Global Occurrence of Cyanotoxins in Drinking Water Systems: Recent Advances, Human Health Risks, Mitigation, and Future Directions.

This paper applies a semi-quantitative approach to review the diversity, environmental controls, detection methods, human health risks, and mitigation of cyanotoxins in drinking water systems (DWSs). It discusses the environmental factors controlling the occurrence of cyanotoxins, presents the merits and limitations of emerging methods of their detection (qPCR, liquid chromatography-mass spectrometry, and electrochemical biosensors), and outlines the human exposure pathways and health outcomes with identification of high-risk groups and settings. High-risk groups include (1) communities relying on untreated drinking water from unsafe, polluted water sources and (2) low-income countries where cyanotoxins are not routinely monitored in DWSs. The fate and behavior processes are discussed, including removing cyanotoxins in DWSs based on conventional and advanced treatment processes. The available methods for cyanotoxin removal presented in this paper include (1) polymer-based adsorbents, (2) coagulation/flocculation, (3) advanced oxidation processes, (4) ultra- and nanofiltration, and (5) multi-soil layer systems. Future research should address (1) detection and fate in storage and conveyance facilities and at the point of consumption, (2) degradation pathways and toxicity of by-products or metabolites, (3) interactive health effects of cyanotoxins with legacy and emerging contaminants, (4) removal by low-cost treatment techniques (e.g., solar disinfection, boiling, bio-sand filtration, and chlorination), (5) quantitative health risk profiling of high-risk groups, and (6) epidemiological studies to link the prevalence of human health outcomes (e.g., cancer) to cyanotoxins in DWSs.