Bioaerosolization behaviour of potential pathogenic microorganisms from wastewater treatment plants: Occurrence profile, social function and health risks

Wastewater treatment plants (WWTPs) are the leading sources of potential pathogenic bioaerosol that cause non-negligible health risks. However, bioaerosolization behaviour of potential pathogenic microorganisms (PPMs) migrating from wastewater to the atmosphere is still unclear. This study investigated the occurrence profile of PPMs in wastewater, sludge and bioaerosol, then analyzed bioaerosolization level, impact factors and social function. Staphylococcus aureus was selected as the target due to its pathogenicity, and the health risks of workers, engineers and researchers wearing various masks (N90, N95 and medical masks) were evaluated. The results showed that there were 38 and 64 PPMs in bioaerosol from plant A and B. Streptomyces in plant A (average bioaerosolization index, BI= 237.71) and Acinetobacter in plant B (average BI = 505.88) were more likely to migrate from wastewater to the atmosphere forming bioaerosol. Environmental factors (relative humidity, wind speed and temperature) affected both BI and microbial species of PPMs in different ways. PPMs related to fermentation, aerobic chemoheterotrophy, and chemoheterotrophy are the most abundant. Meanwhile microbial networks from plants A and B showed that PPMs were well-connected. Emission level of Staphylococcus aureus bioaerosol can reach 980 ± 309.19 CFU/m3 in plant A and 715.55 ± 44.17 CFU/m3 in plant B. For three exposure population, disease burden (DB) and annual probability infection (Py) of Staphylococcus aureus bioaerosol in two plants were both higher than the U.S.EPA benchmark (10-4 DALYs pppy). All three masks (N90,N95 and medical masks) can decrease Py and DB by at least one order of magnitude. This study illustrated the bioaerosolization behaviour of PPMs comprehensively, which provides a scientific basis for exposure risk prevention and control.

Modeling strain variability in Campylobacter jejuni thermal inactivation by quantifying the number of strains required

There is a limited understanding of the survival responses of Campylobacter jejuni during thermal processing, which must be investigated for appropriate risk assessment and processing. Therefore, we aimed to elucidate the survival response of C. jejuni and develop a predictive model considering strain variability and uncertainty, which are important for quantitative microbial risk assessment (QMRA) or risk-based processing control measures. We employed the most probable curve (MPC) method to consider the uncertainty in cell concentrations. Further, the multivariate normal (MVN) distribution served as a model for strain variability in bacterial survival behavior. The prediction curves from the MVN successfully captured the parameter variability of the most probable curves of each strain. More than ten reference strains effectively described the strain variability in parameters using the MVN distribution. The findings indicated that, with sufficient strain data, the MVN could estimate the strain variability, including unknown strains. The multi-level model for strain variability can potentially become a specialized tool for QMRA and risk-based processing controls. The combined approach of MPC and MVN provides valuable insights into strain variability, emphasizing the importance of accounting for variability and uncertainty in predictive models for QMRA and risk-based processing control measures.

Assessing environmental exposure to viruses in wastewater treatment plant and swine farm scenarios with next-generation sequencing and occupational risk approaches

Occupational exposure to pathogens can pose health risks. This study investigates the viral exposure of workers in a wastewater treatment plant (WWTP) and a swine farm by analyzing aerosol and surfaces samples. Viral contamination was evaluated using quantitative polymerase chain reaction (qPCR) assays, and target enrichment sequencing (TES) was performed to identify the vertebrate viruses to which workers might be exposed. Additionally, Quantitative Microbial Risk Assessment (QMRA) was conducted to estimate the occupational risk associated with viral exposure for WWTP workers, choosing Human Adenovirus (HAdV) as the reference pathogen. In the swine farm, QMRA was performed as an extrapolation, considering a hypothetical zoonotic virus with characteristics similar to Porcine Adenovirus (PAdV). The modelled exposure routes included aerosol inhalation and oral ingestion through contaminated surfaces and hand-to-mouth contact. HAdV and PAdV were widespread viruses in the WWTP and the swine farm, respectively, by qPCR assays. TES identified human and other vertebrate viruses WWTP samples, including viruses from families such as Adenoviridae, Circoviridae, Orthoherpesviridae, Papillomaviridae, and Parvoviridae. In the swine farm, most of the identified vertebrate viruses were porcine viruses belonging to Adenoviridae, Astroviridae, Circoviridae, Herpesviridae, Papillomaviridae, Parvoviridae, Picornaviridae, and Retroviridae. QMRA analysis revealed noteworthy risks of viral infections for WWTP workers if safety measures are not taken. The probability of illness due to HAdV inhalation was higher in summer compared to winter, while the greatest risk from oral ingestion was observed in workspaces during winter. Swine farm QMRA simulation suggested a potential occupational risk in the case of exposure to a hypothetical zoonotic virus. This study provides valuable insights into WWTP and swine farm worker's occupational exposure to human and other vertebrate viruses. QMRA and NGS analyses conducted in this study will assist managers in making evidence-based decisions, facilitating the implementation of protection measures, and risk mitigation practices for workers.

Effects of wastewater treatment plant effluent on microbial risks of pathogens and their antibiotic resistance in the receiving river

The increase in effluent discharge from wastewater treatment plants (WWTPs) into urban rivers has raised concerns about the potential effects on pathogen risks. This study utilized metagenomic sequencing combined with flow cytometry to analyze pathogen concentrations and antibiotic resistance in a typical effluent-receiving river. Quantitative microbial risk assessment (QMRA) was employed to assess the microbial risks of pathogens. The results indicated obvious spatial-temporal differences (i.e., summer vs. winter and effluent vs. river) in microbial composition. Microcystis emerged as a crucial species contributing to these variations. Pathogen concentrations were found to be higher in the river than in the effluent, with the winter exhibiting higher concentrations compared to the summer. The effluent discharge slightly increased the pathogen concentrations in the river in summer but dramatically reduced them in winter. The combined effects of cyanobacterial bloom and high temperature were considered key factors suppressing pathogen concentrations in summer. Moreover, the prevalence of antibiotic resistance of pathogens in the river was inferior to that in the effluent, with higher levels in winter than in summer. Three high-concentration pathogens (Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa) were selected for QMRA. The results showed that the risks of pathogens exceeded the recommended threshold value. Escherichia coli posed the highest risks. And the fishing scenario posed significantly higher risks than the walking scenario. Importantly, the effluent discharge helped reduce the microbial risks in the receiving river in winter. The study contributes to the management and decision-making regarding microbial risks in the effluent-receiving river.

Quantitative health risk assessment of microbial hazards from water sources for community and self-supply drinking water systems

In low and medium income countries (LMIC) drinking water sources (wells and boreholes) often contain a high number of pathogenic microorganisms, that can pose significant human and environmental health risks. In this study, a quantitative microbial risk assessment approach based on existing literature was conducted to evaluate and compare the quantitative health risks associated with different age groups using various drinking water supply systems. Results showed that both community-supply and self-supply modes exhibit similar levels of risk. However, the self-supply water source consistently showed higher risks compared to the community-supply one. Borehole water was found to be a more suitable option than well water, consistently showing between 5 and 8 lower health risks for E. coli and fecal coliform levels, respectively. The sensitivity analysis further showed the importance of prioritizing the reduction of E. coli concentration in well water and fecal coliform concentration in borehole water. This study offers a fresh perception on quantifying the impact of exposure concentration and age groups, shedding light on how they affect environmental health risks. These findings provide valuable insights for stakeholders involved in the management and protection of water sources.

Quantitative microbial risk assessment of the gastrointestinal risks to swimmers at Southeast Asian urban beaches using site-specific and combined autochthonous and fecal bacteria exposure data

Recreational exposure to microbial pollution at urban beaches poses a health risk to beachgoers. The accurate quantification of such risks is crucial in managing beaches effectively and establishing warning guidelines. In this study, we employed a quantitative microbial risk assessment (QMRA) framework to assess marine water quality and estimate the risks associated with Vibrio parahaemolyticus, an autochthonous pathogen that causes gastrointestinal illnesses, and enterococci, a traditional fecal bacteria indicator. The microbial contamination levels of V. parahaemolyticus and enterococci were determined from 48 water samples collected at two beaches in Thailand during dry and wet seasons. The accidentally ingested water volumes were obtained through a survey involving 438 respondents. The probability of illness (Pill) was estimated using dose-response models and Monte Carlo simulation. The results revealed that enterococci posed a higher risk of illness than V. parahaemolyticus at all seven study sites. The median combined gastrointestinal (GI) risk from both bacteria at all sites met the US EPA risk benchmark of 0.036 and the 0.05 benchmark set by the WHO, but the 95th percentile risk data at all sites exceeded the benchmarks. This emphasizes the need for the continuous monitoring and management of microbial pollution at these sites. The site-specific exposure data showed higher estimated risks with increased variations compared to the WHO-referenced values, which highlights the significance of locally measured microbial concentrations and survey exposure data to avoid underestimation. Estimating the risks from recreational exposure to waterborne bacteria can inform beach management policies aimed at reducing public health risks to swimmers. The study findings improve the understanding of the risks associated with water recreation activities at Southeast Asian beaches and offer valuable insights for the development of water quality guidelines, which are crucial for the sustainable development of the blue economy.

Quantitative microbiological risk assessments for Salmonella spp. contaminated taiwanese salty chicken in the taiwanese population

The aim of the study is to develop Salmonella spp. Quantitative microbial risk assessments (QMRA) and to evaluate the risk of Salmonellosis illness in the Taiwanese population after consumption of Taiwanese salty chicken (TSC). We assume that Salmonella spp. May contaminate the fresh raw chicken used in TSC. After transport to the diner, fresh raw chicken is received, cleaned, and surface-washed by diner staff. The TSC is then cooked and sold to consumers. We set four different cross-contamination scenarios to evaluate the contamination level of Salmonella spp. In TSC. We used a Monte Carlo simulation method, a probabilistic analysis method, and exceedance risk to evaluate the risk of Salmonellosis illness. When the exceedance risk was 5 %, and taking the Taiwanese population above 19 years old as an example, the rate of contracting Salmonellosis from the consumption of TSC will be 2.94 % (2.94 million per 100 million people) if the chef does not clean their hands, knives, or cutting boards. However, if the chef washes their hands, knives, and cutting boards with cold water and soap, the illness rate of Salmonellosis from consuming TSC will be 1.93E-04 % (193 per 100 million people). Sensitivity analysis indicates that the most important risk factor in the QMRAs of TSC is the temperature of the fresh raw chicken during transportation, following which were the Salmonella spp. Residual. If the staff of the diner separates the cooking tools used for raw ingredients and those for cooked food, the illness risk of Salmonellosis will be very low.

Seasonal variations and health risk assessment of microbial contaminations of groundwater in selected coastal communities of Ghana

This study investigated seasonal variations in microbial contaminations of groundwater and associated health risks in four coastal communities (Essiama, Winneba, Accra, and Keta) in Ghana. Membrane filtration methods, sanitary risk inspection, and quantitative microbial risk assessment were employed, respectively, to (i) quantify bacteriological quality, (ii) identify risks to contamination, and (iii) assess health risks associated with Escherichia coli in groundwater. Results showed 70.00%, 53.33%, 70.37% and 90.00% of groundwater sources in Essiama, Winneba, Accra, and Keta, respectively, were at intermediate risk, whereas 3.33%, 40.00%, 14.81%, and 3.33%, respectively, were at high risk. Very high-risk levels of contamination were recorded only in Accra. The presence of animal wastes within a 10 m radius of groundwater collection point, bad drainage systems, collection of spilt water in apron area, the use of ropes and buckets when fetching groundwater, and absence of aprons and well covers put more than 60.00% of the groundwater points in two or more locations at risk of contaminations. Assessment of bacteriological quality of groundwater indicated that mean total coliforms and E. coli ranged, respectively, between 123.40-501.30 and 30.98-141.90 CFU/100 ml for the communities; the highest microbial counts for dry and wet seasons occurred in Winneba and Keta, respectively. Seasonal variations in E. coli counts in Winneba and Accra were significantly higher in the dry season than in the wet season; Essiama and Keta showed no significant seasonal variations. Exposure to E. coli O157:H7 through drinking groundwater ranged between 5 and 23 cells per day. Although exposure to E. coli O157:H7 through bathing was less than 1 cell per day in all communities, residents were exposed to one E. coli, at least, every 62, 141, 237, and 282 days in Winneba, Accra, Keta, and Essiama, respectively. The risk of infection and illness for all communities was 1 for drinking, whereas that for bathing ranged from 0.57 to 0.98. The estimated Disability-Adjusted Life Years (DALY) exceeded the WHO-acceptable DALY. These findings show that groundwater resources in the selected coastal communities were prone to microbial contaminations, and this may be a setback to Sustainable Development Goals 6. Implications of the findings are discussed.

Identification of risk profiles for Salmonella prevalence in pig supply chains in South Korea using meta-analysis and a quantitative microbial risk assessment model

International travel and the globalization of food supplies have increased the risk of epidemic foodborne infections. Salmonella strains, particularly non-typhoidal Salmonella (NTS), are major zoonotic pathogens responsible for gastrointestinal diseases worldwide. In this study, the prevalence and Salmonella contamination in pigs/carcasses throughout the South Korean pig supply chain and the associated risk factors were evaluated using Systematic reviews and meta-analyses (SRMA), and quantitative microbial risk assessment (QMRA). The prevalence of Salmonella in finishing pigs, which is one of the major starting inputs of the QMRA model was calculated through SRMA of studies conducted in south Korea in order to complement and enhance the robustness of the model. Our findings revealed that the pooled Salmonella prevalence in pigs was 4.15% with a 95% confidence interval (CI) of 2.56 to 6.66%. Considering the pig supply chain, the highest prevalence was detected in slaughterhouses (6.27% [95% CI: 3.36; 11.37]), followed by farms (4.16% [95% CI: 2.32; 7.35]) and meat stores (1.21% [95% CI: 0.42; 3.46]). The QMRA model predicted a 3.9% likelihood of Salmonella-free carcasses and a 96.1% probability of Salmonella-positive carcasses at the end of slaughter, with an average Salmonella concentration of 6.38 log CFU/carcass (95% CI: 5.17; 7.28). This corresponds to an average contamination of 1.23 log CFU/g (95% CI: 0.37; 2.48) of pork meat. Across the pig supply chain, the highest Salmonella contamination was predicted after transport and lairage, with an average concentration of 8 log CFU/pig (95% CI: 7.15; 8.42). Sensitivity analysis indicated that Salmonella fecal shedding (r = 0.68) and Salmonella prevalence in finishing pigs (r = 0.39) at pre-harvest were the most significant factors associated with Salmonella contamination in pork carcasses. Although disinfection and sanitation interventions along the slaughter line can reduce contamination levels to some extent, effective measures should be taken to reduce Salmonella prevalence at the farm level to improve the safety of pork consumption.

QMRA of beach water by Nanopore sequencing-based viability-metagenomics absolute quantification

The majority of the current regulatory practices for routine monitoring of beach water quality rely on the culture-based enumeration of faecal indicator bacteria (FIB) to develop criteria for promoting the general public's health. To address the limitations of culture methods and the arguable reliability of FIB in indicating health risks, we developed a Nanopore metagenomic sequencing-based viable cell absolute quantification workflow to rapidly and accurately estimate a broad range of microbes in beach waters by a combination of propidium monoazide (PMA) and cellular spike-ins. Using the simple synthetic bacterial communities mixed with viable and heat-killed cells, we observed near-complete relic DNA removal by PMA with minimal disturbance to the composition of viable cells, demonstrating the feasibility of PMA treatment in profiling viable cells by Nanopore sequencing. On a simple mock community comprised of 15 prokaryotic species, our results showed high accordance between the expected and estimated concentrations, suggesting the accuracy of our method in absolute quantification. We then further assessed the accuracy of our method for counting viable Escherichia coli and Vibrio spp. in beach waters by comparing to culture-based method, which were also in high agreement. Furthermore, we demonstrated that 1 Gb sequences obtained within 2 h would be sufficient to quantify a species having a concentration of ≥ 10 cells/mL in beach waters. Using our viability-resolved quantification workflow to assess the microbial risk of the beach water, we conducted (1) screening-level quantitative microbial risk assessment (QMRA) to investigate human illness risk and site-specific risk patterns that might guide risk management efforts and (2) metagenomics-based resistome risk assessment to evaluate another layer of risk caused by difficult illness treatment due to antimicrobial resistance (AMR). In summary, our metagenomic workflow for the rapid absolute quantification of viable bacteria demonstrated its great potential in paving new avenues toward holistic microbial risk assessment.

Health risks of Cryptosporidium and Giardia in the application of surface water and septic tank effluent in Chinese agriculture: Impact on cancer patients identified by quantitative microbial risk assessment

The protozoa Cryptosporidium and Giardia are major causes of diarrhea and are commonly found on vegetables in China. They pose a health risk, particularly to immunocompromised individuals, including cancer patients. A quantitative microbial risk assessment of Chinese data evaluated the risks of Cryptosporidium and Giardia exposure arising from the application of surface water and septic tank effluent to agricultural land. Exposure via agricultural produce consumption (consumers) and agricultural practices (farmers) was considered for subpopulations of cancer patients and immunocompetent people in urban and rural areas, and risk mitigation scenarios were modelled. The cumulative disease burdens attributable to cryptosporidiosis and giardiasis were, respectively, 9.68×10^-6 and 5.57×10^-5 disability-adjusted life years per person per year (DALYs pppy) for immunocompetent people, and 3.14×10^-5 and 1.51×10^-4 DALYs pppy for cancer patients. Cancer patients were approximately three times more likely to have an individual disease burden than immunocompetent people. The disease burden was higher for consumers than farmers, and higher in rural areas than urban areas (all exceeding the maximum recommended by the World Health Organization). The highest burdens were in provinces of high population, such as Henan, Guangdong, and Sichuan, while the burden associated with human and livestock fecal effluent application was higher than with surface water irrigation. Of the three vegetables studied, lettuce posed the greatest risk, followed by bok choy, while cucumber posed the least risk. Risk mitigation scenario analysis showed that pre-treatment of surface water and feces, and appropriate post-harvest handling of vegetables, including disinfection, cooking, and adequate surface heat treatment (75 °C for 60 s), should be considered when attempting to reduce disease burdens. The methodology and findings of this study are useful for evaluating and reducing the burden of Cryptosporidium and Giardia infections associated with agricultural irrigation and fertilization practices, particularly on cancer patients.

Integrating consumer risk perception and awareness with simulation-based quantitative microbial risk assessment using a coupled systems framework: A case study of private groundwater users in Ontario

Private well users in Ontario are responsible for ensuring the potability of their own private drinking water source through protective actions (i.e., water treatment, well maintenance, and regular water quality testing). In the absence of regulation and limited surveillance, quantitative microbial risk assessment (QMRA) represents the most practical and robust approach to estimating the human health burden attributable to private wells. For an increasingly accurate estimation, QMRA of private well water should be represented by a coupled model, which includes both the socio-cognitive and physical aspects of private well water contamination and microbial exposure. The objective of the current study was to determine levels of waterborne exposure via well water consumption among three sub-groups (i.e., clusters) of private well users in Ontario and quantify the risk of waterborne acute gastrointestinal illness (AGI) attributed to Giardia, shiga-toxin producing E. coli (STEC) and norovirus from private drinking water sources in Ontario. Baseline simulations were utilized to explore the effect of varying socio-cognitive scenarios on model inputs (i.e., increased awareness, protective actions, aging population). The current study uses a large spatio-temporal groundwater quality dataset and cross-sectional province-wide survey to create socio-cognitive-specific QMRA simulations to estimate the risk of waterborne AGI attributed to three enteric pathogens in private drinking waters source in Ontario. Findings suggest significant differences in the level of exposure among sub-groups of private well users. Private well users within Cluster 3 are characterised by higher levels of exposure and annual illness attributable to STEC, Giardia and norovirus than Clusters 1 and 2. Provincial incidence rates of 520.9 (1522 illness per year), 532.1 (2211 illness per year) and 605.5 (5345 illness per year) cases/100,000 private well users per year were predicted for private well users associated with Clusters 1 through 3. Established models will enable development of necessary tools tailored to specific groups of at-risk well users, allowing for preventative public health management of private groundwater sources.

Evaluation of Seasonal Variation on the Health Risks Using the Quantitative Microbial Risk Assessment Approach in a Wastewater Treatment Plant in Hamadan, Iran

BACKGROUND

Wastewater treatment plants (WWTPs) are a source of airborne bacterial contamination that can pose health risks to staff. The aim of this study was to evaluate seasonal variations in the health risks of exposure to Staphylococcus aureus bioaerosols using the quantitative microbial risk assessment (QMRA) approach in a WWTP in Hamadan, Iran.

STUDY DESIGN

This was a descriptive cross-sectional study.

METHODS

This study determined the emission concentrations of S. aureus bioaerosols in summer and winter. Then, the health risks of three exposure scenarios (the worker, field engineer, and laboratory technician) were evaluated using the QMRA approach. The bioaerosol samples were collected every 12 days in both summer and winter of 2021 with a nutrient agar using a single-stage cascade impactor (Quick Take 30, SKC Inc.) in both outdoor and indoor environments.

RESULTS

The results demonstrated that in both seasons, S. aureus bioaerosol concentrations in outdoor and indoor environments were below the standard established by the American Conference of Governmental Industrial Hygienists (500 CFU/m3 ). While in summer, the annual infection risks and the disease burden for the three exposure scenarios in both outdoor and indoor environments were higher than the United States Environmental Protection Agency (≤10-4 pppy) and the World Health Organization (WHO) (≤10-6 DALYs pppy-1) benchmarks, respectively.

CONCLUSION

The findings provided high health risks for staff in the three exposure scenarios of an indoor environment, which should not be ignored, as well as emphasizing the use of the QMRA approach to estimate health risks caused by occupational exposure to bioaerosols and taking executive measures to protect staff working in the WWTPs.

Spatially explicit model of the Cryptosporidium and Giardia disease burden from surface and ground waters in urban and rural areas of the Three Gorges Reservoir watershed in Chongqing, China

Cryptosporidium and Giardia (major causes of diarrhea) are widely distributed in Chinese source waters and threaten human health. A new spatially explicit GloWPa-TGR-Crypt-Giar C1 model is presented to simultaneously estimate mean monthly (oo)cyst concentrations in surface and ground waters in the Three Gorges Reservoir (TGR) watershed. A quantitative risk assessment of protozoal infections considered different source waters, transmission pathways, regions, susceptible subpopulations, and drinking water treatments. Monthly mean Cryptosporidium oocyst and Giardia cyst concentrations ranged between 0.5-19.3 oocysts/10 L and 0.2-5.0 cysts/10 L in surface water, respectively, and 0.007-0.3 oocysts/10 L and 0.002-0. 2 cysts/10 L in groundwater. The cumulative disease burdens attributable to cryptosporidiosis and giardiasis were, respectively, 5.77×10-5 DALYs (disability-adjusted life years/person/year) and 4.63×10-6 DALYs in urban areas, and 6.35×10-4 DALYs and 8.84×10-5 DALYs in rural areas, which were much higher than the reference risk level recommended by the World Health Organization ([Formula: see text] DALYs). The annual burden associated with consuming surface water was calculated to be 3.84×10-4 DALYs for Cryptosporidium and [Formula: see text] DALYs for Giardia, whereas consuming groundwater entailed the lower burdens (1.26×10-5 and 3.50×10-6 DALYs, respectively). Most DALYs were a consequence of consumption of directly supplied surface water. Fifty percent of the health burden was carried by immunodeficiency with HIV. Children (0-4 years) were more likely to have an individual disease burden than adults (15-64 years). Males were more susceptible than females. Improving sanitation through adequate ozone and microfiltration treatment should be considered when attempting to reduce disease burden. Sensitivity analysis highlighted the importance of reducing (oo)cyst loads to protect the watershed. The methodology and results described will help in evaluating and reducing the burden of protozoal infection associated with surface and ground waters in the TGR and similar watersheds.

Quantitative microbial risk assessment (QMRA) for setting health-based performance targets during soil aquifer treatment

A quantitative microbial risk assessment was conducted to assess the health risks associated with the exposure of agricultural workers to tertiary treated wastewater in irrigated fields through soil ingestion in Cyprus. Three pathogenic microorganisms were chosen, particularly E. coli (bacteria), rotavirus (viruses) and Cryptosporidium. Two extreme exposure scenarios were investigated. Monte Carlo simulations were performed using input data from literature, and the model outputs were compared to the health standards of the World Health Organization (WHO). The results suggested that additional treatment is required for all pathogens to satisfy the health standards. Sensitivity analysis identified the source concentration and pathogen reduction due to soil aquifer passage as the most influential factors in the model outputs. Additional computations were performed to evaluate the minimum pathogen reduction due to soil aquifer passage so that the health targets are achieved for the 95 % of the output values. Rotavirus and Cryptosporidium were found to require more treatment than E. coli. The inclusion of these reference pathogens to the monitoring network of the local authorities is recommended, and the role of soil aquifer passage is emphasized on reducing the concentration of the contaminants.

aureus bioaerosol emission from aeration tanks and residual sludge storage yard in a wastewater treatment plant

A large number of pathogenic bioaerosols are generated during the treatment process of wastewater treatment plants (WWTPs), and they can pose potential risks to human health. Therefore, this study systematically analyzed the emission characteristics of Staphylococcus aureus bioaerosols released from an inverted umbrella aeration tank, a microporous aeration tank, and a residual sludge storage yard in a WWTP, and quantitatively evaluated the health risks of four kinds of exposed populations with nasal/oral breathing patterns under optimistic and conservative estimations. The results displayed that the bioaerosol concentration in inverted umbrella aeration tank was higher than that in microporous aeration tank and residual sludge storage yard. Aerosolization ratio in residual sludge storage yard was an order of magnitude lower than that in aeration tanks. Sludge workers were at higher health risks than the other three exposed populations. The health risks of nasal breathers (infection risk: 1.62 × 10^-5-2.56 × 10^-3 pppy; disease burden: 4.24 × 10^-8-6.72 × 10^-6 DALYs pppy) were 0.61-0.63 times higher than those of oral breathers (infection risk: 9.95 × 10^-6-1.59 × 10^-3 pppy; disease burden: 2.61 × 10^-8-4.18 × 10^-6 DALYs pppy). For female field engineers using oral breathing, laboratory technicians, and researchers without personal protective equipment (PPE), infection risk and disease burden had the opposite results, which indicated that satisfying one certain benchmark did not mean absolute safety. In addition, health risks of exposed populations were reduced by an order of magnitude after wearing PPE. This study can provide a reliable theoretical basis for the risk prevention of bioaerosols and supply data support for the strategies of health risk control perspectives for local sewage utilities.

Assessing the impact of COVID-19 restrictions on the microbial quality of an urban water catchment and the associated probability of waterborne infections

The World Health Organization reported that COVID-19 cases reached 611,421,786 globally by September 23, 2022. Six months after the first reported case, the disease had spread rapidly, reaching pandemic status, leading to numerous preventive measures to curb the spread, including a complete shutdown of many activities worldwide. Such restrictions affected services like waste management, resulting in waste accumulation in many communities and increased water pollution. Therefore, the current study investigated if lockdown impacted surface water microbial quality within an urban water catchment in South Africa. Using quantitative microbial risk assessment, the study further assessed changes in the probability of infection (Pi) with gastrointestinal illnesses from exposure to polluted water in the catchment. Escherichia coli data for 2019, 2020 and 2021 - pre-COVID, lockdown, and post-lockdown periods, respectively - were collected from the area's wastewater treatment management authorities. The Pi was determined using a beta-Poisson model. Mean overall E. coli counts ranged from 2.93 ± 0.16 to 5.30 ± 1.07 Log₁₀ MPN/100 mL. There was an overall statistically significant increase in microbial counts from 2019 to 2021. However, this difference was only accounted for between 2019 and 2021 (p = 0.008); the increase was insignificant between 2019 and 2020, and 2020 and 2021. The Pi revealed a similar trend for incidental ingestion of 100 mL and 1 mL of polluted water. No statistically significant difference was observed between the years based on multiple exposures. Although the overall microbial load and Pi estimated within the catchment exceeded the local and international limits recommended for safe use by humans, especially for drinking and recreation, these were not significantly affected by the COVID-19 restrictions. Nevertheless, these could still represent a health hazard to immunocompromised individuals using such water for personal and household hygiene, especially in informal settlements without access to water and sanitation services.

Bioaerosols emission characteristics from wastewater treatment aeration tanks and associated health risk exposure assessment during autumn and winter

Aeration tanks from activated sludge wastewater treatment plants (WWTPs) can release a large amount of bioaerosols that can pose health risks. However, risk characterization of bioaerosols emissions form wastewater treatment plants is currently not systematically carried out and still in its infancy. Therefore, this study investigated emission characteristic of two indicator model bioaerosols Staphylococcus aureus and Escherichia coli, emitted from aeration tanks of a municipal WWTP. Monte Carlo simulation was then used to quantitatively assess microbial risk posed by different aeration modes under optimistic and conservative estimates. Further to this, two different exposure scenarios were considered during 3 days sampling campaign in autumn and winter. Results showed that the bioaerosol concentration from microporous aeration tank (20-262 CFU m^-3) was one order of magnitude lower than rotating disc aeration tank. Average aerosolization rate was 7.5 times higher with mechanical aeration mode. Health risks of exposed populations were 0.4 and 9.6 times higher in winter than in autumn for E. coli and S. aureus bioaerosol, respectively. Health risks of staff members were 10 times higher than academic visitors. Interesting results were observed for academic visitors without personal protective equipment (PPE) respectively exposed to S. aureus and E. coli bioaerosol in autumn and winter: while the derived infection risk met the United States Environmental Protection Agency (U.S. EPA) benchmark under optimistic estimation, the disease risk burden was over the World Health Organization (WHO) benchmark under conservative estimation. These revealed that only satisfying one of the two benchmarks didn't mean absolute acceptable health risk. This study could facilitate the development of better understanding of bioaerosol quantitative assessment of risk characterizations and corresponding appropriate risk control strategies for wastewater utilities.

What are the disease burden and its sensitivity analysis of workers exposing to Staphylococcus aureus bioaerosol during warm and cold periods in a wastewater treatment plant?

Biological treatment in wastewater treatment plants releases high amounts of pathogenic bioaerosols. Quantitative microbial risk assessment is a framework commonly used for quantitative risk estimation for occupational exposure scenarios. However, the quantitative contributions of health-risk-estimate inputted parameters remain ambiguous. Therefore, this research aimed to study the disease burden of workers exposed to Staphylococcus aureus bioaerosol during warm and cold periods and strictly quantify the contributions of the inputted parameters by sensitivity analysis on the basis of Monte Carlo simulation. Results showed that the disease health risk burden of workers in the warm period was 1.15-6.11 times higher than that of workers in the cold period. The disease health risk burden of workers without personal protective equipment was 23.83-36.55 times higher than that of workers with personal protective equipment. Sensitivity analysis showed that exposure concentration and aerosol ingestion rate were the first and second predominant factors, respectively; the sensitivity partitioning coefficient of the former was 1.17-1.35 times the value of the latter. In addition, no remarkable differences were revealed in the sensitivity percentage ratio between warm and cold periods. The findings could contribute to the mitigation measures for the management of public health risks.

Development of a COVID-19 risk assessment model for participants at outdoor music festivals: evaluation of the validity and control measure effectiveness based on two actual events in Japan and Spain

We developed an environmental exposure model to estimate the coronavirus disease 2019 (COVID-19) risk among participants at outdoor music festivals and validated the model using two real events-one in Japan (Event 1) and one in Spain (Event 2). Furthermore, we considered a hypothetical situation in which Event 1 was held but enhanced measures were implemented to evaluate the extent to which the risk could be reduced by additional infection control measures, such as negative antigen tests on the day of the event, wearing of masks, disinfection of environmental surfaces, and vaccination. Among 7,392 participants, the total number of already- and newly-infected individuals who participated in Event 1 according to the new model was 47.0 (95% uncertainty interval: 12.5-185.5), which is in good agreement with the reported value (45). The risk of infection at Event 2 (1.98 × 10^-2; 95% uncertainty interval: 0.55 × 10^-2-6.39 × 10^-2), calculated by the model in this study, was also similar to the estimated value in the previous epidemiological study (1.25 × 10^-2). These results for the two events in different countries highlighted the validity of the model. Among the additional control measures in the hypothetical Event 1, vaccination, mask-wearing, and disinfection of surfaces were determined to be effective. Based on the combination of all measures, a 94% risk reduction could be achieved. In addition to setting a benchmark for an acceptable number of newly-infected individuals at the time of an event, the application of this model will enable us to determine whether it is necessary to implement additional measures, limit the number of participants, or refrain from holding an event.

Assessment of COVID-19 risk and prevention effectiveness among spectators of mass gathering events

There is a need to evaluate and minimize the risk of novel coronavirus infections at mass gathering events, such as sports. In particular, to consider how to hold mass gathering events, it is important to clarify how the local infection prevalence, the number of spectators, the capacity proportion, and the implementation of preventions affect the infection risk. In this study, we used an environmental exposure model to analyze the relationship between infection risk and infection prevalence, the number of spectators, and the capacity proportion at mass gathering events in football and baseball games. In addition to assessing risk reduction through the implementation of various preventive measures, we assessed how face-mask-wearing proportion affects infection risk. Furthermore, the model was applied to estimate the number of infectors who entered the stadium and the number of newly infected individuals, and to compare them with actual reported cases. The model analysis revealed an 86-95% reduction in the infection risk due to the implementation of face-mask wearing and hand washing. Under conditions in which vaccine effectiveness was 20% and 80%, the risk reduction rates of infection among vaccinated spectators were 36% and 96%, respectively. Among the individual measures, face-mask wearing was particularly effective, and the infection risk increased as the face-mask-wearing proportion decreased. A linear relationship was observed between infection risk at mass gathering events and the infection prevalence. Furthermore, the number of newly infected individuals was also dependent on the number of spectators and the capacity proportion independent of the infection prevalence, confirming the importance of considering spectator capacity in infection risk management. These results highlight that it is beneficial for organisers to ensure prevention compliance and to mitigate or limit the number of spectators according to the prevalence of local infection. Both the estimated and reported numbers of newly infected individuals after the events were small, below 10 per 3-4 million spectators, despite a small gap between these numbers.

Decontamination of SARS-CoV-2 from cold-chain food packaging provides no marginal benefit in risk reduction to food workers

Countries continue to debate the need for decontamination of cold-chain food packaging to reduce possible severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) fomite transmission among frontline workers. While laboratory-based studies demonstrate persistence of SARS-CoV-2 on surfaces, the likelihood of fomite-mediated transmission under real-life conditions is uncertain. Using a quantitative microbial risk assessment model of a frozen food packaging facility, we simulated 1) SARS-CoV-2 fomite-mediated infection risks following worker exposure to contaminated plastic packaging; and 2) reductions in these risks from masking, handwashing, and vaccination. In a frozen food facility without interventions, SARS-CoV-2 infection risk to a susceptible worker from contact with contaminated packaging was 1.5 × 10^-3 per 1h-period (5th - 95th percentile: 9.2 × 10^-6, 1.2 × 10^-2). Standard food industry infection control interventions, handwashing and masking, reduced risk (99.4%) to 8.5 × 10^-6 risk per 1h-period (5th - 95th percentile: 2.8 × 10^-8, 6.6 × 10^-5). Vaccination of the susceptible worker (two doses Pfizer/Moderna, vaccine effectiveness: 86-99%) with handwashing and masking reduced risk to 5.2 × 10^-7 risk per 1h-period (5th - 95th percentile: 1.8 × 10^-9, 5.4 × 10^-6). Simulating increased transmissibility of current and future variants (Delta, Omicron), (2-, 10-fold viral shedding) among a fully vaccinated workforce, handwashing and masking continued to mitigate risk (1.4 × 10^-6 - 8.8 × 10^-6 risk per 1h-period). Additional decontamination of frozen food plastic packaging reduced infection risks to 1.2 × 10^-8 risk per 1h-period (5th - 95th percentile: 1.9 × 10^-11, 9.5 × 10^-8). Given that standard infection control interventions reduced risks well below 1 × 10^-4 (World Health Organization water quality risk thresholds), additional packaging decontamination suggest no marginal benefit in risk reduction. Consequences of this decontamination may include increased chemical exposures to workers, food quality and hazard risks to consumers, and unnecessary added costs to governments and the global food industry.

An assessment of the health risks associated with shared sanitation: a case study of the community ablution blocks in Durban, South Africa

Shared sanitation facilities have been hailed as an innovative approach to solve the challenge with sanitation access. However, these facilities may act as hotspots for disease transmission due to unhygienic conditions. In this study we used quantitative (based on Escherichia coli contamination) techniques to assess the health risks associated with the use of community ablution blocks (CABs). The most contaminated surfaces were the cistern handle (5.7 Log₁₀ cfu/cm²) and internal pull latch (5.8 Log₁₀ cfu/cm²). Based on the E. coli contamination, at least two people out of 100 CAB users might be potentially infected when they touch "hot" surfaces. These risks were modelled assuming transfer of potentially pathogenic E. coli from these surfaces to the mouth. The incorporation of risk-reduction measures, such as wiping of these surfaces or washing of hands, could potentially result in significant reduction of infection risks. The most significant risk-reduction intervention was determined to be wiping of the contact surfaces, especially twice prior to contact. A combination of risk-reduction interventions could further reduce the risks. This study shows that contamination of contact surfaces within shared CABs could lead to increased risks of infections, requiring measures aimed at reducing the associated risks. The risk assessment framework used in this study could therefore be applied in similar settings to estimate associated health risks with the use of such facilities.

Quantitative microbial risk assessment associated with ready-to-eat salads following the application of farmyard manure and slurry or anaerobic digestate to arable lands

Farmyard manure and slurry (FYM&S) and anaerobic digestate are potentially valuable soil conditioners providing important nutrients for plant development and growth. However, these organic fertilisers may pose a microbial health risk to humans. A quantitative microbial risk assessment (QMRA) model was developed to investigate the potential human exposure to pathogens following the application of FYM&S and digestate to agricultural land. The farm-to-fork probabilistic model investigated the fate of microbial indicators (total coliforms and enterococci) and foodborne pathogens in the soil with potential contamination of ready-to-eat salads (RTEs) at the point of human consumption. The processes examined included pathogen inactivation during mesophilic anaerobic digestion (M-AD), post-AD pasteurisation, storage, dilution while spreading, decay in soil, post-harvest washing processes, and finally, the potential growth of the pathogen during refrigeration/storage at the retail level in the Irish context. The QMRA highlighted a very low annual probability of risk (P_annual) due to Clostridium perfringens, norovirus, and Salmonella Newport across all scenarios. Mycobacterium avium may result in a very high mean P_annual for the application of raw FYM&S, while Cryptosporidium parvum and pathogenic E. coli showed high P_annual, and Listeria monocytogenes displayed moderate P_annual for raw FYM&S application. The use of AD reduces this risk; however, pasteurisation reduces the P_annual to an even greater extent posing a very low risk. An overall sensitivity analysis revealed that mesophilic-AD's inactivation effect is the most sensitive parameter of the QMRA, followed by storage and the decay on the field (all negatively correlated to risk estimate). The information generated from this model can help to inform guidelines for policymakers on the maximum permissible indicator or pathogen contamination levels in the digestate. The QMRA can also provide the AD industry with a safety assessment of pathogenic organisms resulting from the digestion of FYM&S.

Exposure parameters and health risk of Cryptosporidium and Giardia in the recreational water activities for urban residents in China

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.

Integrated probabilistic-fuzzy synthetic evaluation of drinking water quality in rural and remote communities

An integrated probabilistic-fuzzy synthetic evaluation (PFSE) approach was developed for assessing drinking water quality in rural and remote communities (RRCs) through the lens of health risks and aesthetic impacts. The probabilistic health risk assessment can handle aleatory uncertainty raised by the variation of contaminant concentrations, and fuzzy synthetic evaluation (FSE) can address vagueness and ambiguity in human perception of risks and aesthetic impacts. The PFSE approach was applied to five RRCs in British Columbia, Canada where different drinking water quality issues, including high metal(loids) concentrations, the presence of coliforms, and poor aesthetics were reported. Cancer, non-cancer, and microbial risks assessed, as well as both quantitative and qualitative aesthetic impact assessment outcomes, were aggregated into synthetic water quality indices for water quality ranking. The probabilistic health risk assessment results revealed significant health risks for a community with relatively high arsenic concentrations (mean value = 7.0 μg/L) in the water supply. The microbial risks were also found significant (disability-adjusted life years >1 × 10^-6) for all communities because of the presence of coliforms in the water. The FSE results indicated that the drinking water quality of five RRCs was associated with high aggregated impacts, which concurred with the "poor" water quality ratings according to the Canadian Water Quality Index. The water quality of the five RRCs was ranked based on the synthetic water quality evaluation indices. The PFSE approach can help decision-makers prioritize RRCs in effective resource allocation for addressing drinking water quality issues.

Hazard identification and risk assessment of the organic, inorganic and microbial contaminants in the surface water after the high magnitude of flood event

The present work has been oriented to the qualitative and quantitative assessments of the aftermath effects of 2014 flood tragedy on the organic, inorganic and microbial contaminants in the floodwater, with a particular emphasis on their relative health risks and microbial infectious hazards to the flood-affected population, using average daily dose, hazard quotient, hazard index (HI), cancer risk (CR) and quantitative microbial risk assessment. Statistical comparison of the organic and inorganic contents was performed using the paired t-tests, while the predominant socio-demographic profiles and health attributes of the respondents to flood-induced health risks (HI) were verified by the chi-square test and binary logistic regression analysis. Among all, Fe, Cu, Pb, Ni, Zn, Cr, Cd, chlorpyrifos, diazinon, polycyclic aromatic hydrocarbons, estriol, 17α-ethinylestradiol, estrone, β-estradiol and bisphenol A were detected at the study area after flooding. The microbiological quality of the floodwater samples has been tracked positive for Escherichia coli, Salmonella typhimurium and Shigella flexneri, with the mean concentrations of 6500, 50 and 180 CFU/100 mL, respectively. Exposure and health risk assessments revealed that the overall HI value for organic and inorganic contaminants in the water samples was 1.19, exceeding the USEPA maximum limit of 1, after the flood incidence. The largest CR contributors were Ni, Cr and Cd, while the infection risks (P_inf,single) associated with the exposure of E. coli, Salmonella spp. and Shigella spp. were identified to be 3.1 × 10^-2, 1.2 × 10^-4 and 3.2 × 10^-5 for incidental scenario; and 8.3 × 10^-1, 3.9 × 10^-1 and 1.9 × 10^-1 for intentional scenario, respectively. The findings of these integrated tools are critically important to provide a more reliable quantitative assessment of human health hazards and microbial risks for different environmental settings, to safeguard water resource, and preservation of public health and the overall river ecosystem.

Quantitative microbial human exposure model for faecal indicator bacteria and risk assessment of pathogenic Escherichia coli in surface runoff following application of dairy cattle slurry and co-digestate to grassland

Animal waste contains high numbers of microorganisms and therefore can present a potential biological threat to human health. During episodic rainfall events resulting in runoff, microorganisms in the waste and soil may migrate into surface runoff, contaminating surface water resources. A probabilistic human exposure (HE) model was created to determine exposure to faecal indicator bacteria (FIB): total coliforms (TC), E. coli and enterococci following application of bio-based fertiliser (dairy cattle slurry, digestate) to grassland; using a combination of experimental field results and literature-based data. This step was followed by a quantitative microbial risk assessment (QMRA) model for pathogenic E. coli based on a literature-based dose-response model. The results showed that the maximum daily HE (HE_daily) is associated with E. coli for unprocessed slurry (treatment T1) on day 1, the worst-case scenario where the simulated mean HE_daily was calculated as 2.84 CFU day ^-1. The results indicate that the overall annual probability of risk (P_annual) of illness from E. coli is very low or low based on the WHO safe-limit of P_annual as 10 ^-6. In the worst-case scenario, a moderate risk was estimated with simulated mean P_annual as 1.0 × 10 ^-5. Unpasteurised digestate application showed low risk on day 1 and 2 (1.651 × 10 ^-6, 1.167 × 10 ^-6, respectively). Pasteurised digestate showed very low risk in all scenarios. These results support the restriction imposed on applying bio-based fertiliser if there is any rain forecast within 48 h from the application time. This study proposes a future extension of the probabilistic model to include time, intensity, discharge, and distance-dependant dilution factor. The information generated from this model can help policymakers ensure the safety of surface water sources through the quality monitoring of FIB levels in bio-based fertiliser.

Objectionable microorganisms in pharmaceutical production: Validation of a decision tree

The release of quality, safe, and effective non-sterile drugs needs to exclude the presence of objectionable microorganisms, which include microorganisms potentially involved in product degradation, or considered as poor hygiene indicator during manufacturing, or causing adverse effect on patient's health. In this paper, a method allowing objective and verifiable evaluations has been investigated through the development of a suitable decision tree with a template for data collection. The decision tree has been used to establish which microorganisms were objectionables, using several hypothetical scenarios in which 24 different biological agents, both harmless microorganisms and opportunistic pathogens, were combined with 9 different products, representing each type of administration route for non-sterile drugs. The results showed that the use of aforementioned approach makes the microorganisms evaluation easy and verifiable and highlighted that even the microbes initially considered harmless could be objectionable.

Controlling risk of SARS-CoV-2 infection in essential workers of enclosed food manufacturing facilities

The SARS-CoV-2 global pandemic poses significant health risks to workers who are essential to maintaining the food supply chain. Using a quantitative risk assessment model, this study characterized the impact of risk reduction strategies for controlling SARS-CoV-2 transmission (droplet, aerosol, fomite-mediated) among front-line workers in a representative indoor fresh fruit and vegetable manufacturing facility. We simulated: 1) individual and cumulative SARS-CoV-2 infection risks from close contact (droplet and aerosols at 1–3 m), aerosol, and fomite-mediated exposures to a susceptible worker following exposure to an infected worker during an 8 h-shift; and 2) the relative reduction in SARS-CoV-2 infection risk attributed to infection control interventions (physical distancing, mask use, ventilation, surface disinfection, hand hygiene, vaccination). Without mitigation measures, the SARS-CoV-2 infection risk was largest for close contact (droplet and aerosol) at 1 m (0.96, 5th – 95th percentile: 0.67–1.0). In comparison, risk associated with fomite (0.26, 5th – 95th percentile: 0.10–0.56) or aerosol exposure alone (0.05, 5th – 95th percentile: 0.01–0.13) at 1 m distance was substantially lower (73–95%). At 1 m, droplet transmission predominated over aerosol and fomite-mediated transmission, however, this changed by 3 m, with aerosols comprising the majority of the exposure dose. Increasing physical distancing reduced risk by 84% (1–2 m) and 91% (1–3 m). Universal mask use reduced infection risk by 52–88%, depending on mask type. Increasing ventilation (from 0.1 to 2–8 air changes/hour) resulted in risk reductions of 14–54% (1 m) and 55–85% (2 m). Combining these strategies, together with handwashing and surface disinfection, resulted in <1% infection risk. Partial or full vaccination of the susceptible worker resulted in risk reductions of 73–92% (1 m risk range: 0.08–0.26). However, vaccination paired with other interventions (ACH 2, mask use, or distancing) was necessary to achieve infection risks <1%. Current industry SARS-CoV-2 risk reduction strategies, particularly when bundled, provide significant protection to essential food workers.

Changes in Escherichia coli to enteric protozoa ratios in rivers: Implications for risk-based assessment of drinking water treatment requirements

Minimum treatment requirements are set in response to established or anticipated levels of enteric pathogens in the source water of drinking water treatment plants (DWTPs). For surface water, contamination can be determined directly by monitoring reference pathogens or indirectly by measuring fecal indicators such as Escherichia coli (E. coli). In the latter case, a quantitative interpretation of E. coli for estimating reference pathogen concentrations could be used to define treatment requirements. This study presents the statistical analysis of paired E. coli and reference protozoa (Cryptosporidium, Giardia) data collected monthly for two years in source water from 27 DWTPs supplied by rivers in Canada. E. coli/Cryptosporidium and E. coli/Giardia ratios in source water were modeled as the ratio of two correlated lognormal variables. To evaluate the potential of E. coli for defining protozoa treatment requirements, risk-based critical mean protozoa concentrations in source water were determined with a reverse quantitative microbial risk assessment (QMRA) model. Model assumptions were selected to be consistent with the World Health Organization (WHO) Guidelines for drinking-water quality. The sensitivity of mean E. coli concentration trigger levels to identify these critical concentrations in source water was then evaluated. Results showed no proportionalities between the log of mean E. coli concentrations and the log of mean protozoa concentrations. E. coli/protozoa ratios at DWTPs supplied by small rivers in agricultural and forested areas were typically 1.0 to 2.0-log lower than at DWTPs supplied by large rivers in urban areas. The seasonal variations analysis revealed that these differences were related to low mean E. coli concentrations during winter in small rivers. To achieve the WHO target of 10^-6 disability-adjusted life year (DALY) per person per year, a minimum reduction of 4.0-log of Cryptosporidium would be required for 20 DWTPs, and a minimum reduction of 4.0-log of Giardia would be needed for all DWTPs. A mean E. coli trigger level of 50 CFU 100 mL^-1 would be a sensitive threshold to identify critical mean concentrations for Cryptosporidium but not for Giardia. Treatment requirements higher than 3.0-log would be needed at DWTPs with mean E. coli concentrations as low as 30 CFU 100 mL^-1 for Cryptosporidium and 3 CFU 100 mL^-1 for Giardia. Therefore, an E. coli trigger level would have limited value for defining health-based treatment requirements for protozoa at DWTPs supplied by small rivers in rural areas.

Monte Carlo Simulation Model for Predicting Salmonella Contamination of Chicken Liver as a Function of Serving Size for Use in Quantitative Microbial Risk Assessment

ABSTRACT

The first step in quantitative microbial risk assessment (QMRA) is to determine the distribution of pathogen contamination among servings of the food in question at some point in the farm-to-table chain. In the present study, the distribution of Salmonella contamination among servings of chicken liver for use in the QMRA was determined at meal preparation. Salmonella prevalence (P), most probable number (MPN, N), and serotype for different serving sizes were determined by use of a combination of five methods: (i) whole sample enrichment; (ii) quantitative PCR; (iii) culture isolation; (iv) serotyping; and (v) Monte Carlo simulation. Epidemiological data also were used to convert serotype data to virulence (V) values for use in the QMRA. A Monte Carlo simulation model based in Excel and simulated with @Risk predicted Salmonella P, N, serotype, and V as a function of a serving size of one (58 g) to eight (464 g) chicken livers. Salmonella P of chicken livers was 72.5% (58 of 80) per 58 g. Four Salmonella serotypes were isolated from chicken livers: (i) Infantis (P = 28%, V = 4.5); (ii) Enteritidis (P = 15%, V = 5); (iii) Typhimurium (P = 15%, V = 4.8); and (iv) Kentucky (P = 15%, V = 0.8). Salmonella N was 1.76 log MPN/58 g (median) with a range of 0 to 4.67 log MPN/58 g, and the median Salmonella N was not affected (P > 0.05) by serotype. The model predicted a nonlinear increase (P ≤ 0.05) of Salmonella P from 72.5%/58 g to 100%/464 g, a minimum N of 0 log MPN/58 g to 1.28 log MPN/464 g, and a median N from 1.76 log MPN/58 g to 3.22 log MPN/464 g. Regardless of serving size, predicted maximum N was 4.74 log MPN per serving, mean V was 3.9 per serving, and total N was 6.65 log MPN per lot (10,000 chicken livers). The data acquired and modeled in this study address an important data gap in the QMRA for Salmonella and whole chicken liver.

HIGHLIGHTS

Sunlight advanced oxidation processes vs ozonation for wastewater disinfection and safe reclamation

Solar processes (sunlight/H₂O_2, solar photo-Fenton with EDDS at neutral pH) were compared to a consolidated technology (ozonation) in the inactivation of target bacteria (E. coli, Salmonella spp. and Enterococcus spp.) under realistic conditions (real secondary treated urban wastewater (WW), pilot scale reactors, natural sunlight) to evaluate their possible industrial application. The highest bacteria inactivation rate (all the target pathogens were inactivated below the detection limit (DL) (100 CFU/100 mL) within 45 min treatment) was observed for ozonation (83 mgO₃/L h). Similar inactivation behavior for all bacteria was observed for sunlight/H₂O₂ (50 mg/L) and solar photo-Fenton (SPF) with EDDS (1:1 molar ratio, 0.1 mM of Fe and 50 mg/L of H₂O₂). Although the DL was not reached, faster inactivation kinetics (0.007, 0.013 and 0.002 1/min for E. coli, Salmonella spp. and Enterococcus spp., respectively) and lower bacterial concentration after a 180 min treatment were observed for sunlight/H₂O₂ process compared to SPF (0.005, 0.01 1/min and no inactivation, respectively), Enterococcus spp. being the higher resistance microorganism. The negative effect of carbonates on disinfection performance was also evaluated. Quantitative microbial risk assessment for the ingestion of lettuce irrigated with untreated and treated WW was estimated. Disinfection by ozonation and sunlight/H₂O₂ processes were found to drastically decrease the associated microbiological risk (the mean risk of illness decreased from 0.10 (untreated) to 1.35 × 10^-4 (treated) for E. coli and from 0.03 to 2.21 × 10^-6 for Salmonella).

Using surrogate data to assess risks associated with microbial peak events in source water at drinking water treatment plants

A monitoring strategy was implemented at two drinking water treatment plants in Quebec, Canada, to evaluate microbial reduction performances of full-scale treatment processes under different source water conditions. β-D-glucuronidase activity in source water was automatically monitored in near-real-time to establish baseline and event conditions at each location. High-volume water samples (50-1,500 L) were collected at the inflow and the outflow of coagulation/flocculation, filtration, and UV disinfection processes and were analysed for two naturally occurring surrogate organisms: Escherichia coli and Clostridium perfringens. Source water Cryptosporidium data and full-scale C. perfringens reduction data were entered into a quantitative microbial risk assessment (QMRA) model to estimate daily infection risks associated with exposures to Cryptosporidium via consumption of treated drinking water. Daily mean E. coli and Cryptosporidium concentrations in source water under event conditions were in the top 5% (agricultural site) or in the top 15% (urban site) of what occurs through the year at these drinking water treatment plants. Reduction performances of up to 6.0-log for E. coli and 5.6-log for C. perfringens were measured by concentrating high-volume water samples throughout the treatment train. For both drinking water treatment plants, removal performances by coagulation/flocculation/sedimentation processes were at the high end of the range of those reported in the literature for bacteria and bacterial spores. Reductions of E. coli and C. perfringens by floc blanket clarification, ballasted clarification and rapid sand filtration did not deteriorate during two snowmelt/rainfall events. QMRA results suggested that daily infection risks were similar during two rainfall/snowmelt events than during baseline conditions. Additional studies investigating full-scale reductions would be desirable to improve the evaluation of differences in treatment performances under various source water conditions.

Quantitative Microbial Risk Assessment of Cryptosporidium and Giardia in Public Drinking Water in China

We aimed to assess the risks of Cryptosporidium and Giardia infections associated with drinking water for local residents, based on a quantitative microbial risk assessment, in three densely populated regions of China. In total, 45 source water samples and 45 treated water samples were collected from June to December 2014. Five Cryptosporidium-positive samples and 5 Giardia-positive samples were found. The annual probability of infection for individuals in Jintan (6.27 × 10 ^-4-2.05 × 10 ^-3 for Cryptosporidium and 7.18 × 10 ^-4-2.32 × 10 ^-3 for Giardia), Ezhou (6.27 × 10 ^-4-1.10 × 10 ^-2 for Cryptosporidium and 3.65 × 10 ^-4-1.20 × 10 ^-3 for Giardia), and Binyang (3.79 × 10 ^-4-1.25 × 10 ^-3 for Cryptosporidium) exceeded the tolerable risk of infection of 10 ^-4 set by the United States Environmental Protection Agency. Moreover, the corresponding disease burdens of cryptosporidiosis and giardiasis, due to direct drinking and residual water in these regions, exceeded the threshold of 10 ^-6 disability-adjusted life years per person per year set by the World Health Organization. These results provide insights into strategies to improve the safety of drinking water.

Modelling the interplay of future changes and wastewater management measures on the microbiological river water quality considering safe drinking water production

Rivers are important for drinking water supply worldwide. However, they are often impacted by pathogen discharges via wastewater treatment plants (WWTP) and combined sewer overflows (CSO). To date, accurate predictions of the effects of future changes and pollution control measures on the microbiological water quality of rivers considering safe drinking water production are hindered due to the uncertainty of the pathogen source and transport variables. The aim of this study was to test an integrative approach for an improved understanding of these effects, i.e. climate change and population growth as well as enhanced treatment at WWTPs and/or prevention of CSOs. We applied a significantly extended version of QMRAcatch (v1.0 Python), a probabilistic-deterministic model that combines fate and transport modelling with quantitative microbial infection risk assessment. The impact of climatic changes until the period 2035-2049 was investigated by a conceptual semi-distributed hydrological model, based on regional climate model outputs. QMRAcatch was calibrated and validated using site- and source-specific data (human-associated genetic microbial source tracking marker and enterovirus). The study showed that the degree to which future changes affect drinking water safety strongly depends on the type and magnitude of faecal pollution sources and are thus highly site- and scenario-specific. For example, if the load of pathogens from WWTPs is reduced through enhanced treatment, climate-change driven increases in CSOs had a considerable impact. Preventing CSOs and installing enhanced treatment at the WWTPs together had the most significant positive effect. The simultaneous consideration of source apportionment and concentrations of reference pathogens, focusing on human-specific viruses (enterovirus, norovirus) and cross-comparison with bacterial and protozoan pathogens (Campylobacter, Cryptosporidium), was found crucial to quantify these effects. While demonstrated here for a large, wastewater-impacted river, the approach is applicable at other catchments and pollution sources. It allows assessing future changes and selecting suitable pollution control measures for long-term water safety planning.

Quantitative microbial risk assessment for occupational health of temporary entrants and staffs equipped with various grade PPE and exposed to microbial bioaerosols in two WWTPs

Purpose

This study was to evaluate the occupational health risks of infection from Gram-negative bacteria and Staphylococcus aureus bioaerosols to temporary entrants and staffs equipped with various grade personal protection equipment (PPE) related to wastewater treatment plants (WWTPs).

Methods

This study determined the emission concentrations of Gram-negative bacteria and Staphylococcus aureus bioaerosols from two WWTPs under various aeration modes. Then, a strict quantitative microbial risk assessment (QMRA) was performed on several exposure scenarios associated with occupational health risks of temporary entrants (researchers, visitors, and inspectors) and staffs (field engineer and laboratory technician).

Results

Although the bioaerosol concentrations were generally regarded as safe according to existing standards, these bioaerosols’ health risks were still unacceptable. The microbial bioaerosols posed considerable infection health risks in WWTPs. These risks were generally above the WHO and US EPA benchmarks. The health risks of females were always smaller than those of male of grown-up age group. Staffs that had been exposed to bioaerosols for a long time were found to have higher health risks compared with temporary entrants. In addition, field engineers equipped with PPE rendered low health risks, thus revealing that wearing PPE could effectively reduce the occupational health risks.

Conclusion

This study provided novel data and enriched the knowledge of microbial bioaerosol emission’s health risks from various aeration modes in WWTPs. Management decisions could be executed by authorities on the basis of the results of QMRA for field engineers equipped with PPE to reduce the related occupational health risks.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00420-021-01663-5.

Quantitative microbial risk assessment and sensitivity analysis for workers exposed to pathogenic bacterial bioaerosols under various aeration modes in two wastewater treatment plants

Wastewater treatment plants (WWTPs) could emit a large amount of bioaerosols containing pathogenic bacteria. Assessing the health risks of exposure to these bioaerosols by using quantitative microbial risk assessment (QMRA) is important to protect workers in WWTPs. However, the relative impacts of the stochastic input variables on the health risks determined in QMRA remain vague. Hence, this study performed a Monte Carlo simulation-based QMRA case study for workers exposing to S. aureus or E. coli bioaerosols and a sensitivity analysis in two WWTPs with various aeration modes. Results showed that when workers equipped without personal protective equipment (PPE) were exposed to S. aureus or E. coli bioaerosol in the two WWTPs, the annual probability of infection considerably exceeded the U.S. EPA benchmark (≤10E-4 pppy), and the disease burden did not satisfy the WHO benchmark (≤10E-6 DALYs pppy) (except exposure to E. coli bioaerosol for disease health risk burden). Nevertheless, the use of PPE effectively reduced the annual infection health risk to an acceptable level and converted the disease health risk burden to a highly acceptable level. Referring to the sensitivity analysis, the contribution of mechanical aeration modes to the variability of the health risks was absolutely dominated in the WWTPs. On the aeration mode that showed high exposure concentration, the three input exposure parameters (exposure time, aerosol ingestion rate, and breathing rate) had a great impact on health risks. The health risks were also prone to being highly influenced by the various choices of the dose-response model and related parameters. Current research systematically delivered new data and a novel perspective on the sensitivity analysis of QMRA. Then, management decisions could be executed by authorities on the basis of the results of this sensitivity analysis to reduce related occupational health risks of workers in WWTPs.

Quantitative microbial risk assessment of bioaerosols in a wastewater treatment plant by using two aeration modes

Nonnegligible emission of bioaerosols usually occurs during aeration of wastewater in aerator tanks in wastewater treatment plants (WWTPs). Literature had shown that the respiratory and intestinal diseases of workers at WWTPs are related to bioaerosols. Thus, quantitative microbial risk assessment (QMRA) based on Monte Carlo simulation was utilized in this research to assess the health risks of Gram-negative bacteria bioaerosol (GNBB) and Staphylococcus aureus bioaerosol (SAB) among academic visitors and staffs. Results showed that the concentrations of GNBB and SAB in the inverted umbrella aeration mode were consistently higher than those in the microporous aeration mode under all six size distribution ranges of the Anderson six-stage impactor. Thus, GNBB and SAB can be highly threatening to the weasand and first bronchus (or alveoli and third bronchus) for the exposure populations. The health risks (annual probability of infection (P_y) and disease burden (DB)) of males were constantly higher than those of females for each certain exposure scenario. The health risks of staffs were higher than those of academic visitors when assessed by Monte Carlo simulation. The wearing of mask is an effective measure to minimize health risks through reducing the bioaerosol concentration intake. Especially, for the academic visitors and staffs exposed to GNBB, all their DB failed to meet the World Health Organization DB benchmark under various credible intervals when they were without a mask on. In a word, the results of health risk assessment in this research can be utilized as an educational tool and policy basis to facilitate the implementation of efficacious prevention measures to protect the public health from bioaerosol health threats in WWTPs.

Quantitative microbial risk assessment of SARS-CoV-2 for workers in wastewater treatment plants

Faecal-oral transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is yet to be validated, but it is a critical issue and additional research is needed to elucidate the risks of the novel coronavirus in sanitation systems. This is the first study that investigates the potential health risks of SARS-CoV-2 in sewage to wastewater treatment plant (WWTP) workers. A quantitative microbial risk assessment (QMRA) is applied for three COVID-19 scenarios (moderate, aggressive and extreme) to study the effects of different stages of the pandemic in terms of percentage of infected population on the probability of infection to WWTP workers. A dose-response model for SARS-CoV-1 (as a surrogate pathogen) is assumed in the QMRA for SARS-CoV-2 using an exponential model with k = 4.1 × 10². Literature data are incorporated to inform assumptions for calculating the viral load, develop the model, and derive a tolerable infection risk. Results reveal that estimates of viral RNA in sewage at the entrance of WWTPs ranged from 4.14 × 10¹ to 5.23 × 10³ GC·mL^-1 (viable virus concentration from 0.04 to 5.23 PFU·mL^-1, respectively). In addition, estimated risks for the aggressive and extreme scenarios (2.6 × 10^-3 and 1.3 × 10^-2, respectively) were likely to be above the derived tolerable infection risk for SARS-CoV-2 of 5.5 × 10^-4 pppy, thus reinforcing the concern of sewage systems as a possible transmission pathway of SARS-CoV-2. These findings are helpful as an early health warning tool and in prioritizing upcoming risk management strategies, such as Emergency Response Plans (ERPs) for water and sanitation operators during the COVID-19 and future pandemics.

Quantitative microbial risk assessment of SARS-CoV-2 for workers in wastewater treatment plants

Faecal-oral transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is yet to be validated, but it is a critical issue and additional research is needed to elucidate the risks of the novel coronavirus in sanitation systems. This is the first study that investigates the potential health risks of SARS-CoV-2 in sewage to wastewater treatment plant (WWTP) workers. A quantitative microbial risk assessment (QMRA) is applied for three COVID-19 scenarios (moderate, aggressive and extreme) to study the effects of different stages of the pandemic in terms of percentage of infected population on the probability of infection to WWTP workers. A dose-response model for SARS-CoV-1 (as a surrogate pathogen) is assumed in the QMRA for SARS-CoV-2 using an exponential model with k = 4.1 × 10². Literature data are incorporated to inform assumptions for calculating the viral load, develop the model, and derive a tolerable infection risk. Results reveal that estimates of viral RNA in sewage at the entrance of WWTPs ranged from 4.14 × 10¹ to 5.23 × 10³ GC·mL^-1 (viable virus concentration from 0.04 to 5.23 PFU·mL^-1, respectively). In addition, estimated risks for the aggressive and extreme scenarios (2.6 × 10^-3 and 1.3 × 10^-2, respectively) were likely to be above the derived tolerable infection risk for SARS-CoV-2 of 5.5 × 10^-4 pppy, thus reinforcing the concern of sewage systems as a possible transmission pathway of SARS-CoV-2. These findings are helpful as an early health warning tool and in prioritizing upcoming risk management strategies, such as Emergency Response Plans (ERPs) for water and sanitation operators during the COVID-19 and future pandemics.

A systematic review of post-harvest interventions for Vibrio parahaemolyticus in raw oysters

BACKGROUND

Non-cholera Vibrio bacteria are a major cause of foodborne illness in the United States. Raw oysters are commonly implicated in gastroenteritis caused by pathogenic Vibrio parahaemolyticus. In response to outbreaks in 1997-1998, the US Food and Drug Administration developed a nation-wide quantitative microbial risk assessment (QMRA) of V. parahaemolyticus in raw oysters in 2005. The QMRA identified information gaps that new research may address. Incidence of sporadic V. parahaemolyticus illness has recently increased and, as oyster consumption increases and sea temperatures rise, V. parahaemolyticus outbreaks may become more frequent, posing health concerns. Updated and region-specific QMRAs will improve the accuracy and precision of risk of infection estimates.

OBJECTIVES

We identify research to support an updated QMRA of V. parahaemolyticus from oysters harvested in Chesapeake Bay and Puget Sound, focusing on observational and experimental research on post-harvest practices (PHPs) published from 2004 to 2019.

METHODS

A predefined search strategy was applied to PubMed, Embase, Scopus, Science.gov, NAL Agricola, and Google Scholar. Study eligibility criteria were defined using a population, intervention, comparator, and outcome statement. Reviewers independently coded abstracts for inclusion/exclusion using predefined criteria. Data were extracted and study quality and relevance evaluated based on published guidance for food safety risk assessments. Findings were synthesized using a weight of evidence approach.

RESULTS

Of 12,174 articles retrieved, 93 were included for full-text review. Twenty-seven studies were found to be high quality and high relevance, including studies on cold storage, high hydrostatic pressure, depuration, and disinfectant, and other PHPs. High hydrostatic pressure consistently emerged as the most effective PHP in reducing abundance of V. parahaemolyticus.

DISCUSSION

Limitations of the knowledge base and review approach involve the type and quantity of data reported. Future research should focus on PHPs for which few or no high quality and high relevance studies exist, such as irradiation and relaying.

Quantitative microbial risk assessment for waterborne pathogens in a wastewater treatment plant and its receiving surface water body

BACKGROUND

Access to safe water for drinking and domestic activities remains a challenge in emerging economies like South Africa, forcing resource-limited communities to use microbiologically polluted river water for personal and household purposes, posing a public health risk. This study quantified bacterial contamination and the potential health hazards that wastewater treatment plant (WWTP) workers and communities may face after exposure to waterborne pathogenic bacteria in a WWTP and its associated surface water, respectively.

RESULTS

Escherichia coli (Colilert®-18/ Quanti-Tray® 2000) and enterococci (Enterolert®/ Quanti-Tray® 2000) were quantified and definitively identified by real-time polymerase chain reaction targeting the uidA and tuf genes, respectively. An approximate beta-Poisson dose-response model was used to estimate the probability of infection (Pi) with pathogenic E. coli. Mean E. coli concentration ranged from 2.60E+ 02/100 mL to 4.84E+ 06/100 mL; enterococci ranged from 2.60E+ 02/100 mL to 3.19E+ 06/100 mL across all sampled sites. Of the 580 E. coli isolates obtained from this study, 89.1% were intestinal, and 7.6% were extraintestinal pathogenic E. coli. The 579 enterococci obtained were 50.4% E. faecalis (50.4%), 31.4% E. faecium, 3.5%, E. casseliflavus and 0.7% E. gallinarum. The community health risk stemming from the use of the water for recreational and domestic purposes revealed a greater health risk (Pi) from the ingestion of 1 mL of river water from upstream (range, 55.1-92.9%) than downstream (range, 26.8-65.3%) sites. The occupational risk of infection with pathogenic E. coli for workers resulting from a once-off unintentional consumption of 1 mL of water was 0% (effluent) and 23.8% (raw influent). Multiple weekly exposures of 1 mL over a year could result in a Pi of 1.2 and 100% for the effluent and influent, respectively.

CONCLUSION

Our findings reveal that there is a potentially high risk of infection for WWTP workers and communities that use river water upstream and downstream of the investigated WWTP.

Addressing and reducing parameter uncertainty in quantitative microbial risk assessment by incorporating external information via Bayesian hierarchical modeling

Probabilistic quantitative microbial risk assessment (QMRA) studies define model inputs as random variables and use Monte-Carlo simulation to generate distributions of potential risk outcomes. If local information on important QMRA model inputs is missing, it is widely accepted to justify assumptions about these model inputs by using external literature information. A question, which remains unexplored, is the extent to which previously published external information should influence local estimates in cases of nonexistent, scarce, and moderate local data. This question can be addressed by employing Bayesian hierarchical modeling (BHM). Thus, we study the effects and potential benefits of BHM on risk and performance target calculations at three wastewater treatment plants (WWTP) in comparison to alternative statistical modeling approaches (separate modeling, no-pooling, complete pooling). The treated wastewater from the WWTPs is used for restricted irrigation, potable reuse, or influences recreational waters, respectively. We quantify the extent to which external data affects local risk estimations in each case depending on the statistical modeling approach applied. Modeling approaches are compared by calculating the pointwise expected log-predictive density for each model. As reference pathogens and example data, we use locally collected Norovirus genogroup II data with varying sample sizes (n = 4, n = 7, n = 27), and complement local information with external information from 44 other WWTPs (n = 307). Results indicate that BHM shows the highest predictive accuracy and improves estimates by reducing parameter uncertainty when data are scarce. In such situations, it may affect risk and performance target calculations by orders of magnitude in comparison to using local data alone. Furthermore, it allows making generalizable inferences about new WWTPs, while providing the necessary flexibility to adjust for different levels of information contained in the local data. Applying this flexible technique more widely may contribute to improving methods and the evidence base for decision-making in future QMRA studies.

Informing water distribution line rehabilitation through quantitative microbial risk assessment

Poor urban water quality has been linked to diminished source water quality, poorly functioning water treatment systems and infiltration into distribution lines after treatment resulting in microbiological contamination. With limited funding to rehabilitate distribution lines, developing nations need tools to identify the areas of greatest concern to human health so as to target cost effective remediation approaches. Herein, a case study of Hyderabad, Pakistan was used to demonstrate the efficacy of combining quantitative microbial risk assessment (QMRA) for multiple pathogens with spatial distribution system modeling to identify areas for pipe rehabilitation. Abundance of Escherichia coli, Enterococcus (enterococci), Salmonella spp., Shigella spp., Giardia intestinalis, Vibrio cholera, norovirus GI and adenovirus 40/41, were determined in 85 locations including the source water, treatment plant effluent and the city distribution lines. Bayesian statistics and Monte Carlo simulations were used in the QMRA to account for left-censored microbial abundance distributions. Bacterial and viral abundances in the distribution system samples decreased as follows: 9400 ± 19,800 norovirus gene copies/100 mL (average ± standard deviation, 100% of samples positive); 340 ± 2200 enterococci CFU/100 mL (94%), 71 ± 97 Shigella sp. CFU/100 mL (97%), 60 ± 360 E. coli CFU/100 mL (89%), 35 ± 79 adenovirus gene copies/100 mL (100%), and 21 ± 46 Salmonella sp. CFU/100 mL (76%). The QMRA revealed unacceptable probabilities of illness (>1 in 10,000 illness level) from the four exposure routes considered (drinking water, or only showering, tooth brushing, and rinsing vegetables consumed raw). Disease severity indices based on the QMRA combined with mapping the distribution system revealed areas for targeted rehabilitation. The combined intensive sampling, risk assessment and mapping can be used in low- and middle-income countries to target distribution system rehabilitation efforts and improve health outcomes.

Evaluation of public health risk for Escherichia coli O157:H7 in cilantro

This study sought to model the growth and die-off of Escherichia coli (E. coli) O157:H7 along the cilantro supply chain from farm-to-fork to investigate its risk to public health. Contributing factors included in the model were on farm contamination from irrigation water and soil, solar radiation, harvesting, and transportation and storage times and temperatures. The developed risk model estimated the microbiological risks associated with E. coli O157:H7 in cilantro and determined the parameters that had the most effect on the estimated number of illnesses per year so future mitigation strategies could be applied. Results showed a similar decrease in the E. coli O157:H7 (median values) concentrations along the supply chain for cilantro grown in both winter and summer weather conditions. With an estimated 0.1% prevalence of E. coli O157:H7 contamination for cilantro post-harvest used for illustration, the model predicted the probability of illness from consuming fresh cilantro as very low with fewer than two illnesses per every one billion servings of cilantro (1.6 × 10^-9; 95th percentile). Although rare, 3.7% and 1.6% of scenarios run in this model for summer and winter grown cilantro, respectively, result in over 10 cases per year in the United States. This is reflected in real life where illnesses from cilantro are seen rarely but outbreaks have occurred. Sensitivity analysis and scenario testing demonstrated that ensuring clean and high quality irrigation water and preventing temperature abuse during transportation from farm to retail, are key to reducing overall risk of illness.

Assessment of health risks from recreational exposure to Giardia and Cryptosporidium in coastal bathing waters

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.

Describing water treatment process performance: Why average log-reduction can be a misleading statistic

The degree to which a technology used for drinking water treatment physically removes or inactivates pathogenic microorganisms is commonly expressed as a log-reduction (or log-removal) and is of central importance to the provision of microbiologically safe drinking water. Many evaluations of water treatment process performance generate or compile multiple values of microorganism log-reduction, and it is common to report the average of these log-reduction values as a summary statistic. This work provides a cautionary note against misinterpretation and misuse of averaged log-reduction values by mathematically proving that the average of a set of log-reduction values characteristically overstates the average performance of which the set of log-reduction values is believed to be representative. This has two important consequences for drinking water and food safety as well as other applications of log-reduction: 1) a technology with higher average log-reduction does not necessarily have higher average performance, and 2) risk analyses using averaged log-reduction values as point estimates of treatment efficiency will underestimate average risk-sometimes by well over an order of magnitude. When analyzing a set of log-reduction values, a summary statistic called the effective log-reduction (which averages reduction or passage rates and expresses this as a log-reduction) provides a better representation of average performance of a treatment technology.

Modelling the combined effect of chlorine, benzyl isothiocyanate, exposure time and cut size on the reduction of Salmonella in fresh-cut lettuce during washing process

This work aimed to study the effect of the combination of Sodium hypochlorite, the most used disinfectant by the vegetable industry, with a natural antimicrobial, benzyl-isothiocyanate (BITC), considering cutting surface and contact time, on the reduction of Salmonella in fresh-cut produce in washing operations under typical industrial conditions. Overall, the combinations of disinfectant and process parameters resulted in a mean reduction of Salmonella of 2.5 log CFU/g. According to statistical analysis, free chlorine and BITC concentrations, contact time and cut size exerted a significant effect on the Salmonella reduction (p ≤ 0.05). The optimum combination of process parameter values yielding the highest Salmonella reduction was a lettuce cut size of 15 cm2 washed for 110 s in industrial water containing 160 mg/L free chlorine and 40 mg/L BITC. A predictive model was also derived, which, as illustrated, could be applied to optimize industrial disinfection and develop probabilistic Exposure Assessments considering the effect of washing process parameters on the levels of Salmonella contamination in leafy green products. The present study demonstrated the efficacy of chlorine to reduce Salmonella populations in fresh-cut lettuce while highlighting the importance of controlling the washing process parameters, such as, contact time, cut size and concentration of the disinfectant to increase disinfectant efficacy and improve food safety.

Risk-based assessment and criteria specification of the microbial safety of wastewater reuse in food processing: Managing Listeria monocytogenes contamination in pasteurized fluid milk

Intense pressure on water resources has led to efforts to reuse reclaimed processing wastewater for cleaning purposes in food processing plants. The milk industry produces considerable amounts of wastewater, which can be used for cleaning of equipment after appropriate treatment. However, due to naturally occurring microbiological contamination in raw milk, the wastewater is often contaminated, and therefore the reuse of reclaimed wastewater is perceived as risky. This study aims to quantify the risks of Listeria monocytogenes infection and associated disease burden when wastewater reclaimed from milk processing operations is used in cleaning-in-place (CIP) systems for pasteurized fluid milk production following a quantitative microbial risk assessment (QMRA) approach. Furthermore, this study aims to inform risk-based tolerable limits for levels of contamination in CIP water based on a public health target of 10^-6 DALY per person annually. The suggested model investigates the passage of L. monocytogenes throughout the fluid milk chain, from receipt of raw milk at the plant to the point of consumption and covering storage in receiving and storage tanks, pasteurization, and storage at retail and at home. Risk and disease burden estimates are simulated for general (younger than 65 years), elderly (65 years and older) and pregnant population subgroups. Additional scenarios covering the effect of using clean water, using water with different levels of contamination and using reclaimed wastewater modeled as recovered from cheese whey after membrane filtration (reclaimed water scenario) are considered to estimate a risk-based limit of contamination and simulate a real-life example. The tolerable limit of contamination in CIP water was estimated as -2 log₁₀ CFU/mL to ensure the protection of the most vulnerable subgroup, pregnant women, while higher limits were estimated for the elderly and general subgroups. Under the reclaimed water scenario, the annual number of listeriosis cases was estimated as 3.36, 5.67, and 0.15 for the general, elderly and pregnant population subgroups, respectively, while in the clean water scenario, the estimates were 3.33, 5.56 and 0.15, respectively. In both scenarios, the DALY estimates were lower than the tolerable limit. The results indicate that reclaimed water can be an alternative to potable water for CIP applications.