Temporal dynamics of human-excreted pollutants in wastewater treatment plant influents: Toward a better knowledge of mass load fluctuations

Evaluation of pharmaceutical consumption between urban and suburban catchments in China by wastewater-based epidemiology

Wastewater-based epidemiology (WBE) is amply used for estimating human consumption of chemicals, yet information on regional variation of pharmaceuticals and their environmental fate are scarce. Thus, this study aims to estimate the consumption of three cardiovascular, four non-steroidal anti-inflammatory pharmaceuticals (NSAIDs), and four psychoactive pharmaceuticals between urban and suburban catchments in China by WBE, and to explore their removal efficiencies and ecological risks. Eleven analytes were detected in both influent and effluent samples. The estimated consumptions ranged from Collapse

Key Words

• Ecological risks
• Pharmaceutical usage
• Regional variation
• Removal efficiency
• Wastewater treatment plant

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MESH Headings

• China
• Water Pollutants, Chemical/analysis
• Wastewater/analysis
• Wastewater/chemistry
• Pharmaceutical Preparations/analysis
• Cities
• Humans
• Risk Assessment
• Anti-Inflammatory Agents, Non-Steroidal/analysis
• Environmental Monitoring
• Wastewater-Based Epidemiological Monitoring
• Psychotropic Drugs/analysis

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Affiliation(s)

Zongrui Li State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Ecology and Environment, Guangzhou, 510655, China
Jincheng Li State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Ecology and Environment, Guangzhou, 510655, China
Yongxia Hu West Center, Guangzhou Institute of Chemistry, Chinese Academy of Sciences, Chongqing, 400714, China
Yile Yan State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Ecology and Environment, Guangzhou, 510655, China
Shaoyu Tang Research Center for Eco-Environmental Engineering, School of Environment and Civil Engineering, Dongguan University of Technology, Dongguan, 523808, China
Ruixue Ma State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Ecology and Environment, Guangzhou, 510655, China
Liangzhong Li State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Ecology and Environment, Guangzhou, 510655, China; CAS Key Laboratory of Renewable Energy, Guangdong Provincial Key Laboratory of New and Renewable Energy Research and Development, Guangzhou Institute of Energy Conversion, Chinese Academy of Sciences, Guangzhou, 510640, China.

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Consumption of common illicit drugs in twenty-one cities in southwest China through wastewater analysis

Wastewater-based epidemiology (WBE) was applied to estimate illicit drugs consumption at a provincial scale in southwest China. A large-scale wastewater sampling campaign was carried out from October to November in 2021 in 156 different wastewater treatment plants (WWTPs). Two 24-h composite influent wastewater samples were collected in each WWTP. Concentrations of 11 illicit drugs or their metabolites were determined using liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS). Benzoylecgonine, cocaine, 6-monoacetylmorphine, norketamine, 3,4-methylenedioxymethamphetamine (MDMA), and MDA were not detected in any of the wastewater samples. Methamphetamine and morphine were detected in >84% of samples, while ketamine was found in about 6% of the samples. The city-specific population-weighted consumption of methamphetamine and ketamine were in the range of 0.6-49.7 and N.D.-7.0 mg 1000 inh^-1 day^-1, respectively, with provincial population-weighted values of 22.6 and 2.4 mg 1000 inh^-1 day^-1 in southwest China. The city-specific load of morphine varied from 3.2 to 10.2 mg 1000 inh^-1 day^-1, with provincial population-weighted load of 6.7 mg 1000 inh^-1 day^-1. Taking into account therapeutic use of morphine and codeine, the provincial heroin consumption was estimated to be 10.3 mg 1000 inh^-1 day^-1, ranging from 1.7 to 18.5 mg 1000 inh^-1 day^-1 in 21 cities. Overall, the patterns of illicit drugs use were similar across southwest China, with high prevalence of methamphetamine and heroin, but relatively low use of ketamine. These findings could provide accurate drugs consumption information for timely identifying potential hotspots of illicit drugs use in southwest China.

Literature Review: Evaluation of Drug Removal Techniques in Municipal and Hospital Wastewater

There are several techniques for the removal of pharmaceuticals (drugs) from wastewater; however, strengths and weaknesses have been observed in their elimination processes that limit their applicability. Therefore, we aimed to evaluate the best techniques for the removal of pharmaceuticals from municipal and hospital wastewater. For this, a non-experimental, descriptive, qualitative-quantitative design was used, corresponding to a systematic review without meta-analysis. Based on established inclusion and exclusion criteria, 31 open-access articles were selected from the Scopus, ProQuest, EBSCOhost, and ScienceDirect databases. The results showed that high concentrations of analgesics such as naproxen (1.37 mg/L) and antibiotics such as norfloxacin (0.561 mg/L) are frequently found in wastewater and that techniques such as reverse osmosis, ozonation, and activated sludge have the best removal efficiency, achieving values of 99%. It was concluded that reverse osmosis is one of the most efficient techniques for eliminating ofloxacin, sulfamethoxazole, carbamazepine, and diclofenac from municipal wastewater, with removal rates ranging from 96 to 99.9%, while for hospital wastewater the activated sludge technique proved to be efficient, eliminating analgesics and antibiotics in the range of 41-99%.

Impact of COVID19 restrictions on organic micropollutants in wastewater treatment plants and human consumption rates

COVID19 pandemic and the consequent restrictions to constrain SARS-CoV-2 spreading produced several impacts on the worldwide population. The present study focused on 10 Organic Micropollutants (illicit drugs, pharmaceuticals including some antibiotics and caffeine) and aimed to assess: (1) if COVID19 pandemic restrictions affected the load of those contaminants released into the sewage network and consequently the removal achieved by the Wastewater Treatment Plants; (2) if pursuant to the COVID19 pandemic, there was a change in population consumption rates of the same compounds through the wastewater-based epidemiology (WBE) approach. Two full-scale wastewater treatment plants (WWTPs) located in Central Italy were chosen as case studies, which are distinguished by different characteristics of the catchment area and water treatment layouts. The study was based on a 2-years monitoring activity of the concentration of the above organic micropollutants, traditional water quality parameters (COD, TSS, nitrogen compounds, total phosphorous) and flow rate in the influent and effluent. The statistical analysis of the monitoring data showed an increase of the influent load of most of the organic micropollutants. A decrease from 22% to -18% of the median removal efficiency was observed for carbamazepine in the WWTP with the lower treatment capacity only. The other compounds were removed roughly at the same rate. The application of the WBE approach demonstrated an increase in the consumption rate of cocaine, trimethoprim, sulfamethoxazole, sulfadiazine, carbamazepine and above all caffeine during the COVID19 restrictions period. These results highlight that COVID19 pandemic affected people's lifestyle and habits also as far as drugs consumption is concerned, which in turn might have an impact on the treatment efficacy of plants and finally on the receiving water body quality. Therefore, it is mandatory to keep monitoring to improve knowledge and eventually to implement the required measures to address this new problem.

Current and future perspectives for wastewater-based epidemiology as a monitoring tool for pharmaceutical use

The medical and societal consequences of the misuse of pharmaceuticals clearly justify the need for comprehensive drug utilization research (DUR). Wastewater-based epidemiology (WBE) employs the analysis of human metabolic excretion products in wastewater to monitor consumption patterns of xenobiotics at the population level. Recently, WBE has demonstrated its potential to evaluate lifestyle factors such as illicit drug, alcohol and tobacco consumption at the population level, in near real-time and with high spatial and temporal resolution. Up until now there have been fewer WBE studies investigating health biomarkers such as pharmaceuticals. WBE publications monitoring the consumption of pharmaceuticals were systematically reviewed from three databases (PubMed, Web of Science and Google Scholar). 64 publications that reported population-normalised mass loads or defined daily doses of pharmaceuticals were selected. We document that WBE could be employed as a complementary information source for DUR. Interest in using WBE approaches for monitoring pharmaceutical use is growing but more foundation research (e.g. compound-specific uncertainties) is required to link WBE data to routine pharmacoepidemiologic information sources and workflows. WBE offers the possibility of i) estimating consumption of pharmaceuticals through the analysis of human metabolic excretion products in wastewater; ii) monitoring spatial and temporal consumption patterns of pharmaceuticals continuously and in near real-time; and iii) triangulating data with other DUR information sources to assess the impacts of strategies or interventions to reduce inappropriate use of pharmaceuticals.

Spatial distribution of pharmaceuticals within the particulate phases of a peri-urban stream

Pharmaceutical products (PPs) are consumed worldwide and are continuously released into hydrological environments, but are not efficiently removed by sewage treatment plants. Their occurrence within the dissolved phase has been extensively studied, but only a few articles concern solid matrices. The mechanisms and extent of sorption depend on the properties of both the molecules (degradability, charge, hydrophobicity) and the matrices (clay content, organic matter content), making the spatio-temporal distribution of PPs in natural environments complex and poorly elucidated. To improve our understanding of PP distribution at a catchment scale, this study investigated different groups of molecules with varying solubility and charges, in water, suspended particulate matter, bed-load and pond sediments. The Egoutier stream, which collects the sewage effluents from two health institutions sewage effluents, is a good candidate for this investigation. Results indicate that PP occurrences in the different particulate compartments were mainly regulated by their wastewater occurrences and charges. Particulate phases all along the Egoutier stream were characterized by a limited clay content (i.e. less than 1%) and significant organic carbon content (i.e. between 0.3% and 18.0%) favouring non-specific adsorption. Therefore, neutral PPs, exhibiting higher discharge rates, persistence and hydrophobicities in comparison with cationic and anionic molecules, were the most abundant PPs in the particulate phases of this catchment. In bed-load sediments, global PP spatial distributions reflected discharge sites and sedimentary accumulation zones, mostly that of organic matter. Spatial distributions of the more hydrophobic and persistent PP in the particulate phases thus followed the stream sedimentary dynamic.

Using Prescription and Wastewater Data to Estimate the Correction Factors of Atenolol, Carbamazepine, and Naproxen for Wastewater-Based Epidemiology Applications

The correction factor (CF) is a critical parameter in wastewater-based epidemiology (WBE) that significantly influences the accuracy of the final consumption estimates. However, most CFs have been derived from a few old pharmacokinetic studies and should be re-evaluated and refined to improve the accuracy of the WBE approach. This study aimed to review and estimate the CFs for atenolol, carbamazepine, and naproxen for WBE using the daily mass loads of those pharmaceuticals in wastewater and their corresponding dispensed prescription data in Australia. Influent wastewater samples were collected from wastewater treatment plants serving approximately 24% of the Australian population and annual national dispensed prescription data. The estimated CFs for atenolol and carbamazepine are 1.37 (95% CI: 1.17-1.66) and 8.69 (95% CI: 7.66-10.03), respectively. Due to significant over-the-counter sales of naproxen, a reliable CF could not be estimated based on prescription statistics. Using an independent dataset of 186 and 149 wastewater samples collected in an urban catchment in 2011 and 2012, WBE results calculated using the new CFs matched well with the dispensed data for atenolol and carbamazepine in the catchment area.

Evaluating the stability of prescription drugs in municipal wastewater and sewers based on wastewater-based epidemiology

Wastewater-based epidemiology (WBE) is considered as an effective tool for monitoring drug consumption, which is often obtained by back-calculation using the influent concentration and other parameters of wastewater treatment plants. Lack of information on the transformation of drugs in municipal wastewater and sewers may lead to inaccurate consumption estimation. Fourteen prescription drugs in four major categories of diseases (cardiovascular, diabetes, depression, and asthma) were selected to study their adsorption and biodegradation in wastewater and biofilm sewers under different temperatures, pH and biofilms conditions. The result demonstrated that the decay percentage of drugs in wastewater is increased with temperature. Within 72 h, eleven of these 14 drugs, such as metformin, metoprolol, bezafibrate, etc., have decay percentages below 20% in wastewater, which are considered as stable drugs; and the decay percentages of the other three, monluster, paroxetine, and sertraline, are greater than 20%, which are the most unstable drugs. In lab-scale aerobic and anaerobic sewers, the decay percentages of metformin, glipizide, metoprolol, gemfibrozil, and atorvastatin are less than 20% within 24 h. The decay percentages of venlafaxine, citalopram, fluoxetine, salmeterol, and salbutamol within 24 h are 20%-60% and paroxetine and sertraline are close to or even exceed 80% within 6 h. Biodegradation of drugs in sewers with aerobic or anaerobic biofilms is higher than that in wastewater systems without biofilms. The results showed that when the per capita consumption of drugs is estimated by using the WBE method, the stability of drugs in wastewater and different types of sewers will significantly affect their residual concentrations.

High-throughput wastewater analysis for substance use assessment in central New York during the COVID-19 pandemic

Wastewater entering sewer networks represents a unique source of pooled epidemiological information. In this study, we coupled online solid-phase extraction with liquid chromatography-high resolution mass spectrometry to achieve high-throughput analysis of health and lifestyle-related substances in untreated municipal wastewater during the coronavirus disease 2019 (COVID-19) pandemic. Twenty-six substances were identified and quantified in influent samples collected from six wastewater treatment plants during the COVID-19 pandemic in central New York. Over a 12 week sampling period, the mean summed consumption rate of six major substance groups (i.e., antidepressants, antiepileptics, antihistamines, antihypertensives, synthetic opioids, and central nervous system stimulants) correlated with disparities in household income, marital status, and age of the contributing populations as well as the detection frequency of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in wastewater and the COVID-19 test positivity in the studied sewersheds. Nontarget screening revealed the covariation of piperine, a nontarget substance, with SARS-CoV-2 RNA in wastewater collected from one of the sewersheds. Overall, this proof-of-the-concept study demonstrated the utility of high-throughput wastewater analysis for assessing the population-level substance use patterns during a public health crisis such as COVID-19.

Sulfamethoxazole/Trimethoprim ratio as a new marker in raw wastewaters: A critical review

Global Trimethoprim (TMP) and Sulfamethoxazole (SMX) occurrences in raw wastewaters were systematically collected from the literature (n = 140 articles) in order to assess the relevance of using the SMX/TMP ratio as a marker of the main origin of wastewaters. These two antibiotics were selected due to their frequent use in association (i.e. co-trimoxazole) in a 5:1 ratio (SMX:TMP) for medication purposes, generating a unique opportunity to globally evaluate the validity of this ratio based on concentration values. Several parameters (e.g. sorption, biodegradation) may affect the theoretical SMX/TMP ratio. However, the collected data highlighted the good agreement between the theoretical ratio and the experimental one, especially in wastewater treatment plant influents and hospital effluents. Only livestock effluents displayed a very high SMX/TMP ratio, indicative of the very significant use of sulfonamide alone in this industry. Conversely, several countries displayed low SMX/TMP ratio values, highlighting local features in the human pharmacopoeia. This review provides new insights in order to develop an easy to handle and sound marker of wastewater origins (i.e. human/livestock), beyond atypical local customs.

Impact of meteorological and social events on human-excreted contaminant loads in raw wastewater: From daily to weekly dynamics

The temporal dynamics of the wastewater influent loads of 25 drug target residues (DTR, both pharmaceuticals and illicit drugs) was assessed during 84 consecutive days. This monitoring scale enables longer temporal patterns than weekday/weekend patterns to be explored. In this study, we focus on day to day variations and the potential statistical correlation of each DTR analyzed in order to better understand the potential forcings that lead to the load variation of DTRs (alone or in clusters). The weekly patterns based on the weekly loads of DTRs were also analyzed and the impact of social and meteorological events on their variations was investigated. Two cold events occurred during the monitoring period and were associated with the highest loads of analgesics and non-steroidal anti-inflammatory drugs, as well as the lowest loads of stimulants. During the Easter holidays, a significant decrease in some year-long medication as well as analgesics was found, consistent with the demographic decrease within the catchment during this period. Lastly, a good correlation between the academic calendar and the loads of stimulants was found, emphasizing the overrepresentation of students in the consumption of recreational drugs. This study furnishes new insights in order to better understand the variations in DTR loads in wastewater influents, beyond the weekday/weekend pattern and the seasonal effect. Further investigations remain necessary, especially a real-time monitoring of the population figures within the catchment in order to improve our understanding of these results.

Organic micropollutants in a large wastewater treatment plant: What are the benefits of an advanced treatment by activated carbon adsorption in comparison to conventional treatment?

Several advanced treatments, such as ozonation or activated carbon adsorption, are currently considered for the removal of organic micropollutants (OMPs) in wastewater treatment plants (WWTP). However, little is known on the overall performances of a WWTP upgraded with those processes and the benefits provided regarding the elimination of multiple families of OMPs. In this study, 5 sampling campaigns were performed to determine the removal of 48 OMPs in a WWTP followed by an activated carbon pilot. The primary treatment had no effect on OMPs (removals < 20%), whereas the biological treatment removed OMPs that can be easily sorbed onto sludges or biodegraded (>60%). The additional elimination provided by the advanced treatment was not significant (<10%) for OMPs already well removed in the WWTP) but was substantial (>30%) for recalcitrant OMPs. Removals higher than 60% were obtained for all OMPs (except azithromycin and sulfamethoxazole) over the WWTP and the activated carbon pilot. The adsorption conditions (10 g/m³ fresh activated carbon addition) were not sufficient to achieve the 80% removal targeted in Switzerland for compounds suggested as indicator substances for wastewater treatment. A higher dose of activated carbon or the combination with another advanced treatment should be used to achieve a satisfactory removal of those compounds.