Standardized epidemiological protocols for assessment of health impacts in eruption crises

Background and aim: Volcanoes produce airborne emissions of ash and gas which may impact public health. Many epidemiological studies have been conducted following eruption crises but they often miss critical periods of highest exposures at eruption onset whilst methodological protocols are being developed and approved. Hence, we still have little understanding of the acute impact of volcanic emissions, particularly on respiratory health. In response to this need, the International Volcanic Health Hazard Network (www.ivhhn.org) developed and published* two standardized epidemiological protocols. Methods: Two workshops were held to develop the protocols. The first focused on technical aspects and content of the protocols, ensuring that they were comprehensive and jargon-free. The second, to present and discuss the protocols, took place after peer review and assessed issues of practical implementation. Results: We developed a ‘basic’ study protocol to assess the respiratory (and other) health impacts from acute exposures by tallying hospital/clinic visits. This is designed to be used during and/or immediately following a volcanic eruption, at the population level, where syndromic surveillance is not already in place or cannot be adapted for the outcomes expected from exposure to volcanic emissions. We also developed a protocol for a more detailed ‘cross-sectional’ survey of individuals, to be undertaken if the basic study or syndromic surveillance indicate adverse health effects, to assess the extent to which volcanic exposures may have been causal. Conclusions: Advising relatively simple and inexpensive methods, the protocols are applicable in all volcanic contexts, regardless of resource availability or health records systems. The data collection forms included in the protocol can be integrated into, or merged with, existing response protocols, for efficiency and to minimize duplication. Standardized protocols will maximize the opportunity for rapid assessments. Consistent use will generate a strong and comparable evidence base of the health impacts of eruptions. * https://www.who.int/bulletin/volumes/98/5/19-244509.pdf