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Background  The occurrence of cyanobacterial blooms in freshwater presents a threat to human health. However, epidemiological studies on the association between cyanobacterial blooms in drinking water sources and human health outcomes are scarce. The objective of this study was to evaluate if cyanobacterial blooms were associated with increased emergency room visits for gastrointestinal (GI), respiratory and dermal illnesses.    Methods  Satellite-derived cyanobacteria cell concentrations were estimated in the source of drinking water for the Greater Boston area, during 2008–2011. Daily counts of hospital emergency room visits for GI, respiratory and dermal illnesses among drinking water recipients were obtained from an administrative record database. A two-stage model was used to analyze time-series data for an association between cyanobacterial blooms and the occurrence of illnesses. At the first stage, predictive autoregressive generalized additive models for Poisson-distributed outcomes were fitted to daily illness count data and daily predictive variables. At the second stage, residuals from the first stage models were regressed against lagged categorized cyanobacteria concentration estimates.    Results  The highest cyanobacteria concentration (above the 75th percentile) was associated with an additional 4.3 cases of respiratory illness (95% confidence interval: 0.7, 8.0,  p  = 0.02,  n  = 268) compared to cyanobacteria concentrations below the 50th percentile in a two-day lag. There were no significant associations between satellite derived cyanobacterial concentrations and lagged data on GI or dermal illnesses.    Conclusion  The study demonstrated a significant positive association between satellite-derived cyanobacteria concentrations in source water and respiratory illness occurring 2 days later. Future studies will require direct measures of cyanotoxins and health effects associated with exposure to cyanobacteria-impacted drinking water sources.    Supplementary Information  The online version contains supplementary material available at 10.1186/s12940-021-00755-6.

Acute health effects associated with satellite-determined cyanobacterial blooms in a drinking water source in Massachusetts