{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T06:18:25Z","timestamp":1788157105014,"version":"build-2803163510"},"reference-count":38,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Med. Sci.","Medical Sciences"],"abstract":"<jats:p>Background: Volcanic gas emissions represent an important but frequently underestimated non-eruptive natural hazard capable of causing severe acute intoxication and sudden death, even in the absence of volcanic eruptions. Although numerous reviews have investigated the chronic health effects of volcanic emissions, evidence regarding acute exposure events remains fragmented. This systematic review aimed to synthesize the available evidence on acute intoxication events and fatalities associated with exposure to sulfur dioxide (SO2), carbon dioxide (CO2), and hydrogen sulfide (H2S) of volcanic origin. Materials and Methods: A systematic literature search was conducted according to the PRISMA 2020 guidelines across six electronic databases (PubMed\/MEDLINE, Scopus, Web of Science, Embase, Google Scholar, and WHO IRIS). Results: Six eligible studies describing fatal and non-fatal acute exposure events from five countries (Italy, France, the United States, Cameroon, and the Democratic Republic of Congo) were included. Carbon dioxide and hydrogen sulfide were the gases most frequently associated with fatal outcomes, predominantly occurring in confined spaces, geothermal areas, fumaroles, topographic depressions, or environments where adverse meteorological conditions promoted gas accumulation. The most common clinical manifestations included sudden loss of consciousness, pulmonary edema, respiratory failure, and asphyxial death. The largest documented event, the 1986 Lake Nyos disaster, resulted in more than 1700 fatalities following a massive limnic release of carbon dioxide. Conclusions: Across the included studies, recurring environmental determinants, exposure pathways, and toxicological mechanisms highlighted the critical role of environmental accumulation in shaping exposure risk. Despite the limited number of published cases, the available evidence demonstrates that acute volcanic gas exposure constitutes a significant yet underrecognized public health hazard. Strengthening environmental monitoring, risk communication, visitor safety measures, and interdisciplinary surveillance systems may substantially reduce preventable morbidity and mortality in volcanically active regions.<\/jats:p>","DOI":"10.3390\/medsci14050531","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T05:55:56Z","timestamp":1788155756000},"page":"531","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Acute Events and Fatal Outcomes Following Exposure to Volcanic Gases (SO2, CO2, H2S): A Systematic Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9282-1030","authenticated-orcid":false,"given":"Cristina","family":"Genovese","sequence":"first","affiliation":[{"name":"Department of Biomedical Sciences, Dental Sciences and Morpho-Functional Imaging, University of Messina, 98100 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni Paolo","family":"Piccolo","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Dental Sciences and Morpho-Functional Imaging, School of Medicine, University of Messina, 98100 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1815-0421","authenticated-orcid":false,"given":"Alessandro","family":"Gattuso","sequence":"additional","affiliation":[{"name":"Palermo and Milazzo Operational Unit, National Institute of Geophysics and Volcanology (INGV), 98057 Milazzo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Mistretta","sequence":"additional","affiliation":[{"name":"Section of Hygiene and Preventive Medicine, Department of Medical and Surgical Sciences and Advanced Technologies \u201cG.F. Ingrassia\u201d, University of Catania, 95100 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Leonforte","sequence":"additional","affiliation":[{"name":"Department of Integrated Hygiene, Organizational, and Service Activities (Structural Department), Health Management, University Hospital Polyclinic \u201cG. Rodolico-San Marco\u201d, 95100 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6228-318X","authenticated-orcid":false,"given":"Daniela","family":"Lo Giudice","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Dental Sciences and Morpho-Functional Imaging, University of Messina, 98100 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Maisano","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Dental Sciences and Morpho-Functional Imaging, University of Messina, 98100 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6851-5703","authenticated-orcid":false,"given":"Raffaele","family":"Squeri","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Dental Sciences and Morpho-Functional Imaging, University of Messina, 98100 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7503-008X","authenticated-orcid":false,"given":"Caterina Elisabetta","family":"Rizzo","sequence":"additional","affiliation":[{"name":"Department of Prevention, Local Health Authority of Enna, 94100 Enna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Simba\u00f1a-Rivera, K., Endara-Mina, J., Jaramillo-Aguilar, D.S., Mera-Lojano, L.D., Jimbo-Sotomayor, R., S\u00e1nchez, X., Rodr\u00edguez-P\u00e9rez, M.C., Fuentes-Ferrer, M.E., and Boada, L.D. (2025). Mapping the global health burden of volcanic exposure: A scoping review approach. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1658384"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Cariello, S., Corradino, C., Torrisi, F., and Del Negro, C. (2024). Cascading Machine Learning to Monitor Volcanic Thermal Activity Using Orbital Infrared Data: From Detection to Quantitative Evaluation. Remote Sens., 16.","DOI":"10.3390\/rs16010171"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Boada, L.D., Simba\u00f1a-Rivera, K., Rodr\u00edguez-P\u00e9rez, C., Fuentes-Ferrer, M., Henr\u00edquez-Hern\u00e1ndez, L.A., L\u00f3pez-Villarrubia, E., and Alvarez-Le\u00f3n, E.E. (2024). Assessing the hidden dangers of volcanic CO2 exposure: A critical review of health impacts. Front. Public Health, 12.","DOI":"10.3389\/fpubh.2024.1465837"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Benavides-Cordoba, V., Suarez, A., Guerrero-Jaramillo, D., Silva-Medina, M., Betancourt-Pe\u00f1a, J., and Palacios-G\u00f3mez, M. (2024). Respiratory and physical health consequences in older adults in a high-risk volcanic area: Comparison of two rural villages. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0310659"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"110990","DOI":"10.1016\/j.isci.2024.110990","article-title":"Hazardous volcanic CO2 diffuse degassing areas\u2014A systematic review on environmental impacts, health, and mitigation strategies","volume":"27","author":"Viveiros","year":"2024","journal-title":"iScience"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1080\/10408444.2023.2229925","article-title":"Low level exposure to hydrogen sulfide: A review of emissions, community exposure, health effects, and exposure guidelines","volume":"53","author":"Batterman","year":"2023","journal-title":"Crit. Rev. Toxicol."},{"key":"ref_7","unstructured":"Sawaya, A., Regina, A.C., and Menezes, R.G. (2024). Hydrogen Sulfide Toxicity. StatPearls, StatPearls Publishing."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Afzal, M., Agarwal, S., Elshaikh, R.H., Babker, A.M.A., Choudhary, R.K., Prabhakar, P.K., Zahir, F., and Sah, A.K. (2025). Carbon Monoxide Poisoning: Diagnosis, Prognostic Factors, Treatment Strategies, and Future Perspectives. Diagnostics, 15.","DOI":"10.20944\/preprints202502.1913.v1"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Navarro-Sempere, A., Cobo, R., Camarinho, R., Garcia, P., Rodrigues, A., Garc\u00eda, M., and Segovia, Y. (2025). Living Under the Volcano: Effects on the Nervous System and Human Health. Environments, 12.","DOI":"10.3390\/environments12020049"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Simba\u00f1a-Rivera, K., Jaramillo-Aguilar, D.S., Guerrero-Gonzalez, J.P., Jimbo-Sotomayor, R., S\u00e1nchez, X., Mulas, M., and Boada, L.D. (2025). Volcanic eruptions and public health in Ecuador: An analysis of institutional gaps and integrated strategies. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1705862"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Forte, G., Rapisarda, V., Ruggieri, F., Battistini, B., Bauleo, L., Filetti, V., Grignani, E., Lovreglio, P., Matera, S., and Senia, P. (2025). Human Exposure to Metals and Potential Human Health Risk in a Volcanic Environment in Italy. Toxics, 13.","DOI":"10.3390\/toxics13121080"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"103064","DOI":"10.1016\/j.ijdrr.2022.103064","article-title":"Defining population socio-economic characteristics, hazard knowledge and risk perception: The adaptive capacity to persistent volcanic threats from Semeru, Indonesia","volume":"77","author":"Thouret","year":"2022","journal-title":"Int. J. Disaster Risk Reduct."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1136\/bmj.298.6685.1437","article-title":"Lake Nyos disaster, Cameroon, 1986: The medical effects of large scale emission of carbon dioxide?","volume":"298","author":"Baxter","year":"1989","journal-title":"BMJ"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Kaya, D., Santiago, C., Pernas, E., Truong, S., Martinez, G., M\u00e9ndez, L.B., and Delgado, Y. (2025). Air Pollutants in Puerto Rico: Key Pollutants and Carcinogenic Properties. Int. J. Environ. Res. Public Health, 22.","DOI":"10.20944\/preprints202508.1606.v1"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1080\/00039890409602947","article-title":"Health hazards from volcanic gases: A systematic literature review","volume":"59","author":"Hansell","year":"2004","journal-title":"Arch. Environ. Health"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1007\/s00414-024-03381-2","article-title":"Humanitarian forensic medicine: A systematic review","volume":"139","author":"Ketsekioulafis","year":"2025","journal-title":"Int. J. Leg. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_18","first-page":"2127","article-title":"Methodological quality of case series studies: An introduction to the JBI critical appraisal tool","volume":"18","author":"Munn","year":"2020","journal-title":"JBI Evid. Synth."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1186\/s12940-020-00615-9","article-title":"Respiratory health and eruptions of the Nyiragongo and Nyamulagira volcanoes in the Democratic Republic of Congo: A time-series analysis","volume":"19","author":"Michellier","year":"2020","journal-title":"Environ. Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.forsciint.2019.01.044","article-title":"Fatal inhalation of volcanic gases in three tourists of a geothermal area","volume":"297","author":"Carfora","year":"2019","journal-title":"Forensic Sci. Int."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2497","DOI":"10.1111\/1556-4029.15111","article-title":"Forensic diagnostic approach of peri-volcanic area fatalities: About two cases at piton de la Fournaise","volume":"67","author":"Pefferkorn","year":"2022","journal-title":"J. Forensic Sci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1580\/08-WEME-CR-199.1","article-title":"Fatal Fall into a Volcanic Fumarole","volume":"20","author":"Cantrell","year":"2009","journal-title":"Wilderness Environ. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1580\/1080-6032(2000)011[0192:PAFCDO]2.3.CO;2","article-title":"Possible asphyxiation from carbon dioxide of a cross-country skier in eastern California: A deadly volcanic hazard","volume":"11","author":"Hill","year":"2000","journal-title":"Wilderness Environ. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1126\/science.236.4798.169","article-title":"The 1986 lake nyos gas disaster in cameroon, west Africa","volume":"236","author":"Kling","year":"1987","journal-title":"Science"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/s12245-017-0142-y","article-title":"Carbon dioxide poisoning: A literature review of an often forgotten cause of intoxication in the emergency department","volume":"10","author":"Permentier","year":"2017","journal-title":"Int. J. Emerg. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"101772","DOI":"10.1016\/j.redox.2020.101772","article-title":"Effects of hydrogen sulfide on mitochondrial function and cellular bioenergetics","volume":"38","author":"Paul","year":"2021","journal-title":"Redox Biol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Genjiafu, A., Shi, M., Zhang, X., and Jian, X. (2023). Case report: Analysis of a case of hydrogen sulfide poisoning in a waste treatment plant. Front. Public Health, 11.","DOI":"10.3389\/fpubh.2023.1226282"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Liu, W.Y., Yi, J.P., Tung, T.H., and Yan, J.B. (2021). Association Between the Ambient Fine Particulate Pollution and the Daily Internal Medicine Outpatient Visits in Zhoushan, China: A Time-Series Study. Front. Public Health, 9.","DOI":"10.3389\/fpubh.2021.749191"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1007\/s12024-023-00743-x","article-title":"A serial analysis of hydrogen sulfide poisoning: Three group accidents","volume":"20","author":"Song","year":"2024","journal-title":"Forensic Sci. Med. Pathol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Genovese, G., Rizzo, C.E., Mistretta, A., Leonforte, F., Squeri, R., Signorelli, C., Genovese, C., and The Italian Prevalence Group (2025). Multiple Chemical Sensitivity: An Italian prevalence multicentric survey. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1685040"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"22001","DOI":"10.1289\/EHP10541","article-title":"Clear and Present Dangers: The Multiple Health Hazards of Volcanic Eruptions","volume":"130","author":"Nicole","year":"2022","journal-title":"Environ. Health Perspect."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Genovese, G., Rizzo, C.E., Nirta, A., Bartucciotto, L., Venuto, R., Fedele, F., Squeri, R., and Genovese, C. (2025). Mapping Healthcare Needs: A Systematic Review of Population Stratification Tools. Med. Sci., 13.","DOI":"10.3390\/medsci13030145"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Rizzo, C.E., Venuto, R., Genovese, G., Squeri, R., and Genovese, C. (2025). Assessment of Food Hygiene Non-Compliance and Control Measures: A Three-Year Inspection Analysis in a Local Health Authority in Southern Italy. Foods, 14.","DOI":"10.3390\/foods14193364"},{"key":"ref_34","first-page":"144","article-title":"A Southern addiction evaluation project: Investigating the impact of addiction through a survey HBSC based","volume":"175","author":"Genovese","year":"2024","journal-title":"Clin. Ter."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Rizzo, C.E., Venuto, R., Caruso, M.G., Genovese, C., and Lagan\u00e0, P. (2026). Where Environment and Healthcare Meet: Air Pollution, Antibiotic Use, and Mortality in an Ageing Population in Southern Italy. Med. Sci., 14.","DOI":"10.3390\/medsci14020198"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Rizzo, C.E., Restivo, V., Rizzo, M.C., and Genovese, C. (2026). Socioeconomic Deprivation, Primary Care Physician Workload and Colorectal Cancer Screening Adherence Across Italian Regions: An Ecological Spatial Analysis. Med. Sci., 14.","DOI":"10.3390\/medsci14040436"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1007\/s00445-018-1219-z","article-title":"Volcano alert level systems: Managing the challenges of effective volcanic crisis communication","volume":"80","author":"Fearnley","year":"2018","journal-title":"Bull. Volcanol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"6506","DOI":"10.1038\/s41598-019-42930-3","article-title":"Short-term detection of volcanic unrest at Mt. Etna by means of a multi-station warning system","volume":"9","author":"Spampinato","year":"2019","journal-title":"Sci. Rep."}],"container-title":["Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/5\/531\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T06:10:44Z","timestamp":1788156644000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/5\/531"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,31]]},"references-count":38,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["medsci14050531"],"URL":"https:\/\/doi.org\/10.3390\/medsci14050531","relation":{},"ISSN":["2076-3271"],"issn-type":[{"value":"2076-3271","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,31]]}}}