Notice to Readers
Results of The Public Health Response to Pfiesteria Workshop --
Atlanta, Georgia, September 29-30, 1997
On September 29-30, 1997, CDC sponsored a workshop to
coordinate a multistate response to public health issues about
Pfiesteria piscicida. Workshop attendees included representatives
from the health departments of eight states (Delaware, Florida,
Georgia, Maryland, North Carolina, South Carolina, Virginia, and
West Virginia) and the District of Columbia, the U.S. Food and Drug
Administration, the National Institutes of Health's National
Institute of Environmental Health Sciences, CDC's National
Institute for Occupational Safety and Health, and the U.S.
Environmental Protection Agency.
P. piscicida and morphologically related organisms (MROs) are
dinoflagellates that have been implicated in recent estuarine *
fish
kills on the U.S. eastern seaboard and have been reported to be
associated with human illness. These dinoflagellates appear similar
under light microscopy and require scanning electron microscopy for
definitive identification. The attendees of the workshop agreed on
a combined set of environmental conditions and clinical signs and
symptoms that together may represent adverse consequences of
exposure to these organisms. The environmental conditions are
exposure to estuarine water characterized by any of the following:
fish with lesions consistent with P. piscicida or MRO toxicity
(20% of a sample of at least 50 fish of one species having
lesions); 2) a fish kill involving fish with lesions consistent
with P. piscicida or MRO toxicity; or 3) a fish kill involving fish
without lesions, if P. piscicida or MROs are present and there is
no alternative reason for the fish kill. The clinical features in
humans include any of the following signs and symptoms: 1) memory
loss, 2) confusion, 3) acute skin burning (on direct contact with
water), or 4) three or more of an additional set of conditions
(headaches, skin rash, eye irritation, upper respiratory
irritation, muscle cramps, and gastrointestinal complaints {i.e.,
nausea, vomiting, diarrhea, and/or abdominal cramps}).
Workshop attendees suggested using the above framework to
identify potentially affected persons and recommended initiating
the following public health activities: 1) uniform multistate
surveillance for potential P. piscicida- and MRO-related illness;
2) multistate, CDC-coordinated, epidemiologic studies to determine
possible human health effects associated with P. piscicida and MRO
exposure; and 3) identification of a biomarker of exposure to the
toxins produced by these organisms. The public health implication
of toxicity of these dinoflagellates is an example of an emerging
environmental and potential occupational health issue that can best
be addressed through collaboration among federal, state, and local
health agencies.
Reported by participants in The Public Health Response to
Pfiesteria Workshop: AL Hathcock, PhD, Div of Public Health,
Delaware Health and Social Svcs; ME Levy, MD, District of Columbia
Commission of Public Health; S Wiersma, MD, Florida Dept of Health;
CL Drenzek, DVM, Div of Public Health, Georgia Dept of Human
Resources; MP Wasserman, MD, Maryland State Dept of Health and
Mental Hygiene; R Levine, MD, S Music, DTPH, North Carolina Dept of
Health and Human Svcs; R Ball, MD, South Carolina Dept of Health
and Environmental Control; SR Jenkins, VMD, Virginia State Health
Dept; C Berryman, DVM, Bur of Public Health, West Virginia Dept of
Health and Human Resources; Office of Public Health and Science, US
Dept of Health and Human Svcs; Office of Seafood, Center for Food
Safety and Applied Nutrition, US Food and Drug Administration;
Geographic Planning and Technology Support Br, Water Management
Div, Region IV, US Environmental Protection Agency; Laboratory of
Pharmacology and Chemistry, National Institute of Environmental
Health Sciences, National Institutes of Health; Hazard Evaluations
and Technical Assistance Br, Div of Surveillance, Hazard
Evaluations, and Field Studies, National Institute for Occupational
Safety and Health, Toxicology Br, Div of Environmental Health
Laboratory Sciences, and Health Studies Br, Div of Environmental
Hazards and Health Effects, National Center for Environmental
Health, CDC.
* A coastal area at the mouth of a river where fresh river water
mixes with salty sea water.
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