Jeffrey A. Soller

Estimated human health risks from exposure to recreational waters impacted by human and non-human sources of faecal contamination

This work was conducted to determine whether estimated risks following exposure to recreational waters impacted by gull, chicken, pig, or cattle faecal contamination are substantially different than those associated with waters impacted by human sources such as treated wastewater. Previously published Quantitative Microbial Risk Assessment (QMRA) methods were employed and extended to meet these objectives. Health outcomes used in the analyses were infection from reference waterborne pathogens via ingestion during recreation and subsequent gastrointestinal (GI) illness. Illness risks from these pathogens were calculated for exposure to faecally contaminated recreational water at the U.S. regulatory limits of 35 cfu 100 mL(-1) enterococci and 126 cfu 100 mL(-1)Escherichia coli. The probabilities of GI illness were calculated using pathogen dose-response relationships from the literature and Monte Carlo simulations. Three scenarios were simulated, representing a range of feasible interpretations of the available data. The primary findings are that: 1) GI illness risks associated with exposure to recreational waters impacted by fresh cattle faeces may not be substantially different from waters impacted by human sources; and 2) the risks associated with exposure to recreational waters impacted by fresh gull, chicken, or pig faeces appear substantially lower than waters impacted by human sources. These results suggest that careful consideration may be needed in the future for the management of recreational waters not impacted by human sources.

A sea change ahead for recreational water quality criteria

The United States Environmental Protection Agency is committed to developing new recreational water quality criteria for coastal waters by 2012 to provide increased protection to swimmers. We review the uncertainties and shortcomings of the current recreational water quality criteria, describe critical research needs for the development of new criteria, as well as recommend a path forward for new criteria development. We believe that among the most needed research needs are the completion of epidemiology studies in tropical waters and in waters adversely impacted by urban runoff and animal feces, as well as studies aimed to validate the use of models for indicator and pathogen concentration and health risk predictions.

Estimating the primary etiologic agents in recreational freshwaters impacted by human sources of faecal contamination

Epidemiology studies of recreational waters have demonstrated that swimmers exposed to faecally-contaminated recreational waters are at risk of excess gastrointestinal illness. Epidemiology studies provide valuable information on the nature and extent of health effects, the magnitude of risks, and how these risks are modified or associated with levels of faecal contamination and other measures of pollution. However, such studies have not provided information about the specific microbial agents that are responsible for the observed illnesses in swimmers. The objective of this work was to understand more fully the reported epidemiologic results from studies conducted on the Great Lakes in the US during 2003 and 2004 by identifying pathogens that could have caused the observed illnesses in those studies. We used a Quantitative Microbial Risk Assessment (QMRA) approach to estimate the likelihood of pathogen-induced adverse health effects. The reference pathogens used for this analysis were Norovirus, rotavirus, adenovirus, Cryptosporidium spp., Giardia lamblia, Campylobacter jejuni, Salmonella enterica, and Escherichia coli O157:H7. Two QMRA-based approaches were used to estimate the pathogen combinations that would be consistent with observed illness rates: in the first, swimming-associated gastrointestinal (GI) illnesses were assumed to occur in the same proportion as known illnesses in the US due to all non-foodborne sources, and in the second, pathogens were assumed to occur in the recreational waters in the same proportion as they occur in disinfected secondary effluent. The results indicate that human enteric viruses and in particular, Norovirus could have caused the vast majority of the observed swimming-associated GI illnesses during the 2003/2004 water epidemiology studies. Evaluation of the time-to-onset of illness strongly supports the principal finding and sensitivity analyses support the overall trends of the analyses even given their substantial uncertainties.

Evaluating the importance of faecal sources in human-impacted waters.

Quantitative microbial risk assessment (QMRA) was used to evaluate the relative contribution of faecal indicators and pathogens when a mixture of human sources impacts a recreational waterbody. The waterbody was assumed to be impacted with a mixture of secondary-treated disinfected municipal wastewater and untreated (or poorly treated) sewage, using Norovirus as the reference pathogen and enterococci as the reference faecal indicator. The contribution made by each source to the total waterbody volume, indicator density, pathogen density, and illness risk was estimated for a number of scenarios that accounted for pathogen and indicator inactivation based on the age of the effluent (source-to-receptor), possible sedimentation of microorganisms, and the addition of a non-pathogenic source of faecal indicators (such as old sediments or an animal population with low occurrence of human-infectious pathogens). The waterbody indicator density was held constant at 35 CFU 100 mL(-1) enterococci to compare results across scenarios. For the combinations evaluated, either the untreated sewage or the non-pathogenic source of faecal indicators dominated the recreational waterbody enterococci density assuming a culture method. In contrast, indicator density assayed by qPCR, pathogen density, and bather gastrointestinal illness risks were largely dominated by secondary disinfected municipal wastewater, with untreated sewage being increasingly less important as the faecal indicator load increased from a non-pathogenic source. The results support the use of a calibrated qPCR total enterococci indicator, compared to a culture-based assay, to index infectious human enteric viruses released in treated human wastewater, and illustrate that the source contributing the majority of risk in a mixture may be overlooked when only assessing faecal indicators by a culture-based method.

A Dynamic Model to Assess Microbial Health Risks Associated with Beneficial Uses of Biosolids

There is increasing interest in the development of a microbial risk assessment methodology for regulatory and operational decision making. This document presents a methodology for assessing risks to human health from pathogen exposure using a population-based model that explicitly accounts for properties unique to an infectious disease process, specifically secondary transmission and immunity. To demonstrate the applicability of this risk-based method, numerical simulations were carried out for a case study example in which the route of exposure was direct consumption of biosolids-amended soil and the pathogen present in the soil was enterovirus. The output from the case study yielded a decision tree that differentiates between conditions in which the relative risk from biosolids exposure is high and those conditions in which the relative risk from biosolids is low. This decision tree illustrates the interaction among the important factors in quantifying risk. For the case study example, these factors include biosolids treatment processes, the pathogen shedding rate of infectious individuals, secondary transmission, and immunity. Further refinement in methods for determining biosolids exposures under field conditions would certainly increase the utility of these approaches.

Meeting report: Knowledge and gaps in developing microbial criteria for inland recreational waters

The U.S. Environmental Protection Agency (EPA) has committed to issuing in 2012 new or revised criteria designed to protect the health of those who use surface waters for recreation. For this purpose, the U.S. EPA has been conducting epidemiologic studies to establish relationships between microbial measures of water quality and adverse health outcomes among swimmers. New methods for testing water quality that would provide same-day results will likely be elements of the new criteria. Although the epidemiologic studies upon which the criteria will be based were conducted at Great Lakes and marine beaches, the new water quality criteria may be extended to inland waters (IWs). Similarities and important differences between coastal waters (CWs) and IWs that should be considered when developing criteria for IWs were the focus of an expert workshop. Here, we summarize the state of knowledge and research needed to base IWs microbial criteria on sound science. Two key differences between CWs and IWs are the sources of indicator bacteria, which may modify the relationship between indicator microbes and health risk, and the relationship between indicators and pathogens, which also may vary within IWs. Monitoring using rapid molecular methods will require the standardization and simplification of analytical methods, as well as greater clarity about their interpretation. Research needs for the short term and longer term are described.

Risk-based evaluation of Escherichia coli monitoring data from undisinfected drinking water.

Drinking water regulations in the United States and elsewhere are based on the occurrence of fecal indicator bacteria. Though not meeting all the criteria of an ideal indicator, nonpathogenic strains of Escherichia coli (E. coli) are used worldwide as an indicator of potential fecal contamination for drinking water and for distribution systems. This is, in part, because real illnesses are related to human pathogens, such as E. coli O157:H7, whose presence may be predicted better by E. coli than by total coliform bacteria. Our objective was to estimate the number of E. coli O157:H7 illnesses attributable to drinking water exposures in the United States and the feasible relationships between positive occurrences of the indicator bacteria E. coli and E. coli O157:H7 in drinking water. Results of the modeling indicate that in undisinfected drinking water systems, the ratio of bacterial indicator E. coli positives to E. coli O157:H7 organisms is estimated to be between 6:1 and 90:1 with few model parameters accounting for the vast majority of the uncertainty. These results provide context for considering the potential public health implications of a positive E. coli result from routine monitoring of undisinfected drinking water.

Evaluation of Microbial Risk Assessment Techniques and Applications

This investigation reviewed and evaluated methodologies used for microbial risk assessment with respect to their applicability for reclaimed water applications. The investigation was comprised of five primary components: a comprehensive database of articles, reports and books describing microbial risk assessment methodologies was established and reviewed. Risk assessment techniques and models were identified for estimating the public health risk from exposure to microorganisms via reclaimed water applications. Two models were identified for further evaluation: a static (individual based) and a dynamic (population based).In the third component, the two models were evaluated to differentiate between the conditions under which models predict similar and substantially different estimations of risk. Through numerical simulation, exposure/pathogen combinations were identified when it may be appropriate to use the less complex, static model. Case study risk assessment scenarios demonstrated the model selection process for three realistic, yet hypothetical reclaimed water scenarios. The fourth component presents a constraint analysis for existing reuse regulations. The constraint analysis is carried out by documenting the existing reuse regulations. The constraint analysis is carried out by documenting the existing regs in three states for landscape irrigation and uses that comparison as a starting point to identify how microbial risk assessment may be useful within the context of existing and potential future water reuse regulations. The investigation concludes by identifying criteria for a computer interface that would allow regulatory and/or municipal agencies/utilities to take advantage of the analysis discussed in the report. This title belongs to WERF Research Report Series ISBN: 9781780404141 (eBook) ISBN: 9781843396840 (Print)

Estimated human health risks from recreational exposures to stormwater runoff containing animal faecal material

Scientific evidence supporting recreational water quality benchmarks primarily stems from epidemiological studies conducted at beaches impacted by human fecal sources. Epidemiological studies conducted at locations impacted by non-human faecal sources have provided ambiguous and inconsistent estimates of risk. Quantitative Microbial Risk Assessment (QMRA) is another tool to evaluate potential human health risks from recreational exposures to non-human faecal contamination. The potential risk differential between human and selected non-human faecal sources has been characterized previously for direct deposition of animal feces to water. In this evaluation, we examine the human illness potential from a recreational exposure to freshwater impacted by rainfall-induced runoff containing agricultural animal faecal material. Risks associated with these sources would be at least an order of magnitude lower than the benchmark level of public health protection associated with current US recreational water quality criteria, which are based on contamination from human sewage sources. We examine the human illness potential from exposure to rainfall-induced runoff.The predicted risks are lower than the benchmark level of protection.This risk assessment should be helpful to inform public health decision-making.

Human Health Risk Assessment of Non-Regulated Xenobiotics in Recycled Water: A Review

ABSTRACT Water suppliers face increased pressure to explain the relative health risks from non-regulated xenobiotics that may be present in recycled water, including pharmaceuticals and personal care products (PPCPs) and endocrine disrupting compounds. This report reviews their occurrence, fate, and recent human health risk assessments for potable and non-potable water reuse. The most effective advanced treatment for PPCPs is reverse osmosis (RO) followed by advanced oxidation. During soil aquifer treatment, the majority of PPCPs are attenuated relatively quickly (within 100 days), yet some are persistent and can migrate to the underlying groundwater at low concentrations. Recently, several investigations have assessed the potential human health risks associated with xenobiotics in recycled water, focusing on exposure from drinking water (e.g., planned and unplanned indirect potable reuse) and non-potable reuse (e.g., exposure via recreational, occupational, and irrigation-related activities at sites utilizing recycled water). Risk assessments conducted over the last 10 years have found no adverse human health effects or significant risks. Though advanced treatment of wastewater that is discharged or recycled may not be required to protect public health, it may be necessary to prevent potential effects on exposed biota and to address, to some degree, the publics perception of water reuse.