Chronic pulmonary effects of volcanic ash: an epidemiologic study

Volcanic Ash as a Precursor for SARS-CoV-2 Infection Among Susceptible Populations in Ecuador: A Satellite Imaging and Excess Mortality-Based Analysis

The global coronavirus disease 2019 (COVID-19) pandemic has altered entire nations and their health systems. The greatest impact of the pandemic has been seen among vulnerable populations, such as those with comorbidities like heart diseases, kidney failure, obesity, or those with worse health determinants such as unemployment and poverty. In the current study, we are proposing previous exposure to fine-grained volcanic ashes as a risk factor for developing COVID-19. Based on several previous studies it has been known since the mid 1980s of the past century that volcanic ash is most likely an accelerating factor to suffer from different types of cancer, including lung or thyroid cancer. Our study postulates, that people who are most likely to be infected during a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) widespread wave will be those with comorbidities that are related to previous exposure to volcanic ashes. We have explored 8703 satellite images from the past 21 y of available data from the National Oceanic and Atmospheric Administration (NOAA) database and correlated them with the data from the national institute of health statistics in Ecuador. Additionally, we provide more realistic numbers of fatalities due to the virus based on excess mortality data of 2020-2021, when compared with previous years. This study would be a very first of its kind combining social and spatial distribution of COVID-19 infections and volcanic ash distribution. The results and implications of our study will also help countries to identify such aforementioned vulnerable parts of the society, if the given geodynamic and volcanic settings are similar.

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.

Long-term health of children following the Eyjafjallajökull volcanic eruption: a prospective cohort study

Background: More than 500 million people worldwide live within exposure range of an active volcano and children are a vulnerable subgroup of such exposed populations. However, studies on the effects of volcanic eruptions on children's health beyond the first year are sparse. Objective: To examine the effect of the 2010 Eyjafjallajökull eruption on physical and mental health symptoms among exposed children in 2010 and 2013 and to identify potential predictive factors for symptoms. Method: In a population-based prospective cohort study, data was collected on the adult population (N = 1615) exposed to the 2010 Eyjafjallajökull eruption and a non-exposed group (N = 697). The exposed group was further divided according to exposure level. All participants answered questionnaires assessing their children´s and their own perceived health status in 2010 and 2013. Results: In 2010, exposed children were more likely than non-exposed children to experience respiratory symptoms (medium exposed OR 1.47; 95% CI 1.07-2.03; high exposed OR 1.52; 95% CI 1.03-2.24) and anxiety/worries (medium exposed OR 2.39; 95% CI 1.67-3.45; high exposed OR 2.77; 95% CI 1.81-4.27). Both genders had an increased risk of symptoms of anxiety/worries but only exposed boys were at increased risk of experiencing headaches and sleep disturbances compared to non-exposed boys. Within the exposed group, children whose homes were damaged were at increased risk of experiencing anxiety/worries (OR 1.62; 95% CI 1.13-2.32) and depressed mood (OR 1.55; 95% CI 1.07-2.24) than children whose homes were not damaged. Among exposed children, no significant decrease of symptoms was detected between 2010 and 2013. Conclusions: Adverse physical and mental health problems experienced by the children exposed to the eruption seem to persist for up to a three-year period post-disaster. These results underline the importance of appropriate follow-up for children after a natural disaster.

Long-term health effects of the Eyjafjallajökull volcanic eruption: a prospective cohort study in 2010 and 2013

OBJECTIVES

To examine the long-term development of physical and mental health following exposure to a volcanic eruption.

DESIGN

Population-based prospective cohort study.

SETTING

In spring 2010, the Icelandic volcano Eyjafjallajökull erupted. Data were collected at 2 time points: in 2010 and 2013.

PARTICIPANTS

Adult residents in areas close to the Eyjafjallajökull volcano (N=1096), divided according to exposure levels, and a non-exposed sample (n=475), with 80% participation rate in 2013.

MAIN OUTCOME MEASURES

Physical symptoms in the previous year (chronic) and previous month (recent), and psychological distress (General Health Questionnaire-12-item version, GHQ-12), perceived stress (Perceived Stress Scale, PSS-4) and post traumatic stress disorder (PTSD) symptoms (Primary Care PTSD, PC-PTSD).

RESULTS

In the exposed group, certain symptoms were higher in 2013 than in 2010, for example, morning phlegm during winter (OR 2.14; 95% CI 1.49 to 3.06), skin rash/eczema (OR 2.86; 95% CI 1.76 to 4.65), back pain (OR 1.45; 95% CI 1.03 to 2.05) and insomnia (OR 1.53; 95% CI 1.01 to 2.30), in addition to a higher prevalence of regular use of certain medications (eg, for asthma (OR 2.80; 95% CI 1.01 to 7.77)). PTSD symptoms decreased between 2010 and 2013 (OR 0.33; 95% CI 0.17 to 0.61), while the prevalence of psychological distress and perceived stress remained similar. In 2013, the exposed group showed a higher prevalence of various respiratory symptoms than did the non-exposed group, such as wheezing without a cold (high exposure OR 2.35; 95% CI 1.27 to 4.47) and phlegm (high exposure OR 2.81; 95% CI 1.48 to 5.55), some symptoms reflecting the degree of exposure (eg, nocturnal chest tightness (medium exposed OR 3.09; 95% CI 1.21 to 10.46; high exposed OR 3.42; 95% CI 1.30 to 11.79)).

CONCLUSIONS

The findings indicate that people exposed to a volcanic eruption, especially those most exposed, exhibit increased risk of certain symptoms 3-4 years after the eruption.

Physicochemical and toxicological profiling of ash from the 2010 and 2011 eruptions of Eyjafjallajökull and Grímsvötn volcanoes, Iceland using a rapid respiratory hazard assessment protocol

The six week eruption of Eyjafjallajökull volcano in 2010 produced heavy ash fall in a sparsely populated area of southern and south eastern Iceland and disrupted European commercial flights for at least 6 days. We adopted a protocol for the rapid analysis of volcanic ash particles, for the purpose of informing respiratory health risk assessments. Ash collected from deposits underwent a multi-laboratory physicochemical and toxicological investigation of their mineralogical parameters associated with bio-reactivity, and selected in vitro toxicology assays related to pulmonary inflammatory responses. Ash from the eruption of Grímsvötn, Iceland, in 2011 was also studied. The results were benchmarked against ash from Soufrière Hills volcano, Montserrat, which has been extensively studied since the onset of eruptive activity in 1995. For Eyjafjallajökull, the grain size distributions were variable: 2-13 vol% of the bulk samples were <4 µm, with the most explosive phases of the eruption generating abundant respirable particulate matter. In contrast, the Grímsvötn ash was almost uniformly coarse (<3.5 vol%<4 µm material). Surface area ranged from 0.3 to 7.7 m2 g(-1) for Eyjafjallajökull but was very low for Grímsvötn (<0.6 m2 g(-1)). There were few fibre-like particles (which were unrelated to asbestos) and the crystalline silica content was negligible in both eruptions, whereas Soufrière Hills ash was cristobalite-rich with a known potential to cause silicosis. All samples displayed a low ability to deplete lung antioxidant defences, showed little haemolysis and low acute cytotoxicity in human alveolar type-1 like epithelial cells (TT1). However, cell-free tests showed substantial hydroxyl radical generation in the presence of hydrogen peroxide for Grímsvötn samples, as expected for basaltic, Fe-rich ash. Cellular mediators MCP-1, IL-6, and IL-8 showed chronic pro-inflammatory responses in Eyjafjallajökull, Grímsvötn and Soufrière Hills samples, despite substantial differences in the sample mineralogy and eruptive styles. The value of the pro-inflammatory profiles in differentiating the potential respiratory health hazard of volcanic ashes remains uncertain in a protocol designed to inform public health risk assessment, and further research on their role in volcanic crises is warranted.

Health effects following the Eyjafjallajokull volcanic eruption: a cohort study

OBJECTIVES

The study aimed to determine whether exposure to a volcanic eruption was associated with increased prevalence of physical and/or mental symptoms.

DESIGN

Cohort, with non-exposed control group.

SETTING

Natural disasters like volcanic eruptions constitute a major public-health threat. The Icelandic volcano Eyjafjallajökull exposed residents in southern Iceland to continuous ash fall for more than 5 weeks in spring 2010. This study was conducted during November 2010-March 2011, 6-9 months after the Eyjafjallajökull eruption.

PARTICIPANTS

Adult (18-80 years of age) eruption-exposed South Icelanders (N=1148) and a control population of residents of Skagafjörður, North Iceland (N=510). The participation rate was 72%.

MAIN OUTCOME MEASURES

Physical symptoms in the previous year (chronic), in the previous month (recent), General Health Questionnaire (GHQ-12) measured psychological morbidity.

RESULTS

The likelihood of having symptoms during the last month was higher in the exposed population, such as; tightness in the chest (OR 2.5; 95% CI 1.1 to 5.8), cough (OR 2.6; 95% CI 1.7 to 3.9), phlegm (OR 2.1; 95% CI 1.3 to 3.2), eye irritation (OR 2.9; 95% CI 2.0 to 4.1) and psychological morbidity symptoms (OR 1.3; 95% CI 1.0 to 1.7). Respiratory symptoms during the last 12 months were also more common in the exposed population; cough (OR 2.2; 95% CI 1.6 to 2.9), dyspnoea (OR 1.6; 95% CI 1.1 to 2.3), although the prevalence of underlying asthma and heart disease was similar. Twice as many in the exposed population had two or more symptoms from nose, eyes or upper-respiratory tract (24% vs 13%, p<0.001); these individuals were also more likely to experience psychological morbidity (OR 4.7; 95% CI 3.4 to 6.5) compared with individuals with no symptoms. Most symptoms exhibited a dose-response pattern within the exposed population, corresponding to low, medium and high exposure to the eruption.

CONCLUSIONS

6-9 months after the Eyjafjallajökull eruption, residents living in the exposed area, particularly those closest to the volcano, had markedly increased prevalence of various physical symptoms. A portion of the exposed population reported multiple symptoms and may be at risk for long-term physical and psychological morbidity. Studies of long-term consequences are therefore warranted.

Geothermal ground gas emissions and indoor air pollution in Rotorua, New Zealand

The emission of toxic gases from the soil is a hazard in geothermal regions that are also urbanized because buildings constructed on geothermal ground may be subject to the ingress of gases from the soil directly into the structure. The Rotorua geothermal field, New Zealand, is extensively urbanized but to date no studies have evaluated the extent of the ground gas hazard. The main gases emitted are hydrogen sulphide (H2S) and carbon dioxide (CO2), both of which are highly toxic and denser than air. This paper reports preliminary findings from a study of selected buildings constructed in the gas anomaly area. Properties were investigated for evidence of ingress by H2S, CO2, and 222Rn, with a view to determine the means and rates of gas entry and the nature of any consequent hazard. H2S and CO2 were investigated using infrared active gas analysers and passive detector tubes left in place for 10-48 h. 222Rn was measured over a period of 3 months by poly-allyl diglycol carbonate sensors. Eight of the nine buildings studied were found to suffer problems with soil gases entering the indoor air through the structure. The primary means of gas entry was directly from the ground through the floors, walls, and subsurface pipes. Indoor vents were located and found emitting up to approximately 200 ppm H2S and approximately 15% CO2, concentrations high enough to present an acute respiratory hazard to persons close to the vent (e.g., children playing at floor level). In some properties, gas problems occurred despite preventative measures having been made during construction or during later renovations. Typically, these measures include the under-laying of concrete floors with a gas-proof butanol seal, under-floor ventilation systems or the installation of positive-pressure air conditioning. Recently constructed buildings (<10 years) with butanol seals were nevertheless affected by ground gas emissions, and we conclude that such measures are not always effective in the long term.

Effects of volcanic ash on ocular symptoms: results of a 10-year survey on schoolchildren

OBJECTIVE

To study the effects of volcanic ash on the ocular symptoms of schoolchildren ages 6 to 15 residing near Mt. Sakurajima, an active volcano.

DESIGN

Retrospective, cross-sectional study.

PARTICIPANTS

A total of 10,380 children ages 6 to 15, 1175 in a high-exposure area and 9205 in a low-exposure area, were studied.

METHODS

High- and low-exposure areas for volcanic ash were selected. All subjects in both areas were examined annually each September in the decade from 1994 to 2003.

MAIN OUTCOME MEASURES

The frequency of positive ocular symptoms in years with and without active volcanic eruptions was compared. The association of ocular symptoms with volcanic ash dispersal was assessed with the Mantel-Haenszel test or chi-square test.

RESULTS

Subjects in the high-exposure area showed ocular symptoms more often than those in the low-exposure area (P<0.0001). Years of active volcanic eruptions (volcanic ash of 5000 g/m2/year or more) were closely related to years with a high frequency of ocular symptoms in subjects in the high-exposure area (P<0.05) but related conversely in subjects in the low-exposure area (P<0.01). Major ocular symptoms were redness, discharge, foreign body sensation, and itching, all treated effectively with eyedrops.

CONCLUSIONS

Ocular symptoms in subjects were strongly influenced by volcanic eruptions in the Mt. Sakurajima area, but direct influence was limited to those living in areas very near the volcano (i.e., 4 km from the volcano's crater).

Montserrat volcanic ash induces lymph node granuloma and delayed lung inflammation

OBJECTIVES

A substantial amount of Montserrat volcanic ash, containing up to 24% of cristobalite (w/w), a fibrogenic crystalline silica, has been generated since the first documented eruption in 1995. The bioreactivity of the ash and its two major components: cristobalite and anorthite have been studied in vivo for a year following intratracheal instillation into rats.

METHODS

The rats (n=5) were instilled with a sterile vehicle solution (0.15 M NaCl) and/or three doses (1.0, 2.5 or 5.0 mg) of each of the dust, and were sacrificed at 13, 25 or 49 weeks post-instillation for quantitative biochemical and histopathological analyses in the lung and lymph nodes.

RESULTS

Cristobalite caused inflammation in the lung and granuloma in the hilar lymph nodes associated with significant size augmentation at 13 weeks post-instillation (P<0.05) and cristobalite (5.0 mg) induced fibrosis in the lung at 49 weeks post-exposure. However, the Montserrat volcanic ash caused inflammation in the lung at 49 weeks post-treatment without any fibrogenic response although the ash (5.0 mg) triggered significant lymph node enlargement without significant changes in the lung at 13 weeks post-treatment (P<0.05). Dose and time independent responses in the anorthite-exposed lung and lymph nodes suggest that a single instillation of 5.0 mg of poorly soluble mineral dust does not induce any change in the lung or lymph nodes.

CONCLUSION

The ash produces inflammatory reactions in lymph nodes at 13 weeks post-instillation in rats. These effects are seen much earlier than any inflammatory reaction in the lung. The onset of the lung inflammation is delayed until 49 weeks post-exposure. Despite the high cristobalite content of the ash, there is no evidence of any lung fibrogenic responses.

Particulate air pollution and chronic respiratory symptoms among traffic policemen in Bangkok

In this cross-sectional study, the authors examined the relationship between traffic-based air pollution and chronic, nonspecific respiratory symptoms among traffic policemen in Bangkok, Thailand. A total of 1,603 policemen who lived and worked in areas that had 3 different levels of airborne particulates were evaluated. The authors used a modified standardized questionnaire to identify nonspecific respiratory disease (NSRD) in participants. The prevalence of NSRD in heavily polluted, moderately polluted, and suburban areas was 13.0%, 10.9%, and 9.4%, respectively. Among nonsmokers, the age-adjusted prevalence of NSRD in the heavily polluted areas was significantly higher than in the suburban control area. Also among nonsmokers, the odds ratio for NSRD for each 10-microg/m3 increase in ambient particulate matter was 1.11. The authors concluded that the increased prevalence of respiratory symptoms among traffic policemen in Bangkok was associated with urban traffic air pollution.

Volcanic ash and respiratory symptoms in children on the island of Montserrat, British West Indies

BACKGROUND

In July 1995 the volcano on the West Indian island of Montserrat erupted after being inactive for several hundred years. Since then, clouds of ash have been released intermittently from the volcano. Some of this ash is <10 micro m in diameter and therefore respirable. Concerns were raised that the particles might cause respiratory problems.

AIMS

To evaluate whether ashfalls had any effect on the respiratory health of children in Montserrat.

METHODS

A survey of asthma diagnoses, respiratory symptoms, exercise induced bronchoconstriction (EIB), and current and previous exposure to volcanic ash was carried out in schools in Montserrat during February 1998.

RESULTS

Questionnaire information was available for nearly 80% of the 443 children on the school rolls. The prevalence of wheeze symptoms in the previous 12 months was 18% in children aged 12 years and under and 16% in children aged 13 years and over. In children aged 12 and under, the prevalence of wheeze was greater in those who had ever been heavily or moderately exposed to volcanic ash compared with the group who had only ever been exposed to low levels (wheeze in last 12 months: odds ratio (OR) 4.30; wheeze ever: OR 3.45). The prevalence of EIB in 8-12 year olds was about four times higher in those who were currently heavily exposed to volcanic ash (OR 3.85) compared to those currently exposed to low levels.

CONCLUSIONS

Volcanic ash emissions adversely affected the respiratory health of Montserrat children. The findings emphasise the need to limit exposures of children to volcanic ash and ensure the appropriate management of respiratory symptoms.

In vitro toxicology of respirable Montserrat volcanic ash

OBJECTIVES

In July 1995 the Soufriere Hills volcano on the island of Montserrat began to erupt. Preliminary reports showed that the ash contained a substantial respirable component and a large percentage of the toxic silica polymorph, cristobalite. In this study the cytotoxicity of three respirable Montserrat volcanic ash (MVA) samples was investigated: M1 from a single explosive event, M2 accumulated ash predominantly derived from pyroclastic flows, and M3 from a single pyroclastic flow. These were compared with the relatively inert dust TiO(2) and the known toxic quartz dust, DQ12.

METHODS

Surface area of the particles was measured with the Brunauer, Emmet, and Teller (BET) adsorption method and cristobalite content of MVA was determined by x ray diffraction (XRD). After exposure to particles, the metabolic competence of the epithelial cell line A549 was assessed to determine cytotoxic effects. The ability of the particles to induce sheep blood erythrocyte haemolysis was used to assess surface reactivity.

RESULTS

Treatment with either MVA, quartz, or titanium dioxide decreased A549 epithelial cell metabolic competence as measured by ability to reduce 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT). On addition of mannitol, the cytotoxic effect was significantly less with M1, quartz, and TiO(2). All MVA samples induced a dose dependent increase in haemolysis, which, although less than the haemolysis induced by quartz, was significantly greater than that induced by TiO(2). Addition of mannitol and superoxide dismutase (SOD) significantly reduced the haemolytic activity only of M1, but not M2 or M3, the samples derived from predominantly pyroclastic flow events.

CONCLUSIONS

Neither the cristobalite content nor the surface area of the MVA samples correlated with observed in vitro reactivity. A role for reactive oxygen species could only be shown in the cytotoxicity of M1, which was the only sample derived from a purely explosive event. These results suggest that in general the bioreactivity of MVA samples in vitro is low compared with pure quartz, but that the bioreactivity and mechanisms of biological interaction may vary according to the ash source.

In the shadow of El Chichon: an overview of the medical impact of the 28 March to 4 April 1982 eruptions of the Mexican volcano

On 28 March 1982, El Chichon, a volcanic peak located in southern Mexico, began an eruptive phase of activity. Four major eruptions occurred within the next eight days, culminating in a cataclysmic eruption on 4 April. When the dust had settled, an estimated 200 million tons of ash blanketed more than 200 square kilometers of southern Mexico and neighboring Central American countries. Forty thousand villagers were left homeless and several thousand people may have lost their lives. Fifty thousand head of cattle were destroyed outright with many more succumbing to lack of water and pasture. Millions of hectares of crops were destroyed (Figure 1).

Health effects of volcanic ash: a repeat study

The Mount Sakurajima volcano in Kyushu, Japan, is proximal to a large residential area, and it emits an enormous amount of volcanic ash during frequent eruptions. In our previous study, we investigated, for the first time, respiratory effects of chronic exposure to volcanic ash. The study demonstrated a low prevalence of respiratory symptoms, even in the area of highest exposure; only a slight excess prevalence of symptoms appeared to be associated with exposure to volcanic ash. To confirm the findings of our previous study, the prevalence study of chronic respiratory symptoms for residents was repeated in Kanoya and Tashiro, which are located 25 and 50 km, respectively, from the crater of Mt. Sakurajima. The concentration of suspended particulate matter in Kanoya frequently exceeded the national environmental quality standards and, during summer and winter, was 2-3 times higher than that found in Tashiro. Women who were 30-59 y of age and who had resided in Kanoya or Tashiro for more than 3 y completed a modified ATS-DLD questionnaire. The prevalence of nonspecific respiratory disease was low, i.e., 6.5% in Kanoya and 6.2% in Tashiro; similar prevalences were found in women who had never smoked. When we restricted the analysis to individuals without a history of occupational exposure to dusts and who had no exposure to passive smoking, there was a slightly higher prevalence of nonspecific respiratory disease in Kanoya than Tashiro, but the difference was not significant. Eye symptoms were equally prevalent in the two areas.(ABSTRACT TRUNCATED AT 250 WORDS)