Comparative human health risk analysis of coastal community water and waste service options

Research gaps and priorities for quantitative microbial risk assessment (QMRA)

The coronavirus disease 2019 pandemic highlighted the need for more rapid and routine application of modeling approaches such as quantitative microbial risk assessment (QMRA) for protecting public health. QMRA is a transdisciplinary science dedicated to understanding, predicting, and mitigating infectious disease risks. To better equip QMRA researchers to inform policy and public health management, an Advances in Research for QMRA workshop was held to synthesize a path forward for QMRA research. We summarize insights from 41 QMRA researchers and experts to clarify the role of QMRA in risk analysis by (1) identifying key research needs, (2) highlighting emerging applications of QMRA; and (3) describing data needs and key scientific efforts to improve the science of QMRA. Key identified research priorities included using molecular tools in QMRA, advancing dose-response methodology, addressing needed exposure assessments, harmonizing environmental monitoring for QMRA, unifying a divide between disease transmission and QMRA models, calibrating and/or validating QMRA models, modeling co-exposures and mixtures, and standardizing practices for incorporating variability and uncertainty throughout the source-to-outcome continuum. Cross-cutting needs identified were to: develop a community of research and practice, integrate QMRA with other scientific approaches, increase QMRA translation and impacts, build communication strategies, and encourage sustainable funding mechanisms. Ultimately, a vision for advancing the science of QMRA is outlined for informing national to global health assessments, controls, and policies.

EMA-amplicon-based sequencing informs risk assessment analysis of water treatment systems

Illumina amplicon-based sequencing was coupled with ethidium monoazide bromide (EMA) pre-treatment to monitor the total viable bacterial community and subsequently identify and prioritise the target organisms for the health risk assessment of the untreated rainwater and rainwater treated using large-volume batch solar reactor prototypes installed in an informal settlement and rural farming community. Taxonomic assignments indicated that Legionella and Pseudomonas were the most frequently detected genera containing opportunistic bacterial pathogens in the untreated and treated rainwater at both sites. Additionally, Mycobacterium, Clostridium sensu stricto and Escherichia/Shigella displayed high (≥80%) detection frequencies in the untreated and/or treated rainwater samples at one or both sites. Numerous exposure scenarios (e.g. drinking, cleaning) were subsequently investigated and the health risk of using untreated and solar reactor treated rainwater in developing countries was quantified based on the presence of L. pneumophila, P. aeruginosa and E. coli. The solar reactor prototypes were able to reduce the health risk associated with E. coli and P. aeruginosa to below the 1 × 10^-4 annual benchmark limit for all the non-potable uses of rainwater within the target communities (exception of showering for E. coli). However, the risk associated with intentional drinking of untreated or treated rainwater exceeded the benchmark limit (E. coli and P. aeruginosa). Additionally, while the solar reactor treatment reduced the risk associated with garden hosing and showering based on the presence of L. pneumophila, the risk estimates for both activities still exceeded the annual benchmark limit. The large-volume batch solar reactor prototypes were thus able to reduce the risk posed by the target bacteria for non-potable activities rainwater is commonly used for in water scarce regions of sub-Saharan Africa. This study highlights the need to assess water treatment systems in field trials using QMRA.

Utility of QMRA to compare health risks associated with alternative urban sewer overflow management strategies

Wet weather sewer overflows pose potential short-term public health risks. With increasing populations, aging infrastructure and climate change, utilities are challenged with managing sewerage infrastructure to provide optimum outcomes. This study compared how modelled public health risk profiles could change under alternative sewer overflow management strategies during 12 and 24-month rainfall-runoff events. Specifically, existing conditions were compared with both a 'business-as-usual' (BAU) sewer upgrade and a more holistic 'effects-based planning' (EBP) approach based on pumped wet weather sewage overflows directed to a local receiving waterway. Options were compared based on their efficacy to reduce manhole overflows, recreational waterway guideline exceedances and downstream recreational waterway health risks estimated through a screening-level Quantitative Microbial Risk Assessment (QMRA). Results indicated that the two management strategies would be equally effective in reducing the frequency, duration and volume of manhole sewer overflows, eliminating them in the 12-month scenarios and reducing them from >5000 m³ for the 24-month baseline scenario, to 23 and 35 m³ for BAU and EBP, respectively. Baseline, BAU and EBP scenarios produced similar hours of enterococci guideline exceedances, ranging from 1 to 4 h difference. The QMRA produced similar health risk profiles for downstream recreational waterway users for all design events, suggesting that sewer overflows are not the primary driver of public health risks during and immediately following high rainfall events. As such, QMRA provided evidence that an EBP strategy may be used to manage wet weather sewer overflows in lieu of an expensive BAU upgrade, without exacerbating the public health of downstream waterway users. Further investigation of the broader environmental health impacts of implementing this type of innovative approach is warranted. Nonetheless, this work highlights the value of integrating QMRA with other modelling approaches to guide and inform sewer overflow management.

Assessing Health Impacts of Conventional Centralized and Emerging Resource Recovery-Oriented Decentralized Water Systems

Energy shortage and climate change call for sustainable water and wastewater infrastructure capable of simultaneously recovering energy, mitigating greenhouse gas emissions, and protecting public health. Although energy and greenhouse gas emissions of water and wastewater infrastructure are extensively studied, the human health impacts of innovative infrastructure designed under the principles of decentralization and resource recovery are not fully understood. In order to fill this knowledge gap, this study assesses and compares the health impacts of three representative systems by integrating life cycle and microbial risk assessment approaches. This study found that the decentralized system options, such as on-site septic tank and composting or urine diverting toilets, presented much lower life cycle cancer and noncancer impacts than the centralized system. The microbial risks of decentralized systems options were also lower than those of the centralized system. Moreover, life cycle cancer and noncancer impacts contributed to approximately 95% of total health impacts, while microbial risks were associated with the remaining 5%. Additionally, the variability and sensitivity assessment indicated that reducing energy use of wastewater treatment and water distribution is effective in mitigating total health damages of the centralized system, while reducing energy use of water treatment is effective in mitigating total health damages of the decentralized systems.

Droplet digital PCR quantification of norovirus and adenovirus in decentralized wastewater and graywater collections: Implications for onsite reuse

Risk-based treatment of onsite wastewaters for decentralized reuse requires information on the occurrence and density of pathogens in source waters, which differ from municipal wastewater due to scaling and dilution effects in addition to variable source contributions. In this first quantitative report of viral enteric pathogens in onsite-collected graywater and wastewater, untreated graywater (n = 50 samples) and combined wastewater (i.e., including blackwater; n = 28) from three decentralized collection systems were analyzed for two norovirus genogroups (GI/GII) and human adenoviruses using droplet digital polymerase chain reaction (ddPCR). Compared to traditional quantitative PCR (qPCR), which had insufficient sensitivity to quantify viruses in graywater, ddPCR allowed quantification of norovirus GII and adenovirus in 4% and 14% of graywater samples, respectively (none quantifiable for norovirus GI). Norovirus GII was routinely quantifiable in combined wastewater by either PCR method (96% of samples), with well-correlated results between the analyses (R² = 0.96) indicating a density range of 5.2-7.9 log₁₀ genome copies/L. These concentrations are greater than typically reported in centralized municipal wastewater, yet agree well with an epidemiology-based model previously used to develop pathogen log-reduction targets (LRTs) for decentralized non-potable water systems. Results emphasize the unique quality of onsite wastewaters, supporting the previous LRTs and further quantitative microbial risk assessment (QMRA) of decentralized water reuse.

A review on microbial contaminants in stormwater runoff and outfalls: Potential health risks and mitigation strategies

Demands on global water supplies are increasing in response to the need to provide more food, water, and energy for a rapidly growing population. These water stressors are exacerbated by climate change, as well as the growth and urbanisation of industry and commerce. Consequently, urban water authorities around the globe are exploring alternative water sources to meet ever-increasing demands. These alternative sources are primarily treated sewage, stormwater, and groundwater. Stormwater including roof-harvested rainwater has been considered as an alternative water source for both potable and non-potable uses. One of the most significant issues concerning alternative water reuse is the public health risk associated with chemical and microbial contaminants. Several studies to date have quantified fecal indicators and pathogens in stormwater. Microbial source tracking (MST) approaches have also been used to determine the sources of fecal contamination in stormwater and receiving waters. This review paper summarizes occurrence and concentrations of fecal indicators, pathogens, and MST marker genes in urban stormwater. A section of the review highlights the removal of fecal indicators and pathogens through water sensitive urban design (WSUD) or Best Management Practices (BMPs). We also discuss approaches for assessing and mitigating health risks associated with stormwater, including a summary of existing quantitative microbial risk assessment (QMRA) models for potable and non-potable reuse of stormwater. Finally, the most critical research gaps are identified for formulating risk management strategies.

Real-time detection of potable-reclaimed water pipe cross-connection events by conventional water quality sensors using machine learning methods

Risk of cross-connection is becoming higher due to greater construction of potable-reclaimed water dual distribution systems. Cross-connection events can result in serious health concerns and reduce public confidence in reclaimed water. Thus, reliable, cost-effective and real-time online detection methods for early warning are required. The current study carried out pilot-scale experiments to simulate potable-reclaimed water pipe cross-connection events for different mixing ratios (from 30% to 1%) using machine learning methods based on multiple conventional water quality parameters. The parameters included residual chlorine, pH, turbidity, temperature, conductivity, oxidation-reduction potential and chemical oxygen demand. The results showed that correlated variation occurred among water quality parameters at the time of the cross-connection event. A single parameter-based method can be effective at high mixing ratios, but not at low mixing ratios. The direct supporting vector machine (SVM)-based method managed to overcome this drawback, but coped poorly with abnormal readings of water parameter sensors. In that respect, a Pearson correlation coefficient (PCC)-SVM-based method was developed. It provided not only high detection performance under normal conditions, but also remained reliable when abnormal readings occurred. The detection accuracy and true positive rate of this method was still over 88%, and the false positive rate was below 12%, given a sudden variation of an individual water quality parameter. The receiver operating characteristic curves further confirmed the promising practical applicability of this PCC-SVM-based method for early detection of cross-connection events.

A Comparative Life Cycle Assessment of Crop Systems Irrigated with the Groundwater and Reclaimed Water in Northern China

Using reclaimed water from treated wastewater as an irrigation source is gaining popularity in arid and semi-arid areas. However, life cycle assessment studies, utilizing experimental data to analyze the environmental and health impacts of crops irrigated with reclaimed water, are lacking. This study presents the first comparative life cycle assessment of corn, soybean and wheat systems irrigated with groundwater and reclaimed water in Northern China. While the life cycle foreground inventory was based on a combination of experimental and modeling datasets, the life cycle background inventory was compiled with commercially available data packages augmented with Chinese electricity mix data. The life cycle impact analyses were based on the characterization factors from state-of-art life cycle impact assessment models. The analyses indicated that the life cycle global warming impacts of the crop systems ranged from 0.37 to 0.64 kg CO2-eq/kg grain, with reclaimed water irrigated soybean and ground water irrigated wheat exhibiting, respectively, the lowest and highest global warming impacts. Irrigation, farming equipment operation, on-field emissions and fertilizer production ranked as top contributors to the life cycle impacts for corn, soybean, and wheat. The comparative analyses of irrigation sources suggested that significant environmental tradeoffs existed. Replacing groundwater with reclaimed water as the irrigation source significantly decreased life cycle global warming, acidification, ozone depletion, smog formation, and respiratory impacts of corn, soybean and wheat systems. However, replacing groundwater with reclaimed water increased the life cycle noncancer impacts of those systems. Coordinating policies within the water–food–health nexus is required, in order to minimize the environmental tradeoffs, while maximizing the benefits of irrigation with reclaimed water.

Marker genes of fecal indicator bacteria and potential pathogens in animal feces in subtropical catchments

We investigated the abundance of marker genes of two fecal indicator bacteria (FIB) and eight potential pathogens in fecal samples of humans (n = 14) and 10 domestic and native wild animals (n = 134). For each target animal, between 10 and 14 individual fecal samples were collected (n = 148 individual fecal samples in total). The abundance of FIB and potential pathogens within each sample was determined using quantitative PCR (qPCR) assays. All animals tested were positive for Escherichia coli (EC) and the concentrations ranged from 6.13 (flying fox) to 8.87 (chicken) log₁₀ GC/g of feces. These values for Enterococcus spp. (ENT) were 5.25 log₁₀ GC/g for flying fox and 8.12 log₁₀ GC/g of feces for chicken. Moderate correlations were observed between EC with P. aeruginosa, EC O157 and Cryptosporidium parvum, whereas weak correlations were observed between EC and Salmonella spp. and Giardia lamblia, Mycobacterium avium complex (MAC) and Campylobacter spp. The prevalence of MAC and P. aeruginosa were low in dog (14.3% each) and moderate (57.2%, MAC; 42.9% P. aeruginosa) in Eastern grey kangaroo fecal samples. Cryptosporidium parvum was detected in one cattle and one human fecal sample, while G. lamblia was detected in one dog, one flying fox, and one pig fecal samples. Among the eight potential pathogens tested, five pathogens were detected in chicken and dog fecal samples. The remaining animal species contained up to three potential pathogens in their feces. The data generated in this study may aid in the calculation of pathogen loads in the environment, and hence to assess the risks from human and animal fecal contamination of source waters.

Holistic Analysis of Urban Water Systems in the Greater Cincinnati Region: (2) Resource Use Profiles by Emergy Accounting Approach

With increasing populations, mounting environmental pressures and aging infrastructure, urban water and wastewater utilities have to make investment decisions limited by both economic and environmental constraints. The challenges facing urban water systems can no longer be sustainably solved by traditional siloed water management approaches. A central premise of contemporary urban water management paradigms is that in order for urban water systems to be more sustainable and economical, an improvement in resource use efficiency at system level must be achieved. This study provides a quantification of the total resource use of a typical urban water system exemplified in Greater Cincinnati region from raw water extraction for drinking water to wastewater treatment and discharge, providing a better understanding of resource expenditure distributions within the system and a necessary benchmark to which future system improvements can be compared. The emergy methodology was used so that the total environmental work required to produce disparate system inputs could be expressed using a common unit. The results were compared to the concurring life cycle assessment (LCA) and life cycle costing (LCC) results of the same system. Emergy results highlight drinking water treatment and drinking water distribution as two resource-intensive stages, with energy for pumping and chemicals for conditioning representing the greatest inputs to the former and energy for pumping and metals for piping representing the greatest inputs to the latter. For wastewater collection and treatment stages, aeration and sludge handling were identified as the highest emergy unit processes, mostly due to energy use. Comparison with LCA results substantiate the environmental concerns associated with energy use in the drinking water treatment and distribution stages but indicate that environmental burdens associated with infrastructure are more dependent upon upstream resource use rather than downstream environmental impact. Results from emergy, LCA and LCC point towards aeration and sludge handling as two unit processes on the wastewater side that are particularly costly and environmentally impactful. Results in total are used to suggest alternative strategies that can alleviate identified environmental burdens and economic costs.

Total staphylococci as performance surrogate for greywater treatment

Faecal indicator bacteria (FIB) are commonly used as water quality indicators; implying faecal contamination and therefore the potential presence of pathogenic enteric bacteria, viruses, and protozoa. Hence in wastewater treatment, the most commonly used treatment process measures (surrogates) are total coliforms, faecal coliforms, Escherichia coli (E. coli), and enterococci. However, greywater potentially contains skin pathogens unrelated to faecal load, and E. coli and other FIB may grow within greywater unrelated to pathogens. Overall, FIB occurs at fluctuating and relatively low concentrations compared to other endogenous greywater bacteria affecting their ability as surrogates for pathogen reduction. Therefore, unlike municipal sewage, FIB provides a very limited and unreliable log-reduction surrogate measure for on-site greywater treatment systems. Based on our recent metagenomic study of laundry greywater, skin-associated bacteria such as Staphylococcus, Corynebacterium, and Propionibacterium spp. dominate and may result in more consistent treatment surrogates than traditional FIB. Here, we investigated various Staphylococcus spp. as potential surrogates to reliably assay over 4-log10 reduction by the final-stage UV disinfection step commonly used for on-site greywater reuse, and compare them to various FIB/phage surrogates. A collimated UV beam was used to determine the efficacy of UV inactivation (255, 265 and 285 nm) against E. coli, Enterococcus faecalis, E. faecium, E. casseliflavus, Staphylococcus aureus, and S. epidermidis. Staphylococcus spp. was estimated by combining the bi-linear dose-response curves for S. aureus and S. epidermidis and was shown to be less resistant to UV irradiation than the other surrogates examined. Hence, a relative inactivation credit is suggested; whereas, the doses required to achieve a 4 and 5-log10 reduction of Staphylococcus spp. (13.0 and 20.9 mJ cm-2, respectively) were used to determine the relative inactivation of the other microorganisms investigated. The doses required to achieve a 4 and 5-log10 reduction of Staphylococcus spp. resulted in a log10 reduction of 1.4 and 4.1 for E. coli, 0.8 and 2.8 for E. faecalis, 0.8 and 3.6 for E. casseliflavus and 0.8 and 1.2 for MS2 coliphage, respectively. Given the concentration difference of Staphylococcus spp. and FIB (3 to 5-log10 higher), we propose the use of Staphylococcus spp. as a novel endogenous performance surrogate to demonstrate greywater treatment performance given its relatively high and consistent concentration and therefore ability to demonstrate over 5-log10 reductions.

Reliable, Resilient and Sustainable Urban Drainage Systems: An Analysis of Robustness under Deep Uncertainty

Reliability, resilience and sustainability are key goals of any urban drainage system. However, only a few studies have recently focused on measuring, operationalizing and comparing such concepts in a world of deep uncertainty. In this study, these key concepts are defined and quantified for a number of gray, green and hybrid strategies, aimed at improving the capacity issues of an existing integrated urban wastewater system. These interventions are investigated by means of a regret-based approach, which evaluates the robustness (that is the ability to perform well under deep uncertainty conditions) of each strategy in terms of the three qualities through integration of multiple objectives (i.e., sewer flooding, river water quality, combined sewer overflows, river flooding, greenhouse gas emissions, cost and acceptability) across four different future scenarios. The results indicate that strategies found to be robust in terms of sustainability were typically also robust for resilience and reliability across future scenarios. However, strategies found to be robust in terms of their resilience and, in particular, for reliability did not guarantee robustness for sustainability. Conventional gray infrastructure strategies were found to lack robustness in terms of sustainability due to their unbalanced economic, environmental and social performance. Such limitations were overcome, however, by implementing hybrid solutions that combine green retrofits and gray rehabilitation solutions.

Constructed wetlands for greywater recycle and reuse: A review

Concern over dwindling water supplies for urban areas as well as environmental degradation from existing urban water systems has motivated research into more resilient and sustainable water supply strategies. Greywater reuse has been suggested as a way to diversify local water supply portfolios while at the same time lessening the burden on existing environments and infrastructure. Constructed wetlands have been proposed as an economically and energetically efficient unit process to treat greywater for reuse purposes, though their ability to consistently meet applicable water quality standards, microbiological in particular, is questionable. We therefore review the existing case study literature to summarize the treatment performance of greywater wetlands in the context of chemical, physical and microbiological water quality standards. Based on a cross-section of different types of wetlands, including surface flow, subsurface flow, vertical and recirculating vertical flow, across a range of operating conditions, we show that although microbiological standards cannot reliably be met, given either sufficient retention time or active recirculation, chemical and physical standards can. We then review existing case study literature for typical water supply disinfection unit processes including chlorination, ozonation and ultraviolet radiation treating either raw or treated greywater specifically. An evaluation of effluent water quality from published wetland case studies and the expected performance from disinfection processes shows that under appropriate conditions these two unit processes together can likely produce effluent of sufficient quality to meet all nonpotable reuse standards. Specifically, we suggest that recycling vertical flow wetlands combined with ultraviolet radiation disinfection and chlorine residual is the best combination to reliably meet the standards.

Current Stormwater Harvesting Guidelines Are Inadequate for Mitigating Risk from Campylobacter During Nonpotable Reuse Activities

Campylobacter is a pathogen frequently detected in urban stormwater worldwide. It is one of the leading causes of enteric disease in many developed countries and is the leading cause of enteric disease in Australia. Prior to harvesting stormwater, adequate treatment is necessary to mitigate risks derived from such harmful pathogens. The goal of this research was to estimate the health risks associated with the exposure to Campylobacter when harvesting urban stormwater for toilet flushing and irrigation activities, and the role treatment options play in limiting risks. Campylobacter data collected from several urban stormwater systems in Victoria, Australia, were the inputs of a Quantitative Microbial Risk Assessment model. The model included seven treatment scenarios, spanning wetlands, biofilters, and more traditional treatment trains including those recommended by the Australian Guidelines for Water Recycling. According to our modeling and acceptable risk thresholds, only two treatment scenarios could supply water of sufficient quality for toilet flushing and irrigation end-uses: (1) using stormwater biofilters coupled with UV-treatment and (2) a more conventional coagulation, filtration, UV, and chlorination treatment plant. Importantly, our modeling results suggest that current guidelines in place for stormwater reuse are not adequate for protecting against exposure to Campylobacter. However, more research is required to better define whether the Campylobacter detectable in stormwater are pathogenic to humans.

Human health risks for Legionella and Mycobacterium avium complex (MAC) from potable and non-potable uses of roof-harvested rainwater

A quantitative microbial risk assessment (QMRA) of opportunistic pathogens Legionella pneumophila (LP) and Mycobacterium avium complex (MAC) was undertaken for various uses of roof-harvested rainwater (RHRW) reported in Queensland, Australia to identify appropriate usages and guide risk management practices. Risks from inhalation of aerosols due to showering, swimming in pools topped up with RHRW, use of a garden hose, car washing, and toilet flushing with RHRW were considered for LP while both ingestion (drinking, produce consumption, and accidental ingestion from various activities) and inhalation risks were considered for MAC. The drinking water route of exposure presented the greatest risks due to cervical lymphadenitis and disseminated infection health endpoints for children and immune-compromised populations, respectively. It is therefore not recommended that these populations consume untreated rainwater. LP risks were up to 6 orders of magnitude higher than MAC risks for the inhalation route of exposure for all scenarios. Both inhalation and ingestion QMRA simulations support that while drinking, showering, and garden hosing with RHRW may present the highest risks, car washing and clothes washing could constitute appropriate uses of RHRW for all populations, and toilet flushing and consumption of lettuce irrigation with RHRW would be appropriate for non- immune-compromised populations.

Simulation of enteric pathogen concentrations in locally-collected greywater and wastewater for microbial risk assessments

As decentralized water reuse continues to gain popularity, risk-based treatment guidance is increasingly sought for the protection of public health. However, effort s to evaluate pathogen risks and log-reduction requirements have been hindered by an incomplete understanding of pathogen occurrence and densities in locally-collected wastewaters (i.e., from decentralized collection systems). Of particular interest is the potentially high enteric pathogen concentration in small systems with an active infected excreter, but generally lower frequency of pathogen occurrences in smaller systems compared to those with several hundred contributors. Such variability, coupled with low concentrations in many source streams (e.g., sink, shower/bath, and laundry waters), has limited direct measurement of pathogens. This study presents an approach to modeling pathogen concentrations in variously sized greywater and combined wastewater collection systems based on epidemiological pathogen incidence rates, user population size, and fecal loadings to various residential wastewater sources. Pathogen infections were modeled within various population sizes (5-, 100-, and 1,000-person) for seven reference pathogens (viruses: adenoviruses, Norovirus, and Rotavirus; bacteria: Campylobacter and Salmonella spp.; and protozoa: Cryptosporidium and Giardia spp.) on each day of 10,000 possible years, accounting for intermittent infection and overlap of infection periods within the population. Fecal contamination of fresh greywaters from bathroom sinks, showers/baths, and laundry, as well as combined greywater and local combined wastewater (i.e., including toilets), was modeled based on reported fecal indicators in the various sources. Simulated daily infections and models of fecal contamination were coupled with pathogen shedding characteristics to generate distributions of pathogen densities in the various waters. The predicted frequency of pathogen occurrences in local wastewaters was generally low due to low infection incidence within small cohort groups, but increased with collection scale (population size) and infection incidence rate (e.g., Norovirus). When pathogens did occur, a decrease in concentrations from 5- to 100- and from 100- to 1,000-person systems was observed; nonetheless, overall mean concentrations (i.e., including non-occurrences) remained the same due to the increased number of occurrences. This highlights value of the model for characterizing scaling effects over averaging methods, which overestimate the frequency of pathogen occurrence in small systems while underestimating concentration peaks that likely drive risk periods. Results of this work will inform development of risk-based pathogen reduction requirements for decentralized water reuse.

Cost, energy, global warming, eutrophication and local human health impacts of community water and sanitation service options

We compared water and sanitation system options for a coastal community across selected sustainability metrics, including environmental impact (i.e., life cycle eutrophication potential, energy consumption, and global warming potential), equivalent annual cost, and local human health impact. We computed normalized metric scores, which we used to discuss the options' strengths and weaknesses, and conducted sensitivity analysis of the scores to changes in variable and uncertain input parameters. The alternative systems, which combined centralized drinking water with sanitation services based on the concepts of energy and nutrient recovery as well as on-site water reuse, had reduced environmental and local human health impacts and costs than the conventional, centralized option. Of the selected sustainability metrics, the greatest advantages of the alternative community water systems (compared to the conventional system) were in terms of local human health impact and eutrophication potential, despite large, outstanding uncertainties. Of the alternative options, the systems with on-site water reuse and energy recovery technologies had the least local human health impact; however, the cost of these options was highly variable and the energy consumption was comparable to on-site alternatives without water reuse or energy recovery, due to on-site reuse treatment. Future work should aim to reduce the uncertainty in the energy recovery process and explore the health risks associated with less costly, on-site water treatment options.

Comparison of Risk Predicted by Multiple Norovirus Dose-Response Models and Implications for Quantitative Microbial Risk Assessment

The application of quantitative microbial risk assessments (QMRAs) to understand and mitigate risks associated with norovirus is increasingly common as there is a high frequency of outbreaks worldwide. A key component of QMRA is the dose-response analysis, which is the mathematical characterization of the association between dose and outcome. For Norovirus, multiple dose-response models are available that assume either a disaggregated or an aggregated intake dose. This work reviewed the dose-response models currently used in QMRA, and compared predicted risks from waterborne exposures (recreational and drinking) using all available dose-response models. The results found that the majority of published QMRAs of norovirus use the ₁ F₁ hypergeometric dose-response model with α = 0.04, β = 0.055. This dose-response model predicted relatively high risk estimates compared to other dose-response models for doses in the range of 1-1,000 genomic equivalent copies. The difference in predicted risk among dose-response models was largest for small doses, which has implications for drinking water QMRAs where the concentration of norovirus is low. Based on the review, a set of best practices was proposed to encourage the careful consideration and reporting of important assumptions in the selection and use of dose-response models in QMRA of norovirus. Finally, in the absence of one best norovirus dose-response model, multiple models should be used to provide a range of predicted outcomes for probability of infection.

QMRA and water safety management: review of application in drinking water systems

Quantitative microbial risk assessment (QMRA), the assessment of microbial risks when model inputs and estimated health impacts are explicitly quantified, is a valuable tool to support water safety plans (WSP). In this paper, research studies undertaken on the application of QMRA in drinking water systems were reviewed, highlighting their relevance for WSP. The important elements for practical implementation include: the data requirements to achieve sufficient certainty to support decision-making; level of expertise necessary to undertake the required analysis; and the accessibility of tools to support wider implementation, hence these aspects were the focus of the review. Recommendations to support the continued and growing application of QMRA to support risk management in the water sector are provided.

Global and local health burden trade-off through the hybridisation of quantitative microbial risk assessment and life cycle assessment to aid water management

Life cycle assessment (LCA) and quantitative risk assessment (QRA) are commonly used to evaluate potential human health impacts associated with proposed or existing infrastructure and products. Each approach has a distinct objective and, consequently, their conclusions may be inconsistent or contradictory. It is proposed that the integration of elements of QRA and LCA may provide a more holistic approach to health impact assessment. Here we examine the possibility of merging LCA assessed human health impacts with quantitative microbial risk assessment (QMRA) for waterborne pathogen impacts, expressed with the common health metric, disability adjusted life years (DALYs). The example of a recent large-scale water recycling project in Sydney, Australia was used to identify and demonstrate the potential advantages and current limitations of this approach. A comparative analysis of two scenarios - with and without the development of this project - was undertaken for this purpose. LCA and QMRA were carried out independently for the two scenarios to compare human health impacts, as measured by DALYs lost per year. LCA results suggested that construction of the project would lead to an increased number of DALYs lost per year, while estimated disease burden resulting from microbial exposures indicated that it would result in the loss of fewer DALYs per year than the alternative scenario. By merging the results of the LCA and QMRA, we demonstrate the advantages in providing a more comprehensive assessment of human disease burden for the two scenarios, in particular, the importance of considering the results of both LCA and QRA in a comparative assessment of decision alternatives to avoid problem shifting. The application of DALYs as a common measure between the two approaches was found to be useful for this purpose.

Environmental (Saprozoic) Pathogens of Engineered Water Systems: Understanding Their Ecology for Risk Assessment and Management

Major waterborne (enteric) pathogens are relatively well understood and treatment controls are effective when well managed. However, water-based, saprozoic pathogens that grow within engineered water systems (primarily within biofilms/sediments) cannot be controlled by water treatment alone prior to entry into water distribution and other engineered water systems. Growth within biofilms or as in the case of Legionella pneumophila, primarily within free-living protozoa feeding on biofilms, results from competitive advantage. Meaning, to understand how to manage water-based pathogen diseases (a sub-set of saprozoses) we need to understand the microbial ecology of biofilms; with key factors including biofilm bacterial diversity that influence amoebae hosts and members antagonistic to water-based pathogens, along with impacts from biofilm substratum, water temperature, flow conditions and disinfectant residual—all control variables. Major saprozoic pathogens covering viruses, bacteria, fungi and free-living protozoa are listed, yet today most of the recognized health burden from drinking waters is driven by legionellae, non-tuberculous mycobacteria (NTM) and, to a lesser extent, Pseudomonas aeruginosa. In developing best management practices for engineered water systems based on hazard analysis critical control point (HACCP) or water safety plan (WSP) approaches, multi-factor control strategies, based on quantitative microbial risk assessments need to be developed, to reduce disease from largely opportunistic, water-based pathogens.

Cost-effectiveness of nitrogen mitigation by alternative household wastewater management technologies

Household wastewater, especially from conventional septic systems, is a major contributor to nitrogen pollution. Alternative household wastewater management technologies provide similar sewerage management services but their life cycle costs and nitrogen flow implications remain uncertain. This paper addresses two key questions: (1) what are the total costs, nitrogen mitigation potential, and cost-effectiveness of a range of conventional and alternative municipal wastewater treatment technologies, and (2) what uncertainties influence these outcomes and how can we improve our understanding of these technologies? We estimate a household nitrogen mass balance for various household wastewater treatment systems and combine this mass balance with life cycle cost assessment to calculate the cost-effectiveness of nitrogen mitigation, which we define as nitrogen removed from the local watershed. We apply our methods to Falmouth, MA, where failing septic systems have caused heightened eutrophication in local receiving water bodies. We find that flushing and dry (composting) urine-diversion toilets paired with conventional septic systems for greywater management demonstrate the lowest life cycle cost and highest cost-effectiveness (dollars per kilogram of nitrogen removed from the watershed). Composting toilets are also attractive options in some cases, particularly best-case nitrogen mitigation. Innovative/advanced septic systems designed for high-level nitrogen removal are cost-competitive options for newly constructed homes, except at their most expensive. A centralized wastewater treatment plant is the most expensive and least cost-effective option in all cases. Using a greywater recycling system with any treatment technology increases the cost without adding any nitrogen removal benefits. Sensitivity analysis shows that these results are robust considering a range of cases and uncertainties.