Airborne bacteria in a wastewater treatment plant: Emission characterization, source analysis and health risk assessment

Bioaerosols emission from source facilities in a wastewater treatment plant: Critical exposure time and sensitivity analysis

Overexposure of sewage workers to bioaerosol released from wastewater treatment plants (WWTPs) can cause serious infections, but practical method for controlling their health risk is lacking. In this study, reverse quantitative microbial risk assessment was used to estimate the daily critical exposure time (CET) of sewage workers exposing to Staphylococcus aureus bioaerosol emitted by three emission sources facilities in a WWTP based on either U.S. EPA or WHO benchmark, and sensitivity analysis was conducted to analyze the influence of various parameters on the outcomes of CET. The results showed that the CET of females was always 1.12-1.29 times that of males. In addition, the CET after wearing face masks was 28.28-52.37 times as long as before. The working time can be determined based on the CET results of male workers wearing face masks exposed to the inverted-umbrella aeration tank (14.73-550.98 min for U.S. EPA benchmark and 55.07-1972.24 min for WHO benchmark). In each scenario, the variable parameter exposure concentration (ec) always showed the most influence on the CET results. After wearing the face masks, the removal fraction by employing face masks also had a significant effect on the results, only second to ec. Therefore, the wearing of face mask is the most convenient and effective measure to prolong the CET. Furthermore, practical methods to reducing bioaerosol concentration in WWTPs exposure are also necessary to extend CET and safeguard worker health. This study enriches the application range of reverse quantitative microbial risk assessment framework and provides theoretical support for stakeholders to establish reasonable working time threshold guidelines, and practical method and novel perspective to protect the on-site health risks of sewage workers exposing to various facilities.

Comparative analysis of bioaerosol emissions: Seasonal dynamics and exposure risks in hospital vs. municipal wastewater treatment systems

Hospital wastewater is known to contain various pathogenic microorganisms and harmful substances. During the hospital wastewater treatment process, the bioaerosols released may encapsulate these pathogens, leading to human infection. This study undertook an investigation to compare the dispersion characteristics and seasonal variations of bioaerosols from hospital and municipal sewage. The results indicated that the airborne bacterial concentration from hospital sewage (119 ± 118 CFU/m3) was higher than municipal sewage (46 ± 19 CFU/m3), with the highest concentration observed in summer. The dominant bacterial genera present in bioaerosols from both sewages were alike, with the proportions varied by sewage types and the structure mainly influenced by seasonal factors. Bacteroides, Escherichia-Shigella and Streptococcus were identified as the most prevalent pathogenic genera in spring, summer and winter bioaerosols, respectively, while Pseudomonas and Acinetobacter were abundant in autumn. Although the non-carcinogenic risk associated with bioaerosols was low (<1), the presence of pathogenic species and their potential synergistic interactions elevated the overall exposure risk. The diffusion modeling results demonstrated that bioaerosol emissions from the surface of hospital sewage can reach up to 10570 CFU/m3 in summer and can spread more than 300 m downwind. The potential pathogenicity of bioaerosols was also highest in summer, which may pose a health hazard to populations located downwind. Therefore, the management and control of bioaerosols from sewage should be strengthened, especially in summer.

Characteristics of bioaerosol emissions from a municipal wastewater treatment plant: Health risk assessment and microbial composition

Bioaerosols released from municipal wastewater treatment plants (MWWTPs) contain pathogenic microorganisms, if dispersed into the atmosphere, which pose potential health risks to humans. In this study, the concentrations and size distribution of bioaerosol, factors on the bioaerosol emission, exposure risk, and microbial composition in different treatment units of a MWWTP were investigated. The results showed that bioaerosol was released to different degrees in each treatment unit, with the concentrations of bioaerosol varied widely, ranging from 978 to 3710 CFU/m3. FG and PST were primary bioaerosol emission sources in MWWTP. COD concentration, wind speed (WS) and relative humidity (RH) significantly influenced bioaerosol concentrations. The proportion of inhalable particles (< 4.7 μm) ranged from 51.35 % to 83.33 %, and bioaerosol emitted from WWTP caused a non-carcinogenic risk to children by the exposure risk assessment (HI > 1), which need to be paid more attention. Bacterial, fungal and actinomycete aerosols were detected in each treatment unit of MWWTP. Among these bioaerosols, bacterial aerosol was dominant. Importantly, several pathogenic bacteria including Sphingobium, Brevundimonas, Romboutsia, Arcobacter, Acinetobacter, and Mycobacterium were identified within the airborne bacteria population, most of which originated from wastewater or sludge, particularly in the ambient air of AeT. Pathogenic bacteria from MWWTP should be studied further to determine their long-term behavior and possible health risks.

The abundance and pathogenicity of microbes in automobile air conditioning filters across the typical cities of China and Europe

Bioaerosols are widely distributed in urban air and can be transmitted across the atmosphere, biosphere, and anthroposphere, resulting in infectious diseases. Automobile air conditioning (AAC) filters can trap airborne microbes. In this study, AAC filters were used to investigate the abundance and pathogenicity of airborne microorganisms in typical Chinese and European cities. Culturable bacteria and fungi concentrations were determined using microbial culturing. High-throughput sequencing was employed to analyze microbial community structures. The levels of culturable bioaerosols in Chinese and European cities exhibited disparities (Analysis of Variance, P < 0.01). The most dominant pathogenic bacteria and fungi were similar in Chinese (Mycobacterium: 18.2-18.9 %; Cladosporium: 23.0-30.2 %) and European cities (Mycobacterium: 15.4-37.7 %; Cladosporium: 18.1-29.3 %). Bartonella, Bordetella, Alternaria, and Aspergillus were also widely identified. BugBase analysis showed that microbiomes in China exhibited higher abundances of mobile genetic elements (MGEs) and biofilm formation capacity than those in Europe, indicating higher health risks. Through co-occurrence network analysis, heavy metals such as zinc were found to correlate with microorganism abundance; most bacteria were inversely associated, while fungi exhibited greater tolerance, indicating that heavy metals affect the growth and reproduction of bioaerosol microorganisms. This study elucidates the influence of social and environmental factors on shaping microbial community structures, offering practical insights for preventing and controlling regional bioaerosol pollution.

Global diversity of airborne pathogenic bacteria and fungi from wastewater treatment plants

Wastewater treatment plants (WWTPs) have been recognized as one of the major potential sources of the spread of airborne pathogenic microorganisms under the global pandemic of COVID-19. The differences in research regions, wastewater treatment processes, environmental conditions, and other aspects in the existing case studies have caused some confusion in the understanding of bioaerosol pollution characteristics. In this study, we integrated and analyzed data from field sampling and performed a systematic literature search to determine the abundance of airborne microorganisms in 13 countries and 37 cities across four continents (Asia, Europe, North America, and Africa). We analyzed the concentrations of bioaerosols, the core composition, global diversity, determinants, and potential risks of airborne pathogen communities in WWTPs. Our findings showed that the culturable bioaerosol concentrations of global WWTPs are 102-105 CFU/m3. Three core bacterial pathogens, namely Bacillus, Acinetobacter, and Pseudomonas, as well as two core fungal pathogens, Cladosporium and Aspergillus, were identified in the air across global WWTPs. WWTPs have unique core pathogenic communities and distinct continental divergence. The sources of airborne microorganisms (wastewater) and environmental variables (relative humidity and air contaminants) have impacts on the distribution of airborne pathogens. Potential health risks are associated with the core airborne pathogens in WWTPs. Our study showed the specificity, multifactorial influences, and potential pathogenicity of airborne pathogenic communities in WWTPs. Our findings can improve the understanding of the global diversity and biogeography of airborne pathogens in WWTPs, guiding risk assessment and control strategies for such pathogens. Furthermore, they provide a theoretical basis for safeguarding the health of WWTP workers and ensuring regional ecological security.

Distribution, source apportionment, and ecological risk assessment of soil antibiotic resistance genes in urban green spaces

Urban green spaces play a crucial role in cities by providing near-natural environments that greatly impacts the health of residents. However, these green spaces have recently been scrutinized as potential reservoirs of antibiotic resistance genes (ARGs), posing significant ecological risks. Despite this concern, our understanding of the distribution, sources, and ecological risks associated with ARGs remains limited. In this study, we investigated the spatial distribution of soil ARGs using spatial interpolation and auto-correlation analysis. To apportion the source of soil ARGs in urban green spaces of Tianjin, Geo-detector method (GDM) was employed. Furthermore, we evaluated the ecological risk posed by ARGs employing risk quotients (RQ). The results of our study showed a significantly higher abundance of Quinolone resistance genes in the soil of urban green spaces in Tianjin. These genes were mainly found in the northwest, central, and eastern regions of the city. Our investigation identified three main factors contributing to the presence of soil ARGs: antibiotic production, precipitation, livestock breeding, and hospital. The results of ecological risk in RQ value showed a high risk associated with Quinolone resistance genes, followed by Aminoglycoside, Tetracycline, Multidrug, MLSB, Beta Lactam, Sulfonamide, and Chloramphenicol. Mantel-test and correlation analysis revealed that the ecological risk of ARGs was greatly influenced by soil properties and heavy metals. This study provides a new perspective on source apportionment and the ecological risk assessment of soil ARGs in urban green spaces.

Characteristics and health impacts of bioaerosols in animal barns: A comprehensive study

Bioaerosols produced during animal production have potential adverse effects on the health of workers and animals. Our objective was to investigate characteristics, antibiotic-resistance genes (ARGs), and health risks of bioaerosols in various animal barns. Poultry and swine barns had high concentrations of airborne bacteria (11156 and 10917 CFU/m3, respectively). Acinetobacter, Clostridium sensu stricto, Corynebacterium, Pseudomonas, Psychrobacter, Streptococcus, and Staphylococcus were dominant pathogenic bacteria in animal barns, with Firmicutes being the most abundant bacterial phylum. Based on linear discriminant analysis effect size (LEfSe), there were more discriminative biomarkers in cattle barns than in poultry or swine barns, although the latter had the highest abundance of bacterial pathogens and high abundances of ARGs (including tetM, tetO, tetQ, tetW sul1, sul2, ermA, ermB) and intI1). Based on network analyses, there were higher co-occurrence patterns between bacteria and ARGs in bioaerosol from swine barns. Furthermore, in these barns, relative abundance of bacteria in bioaerosol samples was greatly affected by environmental factors, mainly temperature, relative humidity, and concentrations of CO2, NH3, and PM2.5. This study provided novel data regarding airborne bio-contaminants in animal enclosures and an impetus to improve management to reduce potential health impacts on humans and animals.

Filling the Knowledge Gap Regarding Microbial Occupational Exposure Assessment in Waste Water Treatment Plants: A Scoping Review

BACKGROUND

Wastewater treatment plants (WWTPs) are crucial in the scope of European Commission circular economy implementation. However, bioaerosol production may be a hazard for occupational and public health. A scoping review regarding microbial contamination exposure assessment in WWTPs was performed.

METHODS

This study was performed through PRISMA methodology in PubMed, Scopus and Web of Science.

RESULTS

28 papers were selected for data extraction. The WWTPs' most common sampled sites are the aeration tank (42.86%), sludge dewatering basin (21.43%) and grit chamber. Air sampling is the preferred sampling technique and culture-based methods were the most frequently employed assays. Staphylococcus sp. (21.43%), Bacillus sp. (7.14%), Clostridium sp. (3.57%), Escherichia sp. (7.14%) and Legionella sp. (3.57%) were the most isolated bacteria and Aspergillus sp. (17.86%), Cladosporium sp. (10.71%) and Alternaria sp. (10.71%) dominated the fungal presence.

CONCLUSIONS

This study allowed the identification of the following needs: (a) common protocol from the field (sampling campaign) to the lab (assays to employ); (b) standardized contextual information to be retrieved allowing a proper risk control and management; (c) the selection of the most suitable microbial targets to serve as indicators of harmful microbial exposure. Filling these gaps with further studies will help to provide robust science to policy makers and stakeholders.

Transport and risk of airborne pathogenic microorganisms in the process of decentralized sewage discharge and treatment

Sewage treatment processes are a critical anthropogenic source of bioaerosols and may present significant health risks to plant workers. Compared with the specialization and scale of urban sewage treatment, many decentralized treatment models are flexible and extensive. These treatment facilities are usually close to residential areas owing to the pipe network layout and other restrictions. Bioaerosols generated by these facilities may present a serious and widespread occupational and non-occupational exposure risk to nearby residents, particularly the elderly and children. An understanding of the characteristics and exposure risks of bioaerosols produced during decentralized sewage treatment is lacking. We compared bioaerosol emission characteristics and potential exposure risks under four decentralized sewage discharge methods and treatment models: small container collection (SCC), open-channel discharge (OCD), single household/combined treatment (SHCT), and centralized treatment (CT) in northwest China. The OCD mode had the highest bioaerosol production, whereas the CT mode had the lowest. The OCD model contained the most pathogenic bacterial species, up to 43 species, including Sphingomonas, Pseudomonas, Cladosporium, and Alternaria. Risk assessments indicated bioaerosol exposure was lower in the models with sewage treatment (SHCT and CT) than in those without (SCC and OCD). Different populations exhibited large variations in potential risks owing to differences in time spent indoors and outdoors. The highest risk was observed in males exposed to the SCC model. This study provides a theoretical basis and theories for the future joint prevention and control of the bioaerosol exposure risk from decentralized sewage treatment.

Monitoring of enteropathogenic Gram-negative bacteria in wastewater treatment plants: a multimethod approach

The wastewater treatment processes are associated with the emission of microbial aerosols, including enteropathogenic bacteria. Their presence in this work environment poses a real threat to the health of employees, both through the possibility of direct inhalation of the contaminated air and indirectly through the pollution of all types of surfaces with such bioaerosol particles. This study aimed to investigate the prevalence of enteropathogenic bacteria in the air, on surfaces, and in wastewater samples collected in four wastewater treatment plants (WWTPs). The effectiveness of conventional culture-biochemical, as well as spectrometric and molecular methods for the rapid detection of enteropathogenic bacteria at workstations related to particular stages of wastewater processing, was also evaluated. Bioaerosol, surface swab, and influent and effluent samples were collected from wastewater plants employing mechanical-biological treatment technologies. The air samples were collected using MAS-100 NT impactor placed at a height of 1.5 m above the floor or ground, simulating aspiration from the human breathing zone. Surface samples were collected with sterile swabs from different surfaces (valves, handles, handrails, and coveyor belts) at workplaces. The raw influent and treated effluent wastewater samples were aseptically collected using sterile bottles. The identification of bacterial entheropathogens was simultaneously conducted using a culture-based method supplemented with biochemical (API) tests, mass-spectrometry (MALDI TOF MS), and molecular (multiplex real-time PCR) methods. This study confirmed the common presence of bacterial pathogens (including enteropathogenic and enterotoxigenic Escherichia coli, Salmonella spp., Campylobacter spp., and Yersinia enterocolitica) in all air, surface, and wastewater samples at studied workplaces. Higher concentrations of enteropathogenic bacteria were observed in the air and on surfaces at workplaces where treatment processes were not hermetized. The results of this study underline that identification of enteropathogenic bacteria in WWTPs is of great importance for the correct risk assessment at workplaces. From the analytical point of view, the control of enteropathogenic bacterial air and surface pollution using rapid multiplex-PCR method should be routinely performed as a part of hygienic quality assessment in WWTPs.

Potential pathogenic microorganisms in rural wastewater treatment process: Succession characteristics, concentration variation, source exploration, and risk assessment

Pathogenic microorganisms can cause infection, sepsis, and other diseases in humans. Although municipal wastewater plants are important sources and sinks for potential pathogenic microorganisms, data on rural wastewater treatment processes are limited. The proximity of rural wastewater facilities to human settlements and the trend toward wastewater resourcing could pose risks to humans. Here, a typical village in southern China was selected to analyze potential pathogenic microorganisms in wastewater, sewage sludge, and aerosols during the collection, treatment, and discharge of domestic wastewater. The succession characteristics and concentration variations of potential pathogenic microorganisms throughout the wastewater treatment process were identified using high-throughput sequencing and culture methods. Bacteria-associated health risks in facility aerosols were estimated based on average daily dose rates from inhalation and dermal exposure. Lower amounts of pathogenic bacteria and pathogenic fungi were detected in the effluent of the 1-ton treatment scale and the 10-ton treatment scale facilities, compared to those in the influent. Pathogen effluent concentrations were significantly lower than influent concentrations after treatment in rural wastewater facilities. 16 and 29 potential pathogenic bacteria and fungi were detected in aerosols from wastewater treatment facilities, respectively. Furthermore, the potential pathogen concentrations were higher than those in the background air. Aerobic units are the main source of pathogen emissions from aerosols. There were 42 potential pathogenic bacteria and 34 potential pathogenic fungi in the sewage sludge. Biochemical units were the main source of potential pathogens in sewage sludge, and more potential airborne pathogens originated from wastewater. In rural wastewater resourcing processes with greater pollutant exposure, the effluent of rural wastewater treatment facilities (WWTFs), downstream rivers, and facility aerosols, could be important potential sources of microbial risk. Inhalation is the main pathway of human exposure to airborne bacteria. Therefore, more attention should be focused on microbiological risk in rural wastewater treatment processes.

Bioaerosols in deodorization covers of wastewater treatment plants: Emission characteristics and health risks

Wastewater treatment plants (WWTPs) are the main source of bioaerosol emissions. The cover of deodorization within WWTPs serves not only to manage odors but also to limit the dispersion of bioaerosols. This study investigated the emission characteristics and exposure risks of bioaerosols inside deodorization covers from a WWTP in Northern China. The results revealed that the concentration of bacteria in bioaerosols ranged from 96 ± 8 to 706 ± 45 CFU/m3, with the highest concentration observed in the biochemical reaction tank. The predominant bacterial genera in bioaerosols within the odor control covers were Cetobacterium, Romboutsia, Bacteroides, Lactobacillus, and Tubricibacter, while the dominant fungal genera included Aspergillus, Alternaria, Fusarium, and Cladosporium. The main water-soluble ions in the air were NH4+, Ca2+, SO42-, and Cl-. SO42- was found to promote the survival of Cetobacterium, Brevibacterium, Fusarium, Penicillium, and Filobasidium, while Cl- exhibited inhibitory effects on most microorganisms in bioaerosols. Source tracker analysis indicated that wastewater was the primary source of bioaerosols in the biochemical reaction tank. The non-carcinogenic risk associated with bioaerosols within deodorization covers was less than 1 (2.34 × 10-9 to 3.08 × 10-2). FunGuild fungal functional prediction suggested that the abundance of animal pathogens was highest in the bioaerosols from the anaerobic sedimentation tank. BugBase phenotypic prediction showed that the abundance of potential pathogens in secondary sedimentation tank bioaerosols was the highest. This study effectively revealed the characteristics and sources of bioaerosols in the sewage and sludge treatment area under the deodorization cover, which provided a theoretical basis for enhancing the management and control of bioaerosols.

Applications of hollow nanostructures in water treatment considering organic, inorganic, and bacterial pollutants

One of the major issues of modern society is water contamination with different organic, inorganic, and contaminants bacteria. Finding cost-effective and efficient materials and methods for water treatment and environment remediation is among the scientists' most important considerations. Hollow-structured nanomaterials, including hollow fiber membranes, hollow spheres, hollow nanoboxes, etc., have shown an exciting capability for wastewater refinement approaches, including membrane technology, adsorption, and photocatalytic procedure due to their extremely high specific surface area, high porosity, unique morphology, and low density. Diverse hollow nanostructures could potentially eliminate organic contaminants, including dyes, antibiotics, oil/water emulsions, pesticides, and other phenolic compounds, inorganic pollutants, such as heavy metal ions, salts, phosphate, bromate, and other ions, and bacteria contaminations. Here, a comprehensive overview of hollow nanostructures' fabrication and modification, water contaminant classification, and recent studies in the water treatment field using hollow-structured nanomaterials with a comparative attitude have been provided, indicating the privilege abd detriments of this class of nanomaterials. Eventually, the future outlook of employing hollow nanomaterials in water refinery systems and the upcoming challenges arising in scaling up are also propounded.

The response and factors of microbial aerosol emission from the sludge bio-drying process

Exposure to high levels of microbial contaminants during waste disposal leads to the development of various diseases, including respiratory symptoms and gastrointestinal infections. In this study, the emissions of airborne bacteria and fungi during the process of sludge bio-drying were investigated. The recorded emission levels of airborne bacteria and fungi were 2398 ± 1307 CFU/m3 and 1963 ± 468 CFU/m3, respectively. Viable bacteria were sized between 1.1 and 3.3 μm, while fungal particles were concentrated between 2.1 and 4.7 μm. High-throughput sequencing was used to conduct a microbial population assay, and correlation analysis was performed to estimate the relationship between key factors and bioaerosol emissions. The main bacteria identified were Bacillus sp., Lysinibacillus sp. YS11, unclassified Enterobacteriaceae, Brevundimonas olei, and Achromobacter sp.; the primary types of fungi were Aspergillus ochraceus, Gibberella intricans, Fusarium concentricum, Aspergillus qinqixianii, and Alternaria sp.; and the dominant opportunistic pathogens were Bacillus anthracis and Aspergillus ochraceus. At lower moisture and temperature levels, airborne bacterial concentrations were higher, especially the release of fine particles. In addition, moisture content had a significant impact on the microbial population in bioaerosols. This study provides insights into strategies for controlling bioaerosols in the exhaust gases of the sludge bio-drying process.

Wastewater surveillance for antibiotics and resistance genes in a river catchment: Spatiotemporal variations and the main drivers

Wastewater-based epidemiology (WBE) is used for mining information about public health such as antibiotics resistance. This study investigated the distribution profiles of six types of antibiotic resistance genes (ARGs) in wastewater and rivers in Wuhu City, China. The levels of ARGs found in the Qingyijiang River were significantly higher than other rivers, and were comparable to effluent levels. Among the ARGs, sulfonamides ARGs and intI1 were the predominant in both wastewaters and rivers. Additionally, the concentrations of ARGs were higher on weekends as opposed to weekdays. Their distribution patterns remained consistent inter-week and inter-season using linear regression analysis (p < 0.001). Interestingly, the occurrence levels of ARGs in wastewaters during spring were significantly higher than in autumn, although insignificant in rivers. The apparent removal rate of ARGs in domestic wastewater sources ranged from 61.52-99.29%, except for qepA (-1.91% to 81.09%), whereas the removal rates in mixed domestic and industrial wastewaters showed a marked decrease (-92.94% to 76.67%). A correlation network analysis revealed that azithromycin and erythromycin were key antibiotics, while blaNDM-1, tetM, tetB, and ermB were identified as key ARGs. Sulfonamide and fluoroquinolone antibiotics, and tetracycline and macrolide ARGs were the primary contributors. Linear mixed models demonstrated that socio-economic variables positively impacted the occurrence levels of ARGs, whereas wastewater flow and river runoff were the negative drivers for their concentrations in wastewaters and surface waters, respectively. Overall, this WBE study contributes to the understanding of spatiotemporal profiles and main drivers of the occurrence of ARGs in wastewater and receiving water.

Altitude-associated trends in bacterial communities in ultrahigh-altitude residences

BACKGROUND

Indoor bacterial communities may change with altitude because their major contributors, outdoor bacterial communities, vary with altitude. People's health effects from bacteria inhalation exposure can also vary with altitude because human respiratory physiology changes with oxygen content in air. Accordingly, adjusting indoor bacterial communities may help to acclimate newcomers from low-altitude environments to ultrahigh-altitude environments. To lay the groundwork for further research, we aimed to first elucidate the bacterial communities in ultrahigh-altitude residences and the effects of altitude on these communities. We collected 187 environmental samples from residential communities at ultrahigh altitudes of 3811-4651 m in Ngari, China and sequenced bacterial 16S rRNA genes.

RESULTS

On one hand, when abundant genera in ultrahigh-altitude residences and those reported by previous studies on low-altitude residences were compared, nine genera were shared, whereas other five genera were abundant only at ultrahigh altitudes. On the other hand, when the bacterial communities of residences at different ultrahigh altitudes were further compared, the bacterial composition in indoor surface samples varied significantly with altitude. The relative abundance of five bacterial genera in indoor air samples and 10 genera and three phyla in indoor surface samples varied monotonically with altitude.

CONCLUSIONS

Altitude may be a long-neglected factor that shapes residential bacterial communities and thus warrants attention.

Disruption and recovery of outdoor bioaerosols before, during, and after the COVID-19 outbreak at a campus in Central China: pathogen composition, particle size distribution, influencing factors, and exposure risk

Before (2019), during (2020), and after (2021) the COVID-19 outbreak, different response methods and measures were taken on campuses to control the spread of COVID-19 within schools. These response methods may have changed the outdoor bioaerosol characteristics, which may affect staff and student health. Therefore, we analyzed the bacterial concentrations, particle size distribution, microbial populations, exposure risks, and environmental influences of bioaerosols at a campus before, during, and after the COVID-19 outbreak. This study used eight-stage Andersen samplers to collect and analyze culturable bacteria in bioaerosols from various locations, high-throughput sequencing to analyze microbial species, principal component analysis to compare differences in samples, RDA to investigate the effects of environmental factors on bioaerosols, and hazard quotient (HQ) and BugBase to evaluate human health risks. The study findings revealed that average bacterial concentrations before, during, and after COVID-19 were 75 CFU m-3, 136 CFU m-3, and 78 CFU m-3, respectively. Moreover, the average percentage of bacteria attached to PM2.5 was 49.2%, 42.7%, and 29.9%, respectively. High-throughput sequencing revealed that species composition changed significantly during the three years of COVID-19. The proportion of Pantoea and Bacillus increased with the development of COVID-19 and these became the dominant strains after COVID-19, whereas Pseudomonas had the maximum proportion during COVID-19. Both risk assessment and BugBase phenotype prediction results indicated that the potential pathogenic risk was the highest in the outdoor environment of the campus during COVID-19 and that bioaerosol contamination was the most severe compared to the outdoor bioaerosol characteristics of the campus recovered after COVID-19.

Antibiotic resistance genes associated with size-segregated bioaerosols from wastewater treatment plants: A review

The antibiotic-resistant pollution in size-segregated bioaerosols from wastewater treatment plants (WWTPs) is of increasing concern due to its public health risks, but an elaborate review is still lacking. This work overviewed the profile, mobility, pathogenic hosts, source, and risks of antibiotic resistance genes (ARGs) in size-segregated bioaerosols from WWTPs. The dominant ARG type in size-segregated bioaerosols from WWTPs was multidrug resistance genes. Treatment units that equipped with mechanical facilities and aeration devices, such as grilles, grit chambers, biochemical reaction tanks, and sludge treatment units, were the primary sources of bioaerosol antibiotic resistome in WWTPs. Higher enrichment of antibiotic resistome in particulate matter with an aerodynamic diameter of <2.5 μm, was found along the upwind-downwind-WWTPs gradient. Only a small portion of ARGs in inhalable bioaerosols from WWTPs were flanked by mobile genetic elements. The pathogens with multiple drug resistance had been found in size-segregated bioaerosols from WWTPs. Different ARGs or antibiotic resistant bacteria have different aerosolization potential associated with bioaerosols from various treatment processes. The validation of pathogenic antibiotic resistance bacteria, deeper investigation of ARG mobility, emission mechanism of antibiotic resistome, and development of treatment technologies, should be systematically considered in future.

Assessment of personal deposited dose and particle size distribution of bacterial aerosol in kindergarten located in southern Poland

The study's primary focus lies in examining the relationship between respiratory and deposition doses of bacterial aerosols in urban kindergarten, providing valuable insights into the specific doses absorbed by individuals in different sections of their respiratory systems based on the aerodynamic diameter of bacterial particles. Samples were collected twice a week, using by an Andersen cascade impactor during autumn and winter seasons 2018/2019 resulting in a total of 1152 Petri dishes analyzed. The highest average concentration of bacterial aerosol was observed during autumn (1698 ± 663 CFU/m3) in comparison to winter months (723 ± 134 CFU/m3). Respirable doses for children and staff were 2945 and 2441 CFU/day during winter and 5988 and 4964 CFU/day during autumn, respectively. Deposition doses incorporated from empirical models for regional deposition in the respiratory tract showed that children in kindergarten absorb 33% less of bacteria into alveolar region if breath by nose instead of mouth. Additionally, risk assessment results indicate that the hazard indices for children attending kindergartens for 3 years and for staff working 25 years are below 1, suggesting minor risks associated with the inhalation of bioaerosols during autumn and winter. HI was <1, so the non-carcinogenic effects are on an acceptable level, but the indoor/outdoor ratio were 3.5 and 2.4 for autumn and winter, respectively, indicating children's and adult's exposure to bacterial aerosol should be reduced.

Pollution characteristics and potential health effects of airborne microplastics and culturable microorganisms during urban haze in Harbin, China

In this study, active sampling technology was used to collect microplastics (MPs) and microorganisms simultaneously on haze days in Harbin, China. Airborne MPs concentrations in Junior high school (162.4 ± 44.6 particles/m3) with high vehicular and pedestrian traffic was higher than those in University (63.2 ± 21.8 particles/m3) and Park (12.8 ± 5.5 particles/m3). More airborne MPs were detected in the night samples than in the morning and noon samples. The majority (69.06 %) of airborne MPs measured less than 100 μm, with fibers (69.4 %) being the predominant form. Polyesters and polyethylene were the dominant polymers. In addition, airborne MPs concentrations were positively correlated with microorganisms and PM10 concentrations, and the health hazards associated with microorganisms and MPs exposure via inhalation far exceeded those associated with skin contact, which can serve as a theoretical foundation for considering MPs as indicators of air quality in the future.

Surge of native rare taxa in tailings soil induced by peat bacterial invasion

The pivotal role of the native bacterial community in maintaining soil health, particularly in degraded tailings environments, is often overlooked. This study utilized peat, rich in microorganisms, to investigate its impact on soil function and native bacteria response in copper tailings-soil. Through 16S rRNA gene sequencing, changes in nutrient cycling, organic matter decomposition, and microbial activity were assessed post one-year peat remediation. Results from FEAST and cluster analysis revealed that peat-derived species disproportionately influenced tailings microbial community remediation, supported by the microbial invasion theory. Tailings responded positively to these species, with optimal function achieved at 5 % peat dosage. Peat biomarkers (Actinobacteriota, Bacteroida, Chloroflexi, and Firmicutes) played key roles in heavy metal removal and nutrition fixation. The Random Forest model and co-occurrence network highlighted contributions from native rare species (Dependentiae and Latescibacterota) activated by peat addition. These insights underscore the resilience of rare taxa and provide a foundation for soil health restoration in tailings areas. By emphasizing the importance of peat as a potential exogenous solution for activating indigenous microbial functions, these findings offer valuable insights for developing effective and sustainable remediation strategies in mining-affected regions.

The bioaerosols generated from the sludge treatment process: Bacterial and fungal variation characteristics, source tracking, and risk assessment

Bioaerosols generated from sludge treatment processes in wastewater treatment plants (WWTPs) may spread infectious diseases. This study investigated the generation characteristics, source, and associated risks of bioaerosols produced during sludge treatment processes. The results showed that the concentration range of total suspended particles was 49 ± 3 to 354 ± 10 μg/m3, and the primary water-soluble ions in bioaerosols were NH4+, SO42- and Cl-. The bacterial concentration in bioaerosols was 50 ± 5 to 1296 ± 261 CFU/m3, with the highest concentration in the biochemical reaction tank. The dominant bacteria in bioaerosols included Bacteroides, Cetobacterium, Romboutsia, Lactobacillus and Turicibacter, while the dominant fungi were Aspergillus, Alternaria, Cladosporium and Fusarium. Pathogenic microorganisms such as Escherichia and Aspergillus were detected in all treatment processes. The results of principal component analysis showed that the bacterial composition in bioaerosols was similar of different technological processes, while the fungal species composition was different. The dominant microbial composition of sludge and bioaerosols was relatively close. The Source Tracker results indicated that sludge was the main source of airborne bacteria in the sludge dewatering house, as well as the main source of airborne fungi in the plate-frame pressure filtration tank and the sloping plate sedimentation tank. The non-carcinogenic risk in each stage was low (1.22 × 10-9-3.99 × 10-2). However, Bugbase phenotype prediction results showed that the bioaerosols in the anaerobic sedimentation tank may have potential pathogenicity. Therefore, the management and control of bioaerosols from the sludge treatment should be strengthened.

Footprints of total coliforms, faecal coliforms and E. coli in a wastewater treatment plant and the probabilistic assessment and reduction of E. coli infection risks

Wastewater contains various pathogenic microorganisms, and the disease of workers caused by exposure to wastewater at the wastewater treatment plants (WWTPs) is a growing concern. The footprints of total coliforms (TC), faecal coliforms (FC) and Escherichia coli (E. coli) in a conventional activated sludge WWTP during 12 consecutive months were clarified. It was found that TC, FC and E.coli in influent were significantly removed (log 4.71, log 4.43 and log 4.62, respectively) by WWTP with sand filtration playing a key role, and excess sludge was a major potential pathway for them flowing to the environment. Through quantitative microbial risk assessment (QMRA), hand-to-mouth ingestion of untreated wastewater and wastewater in secondary/efficient sedimentation tanks, as well as accidental ingestion of sludge in dewatering workshop presented the highest infection risks of pathogenic E.coli in the WWTP, considerably exceeded the U.S. EPA benchmark (≤1 × 10-4 pppy). PPE application and E.coli concentration reduction in wastewater or sludge were recommended to reduce the infection risks at these stages. Further, partial ozonation and dissolved ozone flotation thickening were investigated able to reduce the infection risks at the stages of secondary and tertiary treatment of wastewater or sludge treatment by 90- 98 %. The findings of this study would assist in selecting appropriate processes for the further sanitation of WWTPs.

From air to airway: Dynamics and risk of inhalable bacteria in municipal solid waste treatment systems

Municipal solid waste treatment (MSWT) system emits a cocktail of microorganisms that jeopardize environmental and public health. However, the dynamics and risks of airborne microbiota associated with MSWT are poorly understood. Here, we analyzed the bacterial community of inhalable air particulates (PM10, n = 71) and the potentially exposed on-site workers' throat swabs (n = 30) along with waste treatment chain in Shanghai, the largest city of China. Overall, the airborne bacteria varied largely in composition and abundance during the treatment (P < 0.05), especially in winter. Compared to the air conditions, MSWT-sources that contributed to 15 ∼ 70% of airborne bacteria more heavily influenced the PM10-laden bacterial communities (PLS-SEM, β = 0.40, P < 0.05). Moreover, our year-span analysis found PM10 as an important media spreading pathogens (104 ∼ 108 copies/day) into on-site workers. The machine-learning identified Lactobacillus and Streptococcus as pharynx-niched featured biomarker in summer and Rhodococcus and Capnocytophaga in winter (RandomForest, ntree = 500, mtry = 10, cross = 10, OOB = 0%), which closely related to their airborne counterparts (Procrustes test, P < 0.05), suggesting that MSWT a dynamic hotspot of airborne bacteria with the pronounced inhalable risks to the neighboring communities.

Culturable and inhalable airborne bacteria in a semiunderground municipal wastewater treatment plant: Distribution, transmission, and health risk assessment

Airborne pathogens constitute a growing threat to global public health. Wastewater treatment plants (WWTPs) are important sources of airborne bacteria, which pose great health risks to the employee and nearby residents. In this study, the distribution, transmission and health risk of the airborne culturable and inhalable bacteria carried by PM2.5 in a semiunderground WWTP were evaluated. The concentrations of culturable bacteria in the air were 21.2-1431.1 CFU/m3, with the main contributions of primary and biological treatments. The relative abundances of culturable and total inhalable bacterial taxa were positively correlated (p < 0.05). However, certain bacteria, including Bacillus, Acinetobacter and Enterococcus, exhibited high reproductive capacity despite their low concentration in the air, suggesting that they can survive and regrow in suitable environments. Transmission modeling revealed that the concentrations of airborne bacteria exponentially decreased with distance from 18.67 to 24.12 copies /m3 at the source to 0.06-0.14 copies /m3 at 1000 m downwind. The risks of 8-h exposure in this WWTP except the outlet exceeded the reference value recommended by WHO, which were primarily dependent on P. aeruginosa, Salmonella, and E. coli. Management practices should consider improved controls for bioaerosols in order to reduce the risk of disease transmission.

Spatiotemporal dynamics, traceability analysis, and exposure risks of antibiotic resistance genes in PM2.5 in Handan, China

Fine particulate matter (PM2.5) seriously affects environmental air quality and human health, and antibiotic resistance genes (ARGs) in PM2.5 posed a great challenge to clinical medicine. The year of 2013-2017 was an important 5-year period for the implementation of Air Pollution Prevention and Control Action Plan (APPCAP) in China. Here, we took Handan, a PM2.5 polluted city in northern China, as the research object and analyzed ARGs in PM2.5 in winter (January) from 2013 to 2017. The results showed that the abundance of ARGs was the highest in 2013 (3.7 × 10-2 copies/16S rRNA), and ARGs were positively correlated with air quality index (AQI) (r = 0.328, P < 0.05) and PM2.5 concentration (r = 0.377, P = 0.020 < 0.05) in the 5-year period. The ARGs carried by PM2.5 in four functional regions of sewage treatment plant, steel works, university, and park showed that sul1 and qepA had higher abundance in each functional region, and the total ARG abundance in sewage treatment plant (1.3 × 10-1 copies/16S rRNA) was the highest, while lowest in park (2.0 × 10-3 copies/16S rRNA). Potential source contribution function (PSCF) and concentration-weighted trajectory (CWT) model were used to trace the pollutants at the sampling points, which indicated that the surrounding cities contributed more than quarter to the sampling points. Therefore, regional transportation reduces the spatial distribution difference of ARGs in PM2.5. The exposure dose of ARGs in different functional regions illustrated that the total inhaled dose of ARGs in sewage treatment plant (1.7 × 105 copies/d) was the highest, while lowest in park (3.2 × 104 copies/d). This study is of great significance for assessing the distribution and sources of ARGs under the clean air initiative in China.

Bioaerosol-related studies in wastewater treatment plant with anaerobic-anoxic-oxic processes: Characterization, source analysis, control measures

Sewage in wastewater treatment plants (WWTPs) can produce fugitive bioaerosols that pose a health risk to employees and residents. This study aimed to fugitive bioaerosols from two WWTPs with anaerobic-anoxic-oxic (AAO) processes, and bioaerosols control measures were proposed based on the results of these studies. It was found that the bioaerosols were mainly composed of microorganisms from dominant genera such as Romboutsia, Rubellimicrobium, Sphingomonas, Acidea, Cryptotrichosporon and water-soluble ions dominated by SO₄^2-. Moreover, total suspended particulate (TSP), relative humidity (RH), wind speed (WS), Ca²⁺, NH₄⁺, Na⁺, Cl^-, NO₃^-, and K⁺ had positive effects on most dominant genera, while temperature (T) and SO₄^2- had negative effects on most dominant genera. The source analysis showed that the bioaerosols in the indoor treatment facility's fine screen room and sludge dewatering plant mainly originated from sewage or sludge, and those in the aeration tank of the outdoor treatment facility mainly originated from the background air of WWTPs . By combining the characteristics of bioaerosols and the results of source analysis, targeted control measures were proposed from three aspects: source reduction of bioaerosol fugitives, control of bioaerosol propagation, and collection and treatment systems. This study provides the theoretical basis and ideas for controlling bioaerosols in WWTPs with AAO processes.

The exposure risks associated with pathogens and antibiotic resistance genes in bioaerosol from municipal landfill and surrounding area

Pathogenic microbes with antibiotic resistance can thrive on municipal solid waste as nutrients and be aerosolized and transported to vicinities during waste disposal processes. However, the characterization of pathogenic bioaerosols and assessment of their exposure risks are lacking. Herein, particle size, concentration, activity, antibiotic resistance, and pathogenicity of airborne microorganisms were assessed in different sectors of a typical landfill. Results showed that active sector in downwind direction has the highest bioaerosol level (1234 CFU/m³), while residential area has the highest activity (14.82 mg/L). Botanical deodorizer from mist cannon can effectively remove bioaerosol. Most bioaerosols can be inhaled into respiratory system till bronchi with sizes ranging from 2.1-3.3 and 3.3-4.7 µm. Pathogenic bacteria (Bacilli, Bacillus, and Burkholderia-Paraburkholderia) and allergenic fungi (Aspergillus, Cladosporium, and Curvularia) prevailed in landfill. Although high abundance of microbial volatile organic compounds (mVOCs) producing bioaerosols were detected, these mVOCs contributed little to odor issues in landfill. Notably, surrounding areas have higher levels of antibiotic-resistance genes (ARGs) than inner landfill with tetC, acrB, acrF, mdtF, and bacA as dominant ones. Most ARGs were significantly correlated with bacterial community, while environmental parameters mainly influenced fungal prevalence. These findings can assist in reducing and preventing respiratory allergy or infection risks in occupational environments relating to waste management.

Genomic insight into transmission mechanisms of carbapenem-producing Citrobacter spp. isolates between the WWTP and connecting rivers

Carbapenem-resistant Enterobacteriaceae (CRE) poses major health risks worldwide. Most studies have focused on carbapenem resistance in Klebsiella pneumoniae and Escherichia coli; however, the occurrence and transmission of carbapenem-resistant Citrobacter spp. (CRCS) are poorly understood. In this study, we investigated the occurrence and potential transmission patterns of CRCS in different functional areas of an urban wastewater treatment plant (WWTP) and connecting rivers during one-year monitoring in Shandong Province, China. In total, 14 CRCS were detected in 376 environmental samples, including those from the WWTP inlet (n = 7), WWTP anaerobic tank (n = 2), and rivers (n = 5). Citrobacter braakii (n = 6) was the dominant subtype among 14 CRCS isolates, followed by Citrobacter freundii (n = 5), Citrobacter sedlakii (n = 2), and Citrobacter werkmanii (n = 1). All CRCS were resistant to imipenem, meropenem, ampicillin, amoxicillin/clavulanic acid, cefotaxime, ceftazidime, trimethoprim/sulfamethoxazole, and ciprofloxacin. Plasmid analysis showed that the bla_KPC-2 gene was located on IncN and IncFII (Yp) plasmids, whereas the bla_NDM gene was located on IncX3 and IncN2 plasmids. Clonal transmission of CRCS harboring carbapenem genes occurred between the WWTP and connecting rivers on a temporal or spatial scale. High genomic relatedness of NDM-5-producing C. sedlakii was identified between river water and WWTP aerosol, suggesting a potential exposure risk of CRCS for workers and surrounding residents near the WWTP. Furthermore, NDM-5-producing C. sedlakii isolated from rivers was related to C. sedlakii isolated from soil and well water in different regions of China, indicating that NDM-5-producing C. sedlakii may be widespread in China. These findings indicate that rare healthcare-associated pathogens such as CRCS can contribute to widespread carbapenem production in the environment; thus, CRCS should be continuously monitored.

Evaluating the threshold limit value of acceptable exposure concentration for exposure to bioaerosols in a wastewater treatment plant: Reverse-quantitative microbial risk assessment and sensitivity analysis

Agitation operations produce numerous pathogenic bioaerosols in WWTPs¹. QMRA² can determine risks of persons exposed to these bioaerosols. However, QMRA framework cannot help stakeholders in immediately deciding whether a risk is intolerable. Thus, evaluating threshold of acceptable exposure concentration is an urgent issue but is still rarely addressed in WWTPs. This study analyzed TLV³ benchmarks of E. coli and S. aureus bioaerosols emitted from a WWTP by reverse-QMRA. Furthermore, variance of input parameters was clarified by sensitivity analysis. Results showed that, under conservative and optimistic estimates, TLV of technicians was 1.52-2.06 and 1.26-1.68 times as large as those of workers, respectively; wearing mask drive TLV up to 1-2 orders of magnitude; TLV of M⁴ was at most 1.33 and 1.31 times as large as that of RD⁵, respectively. For sensitivity analysis, removal fraction by equipping PPE enlarge TLV for effortlessly obtaining an acceptable assessment result; exposure time was dominant when without PPE excepting the scenario of technicians exposed to E. coli bioaerosol. This study helps establish threshold guidelines for bioaerosols in WWTPs and contribute innovative perspectives for stakeholders.

Adverse impacts of Asian dust events on human health and the environment-A probabilistic risk assessment study on particulate matter-bound metals and bacteria in Seoul, South Korea

This study aimed to assess the impact of Asian dust (AD) on the human health and the environment. Particulate matter (PM) and PM-bound trace elements and bacteria were examined to determine the chemical and biological hazards associated with AD days and compared with non-AD days in Seoul. On AD days, the mean PM10 concentration was ∼3.5 times higher than that on non-AD days. Elements generated from the Earth's crust (Al, Fe, and Ca) and anthropogenic sources (Pb, Ni, and Cd) were identified as major contributors to coarse and fine particles, respectively. During AD days, the study area was recognized as "severe" for pollution index and pollution load index levels, and "moderately to heavily polluted" for geoaccumulation index levels. The potential cancer risk (CR) and non-CR were estimated for the dust generated during AD events. On AD days, total CR levels were significant (in 1.08 × 10^-5-2.22 × 10^-5), which were associated with PM-bound As, Cd, and Ni. In addition, inhalation CR was found to be similar to the incremental lifetime CR levels estimated using the human respiratory tract mass deposition model. In a short exposure duration (14 days), high PM and bacterial mass deposition, significant non-CR levels, and a high presence of potential respiratory infection-causing pathogens (Rothia mucilaginosa) were observed during AD days. Significant non-CR levels were observed for bacterial exposure, despite insignificant levels of PM10-bound elements. Therefore, the substantial ecological risk, CR, and non-CR levels for inhalation exposure to PM-bound bacteria, and the presence of potential respiratory pathogens, indicate that AD events pose a significant risk to both human lung health and the environment. This study provides the first comprehensive examination of significant non-CR levels for bacteria and carcinogenicity of PM-bound metals during AD events.

Enhance antibiotic resistance and human health risks in aerosols during the COVID-19 pandemic

Aerosols are an important route for the transmission of antibiotic resistance genes (ARGs). Since the 2019 (COVID-19) pandemic, the large-scale use of disinfectants has effectively prevented the spread of environmental microorganisms, but studies regarding the antibiotic resistance of airborne bacteria remain limited. This study focused on four functional urban areas (commercial areas, educational areas, residential areas and wastewater treatment plant) to study the variations in ARG abundances, bacterial community structures and risks to human health during the COVID-19 pandemic in aerosol. The results indicated the abundance of ARGs during the COVID-19 period were up to approximately 13-fold greater than before the COVID-19 period. Large-scale disinfection resulted in a decrease in total bacterial abundance. However, chlorine-resistant bacteria tended to be survived. Among the four functional areas, the diversity and abundance of aerosol bacteria were highest in commercial aera. Antibiotic susceptibility assays suggested elevated resistance of isolated bacteria to several tested antibiotics due to disinfection exposure. The potential exposure risks of ARGs to human health were 2 times higher than before the COVID-19 pandemic, and respiratory intake was the main exposure route. The results highlighted the elevated antibiotic resistance of bacteria in aerosols that were exposed to disinfectants after the COVID-19 pandemic. This study provides theoretical guidance for the rational use of disinfectants and control of antimicrobial resistance.

Aircraft surveys for air eDNA: probing biodiversity in the sky

Air is a medium for dispersal of environmental DNA (eDNA) carried in bioaerosols, yet the atmosphere is mostly unexplored as a source of genetic material encompassing all domains of life. In this study, we designed and deployed a robust, sterilizable hardware system for airborne nucleic acid capture featuring active filtration of a quantifiable, controllable volume of air and a high-integrity chamber to protect the sample from loss or contamination. We used our hardware system on an aircraft across multiple height transects over major aerosolization sources to collect air eDNA, coupled with high-throughput amplicon sequencing using multiple DNA metabarcoding markers targeting bacteria, plants, and vertebrates to test the hypothesis of large-scale genetic presence of these bioaerosols throughout the planetary boundary layer in the lower troposphere. Here, we demonstrate that the multi-taxa DNA assemblages inventoried up to 2,500 m using our airplane-mounted hardware system are reflective of major aerosolization sources in the survey area and show previously unreported airborne species detections (i.e., Allium sativum L). We also pioneer an aerial survey flight grid standardized for atmospheric sampling of genetic material and aeroallergens using a light aircraft and limited resources. Our results show that air eDNA from terrestrial bacteria, plants, and vertebrates is detectable up to high altitude using our airborne air sampler and demonstrate the usefulness of light aircraft in monitoring campaigns. However, our work also underscores the need for improved marker choices and reference databases for species in the air column, particularly eukaryotes. Taken together, our findings reveal strong connectivity or mixing of terrestrial-associated eDNA from ground level aerosolization sources and the atmosphere, and we recommend that parameters and indices considering lifting action, atmospheric instability, and potential for convection be incorporated in future surveys for air eDNA. Overall, this work establishes a foundation for light aircraft campaigns to comprehensively and economically inventory bioaerosol emissions and impacts at scale, enabling transformative future opportunities in airborne DNA technology.

The spread of antibiotic resistance to humans and potential protection strategies

Antibiotic resistance is currently one of the greatest threats to human health. Widespread use and residues of antibiotics in humans, animals, and the environment can exert selective pressure on antibiotic resistance bacteria (ARB) and antibiotic resistance gene (ARG), accelerating the flow of antibiotic resistance. As ARG spreads to the population, the burden of antibiotic resistance in humans increases, which may have potential health effects on people. Therefore, it is critical to mitigate the spread of antibiotic resistance to humans and reduce the load of antibiotic resistance in humans. This review briefly described the information of global antibiotic consumption information and national action plans (NAPs) to combat antibiotic resistance and provided a set of feasible control strategies for the transmission of ARB and ARG to humans in three areas including (a) Reducing the colonization capacity of exogenous ARB, (b) Enhancing human colonization resistance and mitigating the horizontal gene transfer (HGT) of ARG, (c) Reversing ARB antibiotic resistance. With the hope of achieving interdisciplinary one-health prevention and control of bacterial resistance.

Monitoring Longitudinal Trends and Assessment of the Health Risk of Shigella flexneri Antimicrobial Resistance

Shigella flexneri infection is the main cause of diarrhea in humans worldwide. The emergence of antimicrobial resistance (AMR) of S. flexneri is a growing public health threat worldwide, while large-scale studies monitoring the longitudinal AMR trends of isolates remain scarce. Here, the AMR gene (ARG) profiles of 717 S. flexneri isolates from 1920 to 2020 worldwide were determined. The results showed that the average number of ARGs in isolates has increased significantly, from 19.2 ± 2.4 before 1970 to 29.6 ± 5.3 after 2010. In addition, mobile genetic elements were important contributors to ARGs in S. flexneri isolates. The results of the structural equation model showed that the human development index drove the consumption of antibiotics and indirectly promoted the antibiotic resistance. Finally, a machine learning algorithm was used to predict the antibiotic resistance risk of global terrestrial S. flexneri isolates and successfully map the antibiotic resistance threats in global land habitats with over 80% accuracy. Collectively, this study monitored the longitudinal AMR trends, quantitatively surveilled the health risk of S. flexneri AMR, and provided a theoretical basis for mitigating the threat of antibiotic resistance.

ADMS simulation and influencing factors of bioaerosol diffusion from BRT under different aeration modes in six wastewater treatment plants

Bioaerosols produced by municipal wastewater treatment plants (MWTP) can spread in air, thereby polluting the atmosphere and causing safety hazards to workers and surrounding residents. In this study, the biological reaction tanks (BRTs) of six MWTPs undergoing typical processes in North China, Yangtze River Delta, and the Greater Bay Area were selected to set up sampling points and investigate the production characteristics of bioaerosols. The Atmospheric Dispersion Modelling System method was used to simulate the diffusion of bioaerosols in the MWTPs. The concentrations of bacteria and, specifically, intestinal bacteria in the bioaerosols ranged from 389 CFU/m³ to 1,536 CFU/m³ and 30 CFU/m³ to 152 CFU/m³, respectively, and the proportion of the intestinal bacteria was 8.85%. The concentration of soluble chemicals (SCs) in the bioaerosols was 18.36 μg/m³-82.19 μg/m³, and the main SCs found were Mg²⁺, Ca²⁺, and SO₄^2-. The proportion of intestinal bacteria (75.79%) produced via surface aeration by a BRT attached to large-sized bioaerosol particles was higher than that of a BRT undergoing the bottom aeration process (37.28%). The main microorganisms found in the bioaerosols included Moraxellaceae, Escherichia-Shigella, Psychrobacter, and Cyanobacteria. The generation of bioaerosols exhibited regional characteristics. The wastewater treatment scale, wastewater quality, and aeration mode were the main factors influencing bioaerosol production. Model simulation showed that, after 1 h, the diffusion distance of bioaerosol was 292 m-515 m, and the affected area was 42,895 m²-91,708 m². The diffusion distance and range of the bioaerosols were significantly correlated with the concentration at the bioaerosol source and the aeration mode adopted by the BRTs. Wind speed and direction were two environmental factors that affected the diffusion of bioaerosols. With an increase in the diffusion distance, the concentration of microorganisms, intestinal bacteria, ions, and fine particles in the bioaerosols decreased significantly, resulting in a corresponding reduction in the exposure risk. This study provides new insights to help predict bioaerosol risks at MWTPs and identify safe areas around MWTPs. The study also provides a basis for selecting safe MWTP sites and reducing bioaerosol pollution risks.

Escape and functional alterations of microbial aerosol particles containing Pseudomonas sp. during wastewater treatment

Wastewater treatment plants (WWTP) are considered sources of bioaerosols emission that negatively affects the surrounding atmosphere. This study focused on Pseudomonas sp. Emissions in bioaerosols from a WWTP that adopts the A²O treatment process, and their inactivation through ultraviolet (UV) radiation. High-throughput sequencing was used to assay the microbial population, and functional composition profiles were predicted using 16 S rRNA sequencing data with PICRUSt2. Recorded emission levels of airborne bacteria and Pseudomonas sp. In WWTP were 130 ± 83-6113 ± 3015 CFU/m³ and 0-6431 ± 1945 CFU/m³, respectively. Bioaerosol emissions presented site-related and temporal variation. Over 80% of Pseudomonas sp. Were attached to coarse particles with sizes over 2.1 μm. Bioaerosol concentration and particle-size distribution in the air were closely related to ambient temperature, relative humidity, light intensity, and wind speed. Exposure to 45.67 μW/cm³ UV radiation led to a significant decline in bioaerosol concentrations in the air, and reduction rate reached 89.16% and 95.77% for airborne bacteria and Pseudomonas sp., respectively. The results suggested that UV radiation can be an effective method in reducing bioaerosols. Compared with other bacteria, Pseudomonas stutzeri and Bacillus sp. Are more resistant to UV radiation. The abundance of antibiotic resistance genes noticeably receded when exposed to UV irradiation. The relative abundance of cationic antimicrobial peptide resistance, categorized under human diseases in KEGG (level 3), significantly decreased in Pseudomonas sp. After 120 min of UV irradiation. This study provides a novel insight into the control of bioaerosol emissions carrying pathogenic bacteria.

Bioaerosols in an industrial park and the adjacent houses: Dispersal between indoor/outdoor, the impact of air purifier, and health risk reduction

Inhaling airborne pathogens may cause severe epidemics showing huge threats to indoor dwellings residents. The ventilation, environmental parameters, and human activities would affect the abundance and pathogenicity of bioaerosols in indoor. However, people know little about the indoor airborne microbes especially pathogens near the industrial park polluted with organics and heavy metals. Herein, the indoor bioaerosols' community composition, source and influencing factors near an electronic waste (e-waste) industrial park were investigated. Results showed that the average bioaerosol level in the morning was lower than evening. Bioaerosol concentration and activity in indoor (1936 CFU/m³ and 7.62 × 10⁵ ng/m³ sodium fluorescein in average) were lower than the industrial park (4043 CFU/m³ and 7.77 × 10⁵ ng/m³ sodium fluorescein), and higher microbial viability may be caused by other pollutants generated during e-waste dismantling process. Fluorescent biological aerosol particles occupied 17.6%-23.7% of total particles, indicating that most particles were non-biological. Bacterial communities were richer and more diverse than fungi. Furthermore, Bacillus and Cladosporium were the dominant indoor pathogens, and pathogenic fungi were more influenced by environmental factors than bacteria. SourceTracker analysis indicates that outdoor was the main source of indoor bioaerosols. The hazard quotient (<1) of airborne microbes through inhalation was negligible, but long-term exposure to pathogens could be harmful. Air purifiers could effectively remove the airborne fungi and spheroid bacteria than cylindrical bacteria, but open doors and windows would reduce the purification efficiency. This study is great important for risk assessments and control of indoor bioaerosols near industrial park.

Quantitative microbial risk assessment with nasal/oral breathing pattern for S. aureus bioaerosol emission from aeration tanks and residual sludge storage yard in a wastewater treatment plant

A large number of pathogenic bioaerosols are generated during the treatment process of wastewater treatment plants (WWTPs), and they can pose potential risks to human health. Therefore, this study systematically analyzed the emission characteristics of Staphylococcus aureus bioaerosols released from an inverted umbrella aeration tank, a microporous aeration tank, and a residual sludge storage yard in a WWTP, and quantitatively evaluated the health risks of four kinds of exposed populations with nasal/oral breathing patterns under optimistic and conservative estimations. The results displayed that the bioaerosol concentration in inverted umbrella aeration tank was higher than that in microporous aeration tank and residual sludge storage yard. Aerosolization ratio in residual sludge storage yard was an order of magnitude lower than that in aeration tanks. Sludge workers were at higher health risks than the other three exposed populations. The health risks of nasal breathers (infection risk: 1.62 × 10^-5-2.56 × 10^-3 pppy; disease burden: 4.24 × 10^-8-6.72 × 10^-6 DALYs pppy) were 0.61-0.63 times higher than those of oral breathers (infection risk: 9.95 × 10^-6-1.59 × 10^-3 pppy; disease burden: 2.61 × 10^-8-4.18 × 10^-6 DALYs pppy). For female field engineers using oral breathing, laboratory technicians, and researchers without personal protective equipment (PPE), infection risk and disease burden had the opposite results, which indicated that satisfying one certain benchmark did not mean absolute safety. In addition, health risks of exposed populations were reduced by an order of magnitude after wearing PPE. This study can provide a reliable theoretical basis for the risk prevention of bioaerosols and supply data support for the strategies of health risk control perspectives for local sewage utilities.

Dechlorination of dichloromethane by a biofilter enriched with electroactive bacteria: Performance, kinetics, and microbial community

Dichloromethane (DCM) is a recalcitrant volatile organic compound that exhibits biological toxicity and bioaccumulation. In this study, gaseous DCM was removed using an electroactive bacterial biofilter (EBB) with graphite rod as the anode and carbon felt as the cathode. The highest removal efficiency (97.09%) was achieved at a cathodic potential of -600 mV (vs. Ag/AgCl). The EBB had a maximum elimination capacity of 79.29 g m^-3 h^-1 when the inlet load was 96.48 g m^-3 h^-1. There was no substrate inhibition phenomenon observed in the EBB, and the Michaelis-Menten model was used to describe the kinetics of the EBB. High-throughput sequencing indicated that electroactive genera such as Rhodanobacter sp., Sphingomonas sp., Pseudomonas sp., Chryseobacterium sp., Pseudochrobactrum sp., and Mycobacterium sp. dominated the EBB. The microbial communities were stable and were slightly affected by the DCM inlet concentration. The results can be applied for the effective treatment of recalcitrant volatile organic compounds (VOCs).

The difference between drainage channels and sewers in rural areas: from sewage quality to bacterial characteristics

Channels and sewers are commonly used to collect sewage during extensively rural areas. The sewage and bacterial characteristics of rural sewage collection systems can influence their operation and maintenance performance which further affect appropriate system decision. In this study, eight rural sewage collection systems (four each of channels and sewers) were applied to evaluate the sewage quality, bacterial characteristics, and their differences of two kinds of collection systems. The results indicate that significantly distinction existed between the rural sewage collection systems of channels and sewers. Sewage in channels had higher suspended solid (SS) concentration but lower sulfide concentration than that in sewers. The SS, sulfate, and chemical oxygen demand (COD) removal capacity in channels was nearly 3.5, 4.0, and 0.6 times than those in sewers. At least 14 genera and 18 species of bacteria showed significantly distinction between channels and sewers even their main phylum, genus, and species of bacteria communities was Proteobacteria (∼70.3%), Acinetobacter (∼22.3%), and Pseudomonas fragi (∼13.8%), respectively. The structural characteristics and bacterial function caused the difference between channels and sewers. Overall, this study revealed the intrinsic and essential differences of channels and sewers, providing basic and meaningful data for rural sewage collection systems decision.

A probabilistic assessment of microbial infection risks due to occupational exposure to wastewater in a conventional activated sludge wastewater treatment plant

Exposure to pathogens during wastewater treatment could result in significant health risks. In this paper, a probabilistic approach for assessing the risks of microbial infection for workers in an activated sludge wastewater treatment plant is presented. A number of exposure routes were modelled, including hand-to-mouth and droplet ingestion of untreated wastewater, droplet ingestion and inhalation of aerosols after secondary treatment, and ingestion of sludge during drying. Almost all workers exposed to untreated wastewater could be infected with the three selected potential pathogens of pathogenic E. coli, Norovirus and Cryptosporidium spp. Hand-to-mouth ingestion is the single most significant route of exposure at the head of works. There is also a risk of infections resulting from ingestion of droplets or inhalation of aerosols at the aeration tanks or contaminated hands at the clarifiers during secondary wastewater treatment. For sludge, the risks of infection with Norovirus was found to be the highest due to accidental ingestion (median risks of 2.2 × 10^-2(±3.3 × 10^-3)). Regardless of the point and route of exposure, Norovirus and Cryptosporidium spp. presented the highest risks. The study finds that occupational exposure to wastewater at wastewater treatment plants can result in significant viral and protozoan infections. This risk assessment framework can be used to establish and measure the success of risk reduction measures in wastewater treatment plants. These measures could include the use of personal protective equipment and adherence to strict personal hygiene.

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.

Airborne fungi and human exposure in different areas of composting facilities

Airborne fungi can pose serious health concerns in humans; however, the area-specific abundance and composition of airborne fungal microbiota discharged from composting facilities remain unclear. In the present study, we collected air samples from composting, packaging, office, and downwind areas of four commercial composting facilities. The characteristics of airborne fungi, including pathogen/allergen-containing genera, and their corresponding human exposure in different areas of composting facilities were analyzed using high-throughput sequencing and ddPCR. High fungal concentrations and richness were detected in the air of the packaging area. In all four areas, Ascomycota, Basidiomycota, and Mucoromycota were observed to be the primary fungal phyla, with Cladosporium, Alternaria, and Aspergillus as the consistently dominant fungal genera. A large number of endemic airborne fungi were found in the composting and packaging areas, which also shared the most common airborne fungi as well as pathogen/allergen-containing genera. The packaging area contributed substantially to airborne fungi in the office and downwind areas. Area-specific human exposure to broad airborne fungal compositions was revealed, especially regarding the pathogen/allergen-containing genera. Current results provide valuable data for a comprehensive understanding of area-specific airborne fungi in composting facilities and highlight the importance of assessing the inhaled exposure to airborne fungi in evaluating their following health risks.

A systematic review of enteric pathogens and antibiotic resistance genes in outdoor urban aerosols

Aerosol transport of enteric microbiota including fecal pathogens and antimicrobial resistance genes (ARGs) has been documented in a range of settings but remains poorly understood outside indoor environments. We conducted a systematic review of the peer-reviewed literature to summarize evidence on specific enteric microbiota including enteric pathogens and ARGs that have been measured in aerosol samples in urban settings where the risks of outdoor exposure and antibiotic resistance (AR) spread may be highest. Following PRISMA guidelines, we conducted a key word search for articles published within the years 1990-2020 using relevant data sources. Two authors independently conducted the keyword searches of databases and conducted primary and secondary screenings before merging results. To be included, studies contained extractable data on enteric microbes and AR in outdoor aerosols regardless of source confirmation and reported on qualitative, quantitative, or viability data on enteric microbes or AR. Qualitative analyses and metric summaries revealed that enteric microbes and AR have been consistently reported in outdoor aerosols, generally via relative abundance measures, though gaps remain preventing full understanding of the role of the aeromicrobiological pathway in the fate and transport of enteric associated outdoor aerosols. We identified remaining gaps in the evidence base including a need for broad characterization of enteric pathogens in bioaerosols beyond bacterial genera, a need for greater sampling in locations of high enteric disease risk, and a need for quantitative estimation of microbial and nucleic acid densities that may be applied to fate and transport models and in quantitative microbial risk assessment.

Seasonal variation of quantitative microbial risk assessment for three airborne enteric bacteria from wastewater treatment plant emissions

Airborne E. coli, fecal coliform, and Enterococcus are all related to sewage worker's syndrome and therefore used as target enteric bioaerosols about researches in wastewater treatment plants (WWTPs). However, most of the studies are often inadequately carried out because they lack systematic studies reports bioaerosols emission characteristics and health risk assessments for these three enteric bacteria during seasonal variation. Therefore, quantitative microbial risk assessment based on Monte Carlo simulation was utilized in this research to assess the seasonal variations of health risks of the three enteric bioaerosols among exposure populations (academic visitors, field engineers, and office staffs) in a WWTP equipped with rotating-disc and microporous aeration modes. The results show that the concentrations of the three airborne bacteria from the rotating-disc aeration mode were 2-7 times higher than the microporous aeration mode. Field engineers had health risks 1.5 times higher than academic visitors due to higher exposure frequency. Health risks of airborne Enterococcus in summer were up to 3 times higher than those in spring and winter. Similarly, health risks associated to E. coli aerosol exposure were 0.3 times higher in summer compared to spring. In contrast, health risks associated with fecal coliform aerosol were between 2 and 19 times lower in summer compared to spring and winter seasons. Data further suggest that wearing of N95 mask could minimize health risks by 1-2 orders of magnitude. This research shed light on seasonal variation of health risks associated with bioaerosol emission from wastewater utilities.

The changing pattern of bioaerosol characteristics, source and risk under diversity brush aerator speed

Bioaerosols containing pathogens released from wastewater treatment plants (WWTP) may pose potential health risks to workers on-site and residents downwind. In this study, sampling points were set up in the wastewater treatment facility to investigate the generation pattern of bioaerosols in the aeration tank section. High-throughput sequencing was utilized to assay the intestinal bacteria population, while the health risks associated with airborne bacteria were estimated based on average daily dose rates. The contribution of wastewater to bioaerosols was evaluated using the traceability analysis. As the rotational speed increased from 200 rpm to 800 rpm, the concentration of culturable bacteria increased from 397 CFU/m³ to 1611 CFU/m³, the proportion of bacteria attached to particles with an aerodynamic diameter larger than 4.7 µm increased from 30.41% to 48.44%, and the Shannon index of air samples increased from 1.032485 to 1.282065. Microbial composition, sources, and health risks of bioaerosols also changed as the rotational speed increased. The results showed that the predominant bacteria in the air at 200 rpm were Bacillus (78.78%), Paenibacillus (11.77%) and Lysinibacillus (1.40%). When the rotating speed reached 800 rpm, the dominant bacteria became Bacillus (55.50%), Acinetobacter (31.01%), and Paenarthrobacter (13.17%). The contribution of the wastewater to bioaerosols increased from 46.49% to 65.10%, in which surface water was the main source of bioaerosols (34.64% on average). Although the contribution of bottom water was lower than that of surface water, its contribution increased more, from 15.36% to 29.31%. The health risk of bioaerosols was 1.28 × 10^-2 on average, which increased with the increase of rotational speed. At the same exposure concentration, children (2.31 × 10^-2) have a higher exposure risk than adults (7.67 × 10^-3). This study is aimed at exploring the variation law of bioaerosols discharged from WWTP with oxidation ditch process and providing preliminary data for reducing its risk.

Characteristics and Determinants of the Presence of Respiratory Symptoms among Sewage Workers in Malaysia

Background

The purpose of this study was to determine the relationships of PM 2.5 and H₂S exposure with the presence of work-related respiratory symptoms among sewage workers.

Methods

A cross-sectional study was conducted in eleven sewage plants located in the central region of Peninsular Malaysia. One hundred ninety-one sewage workers were assessed using the British Medical Research Council (BMRC) questionnaire. Area air sampling was performed in three different sewage plants to measure the following parameters: physical air quality and concentration of PM 2.5 and H₂S.

Result

Chronic cough (34.0%) was reported as the most common symptom, followed by chronic phlegm (26.2%), shortness of breath (7.9%), and chest tightness (3.7%). There were five significant determinants of the presence of respiratory symptoms among the sewage workers: shift work (AOR 23.50, 95% CI: 1.90–616.52), working at a sludge treatment facility (STF) (AOR 25.46, 95% CI: 2.06–314.29), a longer duration of working years (AOR 1,21, 95% CI: 1.01–1.44), individual cumulative exposure to PM 2.5 (AOR 9.01, 95% CI: 1.98–83.33), and individual cumulative exposure to H₂S (AOR 1.04, 95% CI: 1.01–1.07). The majority of STF and non-STF workers had higher exposure to PM 2.5 and H₂S concentrations in the air than office workers.

Conclusion

Sewage workers working at non-STFs or STFs reported a significantly higher prevalence of work-related respiratory symptoms and exposure to PM 2.5 and H₂S compared with office workers. Exposure-response relationships were also found in sewage workers' cumulative exposure to PM 2.5 and H₂S and the presence of respiratory symptoms.

Characteristics of airborne bacterial communities and antibiotic resistance genes under different air quality levels

Pathogenic bacteria and antibiotic resistance genes (ARGs) in bioaerosols are major threats to human health. In this study, the microbial community structure and ARG distribution characteristics of airborne bacteria in total suspended particulates (TSP) and PM_2.5 were investigated under different air quality levels in Xinxiang, Central China. The results revealed that with the deterioration of air quality, the concentrations of airborne bacteria in both TSP and PM_2.5 decreased; however, the relative amounts of pathogenic bacteria increased. The predominant genera in pathogenic bacteria of Bacillus, Sphingomonas, Corynebacterium, Rhodococcus, and Staphylococcus were identified in both TSP and PM_2.5. Although the airborne bacteria concentrations and absolute abundances of ARGs in TSP were higher than those in PM_2.5 under identical air quality conditions, the bacterial community structure and relative amounts of pathogenic bacteria were similar. In addition, the relationship between environmental factors of ions, metal elements, and meteorological parameters and the community structures of airborne bacteria and pathogenic bacteria were also analyzed. The effects of soluble ions and metal elements on several dominant genera of total bacteria and pathogenic bacteria differed, probably due to the strong tolerance of pathogenic bacteria to harsh atmospheric environments Different subtypes of ARGs showed various distribution characteristics with variations in air quality. The deterioration of air quality can inhibit the dissemination of ARGs, as the minimum values of all ARGs and class 1 integrase intI1 were observed under Severely Polluted conditions. This study provides a comprehensive understanding of the effect of air pollution levels on the airborne bacteria community composition and ARG distribution.

The source and fate of Mycobacterium tuberculosis complex in wastewater and possible routes of transmission

BACKGROUND

The Mycobacterium tuberculosis complex (MTBC) consists of causative agents of both human and animal tuberculosis and is responsible for over 10 million annual infections globally. Infections occur mainly through airborne transmission, however, there are possible indirect transmissions through a faecal-oral route which is poorly reported. This faecal-oral transmission could be through the occurrence of the microbe in environments such as wastewater. This manuscript, therefore, reviews the source and fate of MTBC in the wastewater environment, including the current methods in use and the possible risks of infections.

RESULTS

The reviewed literature indicates that about 20% of patients with pulmonary TB may have extra-pulmonary manifestations such as GITB, resulting in shedding in feaces and urine. This could potentially be the reason for the detection of MTBC in wastewater. MTBC concentrations of up to 5.5 × 105 (±3.9 × 105) copies/L of untreated wastewater have been reported. Studies have indicated that wastewater may provide these bacteria with the required nutrients for their growth and could potentially result in environmental transmission. However, 98.6 (± 2.7) %, removal during wastewater treatment, through physical-chemical decantation (primary treatment) and biofiltration (secondary treatment) has been reported. Despite these reports, several studies observed the presence of MTBC in treated wastewater via both culture-dependent and molecular techniques.

CONCLUSION

The detection of viable MTBC cells in either treated or untreated wastewater, highlights the potential risks of infection for wastewater workers and communities close to these wastewater treatment plants. The generation of aerosols during wastewater treatment could be the main route of transmission. Additionally, direct exposure to the wastewater containing MTBC could potentially contribute to indirect transmissions which may lead to pulmonary or extra-pulmonary infections. This calls for the implementation of risk reduction measures aimed at protecting the exposed populations.