Lorraine C Backer's research while affiliated with Centers for Disease Control and Prevention and other places

Publications (111)

Article
Background Prenatal exposure to drinking water with arsenic concentrations >50 μg/L is associated with adverse birth outcomes, with inconclusive evidence for concentrations ≤50 μg/L. In a collaborative effort by public health experts, hydrologists, and geologists, we used published machine learning model estimates to characterize arsenic concentrat...
Article
Harmful algal and cyanobacterial blooms (harmful algal blooms) are large colonies of algae or cyanobacteria that can harm humans, animals, and the environment (1-3). The number of algal blooms has been increasing in the United States, augmented by increasing water temperatures and nutrients in water from industry and agricultural run-off (4,5). The...
Book
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Recreational use of water can have major benefits for health and well-being. From children playing in a river to families relaxing on a beach, from people taking part in water sports to observing waterside nature, all shapes and sizes of bodies – be they oceans, lakes or rivers – of water can uplift the spirit and enhance physical and mental well-b...
Technical Report
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This guidance is focused on strategies that you may use in response to cyanobacterial blooms that are found in freshwater aquatic environments, including lakes, streams, rivers, reservoirs, ponds, and freshwater-influenced estuaries. It is intended to help you select monitoring, excess nutrient reduction, in-lake management, and communication appro...
Article
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Arsenic from geologic sources is widespread in groundwater within the United States (U.S.). In several areas, groundwater arsenic concentrations exceed the U.S. Environmental Protection Agency maximum contaminant level of 10 μg per liter (μg/L). However, this standard applies only to public-supply drinking water and not to private-supply, which is...
Article
Hardy FJ, Preece E, Backer L. 2021. Status of state cyanoHAB outreach and monitoring efforts, United States. Lake Reserv Manage. XX:XXX–XXX. A widespread effort is underway to improve awareness of cyanobacteria harmful algal blooms (cyanoHABs) across the United States using a variety of monitoring programs and public health outreach measures to pro...
Article
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Harmful algal bloom events can result from the rapid growth, or bloom, of photosynthesizing organisms in natural bodies of fresh, brackish, and salt water. These events can be exacerbated by nutrient pollution (e.g., phosphorus) and warming waters and other climate change effects (1); have a negative impact on the health of humans, animals, and the...
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Background: Pollution – unwanted waste released to air, water, and land by human activity – is the largest environmental cause of disease in the world today. It is responsible for an estimated nine million premature deaths per year, enormous economic losses, erosion of human capital, and degradation of ecosystems. Ocean pollution is an important, b...
Article
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Background: Pollution – unwanted waste released to air, water, and land by human activity – is the largest environmental cause of disease in the world today. It is responsible for an estimated nine million premature deaths per year, enormous economic losses, erosion of human capital, and degradation of ecosystems. Ocean pollution is an important, b...
Article
Full-text available
Pollution – unwanted waste released to air, water, and land by human activity – is the largest environmental cause of disease in the world today. It is responsible for an estimated nine million premature deaths per year, enormous economic losses, erosion of human capital, and degradation of ecosystems.Ocean pollution is an important, but insufficie...
Article
Over 2 million mostly rural Americans are at risk of drinking water from private wells that contain arsenic (As) exceeding the U.S. Environmental Protection Agency (USEPA) Maximum Contaminant Level (MCL) of 10 μg/L. How well existing treatment technologies perform in real world situations, and to what extent they reduce health risks, are not well u...
Article
Background: People living in coastal communities are at risk for exposure to environmental hazards, including legacy chemicals. We can use databases such as NHANES to assess whether contaminants in coastal communities are present in higher levels than in the United States overall. We can use information from studies of local animal populations to...
Article
Well water around the world can be contaminated with arsenic, a naturally occurring geological element that has been associated with myriad adverse health effects. Persons obtaining their drinking water from private wells are often responsible for well testing and water treatment. High levels of arsenic have been reported in well water-supplied are...
Article
Currently, no federal policies exist in the United States regarding private wells; this authority is devolved to states. This study inventoried state-level policies governing private wells in the United States in order to identify the topics addressed by each state, division of responsibilities across state agencies, and geographic differences in p...
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This report summarizes trends in outbreaks associated with untreated recreational water exposure from 2000–2014; this includes infections with pathogens of concern for transplant recipients, such as norovirus, Shigella, and Cryptosporidium.
Article
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Outbreaks associated with untreated recreational water can be caused by pathogens, toxins, or chemicals in fresh water (e.g., lakes, rivers) or marine water (e.g., ocean). During 2000-2014, public health officials from 35 states and Guam voluntarily reported 140 untreated recreational water-associated outbreaks to CDC. These outbreaks resulted in a...
Article
Arsenic concentrations from 20 450 domestic wells in the U.S. were used to develop a logistic regression model of the probability of having arsenic >10 μg/L (“high arsenic”), which is presented at the county, state, and national scales. Variables representing geologic sources, geochemical, hydrologic, and physical features were among the significan...
Technical Report
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This report provides a research plan and action strategy for addressing the causes and impacts of harmful algal blooms (HABs) and hypoxia on stakeholders of all types within the Great Lakes region. Over the past several decades, HABs and hypoxia (low-oxygen conditions) have caught the nation’s attention due to the associated negative socioeconomic,...
Article
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Ciguatera Fish Poisoning (CFP) is the most frequently reported seafood-toxin illness in the world. It causes substantial human health, social, and economic impacts. The illness produces a complex array of gastrointestinal, neurological and neuropsychological, and cardiovascular symptoms, which may last days, weeks, or months. This paper is a genera...
Article
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We reviewed patient records with a first-listed diagnosis of urolithiasis-also known as urinary tract or kidney stone disease, nephrolithiasis-upon discharge from Guam's sole civilian hospital during 2006 to 2010 and urinary cancer mortality records from the Guam Cancer Registry for 1970 to 2009 to determine the source of municipal water supplied t...
Article
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People, domestic animals, and wildlife are all exposed to numerous environmental threats, including harmful algal blooms (HABs). However, because animals exhibit wide variations in diet, land use and biology, they are often more frequently or heavily exposed to HAB toxins than are people occupying the same habitat, making them sentinels for human e...
Technical Report
Full-text available
The report outlines Federal agencies’ roles and responsibilities for evaluating and managing HABs and hypoxia, agency successes since the 2008 authorization of HABHRCA, and their management and response actions. It also identifies remaining challenges and makes recommendations for actions to address these events. It draws from direct contributions...
Article
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There is little published literature on the efficacy of strategies to reduce exposure to residential well water arsenic. The objectives of our study were to: 1) determine if water arsenic remained a significant exposure source in households using bottled water or point-of-use treatment systems; and 2) evaluate the major sources and routes of any re...
Article
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During an October 2005 algal bloom (i.e., a rapid increase or accumulation in the population of algae) off the coast of Nicaragua, 45 people developed symptoms of paralytic shellfish poisoning (PSP) and one person died. PSP in humans is caused by ingestion of saxitoxin, which is a neurotoxin often associated with shellfish contaminated by algal blo...
Article
Microalgal blooms are a natural part of the seasonal cycle of photosynthetic organisms in marine ecosystems. They are key components of the structure and dynamics of the oceans and thus sustain the benefits that humans obtain from these aquatic environments. However, some microalgal blooms can cause harm to humans and other organisms. These harmful...
Article
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Exposure to chlorination disinfection by-products (CxDBPs) is prevalent in populations using chlorination-based methods to disinfect public water supplies. Multifaceted research has been directed for decades to identify, characterize, and understand the toxicology of these compounds, control and minimize their formation, and conduct epidemiologic s...
Article
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Algae and cyanobacteria are present in all aquatic environments. We do not have a good sense of the extent of human and animal exposures to cyanobacteria or their toxins, nor do we understand the public health impacts from acute exposures associated with recreational activities or chronic exposures associated with drinking water. We describe the Ha...
Article
Recreational water-associated disease outbreaks result from exposure to infectious pathogens or chemical agents in treated recreational water venues (e.g., pools and hot tubs or spas) or untreated recreational water venues (e.g., lakes and oceans). For 2009-2010, the most recent years for which finalized data are available, public health officials...
Article
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Harmful algal blooms (HABs) are excessive accumulations of microscopic photosynthesizing aquatic organisms (phytoplankton) that produce biotoxins or otherwise adversely affect humans, animals, and ecosystems. HABs occur sporadically and often produce a visible algal scum on the water. This report summarizes human health data and water sampling resu...
Article
Background: Ciguatera and scombroid fish poisonings are common causes of fish-related foodborne illness in the United States; however, existing surveillance systems underestimate the overall human health impact. Objectives: This study aimed to describe existing data on ciguatera and scombroid fish poisonings from outbreak and poison control cent...
Article
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Cyanobacteria (also called blue-green algae) are ubiquitous in aquatic environments. Some species produce potent toxins that can sicken or kill people, domestic animals, and wildlife. Dogs are particularly vulnerable to cyanotoxin poisoning because of their tendency to swim in and drink contaminated water during algal blooms or to ingestalgal mats....
Article
Although disinfection of domestic water supply is crucial for protecting public health from waterborne diseases, this process forms potentially harmful by-products, such as trihalomethanes (THMs). We evaluated the influence of physicochemical properties of four THMs (chloroform, bromodichloromethane, dibromochloromethane, and bromoform) on the inte...
Article
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Although ciguatera fish poisoning (CFP) is the most common seafood intoxication worldwide, its burden has been difficult to establish because there are no biomarkers to diagnose human exposure. We explored the incidence of CFP, percentage of CFP case-patients with laboratory-confirmed ciguatoxic meal remnants, cost of CFP illness, and potential ris...
Conference Paper
Introduction: In previous studies, we demonstrated statistically significant changes in pulmonary function testing (PFTs) and reported symptoms for asthmatics before and after 1 hour at the beach with exposure to brevetoxins in Florida red tide (Karenia brevis bloom) aerosols. In this study, we explored the possible longer term health effects over...
Chapter
Introduction Natural Pollutants-Chemicals Natural Pollutants-Microbes Conclusion References
Chapter
Introduction Cyanobacterial Toxins (“Cyanotoxins”) Chronic Exposure to Cyanotoxins in Drinking Water Acute Exposures to Toxic Cyanobacteria Dam Building and Problem Cyanobacteria Future Problems Toxic Cyanobacteria and Safe Drinking Water Supplies Concluding Remarks Acknowledgments References
Article
Having demonstrated significant and persistent adverse changes in pulmonary function for asthmatics after 1 hour exposure to brevetoxins in Florida red tide (Karenia brevis bloom) aerosols, we assessed the possible longer term health effects in asthmatics from intermittent environmental exposure to brevetoxins over 7 years. 125 asthmatic subjects w...
Article
To enhance information sharing and garner increased support from the public for scientific research, funding agencies now typically require that research groups receiving support convey their work to stakeholders. The National Institute of Environmental Health Sciences (NIEHS) funded Aerosolized Florida Red Tide P01 research group (Florida Red Tide...
Article
The critical public health need to assess and protect the drinking water used by 37 million Americans requires attention and resources. NCEH, in partnership with states, has begun the process to identify information available on unregulated drinking water sources to improve the availability of data to support decisive public health actions and reso...
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This paper reviews the literature describing research performed over the past decade on the known and possible exposures and human health effects associated with Florida red tides. These harmful algal blooms are caused by the dinoflagellate, Karenia brevis, and similar organisms, all of which produce a suite of natural toxins known as brevetoxins....
Article
Blooms of the toxic dinoflagellate, Karenia brevis, produce potent neurotoxins in marine aerosols. Recent studies have demonstrated acute changes in both symptoms and pulmonary function in asthmatics after only 1 h of beach exposure to these aerosols. This study investigated if there were latent and/or sustained effects in asthmatics in the days fo...
Article
The objectives of this work were to compare enterococci (ENT) measurements based on the membrane filter, ENT(MF) with alternatives that can provide faster results including alternative enterococci methods (e.g., chromogenic substrate (CS), and quantitative polymerase chain reaction (qPCR)), and results from regression models based upon environmenta...
Article
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Background: Private water systems are more likely to have nitrate levels above the maximum contaminant level (MCL). Pregnant women are considered vulnerable to the effects of exposure to high levels of nitrates in drinking water due to their altered physiological states. The level of methemoglobin in the blood is the biomarker often used in resear...
Article
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Microbial water-quality indicators, in high concentrations in sewage, are used to determine whether water is safe for recreational purposes. Recently, the use of these indicators to regulate recreational water bodies, particularly in sub/tropical recreational marine waters without known sources of sewage, has been questioned. The objectives of this...
Article
The west coast of Florida has annual blooms of the toxin-producing dinoflagellate, Karenia brevis with Sarasota, FL considered the epicenter for these blooms. Numerous outreach materials, including Frequently Asked Question (FAQ) cards, exhibits for local museums and aquaria, public beach signs, and numerous websites have been developed to dissemin...
Article
The use of enterococci as the primary fecal indicator bacteria (FIB) for the determination of recreational water safety has been questioned, particularly in sub/tropical marine waters without known point sources of sewage. Alternative FIB (such as the Bacteroidales group) and alternative measurement methods (such as rapid molecular testing) have be...
Article
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Florida red tides occur annually in the Gulf of Mexico from blooms of the marine dinoflagellate, Karenia brevis, which produces highly potent natural polyether toxins, brevetoxins. Several epidemiologic studies have demonstrated that human exposure to red tide aerosol could result in increased respiratory symptoms. Environmental monitoring of aeros...
Article
Full-text available
Florida red tides, an annual event off the west coast of Florida, are caused by the toxic dinoflagellate, Karenia brevis. K. brevis produces a suite of potent neurotoxins, brevetoxins, which kill fish, sea birds, and marine mammals, as well as sickening humans who consume contaminated shellfish. These toxins become part of the marine aerosol, and c...
Conference Paper
The extent of human illness caused by environmental exposure to algal toxins in drinking and recreational waters is unknown. There are some national and World Health Organization guidelines that public health agencies can follow to make decisions about allowing access to drinking water sources and recreational areas with ongoing HABs. However, ther...
Conference Paper
The toxic aerosols from the blooms of Florida red tide, Karenia brevis, cause respiratory irritation in healthy beachgoers and can trigger reactive airway responses in asthmatics. Two strategies have been developed and maintained to inform the public about these toxic aerosols and their human health effects. The Beach Conditions Reporting System pr...
Article
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Algal blooms of Karenia brevis, a harmful marine algae, occur almost annually off the west coast of Florida. At high concentrations, K. brevis blooms can cause harm through the release of potent toxins, known as brevetoxins, to the atmosphere. Epidemiologic studies suggest that aerosolized brevetoxins are linked to respiratory illnesses in humans....
Article
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We conducted a study of recreational exposure to microcystins among 81 children and adults planning recreational activities on either of three California reservoirs, two with significant, ongoing blooms of toxin-producing cyanobacteria, including Microcystis aeruginosa (Bloom Lakes), and one without a toxin-producing algal bloom (Control Lake). We...
Article
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Background: Harmful Algal Blooms (HABs) occur throughout the world with Florida having the distinction of being home to all major toxin-producing marine, estuarine and freshwater microalgae. The subtropical warm climate, 1200 miles of coastline, varied aquatic habitats and the human interface through seafood consumption and from water activities co...
Article
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In previous studies we demonstrated statistically significant changes in reported symptoms for lifeguards, general beach goers, and persons with asthma, as well as statistically significant changes in pulmonary function tests (PFTs) in asthmatics, after exposure to brevetoxins in Florida red tide (Karenia brevis bloom) aerosols. In this study we ex...
Article
Over the last few decades, scientific research has helped to describe the disease neurotoxic shellfish poisoning (NSP) by identifying the causative organism, Karenia brevis, and by characterizing the disease-causing toxins, a suite of polyether toxins called brevetoxins. In addition to causing disease in exposed human populations, K. brevis blooms...
Article
In the United States, the proportion of foodborne illness outbreaks associated with consumption of contaminated domestic and imported fresh fruits and vegetables (produce) has increased over the past several decades. To address this public health concern, the goal of this work was to identify and quantify factors associated with microbial contamina...
Article
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We review the major linkages between the oceans and public health, focusing on exposures and potential health effects due to anthropogenic and natural factors including: harmful algal blooms, microbes, and chemical pollutants in the oceans; consumption of seafood; and flooding events. We summarize briefly the current state of knowledge about public...
Article
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Anthropogenically-derived increases in atmospheric greenhouse gas concentrations have been implicated in recent climate change, and are projected to substantially impact the climate on a global scale in the future. For marine and freshwater systems, increasing concentrations of greenhouse gases are expected to increase surface temperatures, lower p...
Article
With over 50% of the US population living in coastal counties, the ocean and coastal environments have substantial impacts on coastal communities. While many of the impacts are positive, such as tourism and recreation opportunities, there are also negative impacts, such as exposure to harmful algal blooms (HABs) and water borne pathogens. Recent ad...
Article
Exposure to excess heat is preventable yet it is the primary weather-related cause of mortality in the United States. In the Southwest United States, high temperatures are common and indoor environments often have cooling devices. In summer 2005, Maricopa County, Arizona experienced a 182% increase in reported heat-related deaths in comparison to 2...
Article
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We measured microcystins in blood from people at risk for swallowing water or inhaling spray while swimming, water skiing, jet skiing, or boating during an algal bloom. We monitored water samples from a small lake as a Microcystis aeruginosa bloom developed. We recruited 97 people planning recreational activities in that lake and seven others who v...