Environmental public health surveillance: Possible estuary-associated syndrome

Public health surveillance involves the collection, analysis, and dissemina tion of data for use in public health practice. A surveillance system inclu des the capacity to collect and analyze data as well as the ability to diss eminate the data to public health agencies that can undertake effective pre vention and control activities. An emerging issue in environmental public h ealth surveillance involves human exposure to the toxins produced by microo rganisms present in oceans and estuaries. One of these organisms is Pfieste ria piscicida Steidinger & Burkholder, a dinoflagellate found in estuaries along the Atlantic and gulf coasts of the United States. There have been re ports of both human illness associated with occupational exposures to conce ntrated laboratory cultures of P. piscicida and massive fill kills associat ed with the presence of the organism in rivers and estuaries. These reports , and anecdotal reports from people who worked on rivers where the organism has been found, generated concern that environmental exposures to P. pisci cida, similar organisms, or perhaps a toxin or toxins produced by the organ ism(s), could cause adverse human health effects. To begin to evaluate the public health burden associated with P. piscicida, investigators from the N ational Center for Environmental Health at Centers for Disease Control and Prevention and health agencies from states along the Atlantic coast collabo rated to develop a passive surveillance system for collecting, classifying, and tracking public inquiries about the organism. Specifically, the group developed exposure and symptom criteria and developed data collection and r eporting capabilities to capture the human health parameters collectively r eferred to as possible estuary-associated syndrome (PEAS). The surveillance system was implemented in six states (Delaware, Florida, Maryland, North C arolina, South Carolina, Virginia) beginning in June 1998. From 1 June 1998 through 30 June 2601, the six state health agencies participating in the P EAS surveillance system received 3,859 calls: 3,768 callers requested infor mation and 91 callers reported symptoms. Five individuals have-been identif ied as meeting PEAS criteria. Key words: CDC, Centers for Control and Preve ntion, environmental public health, epidemiology, estuary, human health, PE AS, Pfiesteria piscicida, possible estuary-associated syndrome, surveillanc e.