ABSTRACT
Evidence for adverse human health effects from cyanotoxins derives from three principal sources: epidemiological evidence including human poison ings, animal poisonings, and toxicological studies.
Epidemiological evidence results from studies of human populations that have shown symptoms of poisoning or injury attributed to the presence of cyanotoxins in drinking water or other sources of water. This type of evidence depends upon good case definition, good characterisation of expo sure and a reporting system that enables these data to be compared. Such evidence, discussed later, includes the fatal intoxication by microcystin of 50 dialysis patients in Brazil, and the hospitalisation of 140 children supplied with water from a dam containing Cylindrospermopsis raciborskii in Australia. Reports of gastro-enteritis after the appearance of cyanobacterial blooms in drinking water sources come from North and South America, Africa and Europe. Most cases of human injury attributed to cyanobacterial toxins have been studied retrospectively, and complete epidemiological data, especially regarding exposure (number oTorganisms, type and concentration of cyanotoxins), are rarely available. Nevertheless, epidemiological evidence is of special importance in directly demonstrating the link between toxin exposures and human health outcomes, which otherwise cannot be derived directly from animal experiments.
