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Denissen J, Reyneke B, Barnard T, Khan S, Khan W. Risk assessment of Enterococcus faecium, Klebsiella pneumoniae, and Pseudomonas aeruginosa in environmental water sources: Development of surrogate models for antibiotic resistance genes. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 901:166217. [PMID: 37604372 DOI: 10.1016/j.scitotenv.2023.166217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 08/23/2023]
Abstract
The presence of Enterococcus faecium (E. faecium), Klebsiella pneumoniae (K. pneumoniae), Pseudomonas aeruginosa (P. aeruginosa), and the aminoglycoside resistance genes, aac(6')-Ib and aac(6')-aph(2″), was investigated in environmental water sources obtained from informal settlements in the Western Cape (South Africa). Using ethidium monoazide bromide quantitative polymerase chain reaction (EMA-qPCR) analysis, E. faecium, K. pneumoniae, and P. aeruginosa were detected in 88.9 %, 100 %, and 93.3 % of the samples (n = 45), respectively, with a significantly higher mean concentration recorded for K. pneumoniae (7.83 × 104 cells/100 mL) over the sampling period. The aac(6')-Ib gene was detected in 95.6 % (43/45) of the environmental water samples [mean concentration of 7.07 × 106 gene copies (GC)/100 mL], while the aac(6')-aph(2″) gene was detected in 100 % (n = 45) of the samples [mean concentration of 6.68 × 105 GC/100 mL]. Quantitative microbial risk assessment (QMRA) subsequently indicated that the risks posed by K. pneumoniae and P. aeruginosa were linked to intentional drinking, washing/bathing, cleaning of the home, and swimming, in the samples collected from the various sampling sites. Surrogate risk assessment models were then designed and applied for Gram-positive [aac(6')-aph(2″) gene] and Gram-negative [aac(6')-Ib gene] pathogens that may exhibit aminoglycoside resistance. The results indicated that only the Gram-negative pathogens posed a risk (>10-4) in all the samples for cleaning of the home and intentional drinking, as well as for washing laundry by hand, garden hosing, garden work, washing/bathing, accidental consumption, and swimming at the stream and marsh sites. Thus, while environmental waters may pose a health risk of exposure to pathogenic bacteria, the results obtained indicate that screening for antibiotic resistant genes, associated with multiple genera/species, could serve as a surrogate model for estimating risks with the target group under investigation.
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Affiliation(s)
- Julia Denissen
- Department of Microbiology, Faculty of Science, Stellenbosch University, Private Bag X1, Stellenbosch 7602, South Africa
| | - Brandon Reyneke
- Department of Microbiology, Faculty of Science, Stellenbosch University, Private Bag X1, Stellenbosch 7602, South Africa
| | - Tobias Barnard
- Water and Health Research Centre, Faculty of Health Sciences, University of Johannesburg, PO Box 17011, Doornfontein 7305, South Africa
| | - Sehaam Khan
- Water and Health Research Centre, Faculty of Health Sciences, University of Johannesburg, PO Box 17011, Doornfontein 7305, South Africa
| | - Wesaal Khan
- Department of Microbiology, Faculty of Science, Stellenbosch University, Private Bag X1, Stellenbosch 7602, South Africa.
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González-Fernández A, Symonds EM, Gallard-Gongora JF, Mull B, Lukasik JO, Rivera Navarro P, Badilla Aguilar A, Peraud J, Mora Alvarado D, Cantor A, Breitbart M, Cairns MR, Harwood VJ. Risk of Gastroenteritis from Swimming at a Wastewater-Impacted Tropical Beach Varies across Localized Scales. Appl Environ Microbiol 2023; 89:e0103322. [PMID: 36847564 PMCID: PMC10057883 DOI: 10.1128/aem.01033-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 01/21/2023] [Indexed: 03/01/2023] Open
Abstract
Population growth and changing climate are expected to increase human exposure to pathogens in tropical coastal waters. We examined microbiological water quality in three rivers within 2.3 km of each other that impact a Costa Rican beach and in the ocean outside their plumes during the rainy and dry seasons. We performed quantitative microbial risk assessment (QMRA) to predict the risk of gastroenteritis associated with swimming and the amount of pathogen reduction needed to achieve safe conditions. Recreational water quality criteria based on enterococci were exceeded in >90% of river samples but in only 13% of ocean samples. Multivariate analysis grouped microbial observations by subwatershed and season in river samples but only by subwatershed in the ocean. The modeled median risk from all pathogens in river samples was between 0.345 and 0.577, 10-fold above the U.S. Environmental Protection Agency (U.S. EPA) benchmark of 0.036 (36 illnesses/1,000 swimmers). Norovirus genogroup I (NoVGI) contributed most to risk, but adenoviruses raised risk above the threshold in the two most urban subwatersheds. The risk was greater in the dry compared to the rainy season, due largely to the greater frequency of NoVGI detection (100% versus 41%). Viral log10 reduction needed to ensure safe swimming conditions varied by subwatershed and season and was greatest in the dry season (3.8 to 4.1 dry; 2.7 to 3.2 rainy). QMRA that accounts for seasonal and local variability of water quality contributes to understanding the complex influences of hydrology, land use, and environment on human health risk in tropical coastal areas and can contribute to improved beach management. IMPORTANCE This holistic investigation of sanitary water quality at a Costa Rican beach assessed microbial source tracking (MST) marker genes, pathogens, and indicators of sewage. Such studies are still rare in tropical climates. Quantitative microbial risk assessment (QMRA) found that rivers impacting the beach consistently exceeded the U.S. EPA risk threshold for gastroenteritis of 36/1,000 swimmers. The study improves upon many QMRA studies by measuring specific pathogens, rather than relying on surrogates (indicator organisms or MST markers) or estimating pathogen concentrations from the literature. By analyzing microbial levels and estimating the risk of gastrointestinal illness in each river, we were able to discern differences in pathogen levels and human health risks even though all rivers were highly polluted by wastewater and were located less than 2.5 km from one another. This variability on a localized scale has not, to our knowledge, previously been demonstrated.
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Affiliation(s)
| | - Erin M. Symonds
- College of Marine Science, University of South Florida, Saint Petersburg, Florida, USA
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
| | | | - Bonnie Mull
- BCS Laboratories, Inc., Gainesville, Florida, USA
| | | | - Pablo Rivera Navarro
- Laboratorio Nacional de Aguas, Instituto Costarricense de Acueductos y Alcantarillados, Tres Ríos, Cartago, Costa Rica
| | - Andrei Badilla Aguilar
- Laboratorio Nacional de Aguas, Instituto Costarricense de Acueductos y Alcantarillados, Tres Ríos, Cartago, Costa Rica
| | - Jayme Peraud
- Department of Integrative Biology, University of South Florida, Tampa, Florida, USA
| | - Darner Mora Alvarado
- Laboratorio Nacional de Aguas, Instituto Costarricense de Acueductos y Alcantarillados, Tres Ríos, Cartago, Costa Rica
| | - Allison Cantor
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
| | - Mya Breitbart
- College of Marine Science, University of South Florida, Saint Petersburg, Florida, USA
| | - Maryann R. Cairns
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
| | - Valerie J. Harwood
- Department of Integrative Biology, University of South Florida, Tampa, Florida, USA
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3
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Denissen J, Reyneke B, Waso-Reyneke M, Havenga B, Barnard T, Khan S, Khan W. Prevalence of ESKAPE pathogens in the environment: Antibiotic resistance status, community-acquired infection and risk to human health. Int J Hyg Environ Health 2022; 244:114006. [PMID: 35841823 DOI: 10.1016/j.ijheh.2022.114006] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 01/10/2023]
Abstract
The ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.) pathogens are characterised by increased levels of resistance towards multiple classes of first line and last-resort antibiotics. Although these pathogens are frequently isolated from clinical environments and are implicated in a variety of life-threatening, hospital-associated infections; antibiotic resistant ESKAPE strains have been isolated from environmental reservoirs such as surface water, wastewater, food, and soil. Literature on the persistence and subsequent health risks posed by the ESKAPE isolates in extra-hospital settings is however, limited and the current review aims to elucidate the primary reservoirs of these pathogens in the environment, their antibiotic resistance profiles, and the link to community-acquired infections. Additionally, information on the current state of research regarding health-risk assessments linked to exposure of the ESKAPE pathogens in the natural environment, is outlined.
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Affiliation(s)
- Julia Denissen
- Department of Microbiology, Faculty of Science, Stellenbosch University, Private Bag X1, Stellenbosch, 7602, South Africa
| | - Brandon Reyneke
- Department of Microbiology, Faculty of Science, Stellenbosch University, Private Bag X1, Stellenbosch, 7602, South Africa
| | - Monique Waso-Reyneke
- Faculty of Health Sciences, University of Johannesburg, PO Box 17011, Doornfontein, 2028, South Africa
| | - Benjamin Havenga
- Department of Microbiology, Faculty of Science, Stellenbosch University, Private Bag X1, Stellenbosch, 7602, South Africa
| | - Tobias Barnard
- Water and Health Research Centre, University of Johannesburg, PO Box 17011, Doornfontein, 7305, South Africa
| | - Sehaam Khan
- Faculty of Health Sciences, University of Johannesburg, PO Box 17011, Doornfontein, 2028, South Africa
| | - Wesaal Khan
- Department of Microbiology, Faculty of Science, Stellenbosch University, Private Bag X1, Stellenbosch, 7602, South Africa.
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Relationships between Recreation and Pollution When Striving for Wellbeing in Blue Spaces. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074170. [PMID: 35409855 PMCID: PMC8998665 DOI: 10.3390/ijerph19074170] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/14/2022] [Accepted: 03/26/2022] [Indexed: 12/10/2022]
Abstract
Our aim for this research was to identify and examine how recreation enthusiasts cope with and mitigate the violence of pollution as they strive for wellbeing in polluted “blue spaces” (e.g., seas, oceans). Our methodology to undertake the research was ethnography (online and offline), including autoethnography and informal interviews (40). The study proceeded from a constructivist epistemology which emphasizes that knowledge is situated and perspectival. The study site was a post-industrial area of northeast England where a long-standing but also rapidly growing surfing culture has to live with pollution (legacy and ongoing). We found evidence of what have become quotidian tactics that attach to themes of familiarity, embodiment, resignation, denial, and affect/emotion used by enthusiasts to cope with and mitigate the violence of pollution. We argue that by necessity some surfers are persisting in striving for wellbeing not simply in spite of pollution but rather with pollution. We assert surfers enact a “resigned activism” that influences their persistence. We extend critical scholarship concerning relationships between recreation, blue spaces, and wellbeing by moving beyond a restrictive binary of focusing on either threats and risks or opportunities and benefits of blue space to health and wellbeing, instead showing how striving for wellbeing through recreation in the presence of pollution provides evidence of how such efforts are more negotiated, fluid, situated, uncertain, dissonant, and even political than any such binary structure allows for.
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Zhang CM, Xu PC, Du WW, Wang XC. Exposure parameters and health risk of Cryptosporidium and Giardia in the recreational water activities for urban residents in China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:1573-1583. [PMID: 34363153 DOI: 10.1007/s11356-021-15463-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 07/12/2021] [Indexed: 06/13/2023]
Abstract
Knowledge gaps in the exposure parameters for recreational water activities make quantitative risk assessment related to water recreation difficult. Therefore, the annual exposure frequency and single exposure duration for the recreational water activities of residents from ten cities in the North and South of China were investigated. Questionnaire interviews were carried on recreational water activities comprising swimming (SW), boating (BA), playing in interactive fountains (PF), and watching fountains (WF). Quantitative microbial risk assessment for the exposure of urban residents to Cryptosporidium and Giardia was also performed. For the four recreational water activities, the participation rates of urban residents in SW and WF were higher than the others. For SW and BA, the mean annual exposure frequency and single exposure duration for males were significantly higher than those for females. PF and WF showed the opposite. The annual exposure frequency for above 35-year-old residents was higher than that for young residents (18-35 years). However, the single exposure duration for young residents was highest in SW, BA, and PF. The mean annual exposure frequency and single exposure duration for North China residents were higher than those for South China residents in all recreational water activities, except for SW. Overall, the annual exposure frequency and single exposure duration in recreational water activities for all urban residents followed a lognormal distribution. In the four recreational water activities, the total annual infection risk of male exposure to Cryptosporidium was 1.0 × 10-2, with the confidence intervals between 95 and 5% of [4.3 × 10-4, 3.7 × 10-2], whereas that for females was 6.8 × 10-3 and [4.2 × 10-4, 2.4 × 10-2]. Also, the annual infection risk of males to Giardia was 8.8 × 10-3 and [5.1×10-4, 3.2×10-2], and that of females was 5.3 × 10-3 and [4.0 × 10-4, 1.8 × 10-2]. These results demonstrated that SW and PF made the highest contribution to the total annual infection risk. Sensitivity analysis highlighted that the characterization of exposure parameters plays a critical role in health risk assessment, which may provide a scientific basis for recreational water quality standards formulation.
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Affiliation(s)
- Chong-Miao Zhang
- School of Environmental and Municipal Engineering, Xi'an University of Architecture and Technology, Xi'an, 710055, China.
- Key Laboratory of Northwest Water Resource, Environment and Ecology, Ministry of Education, Xi'an University of Architecture and Technology, Xi'an, 710055, China.
- Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an, 710055, China.
- International Science and Technology Cooperation Center for Urban Alternative Water Resources Development, Xi'an University of Architecture and Technology, Xi'an, 710055, China.
| | - Peng-Cheng Xu
- School of Environmental and Municipal Engineering, Xi'an University of Architecture and Technology, Xi'an, 710055, China
- Key Laboratory of Northwest Water Resource, Environment and Ecology, Ministry of Education, Xi'an University of Architecture and Technology, Xi'an, 710055, China
- Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an, 710055, China
- International Science and Technology Cooperation Center for Urban Alternative Water Resources Development, Xi'an University of Architecture and Technology, Xi'an, 710055, China
| | - Wei-Wei Du
- School of Environmental and Municipal Engineering, Xi'an University of Architecture and Technology, Xi'an, 710055, China
- Key Laboratory of Northwest Water Resource, Environment and Ecology, Ministry of Education, Xi'an University of Architecture and Technology, Xi'an, 710055, China
- Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an, 710055, China
| | - Xiaochang C Wang
- Key Laboratory of Northwest Water Resource, Environment and Ecology, Ministry of Education, Xi'an University of Architecture and Technology, Xi'an, 710055, China
- International Science and Technology Cooperation Center for Urban Alternative Water Resources Development, Xi'an University of Architecture and Technology, Xi'an, 710055, China
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6
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Jones DL, Baluja MQ, Graham DW, Corbishley A, McDonald JE, Malham SK, Hillary LS, Connor TR, Gaze WH, Moura IB, Wilcox MH, Farkas K. Shedding of SARS-CoV-2 in feces and urine and its potential role in person-to-person transmission and the environment-based spread of COVID-19. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 749:141364. [PMID: 32836117 PMCID: PMC7836549 DOI: 10.1016/j.scitotenv.2020.141364] [Citation(s) in RCA: 238] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 04/14/2023]
Abstract
The recent detection of SARS-CoV-2 RNA in feces has led to speculation that it can be transmitted via the fecal-oral/ocular route. This review aims to critically evaluate the incidence of gastrointestinal (GI) symptoms, the quantity and infectivity of SARS-CoV-2 in feces and urine, and whether these pose an infection risk in sanitary settings, sewage networks, wastewater treatment plants, and the wider environment (e.g. rivers, lakes and marine waters). A review of 48 independent studies revealed that severe GI dysfunction is only evident in a small number of COVID-19 cases, with 11 ± 2% exhibiting diarrhea and 12 ± 3% exhibiting vomiting and nausea. In addition to these cases, SARS-CoV-2 RNA can be detected in feces from some asymptomatic, mildly- and pre-symptomatic individuals. Fecal shedding of the virus peaks in the symptomatic period and can persist for several weeks, but with declining abundances in the post-symptomatic phase. SARS-CoV-2 RNA is occasionally detected in urine, but reports in fecal samples are more frequent. The abundance of the virus genetic material in both urine (ca. 102-105 gc/ml) and feces (ca. 102-107 gc/ml) is much lower than in nasopharyngeal fluids (ca. 105-1011 gc/ml). There is strong evidence of multiplication of SARS-CoV-2 in the gut and infectious virus has occasionally been recovered from both urine and stool samples. The level and infectious capability of SARS-CoV-2 in vomit remain unknown. In comparison to enteric viruses transmitted via the fecal-oral route (e.g. norovirus, adenovirus), the likelihood of SARS-CoV-2 being transmitted via feces or urine appears much lower due to the lower relative amounts of virus present in feces/urine. The biggest risk of transmission will occur in clinical and care home settings where secondary handling of people and urine/fecal matter occurs. In addition, while SARS-CoV-2 RNA genetic material can be detected by in wastewater, this signal is greatly reduced by conventional treatment. Our analysis also suggests the likelihood of infection due to contact with sewage-contaminated water (e.g. swimming, surfing, angling) or food (e.g. salads, shellfish) is extremely low or negligible based on very low predicted abundances and limited environmental survival of SARS-CoV-2. These conclusions are corroborated by the fact that tens of million cases of COVID-19 have occurred globally, but exposure to feces or wastewater has never been implicated as a transmission vector.
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Affiliation(s)
- David L Jones
- Centre for Environmental Biotechnology, School of Natural Sciences, Bangor University, Bangor, Gwynedd LL57 2UW, UK; UWA School of Agriculture and Environment, The University of Western Australia, Perth, WA 6009, Australia.
| | | | - David W Graham
- School of Engineering, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Alexander Corbishley
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, Easter Bush Campus Midlothian, EH25 9RG, UK
| | - James E McDonald
- Centre for Environmental Biotechnology, School of Natural Sciences, Bangor University, Bangor, Gwynedd LL57 2UW, UK
| | - Shelagh K Malham
- School of Ocean Sciences, Bangor University, Menai Bridge, Anglesey LL59 5AB, UK
| | - Luke S Hillary
- Centre for Environmental Biotechnology, School of Natural Sciences, Bangor University, Bangor, Gwynedd LL57 2UW, UK
| | - Thomas R Connor
- Organisms and Environment Division, School of Biosciences, Cardiff University, Cardiff CF10 3AX, UK; Public Health Wales, University Hospital of Wales, Cardiff CF14 4XW, UK
| | - William H Gaze
- European Centre for Environment and Human Health, University of Exeter Medical School, ESI, Penryn Campus, TR10 9FE, UK
| | - Ines B Moura
- Leeds Institute for Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds LS1 3EX, UK
| | - Mark H Wilcox
- Healthcare Associated Infections Research Group, Leeds Teaching Hospitals NHS Trust and University of Leeds, Leeds, UK
| | - Kata Farkas
- Centre for Environmental Biotechnology, School of Natural Sciences, Bangor University, Bangor, Gwynedd LL57 2UW, UK; School of Ocean Sciences, Bangor University, Menai Bridge, Anglesey LL59 5AB, UK
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7
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Jones DL, Baluja MQ, Graham DW, Corbishley A, McDonald JE, Malham SK, Hillary LS, Connor TR, Gaze WH, Moura IB, Wilcox MH, Farkas K. Shedding of SARS-CoV-2 in feces and urine and its potential role in person-to-person transmission and the environment-based spread of COVID-19. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 749:141364. [PMID: 32836117 DOI: 10.20944/preprints202007.0471.v1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 05/18/2023]
Abstract
The recent detection of SARS-CoV-2 RNA in feces has led to speculation that it can be transmitted via the fecal-oral/ocular route. This review aims to critically evaluate the incidence of gastrointestinal (GI) symptoms, the quantity and infectivity of SARS-CoV-2 in feces and urine, and whether these pose an infection risk in sanitary settings, sewage networks, wastewater treatment plants, and the wider environment (e.g. rivers, lakes and marine waters). A review of 48 independent studies revealed that severe GI dysfunction is only evident in a small number of COVID-19 cases, with 11 ± 2% exhibiting diarrhea and 12 ± 3% exhibiting vomiting and nausea. In addition to these cases, SARS-CoV-2 RNA can be detected in feces from some asymptomatic, mildly- and pre-symptomatic individuals. Fecal shedding of the virus peaks in the symptomatic period and can persist for several weeks, but with declining abundances in the post-symptomatic phase. SARS-CoV-2 RNA is occasionally detected in urine, but reports in fecal samples are more frequent. The abundance of the virus genetic material in both urine (ca. 102-105 gc/ml) and feces (ca. 102-107 gc/ml) is much lower than in nasopharyngeal fluids (ca. 105-1011 gc/ml). There is strong evidence of multiplication of SARS-CoV-2 in the gut and infectious virus has occasionally been recovered from both urine and stool samples. The level and infectious capability of SARS-CoV-2 in vomit remain unknown. In comparison to enteric viruses transmitted via the fecal-oral route (e.g. norovirus, adenovirus), the likelihood of SARS-CoV-2 being transmitted via feces or urine appears much lower due to the lower relative amounts of virus present in feces/urine. The biggest risk of transmission will occur in clinical and care home settings where secondary handling of people and urine/fecal matter occurs. In addition, while SARS-CoV-2 RNA genetic material can be detected by in wastewater, this signal is greatly reduced by conventional treatment. Our analysis also suggests the likelihood of infection due to contact with sewage-contaminated water (e.g. swimming, surfing, angling) or food (e.g. salads, shellfish) is extremely low or negligible based on very low predicted abundances and limited environmental survival of SARS-CoV-2. These conclusions are corroborated by the fact that tens of million cases of COVID-19 have occurred globally, but exposure to feces or wastewater has never been implicated as a transmission vector.
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Affiliation(s)
- David L Jones
- Centre for Environmental Biotechnology, School of Natural Sciences, Bangor University, Bangor, Gwynedd LL57 2UW, UK; UWA School of Agriculture and Environment, The University of Western Australia, Perth, WA 6009, Australia.
| | | | - David W Graham
- School of Engineering, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Alexander Corbishley
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, Easter Bush Campus Midlothian, EH25 9RG, UK
| | - James E McDonald
- Centre for Environmental Biotechnology, School of Natural Sciences, Bangor University, Bangor, Gwynedd LL57 2UW, UK
| | - Shelagh K Malham
- School of Ocean Sciences, Bangor University, Menai Bridge, Anglesey LL59 5AB, UK
| | - Luke S Hillary
- Centre for Environmental Biotechnology, School of Natural Sciences, Bangor University, Bangor, Gwynedd LL57 2UW, UK
| | - Thomas R Connor
- Organisms and Environment Division, School of Biosciences, Cardiff University, Cardiff CF10 3AX, UK; Public Health Wales, University Hospital of Wales, Cardiff CF14 4XW, UK
| | - William H Gaze
- European Centre for Environment and Human Health, University of Exeter Medical School, ESI, Penryn Campus, TR10 9FE, UK
| | - Ines B Moura
- Leeds Institute for Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds LS1 3EX, UK
| | - Mark H Wilcox
- Healthcare Associated Infections Research Group, Leeds Teaching Hospitals NHS Trust and University of Leeds, Leeds, UK
| | - Kata Farkas
- Centre for Environmental Biotechnology, School of Natural Sciences, Bangor University, Bangor, Gwynedd LL57 2UW, UK; School of Ocean Sciences, Bangor University, Menai Bridge, Anglesey LL59 5AB, UK
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8
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Jones DL, Baluja MQ, Graham DW, Corbishley A, McDonald JE, Malham SK, Hillary LS, Connor TR, Gaze WH, Moura IB, Wilcox MH, Farkas K. Shedding of SARS-CoV-2 in feces and urine and its potential role in person-to-person transmission and the environment-based spread of COVID-19. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020. [PMID: 32836117 DOI: 10.1016/j.scitotenv.2020.141364pmid-32836117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The recent detection of SARS-CoV-2 RNA in feces has led to speculation that it can be transmitted via the fecal-oral/ocular route. This review aims to critically evaluate the incidence of gastrointestinal (GI) symptoms, the quantity and infectivity of SARS-CoV-2 in feces and urine, and whether these pose an infection risk in sanitary settings, sewage networks, wastewater treatment plants, and the wider environment (e.g. rivers, lakes and marine waters). A review of 48 independent studies revealed that severe GI dysfunction is only evident in a small number of COVID-19 cases, with 11 ± 2% exhibiting diarrhea and 12 ± 3% exhibiting vomiting and nausea. In addition to these cases, SARS-CoV-2 RNA can be detected in feces from some asymptomatic, mildly- and pre-symptomatic individuals. Fecal shedding of the virus peaks in the symptomatic period and can persist for several weeks, but with declining abundances in the post-symptomatic phase. SARS-CoV-2 RNA is occasionally detected in urine, but reports in fecal samples are more frequent. The abundance of the virus genetic material in both urine (ca. 102-105 gc/ml) and feces (ca. 102-107 gc/ml) is much lower than in nasopharyngeal fluids (ca. 105-1011 gc/ml). There is strong evidence of multiplication of SARS-CoV-2 in the gut and infectious virus has occasionally been recovered from both urine and stool samples. The level and infectious capability of SARS-CoV-2 in vomit remain unknown. In comparison to enteric viruses transmitted via the fecal-oral route (e.g. norovirus, adenovirus), the likelihood of SARS-CoV-2 being transmitted via feces or urine appears much lower due to the lower relative amounts of virus present in feces/urine. The biggest risk of transmission will occur in clinical and care home settings where secondary handling of people and urine/fecal matter occurs. In addition, while SARS-CoV-2 RNA genetic material can be detected by in wastewater, this signal is greatly reduced by conventional treatment. Our analysis also suggests the likelihood of infection due to contact with sewage-contaminated water (e.g. swimming, surfing, angling) or food (e.g. salads, shellfish) is extremely low or negligible based on very low predicted abundances and limited environmental survival of SARS-CoV-2. These conclusions are corroborated by the fact that tens of million cases of COVID-19 have occurred globally, but exposure to feces or wastewater has never been implicated as a transmission vector.
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Affiliation(s)
- David L Jones
- Centre for Environmental Biotechnology, School of Natural Sciences, Bangor University, Bangor, Gwynedd LL57 2UW, UK; UWA School of Agriculture and Environment, The University of Western Australia, Perth, WA 6009, Australia.
| | | | - David W Graham
- School of Engineering, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Alexander Corbishley
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, Easter Bush Campus Midlothian, EH25 9RG, UK
| | - James E McDonald
- Centre for Environmental Biotechnology, School of Natural Sciences, Bangor University, Bangor, Gwynedd LL57 2UW, UK
| | - Shelagh K Malham
- School of Ocean Sciences, Bangor University, Menai Bridge, Anglesey LL59 5AB, UK
| | - Luke S Hillary
- Centre for Environmental Biotechnology, School of Natural Sciences, Bangor University, Bangor, Gwynedd LL57 2UW, UK
| | - Thomas R Connor
- Organisms and Environment Division, School of Biosciences, Cardiff University, Cardiff CF10 3AX, UK; Public Health Wales, University Hospital of Wales, Cardiff CF14 4XW, UK
| | - William H Gaze
- European Centre for Environment and Human Health, University of Exeter Medical School, ESI, Penryn Campus, TR10 9FE, UK
| | - Ines B Moura
- Leeds Institute for Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds LS1 3EX, UK
| | - Mark H Wilcox
- Healthcare Associated Infections Research Group, Leeds Teaching Hospitals NHS Trust and University of Leeds, Leeds, UK
| | - Kata Farkas
- Centre for Environmental Biotechnology, School of Natural Sciences, Bangor University, Bangor, Gwynedd LL57 2UW, UK; School of Ocean Sciences, Bangor University, Menai Bridge, Anglesey LL59 5AB, UK
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9
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Cristiane Pinto K, de Souza Lauretto M, Navarro Gonzaléz MIJ, Sato MIZ, Nardocci AC, Razzolini MTP. Assessment of health risks from recreational exposure to Giardia and Cryptosporidium in coastal bathing waters. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:23129-23140. [PMID: 32333348 DOI: 10.1007/s11356-020-08650-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 03/27/2020] [Indexed: 06/11/2023]
Abstract
Some Brazilian beaches are impacted by raw or poorly treated sewage. Thus, users (beachgoers, sports people, and children) are exposed to pathogens, which pose health concerns. This study aimed to estimate the probability of infection and disease by Giardia and Cryptosporidium, using the quantitative microbial risk assessment (QMRA), for three groups of bathers: children, adults, and open water swimmers. The concentrations of (oo)cysts were taken from a study run by CETESB (Environmental Company of Sao Paulo State) throughout 2011 and 2012, in which 203 samples were collected monthly and analyzed for (oo)cysts of Giardia and Cryptosporidium. Giardia was present in 43% of the samples, while Cryptosporidium in 13%. Infection probability was higher in beaches with more positive samples for Giardia cysts for the group of open water swimmers. In some cases, the highest annual risk obtained for giardiasis and cryptosporidiosis was 2.4 × 10-1 and 8.9 × 10-3 for open water swimmers, respectively, exceeding the incidence results found in the epidemiological study run in summer of 1999 in São Paulo state coast. The results bring insights to improve environmental quality in order to protect tourists' and residents' wellbeing.
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Affiliation(s)
- Karla Cristiane Pinto
- Environmental Company of the State of São Paulo, Department of Environmental Analyses, Av. Prof. Frederico Hermann Jr., 345, Sao Paulo, Brazil
| | - Marcelo de Souza Lauretto
- School of Arts, Science and Humanities, University of São Paulo-Brazil, R. Arlindo Bettio, 1000, Sao Paulo, Brazil
- NARA - Center for Research in Environmental Risk Assessment. School of Public Health, Environmental Health Department, Av. Dr Arnaldo 715, 1° andar, 01246-904, Sao Paulo, Brazil
| | - Maria Inés J Navarro Gonzaléz
- II/UNAM - Instituto de Ingeniería/Universidad Nacional Autónoma de México, Edifício 5, 1 er Nivel, Cub. 220-Circuito Escolar, Ciudad Universitaria, 04510, Mexico, D.F., Mexico
| | - Maria Inês Zanoli Sato
- Environmental Company of the State of São Paulo, Department of Environmental Analyses, Av. Prof. Frederico Hermann Jr., 345, Sao Paulo, Brazil
- NARA - Center for Research in Environmental Risk Assessment. School of Public Health, Environmental Health Department, Av. Dr Arnaldo 715, 1° andar, 01246-904, Sao Paulo, Brazil
| | - Adelaide Cássia Nardocci
- FSP/USP - School of Public Health, University of Sao Paulo, Environmental Health Department, Av. Dr Arnaldo 715, 1° andar, 01246-904, Sao Paulo, Brazil
- NARA - Center for Research in Environmental Risk Assessment. School of Public Health, Environmental Health Department, Av. Dr Arnaldo 715, 1° andar, 01246-904, Sao Paulo, Brazil
| | - Maria Tereza Pepe Razzolini
- FSP/USP - School of Public Health, University of Sao Paulo, Environmental Health Department, Av. Dr Arnaldo 715, 1° andar, 01246-904, Sao Paulo, Brazil.
- NARA - Center for Research in Environmental Risk Assessment. School of Public Health, Environmental Health Department, Av. Dr Arnaldo 715, 1° andar, 01246-904, Sao Paulo, Brazil.
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10
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Di Dato M, Galešić M, Šimundić P, Andričević R. A novel screening tool for the health risk in recreational waters near estuary: The Carrying Capacity indicator. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 694:133584. [PMID: 31400678 DOI: 10.1016/j.scitotenv.2019.133584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/20/2019] [Accepted: 07/23/2019] [Indexed: 06/10/2023]
Abstract
The present study aims to provide a conceptual framework to help practitioners to improve the quality of recreational waters near estuary, which may be affected by untreated wastewater from Combined Sewer Overflows (CSOs). When CSOs are activated, the concentration of bacteria (e.g., Enterococci and E. coli) in estuary increases, thereby resulting in a potential health threat to swimmers. Here, the bacterial exposure is evaluated using physically-based stochastic model for contaminant transport, while human health risk is determined by Quantitative Microbial Risk Assessment (QMRA). Based on human health risk framework, we quantify the Carrying Capacity (CC) of the recreational water body. Such an indicator is defined as the number of swimming individuals that can be sustained in a beach resort with an acceptable risk threshold. The CC increases by dilution processes and by reduction of the source concentration, which in turn depends on the improvements in the sewage system. The presented approach can be a useful screening tool for policy-makers and other stakeholders, thereby providing a potential solution to the trade-off between economic development and the sustainable ecosystem in coastal areas.
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Affiliation(s)
- Mariaines Di Dato
- Center of Excellence for Science and Technology-Integration of Mediterranean Region, University of Split, Croatia.
| | - Morena Galešić
- Faculty of Civil Engineering, Architecture and Geodesy, University of Split, Croatia
| | - Petra Šimundić
- Faculty of Civil Engineering, Architecture and Geodesy, University of Split, Croatia
| | - Roko Andričević
- Center of Excellence for Science and Technology-Integration of Mediterranean Region, University of Split, Croatia; Faculty of Civil Engineering, Architecture and Geodesy, University of Split, Croatia
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11
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Clark GG, Jamal R, Weidhaas J. Roofing material and irrigation frequency influence microbial risk from consuming homegrown lettuce irrigated with harvested rainwater. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 651:1011-1019. [PMID: 30266046 DOI: 10.1016/j.scitotenv.2018.09.277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/20/2018] [Accepted: 09/20/2018] [Indexed: 06/08/2023]
Abstract
Rooftop harvested rainwater has become an alternative, potable, and non-potable water source used around the world. In the United States, rooftop harvested rainwater is most commonly used for irrigation. Rooftop harvested rainwater may contain contaminants from bird or animal feces that may present a risk to water users. Different roofing materials may influence the survival of fecal bacteria on the rooftop prior to runoff during rainfall. In this study, three pathogen groups (E. coli, enterococci and Salmonella enterica) in rooftop runoff from three, replicated roof types (asphalt shingle, synthetic slate, and wood shake) were quantified in multiple rain events. Matched roofs were selected from locations with differing amounts of tree cover. Enterococci were the most frequently detected bacteria from all roof types. Wood shake and asphalt shingle roofing materials had the poorest microbial water quality. Rainwater runoff from two of the six buildings failed to meet United States Food and Drug Administration microbial standards for irrigation water. A quantitative microbial risk assessment indicated that the annual probability of illness from consuming lettuce irrigated with rooftop harvested rainwater varied by roofing material, irrigation water withholding period, and exposure frequency. Consuming lettuce immediately after irrigation with rooftop rainwater presented the highest human health risk based on the probability of illness from E. coli and enterococci exposure. Withholding irrigation by 1 day prior to harvest decreased the annual probability of illness from E. coli by 2 log, but had a minimal effect on the risk from enterococci.
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Affiliation(s)
- Gemma G Clark
- Civil and Environmental Engineering, University of Utah, 110 Central Campus Drive Suite 2000, Salt Lake City, UT 84112, USA
| | - Rubayat Jamal
- Civil and Environmental Engineering, University of Utah, 110 Central Campus Drive Suite 2000, Salt Lake City, UT 84112, USA
| | - Jennifer Weidhaas
- Civil and Environmental Engineering, University of Utah, 110 Central Campus Drive Suite 2000, Salt Lake City, UT 84112, USA.
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12
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DeFlorio-Barker S, Arnold BF, Sams EA, Dufour AP, Colford JM, Weisberg SB, Schiff KC, Wade TJ. Child environmental exposures to water and sand at the beach: Findings from studies of over 68,000 subjects at 12 beaches. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2018; 28:93-100. [PMID: 29115288 PMCID: PMC5814355 DOI: 10.1038/jes.2017.23] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 07/30/2017] [Indexed: 05/13/2023]
Abstract
Swimming and recreating in lakes, oceans, and rivers is common, yet the literature suggests children may be at greater risk of illness following such exposures. These effects might be due to differences in immunity or differing behavioral factors such as poorer hygiene, longer exposures to, and greater ingestion of potentially contaminated water and sand. We pooled data from 12 prospective cohorts (n=68,685) to examine exposures to potentially contaminated media such as beach water and sand among children compared with adults, and conducted a simulation using self-reported time spent in the water and volume of water swallowed per minute by age to estimate the total volume of water swallowed per swimming event by age category. Children aged 4-7 and 8-12 years had the highest exposures to water, sand, and algae compared with other age groups. Based on our simulation, we found that children (6-12 years) swallow a median of 36 ml (90th percentile=150 ml), whereas adults aged ≥35 years swallow 9 ml (90th percentile=64 ml) per swimming event, with male children swallowing a greater amount of water compared with females. These estimates may help to reduce uncertainty surrounding routes and durations of recreational exposures and can support the development of chemical and microbial risk assessments.
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Affiliation(s)
- Stephanie DeFlorio-Barker
- National Health and Environmental Effects Research Laboratory, Office of Research and Development, US Environmental Protection Agency, 109 TW Alexander MC 58C, Research Triangle Park, North Carolina, USA
| | - Benjamin F Arnold
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkley, California, USA
| | - Elizabeth A Sams
- National Health and Environmental Effects Research Laboratory, Office of Research and Development, US Environmental Protection Agency, 109 TW Alexander MC 58C, Research Triangle Park, North Carolina, USA
| | - Alfred P Dufour
- National Exposure Research Laboratory, Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, North Carolina, USA
| | - John M Colford
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkley, California, USA
| | - Steven B Weisberg
- Southern California Coastal Water Research Project, Costa Mesa, California, USA
| | - Kenneth C Schiff
- Southern California Coastal Water Research Project, Costa Mesa, California, USA
| | - Timothy J Wade
- National Health and Environmental Effects Research Laboratory, Office of Research and Development, US Environmental Protection Agency, 109 TW Alexander MC 58C, Research Triangle Park, North Carolina, USA
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13
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Soller JA, Schoen M, Steele JA, Griffith JF, Schiff KC. Incidence of gastrointestinal illness following wet weather recreational exposures: Harmonization of quantitative microbial risk assessment with an epidemiologic investigation of surfers. WATER RESEARCH 2017; 121:280-289. [PMID: 28558279 DOI: 10.1016/j.watres.2017.05.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 05/02/2017] [Accepted: 05/08/2017] [Indexed: 05/26/2023]
Abstract
We modeled the risk of gastrointestinal (GI) illness associated with recreational exposures to marine water following storm events in San Diego County, California. We estimated GI illness risks via quantitative microbial risk assessment (QMRA) techniques by consolidating site specific pathogen monitoring data of stormwater, site specific dilution estimates, literature-based water ingestion data, and literature based pathogen dose-response and morbidity information. Our water quality results indicated that human sources of contamination contribute viral and bacterial pathogens to streams draining an urban watershed during wet weather that then enter the ocean and affect nearshore water quality. We evaluated a series of approaches to account for uncertainty in the norovirus dose-response model selection and compared our model results to those from a concurrently conducted epidemiological study that provided empirical estimates for illness risk following ocean exposure. The preferred norovirus dose-response approach yielded median risk estimates for water recreation-associated illness (15 GI illnesses per 1000 recreation events) that closely matched the reported epidemiological results (12 excess GI illnesses per 1000 wet weather recreation events). The results are consistent with norovirus, or other pathogens associated with norovirus, as an important cause of gastrointestinal illness among surfers in this setting. This study demonstrates the applicability of QMRA for recreational water risk estimation, even under wet weather conditions and describes a process that might be useful in developing site-specific water quality criteria in this and other locations.
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Affiliation(s)
- Jeffrey A Soller
- Soller Environmental, LLC, 3022 King St., Berkeley, CA 94703, USA.
| | - Mary Schoen
- Soller Environmental, LLC, 3022 King St., Berkeley, CA 94703, USA
| | - Joshua A Steele
- Southern California Coastal Water Research Project, 3535 Harbor Blvd #110, Costa Mesa, CA 92626, USA
| | - John F Griffith
- Southern California Coastal Water Research Project, 3535 Harbor Blvd #110, Costa Mesa, CA 92626, USA
| | - Kenneth C Schiff
- Southern California Coastal Water Research Project, 3535 Harbor Blvd #110, Costa Mesa, CA 92626, USA
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14
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Abia ALK, Ubomba-Jaswa E, Genthe B, Momba MNB. Quantitative microbial risk assessment (QMRA) shows increased public health risk associated with exposure to river water under conditions of riverbed sediment resuspension. THE SCIENCE OF THE TOTAL ENVIRONMENT 2016; 566-567:1143-1151. [PMID: 27297265 DOI: 10.1016/j.scitotenv.2016.05.155] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 05/20/2016] [Accepted: 05/21/2016] [Indexed: 06/06/2023]
Abstract
Although higher microbial concentrations have been reported in sediments than in the overlying water column, most quantitative microbial risk assessment (QMRA) studies have not clearly indicated the contribution of sediment-borne pathogens to estimated risks. Thus, the present study aimed at determining the public health risk associated with exposure to pathogenic bacteria in polluted river water under undisturbed conditions and conditions of sediment resuspension in the Apies River, Gauteng, South Africa. Microbial pathogens were isolated and identified using culture and molecular methods. The beta-Poisson dose-response model was used to estimate the probability of infection (Pi) with the various pathogens, following accidental/intentional ingestion of 1mL or 100mL (or 50mL) of untreated river water. Mean wet season Escherichia coli counts ranged between 5.8E+01 and 8.8E+04MPN/100mL (water column) and between 2.40E+03 and 1.28E+05MPN/100mL (sediments). Mean dry season E. coli counts ranged between 5.11E+00 and 3.40E+03MPN/100mL (water column) and between 5.09E+00 and 6.30E+03MPN/100mL (sediments). Overall (water and sediments) Vibrio cholerae was the most detected pathogen (58.8%) followed by Salmonella spp. (23.9%) and Shigella (10.1%). Ingestion of 1mL of river water could lead to 0%-4% and 1%-74% Pi with E. coli during the dry and wet season, respectively. During the dry season, the Pi with V. cholerae, Salmonella spp. and Shigella spp. were 0%-1.39%, 0%-4.11% and 0%-0.16% respectively, depending on volume of water ingested. The risks of infections with all microorganisms increased during the wet season. A 2-log increase in water E. coli count following sediments disturbance led to approximately 10 times higher Pi with E. coli than when sediments were undisturbed. Therefore, the use of the untreated water from the Apies River for drinking, household purposes or recreational activities poses a potential health risk to the users of the river.
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Affiliation(s)
- Akebe Luther King Abia
- Department of Environmental, Water and Earth Science, Tshwane University of Technology, Arcadia Campus, 175 Nelson Mandela Drive, Pretoria 0001, South Africa.
| | - Eunice Ubomba-Jaswa
- Natural Resources and the Environment, CSIR, PO Box 395, Pretoria 0001, South Africa.
| | - Bettina Genthe
- Natural Resources and the Environment, CSIR, Stellenbosch, South Africa.
| | - Maggy Ndombo Benteke Momba
- Department of Environmental, Water and Earth Science, Tshwane University of Technology, Arcadia Campus, 175 Nelson Mandela Drive, Pretoria 0001, South Africa.
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15
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Abstract
This paper reviews the latest evidence provided by epidemiological studies and quantitative microbial risk assessments (QMRAs) of infection risk from recreational water use. Studies for review were selected following a PubMed search for articles published between January 2010 and April 2014. Epidemiological studies show a generally elevated risk of gastrointestinal illness in bathers compared to non-bathers but often no clear association with water quality as measured by faecal indicator bacteria; this is especially true where study sites are impacted by non-point source pollution. Evidence from QMRAs support the lack of a consistent water quality association for non-point source-impacted beaches. It is suggested that source attribution, through quantified microbial source apportionment, linked with appropriate use of microbial source tracking methods should be employed as an integral part of future epidemiological surveys.
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Affiliation(s)
- Lorna Fewtrell
- Centre for Research into Environment and Health (CREH), Department of Geography and Earth Sciences, Aberystwyth University, Ceredigion, SY23 3DB UK
| | - David Kay
- Centre for Research into Environment and Health (CREH), Department of Geography and Earth Sciences, Aberystwyth University, Ceredigion, SY23 3DB UK
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16
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Leonard AFC, Zhang L, Balfour AJ, Garside R, Gaze WH. Human recreational exposure to antibiotic resistant bacteria in coastal bathing waters. ENVIRONMENT INTERNATIONAL 2015; 82:92-100. [PMID: 25832996 DOI: 10.1016/j.envint.2015.02.013] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 02/23/2015] [Accepted: 02/24/2015] [Indexed: 05/24/2023]
Abstract
Infections caused by antibiotic resistant bacteria (ARB) are associated with poor health outcomes and are recognised globally as a serious health problem. Much research has been conducted on the transmission of ARB to humans. Yet the role the natural environment plays in the spread of ARB and antibiotic resistance genes is not well understood. Antibiotic resistant bacteria have been detected in natural aquatic environments, and ingestion of seawater during water sports is one route by which many people could be directly exposed. The aim was to estimate the prevalence of resistance to one clinically important class of antibiotics (third-generation cephalosporins (3GCs)) amongst Escherichia coli in coastal surface waters in England and Wales. Prevalence data was used to quantify ingestion of 3GC-resistant E. coli (3GCREC) by people participating in water sports in designated coastal bathing waters. A further aim was to use this value to derive a population-level estimate of exposure to these bacteria during recreational use of coastal waters in 2012. The prevalence of 3GC-resistance amongst E. coli isolated from coastal surface waters was estimated using culture-based methods. This was combined with the density of E. coli reported in designated coastal bathing waters along with estimations of the volumes of water ingested during various water sports reported in the literature to calculate the mean number of 3GCREC ingested during different water sports. 0.12% of E. coli isolated from surface waters were resistant to 3GCs. This value was used to estimate that in England and Wales over 6.3 million water sport sessions occurred in 2012 that resulted in the ingestion of at least one 3GCREC. Despite the low prevalence of resistance to 3GCs amongst E. coli in surface waters, there is an identifiable human exposure risk for water users, which varies with the type of water sport undertaken. The relative importance of this exposure is likely to be greater in areas where a large proportion of the population enjoys water sports. Millions of water sport sessions occurred in 2012 that were likely to have resulted in people ingesting E. coli resistant to a single class of antibiotics (3GCs). However, this is expected to be a significant underestimate of recreational exposure to all ARB in seawater. This is the first study to use volumes of water ingested during different water sports to estimate human exposure to ARB. Further work needs to be done to elucidate the health implications and clinical relevance of exposure to ARB in both marine and fresh waters in order to fully understand the risk to public health.
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Affiliation(s)
- Anne F C Leonard
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, UK.
| | - Lihong Zhang
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, UK.
| | - Andrew J Balfour
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, UK
| | - Ruth Garside
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, UK.
| | - William H Gaze
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, UK.
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17
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Harding AK, Stone DL, Cardenas A, Lesser V. Risk behaviors and self-reported illnesses among Pacific Northwest surfers. JOURNAL OF WATER AND HEALTH 2015; 13:230-242. [PMID: 25719482 DOI: 10.2166/wh.2014.231] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Although surfers have high incidental exposure to marine waters, no studies have investigated if surfer risk behaviors (such as surfing during advisories, near an outfall, during a rain event, or use of personal protective equipment) increase or decrease the risk of acquiring waterborne illnesses. We used a web-based survey to assess the association between risk-based behaviors and self-reported illnesses among Pacific Northwest surfers. Commonly reported illnesses include: ear infection or discharge (38%), sore throat or a cough (28%), diarrhea (16%), fever (10.5%), and vomiting (7%). Surfing often during rain events was associated with an increased likelihood of diarrhea (OR = 2.7; 95% CI: 1.4-5.47), sore throat (OR = 1.26; 95% CI: 1.01-2.05), and ear infection (OR = 1.39; 95% CI: 1.01-2.32). Surfing during a health advisory was associated with increased likelihood of diarrhea (OR = 1.94; 95% CI: 1.03-4.64) and sore throat (OR = 2.32; 95% CI: 1.23-4.40). Other behaviors associated with increased illnesses include body surfing, surfing near an outfall, frequency of surfing, and use of ear plugs. Approximately 40% of surfers were unaware if they had surfed during an active health advisory and 29% knowingly surfed during advisories, suggesting the need to engage this population about potential harm and behaviors that may increase health risk.
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Affiliation(s)
- Anna K Harding
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, 100 Milam Hall, Oregon State University, Corvallis, OR, 97331, USA E-mail:
| | - David L Stone
- Department of Environmental and Molecular Toxicology, 327 Weniger Hall, Oregon State University, Corvallis, OR, 97331, USA
| | - Andres Cardenas
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, 100 Milam Hall, Oregon State University, Corvallis, OR, 97331, USA E-mail:
| | - Virginia Lesser
- Department of Statistics, Survey Research Center, 46 Kidder Hall, Oregon State University, Corvallis, OR, 97331, USA
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18
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Sabino R, Rodrigues R, Costa I, Carneiro C, Cunha M, Duarte A, Faria N, Ferreira FC, Gargaté MJ, Júlio C, Martins ML, Nevers MB, Oleastro M, Solo-Gabriele H, Veríssimo C, Viegas C, Whitman RL, Brandão J. Routine screening of harmful microorganisms in beach sands: implications to public health. THE SCIENCE OF THE TOTAL ENVIRONMENT 2014; 472:1062-1069. [PMID: 24355396 DOI: 10.1016/j.scitotenv.2013.11.091] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 10/29/2013] [Accepted: 11/18/2013] [Indexed: 06/03/2023]
Abstract
Beaches worldwide provide recreational opportunities to hundreds of millions of people and serve as important components of coastal economies. Beach water is often monitored for microbiological quality to detect the presence of indicators of human sewage contamination so as to prevent public health outbreaks associated with water contact. However, growing evidence suggests that beach sand can harbor microbes harmful to human health, often in concentrations greater than the beach water. Currently, there are no standards for monitoring, sampling, analyzing, or managing beach sand quality. In addition to indicator microbes, growing evidence has identified pathogenic bacteria, viruses, and fungi in a variety of beach sands worldwide. The public health threat associated with these populations through direct and indirect contact is unknown because so little research has been conducted relating to health outcomes associated with sand quality. In this manuscript, we present the consensus findings of a workshop of experts convened in Lisbon, Portugal to discuss the current state of knowledge on beach sand microbiological quality and to develop suggestions for standardizing the evaluation of sand at coastal beaches. The expert group at the "Microareias 2012" workshop recommends that 1) beach sand should be screened for a variety of pathogens harmful to human health, and sand monitoring should then be initiated alongside regular water monitoring; 2) sampling and analysis protocols should be standardized to allow proper comparisons among beach locations; and 3) further studies are needed to estimate human health risk with exposure to contaminated beach sand. Much of the manuscript is focused on research specific to Portugal, but similar results have been found elsewhere, and the findings have worldwide implications.
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Affiliation(s)
- R Sabino
- Reference Unit for Systemic Infections and Zoonosis, Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Portugal
| | - R Rodrigues
- Microbiology Laboratory, Department of Environmental Health, National Institute of Health Dr. Ricardo Jorge, Portugal
| | - I Costa
- Laboratory of Molecular Biology, Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Av. Padre Cruz, 1649-016 Lisbon, Portugal
| | - C Carneiro
- REQUIMTE/Centro de Química Fina e Biotecnologia, Departamento de Química, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, Portugal
| | - M Cunha
- Portuguese Environment Agency, Environment Reference Laboratory, Portugal
| | - A Duarte
- Faculty of Pharmacy, iMed.UL-Research Institute for Medicines and Pharmaceutical Sciences, University of Lisboa, Portugal
| | - N Faria
- Microbiology Laboratory, Department of Environmental Health, National Institute of Health Dr. Ricardo Jorge, Portugal
| | - F C Ferreira
- Microbiology Laboratory, Department of Environmental Health, National Institute of Health Dr. Ricardo Jorge, Portugal
| | - M J Gargaté
- Reference Unit for Systemic Infections and Zoonosis, Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Portugal
| | - C Júlio
- Reference Unit for Gastro-intestinal Infections, Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Portugal
| | - M L Martins
- Unit of Medical Microbiology, Instituto de Higiene e Medicina Tropical-Centro de Recursos Microbiológicos (CREM), Universidade Nova de Lisboa (UNL), Portugal
| | - M B Nevers
- United States Geological Survey, Great Lakes Science Center, Porter, IN, USA
| | - M Oleastro
- Laboratory of Molecular Biology, Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Av. Padre Cruz, 1649-016 Lisbon, Portugal
| | - H Solo-Gabriele
- Department of Civil, Architectural, and Environmental Engineering, University of Miami, Coral Gables, FL, USA
| | - C Veríssimo
- Reference Unit for Systemic Infections and Zoonosis, Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Portugal
| | - C Viegas
- Lisbon School of Health Technology, Polytechnic Institute of Lisboa, Portugal
| | - R L Whitman
- United States Geological Survey, Great Lakes Science Center, Porter, IN, USA
| | - J Brandão
- Reference Unit for Systemic Infections and Zoonosis, Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Portugal.
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19
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Quantitative microbial risk assessment of pathogenic vibrios in marine recreational waters of southern california. Appl Environ Microbiol 2012; 79:294-302. [PMID: 23104412 DOI: 10.1128/aem.02674-12] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
This study investigated the occurrence of three types of vibrios in Southern California recreational beach waters during the peak marine bathing season in 2007. Over 160 water samples were concentrated and enriched for the detection of vibrios. Four sets of PCR primers, specific for Vibrio cholerae, V. parahaemolyticus, and V. vulnificus species and the V. parahaemolyticus toxin gene, respectively, were used for the amplification of bacterial genomic DNA. Of 66 samples from Doheny State Beach, CA, 40.1% were positive for V. cholerae and 27.3% were positive for V. parahaemolyticus, and 1 sample (1.5%) was positive for the V. parahaemolyticus toxin gene. Of the 96 samples from Avalon Harbor, CA, 18.7% were positive for V. cholerae, 69.8% were positive for V. parahaemolyticus, and 5.2% were positive for the V. parahaemolyticus toxin gene. The detection of the V. cholerae genetic marker was significantly more frequent at Doheny State Beach, while the detection of the V. parahaemolyticus genetic marker was significantly more frequent at Avalon Harbor. A probability-of-illness model for V. parahaemolyticus was applied to the data. The risk for bathers exposed to recreational waters at two beaches was evaluated through Monte Carlo simulation techniques. The results suggest that the microbial risk from vibrios during beach recreation was below the illness benchmark set by the U.S. EPA. However, the risk varied with location and the type of water recreation activities. Surfers and children were exposed to a higher risk of vibrio diseases. Microbial risk assessment can serve as a useful tool for the management of risk related to opportunistic marine pathogens.
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Tseng LY, Jiang SC. Comparison of recreational health risks associated with surfing and swimming in dry weather and post-storm conditions at Southern California beaches using quantitative microbial risk assessment (QMRA). MARINE POLLUTION BULLETIN 2012; 64:912-918. [PMID: 22472787 DOI: 10.1016/j.marpolbul.2012.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 03/07/2012] [Accepted: 03/09/2012] [Indexed: 05/31/2023]
Abstract
Southern California is an increasingly urbanized hotspot for surfing, thus it is of great interest to assess the human illness risks associated with this popular ocean recreational water sport from exposure to fecal bacteria contaminated coastal waters. Quantitative microbial risk assessments were applied to eight popular Southern California beaches using readily available enterococcus and fecal coliform data and dose-response models to compare health risks associated with surfing during dry weather and storm conditions. The results showed that the level of gastrointestinal illness risks from surfing post-storm events was elevated, with the probability of exceeding the US EPA health risk guideline up to 28% of the time. The surfing risk was also elevated in comparison with swimming at the same beach due to ingestion of greater volume of water. The study suggests that refinement of dose-response model, improving monitoring practice and better surfer behavior surveillance will improve the risk estimation.
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Affiliation(s)
- Linda Y Tseng
- Department of Civil and Environmental Engineering, University of California, Irvine, CA 926917, USA
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Sunger N, Teske SS, Nappier S, Haas CN. Recreational use assessment of water-based activities, using time-lapse construction cameras. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2012; 22:281-90. [PMID: 22354175 DOI: 10.1038/jes.2012.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Recreational exposure to surface waters during periods of increased pathogen concentration may lead to a significantly higher risk of illness. However, estimates of elementary exposure factors necessary to evaluate health risk (i.e., usage distributions and exposure durations) are not available for many non-swimming water-related activities. No prior studies have assessed non-swimming water exposure with respect to factors leading to impaired water quality from increased pathogen concentration, such as weather condition (rain events produce increased runoff and sewer overflows) and type of day (heavy recreational periods). We measured usage patterns and evaluated the effect of weather and type of day at eight water sites located within Philadelphia, by using a novel "time lapse photography" technology during three peak recreational seasons (May-September) 2008-2010. Camera observations validated with simultaneous in-person surveys exhibited a strong correlation (R(2)=0.81 to 0.96) between the two survey techniques, indicating that the application of remote photography in collecting human exposure data was appropriate. Recreational activities usage varied more on a temporal basis than due to inclement weather. Only 14% (6 out of 44) of the site-specific activity combinations showed dry weather preference, whereas 41.5% (17 out of 41) of the combinations indicated greater usage on weekends as compared with weekday. In general, the log normal distribution described the playing and wading duration distribution, while the gamma distribution was the best fit for fishing durations. Remote photography provided unbiased, real-time human exposure data and was less personnel intensive compared with traditional survey methods. However, there are potential limitations associated with remote surveillance data related to its limited view. This is the first study to report that time lapse cameras can be successfully applied to assess water-based human recreational patterns and can provide precise exposure statistics for non-swimming recreational exposures.
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Affiliation(s)
- Neha Sunger
- Department of Civil, Architectural, and Environmental Engineering, Drexel University, Philadelphia, PA 19104, USA.
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Carolan JV, Hughes CE, Hoffmann EL. Dose assessment for marine biota and humans from discharge of (131)I to the marine environment and uptake by algae in Sydney, Australia. JOURNAL OF ENVIRONMENTAL RADIOACTIVITY 2011; 102:953-63. [PMID: 22180886 DOI: 10.1016/j.jenvrad.2009.10.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Iodine-131 reaches the marine environment through its excretion to the sewer by nuclear medicine patients followed by discharge through coastal and deepwater out falls. 131I has been detected in macroalgae,which bio-accumulate iodine, growing near the coastal out fall of Cronulla sewage treatment plant (STP) since 1995. During this study, (131)I levels in liquid effluent and sludge from three Sydney STP's as well as in macroalgae (Ulva sp. and Ecklonia radiata) growing near their shoreline out falls were measured. Concentration factors of 176 for Ulva sp. and 526 for E. radiata were derived. Radiation dose rates to marine biota from (131)I discharged to coastal waters calculated using the ERICA dose assessment tool were below the ERICA screening level of 10 μGy/hr. Radiation dose rates to humans from immersion in seawater or consumption of Ulva sp. containing (131)I were three and two orders of magnitude below the IAEA screening level of 10 μSv/year, respectively.
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Dorevitch S, Panthi S, Huang Y, Li H, Michalek AM, Pratap P, Wroblewski M, Liu L, Scheff PA, Li A. Water ingestion during water recreation. WATER RESEARCH 2011; 45:2020-8. [PMID: 21227479 DOI: 10.1016/j.watres.2010.12.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 11/26/2010] [Accepted: 12/06/2010] [Indexed: 05/24/2023]
Abstract
Quantitative risk assessments have estimated health risks of water recreation. One input to risk assessment models is the rate of water ingestion. One published study estimated rates of water ingestion during swimming, but estimates of water ingestion are not available for common limited contact water recreation activities such as canoeing, fishing, kayaking, motor boating, and rowing. In the summer of 2009 two related studies were conducted to estimate water ingestion during these activities. First, at Chicago area surface waters, survey research methods were utilized to characterize self-reported estimates of water ingestion during canoeing, kayaking, and fishing among 2705 people. Second, at outdoor swimming pools, survey research methods and the analysis of cyanuric acid, a tracer of swimming pool water, were used to characterize water ingestion among 662 people who engaged in a variety of full-contact and limited-contact recreational activities. Data from the swimming study was used to derive translation factors that quantify the volume of self-reported estimates. At surface waters, less than 2% of canoers and kayakers reported swallowing a teaspoon or more and 0.5% reported swallowing a mouthful or more. Swimmers in a pool were about 25-50 times more likely to report swallowing a teaspoon of water compared to those who participate in limited-contact recreational activities on surface waters. Mean and upper confidence estimates of water ingestion during limited-contact recreation on surface waters are about 3-4 mL and 10-15 mL, respectively. These estimates of water ingestion rates may be useful in modeling the health risks of water recreation.
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Affiliation(s)
- Samuel Dorevitch
- University of Illinois at Chicago School of Public Health, Division of Environmental and Occupational Health Sciences, 2121 W. Taylor, M/C 922, Chicago, IL 60612, USA.
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Honner S, Kudela RM, Handler E. Bilateral mastoiditis from red tide exposure. J Emerg Med 2010; 43:663-6. [PMID: 20800412 DOI: 10.1016/j.jemermed.2010.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Revised: 04/27/2010] [Accepted: 06/12/2010] [Indexed: 11/16/2022]
Abstract
BACKGROUND Bilateral mastoiditis in adults has previously been reported only in association with diabetes mellitus or immunocompromised patients. OBJECTIVES To describe a case of bilateral mastoiditis in a healthy adult and to investigate the etiology. CASE REPORT A 53-year-old woman presented to the Emergency Department with bilateral otitis externa and mastoiditis after scuba diving during a harmful algal bloom, commonly known as a "red tide." The levels of coliform bacteria recorded at the time and location of her dive exceeded health regulatory limits and correlate with her atypical culture results. CONCLUSION Elevated bacterial counts that result from harmful algal blooms may account for this rare infection.
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Affiliation(s)
- Samantha Honner
- Department of Emergency Medicine, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
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