Harmful algal bloom aerosols and human health.

Harmful algal blooms (HABs) are increasing across many locations globally. Toxins from HABs can be incorporated into aerosols and transported inland, where subsequent exposure and inhalation can induce adverse health effects. However, the relationship between HAB aerosols and health outcomes remains unclear despite the potential for population-level exposures. In this review, we synthesized the current state of knowledge and identified evidence gaps in the relationship between HAB aerosols and human health. Aerosols from Karenia brevis, Ostreopsis sp., and cyanobacteria were linked with respiratory outcomes. However, most works did not directly measure aerosol or toxin concentrations and instead relied on proxy metrics of exposure, such as cell concentrations in nearby waterbodies. Furthermore, the number of studies with epidemiological designs was limited. Significant uncertainties remain regarding the health effects of other HAB species; threshold dose and the dose-response relationship; effects of concurrent exposures to mixtures of toxins and other aerosol sources, such as microplastics and metals; the impact of long-term exposures; and disparities in exposures and associated health effects across potentially vulnerable subpopulations. Additional studies employing multifaceted exposure assessment methods and leveraging large health databases could address such gaps and improve our understanding of the public health burden of HABs.

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Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.

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Declaration of interests C.C.L.-grants from the Robert Wood Johnson Foundation (RWJF) and the University of Arizona Health Sciences. J.Y., S.H. and K.R. have no declarations of interest. LBG-grants from the National Institutes of Health (NIH); American Lung Association; Southern California National Institute for Occupational Safety & Health Education Center; Centers for Disease Control and Prevention; royalties or licenses from Up-to-Date and Wolters Kluwer; consulting fees Nemours Foundation; leadership or fiduciary role in American Lung Association of Arizona (unpaid) and Arizona Asthma Coalition (unpaid); receipt of equipment, materials, drugs, medical writing, gifts, or other services from Thayer Medical Corporation. A.P.A.-grants from the National Science Foundation (NSF), National Oceanic and Atmospheric Administration (NOAA), NIH, and Sloan Foundation; patents pending on instrument for determining aerosol acidity. M.L.B.-grants from the U.S. Environmental Protection Agency (EPA), NIH, High Tide Foundation, Yale Climate Change and Health Center, RWJF, Environmental Defense Fund, Health Effects Institute, Wellcome Trust; consulting fees from EPA and Clinique; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Boston University, Korea University, Organization of Teratology Information Specialists, University of Pennsylvania, Duke University, University of Texas, Data4Justice, NIH, Health Canada, PAC-10, UKRI, AXA Research Fund Fellowship, Harvard University, University of Montana, IOP Publishing; support for attending meetings and/or travel from Boston University, Harvard University, University of Illinois at Champaign, University of Texas, EPA, UPenn; participation on a data safety monitoring board or advisory board from US EPA Clean Air Scientific Advisory Board, National Academies Panels and Committees, Member of Lancet Countdown, Fifth National Climate Assessment NCAS, Johns Hopkins University, World Health Organization Global Air Pollution and Health Technical Advisory Group.