1. Cyanobacteria—Needs for Toxicology and Human Health Lorraine C. Backer National Center for Environmental Health Centers for Disease Control and Prevention

2. The Public Health Impact from Our Environment What is the hazard? What are the possible exposure routes? What are the “completed” exposure pathways? What is the exposure?

3. The Public Health Impact from Our Environment What are the biological effects? What are the associated health outcomes in exposed communities?

4. Hazard Cyanobacterial toxins in ambient waters –Hepatotoxins –Neurotoxins –Kidney toxins –Dermatoxins –Carcinogens –Tumor promorters –Genotoxins

5. What are the possible exposure routes? Drinking water Recreational waters Other uses of water Seafood Aerosols

6. What are the completed pathways? Drinking water –Treatment? Recreational waters –Monitoring and beach closures? Other uses of water –Monitoring and quality control? Seafood –Are the toxins bioaccumulated? Aerosols –Monitoring and recreational area closures?

7. Verifying Exposures Biological markers of exposure Biological markers of effect Measure of body burden –What body burden is important?

8. Health Outcomes We know about acute effects from high exposures –Dialysis in Brazil –Army recruits –Palm Island –Wisconsin

9. Health Outcomes: Needs Clinical –Mechanisms of action –Diagnostic tools –Case definitions –Verification of exposure –Clinical progression of outcome –Treatments –Assessment of chronic effects

10. Health Outcomes: Needs Outreach and education –Health care professionals –Veterinarians –Affected communities e.g. Florida red tide