The risk of enteric infections associated with wastewater reuse: the effect of season and degree of storage of wastewater

Microbial Quality of Treated Wastewater and Borehole Water Used for Irrigation in a Semi-Arid Area

The current study investigated the distribution of microbial populations and diversity in treated wastewater used for irrigation at the University of Limpopo Experimental Farm (ULEF), from different stages of post treatment disposal at Mankweng Wastewater Treatment Plant (MWTP) in Limpopo Province, South Africa. The study was arranged in a 4 × 5 factorial experiment, which studied the interactive effects of four collection points and five months of sampling, with borehole water used as a reference point. Water samples were analyzed for bacteria, helminths, and protozoa. All data were transformed and subjected to factorial analysis of variance. The site-time interactions were significant for Salmonella spp. and Ascaris lumbricoides, whereas collection point was significant for all variables. In conclusion, movement and storage of water post treatment at MWTP were able to improve the microbial quality of the treated wastewater disposed for irrigation at ULEF.

Helminth eggs inactivation efficiency by sludge co-composting under arid climates

Primary sludge (PS) from the wastewater treatment plants is constituted of organic matter and other nutrients that could be reused as soil fertilizers. However, primary sludge amendment is hampered due to the presence of pathogens that could be responsible for several infections in various ways depending on the prevalence of the human sources. This study investigates helminth eggs (HE) removal and inactivation efficiency by co-composting. So, PS was mixed with date palm waste as a bulking material at a 1:1 volume ratio. The C/N ratio decreased from 25:1 to 12:1 and temperatures above 50ºC were observed since 33 days. The initial concentration of HE eggs in the PS is 135.9 per 10 g DR. Microscopic examination of the PS, according to the Bailenger method, showed the presence of nematodes and Cestodes represented by: Ascaris lombricoïde, Ancylostomes duodenale, Trichuris trichiura, Capilaria spp, Hymenolepis nana, Taenia saginata, and Ascaris lombricoïde. After 60 days of co-composting, the charge of parasites was reduced to 18 eggs per 10 g per DR. The viability of ascaris eggs was examined using a light microscope and the percentage of the embryonated eggs was determined. No viable eggs were observed in the final compost. The result corroborates the WHO guidelines for the application of the composted sewage sludge safely for agriculture purposes.

Epidemiological Evidence and Health Risks Associated With Agricultural Reuse of Partially Treated and Untreated Wastewater: A Review

The use of partially treated and untreated wastewater for irrigation is beneficial in agriculture but may be associated with human health risks. Reports from different locations globally have linked microbial outbreaks with agricultural reuse of wastewater. This article reviews the epidemiological evidence and health risks associated with this practice, aiming toward evidence-based conclusions. Exposure pathways that were addressed in this review included those relevant to agricultural workers and their families, consumers of crops, and residents close to areas irrigated with wastewater (partially treated or untreated). A meta-analysis gave an overall odds ratio of 1.65 (95% CI: 1.31, 2.06) for diarrheal disease and 5.49 (95% CI: 2.49, 12.10) for helminth infections for exposed agricultural workers and family members. The risks were higher among children and immunocompromised individuals than in immunocompetent adults. Predominantly skin and intestinal infections were prevalent among individuals infected mainly via occupational exposure and ingestion. Food-borne outbreaks as a result of crops (fruits and vegetables) irrigated with partially or untreated wastewater have been widely reported. Contamination of crops with enteric viruses, fecal coliforms, and bacterial pathogens, parasites including soil-transmitted helminthes (STHs), as well as occurrence of antibiotic residues and antibiotic resistance genes (ARGs) have also been evidenced. The antibiotic residues and ARGs may get internalized in crops along with pathogens and may select for antibiotic resistance, exert ecotoxicity, and lead to bioaccumulation in aquatic organisms with high risk quotient (RQ). Appropriate mitigation lies in adhering to existing guidelines such as the World Health Organization wastewater reuse guidelines and to Sanitation Safety Plans (SSPs). Additionally, improvement in hygiene practices will also provide measures against adverse health impacts.

Soil-transmitted helminth infections associated with wastewater and sludge reuse: a review of current evidence

OBJECTIVE

To review current evidence on infections related to the concentration of soil-transmitted helminth (STH) eggs in wastewater, sludge and vegetables irrigated with wastewater or grown on sludge-amended soils.

METHOD

Search of Web of Science, Science Direct, PubMed and Google Scholar databases for publications reporting on STH egg concentration in wastewater, sludge and vegetables and for epidemiological studies on wastewater/sludge reuse and STH infections.

RESULTS

STH egg concentrations were variable but high in wastewater and sludge especially in developing countries. They ranged from 6 to 16 000 eggs/L in wastewater and from 0 to 23 000 eggs/g in sludge and far exceed limits set in the WHO guideline for wastewater/sludge reuse. Numbers of STH eggs on vegetables ranged from 0 to 100 eggs/g. The concentration of STH eggs in wastewater, sludge and vegetables therefore relates to risks of infection through different exposure routes.

CONCLUSION

Epidemiological evidence reveals an increased prevalence of STH infections associated with direct exposure to wastewater or sludge (farmers) and consumption of vegetables grown on soil treated with it. This calls for increased efforts to reduce the adverse health impact of wastewater and sludge reuse in line with the WHO multi-barrier approach.

Health risks from exposure to untreated wastewater used for irrigation in the Mezquital Valley, Mexico: A 25-year update

Wastewater reuse for agriculture is common worldwide; wastewater treatment, however, is rare in many countries, leading to high potential for exposure to harmful pathogens. Mexico City, one of the largest producers of untreated wastewater for agricultural use worldwide, was the site of key epidemiologic studies conducted in the 1990s. We both reviewed the literature on and conducted a cross-sectional study of diarrheal risk and wastewater contamination to provide an updated assessment of health risks and to inform an upcoming update of the 2006 WHO guidelines on wastewater reuse. We surveyed communities in the Mezquital Valley that use wastewater for irrigation and communities that use well water to compare the prevalence of self-reported diarrheal disease in children under five years old. Wastewater, well water, household environmental samples, and stool samples were collected and analyzed. Communities exposed to wastewater had a higher one-week prevalence of diarrhea (10%) compared to unexposed communities (5%). This association remained in an adjusted modified Poisson regression model (PR = 2.31, 95% CI 1.00, 5.31), but not when limited to households engaged in agriculture. Water quality indicators document differences between irrigation water from the two community groups. These results are in agreement with 25 population studies identified by our review that were conducted since or not included in the 2006 WHO guidelines and show consistent negative impacts of wastewater exposure on health. While overall diarrheal prevalence has declined when compared to studies conducted over 25 years ago in the same region, the association of diarrheal disease and wastewater exposure has remained and possibly increased. With rising urbanization worldwide, attention to these risks and wastewater treatment is becoming increasingly important.

Detection and quantification of soil-transmitted helminths in environmental samples: A review of current state-of-the-art and future perspectives

It is estimated that over a billion people are infected with soil-transmitted helminths (STHs) globally with majority occurring in tropical and subtropical regions of the world. The roundworm (Ascaris lumbricoides), whipworm (Trichuris trichiura), and hookworms (Ancylostoma duodenale and Necator americanus) are the main species infecting people. These infections are mostly gained through exposure to faecally contaminated water, soil or contaminated food and with an increase in the risk of infections due to wastewater and sludge reuse in agriculture. Different methods have been developed for the detection and quantification of STHs eggs in environmental samples. However, there is a lack of a universally accepted technique which creates a challenge for comparative assessments of helminths egg concentrations both in different samples matrices as well as between locations. This review presents a comparison of reported methodologies for the detection of STHs eggs, an assessment of the relative performance of available detection methods and a discussion of new emerging techniques that could be applied for detection and quantification. It is based on a literature search using PubMed and Science Direct considering all geographical locations. Original research articles were selected based on their methodology and results sections. Methods reported in these articles were grouped into conventional, molecular and emerging techniques, the main steps in each method were then compared and discussed. The inclusion of a dissociation step aimed at detaching helminth eggs from particulate matter was found to improve the recovery of eggs. Additionally the selection and application of flotation solutions that take into account the relative densities of the eggs of different species of STHs also results in higher egg recovery. Generally the use of conventional methods was shown to be laborious and time consuming and prone to human error. The alternate use of nucleic acid-based techniques has improved the sensitivity of detection and made species specific identification possible. However, these nucleic acid based methods are expensive and less suitable in regions with limited resources and skill. The loop mediated isothermal amplification method shows promise for application in these settings due to its simplicity and use of basic equipment. In addition, the development of imaging soft-ware for the detection and quantification of STHs shows promise to further reduce human error associated with the analysis of environmental samples. It may be concluded that there is a need to comparatively assess the performance of different methods to determine their applicability in different settings as well as for use with different sample matrices (wastewater, sludge, compost, soil, vegetables etc.).

A Review of Health Risks and Pathways for Exposure to Wastewater Use in Agriculture

BACKGROUND

Wastewater is increasingly being used in the agricultural sector to cope with the depletion of freshwater resources as well as water stress linked to changing climate conditions. As wastewater irrigation expands, research focusing on the human health risks is critical because exposure to a range of contaminants must be weighed with the benefits to food security, nutrition and livelihoods.

OBJECTIVES

The goal of this paper was to review research examining health risks and exposure pathways associated with wastewater irrigation to identify research trends and gaps.

METHODS

We conducted a review of the literature and identified a total of 126 studies published from 1995 to 2013. Findings were summarized based on several themes including types of exposure pathways, wastewater contaminants, methodological approaches and the geographical distribution of research.

RESULTS

Only 23 studies used epidemiological methods, while most research applied alternative methods to estimate risk, such as quantitative risk assessment models or comparisons of crop contamination to established guidelines for wastewater reuse. A geographic breakdown demonstrated a focus on microbiological contaminants in specific regions such as sub-Saharan Africa and Southeast Asia, despite growing chemical risks associated with rapid urbanization and industrialization that may change the types and distribution of wastewater contaminants.

CONCLUSIONS

To provide a more comprehensive understanding of the health risks of wastewater use in agriculture, future research should consider multiple exposure routes, long-term health implications, and increase the range of contaminants studied, particularly in regions heavily dependent on wastewater irrigation.

CITATION

Dickin SK, Schuster-Wallace CJ, Qadir M, Pizzacalla K. 2016. A review of health risks and pathways for exposure to wastewater use in agriculture. Environ Health Perspect 124:900-909; http://dx.doi.org/10.1289/ehp.1509995.

Identification and quantification of pathogenic helminth eggs using a digital image system

A system was developed to identify and quantify up to seven species of helminth eggs (Ascaris lumbricoides -fertile and unfertile eggs-, Trichuris trichiura, Toxocara canis, Taenia saginata, Hymenolepis nana, Hymenolepis diminuta, and Schistosoma mansoni) in wastewater using different image processing tools and pattern recognition algorithms. The system was developed in three stages. Version one was used to explore the viability of the concept of identifying helminth eggs through an image processing system, while versions 2 and 3 were used to improve its efficiency. The system development was based on the analysis of different properties of helminth eggs in order to discriminate them from other objects in samples processed using the conventional United States Environmental Protection Agency (US EPA) technique to quantify helminth eggs. The system was tested, in its three stages, considering two parameters: specificity (capacity to discriminate between species of helminth eggs and other objects) and sensitivity (capacity to correctly classify and identify the different species of helminth eggs). The final version showed a specificity of 99% while the sensitivity varied between 80 and 90%, depending on the total suspended solids content of the wastewater samples. To achieve such values in samples with total suspended solids (TSS) above 150 mg/L, it is recommended to dilute the concentrated sediment just before taking the images under the microscope. The system allows the helminth eggs most commonly found in wastewater to be reliably and uniformly detected and quantified. In addition, it provides the total number of eggs as well as the individual number by species, and for Ascaris lumbricoides it differentiates whether or not the egg is fertile. The system only requires basically trained technicians to prepare the samples, as for visual identification there is no need for highly trained personnel. The time required to analyze each image is less than a minute. This system could be used in central analytical laboratories providing a remote analysis service.

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The system identifies and quantifies seven species of helminth eggs.

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The system shows a specificity of 99% and a sensitivity between 80 and 90%.

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The time required to analyze each image is less than a minute.

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The system reduces the need for highly trained personnel for the identification of helminth eggs.

Presence of helminth eggs in domestic wastewater and its removal at low temperature UASB reactors in Peruvian highlands

This work studied the anaerobic sludge filtration capacity for pathogens reduction in a 29 L and 1.65 m height lab-scale UASB reactor treating domestic wastewater at low temperatures in the city of Puno (Peru). The anaerobic sludge filtration capacity was performed applying upflow velocities of 0.12, 0.14, 0.16, 0.20, 0.27 and 0.41 m/h. Results show that the HE removal varied between 89 and 95% and the most common specie was Ascaris lumbricoides. Faecal coliform and Escherichia coli removal varied in the range of 0.9-2.1 and 0.8-1.6 log10 respectively. Likely related to the low operational temperatures, the total COD removal varied between 37 and 62%. The best performance in terms of removal of HE, total COD and turbidity was obtained at the lowest upflow velocity of 0.12 m/h. In order to meet WHO standards for water reuse a post-treatment unit will be required to polish the effluent.

Diarrhoeal diseases among adult population in an agricultural community Hanam province, Vietnam, with high wastewater and excreta re-use

BACKGROUND

Despite the potential health risks of wastewater and excreta use as fertiliser in agriculture, it is still widespread in Vietnam. However, the importance of diarrheal risk in adults' associated with the combined exposures to both excreta and wastewater use in agriculture is largely unknown. This study was carried out to determine diarrhoeal incidence and associated risk factors among the adult population exposed to wastewater and excreta used in agriculture in Hanam province, Vietnam.

METHODS

An open cohort of 867 adults, aged 16-65 years, was followed weekly for 12 months to determine the incidence of diarrhoea. A nested case-control study was used to assess the risk factors of diarrhoeal episodes. Two hundred and thirty-two pairs of cases and controls were identified and exposure information related to wastewater, human and animal excreta, personal hygiene practices, and food and water consumption was collected.

RESULTS

The incidence rate of reported diarrhoea was 0.28 episodes per person-years at risk. The risk factors for diarrhoeal diseases included direct contact with the Nhue River water (odds ratio [OR] = 2.4, attributable fraction [AF] 27%), local pond water (OR = 2.3, AF 14%), composting of human excreta for a duration less than 3 months (OR = 2.4, AF 51%), handling human excreta in field work (OR = 5.4, AF 7%), handling animal excreta in field work (OR = 3.3, AF 36%), lack of protective measures while working (OR = 6.9, AF 78%), never or rarely washing hands with soap (OR = 3.3, AF 51%), use of rainwater for drinking (OR = 5.4, AF 77%) and eating raw vegetables the day before (OR = 2.4, AF 12%).

CONCLUSIONS

Our study shows that professional exposure to wastewater and excreta during agricultural activities are significantly contributing to the risk of diarrhoea in adults. The highest attributable fractions were obtained for direct contact with Nhue River and local ponds, handling practices of human and animal excreta as fertilisers, lack of protective measures while working and poor personal hygiene practices, and unsafe food and water consumption were associated with the risk of diarrhoeal episodes in adults. Improve personal hygiene practices and use of relevant treated wastewater and excreta as the public health measures to reduce these exposures will be most effective and are urgently warranted.

Influence of wastewater application and fertilizer use on growth, photosynthesis, nutrient homeostatis, yield and heavy metal accumulation in okra (Abelmoschus esculentus L. Moench)

The scarceness of freshwater assets is a serious problem in semi-arid zones and marginal quality water is increasingly being used in agriculture. This study aimed at evaluating the physico-chemical and biological risks on irrigated soils of treated wastewater, the nutrient supply and the effect on okra plant. A pot experiment based on completely randomized block design was conducted with Treated Wastewater (TW) and inorganic fertilizers to observe a comparative effect on biochemical characters using Okra var. Nidhi. The physico-chemical analysis of the TW showed that it was rich in total suspended and dissolved solids with large amount of BOD and COD. The higher amount of Cl-, Ca++, Mg++ and K+ were also present in the effluent. The heavy metal (Cd, Cr, Ni and Pb) content in TW is comparatively more than groundwater (GW). The values of these heavy metals were slightly higher in the soil irrigated with TW. The effluent severely affects crop plants and soil properties when used for irrigation. The growth parameters, photosynthetic characteristics, chlorophyll content, yield and nutrient homeostatis were analyzed during different growth periods in all treatments. All the parameters were found to increase due to wastewater application. Among the fertilizer treatments, N120 proved optimum, N90 deficient and N150 proved as luxury dose. The seeds accumulated Cd and Ni but their level was under permissible limits. Thus, it may be concluded that wastewater may be used profitably for the cultivation of okra.

Occupational exposure to Staphylococcus aureus and Enterococcus spp. among spray irrigation workers using reclaimed water

As reclaimed water use expands, it is important to evaluate potential occupational health risks from exposure to this alternative water source. We compared odds of colonization with methicillin-resistant Staphylococcus aureus (MRSA), methicillin-susceptible S. aureus (MSSA), vancomycin-resistant enterococci (VRE), and vancomycin-susceptible enterococci (VSE) between spray irrigation workers using reclaimed water and office worker controls. Nasal and dermal swabs from 19 spray irrigation workers and 24 office worker controls were collected and analyzed for MRSA, MSSA, VRE, and VSE. Isolates were confirmed using standard biochemical tests and polymerase chain reaction assays. Antimicrobial susceptibility testing was performed by Sensititre^® microbroth dilution. Data were analyzed by two-sample proportion, chi-square, Fisher’s exact tests, and logistic regression. No MRSA or VRE were detected in any samples. MSSA was detected in 26% and 29% of spray irrigators and controls, respectively. VSE was detected in 11% and 0% of spray irrigation workers and controls, respectively. The adjusted odds of MSSA, multidrug-resistant MSSA, and either MSSA or VSE colonization were greater among spray irrigation workers, however results were not statistically significant. Future studies with larger sample sizes are needed to further evaluate this relationship.

Retention of Escherichia coli, Giardia lamblia cysts and Ascaris lumbricoides eggs in agricultural soils irrigated by untreated wastewater

In central Mexico, agricultural irrigation reusing Mexico City's municipal wastewater has been occurring for the last century, resulting in the recharge of the local aquifer. However, groundwater of this zone is of good quality, indicating that the microorganisms contained in wastewater are retained by soil after infiltration. This study aims to assess the capacity of three agricultural soils to retain three microorganisms frequently found in wastewater, namely Escherichia coli (E. coli), Giardia lamblia (G. lamblia) cysts and Ascaris lumbricoides (A. lumbricoides) eggs, through batch sorption-desorption assays. The tested soils were: an organic-clayey soil (C-OM), a clayey soil (C-om) and a sandy soil (c-om). For the three soils, sorption equilibrium of E. coli was reached before 1 h, while for G. lamblia cysts and A. lumbricoides eggs, sorption equilibrium took 2.5 h. Sorption of E. coli was better described by the Freundlich model than by the Langmuir one. Higher retention of bacteria was observed in the C-om soil (KF = 4340) than in the C-OM and c-om ones (KF = 1821 and 0.01, respectively). Regarding G. lamblia cysts and A. lumbricoides eggs, data could not be fitted to the tested sorption models. For both organisms, retention was lower in the C-OM soil than in the C-om and c-om ones. In the desorption tests, a sudden liberation of E. coli from soils was observed, probably due to bacterial re-growth. Desorption of G. lamblia was higher in the sandy soil than in the clayey ones; desorption was not increased when a surfactant was applied to the soil, suggesting that hydrophobic interactions are not necessarily responsible for retention of the cysts onto the tested soils. For A. lumbricoides eggs, desorption using NaOCl solution suggested that retention was caused by interactions between the mineral fraction of the soil and the external walls of eggs. This study showed that the three target microorganisms are retained by the tested soils and that mineral domain of soil has an important role in such retention.

Ascaris lumbricoides and Trichuris trichiura infections associated with wastewater and human excreta use in agriculture in Vietnam

BACKGROUND

We assessed the risk of helminth infections in association with the use of wastewater and excreta in agriculture in Hanam province, northern Vietnam. In two cross-sectional surveys, we obtained samples from 1,425 individuals from 453 randomly selected households. Kato-Katz thick smear and formalin-ether concentration techniques were used for helminth diagnosis in two stool samples per person. Socio-demographic and water, sanitation and hygiene related characteristics, including exposure to human and animal excreta and household wastewater management, were assessed with a questionnaire.

RESULTS

Overall 47% of study participants were infected with any helminth (Ascaris lumbricoides 24%, Trichuris trichiura 40% and hookworm 2%). Infections with intestinal protozoa were rare (i.e. Entamoeba histolytica 6%, Entamoeba coli 2%, Giardia lamblia 2%, Cryptosporidium parvum 5% and Cyclospora cayetanensis 1%). People having close contact with polluted Nhue River water had a higher risk of helminth infections (odds ratio [OR]=1.5, 95% confidence interval [CI] 1.1-2.2) and A. lumbricoides (OR=2.1, 95% CI 1.4-3.2), compared with those without contact. The use of human excreta for application in the field had an increased risk for a T. trichiura infection (OR=1.5, 95% CI 1.0-2.3). In contrast, tap water use in households was a protective factor against any helminth infection (i.e. T. trichiura OR=0.6, 95% CI 0.4-0.9). Prevalences increased with age and males had generally lower prevalences (OR=0.8, 95% CI 0.6-1.0), participants performing agricultural (OR=1.5, 95% CI 1.1-2.1) and having a low educational level (OR=1.7, 95% CI 1.2-2.4) were significantly associated with helminth infections. None of the factors related to household's sanitary condition, type of latrine, household's SES, use of animal excreta, and personal hygiene practices were statistically significant associated with helminth infection.

CONCLUSIONS

Our study suggests that in agricultural settings, direct contact with water from Nhue River and the use of human excreta as fertiliser in the fields are important risk factors for helminth infection. Daily use of clean water is likely to reduce the risk of worm infection. Deworming policies and national programs should give more attention to these agricultural at risk populations.

Helminth infections among people using wastewater and human excreta in peri-urban agriculture and aquaculture in Hanoi, Vietnam

OBJECTIVE

To assess the prevalence of helminth infections and their associated risks in a community using both wastewater and human excreta in agriculture and aquaculture.

METHODS

A cross-sectional study was conducted in a peri-urban area in Hanoi, Vietnam. Data on the demography, socioeconomics and sanitation were collected from a survey of 400 agricultural households. Parasitological examination for the eggs of Ascaris sp., Trichuris sp. and hookworm was performed on single stool specimens obtained from study household members' 15-70 years and 0-72 months of age.

RESULTS

Of 807 stool samples collected from 620 adults and 187 children, 39% were infected with helminths. The prevalence of infections with Ascaris sp., Trichuris sp. and hookworm was 21.6%, 9.8% and 21.8%, respectively. Univariate and multivariate analyses showed that being an adult, female gender, living in a household without a latrine, excreta composted for less than 1 month and use of fresh human excreta were significantly associated with co-infection with all three helminths. Being an adult was an independent determinant for infections with individual helminths. The absence of a latrine and use of stored urine for irrigation were associated with an increased risk of Ascaris infection. Risk factors for Trichuris infection were inadequately composted excreta and year-round wastewater contact; risk factors for hookworm infection were female gender, household without a latrine and use of fresh human excreta.

CONCLUSION

Wastewater exposure did not pose a major risk for helminth infection in this community. Instead, lack of sanitation facilities and use of fresh or inadequately composted human excreta in agriculture were important risk factors.

Diarrhoeagenic Escherichia coli and other causes of childhood diarrhoea: a case-control study in children living in a wastewater-use area in Hanoi, Vietnam

A case-control study was conducted to identify the aetiology of diarrhoeal diseases in pre-school children in a suburban area of Hanoi where the use of untreated wastewater in agriculture and aquaculture is a common practice. Stool specimens and clinical information were collected from 111 pairs of children with diarrhoea and healthy controls. A total of 73 cases (66 %) and 41 controls (36 %) had an enteric pathogen. The pathogens most often associated with diarrhoea were rotavirus (17 % of cases) and Entamoeba histolytica (15 %), followed by Shigella (5 %). Diarrhoeagenic Escherichia coli (DEC) was found in 23 % of both patients and controls. Characterization of DEC by serotyping, antimicrobial susceptibility test and PFGE showed that DEC represented by different pathotypes belonged to various serotypes. Except for three enterotoxigenic E. coli strains, typing by PFGE revealed no correlation between pathotype and serotype of DEC strains. This suggests a high prevalence of a variety of DEC subtypes in this area. For this particular region, vaccine development strategies targeting rotavirus and Shigella are likely to be of public health benefit, whereas the role of DEC and preventive measures need to be further elaborated.

Estimating the microbial risk of E. coli in reclaimed wastewater irrigation on paddy field

Microbial risk was quantified to assess human health risk as a result of exposure to E. coli in reclaimed wastewater irrigation. Monitoring data on E. coli were collected from pond water in paddy rice plots during the growing season. Five treatments were used and each was triplicated to evaluate the changes in E. coli concentrations in experiments performed in 2003 and 2004. The Beta-Poisson model was used to estimate the microbial risk of pathogen ingestion among farmers and neighboring children. A Monte Carlo simulation (10,000 trials) was conducted to estimate the risk associated with uncertainty. In this study, risk values ranged from 10(-4) to 10(-8). UV-disinfected irrigation water showed a lower risk value than others, and its level was within the range of the actual paddy rice field with surface water. Agricultural activity was thought to be safer after 1-2 days, when the paddy field was irrigated with reclaimed wastewater. Also, children were found to have a greater risk of infection with E. coli. This paper should be viewed as a first step in the application of quantitative microbial risk assessment of wastewater reuse in paddy rice culture.

Incidence of and risk factors for skin ailments among farmers working with wastewater-fed agriculture in Hanoi, Vietnam

The use of wastewater in agriculture and aquaculture is widespread in many developing countries, but limited information is available about the health hazards associated with this practice. To study the occurrence of skin ailments in relation to wastewater use in agriculture and aquaculture, an open cohort of 636 adults aged 15-70 years living in a wastewater-irrigated area in Hanoi, Vietnam, was followed by weekly visits for 12 months. A nested case-control study with 108 case/control pairs was conducted to investigate possible risk factors for skin ailments. The incidence rate of skin ailments was 32.5 episodes per 100 person-years at risk. Independent determinants of skin ailments included wastewater contact in the past 7 days (odds ratio (OR=2.74, 95% confidence interval (CI) 1.29-5.82), female gender (OR=2.48, 95% CI 1.06-5.76), fish farming-related jobs (OR=3.47, 95% CI 1.27-9.50) and lack of protective measures (OR=2.24, 95% CI 1.21-4.12). It is likely that effective promotion of personal protective measures and improved hygiene practices amongst wastewater users will mitigate the risk of dermatological problems and will thus be of benefit to public health in communities that rely on the use of wastewater for agricultural and aquacultural productions.

[Prevalence of Giardia intestinalis in a farming population using sewage water in agriculture, Settat, Morocco]

OBJECTIVE

This investigation was undertaken to assess the risk linked to the use of raw sewage waters in agriculture, and the prevalence of Giardia intestinalis.

DESIGN

The survey was made on 214 individuals, average age 28.6+/-19.4 years, belonging to two douars using raw sewage waters in agriculture, and 119 individuals, age 31.8+/-19.5 years, belonging to a control douar not using raw sewage waters. These three douars are located in around the city of Settat, in Morocco. Every consenting individual was given a complete clinical examination and 3 stools samples were collected in 3 consecutive days.

RESULTS

The prevalence of G. intestinalis in the exposed population was 11.7% compared to 2.5% in the control population. The relative risk was 4.6. This difference is statistically significant. The most concerned individuals were essentially children between 3 and 14 years of age. Close contact was an important factor of infection in the exposed population, with a higher prevalence in the case of high promiscuity index. In the exposed population, more than 50% of the cases were familial ones. Giardiasis causes a trophic state, essentially in children.

CONCLUSION

The use of the raw sewage waters in agriculture is responsible for an increased risk of giardiasis. Some preventive measures are mandatory, including hygiene education and an adequate treatment of sewage waters.

Survival of total coliforms in lawn irrigated with secondary wastewater and chlorinated effluent in the Mediterranean region

Pregrown, two-month-old lawn was layered in 12 large square pots with an area of 0.25 m2 each, filled with a mixture of topsoil, peat, and sand. In late July, in the heart of the Mediterranean summer, the pots were divided into two groups, with six pots per group. On four different occasions, the pots in each group were sprinkled (surface irrigation) with 2 L of either secondary-treated wastewater (STW, group A) or chlorinated effluent (CHE, group B). Wastewater application always took place at 0700 hours. Samples of the surface soil and grass from each pot were collected at the following times: before irrigation, immediately after irrigation, two hours later (0900 hours), and four hours later (1100 hours). In the samples collected, the number of total coliforms per gram was measured using standard microbiological analyses. Temperature and sunlight intensity were also monitored. There was an increase in the coliforms population in soil and grass samples of both groups immediately after the wastewater application. In group A, the mean number of coliforms recorded in the soil samples reached mean values higher than 5000 cfu/g compared to 312 cfu/g recorded before application. The increase in group B was smaller but still significant. Two hours later, the number of coliforms was reduced substantially in all samples (e.g., group A, soil samples 477 cfu/g). Coliform inactivation is thought to result from the effect of temperature and mainly sunlight. However, four hours after application (1100 hours), there was a noticeable increase in the coliform number again, in all sample categories of both groups. Coliform reactivation could be a result of shadowing effect resulting from the thick foliage of the grass, where the microorganisms were protected by the sunlight radiation and regrowth in a friendly environment (especially of the soil) where moisture and nutrients were present. This, in addition to the fact that coliforms seemed to retain a sizable population between applications, results in three conclusions: (1) coliforms can survive in grass and soil for a substantial period of time, recovering from the destructive effect of chlorination, (2) use of STW, even during the Mediterranean summer, could result in a substantial "contamination" of lawns, without any proof that sun and temperature can reduce the coliform number, and (3) intense sunlight (up to 68 000 lux) was far more effective in coliform suppression than elevated temperature (up to 38 degrees C).

High risk of hookworm infection among wastewater farmers in Pakistan

The health risks of wastewater use in agriculture were investigated in the city of Faisalabad, Pakistan, by means of a cross-sectional study. The study showed an increased risk of intestinal nematode infection and hookworm infection, in particular, in wastewater farmers (OR = 31.4, 95% CI 4.1-243) and their children (OR = 5.7, 95% CI 2.1-16) when compared with farming households using regular (non-wastewater) irrigation water. Textile labourers living in the same village as the wastewater farmers showed a lower risk of hookworm infection than wastewater farmers but an increased risk compared with farming households using regular irrigation water. Many urban and peri-urban farmers make a living by using untreated wastewater in the production of fresh produce for the urban market. Banning the use of untreated wastewater would deprive these farmers of their livelihood and affect food supply for the urban population. If treatment of wastewater is not a feasible option, the promotion of footwear and improved hygiene, the construction of toilets, in combination with regular anthelminthic treatment, would be suitable alternatives to safeguard the health of wastewater farmers and their children.

Prevalence and risk factors for protozoan and nematode infections among children in an Ecuadorian highland community

In order to create a parasite prevention program for Santa Ana, Ecuador, we worked with local physicians to identify the prevalence and risk factors for intestinal parasitic infection among children. Two hundred households were randomly selected and asked to submit three stool samples from a selected child. Information from direct observation and questionnaires was used to determine environmental and behavioral risk factors for parasitic infection. Prevalence of any parasitic infection was 65.6% of the 189 children who submitted fecal samples. Parasitic infections included Entamoeba histolytica/E. dispar (46.6%), Giardia lamblia (18.5%) and Ascaris lumbricoides (20.1%). In a multivariate logistic model, risk factors (P<0.05) for E. histolytica/E. dispar included >1 month since antiparasitic treatment, not adding chlorine to drinking water, children not washing their hands before eating, and having a fewer number of electrical appliances in the home. The risk factor identified for G. lamblia was children not washing their hands before eating. Risk factors for A. lumbricoides included >6 months since antiparasitic treatment and having a fewer number of electrical appliances in the home. This study may have implications for other communities throughout the developing world.

The health effects of wastewater on the prevalence of ascariasis among the children of the discharge zone of El Jadida, Morocco

Proximity to wastewater constitutes an infection hazard by ascariasis. This is supported by the results of an epidemiologic study of a group of children living near an area of wastewater effluents. The subjects of this study were schoolchildren from Sidi Daoui, a neighborhood located in the area of the main effluent of the city of El Jadida, Morocco. For a comparative approach, a control group was selected from Sidi Moussa, a neighborhood far from the discharge area. The incidence of ascariasis was 18.1% in the study group (Sidi Daoui) and 1% in the control group (Sidi Moussa). It was found that 71% of the exposed children were suffering from acute parasitic infections. The risk attributable to wastewater in transmitting ascariasis to examined children in Sidi Daoui was about 17%. Boys, particularly those aged 7 - 10, appeared to be the most vulnerable to contracting ascariasis. This study demonstrates the relationship between ascariasis in children and their proximity to wastewater effluents.

Prevalence of Giardiasis due to wastewater reuse for agriculture in the suburbs of Asmara City, Eritrea

A study was undertaken to assess the health impact of utilization of the raw domestic sewage for vegetable cultivation in the suburbs of the capital city of Asmara, Eritrea. Standard techniques were adopted for the analysis of the samples. Results showed heavy contamination of vegetables by faecal coliforms as well as with Giardia cysts. Stool samples of 75 farmers who were occupationally exposed revealed that 45% of them were harbouring giardia cysts. The dietary intake of raw salads (lettuce, cabbage) grown on the raw sewage appear to be a causative factor of Giardiasis in the farming community as well as in the town of Tsadachristian located on the suburbs of the capital city of Asmara. The hospital data of the affected town is compared with other towns of Eritrea. The result indicates agriculture reuse of untreated wastewater is a major cause for the increase in Giardasis.