Modelling faecal pathogen flows and health risks in urban Bangladesh: Implications for sanitation decision making

Review of linear and circular approaches to on-site domestic wastewater treatment: Analysis of research achievements, trends and distance to target

This comprehensive review critically assesses traditional and emerging technologies for domestic wastewater treatment and reuse, focusing on the transition from conventional centralised systems to innovative decentralised approaches. Through an extensive literature search on domestic wastewater systems serving a population equivalent of less than or equal to 10, the study juxtaposes linear and circular methods and highlights their impact on urban water management and the environment. The papers reviewed were classified into five categories: Environmental studies, economic studies, social studies, technological studies, and reviews and policy papers. The analysis was carried out separately for linear and circular approaches within each category. In addition, the maturity of the technology (lab/pilot or full-scale application) was taken into account in the analysis. The research landscape is shown to be evolving towards circular methods that promise sustainability through resource recovery, despite the dominance of linear perspectives. The lack of clear progress in decentralised technologies, the scarcity of circularity assessments and the challenges of urban integration are highlighted. Operational reliability, regulatory compliance and policy support are identified as key barriers to the adoption of decentralised systems. While conventional pollutants and their environmental impacts are well addressed for linear systems, the study of emerging pollutants is in its infancy. Conclusions on the impact of these hazardous pollutants are tentative and cautious. Social and economic studies are mainly based on virtual scenarios, which are useful research tools for achieving sustainability goals. The conceptual frameworks for assessing the social dimension need further refinement to be effective. The paper argues for a balanced integration of centralisation and decentralisation, proposing a dual strategy that emphasizes the development of interoperable technologies. It calls for further research, policy development and widespread implementation to promote decentralised solutions in urban water management and pave the way for sustainable urban ecosystems.

Prevalence of opportunistic pathogens and anti-microbial resistance in urban aquaculture ponds

Bacterial antimicrobial resistance (AMR) has emerged as a significant concern worldwide. The microbial community profile and potential AMR level in aquaculture ponds are often undervalued and attract less attention than other aquatic environments. We used amplicon and metagenomic shotgun sequencing to study microbial communities and AMR in six freshwater polyculture ponds in rural and urban areas of Bangladesh. Amplicon sequencing revealed different community structures between rural and urban ponds, with urban ponds having a higher bacterial diversity and opportunistic pathogens including Streptococcus, Staphylococcus, and Corynebacterium. Despite proteobacterial dominance, Firmicutes was the most interactive in the community network, especially in the urban ponds. Metagenomes showed that drug resistance was the most common type of AMR found, while metal resistance was only observed in urban ponds. AMR and metal resistance genes were found mainly in beta and gamma-proteobacteria in urban ponds, while AMR was found primarily in alpha-proteobacteria in rural ponds. We identified potential pathogens with a high profile of AMR and metal resistance in urban aquaculture ponds. As these ponds provide a significant source of protein for humans, our results raise significant concerns for the environmental sustainability of this food source and the dissemination of AMR into the food chain.

Hospital wastewater (HWW) treatment in low- and middle-income countries: A systematic review of microbial treatment efficacy

BACKGROUND

Proper treatment of hospital wastewater (HWW) is crucial to minimize the long-term effects on human health and aquatic ecosystems. However, the majority of HWW generated in low and middle-income countries (LMICs), is discharged without adequate treatment. This systematic review aims to fill the knowledge gap in LMICs by examining the efficacy of HWW treatment and the types of technologies used.

METHODS

Studies included in the review offered valuable insights into the current state of HWW management in LMICs. Between 2000 and 2022, only 36 research studies focused on hospital-based wastewater treatment within LMICs. Data were extracted on wastewater treatment technologies in hospitals or healthcare settings in LMICs. Data on sampling techniques, effectiveness, microorganisms and risk of bias of included studies were recorded.

RESULTS

A total of 36 articles met the eligibility criteria: mentioned about 1) hospitals 2) wastewater treatment 3) LMICs and 4) treatment efficacy. Twenty-two studies were conducted in Asia (22/36), 17 were conducted in countries with high Human Development Index. Constructed wetland, and activated sludge process were the most common technologies used in LMICs. A few studies utilized membrane bioreactors and ozone/UV treatment. Fourteen studies reported the concentration reduction to assess the microbial efficacy of the treatment process, 29/36 studies did not meet the national standards for effluent discharge. Reporting on sampling methods, wastewater treatment processes and efficacy of HWW treatment were at high risk of bias. Extreme heterogeneity in study methods and outcomes reporting precluded meta-analysis.

CONCLUSIONS

The existing evidence indicates inadequate microbial treatment in low- and middle-income country hospitals, with this systematic review emphasizing the need for improvement in healthcare waste management. It underscores the importance of long-term studies using innovative treatment methods to better understand waste removal in LMIC hospitals and calls for further research to develop context-specific healthcare waste treatment approaches in these regions.

Development of a computational model to inform environmental surveillance sampling plans for Salmonella enterica serovar Typhi in wastewater

Typhoid fever-an acute febrile disease caused by infection with the bacterium Salmonella enterica serotype Typhi (S. Typhi)-continues to be a leading cause of global morbidity and mortality, particularly in developing countries with limited access to safe drinking water and adequate sanitation. Environmental surveillance, the process of detecting and enumerating disease-causing agents in wastewater, is a useful tool to monitor the circulation of typhoid fever in endemic regions. The design of environmental surveillance sampling plans and the interpretation of sampling results is complicated by a high degree of uncertainty and variability in factors that affect the final measured pathogens in wastewater samples, such as pathogen travel time through a wastewater network, pathogen dilution, decay and degradation, and laboratory processing methods. Computational models can, to an extent, assist in the design of sampling plans and aid in the evaluation of how different contributing factors affect sampling results. This study presents a computational model combining dynamic and probabilistic modeling techniques to estimate-on a spatial and temporal scale-the approximate probability of detecting S. Typhi within a wastewater system. This model may be utilized to inform environmental surveillance sampling plans and may provide useful insight into selecting appropriate sampling locations and times and interpreting results. A simulated applied modeling scenario is presented to demonstrate the model's functionality for aiding an environmental surveillance study in a typhoid-endemic community.

Environmental surveillance for COVID-19 using SARS-CoV-2 RNA concentration in wastewater - a study in District East, Karachi, Pakistan

Background

Wastewater-based surveillance is used to track the temporal patterns of the SARS-CoV-2 virus in communities. Viral RNA particle detection in wastewater samples can indicate an outbreak within a catchment area. We describe the feasibility of using a sewage network to monitor SARS-CoV-2 trend and use of genomic sequencing to describe the viral variant abundance in an urban district in Karachi, Pakistan. This was among the first studies from Pakistan to demonstrate the surveillance for SARS-CoV-2 from a semi-formal sewage system.

Methods

Four sites draining into the Lyari River in District East, Karachi, were identified and included in the current study. Raw sewage samples were collected early morning twice weekly from each site between June 10, 2021 and January 17, 2022, using Bag Mediated Filtration System (BMFS). Secondary concentration of filtered samples was achieved by ultracentrifugation and skim milk flocculation. SARS-CoV-2 RNA concentrations in the samples were estimated using PCR (Qiagen ProMega kits for N1 & N2 genes). A distributed-lag negative binomial regression model within a hierarchical Bayesian framework was used to describe the relationship between wastewater RNA concentration and COVID-19 cases from the catchment area. Genomic sequencing was performed using Illumina iSeq100.

Findings

Among the 151 raw sewage samples included in the study, 123 samples (81.5%) tested positive for N1 or N2 genes. The average SARS-CoV-2 RNA concentrations in the sewage samples at each lag (1-14 days prior) were associated with the cases reported for the respective days, with a peak association observed on lag day 10 (RR: 1.15; 95% Credible Interval: 1.10-1.21). Genomic sequencing showed that the delta variant dominated till September 2022, while the omicron variant was identified in November 2022.

Interpretation

Wastewater-based surveillance, together with genomic sequencing provides valuable information for monitoring the community temporal trend of SARS-CoV-2.

Funding

PATH, Bill & Melinda Gates Foundation, and Global Innovation Fund.

Mitigating risks and maximizing sustainability of treated wastewater reuse for irrigation

Scarcity of freshwater for agriculture has led to increased utilization of treated wastewater (TWW), establishing it as a significant and reliable source of irrigation water. However, years of research indicate that if not managed adequately, TWW may deleteriously affect soil functioning and plant productivity, and pose a hazard to human and environmental health. This review leverages the experience of researchers, stakeholders, and policymakers from Israel, the United-States, and Europe to present a holistic, multidisciplinary perspective on maximizing the benefits from municipal TWW use for irrigation. We specifically draw on the extensive knowledge gained in Israel, a world leader in agricultural TWW implementation. The first two sections of the work set the foundation for understanding current challenges involved with the use of TWW, detailing known and emerging agronomic and environmental issues (such as salinity and phytotoxicity) and public health risks (such as contaminants of emerging concern and pathogens). The work then presents solutions to address these challenges, including technological and agronomic management-based solutions as well as source control policies. The concluding section presents suggestions for the path forward, emphasizing the importance of improving links between research and policy, and better outreach to the public and agricultural practitioners. We use this platform as a call for action, to form a global harmonized data system that will centralize scientific findings on agronomic, environmental and public health effects of TWW irrigation. Insights from such global collaboration will help to mitigate risks, and facilitate more sustainable use of TWW for food production in the future.

Situational assessment for fecal sludge management in major cities of Pakistan

With enhanced focus on global sanitation, access to toilets at the household level is increasing in developing countries although the provision of sewer networks is not expanding at the same pace. This is resulting in the adaptation of on-site sanitation facilities to contain the fecal sludge. The fecal sludge generated by the on-site sanitation facilities requires emptying, treatment, and safe end-use or disposal. In this study, the sanitation situation and need for fecal sludge management was evaluated in major cities of Pakistan including Karachi (provincial capital), Lahore (provincial capital), and Islamabad (national capital). Primary and secondary data were collected from key informant interviews of the stakeholders, national and international reports, research, and review articles. Infographics on wastewater and fecal sludge from origin to disposal were developed using a shit flow diagram tool and enabling environment was evaluated with a modified service delivery assessment tool. The results indicate that sewerage network coverage exists for 60%, 63%, and 50% of the areas in Karachi, Lahore, and Islamabad respectively. The sewerage network in major cities is old, leaking, and insufficient, thus a limited amount of wastewater reaches the treatment plants. Total wastewater treatment in Karachi and Islamabad is 10% and 9% respectively whereas, in Lahore, there is no infrastructure for the same. The safe sanitation in Lahore (8%) and Islamabad (25%) is coming from on-site sanitation systems with fecal sludge buried safely onsite. National level sanitation programs exist in the country but are limited to reducing open defecation and containments of fecal sludge only. The inclusion of complete fecal sludge management related framework, guidelines, and policies can help achieve the goal of safe sanitation for all.

Association of access to water, sanitation and handwashing facilities with undernutrition of children below 5 years of age in Bangladesh: evidence from two population-based, nationally representative surveys

OBJECTIVE

To examine the association between household access to water, sanitation and handwashing (WaSH) facilities and child undernutrition in Bangladesh.

DESIGN, SETTING AND PARTICIPANTS

Cross-sectional study of children less than 5 years using data collected from the 2019 Multiple Indicator Cluster Survey (MICS) and the 2017-2018 Bangladesh Demographic and Health Survey (BDHS).

OUTCOME MEASURES

Stunting, wasting and underweight, defined as a Z-score <-2 SD for height-for-age, weight-for-height and weight-for-age, respectively. We applied hierarchical multiple binary logistic regression models.

RESULTS

Among 30 514 children 0-59 months, there was a high prevalence of child undernutrition (MICS: 28.0% stunted, 9.8% wasted, 22.6% underweight; BDHS: 30.8% stunted, 8.4% wasted, 21.7% underweight). Most children came from households lacking basic sanitation (MICS: 39.1%, BDHS: 55.3%) or handwashing facilities (MICS: 43.8%, BDHS: 62.6%). Children from households without access to WaSH facilities experienced the highest rates of undernutrition. Exposure-specific adjusted logistic regression models showed that a lack of access to improved water sources was associated with greater odds of wasting (MICS: adjusted OR (AOR) 1.36, 95% CI 1.00 to 1.85, p<0.05); basic sanitation facility with higher rates of stunting (MICS: 1.13, 1.04 to 1.23, p<0.01) and underweight (BDHS: 1.18, 1.02 to 1.37, p<0.05); and a lack of handwashing facilities with stunting (BDHS: 1.27, 1.10 to 1.48, p<0.01) and underweight (MICS: 1.10, 1.01 to 1.19, p<0.05). In fully adjusted models, no basic sanitation facility was associated with higher odds of stunting (MICS: AOR 1.12, 1.03 to 1.22, p<0.01) and a lack of handwashing facilities with higher odds of underweight (BDHS: AOR 1.30, 1.10 to 1.54, p<0.01;MICS: AOR 1.09, 1.01 to 1.19, p<0.05).

CONCLUSION

These findings demonstrate a significant association between poor household WaSH facilities and high prevalence of child undernutrition. Improving WaSH may help reduce child undernutrition in Bangladesh.

Change in the incidence of intestinal diseases caused by parasitic protozoa in the Mexican population during the period (2015-2019) and its association with environmental and socioeconomic risk factors

Diarrheal diseases are one of the main health problems worldwide, especially in developing countries with poor health systems, high rates of poverty, and poor nutrition. The main causative agents of diarrheal disease are bacteria, viruses, and parasites; among the latter, the intestinal protozoa Giardia and Entamoeba stand out. In the present work, a observational analysis of the national surveillance data of amebiasis, giardiasis, and other protozoan intestinal infections was carried out. The data issued by the Directorate General of Epidemiology was analyzed to establish its relationship with geography, socioeconomic, and environmental conditions in Mexico during the 2015-2019 period. New cases of amebiasis decreased by 25.03% between 2015 and 2019, while giardiasis and other protozoan intestinal infections remained constant; in all cases, incidence was higher in females than in males, and children under 5 years of age were the most affected. The contribution of environmental conditions (seasonality, temperature, and humidity) and socioeconomic factors in the number of protozoan intestinal infection cases was assessed by a multivariable regression model using a backward selection procedure. Peaks in cases were observed in spring and summer, which are characterized by warm and humid climates. Additionally, states with high humidity and annual average temperature contribute to a notably higher incidence of these parasites, especially annual average temperature, as demonstrated through multivariable linear regression models. Moreover, the majority of these states have the largest population living in poverty with inadequate measures for the distribution, dispensing, and sanitation of water. These data are essential to incidence rate monitoring and focus efforts on eliminating risk factors and improving health programs in Mexico.

Dependency of sanitation infrastructure on the discharge of faecal coliform and SARS-CoV-2 viral RNA in wastewater from COVID and non-COVID hospitals in Dhaka, Bangladesh

The detection of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) RNA in wastewater can be used as an indicator of the presence of SARS-CoV-2 infection in specific catchment areas. We conducted a hospital-based study to explore wastewater management in healthcare facilities and analyzed SARS-CoV-2 RNA in the hospital wastewater in Dhaka city during the Coronavirus disease (COVID-19) outbreak between September 2020-January 2021. We selected three COVID-hospitals, two non-COVID-hospitals, and one non-COVID-hospital with COVID wards, conducted spot-checks of the sanitation systems (i.e., toilets, drainage, and septic-tank), and collected 90 untreated wastewater effluent samples (68 from COVID and 22 from non-COVID hospitals). E. coli was detected using a membrane filtration technique and reported as colony forming unit (CFU). SARS-CoV-2 RNA was detected using the iTaq Universal Probes One-Step kit for RT-qPCR amplification of the SARS-CoV-2 ORF1ab and N gene targets and quantified for SARS-CoV-2 genome equivalent copies (GEC) per mL of sample. None of the six hospitals had a primary wastewater treatment facility; two COVID hospitals had functional septic tanks, and the rest of the hospitals had either broken onsite systems or no containment of wastewater. Overall, 100 % of wastewater samples were positive with a high concentration of E. coli (mean = 7.0 log10 CFU/100 mL). Overall, 67 % (60/90) samples were positive for SARS-CoV-2. The highest SARS-CoV-2 concentrations (median: 141 GEC/mL; range: 13-18,214) were detected in wastewater from COVID-hospitals, and in non-COVID-hospitals, the median SARS-CoV-2 concentration was 108 GEC/mL (range: 30-1829). Our results indicate that high concentrations of E. coli and SARS-CoV-2 were discharged through the hospital wastewater (both COVID and non-COVID) without treatment into the ambient water bodies. Although there is no evidence for transmission of SARS-CoV-2 via wastewater, this study highlights the significant risk posed by wastewater from health care facilities in Dhaka for the many other diseases that are spread via faecal oral route. Hospitals in low-income settings could function as sentinel sites to monitor outbreaks through wastewater-based epidemiological surveillance systems. Hospitals should aim to adopt the appropriate wastewater treatment technologies to reduce the discharge of pathogens into the environment and mitigate environmental exposures.

A systematic review and meta-analysis of pathogen reduction in onsite sanitation systems

The safe management of fecal sludge from the 3.4 billion people worldwide that use onsite sanitation systems can greatly reduce the global infectious disease burden. However, there is limited knowledge about the role of design, operational, and environmental factors on pathogen survival in pit latrines, urine diverting desiccation toilets, and other types of onsite toilets. We conducted a systematic literature review and meta-analysis to characterize pathogen reduction rates in fecal sludge, feces, and human excreta with respect to pH, temperature, moisture content, and the use of additives for desiccation, alkalinization, or disinfection. A meta-analysis of 1,382 data points extracted from 243 experiments described in 26 articles revealed significant differences between the decay rates and T₉₉ values of pathogens and indicators from different microbial groups. The overall median T₉₉ values were 4.8 days, 29 days, >341 days, and 429 days for bacteria, viruses, protozoan (oo)cysts, and Ascaris eggs, respectively. As expected, higher pH values, higher temperatures, and the application of lime all significantly predicted greater pathogen reduction rates but the use of lime by itself was more effective for bacteria and viruses than for Ascaris eggs, unless urea was also added. In multiple lab-scale experiments, the application of urea with enough lime or ash to reach a pH of 10 - 12 and a sustained concentration of 2,000 - 6,000 mg/L of non-protonated NH_3-N reduced Ascaris eggs more rapidly than without urea. In general, the storage of fecal sludge for 6 months adequately controls hazards from viruses and bacteria, but much longer storage times or alkaline treatment with urea and low moisture or heat is needed to control hazards from protozoa and helminths. More research is needed to demonstrate the efficacy of lime, ash, and urea in the field. More studies of protozoan pathogens are also needed, as very few qualifying experiments were found for this group.

Persistent Ascaris Transmission Is Possible in Urban Areas Even Where Sanitation Coverage Is High

In low-income, urban, informal communities lacking sewerage and solid waste services, onsite sanitation (sludges, aqueous effluent) and child feces are potential sources of human fecal contamination in living environments. Working in informal communities of urban Maputo, Mozambique, we developed a quantitative, stochastic, mass-balance approach to evaluate plausible scenarios of localized contamination that could explain why the soil-transmitted helminth Ascaris remains endemic despite nearly universal coverage of latrines that sequester most fecal wastes. We used microscopy to enumerate presumptively viable Ascaris ova in feces, fecal sludges, and soils from compounds (i.e., household clusters) and then constructed a steady-state mass-balance model to evaluate possible contamination scenarios capable of explaining observed ova counts in soils. Observed Ascaris counts (mean = -0.01 log10 ova per wet gram of soil, sd = 0.71 log10) could be explained by deposits of 1.9 grams per day (10th percentile 0.04 grams, 90th percentile 84 grams) of child feces on average, rare fecal sludge contamination events that transport 17 kg every three years (10th percentile 1.0 kg, 90th percentile 260 kg), or a daily discharge of 2.7 kg aqueous effluent from an onsite system (10th percentile 0.09 kg, 90th percentile 82 kg). Results suggest that even limited intermittent flows of fecal wastes in this setting can result in a steady-state density of Ascaris ova in soils capable of sustaining transmission, given the high prevalence of Ascaris shedding by children (prevalence = 25%; mean = 3.7 log10 per wet gram, sd = 1.1 log10), the high Ascaris ova counts in fecal sludges (prevalence = 88%; mean = 1.8 log10 per wet gram, sd = 0.95 log10), and the extended persistence and viability of Ascaris ova in soils. Even near-universal coverage of onsite sanitation may allow for sustained transmission of Ascaris under these conditions.

Sanitation, water, energy use, and traffic volume affect environmental quality: Go-for-green developmental policies

Carbon emissions are primarily the result of human activity in urban areas. Inadequate sanitary facilities, contaminated drinking water, nonrenewable energy, and high traffic congestion have all impacted the natural ecosystem. Using data from 1975 to 2019, the study assessed the impact of the aforementioned variables on Pakistan's carbon emissions in light of this crucial fact. The ARDL cointegration method was used to estimate the short- and long-run parameter estimates. Urban sanitation challenges and energy consumption increase carbon emissions, which affects the natural environment by raising a country's carbon intensity. Economic expansion confirmed the inverted U-shaped relationship between carbon emissions and economic growth to verify the Environmental Kuznets Curve (EKC) hypothesis in the long run. In contrast, the monotonically rising function of carbon emissions provides evidence of the nation's economic development in the short run. Access to clean drinking water improves population health and encourages the purchase of eco-friendly products. The government must improve sanitation services and use renewable energy sources to enhance air quality.

Back-estimation of norovirus infections through wastewater-based epidemiology: A systematic review and parameter sensitivity

The amount of norovirus RNA (Ribonucleic Acid) in raw wastewater, collected from a wastewater treatment plant (WWTP), can provide an indication of disease prevalence within the sampled catchment. However, an accurate back-estimation might be impeded by the uncertainties from in-sewer/in-sample degradation of viral RNA, variable shedding magnitude, and difficulties in measurement within raw wastewater. The current study reviewed the published literature regarding the factors of norovirus shedding, viral RNA decay in wastewater, and the occurrence of norovirus RNA in raw wastewater based on molecular detection. Sensitivity analysis for WBE back-estimation was conducted using the reported data of the factors mentioned above considering different viral loads in wastewater samples. It was found that the back-estimation is more sensitive to analytical detection uncertainty than shedding variability for norovirus. Although seasonal temperature change can lead to variation of decay rates and may influence the sensitivity of this pathogen-specific parameter, decay rates of norovirus RNA contribute negligibly to the variance in estimating disease prevalence, based on the available data from decay experiments in bulk wastewater under different temperatures. However, the effects of in-sewer transportation on viral RNA decay and retardation by sewer biofilms on pipe surfaces are largely unknown. Given the highest uncertainty from analytical measurement by molecular methods and complexity of in-sewer processes that norovirus experienced during the transportation to WWTP, future investigations are encouraged to improve the accuracy of viral RNA detection in wastewater and delineate viral retardation/interactions with wastewater biofilms in real sewers.

Microbial contamination in surface water and potential health risks for peri-urban farmers of the Bengal delta

Ensuring safe irrigation practices is vital to sustaining food production in water-scarce delta areas. Bangladesh and many other developing countries discharge untreated wastewater into their surrounding surface water bodies, serving as the primary irrigation source. This indirect irrigation of wastewater is believed to pose threats to the farmers, consumers and market vendors and may also affect crop and soil quality. To assess the risk, peri-urban farmers who use surrounding water bodies of Khulna city, Bangladesh, for crop irrigation were selected for the study. The microbial and heavy metal concentrations were measured in water samples collected from various locations over different seasons. For heavy metals As, Co, Ni, Cd, Cr, Cu and Pb, concentrations were below the detection limit, whereas Al, Fe, Mn, Ti and Zn were present but below the FAO recommendation limit for safe irrigation. The mean concentrations of microbial parameters were above the thresholds of WHO guidelines for crop irrigation intended for human consumption. Significant temporal variations in Faecal Coliform, E. coli and Enterococcus concentrations in the water samples were observed. The annual risk of infection for farmers was determined using the screening-level Quantitative Microbial Risk Assessment (QMRA). The results indicated that the annual probability of infection with pathogenic E. coli in different seasons ranges between 5 × 10^-3 to 5 × 10^-2, above the WHO's acceptable threshold for annual risk of infection for safe water reuse in agriculture. During the farmers' survey, around 45% reported health-related issues and more than 26% reported suffering from water-borne diseases after getting in contact with polluted surface water. This illustrates the actuality of the risks in practice. To ensure safe irrigation, the health risks need to be reduced below the acceptable limits. Suggested technical measures include adequate treatment of wastewater before disposal into rivers and access to protective equipment for farmers. This should be complemented by raising awareness through education programs among farmers to reduce accidental ingestion.

Wastewater surveillance of SARS-CoV-2 in Bangladesh: Opportunities and challenges

The ongoing pandemic of the coronavirus disease 2019 (COVID-19) is a public health crisis of global concern. The progression of the COVID-19 pandemic has been monitored in the first place by testing symptomatic individuals for SARS-CoV-2 virus in the respiratory samples. Concurrently, wastewater carries feces, urine, and sputum that potentially contains SARS-CoV-2 intact virus or partially damaged viral genetic materials excreted by infected individuals. This brings significant opportunities for understanding the infection dynamics by environmental surveillance. It has advantages for the country, especially in densely populated areas where individual clinical testing is difficult. However, there are several challenges including: 1) establishing a sampling plan and schedule that is representative of the various catchment populations 2) development and validation of standardized protocols for the laboratory analysis 3) understanding hydraulic flows and virus transport in complex wastewater drainage systems and 4) collaborative efforts from government agencies, NGOs, public health units and academia.

Public health performance of sanitation technologies in Tamil Nadu, India: Initial perspectives based on E. coli release

Sanitation is intended to reduce the spread and burden of diseases transmitted from excreta. Pathogen reduction from excreta before sludge or effluent discharge to the environment would seem a logical and useful performance indicator for sanitation systems. However, the relative magnitudes of pathogen release from common sanitation technologies are not well understood. We, therefore, investigated the feasibility of performance measurement of different sanitation technologies in Tamil Nadu, India in reducing the release of the pathogen indicator Escherichia coli (E. coli). After conducting users’ surveys and technical assessments of the locally prevalent sanitation systems, we classified them into 7 distinct categories (based on both observed physical characteristic and usage) within a widely-accepted physical typology. Faecal sludge and wastewater samples were collected and analysed for E. coli and total solids from 136 household systems, 24 community systems, and 23 sanitary sewer oveflows. We estimated the average volumetric release rates of wastewater and faecal sludge from the different sanitation technologies. Average daily per capita E. coli release was computed, and used as one indicator of the public health performance of technologies. We found that on-site installations described by owners as “septic systems” included diverse forms of tanks and pits of uncertain performance. We observed a statistically significant difference in the average daily per capita E. coli release from different sanitation technologies (p = 0.00001). Pathogen release from the studied on-site sanitation technologies varied by as much as 5 orders of magnitude from “lined pits” (5.4 Log10 E. coli per person per day) to “overflowing sanitary sewers” and “direct discharge pipes” (10.3–10.5 Log10 E. coli per person per day). Other technologies lay between these extremes, and their performances in E. coli removal also varied significantly, in both statistical and practical terms. Our results suggest that although faecal sludge management along the sanitation service chain is important, sanitation planners of the observed systems (and probably elsewhere) should direct higher priority to proper management of the liquid effluents from these systems to minimize public health hazards. We conclude that (i) the work demonstrates a new and promising approach for estimating the public health performance of differing sanitation technologies, (ii) if E.coli is accepted as an indicator of the public health hazard of releases from sanitation systems, our results strongly suggest that safe containment of excreta for an extended period substantially reduces pathogen numbers and the risk of pathogen release into the environment; and (iii) there are some simple but little-used technical improvements to design and construction of on-site sanitation systems which could significantly reduce the release of pathogens to the environment.

Impact of sewer overflow on public health: A comprehensive scientometric analysis and systematic review

Sewer overflow (SO), which has attracted global attention, poses serious threat to public health and ecosystem. SO impacts public health via consumption of contaminated drinking water, aerosolization of pathogens, food-chain transmission, and direct contact with fecally-polluted rivers and beach sediments during recreation. However, no study has attempted to map the linkage between SO and public health including Covid-19 using scientometric analysis and systematic review of literature. Results showed that only few countries were actively involved in SO research in relation to public health. Furthermore, there are renewed calls to scale up environmental surveillance to safeguard public health. To safeguard public health, it is important for public health authorities to optimize water and wastewater treatment plants and improve building ventilation and plumbing systems to minimize pathogen transmission within buildings and transportation systems. In addition, health authorities should formulate appropriate policies that can enhance environmental surveillance and facilitate real-time monitoring of sewer overflow. Increased public awareness on strict personal hygiene and point-of-use-water-treatment such as boiling drinking water will go a long way to safeguard public health. Ecotoxicological studies and health risk assessment of exposure to pathogens via different transmission routes is also required to appropriately inform the use of lockdowns, minimize their socio-economic impact and guide evidence-based welfare/social policy interventions. Soft infrastructures, optimized sewer maintenance and prescreening of sewer overflow are recommended to reduce stormwater burden on wastewater treatment plant, curtail pathogen transmission and marine plastic pollution. Comprehensive, integrated surveillance and global collaborative efforts are important to curtail on-going Covid-19 pandemic and improve resilience against future pandemics.

Poor awareness and attitudes to sanitation servicing can impede China's Rural Toilet Revolution: Evidence from Western China

The ongoing Toilet Revolution in China offers an opportunity to improve sanitation in rural areas by introducing new approaches, such as urine source separation, that can contribute to achieving SDG6. However, few studies have systematically assessed the social acceptability of managing human excreta collected in new sanitation systems. Therefore, in this study we performed face-to-face interviews with 414 local residents from 13 villages across three provinces in western China, to analyze the current situation and attitudes to possible changes in the rural sanitation service chain. We found that the sanitation chain was predominantly pit latrine-based, with 86.2% of households surveyed collecting their excreta in a simple pit, 82% manually emptying their pits, and 80.2% reusing excreta in agriculture without adequate pre-treatment. A majority (72%) of the households had a generally positive attitude to production of human excreta-derived fertilizer, but only 24% agreed that urine and feces should be collected separately. Multivariate logistic regression indicated that three factors (level of education, number of permanent household residents, perceived social acceptability) significantly influenced respondents' attitudes to reuse of excreta, although only perceived social acceptability had a high strength of association. Overall, our survey revealed that rural households often misuse toilet systems, fail to comply with government-specified sanitation guidelines, have low awareness of alternative solutions, and are over-reliant on the government to fix problems in the service chain. Thus while new sanitation technologies should be developed and implemented, information campaigns that encourage rural households to manage their excreta safely are also important.

A method for correcting underestimation of enteric pathogen genome quantities in environmental samples

Exposure to enteric pathogens in the environment poses a serious risk for infection and disease. The accurate detection and quantification of enteric pathogens in environmental samples is critical for understanding pathogen transport and fate and developing risk assessment models. In this study, we successfully applied TaqMan real-time PCR assays to quantitatively detect five human-specific pathogens (Shigella/EIEC, Salmonella Typhi, Vibrio cholera, Norovirus, and Giardia) in samples from open drains, canals, floodwater, septic tanks, and anaerobic baffled reactors (ABR) collected in Mirpur, Dhaka, Bangladesh from April to October 2019. Overall, the grab and sediment samples showed low inhibition but the ultrafiltration samples collected from open drain had significantly higher (P = 0.0049) degree of PCR inhibition (median Ct = 31.06) compared to the extraction controls (Ct = 28.54). We developed a two-step method to adjust underestimation of pathogen quantities due to PCR inhibition and non-optimum PCR efficiency. Compared to other sample types, ultrafiltration samples demonstrated a wide range of concentration increase (1.0%-182.5%) by pathogens after adjusting for PCR inhibition and non-optimum efficiencies. These quantitative qPCR assays are successful in quantifying multiple enteric pathogens in environmental samples, and the adjustment method would be useful for correcting underestimates of pathogen quantities due to partial PCR inhibition and non-optimum efficiency.

Development of Moore Swab and Ultrafiltration Concentration and Detection Methods for Salmonella Typhi and Salmonella Paratyphi A in Wastewater and Application in Kolkata, India and Dhaka, Bangladesh

Enteric fever is a severe systemic infection caused by Salmonella enterica serovar Typhi (ST) and Salmonella enterica serovar Paratyphi A (SPA). Detection of ST and SPA in wastewater can be used as a surveillance strategy to determine burden of infection and identify priority areas for water, sanitation, and hygiene interventions and vaccination campaigns. However, sensitive and specific detection of ST and SPA in environmental samples has been challenging. In this study, we developed and validated two methods for concentrating and detecting ST/SPA from wastewater: the Moore swab trap method for qualitative results, and ultrafiltration (UF) for sensitive quantitative detection, coupled with qPCR. We then applied these methods for ST and SPA wastewater surveillance in Kolkata, India and Dhaka, Bangladesh, two enteric fever endemic areas. The qPCR assays had a limit of detection of 17 equivalent genome copies (EGC) for ST and 25 EGC for SPA with good reproducibility. In seeded trials, the Moore swab method had a limit of detection of approximately 0.05–0.005 cfu/mL for both ST and SPA. In 53 Moore swab samples collected from three Kolkata pumping stations between September 2019 and March 2020, ST was detected in 69.8% and SPA was detected in 20.8%. Analysis of sewage samples seeded with known amount of ST and SPA and concentrated via the UF method, followed by polyethylene glycol precipitation and qPCR detection demonstrated that UF can effectively recover approximately 8, 5, and 3 log₁₀ cfu of seeded ST and SPA in 5, 10, and 20 L of wastewater. Using the UF method in Dhaka, ST was detected in 26.7% (8/30) of 20 L drain samples with a range of 0.11–2.10 log₁₀ EGC per 100 mL and 100% (4/4) of 20 L canal samples with a range of 1.02–2.02 log₁₀ EGC per 100 mL. These results indicate that the Moore swab and UF methods provide sensitive presence/absence and quantitative detection of ST/SPA in wastewater samples.