystin: 0.8 µg/L; Anatoxin-a: 90 µg/L; Cylindrospermopsin: 4 µg/L
Connecticut
-Visual Rank Category 1: Visible Material is not likely cyanobacteria or water is generally clear. -Visual Rank Category 2: Cyanobacteria present in low numbers.
-Visual Rank Category 3: Cyanobacteria present in high numbers.
Illinois
Microcystin-LR concentration results approach or exceed 10 µg/L
Indiana
Level 1: very low/no risk < 4 µg/L microcystin-LR
Level 2: low to moderate risk 4 to 20 µg/L microcystin-LR Level 3: serious risk > 20 µg/L microcystin-LR Warning Level: Cylindrospermopsin: 5 ppb
Iowa
Microcystin ≥ 20 µg/L
Kansas
Health advisory: >4 µg/L to <20 µg/L for microcystin or > 20,000 cell/mL to <100,000 cell/mL cyanobacteria cell counts Health Warning: > 20 µg/L or > 100,000 cell/mL cyanobacterial cell counts and visible scum present
Kentucky (Louisville District)
Advisory: >20,000 cells/mL of cyanobacteria cell counts; Caution: > 100,000 cells/mL of cyanobacteria cell counts
Massachusetts
14 µg/L for microcystin-LR and ≥ 70,000 cells/mL for cyanobacteria cell counts
Nebraska
New Hampshire
>50% of cell counts from toxigenic cyanobacteria
North Carolina
Visible discoloration of the water or a surface scum may be considered for microcystin testing
Ohio
Microcystin-LR: PHA: 6 µg/L; NCA: 20 µg/L; Anatoxin-a: PHA: 80 µg/L; NCA: 300 µg/L Saxitoxin: PHA: 0.8 µg/L; NCA: 3 µg/L; Cylindrospermopsin: PHA: 5 µg/L; NCA: 20 µg/L
Oklahoma
100,000 cell/mL of cyanobacteria cell counts and > 20µg/L for microcystin
Oregon
Option 1: Visible scum and cell count or toxicity
Option 2: Toxigenic species >100,000 cells/mL Option 3: Microcystis or Planktothrix > 40,000 cells/mL
Option 4: Microcystin : 10 µg/L ; Anatoxin-a: 20 µg/L; Cylindrospermopsin: 6µg/L; Saxitoxin: 100 µg/L
Rhode Island
Visible cyanobacteria scum or mat and/or cyanobacteria cell count > 70,000 cells/mL and/or ≥14 µg/L of microcystin-LR
Texas
> 100,000 cell/mL of cyanobacteria cell counts and >20µg/L microcystin
Vermont
4,000 cells/mL cyanobacteria cell counts or ≥ 6µg/L microcystin-LR and the visible presence of cyanobacterial scum Anatoxin-a ≥ 10 µg/L
Virginia
Microcystin provisional action level: 6µg/L
Washington
Microcystin-LR: 6 µg/L; Anatoxin-a: 1 µg/L; Cylindrospermopsin: 4.5 µg/L; Saxitoxin: 75 µg/L
Wisconsin
> 100,000 cells/mL or scum layer

17. Overview of USEPA’s Drinking Water Health Advisories for Cyanotoxins

18. EPA Drinking Water Health Advisories (HA)
Informal technical guidance for unregulated drinking water contaminants to assist federal, state and local officials, and managers of public or community water systems in protecting public health during emergency situations.
HAs are non-regulatory concentrations in drinking water that is not expected to cause adverse non carcinogenic effects for a specific exposure period.
Short term exposures: one-day and ten-day (children)
Chronic Exposures: lifetime (for adults)
Carcinogenic
Reference:
Calabrase, E. (1989). Safe Drinking Water Act. CRC Press, ISBN pages.

19. US EPA Health Advisories
As of 2016, Drinking Water Health Advisories for 200 chemicals (and toxins).
162 One-day HA
162 Ten-day HA
119 lifetime advisories for adults.
Only one HA (Nitrate and Nitrite) targeted a different age subgroup (4 months old). Infants less than 4 months old are most sensitives for methemoglobinemia following exposure to nitrates and nitrites.
They are subject to change as new information becomes available.

20. HESD Development 2012 - Joint effort with Health Canada
HC: Update the 2002 DW Guideline for microcystins
USEPA: Develop Health Advisories (HAs) for Cyanotoxins
Literature Review
Development of Health Effects Support Documents (HESD) for microcystins, cylindrospermopsin and anatoxin-a
Comprehensive review of the health effects information
Provides the health effects basis for the development of HAs
2014/15 - External Peer Reviews HESDs for microcystins, cylindrospermopsin and anatoxin-a
Peer reviewers affirmed data are inadequate to develop an HA for anatoxin-a
EPA will continue evaluating health effects data on anatoxin-a as new information becomes available.
Peer reviewers confirmed data are adequate to develop HAs for microcystins and cylindrospermopsin

21. HAs Development
2015 – Development of Health Advisories for microcystins and cylindrospermopsin
June 17th, 2015 – HAs Published
EPA’s Office of Ground Water and Drinking Water (OGWDW) published the Recommendations for Public Water Systems to Manage Cyanotoxins in Drinking Water
Companion to the HAs to assist public drinking water systems (PWSs) that choose to develop system-specific plans for evaluating their source waters for vulnerability to contamination by microcystins and cylindrospermopsin.)

22. HAs for Microcystins and Cylindrospermopsin
EPA published Drinking Water Health Advisories (HA) for microcystins and cylindrospermopsin in 2015
MC-LR is considered a surrogate for all microcystins.
Exposure duration: 10-day value
Short term exposure is more consistent with expected exposure pattern.
No lifetime or carcinogenic value derived.
Toxin
10-day Health Advisory
Bottle-fed infants and
pre-school children
School-age children
and adults
Microcystins
0.3 µg/L
1.6 µg/L
Cylindrospermopsin
0.7 µg/L
3 µg/L

23. Mean Drinking Water Ingestion Rates by Age Groups
Bottle-fed infants consume large amounts of water compared to their body weight.
At 6 years and older, exposure on a body-weight basis is similar to that of an adult.
HAs for Microcystins HAs for Cylindrospermopsin

24. Toxicity Research Needs Identified
Male reproductive system toxicity following sub-acute to chronic oral exposure.
Toxicity of microcystin during pregnancy and effects on offspring following oral exposure.
The potencies of other microcystin congeners relative to microcystin- LR.
Effects of inhalation and/or dermal exposures to microcystins, cylindrospermopsin, and anatoxin-a.
Acute and chronic toxicity of anatoxin-a.
Chronic toxicity of cylindrospermopsin.
Carcinogenic potential of cyanotoxins.
Health risks from exposure to mixtures of cyanotoxins.
Bioaccumulation of cyanotoxins in aquatic food webs.

25. Next: Recreational AWQC for cyanotoxins
Clean Water Act  §304(a) recommends recreational Ambient Water Quality Criteria (AWQC) values protective of human health given a primary contact recreational exposure scenario.
EPA is developing recreational AWQC recommendations for the cyanotoxins microcystin toxins and cylindrospermopsin.
The AWQC will focus on exposure as a result of primary contact recreation activities such as swimming where immersion and incidental ingestion of ambient water are likely.
Dermal and inhalation exposures associated with primary contact recreation will be considered if data are sufficient.
Consumption of fish and shellfish will not be considered in the assessments.
Expected Draft: 2016

26. Disclaimer
The views expressed in this presentation are those of the author and do not necessarily represent the views or policies of the U.S. Environmental Protection Agency.

27. Lesley V. D’Anglada, Dr.PH U.S. Environmental Protection Agency
Contact Information
Lesley V. D’Anglada, Dr.PH
U.S. Environmental Protection Agency
Office of Water / Office of Science and Technology
EPA’s CyanoHABs Website