Occurrence of disinfection by-products in swimming pools and the estimated resulting cytotoxicity

Understanding the fate of disinfection by-products in swimming pools: current empirical and mechanistic modeling insights

Disinfecting swimming pool water plays a crucial role in preventing the spread of harmful bacteria. However, the interaction between disinfectants and precursors can lead to the formation of potentially disinfection by-products (DBPs). Prolonged exposure to these DBPs may pose health risks. This review study investigates recent research advancements concerning the formation, exposure, and regulation of DBPs within swimming pools. It also provides an overview of existing models that predict DBPs generation in pools, highlighting their limitations. The review explores the mechanisms behind DBPs formation under different disinfectant and precursor conditions. It specifically discusses two types of models that simulate the production of these by-products. Compared to drinking water, swimming pool water presents unique challenges for model development due to its complex mix of external substances, human activities, and environmental factors. Existing models can be categorized as empirical or mechanistic. Empirical models focus on water quality parameters and operational practices, while mechanistic models delve deeper into the kinetics of DBPs generation and the dynamic nature of these compounds. By employing these models, it becomes possible to minimize DBPs production, optimize equipment design, enhance operational efficiency, and manage mechanical ventilation systems effectively.

Formation and control of disinfection by-products during the trichloroisocyanuric acid disinfection in swimming pool water

The increasing demand for trichloroisocyanuric acid (TCCA) in swimming pool disinfection highlights the need to evaluate its applicability in terms of disinfection by-product (DBP) formation. Nevertheless, there is limited understanding of DBP formation and control during TCCA disinfection, particularly concerning the effects of various management parameters. This study aimed to fill this knowledge gap by comprehensively investigating DBP formation during TCCA chlorination, with a particular focus on assessing the contribution and interaction of influencing factors using Box-Behnken Design and response surface methodology. Results indicated that the concentrations of trichloroacetaldehyde, chloroform, dichloroacetic acid, trichloroacetic acid, and dichloroacetonitrile produced by TCCA disinfectant were 42.5%, 74.0%, 48.1%, 94.7% and 42.6% of those by the conventional sodium hypochlorite disinfectant, respectively. Temperature exhibited the most significant impact on chloroform formation (49%), while pH played a major role in trichloroacetaldehyde formation (44%). pH2 emerged as the primary contributor to dichloroacetic acid (90%) and trichloroacetic acid (93%) formation. The optimum water quality conditions were determined based on the minimum total DBPs (pH = 7.32, Temperature = 23.7 °C, [Cl-] = 437 mg/L). Chlorine dosage and contact time exhibited greater influence than precursor concentration on chloroform, dichloroacetonitrile, trichloroacetaldehyde, trichloroacetic acid, and total DBPs. Although the interaction between water quality parameters was weak, the interaction between disinfection operating parameters demonstrated substantial effects on DBP formation (8.56-19.06%). Furthermore, the DBP predictive models during TCCA disinfection were provided for the first time, which provides valuable insights for DBP control and early warning programs.

Formation of halonitromethanes from benzylamine during UV/chlorination: Impact factors, toxicity alteration, and pathways

Halonitromethanes (HNMs), a representative nitrogen-containing disinfection byproduct, have gained significant concerns due to their higher cytotoxicity and genotoxicity. UV/chlorination is considered a promising alternative disinfection technology for chlorination. This study aimed to investigate the HNMs formation from benzylamine (BZA) during UV/chlorination. The experimental results revealed that the yields of HNMs initially raised to a peak then dropped over time. Higher chlorine dosage and BZA concentration promoted the formation of HNMs, whereas alkaline pH inhibited their formation. The presence of bromine ion (Br-) not only converted chlorinated-HNMs (Cl-HNMs) to brominated (chlorinated)-HNMs Br (Cl)-HNMs) and brominated-HNMs (Br-HNMs) but also enhanced the total concentration of HNMs. Besides, the calculated cytotoxicity index (CTI) and genotoxicity index (GTI) of HNMs were elevated by 68.97% and 60.66% as Br- concentration raised from 2 to 6 µM. The possible formation pathways of HNMs from BZA were proposed based on the intermediates identified by a gas chromatography/mass spectrometry (GC/MS). In addition, the formation rules of HNMs in actual water verified the results in deionized water during UV/chlorination. The results of this study provide basic data and a theoretical basis for the formation and control of HNMs, which is conducive to applying UV/chlorination.

Lifetime exposure to brominated trihalomethanes in drinking water and swimming pool attendance are associated with chronic lymphocytic leukemia: a Multicase-Control Study in Spain (MCC-Spain)

BACKGROUND

Chronic lymphocytic leukemia (CLL) etiology is poorly understood, and carcinogenic chemicals in drinking and recreational water are candidates.

OBJECTIVE

To evaluate the association between drinking-water exposure to trihalomethanes (THMs) and nitrate as well as lifetime swimming pool attendance and CLL.

METHODS

During 2010-2013, hospital-based CLL cases and population-based controls were recruited in Spain, providing information on residential histories, type of water consumed and swimming pool attendance. Average THMs and nitrate levels in drinking water were linked to lifetime water consumption. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using mixed models.

RESULTS

Final samples for residential tap water analyses and swimming pool attendance analyses were 144 cases/1230 controls and 157 cases/1240 controls, respectively. Mean (SD) values for average lifetime residential brominated THMs and chloroform in tap water (μg/L), and ingested nitrate (mg/day) were 48.1 (35.6), 18.5 (6.7) and 13.7 (9.6) respectively in controls; and 72.9 (40.7), 17.9 (5.4), and 14.1 (8.8) in CLL cases. For each 10 μg/L increase of brominated THMs and chloroform lifetime-average levels, the ORs (95% CI) were 1.22 (1.14, 1.31) and 0.54 (0.34, 0.87), respectively. For each 5 mg/day increase of ingested nitrate, the OR of CLL was 0.91 (0.80, 1.04). The OR of lifetime pool users (vs. non-users) was 2.38 (1.61, 3.52). Upon performing annual frequency of attending pools analysis through categorization, the second and third categories showed an ORs of 2.36 (1.49, 3.72) and 2.40 (1.51, 3.83), respectively, and P-trend of 0.001.

IMPACT STATEMENT

This study identifies an association of long-term exposure to THMs in drinking water, at concentrations below the regulatory thresholds and WHO guidelines, and swimming pool attendance, with chronic lymphocytic leukemia (CLL). These unprecedented findings are highly relevant since CLL is an incurable cancer with still unknown etiology and because the widespread exposure to chlorination by-products that remain in drinking and recreational water worldwide. Despite the demonstrated carcinogenicity in animals of several chlorination by-products, little is known about their potential risks on human health. This study makes a significant contribution to the search for environmental factors involved in the etiology of CLL and to the evidence of the health impact of these high prevalent water contaminants.

Review on the management of water quality for bio-mineral swimming pools in Western Europe

In this review, we depict the state of the art concerning the water quality management of bio-mineral bathing pools, and compare these to traditional swimming pools. Bio-mineral pools use a combination of mechanic filtration, bio-filtration, and UV-treatment to disinfect the water. Studies in test tanks have shown that bio-filtration is effective in maintaining the water quality with regard to the treatment of organic pollution. Concerning biological risks, the bio-mineral pool relies on UV-treatment to degrade bacteria. Unlike chemical disinfectant treatments, UV disinfection does not lose its effectiveness in the event of high traffic in the pool. However, as only the water taken up by the filtration system is disinfected, it is essential that all the water in the pool is filtered. If the pool has a dead zone, its water is not disinfected and there is a risk of localized pathogen development. As the development of bio-mineral pools spreads in Europe, legislation gradually follows. The health parameters measured differ slightly from one country to another, but there are constants: the measurement of Escherichia coli, Enterococci, and Pseudomonas aeruginosa. In terms of biological swimming pools, regulatory homogeneity across Europe does not exist. From these comparisons, Austrian legislation segmenting water quality into 4 categories ranging from "excellent" to "poor" represents legislation that combines health and safety with indications of possible malfunctions. Next, a study of three real sites of bio-mineral pools is presented. It appears that whatever the type of pool, bio-mineral filtration makes it possible to achieve performances comparable to those encountered in chlorinated swimming pools concerning the risks associated with fecal contamination and external pollution. On the other hand, when frequentation is high, as is the case in small pools used for aquafitness, monitoring the risks of inter-bather contamination, as illustrated by the presence of Staphylococcus aureus, reveals a recurring problem. Knowing that this parameter is not evaluated in bathing waters in the natural environment and that numerous studies show that Staphyloccocus aureus are always detected, even on beaches, we propose the definition of three thresholds: i.e., 0 CFU/100 mL (threshold value in Wallonia) for water of excellent quality, less than 20 CFU/100 mL (threshold value in France) for water of very good quality, less than 50 CFU/100 mL (contribution of bathers by simple immersion) for good quality water, and more than 50 CFU/100 mL for poor quality water. This document could therefore be converted into a manual for operators on the use and management of bio-mineral baths.

Advances and research needs for disinfection byproducts control strategies in swimming pools

The control of disinfection byproducts (DBPs) in swimming pools is of great significance due to the non-negligible toxicity and widespread existence of DBPs. However, the management of DBPs remains challenging as the removal and regulation of DBPs is a multifactorial phenomenon in pools. This study summarized recent studies on the removal and regulation of DBPs, and further proposed some research needs. Specifically, the removal of DBPs was divided into the direct removal of the generated DBPs and the indirect removal by inhibiting DBP formation. Inhibiting DBP formation seems to be the more effective and economically practical strategy, which can be achieved mainly by reducing precursors, improving disinfection technology, and optimizing water quality parameters. Alternative disinfection technologies to chlorine disinfection have attracted increasing attention, while their applicability in pools requires further investigation. The regulation of DBPs was discussed in terms of improving the standards on DBPs and their preccursors. The development of online monitoring technology for DBPs is essential for implementing the standard. Overall, this study makes a significant contribution to the control of DBPs in pool water by updating the latest research advances and providing detailed perspectives.

Disinfection byproducts in indoor swimming pool water: Detection and human lifetime health risk assessment

Quantification of regulated and emerging disinfection byproducts (DBPs) in swimming pool water, as well as the assessment of their lifetime health risk are limited in China. In this study, the occurrence of regulated DBPs (e.g., trihalomethanes, haloacetic acids) and emerging DBPs (e.g., haloacetonitriles, haloacetaldehydes) in indoor swimming pool water and the corresponding source water at a city in Eastern China were determined. The concentrations of DBPs in swimming pool water were 1-2 orders of magnitude higher than that in source water. Lifetime cancer and non-cancer risks of DBPs stemming from swimming pool water were also estimated. Inhalation and dermal exposure were the most significant exposure routes related to swimming pool DBP cancer and non-cancer risks. For the first time, buccal and aural exposure were considered, and were proven to be important routes of DBP exposure (accounting for 17.9%-38.9% of total risk). The cancer risks of DBPs for all swimmers were higher than 10^-6 of lifetime exposure risk recommended by United States Environmental Protection Agency, and the competitive adult swimmers experienced the highest cancer risk (7.82 × 10^-5). These findings provide important information and perspectives for future efforts to lower the health risks associated with exposure to DBPs in swimming pool water.

Halogenated By-Products in Chlorinated Indoor Swimming Pools: A Long-Term Monitoring and Empirical Modeling Study

Monitoring the disinfection process and swimming pool water quality is essential for the prevention of microbial infections and associated diseases. However, carcinogenic and chronic-toxic disinfection by-products (DBPs) are formed with reactions between disinfectants and organic/inorganic matters. DBP precursors in swimming pools originate from anthropogenic sources (body secretions, personal care products, pharmaceuticals, etc.) or chemicals used in pools. Temporal (48 weeks) water quality trends of trihalomethanes (THMs), haloacetic acids (HAAs), haloacetonitriles (HANs), and halonitromethanes (HNMs) in two swimming pools (SP-A and SP-B) and precursor-DBP relationships were investigated in this study. Weekly samples were taken from swimming pools, and several physical/chemical water quality parameters, absorbable organic halides (AOX), and DBPs were determined. THMs and HAAs were the most detected DBP groups in pool water. While chloroform was determined to be the dominant THM compound, dichloroacetic acid and trichloroacetic acid were the dominant HAA compounds. The average AOX concentrations were measured to be 304 and 746 μg/L as Cl^- in SP-A and SP-B, respectively. Although the amount of AOX from unknown chlorinated by-products in SP-A did not vary temporally, a significant increase in unknown DBP concentrations in SP-B was observed over time. AOX concentrations of chlorinated pool waters were determined to be an important parameter that can be used to estimate DBP concentrations.

Developmental toxicity of 2-bromoacetamide on peri- and early post-implantation mouse embryos in vitro

2-bromoacetamide (BAcAm), a new class of disinfection by-products (DBPs), is widely detected in drinking water across the world. Reports of the high cytogenetic toxicity of BAcAm have aroused public attention concerning its toxic effects on early embryonic development. In this study, we optimized an in vitro culture (IVC) system for peri- and early post-implantation mouse embryos and used this system to determine the developmental toxicity of BAcAm. We found that exposure to BAcAm caused a reduction in egg cylinder formation rate and abnormal lineage differentiation in a dose-dependent manner. Transcriptomic analysis further revealed that BAcAm exposure at early developmental stages altered the abundance of transcripts related to a variety of biological processes including gene expression, metabolism, cell proliferation, cell death and embryonic development, thus indicating its toxic effects on embryonic development. Thus, we developed a robust tool for studying the toxicology of chemicals at the early stages of embryonic development and demonstrated the developmental toxicity of BAcAm in the early embryonic development of mammals.

Swimming pool water disinfection by-products profiles and association patterns

The aim of this work was to determine and study the concentration of different groups of disinfection by-products (DBPs): trihalomethanes, haloacetic acids, haloacetonitriles, haloacetones and combined chlorine (as an indicator of chloramine levels), in the water of 175 public swimming pools in Gipuzkoa (Basque Country, Spain). The study included chlorinated and brominated pools, indoor and outdoor, used for recreational and sports purposes, and filled with water from calcareous and siliceous soils. The most abundant were haloacetic acids, followed by trihalomethanes, with chlorinated or brominated forms predominating depending on whether the pools were disinfected by chlorination or bromination, respectively. All the 75th percentiles of DBPs were below the limits established by the European Chemical Agency (ECHA), although the maximum values of trihalomethanes exceeded them. The same was true for dichloroacetonitrile in chlorinated pools and dibromoacetonitrile in brominated pools. All families of DBPs showed positive associations with each other, all being significant except for combined chlorine. Their mean levels were higher in outdoor pools than in indoor pools, significantly so in all except combined chlorine. Recreational pools showed higher levels of haloacetic acids and combined chlorine than sports pools. The concentrations of the different groups of DBPs were higher in the pools than in the mains water that fed them. This increase, especially that of the haloacetonitriles, as well as the high concentrations of brominated forms in the pools disinfected by bromination, make it necessary to focus on their toxicological implication. The differences in the DBP profiles of the filling network water were not transferred to the pool water.

Studying Respiratory Symptoms Related to Swimming Pools Attendance in Young Athletes: The SPHeRA Study

This study investigates the prevalence of respiratory symptoms and the training factors possibly associated with them in a sample of young Italian competitive swimmers. A questionnaire about training information and symptoms was administered to participants during the winter and summer 2021 training seasons. In total, 396 athletes took part in the study. In the winter training subgroup (n = 197), we found significant associations between increasing training hours per session and the presence of nasal congestion/rhinorrhoea (OR = 3.10; p = 0.039) and cough (OR = 3.48; p = 0.015). Total training hours per week were significantly associated with nasal congestion/rhinorrhoea (OR = 1.12; p = 0.010). In the summer group (n = 199), the same factors were not associated with respiratory symptoms. Having an allergy was significantly related to nasal congestion/rhinorrhea in both the logistic models (model 1 OR = 2.69, p = 0.013; model 2 OR = 2.70, p = 0.012), while having asthma significantly increased the risk of coughing (OR = 3.24, p = 0.033). The kind of environment (indoor or outdoor facilities) did not affect the studied symptoms either in summer or winter. Further investigations are needed to better understand the mechanisms involved in the development of respiratory symptoms in swimmers, particularly on how inflammation and remodelling develop and which environmental conditions can favour these processes.

Occurrence of brominated disinfection by-products in thermal spas

Thermal spas are gaining more and more popularity among the population because they are used for recreational purposes. Disinfecting these baths without losing the health benefits poses a challenge for swimming pool operators. Previous studies have mainly focused on regulated chlorinated DBPs in freshwater pools with no bromide or seawater pools with very high bromide content. Thermal water pools have a low bromide content and in combination with chlorine can lead to chlorinated, brominated and mixed halogenated DBP species. The occurrence of brominated and mixed halogenated DBPs in these types of pools is largely unexplored, with very few or limited studies published on regulated DBPs and even fewer on emerging DBP classes. In the field of swimming pool water disinfection, apart from extensive studies in the field of drinking water disinfection, only a few studies are known in which >39 halogenated and 16 non-halogenated disinfection by-products, including regulated trihalomethanes (THM) and haloacetic acids (HAA), were investigated in swimming pool water. Calculated bromine incorporation factor (BIF) demonstrated that even small amounts of bromide in swimming pool water can lead to a large shift in DBP species towards brominated and mixed halogenated DBPs. Dihaloacetonitriles (DHANs) accounted for >50% of the calculated cytotoxicity and genotoxicity on average. Comparison of the target analysis with the TOX showed that a major part of the measured TOX (69% on average) could be explained by the regulated classes THMs, HAAs, and the unregulated class of HANs. This study aims to help operators of swimming pools with bromide-containing water to gain a better understanding of DBP formation in future monitoring and to fill the knowledge gap that has existed so far on the occurrence of DBPs in thermal water pools.

NRF2-ARE signaling is responsive to haloacetonitrile-induced oxidative stress in human keratinocytes

Humans are exposed to disinfection by-products through oral, inhalation, and dermal routes, during bathing and swimming, potentially causing skin lesions, asthma, and bladder cancer. Nuclear factor E2-related factor 2 (NRF2) is a master regulator of the adaptive antioxidant response via the antioxidant reaction elements (ARE) orchestrating the transcription of a large group of antioxidant and detoxification genes. Here we used an immortalized human keratinocyte model HaCaT cells to investigate NRF2-ARE as a responder and protector in the acute cytotoxicity of seven haloacetonitriles (HANs), including chloroacetonitrile (CAN), bromoacetonitrile (BAN), iodoacetonitrile (IAN), bromochloroacetonitrile (BCAN), dichloroacetonitrile (DCAN), dibromoacetonitrile (DBAN), and trichloroacetonitrile (TCAN) found in drinking water and swimming pools. The rank order of cytotoxicity among the HANs tested was IAN ≈ BAN ˃ DBAN ˃ BCAN ˃ CAN ˃ TCAN ˃ DCAN based on their LC₅₀. The HANs induced intracellular reactive oxygen species accumulation and activated cellular antioxidant responses in concentration- and time-dependent fashions, showing elevated NRF2 protein levels and ARE activity, induction of antioxidant genes, and increased glutathione levels. Additionally, knockdown of NRF2 by lentiviral shRNAs sensitized the HaCaT cells to HANs-induced cytotoxicity, emphasizing a protective role of NRF2 against the cytotoxicity of HANs. These results indicate that HANs cause oxidative stress and activate NRF2-ARE-mediated antioxidant response, which in turn protects the cells from HANs-induced cytotoxicity, highlighting that NRF2-ARE activity could be a sensitive indicator to identify and characterize the oxidative stress induced by HANs and other environmental pollutants.

Disinfection byproducts in chlorinated or brominated swimming pools and spas: Role of brominated DBPs and association with mutagenicity

Although the health benefits of swimming are well-documented, health effects such as asthma and bladder cancer are linked to disinfection by-products (DBPs) in pool water. DBPs are formed from the reaction of disinfectants such as chlorine (Cl) or bromine (Br) with organics in the water. Our previous study (Daiber et al., Environ. Sci. Technol. 50, 6652; 2016) found correlations between the concentrations of classes of DBPs and the mutagenic potencies of waters from chlorinated or brominated swimming pools and spas. We extended this study by identifying significantly different concentrations of 21 individual DBPs in brominated or chlorinated pool and spa waters as well as identifying which DBPs and additional DBP classes were most associated with the mutagenicity of these waters. Using data from our previous study, we found that among 21 DBPs analyzed in 21 pool and spa waters, the concentration of bromoacetic acid was significantly higher in Br-waters versus Cl-waters, whereas the concentration of trichloroacetic acid was significantly higher in Cl-waters. Five Br-DBPs (tribromomethane, dibromochloroacetic acid, dibromoacetonitrile, bromoacetic acid, and tribromoacetic acid) had significantly higher concentrations in Br-spa versus Cl-spa waters. Cl-pools had significantly higher concentrations of Cl-DBPs (trichloroacetaldehyde, trichloromethane, dichloroacetic acid, and chloroacetic acid), whereas Br-pools had significantly higher concentrations of Br-DBPs (tribromomethane, dibromoacetic acid, dibromoacetonitrile, and tribromoacetic acid). The concentrations of the sum of all 4 trihalomethanes, all 11 Br-DBPs, and all 5 nitrogen-containing DBPs were each significantly higher in brominated than in chlorinated pools and spas. The 8 Br-DBPs were the only DBPs whose individual concentrations were significantly correlated with the mutagenic potencies of the pool and spa waters. These results, along with those from our earlier study, highlight the importance of Br-DBPs in the mutagenicity of these recreational waters.

Do DBPs swim in salt water pools? Comparison of 60 DBPs formed by electrochemically generated chlorine vs. conventional chlorine

Disinfectants are added to swimming pools to kill harmful pathogens. Although liquid chlorine (sodium hypochlorite) is the most commonly used disinfectant, alternative disinfection techniques like electrochemically generated mixed oxidants or electrochemically generated chlorine, often referred to as salt water pools, are growing in popularity. However, these disinfectants react with natural organic matter and anthropogenic contaminants introduced to the pool water by swimmers to form disinfection byproducts (DBPs). DBPs have been linked to several adverse health effects, such as bladder cancer, adverse birth outcomes, and asthma. In this study, we quantified 60 DBPs using gas chromatography-mass spectrometry and assessed the calculated cytotoxicity and genotoxicity of an indoor community swimming pool before and after switching to a salt water pool with electrochemically generated chlorine. Interestingly, the total DBPs increased by 15% upon implementation of the salt water pool, but the calculated cytotoxicity and genotoxicity decreased by 45% and 15%, respectively. Predominant DBP classes formed were haloacetic acids, with trichloroacetic acid and dichloroacetic acid contributing 57% of the average total DBPs formed. Haloacetonitriles, haloacetic acids, and haloacetaldehydes were the primary drivers of calculated cytotoxicity, and haloacetic acids were the primary driver of calculated genotoxicity. Diiodoacetic acid, a highly toxic iodinated DBP, is reported for the first time in swimming pool water. Bromide impurities in sodium chloride used to electrochemically generate chlorine led to a 73% increase in brominated DBPs, primarily driven by bromochloroacetic acid. This study presents the most extensive DBP study to-date for salt water pools.

Formation and transformation of halonitromethanes from dimethylamine in the presence of bromide during the UV/chlorine disinfection

Halonitromethanes (HNMs) is a typical class of nitrogenous disinfection byproducts with high toxicity. The effect of Br^- on the formation and transformation of HNMs from dimethylamine (DMA) during the ultraviolet (UV)/chlorine disinfection has been investigated in current study. Results reveal that only chloronitromethane, dichloronitromethane and trichloronitromethane (TCNM) could be found during the UV/chlorine disinfection. Whereas in the presence of Br^-, nine species of HNMs could be observed simultaneously. When Br^- concentration increased from 0 to 15.0 mg L^-1, the predominant species of HNMs were gradually changed from TCNM to dibromonitromethane and tribromonitromethane, which contributed to 23.37% and 31.07% of total HNMs concentration at 15 mg L^-1 Br^-, respectively. The presence of Br^- not only shifted the chlorinated-HNMs (Cl-HNMs) towards brominated-HNMs (Br-HNMs) but also affected the dominant species and total concentration of HNMs. When Br^- concentration was 4.0 mg L^-1, the formation of HNMs decreased with the increase of pH from 6.0 to 8.0 and increased with the increase of free chlorine and DMA. When free chlorine concentration rose from 0.25 to 1.1 mmol L^-1, Br-HNMs were shifted to Br(Cl)-HNMs and then to Cl-HNMs. According to the findings, possible formation and transformation pathways of HNMs from DMA were proposed in the presence of Br^- during the UV/chlorine disinfection. Finally, it was proved that the effect of Br^- on the trend of HNMs in real water was similar to that in deionized water, but higher HNMs concentrations and delayed peak time were observed in real water. This study can provide the scientific evidence and fundamental data for the applications of UV/chlorine disinfection in the treatment of water containing Br^-.

Drinking Water Source, Chlorinated Water, and Colorectal Cancer: A Matched Case-Control Study in Ethiopia

BACKGROUND

There is no study conducted on the association between disinfection byproducts (DBPs) in chlorinated drinking water and colorectal cancer (CRC) in Ethiopia. Therefore, this study aimed to determine the relation between chlorine based DBPs in drinking water and CRC in Addis Ababa, Ethiopia.

METHODS

A facility based matched case control study was conducted involving 224 cases and 448 population controls from June 2020 to May 2021. Cases were defined as histologically confirmed CRC cases. Cases were matched with controls by residence, age, and sex using frequency and individual matching. Geocoding of cases, health facility, and georeferencing of controls were carried out. Data was collected using a pretested structured questionnaire. Pearson Chi square and Fisher's exact tests were employed to assess associations. Stratified analysis was used to detect confounding factors and effect modification. A multivariable conditional logistic regression was used to identify risk factors of CRC.

RESULTS

Of 214 CRC cases, 148 (69.2%) used chlorinated water whereas out of 428 controls 161 (37.6%) used chlorinated water. In the final regression model, drinking chlorinated surface water (adjusted matched odds ratio [adjusted mOR] = 2.6; 95% CI 1.7-4.0), history of swimming (adjusted mOR = 2.4; 95% CI 1.4-4.1), years at the place of current residence (adjusted mOR = 1.5; 95% CI 1.1-2.2), hot tap water use for showering (adjusted mOR; 3.8 = 95% CI 2.5-5.9) were significantly associated with CRC. The stratified analysis confirmed that smoking and meat ingestion were not effect modifiers and confounders.

CONCLUSION

Drinking chlorinated water for extended years is a significant risk factor for CRC in Addis Ababa, Ethiopia. In addition, hot tap water use for showering, and swimming history are risk factors for CRC. This information is essential to design integrated interventions that consider chlorination by-products and exposure routes toward the prevention and control of CRC in Ethiopia. Initiating alternative methods to chlorine disinfection of drinking water is also essential.

Occurrence of Disinfection By-Products in Swimming Pools in the Area of Thessaloniki, Northern Greece. Assessment of Multi-Pathway Exposure and Risk

This study investigated the occurrence of disinfection by-products (DBPs) (trihalomethanes (THMs), haloacetic acids (HAAs), halonitriles (HANs), halonitromethane (TCNM) and haloketones (HKs)) in different type of swimming pools in the area of Thessaloniki, northern Greece by employing the EPA methods 551.1 and 552.3. Moreover, general water quality parameters (pH, residual chlorine, dissolved organic carbon, UV₂₅₄ absorption, total nitrogen, alkalinity and conductivity) were also measured. The concentrations of DBPs showed great variability among swimming pools as well as within the same pool between sampling campaigns. HAAs exhibited the highest concentrations followed by THMs, HANs, TCNM and HKs. Exposure doses for four age groups (3–<6 y, 6–<11 y, 11–<16 y and adults) were calculated. Route-specific exposures varied among DBPs groups. Inhalation was the dominant exposure route to THMs and TCNM (up to 92–95%). Ingestion and dermal absorption were the main exposure routes to HAAs (40–82% and 18–59%, respectively), depending on the age of swimmers. HANs contributed up to 75% to the calculated cytotoxicity of pool water. Hazard indices for different exposure routes were <1, suggesting non-carcinogenic risk. Inhalation posed the higher carcinogenic risk for THMs, whereas risk via oral and dermal routes was low. Ingestion and dermal contact posed the higher risk for HAAs. Risk management strategies that minimise DBPs exposure without compromising disinfection efficiency in swimming pools are necessary.

The Occurrence of N-nitrosodimethylamine (NDMA) in Swimming Pools: An Overview

The occurrence of several disinfectant byproducts has been investigated in swimming pools. Until now, there are only a few studies on nitrosamine, particularly N-nitrosodimethylamine in swimming pool water. This could be due to the lack of a suitable method that is sensitive enough for the measurement of N-nitrosodimethylamine in pool waters. Other disinfectant byproducts formed in pool water widely documented are trihalomethanes, haloacetic acids, halonitromethanes, and chloramines but inadequate information on N-nitrosodimethylamine. This paper provides a review of the nitrogenous disinfectant byproduct in swimming pools and its health implications. Anthropogenic substances introduced by swimmers such as sweat, lotions, and urine contribute to the formation of N-nitrosodimethylamine. The reaction of secondary amines such as dimethylamine with mono/dichloroamines produced dimethyl hydrazine and further undergo oxidation to form N-nitrosodimethylamine. The reaction of chlorine and other disinfectants with these anthropogenic sources in swimming pools cause cancer and asthma in human tissues. Thus, the assessment of N-nitrosodimethylamine in the swimming pool is less well documented. Therefore, the health consequences, mutagenic, and genotoxic potentials of N-nitrosodimethylamine should be the focus of more research studies.

Inactivation of waterborne fungal spores by 1-bromo-3-chloro-5,5-dimethylhydantoin: Kinetics, influencing factors and mechanisms

Fungal contamination in drinking water source has become a problem worth studying, as waterborne fungi may cause deterioration of water quality and outbreak of diseases. Various disinfection methods have been explored to control fungal spores in drinking water, such as chlor(am)ination, ozonation, chlorine dioxide treatment, but these methods are not appropriate for remote areas, owing to the difficulties in preparation, carriage and storage. In this study, a powdery disinfectant of 1-bromo-3-chloro-5,5-dimethylhydantoin (BCDMH), which facilitated transportation and preservation, was firstly chosen to inactivate opportunistic pathogens of Aspergillus niger (A. niger) and Penicillium polonicum (P. polonicum). The results revealed that the inactivation kinetics of fungal spores by BCDMH fitted to Chick-Watson model well, with the inactivation rate constant of 0.011 and 0.034 L mg^-1 min^-1 for A. niger and P. polonicum, respectively. Acidic condition and high temperature promoted the inactivation by BCDMH. Compared with chlorine, BCDMH showed relative weaker ability on inactivation of fungal spores. However, it was demonstrated that the inactivation efficiency of BCDMH was obviously enhanced by adding halide ions, with 11 or 36 folds for A. niger and 4 or 15 folds for P. polonicum by adding 40 μM Br^- or I^-. The inactivation mechanisms were detected by flow cytometry and scanning electron microscope. Fungal spores lost their culturability firstly, then membrane integrity was damaged. Meanwhile, the esterase activity and intracellular reactive oxygen species level changed, and finally intracellular adenosine triphosphate released.

Monohaloacetonitriles induce cytotoxicity and exhibit different mode of action in endocrine disruption

Haloacetonitriles are emerging disinfection by-products that can be detected in various aquatic environments. They are cytotoxic, genotoxic, mutagenic, and tumorigenic in vitro and in vivo, but their endocrine-disrupting potency remains unknown. In this study, we examined the agonistic and antagonistic estrogenic and androgenic activities of haloacetonitriles, as well as their cytotoxicity, using a yeast-based reporter assay. We also investigated the interactions of haloacetonitriles with human estrogen receptor alpha (hERα) through molecular docking. We observed that iodoacetonitrile (median lethal dose: 1.96 × 10^-5 M) and bromoacetonitrile (median lethal dose: 1.97 × 10^-5 M) had similar cytotoxicities, which are higher than that of chloroacetonitrile (median lethal dose: 7.16 × 10^-5 M). We observed bromoacetonitrile and chloroacetonitrile elicited estrogenic activity with 10% effective concentrations of 3.30 × 10^-9 M and 2.36 × 10^-9 M, respectively. This finding indicates that bromoacetonitrile and chloroacetonitrile may mimic estrogen signaling through interaction with hERα. Consistent with that result, we identified bromoacetonitrile and chloroacetonitrile interacted with residues in the original estrogen recognition sites of hERα. Our results show that bromoacetonitrile and chloroacetonitrile affect the endocrine-disrupting potency mediated via estrogen receptors by using in vitro assay and molecular docking.

Making Swimming Pools Safer: Does Copper-Silver Ionization with Chlorine Lower the Toxicity and Disinfection Byproduct Formation?

Swimming pools are commonly treated with chlorine, which reacts with the natural organic matter and organic matter introduced by swimmers and form disinfection byproducts (DBPs) that are associated with respiratory-related issues, including asthma, in avid swimmers. We investigated a complementary disinfectant to chlorine, copper-silver ionization (CSI), with the aim of lowering the amount of chlorine used in pools and limiting health risks from DBPs. We sampled an indoor and outdoor pool treated with CSI-chlorine during the swimming season in 2017-2018 and measured 71 DBPs, speciated total organic halogen, in vitro mammalian cell cytotoxicity, and N-acetyl-l-cysteine (NAC) thiol reactivity as a cytotoxicity predictor. Controlled, simulated swimming pools were also investigated. Emerging DBP concentrations decreased by as much as 80% and cytotoxicity decreased as much as 70% in the indoor pool when a lower chlorine residual (1.0 mg/L) and CSI was used. Some DBPs were quantified for the first time in pools, including chloroacetaldehyde (up to 10.6 μg/L), the most cytotoxic haloacetaldehyde studied to date and a major driver of the measured cytotoxicity in this study. Three highly toxic iodinated haloacetic acids (iodoacetic acid, bromoiodoacetic acid, and chloroiodoacetic acid) were also quantified in pools for the first time. We also found that the NAC thiol reactivity was significantly correlated to cytotoxicity, which could be useful for predicting the cytotoxicity of swimming pool waters in future studies.

Formation of disinfection byproducts during chlorination of mixed nitrogenous compounds in swimming pools

Disinfection byproducts (DBPs) in swimming pool waters are receiving increasing attention because of their toxicity and widespread occurrence. Current studies rarely investigate the formation of DBPs from typical precursors in swimming pools under mixed exposure. They also rarely investigate the formation of carbonaceous DBPs (C-DBPs) and nitrogenous DBPs (N-DBPs) simultaneously. In this study, the formation of C-DBPs and N-DBPs were investigated during chlorination of mixed precursors (i.e., tryptophan, urea, creatinine, and ammonia). The effects of precursors and operation parameters were also investigated. Among the four precursors, tryptophan had the highest DBP formation potential. Urea and ammonia restrained the formation of C-DBPs but promoted the formation of more toxic N-DBPs. C-DBP yields were significantly higher than N-DBP yields under all experimental conditions. Longer reaction time and higher chlorine dosage promoted the formation of C-DBPs, while higher temperature decreased the concentration of N-DBPs. The presence of bromide not only improved the sum yields of DBPs, but also shifted chlorinated DBPs to brominated species.

Effects of amines on the formation and photodegradation of DCNM under UV/chlorine disinfection

Investigations were conducted to examine the effects of amine type and initial concentration, free chlorine concentration, UV light intensity, pH and tert-butyl alcohol (TBA) on the formation of dichloronitromethane (DCNM) under UV/chlorine. Methylamine (MA), dimethylamine (DMA) and poly-dimethyl diallyl ammonium chloride (PolyDADMAC) were selected as the amine precursors of DCNM. And the reaction products of amines were explored through observing the contents of various nitrogen under UV/chlorine. Experimental results indicated that the higher of the intensity of UV light, the concentration of amines and free chlorine, the greater of the amount of DCNM formation; the amine substance with simple structure is more likely oxidized to form DCNM, so the potential of MA to form DCNM is the largest among three amines; the formation of DCNM decreased with increasing pH from 6.0 to 8.0; due to adding TBA into the reaction solution, halogen and hydroxyl radicals were restrained which resulted the DCNM formation decreased. In the reaction process, the formation of DCNM from amines increased at the beginning, then decreased and almost disappeared due to photodegradation. During the formation and photodegradation of DCNM, the dissolved organic nitrogen could be transformed into the ammonia-nitrogen (NH₃-N) and nitrate-nitrogen (NO₃^--N).

Health risks and predictive modeling of disinfection byproducts in swimming pools

Disinfection is an indispensable water treatment process used to inactivate pathogens and prevent outbreaks of infectious diseases in swimming pools. However, toxic disinfection byproducts (DBPs) are inevitably formed during the process. To improve the supervision and regulation of DBPs in swimming pools, the reliability of using trihalomethanes (THMs) as the sole indicator of organic DBPs and the possibility of using easily detectable water quality parameters as predictors of DBPs were discussed based on the occurrence of 29 typical DBPs in swimming pools. Among the target DBP categories, THMs and haloacetic acids (HAAs) were the prominent species, and the concentrations of HAAs were the highest. The risk assessment results indicated that the total risk values in most pools were higher than the acceptable value (10^-6). Compared with nitrosamines and THMs, HAAs were the main contributors to the cancer risks posed by dermal absorption and ingestion. THMs (r = 0.619; p < 0.01) and HAAs (r = 0.989; p < 0.01) were both significantly correlated with total DBPs (the sum of 29 DBPs). A stepwise multivariate regression model was developed by analyzing the correlations between total DBPs and water quality parameters, and the relationship coefficient R² was 0.756. This study provides important information and perspectives for the improvement and implementation of standards for swimming pool water.

+Chlorination by-products in indoor swimming pools: Development of a pilot pool unit and impact of operating parameters

Chlorine addition in swimming pools ensures the microbiological quality of the water and the bathers' safety. However, water chlorination is associated with disinfection byproducts (DBP) formation and adverse health effects. The impact of operating parameters and innovative water treatment systems on DBPs levels has been reported in several studies, but sampling campaign in real pools remain difficult to carry out, mainly due to unexpected attendance variations. This study presents the development of a pilot pool plant allowing to perform experiments under controlled and reproducible conditions. Bathers inputs were simulated both for the organic load and for the mechanical agitation of water. Two sampling campaigns were performed during the building of the pilot, before and after the hall was closed. Key operating parameters such as chlorine dose, water temperature and attendance were controlled and monitored. DBP levels in the pilot plant were representative of French indoor swimming pools and the impact of bathers' activity was visible on volatile DBPs. Furthermore, correlations could be stated between operating parameters and DBP levels. Stripping effectively reduced volatile DBP concentrations in water. Moreover, energy consumption data, which are usually very scarce in experimental studies, showed the influence of heat pump consumption on the global energy consumption.