Increased respiratory morbidity associated with exposure to a mature volcanic plume from a large Icelandic fissure eruption.

The 2014-15 Holuhraun eruption in Iceland was the largest fissure eruption in over 200 years, emitting prodigious amounts of gas and particulate matter into the troposphere. Reykjavík, the capital area of Iceland (250 km from eruption site) was exposed to air pollution events from advection of (i) a relatively young and chemically primitive volcanic plume with a high sulphur dioxide gas (SO2) to sulphate PM (SO42-) ratio, and (ii) an older and chemically mature volcanic plume with a low SO2/SO42- ratio. Whereas the advection and air pollution caused by the primitive plume were successfully forecast and forewarned in public advisories, the mature plume was not. Here, we show that exposure to the mature plume is associated with an increase in register-measured health care utilisation for respiratory disease by 23% (95% CI 19.7-27.4%) and for asthma medication dispensing by 19.3% (95% CI 9.6-29.1%). Absence of public advisories is associated with increases in visits to primary care medical doctors and to the hospital emergency department. We recommend that operational response to volcanic air pollution considers both primitive and mature types of plumes.

Health Impact Assessment of Volcanic Ash Inhalation: A Comparison With Outdoor Air Pollution Methods.

This paper critically appraises the extrapolation of concentration-response functions (CRFs) for fine and coarse particulate matter, PM2.5 and PM10, respectively, used in outdoor air pollution health impact assessment (HIA) studies to assess the extent of health impacts in communities exposed to volcanic emissions. Treating volcanic ash as PM, we (1) consider existing models for HIA for general outdoor PM, (2) identify documented health effects from exposure to ash in volcanic eruptions, (3) discuss potential issues of applying CRFs based on the composition and concentration of ash-related PM, and (4) critically review available case studies of volcanic exposure scenarios utilizing HIA for outdoor air pollution. We identify a number of small-scale studies focusing on populations exposed to volcanic ash; exposure is rarely quantified, and there is limited evidence concerning the health effects of PM from volcanic eruptions. That limited evidence is, however, consistent with the CRFs typically used for outdoor air pollution HIA. Two health assessments of exposure to volcanic emissions have been published using population- and occupational-based CRFs, though each application entails distinct assumptions and limitations. We conclude that the best available strategy, at present, is to apply outdoor air pollution risk estimates to scenarios involving volcanic ash emissions for the purposes of HIA. However, due to the knowledge gaps on, for example, the health effects from exposure to volcanic ash and differences in ash composition, there is inherent uncertainty in this application. To conclude, we suggest actions to enable better prediction and assessment of health impacts of volcanic emissions.

Haemolytic activity of soil from areas of varying podoconiosis endemicity in Ethiopia.

BACKGROUND: Podoconiosis, non-filarial elephantiasis, is a non-infectious disease found in tropical regions such as Ethiopia, localized in highland areas with volcanic soils cultivated by barefoot subsistence farmers. It is thought that soil particles can pass through the soles of the feet and taken up by the lymphatic system, leading to the characteristic chronic oedema of the lower legs that becomes disfiguring and disabling over time. METHODS: The close association of the disease with volcanic soils led us to investigate the characteristics of soil samples in an endemic area in Ethiopia to identify the potential causal constituents. We used the in vitro haemolysis assay and compared haemolytic activity (HA) with soil samples collected in a non-endemic region of the same area in Ethiopia. We included soil samples that had been previously characterized, in addition we present other data describing the characteristics of the soil and include pure phase mineral standards as comparisons. RESULTS: The bulk chemical composition of the soils were statistically significantly different between the podoconiosis-endemic and non-endemic areas, with the exception of CaO and Cr. Likewise, the soil mineralogy was statistically significant for iron oxide, feldspars, mica and chlorite. Smectite and kaolinite clays were widely present and elicited a strong HA, as did quartz, in comparison to other mineral phases tested, although no strong difference was found in HA between soils from the two areas. The relationship was further investigated with principle component analysis (PCA), which showed that a combination of an increase in Y, Zr and Al2O3, and a concurrent increase Fe2O3, TiO2, MnO and Ba in the soils increased HA. CONCLUSION: The mineralogy and chemistry of the soils influenced the HA, although the interplay between the components is complex. Further research should consider the variable biopersistance, hygroscopicity and hardness of the minerals and further characterize the nano-scale particles.

Human survival in volcanic eruptions: Thermal injuries in pyroclastic surges, their causes, prognosis and emergency management.

This study of burns patients from two eruptions of Merapi volcano, Java, in 1994 and 2010, is the first detailed analysis to be reported of thermal injuries in a large series of hospitalised victims of pyroclastic surges, one of the most devastating phenomena in explosive eruptions. Emergency planners in volcanic crises in populated areas have to integrate the health sector into disaster management and be aware of the nature of the surge impacts and the types of burns victims to be expected in a worst scenario, potentially in numbers and in severity that would overwhelm normal treatment facilities. In our series, 106 patients from the two eruptions were treated in the same major hospital in Yogyakarta and a third of these survived. Seventy-eight per cent were admitted with over 40% TBSA (total body surface area) burns and around 80% of patients were suspected of having at least some degree of inhalation injury as well. Thirty five patients suffered over 80% TBSA burns and only one of these survived. Crucially, 45% of patients were in the 40-79% TBSA range, with most suspected of suffering from inhalation injury, for whom survival was most dependent on the hospital treatment they received. After reviewing the evidence from recent major eruptions and outlining the thermal hazards of surges, we relate the type and severity of the injuries of these patients to the temperatures and dynamics of the pyroclastic surges, as derived from the environmental impacts and associated eruption processes evaluated in our field surveys and interviews conducted by our multi-disciplinary team. Effective warnings, adequate evacuation measures, and political will are all essential in volcanic crises in populated areas to prevent future catastrophes on this scale.

Volcanic Ash Activates the NLRP3 Inflammasome in Murine and Human Macrophages.

Volcanic ash is a heterogeneous mineral dust that is typically composed of a mixture of amorphous (glass) and crystalline (mineral) fragments. It commonly contains an abundance of the crystalline silica (SiO2) polymorph cristobalite. Inhalation of crystalline silica can induce inflammation by stimulating the NLRP3 inflammasome, a cytosolic receptor complex that plays a critical role in driving inflammatory immune responses. Ingested material results in the assembly of NLRP3, ASC, and caspase-1 with subsequent secretion of the interleukin-1 family cytokine IL-1ß. Previous toxicology work suggests that cristobalite-bearing volcanic ash is minimally reactive, calling into question the reactivity of volcanically derived crystalline silica, in general. In this study, we target the NLRP3 inflammasome as a crystalline silica responsive element to clarify volcanic cristobalite reactivity. We expose immortalized bone marrow-derived macrophages of genetically engineered mice and primary human peripheral blood mononuclear cells (PBMCs) to ash from the Soufrière Hills volcano as well as representative, pure-phase samples of its primary componentry (volcanic glass, feldspar, cristobalite) and measure NLRP3 inflammasome activation. We demonstrate that respirable Soufrière Hills volcanic ash induces the activation of caspase-1 with subsequent release of mature IL-1ß in a NLRP3 inflammasome-dependent manner. Macrophages deficient in NLRP3 inflammasome components are incapable of secreting IL-1ß in response to volcanic ash ingestion. Cellular uptake induces lysosomal destabilization involving cysteine proteases. Furthermore, the response involves activation of mitochondrial stress pathways leading to the generation of reactive oxygen species. Considering ash componentry, cristobalite is the most reactive pure-phase with other components inducing only low-level IL-1ß secretion. Inflammasome activation mediated by inhaled ash and its potential relevance in chronic pulmonary disease was further evidenced in PBMC using the NLRP3 small-molecule inhibitor CP-456,773 (CRID3, MCC950). Our data indicate the functional activation of the NLRP3 inflammasome by volcanic ash in murine and human macrophages in vitro. Cristobalite is identified as the apparent driver, thereby contesting previous assertions that chemical and structural imperfections may be sufficient to abrogate the reactivity of volcanically derived cristobalite. This is a novel mechanism for the stimulation of a pro-inflammatory response by volcanic particulate and provides new insight regarding chronic exposure to environmentally occurring particles.

The east coast Big Flood, 31 January-1 February 1953: a summary of the human disaster.

The Big Flood was the worst natural disaster to befall Britain during the twentieth century, and the scale of its human impact was due to the lack of adequate disaster preparedness. The 307 deaths on land were caused by drowning or from the effects of exposure. Two-thirds occurred in four clusters along the shoreline and mainly comprised inhabitants of post-war prefabricated buildings, bungalows and chalets, with the highest mortality among the elderly. The emergency response was spontaneous and community led, with the main search and rescue completed before central government became involved. No individuals or agencies were blamed for the neglected state of the flood defences or the absence of warnings, along with the post-war shortage of adequate housing, which were the main causes of vulnerability. The media played a limited role, and television was in its infancy. Mental health impacts were either self-limiting or failed to be articulated in a society recovering from the Second World War. The major mitigating factors included the empathetic response of people, locally and nationally, as well as the availability of armed forces personnel based in East Anglia, whose actions played a decisive part in the battle against the sea. The major legacies of the Big Flood were a coastal flood forecasting system, a more scientific approach to sea defences and the building of the Thames barrier.

Medidas de prevención a la salud en caso de erupciones volcánicas / Health prevention measures in case of volcanic emergencies

El tratamiento médico solo juega un minimo papel durante las erupciones volcánicas severas, así que lo mas importante son las medidas preventivas si se desea reducir el número de lesionados y muertos. Los equipos de salud deben incorporarse a la planeación y respuesta de emergencia desde la primera etapa. Para beneficio de los trabajadores sanitarios, se resume el asesorameinto sobre la interpretación de la información geológica del volcán, así como las medidas sanitarias adecuadas que deben adoptarse antes y después de una erupción (AU)

Thetford plastics fire, october 1991 : The role of a preventive medical team in chemical incidents

To review the role of a medical team in the emergency management of a major polyvinyl chloride (PVC) fire in an urban area. The main issues requiring the imput of the medical team included : the possible products of combustion and their effects on health; the clinical management of those exposed; the alerting of local hospitals to the type of casualties to expect; the special health risks posed to emergency workers, especially the fireman; the need for evacuation of local residents; the risks of contamination of soil, water, and crops; the potential health impact of the plume; and the provision of expert and authoritative advice on the short and long term health implications to the public. Active surveillance systems, which included the local general practitioners and hospital, were established and air monitoring instigated. The 46 casualties were restricted to emergency personnel who had inadvertently received exposure to the fire smoke : all recovered within 48 hours. Local residents were unharmed. The incident showed the need for preventive medical teams trained to fill a formal advisory and investigative role chemical releases and fires, and which can play an integral part in emergency management (AU)