Quantitative Microbial Risk Assessment as support for bathing waters profiling

Exploring adenovirus in water environments: a systematic review and meta-analysis

Adenoviruses (AdVs) have a significant impact in both medical and environmental contexts. The objective of this study was to investigate the prevalence of AdV in different water types, such as untreated and treated wastewater, surface water, groundwater, drinking water, and other water matrices. A total of 239 articles were included in this meta-analysis. Adenoviruses were detected in various waters worldwide. The overall prevalence in water was found to be 59.2%, with the highest prevalence in untreated wastewater (83.1%) and treated wastewater (75.3%), followed by "other water matrices" (53.4%), surface water (49.5%) drinking water (22.7%), and groundwater (18.5%). Most of the studies did not assess the viability of the viruses, leading to weak links between water contamination and risk. Both human and animal AdV were found in water environments. The findings suggest that water, including drinking water, could be a significant route of AdV transmission in both developed and developing economies.

Health risk assessment of swimming beaches microbial contamination: a case study - Mahmoudabad, Iran

Waterborne organisms in marine water generally originate from untreated wastewater discharged into the sea. The presence of numerous leisure beaches in Mahmoudabad city, Iran, annually attracts thousands of tourists from all over the country to participate in recreational swimming activities. This study probabilistically characterized the health risks associated with recreational swimming engendered by waterborne pathogens, such as intestinal enterococci and Escherichia coli (E. coli) at 15 sampling points along the beaches of the study using quantitative microbial risk assessment (QMRA). The mean annual infection risk of E. coli in children and adults was 0.424 and 0.229, respectively. The respective risk in terms of enterococci was 0.999 and 0.997, which were higher than the level recommended by the WHO and EPA. The results show that the risk of infection for children was higher than adults. Related authorities have to consider measures to improve environmental quality to protect tourists' and residents' well-being.

Examining the influence of COVID-19 lockdowns on coastal water quality: A study on fecal bacteria levels in Moroccan seawaters

Fecal bacteria in bathing seawater pose a substantial public health risk and require rigorous monitoring. The unexpected beach closures during the COVID-19 lockdowns have afforded unique opportunities to evaluate the impact of human activities on bathing water quality (BWQ). This study examined the temporal changes in fecal coliforms (FC) and streptococci (FS) within bathing seawater across a popular coastal region in Morocco during two lockdown periods (2020 L and 2021 L), comparing these data with observations from pre-lockdown years (2018, 2019) and post-lockdown periods (2020, 2021, 2022). Our findings illuminate the influential role the hiatus periods played in enhancing bathing water quality, attaining an "excellent" status with marked reductions in fecal coliform and streptococci levels. Consequently, the FC/FS analysis exposed a clear preponderance of humans as the primary sources of fecal contamination, a trend that aligns with the burgeoning coastal tourism and the escalating numbers of beach visitors. Additionally, the presence of domestic animals like camels and horses used for tourist rides, coupled with an increase in wild animals such as dogs during the lockdown periods, compounded the potential sources of fecal bacteria in the study area. Furthermore, occasional sewage discharge from tourist accommodations and wastewater treatment plants may also contribute to fecal contamination. To effectively mitigate these concerns and bolster public health, a commitment to relentless surveillance efforts, leveraging novel and innovative tools, is essential. These findings underline the crucial interplay between human activities and the health of our coastal ecosystems, emphasizing the need for sustainable practices for a safer and healthier future.

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.

Virus contamination and infectivity in beach environment: Focus on sand and stranded material

To assess the exposure of beachgoers to viruses, a study on seawater, sand, and beach-stranded material was carried out, searching for human viruses, fecal indicator organisms, and total fungi. Moreover, for the first time, the genome persistence and infectivity of two model viruses was studied in laboratory-spiked sand and seawater samples during a one-week experiment. Viral genome was detected in 13.6 % of the environmental samples, but it was not infectious (Human Adenovirus - HAdV, and enterovirus). Norovirus and SARS-CoV-2 were not detected. The most contaminated samples were from sand and close to riverine discharges. In lab-scale experiments, the infectivity of HAdV5 decreased by ~1.5-Log₁₀ in a week, the one of Human Coronavirus-229E disappeared in <3 h in sand. The genome of both viruses persisted throughout the experiment. Our results confirm viral contamination of the beach and suggest HAdV as an index pathogen for beach monitoring and quantitative risk assessment.

Assessment of rotavirus and norovirus emitted from water spray park: QMRA, diseases burden and sensitivity analysis

A quantitative model on exposure to pathogenic viruses in air of recreational area and their corresponding health effects is necessary to provide mitigation actions in content of emergency response plans (ERP). Here, the health risk associated with exposure to two pathogenic viruses of concern: Rotavirus (RoV) and Norovirus (NoV) in air of water spray park were estimated using a quantitative microbial risk assessment (QMRA) model. To this end, real-time Reverse Transcriptase polymerase chain reaction (real-time RT-PCR) was employed to measure the concentration levels of RoV and NoV over a twelve-month period. The probability of infection, illness and diseases burden of gastrointestinal illness (GI) caused by RoV and NoV for both workers and visitors were estimated using QMRA and Monto-Carlo simulation technique. The annual mean concentration for RoV and NoV in sampling air of water spray park were 20and 1754, respectively. The %95 confidence interval (CI) calculated annual DALY indicator for RoV (Workers: 2.62 × 10⁻⁴–2.62 × 10⁻¹, Visitors: 1.50 × 10⁻⁵–2.42 × 10⁻¹) and NoV (Workers: 5.54 × 10⁻³–2.53 × 10⁻¹; Visitors: 5.18 × 10⁻⁴–2.54 × 10⁻¹) were significantly higher the recommended values by WHO and US EPA (10⁻⁶–10⁻⁴ DALY pppy). According to sensitivity analysis, exposure dose and disease burden per case (DBPC) were found as the most influencing factors on disease burden as a consequences of exposure to RoV and NoV, respectively. The comprehensive information on DALY and QMRA can aid authorities involved in risk assessment and recreational actions to adopt proper approach and mitigation actions to minimize the health risk.

Quantitative Microbial Risk Assessment Applied to Legionella Contamination on Long-Distance Public Transport

The quantitative microbial risk assessment (QMRA) framework is used for assessing health risk coming from pathogens in the environment. In this paper, we used QMRA to evaluate the infection risk of L. pneumophila attributable to sink usage in a toilet cabin on Italian long-distance public transportation (LDT). LDT has water distribution systems with risk points for Legionella proliferation, as well as premise plumbing for drinking water, but they are not considered for risk assessment. Monitoring data revealed that approximately 55% of water samples (217/398) were positive for L. pneumophila, and the most frequently isolated was L. pneumophila sg1 (64%, 139/217); therefore, such data were fitted to the best probability distribution function to be used as a stochastic variable in the QMRA model. Then, a sink-specific aerosolization ratio was applied to calculate the inhaled dose, also considering inhalation rate and exposure time, which were used as stochastic parameters based on literature data. At L. pneumophila sg1 concentration ≤100 CFU/L, health risk was approximately 1 infection per 1 million exposures, with an increase of up to 5 infections per 10,000 exposures when the concentrations were ≥10,000 CFU/L. Our QMRA results showed a low Legionella infection risk from faucets on LDT; however, it deserves consideration since LDT can be used by people highly susceptible for the development of a severe form of the disease, owing to their immunological status or other predisposing factors. Further investigations could also evaluate Legionella-laden aerosols from toilet flushing.

Evaluating the potential for exposure to organisms of public health concern in naturally occurring bathing waters in Europe: A scoping review

Globally, water-based bathing pastimes are important for both mental and physical health. However, exposure to waterborne organisms could present a substantial public health issue. Bathing waters are shown to contribute to the transmission of illness and disease and represent a reservoir and pathway for the dissemination of antimicrobial resistant (AMR) organisms. Current bathing water quality regulations focus on enumeration of faecal indicator organisms and are not designed for detection of specific waterborne organisms of public health concern (WOPHC), such as antimicrobial resistant (AMR)/pathogenic bacteria, or viruses. This investigation presents the first scoping review of the occurrence of waterborne organisms of public health concern (WOPHC) in identified natural bathing waters across the European Union (EU), which aimed to critically evaluate the potential risk of human exposure and to assess the appropriateness of the current EU bathing water regulations for the protection of public health. Accordingly, this review sought to identify and synthesise all literature pertaining to a selection of bacterial (Campylobacter spp., Escherichia coli, Salmonella spp., Shigella spp., Vibrio spp., Pseudomonas spp., AMR bacteria), viral (Hepatitis spp., enteroviruses, rotavirus, adenovirus, norovirus), and protozoan (Giardia spp., and Cryptosporidium spp.) contaminants in EU bathing waters. Sixty investigations were identified as eligible for inclusion and data was extracted. Peer-reviewed investigations included were from 18 countries across the EU, totalling 87 investigations across a period of 35 years, with 30% published between 2011 and 2015. A variety of water bodies were identified, with 27 investigations exclusively assessing coastal waters. Waterborne organisms were classified into three categories; bacteria, viruses, and protozoa; amounting to 58%, 36% and 17% of the total investigations, respectively. The total number of samples across all investigations was 8,118, with detection of one or more organisms in 2,449 (30%) of these. Viruses were detected in 1281 (52%) of all samples where WOPHC were found, followed by bacteria (865(35%)) and protozoa (303(12%)). Where assessed (442 samples), AMR bacteria had a 47% detection rate, emphasising their widespread occurrence in bathing waters. Results of this scoping review highlight the potential public health risk of exposure to WOPHC in bathing waters that normally remain undetected within the current monitoring parameters.

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.

Indexes for the assessment of bacterial pollution in bathing waters from point sources: The northern Adriatic Sea CADEAU service

This paper presents a novel set of water quality indexes to identify the area potentially affected by point sources of bacterial pollution in coastal bathing waters. The indexes, developed in the framework of the CADEAU service, are evaluated on the results of a modelling system based on the integration of a high-resolution ocean model, remote sensing observations and in situ monitoring data for the northern Adriatic Sea. In particular, the system is a downscaling of the Mediterranean Copernicus Marine Environment Monitoring Service and exploits data produced within the Bathing Waters Directive, the Water Framework Directive and the Urban Waste Water Treatment Directive to create added value products. The aim of the proposed indexes is to support the identification of areas of influence for bathing waters by identifying the potential threat from point sources of bacterial pollution, both in standard conditions and peculiar events such as a total bypass of wastewater treatment plants. The results for the Chioggia Municipality case study show the potential of the indexes to significantly improve the geographical identification and quantitative evaluation of the impacts of bacterial pollution sources on bathing waters, facilitating the design of mitigation measures. The proposed methodology represents a new management approach to support local authorities in defining the area of influence within the water bathing profile through the proper characterization of the point sources of bacterial pollution.