Health effects of beach water pollution in Hong Kong

Persistence of sewage-associated genetic markers in advanced and conventional treated recycled water: implications for microbial source tracking in surface waters

Sewage contamination of environmental waters is increasingly assessed by measuring DNA from sewage-associated microorganisms in microbial source tracking (MST) approaches. However, DNA can persist through wastewater treatment and reach surface waters when treated sewage/recycled water is discharged, which may falsely indicate pollution from untreated sewage. Recycled water discharged from an advanced wastewater treatment (AWT) facility into a Florida stream elevated the sewage-associated HF183 marker 1,000-fold, with a minimal increase in cultured Escherichia coli. The persistence of sewage-associated microorganisms was compared by qPCR in untreated sewage and recycled water from conventional wastewater treatment (CWT) and AWT facilities. E. coli (EC23S857) and sewage-associated markers HF183, H8, and viral crAssphage CPQ_056 were always detected in untreated sewage (6.5-8.7 log10 GC/100 mL). Multivariate analysis found a significantly greater reduction of microbial variables via AWT vs CWT. Bacterial markers decayed ~4-5 log10 through CWT, but CPQ_056 was ~100-fold more persistent. In AWT facilities, the log10 reduction of all variables was ~5. In recycled water, bacterial marker concentrations were significantly correlated (P ≤ 0.0136; tau ≥ 0.44); however, CPQ_056 was not correlated with any marker, suggesting varying drivers of decay. Concentrations of cultured E. coli carrying the H8 marker (EcH8) in untreated sewage were 5.24-6.02 log10 CFU/100 mL, while no E. coli was isolated from recycled water. HF183 and culturable EcH8 were also correlated in contaminated surface waters (odds ratio β1 = 1.701). Culturable EcH8 has a strong potential to differentiate positive MST marker signals arising from treated (e.g., recycled water) and untreated sewage discharged into environmental waters.

IMPORTANCE

Genes in sewage-associated microorganisms are widely accepted indicators of sewage pollution in environmental waters. However, DNA persists through wastewater treatment and can reach surface waters when recycled water is discharged, potentially causing false-positive indications of sewage contamination. Previous studies have found that bacterial and viral sewage-associated genes persist through wastewater treatment; however, these studies did not compare different facilities or identify a solution to distinguish sewage from recycled water. In this study, we demonstrated the persistence of bacterial marker genes and the greater persistence of a viral marker gene (CPQ_056 of crAssphage) through varying wastewater treatment facilities. We also aim to provide a tool to confirm sewage contamination in surface waters with recycled water inputs. This work showed that the level of wastewater treatment affects the removal of microorganisms, particularly viruses, and expands our ability to identify sewage in surface waters.

The Association of Helicobacter pylori Biofilm with Enterovirus 71 Prolongs Viral Viability and Survival

The transition time during which a virus leaves its host and infects the next susceptible host is critical for virus survival. Enterovirus 71 (EV71) is stable in aqueous environments, but its molecular interactions with bacteria and their biofilms are not well-established. Helicobacter pylori is a highly successful gut bacterial pathogen, with its capacity to form biofilms being linked to its transmission. Given that both are gut-associated microbes, we hypothesized that biofilms formed by H. pylori may play a significant role in the survival of EV71 in the external environment. In this study, we examine the interactions of EV71 with the preformed biofilm of H. pylori to mimic its natural state in the environment. Immunofluorescence confocal microscopy and scanning electron microscopy revealed that EV71 particles persisted for up to 10 days when incubated with the H. pylori biofilm. Furthermore, the presence of the H. pylori biofilm significantly augmented viral viability, as verified through virus plaque assays. Interestingly, the viability of EV71 was dependent on the quantity of H. pylori biofilm formation. Thus, two H. pylori strains able to generate large amounts of biofilm could facilitate EV71 viability for up to 17 days, whereas two other H. pylori strains that produced moderate or low quantities of biofilm could not prolong virus viability. It is interesting that biofilm contains N-acetyl-glucosamine and glycosaminoglycan, and that EV71 has binding affinity to cell-surface heparan sulfate glycosaminoglycan, which acts as an EV71 attachment receptor. The synergistic ability of H. pylori biofilm to promote EV71 viability for extended periods implies that H. pylori biofilm may serve as an additional pathway of EV71 transmission.

Land use as a critical determinant of faecal and antimicrobial resistance gene pollution in riverine systems

The WHO recognises antimicrobial resistance (AMR) as a global health threat. The environment can act as a reservoir, facilitating the exchange and the physical movement of resistance. Aquatic environments are at particular risk of pollution, with large rivers subject to pollution from nearby human, industrial or agricultural activities. The land uses associated with these activities can influence the type of pollution. One type of pollution and a likely contributor to AMR pollution that lowers water quality is faecal pollution. Both pose an acute health risk and could have implications for resistance circulating in communities. The effects of land use are typically studied using physiochemical parameters or in isolation of one another. However, this study aimed to investigate the impact of different land uses on riverine systems. We explored whether differences in sources of faecal contamination are reflected in AMR gene concentrations across agricultural and urban areas. Water quality from three rivers impacted by different land uses was assessed over one year by quantifying faecal indicator bacteria (FIB), microbial source tracking markers (MST) and AMR genes. In addition, a multiparametric analysis of AMR gene pollution was carried out to understand whether agricultural and urban areas are similarly impacted. Faecal indicators varied greatly, with the highest levels of FIB and the human MST marker observed in urban regions. In addition, these faecal markers correlated with AMR genes. Similarly, significant correlations between the ruminant MST marker and AMR gene levels in agriculture areas were observed. Overall, applying multiparametric analyses to include AMR gene levels, separation and clustering of sites were seen based on land use characterisation. This study suggests that differences in prescription of antimicrobials used in animal and human healthcare may influence environmental resistomes across agricultural and urban areas. In addition, public health risks due to exposure to faecal contamination and AMR genes are highlighted.

Storm accelerated subsurface Escherichia coli growth and exports to coastal waters

Storm significantly deteriorates coastal water fecal pollution now and beyond. Questions relating to storm exerting on coastal water safety are often intertwined with both surface water and subsurface processes. Stormwater runoff is a vital metric for coastal water fecal pollution under current cognition, while the controls of subsurface system remain unclear. Here, this study leveraged two time-series field data collected in a sandy beach during storm and non-storm periods to probe subsurface Escherichia coli (E. coli) growth and exports to coastal waters under storm events. Results demonstrated that storm events can not only stimulate subsurface E. coli growth, but also accelerate subsurface E. coli exports into the receiving water. Storm-intensified rainfall injected more oxygenous rainwater in the shallow groundwater, subsequently stimulating subsurface E. coli growth. Storm-strengthened wave energy was responsible for accelerating subsurface E. coli exports through enhanced wave-induced recirculated seawater. This study proposes a new insight for the stress of storm events on microbial pollution in coastal waters. The findings are constructive to the prevention of beach ecosystem pollution and can pave the way for coastal safety management to future extreme weather.

Effective coastal Escherichia coli monitoring by unmanned aerial vehicles (UAV) thermal infrared images

Coastal Escherichia coli (E. coli) significantly influence ocean safety and public health, thus requiring an effective E. coli pollution monitoring. However conventional detection relying on manual field sampling is time-consuming. Here, this study established an E. coli estimation model based on thermal remote sensing of unmanned aerial vehicles (UAV). This model was developed against one-year comprehensive field work in a representative sandy beach and further validated against 50 beaches in Hong Kong to evaluate its applicability. The estimated E. coli concentrations were in a reliable agreement with direct measurements. For this model, this study deployed the radon-222 (²²²Rn) as a bridging tracer to couple UAV thermal images and coastal E. coli concentrations. Coastal ²²²Rn can be reflected on the UAV thermal images, and there was a good positive correlation between the ²²²Rn activity and coastal E. coli concentration via one-year field data. Hence, coupling the ²²²Rn activity estimated from UAV thermal images and the relationship between ²²²Rn and E. coli, this study can readily monitor coastal E. coli by UAV. These findings highlighted that UAV technology is an effective approach to measure the E. coli concentrations and can further pave the way for an efficient coastal E. coli monitoring and public health risk warning.

Quantitative modelling of Ostracod bioassay: assigning toxicity index to potentially chemical contaminated swimming pools

One of the primary objectives of any public health programme is to design a protocol that will curtail a population from being predisposed to toxic substances in the environment. Biomarkers help in actualising such an objective by their potential to detect the presence of toxic substances in environmental media such as soil, water and air. The Ostracod Heterocypris incongruens, an already established biomarker for quality evaluation of freshwater, does not quantify toxicity. This work was aimed at modelling Ostracod bioassay as a quantitative whole-water toxicity assay (QWTA) for the determination of potentially chemical contaminated swimming pools. In this modelling approach, a pool water sample was deliberately contaminated with a mixture of Fenton reagent (FR) and Bonny light (BL) crude oil. The mechanism of toxic injury of this mixture is via oxidative stress-mediated superoxide ion and other free radicals. The mortalities and growth factors of the exposed freshly hatched Ostracods to the serial dilutions of the contaminated swimming pool water sample for 6 days were mathematically modelled to toxicity indices (Ti), which were used to construct the toxicity reference curve (TRC). A graph of the "toxic concentrations" of the serially diluted contaminated pool water sample against Ostracod mortality was plotted. The TRC and the linear graph constitute the "Ostracod-linked mathematical model". Against the reference mortality ≤ 20% of the Ostracods, the toxicity index based on the model prediction is ≤ 32.5, and this signifies "no observed toxic effect" for toxicity values below 32.5 units. Using this model, toxicity indices were calculated for 5 randomly selected swimming pools in the study area. The results showed that the outdoor pool SP 5 has a toxic index of 49.0, while outdoor pools SP 2 and SP 3 each has a toxic index of 42.5. The indoor swimming pool (SP 4) and Standard water (control) have zero toxicity, thus suggesting that that the outdoor pools SP 2, SP 3 and SP 5 were possibly contaminated by chemicals from extraneous sources while contamination of SP 1 was very much negligible, hence the "no observed toxic effect".

Temporal variations in fecal indicator bacteria in bathing water and sediment in a coastal ecosystem (Aytré Bay, Charente-Maritime, France)

This study presents the fecal contamination dynamic at the two bathing sites of Aytré Bay (Charente Maritime, France). We quantified fecal indicator bacteria (FIB) abundances (Escherichia coli and enterococci) from water and sediment samples over one-year survey. Then we measured biological (bacterial abundance, chlorophyll-a), physico-chemical (dissolved nutrients and oxygen, salinity, pH …) and climatic (temperatures, rainfall and tidal coefficient) parameters. Results showed that FIB abundances were occasionally higher than the European regulatory threshold during winter, summer and fall. The "poor quality" of the bathing water was due to high enterococci abundance. We found negative significant correlations between FIB and water temperature and salinity, and positive significant correlations between FIB and rainfall, PO₄, NO₃, NO₂, and SiO₂ mainly in water. Relationships between parameters showed that during summer and spring the main environmental drivers were temperature and salinity, while in fall and winter they were rainfall and dissolved nutrients.

Development of Predictive Models for "Very Poor" Beach Water Quality Gradings Using Class-Imbalance Learning

Statistical water quality forecast models are useful tools to assist with beach management. In particular, multiple linear regression (MLR) models have been successfully developed for prediction of fecal indicator bacteria concentrations for beaches in river, lake, and marine environments. Nevertheless, an unresolved challenging issue is the reliable prediction of infrequent events of high bacterial concentrations to inform beach closure decisions to protect public health. The number of field data available for the infrequent events is typically an order of magnitude less than that for days when the water quality criterion is met-MLR models often perform poorly in predicting bacterial concentrations on days when the beaches should be closed. For beach management in Hong Kong, MLR models have been developed to predict beach water quality indices in terms of four gradings (BWQI-1 to 4) based on Escherichia coli (E. coli) concentrations. In this study, we propose an artificial intelligence (AI)-based binary classification (EasyEnsemble) model using class-imbalance learning to predict "very poor" occasions (BWQI-4)-when E. coli concentration exceeds 610 counts/100 mL. Models are developed for three marine beaches with different hydrographic and pollution characteristics using a 30 year data set spanning three periods with different water quality status. The model-data comparison over a wide range of conditions shows that the proposed method results in a significant improvement in the prediction of "very poor" water quality. The proposed class-imbalance method for predicting rare events has an F-score of 0.84, and it significantly outperforms MLR and classification tree (CT) models with corresponding F-scores of 0.39 and 0.69. A robust beach water quality forecast system can hence be developed using hybrid MLR-binary classification modeling.

Human Fecal Contamination Corresponds to Changes in the Freshwater Bacterial Communities of a Large River Basin

Microbial water quality is generally monitored by culturable fecal indicator bacteria (FIB), which are intended to signal human health risk due to fecal pollution. However, FIB have limited utility in most urbanized watersheds as they do not discriminate among fecal pollution sources, tend to make up a small fraction of the total microbial community, and do not inform on pollution impacts on the native ecosystem. To move beyond these limitations, we assessed entire bacterial communities and investigated how bacterial diversity relates to traditional ecological and human health-relevant water quality indicators throughout the Milwaukee River Basin. Samples were collected from 16 sites on 5 days during the summer, including both wet and dry weather events, and were processed by 16S rRNA gene amplicon sequencing. Historical water quality at each sampling location, as opposed to upstream land use, was associated significantly with bacterial community alpha diversity. Source partitioning the sequence data was important for determining water quality relationships. Sewage-associated bacterial sequences were detected in all samples, and the relative abundance of sewage sequences was strongly associated with the human Bacteroides fecal marker. From this relationship, we developed a preliminary threshold for human sewage pollution when using bacterial community sequence data. Certain abundant freshwater bacterial sequences were also associated with human fecal pollution, suggesting their possible utility in water quality monitoring. This study sheds light on how bacterial community analysis can be used to supplement current water quality monitoring techniques to better understand interactions between ecological water quality and human health indicators. IMPORTANCE Surface waters in highly developed mixed-use watersheds are frequently impacted by a wide variety of pollutants, leading to a range of impairments that must be monitored and remediated. With advancing technologies, microbial community sequencing may soon become a feasible method for routine evaluation of the ecological quality and human health risk of a water body. In this study, we partnered with a local citizen science organization to evaluate the utility of microbial community sequencing for identifying pollution sources and ecological impairments in a large mixed-use watershed. We show that changes in microbial community diversity and composition are indicative of both long-term ecological impairments and short-term fecal pollution impacts. By source partitioning the sequence data, we also estimate a threshold target for human sewage pollution, which may be useful as a starting point for future development of sequencing-based water quality monitoring techniques.

Environmental Surveillance and Characterization of Antibiotic Resistant Staphylococcus aureus at Coastal Beaches and Rivers on the Island of Hawai'i

Staphylococcus aureus are human facultative pathogenic bacteria and can be found as contaminants in the environment. The aim of our study was to determine whether methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) isolated from coastal beach and river waters, anchialine pools, sand, and wastewater on the island of Hawaiʻi, Hawaiʻi, are a potential health risk. Samples were collected from three regions on Hawaiʻi Island from July to December 2020 during the COVID-19 pandemic and were characterized using whole-genome sequencing (WGS). From WGS data, multilocus sequence typing (MLST), SCCmec type, antimicrobial resistance genes, virulence factors, and plasmids were identified. Of the 361 samples, 98.1% were positive for Staphylococcus spp. and 7.2% were S. aureus positive (n = 26); nine MRSA and 27 MSSA strains were characterized; multiple isolates were chosen from the same sample in two sand and seven coastal beach water samples. The nine MRSA isolates were multi-drug resistant (6–9 genes) sequence type (ST) 8, clonal complex (CC) 8, SCCmec type IVa (USA300 clone), and were clonally related (0–16 SNP differences), and carried 16–19 virulence factors. The 27 MSSA isolates were grouped into eight CCs and 12 STs. Seventy-eight percent of the MSSA isolates carried 1–5 different antibiotic resistance genes and carried 5–19 virulence factors. We found S. aureus in coastal beach and river waters, anchialine pools, and sand at locations with limited human activity on the island of Hawaiʻi. This may be a public health hazard.

Staphylococcus aureus-An Additional Parameter of Bathing Water Quality for Crowded Urban Beaches

During the last years, the report of the occurrence of waterborne disease symptoms related to non-enteric pathogens has increased, without any record of higher levels of indicator bacteria (Escherichia coli and intestinal enterococci). Therefore, the use of current indicators is not always adequate when assessing the overall potential health risk and the inclusion of additional parameters needs to be examined. This paper reports on the incidence and levels of Staphylococcus aureus at 258 locations in Primorje-Gorski Kotar County (Croatia) recorded by official bathing water quality monitoring, as well as supplemental monitoring carried out at the two most frequented beaches in the City of Rijeka. The number of bathers was found to be the main factor affecting S. aureus levels (r = 0.321, p < 0.05). The share of S. aureus positive samples from the official monitoring was significantly lower, when compared to the share of samples from supplemental monitoring (2.2% and 36.3%, respectively; p < 0.01). Besides the number of bathers, one of the main reasons is likely the higher sampling frequency. No correlation was found between S. aureus levels and the indicator bacteria. The results indicate that the determination of S. aureus and increased sampling frequency is recommended for overcrowded beaches.

Two-decade variations of fresh submarine groundwater discharge to Tolo Harbour and their ecological significance by coupled remote sensing and radon-222 model

Although submarine groundwater discharge (SGD) comprises an insignificant proportion of the global hydrologic cycle, it contributes significantly to chemical fluxes into the coastal waters due to concentrated constituents in coastal groundwater. Large nutrient loadings derived from SGD can lead to a series of environmental and ecological problems such as algal blooms, resulting in water discoloration, severe dissolved oxygen depletion, and eventually beach closures and massive fish kills. Previous studies have demonstrated the relationship between algal blooms and SGD obtained from direct measurement with seepage meters or from geo-tracer (i.e., radon and radium) based models; these traditional methods are time-consuming, laborious and point monitoring, and can hardly achieve a high spatiotemporal resolution SGD estimation, which is vital in revealing the effects of SGD to algal blooms over a long period. Alternatively, remote sensing methods for high spatiotemporal resolution SGD localization and quantification are applicable and effective. The temperature difference or anomaly between groundwater and coastal water extracted from satellite thermal images can be used as the indicator to localize and detect SGD especially its fresh component (or fresh SGD). In this study, multi-year (2005, 2011 and 2018) radon samples in Tolo Harbour were used to train regression models between in-situ radon (Rn) activity and the temperature anomaly by Landsat satellite thermal images. The models were used to estimate two-decade variations of fresh SGD in Tolo Harbour. The synergistic analysis between the time series of fresh SGD derived from regression models and high spatiotemporal resolution ecological metrics (chlorophyll-a, algal cell counts, and E.coli) leads to the findings that the increase of the fresh SGD associated with high nutrient concentrations is witnessed 10-20 days before the observations of algal bloom events. This study makes the first attempt to demonstrate the strong relation between the SGD and algal blooms over a vicennial span, and also provides a cost effective and robust technique to estimate SGD on a bay scale.

Evaluating health risks associated with exposure to ambient surface waters during recreational activities: A systematic review and meta-analysis

Recreational water quality guidelines protect the public from health risks associated with water recreation by helping to prevent unacceptable concentrations of pathogenic organisms in ambient water. However, illness risk is associated with both the concentration of pathogens in the water and the degree of contact with those pathogens. Different recreational activities can result in different levels of contact with ambient water containing water-borne pathogens. We conducted a systematic literature review and meta-analysis to evaluate risks of illness associated with different recreational activities and different levels of contact to ambient surface waters. We screened 8,618 potentially relevant studies for quantitative measures of risk using inclusion/exclusion criteria established in advance. We categorized recreational activities as swimming, sports-related contact, minimal contact, and sand contact. We combined relative risks using a random effects meta-analysis for adverse health outcome categories representing gastrointestinal illness, respiratory illness, skin, eye, ear, nose, throat, and cold/flu illness. We identified 92 studies meeting our inclusion criteria. Pooled risk estimates indicate significant elevation of gastrointestinal illness with the recreational activity categories swimming (2.19, 95% CI: 1.82, 2.63) and sports-related contact (2.69, 95% CI: 1.04, 6.92), and nonsignificant elevation of gastrointestinal illness with minimal contact (1.27, 95% CI: 0.74, 2.16). We also found a significant elevation of respiratory illness with swimming (1.78, 95% CI: 1.38, 2.29) and sports-related contact (1.49, 95% CI: 1.00, 2.24), and no elevation of respiratory illness with minimal contact (0.90, 95% CI: 0.71, 1.14). This study suggests that exposures associated with different types of recreational activities are important characteristics of the exposure pathway when assessing illness risk associated with recreation in ambient surface waters.

Sunscreens containing zinc oxide nanoparticles can trigger oxidative stress and toxicity to the marine copepod Tigriopus japonicus

The study, for the first time, evaluated the leaching rate of zinc oxide nanoparticles (nZnO) from human skins which were applied with three commercial sunscreens containing nZnO as an active ingredient. The leaching rate of nZnO varied greatly among the sunscreens, with a range of 8-72% (mean ± SD: 45% ± 33%). We further investigated their toxicities to the marine copepod Tigriopus japonicus. We found that 96-h median lethal concentrations of the three sunscreens to T. japonicus were > 5000, 230.6, and 43.0 mg chemical L^-1, respectively, equivalent to Zn²⁺ concentrations at >82.5, 3.2, and 1.2 mg Zn L^-1, respectively. Exposure to the individual sunscreens at environmentally realistic concentrations for 96 h led to up-regulation of antioxidant genes in T. japonicus, while they triggered the release of reactive oxygen species based on the results of in vivo assays. Evidently, these nZnO-included sunscreens can cause oxidative stress and hence pose risk to marine organisms.

Evaluation of the proinflammatory effects of contaminated bathing water

Contaminated marine bathing water has been reported to adversely affect human health. Our data demonstrated a correlation between total endotoxin (lipopolysaccharide; LPS) levels and degree of contamination of marine bathing waters. To assess the potential health implications of LPS present in marine bathing waters, the inflammation-inducing potency of water samples collected at different time points at multiple sampling sites were assessed using a cell culture-based assay. The numbers of fecal indicator bacteria (FIB) were also examined in the same samples. Water samples were used to stimulate two cell culture models: (1) a novel non-transformed continuously growing murine cell line Max Plank Institute (MPI) characteristic of alveolar macrophages and (2) human MonoMac 6 monocyte cell line. The inflammatory potential of the samples was assessed by measuring the release of inflammatory cytokines. The presence of high levels of LPS in contaminated bathing water led to induction of inflammatory response from our in vitro cell-based bioassays suggesting its potential health impact. This finding introduces an in vitro culture assay that reflects the level of LPS in water samples. These observations further promote previous finding that LPS is a reliable surrogate biomarker for fecal contamination of bathing water.

A novel screening tool for the health risk in recreational waters near estuary: The Carrying Capacity indicator

The present study aims to provide a conceptual framework to help practitioners to improve the quality of recreational waters near estuary, which may be affected by untreated wastewater from Combined Sewer Overflows (CSOs). When CSOs are activated, the concentration of bacteria (e.g., Enterococci and E. coli) in estuary increases, thereby resulting in a potential health threat to swimmers. Here, the bacterial exposure is evaluated using physically-based stochastic model for contaminant transport, while human health risk is determined by Quantitative Microbial Risk Assessment (QMRA). Based on human health risk framework, we quantify the Carrying Capacity (CC) of the recreational water body. Such an indicator is defined as the number of swimming individuals that can be sustained in a beach resort with an acceptable risk threshold. The CC increases by dilution processes and by reduction of the source concentration, which in turn depends on the improvements in the sewage system. The presented approach can be a useful screening tool for policy-makers and other stakeholders, thereby providing a potential solution to the trade-off between economic development and the sustainable ecosystem in coastal areas.

Twenty five years of beach monitoring in Hong Kong: A re-examination of the beach water quality classification scheme from a comparative and global perspective

Hong Kong's beach water quality classification scheme, used effectively for >25 years in protecting public health, was first established in local epidemiology studies during the late 1980s where Escherichia coli (E. coli) was identified as the most suitable faecal indicator bacteria. To review and further substantiate the scheme's robustness, a performance check was carried out to classify water quality of 37 major local beaches in Hong Kong during four bathing seasons (March-October) from 2010 to 2013. Given the enterococci and E. coli data collected, beach classification by the local scheme was found to be in line with the prominent international benchmarks recommended by the World Health Organization and the European Union. Local bacteriological studies over the last 15 years further confirmed that E. coli is the more suitable faecal indicator bacteria than enterococci in the local context.

Variation of Bacterial Communities with Water Quality in an Urban Tropical Catchment

A major challenge for assessment of water quality in tropical environments is the natural occurrence and potential growth of Fecal Indicator Bacteria (FIB). To gain a better understanding of the relationship between measured levels of FIB and the distribution of sewage-associated bacteria, including potential pathogens, in the tropics this study compared the abundance of FIB (Total coliforms and E. coli) and the Bacteroidales (HF183 marker) with bacterial community structure determined by next-generation amplicon sequencing. Water was sampled twice over 6 months from 18 sites within a tropical urban catchment and reservoir, followed by extraction of DNA from microorganisms, and sequencing targeting the V3-V4 region of the 16S rRNA gene. Multivariate statistical analyses indicated that bacterial community composition (BCC) varied between reservoir and catchment, within catchment land-uses, and with E. coli concentration. Beta-regression indicated that the proportion of sequences from sewage-associated taxa (SAT) or pathogen-like sequences (PLS) were predicted most significantly by measured levels of E. coli(log MPN/100 mL) (χ² > 8.7; p < 0.003). In addition, SAT were significantly predicted by log HF183 levels (χ²=13.1; p = 0.0003) while PLS were not. Our study suggests that measurements of E. coli concentration could be useful in predicting samples enriched in sewage-associated and pathogen-like bacteria in tropical environments despite the potential for nonconservative behavior.

Predicting 'very poor' beach water quality gradings using classification tree

A beach water quality prediction system has been developed in Hong Kong using multiple linear regression (MLR) models. However, linear models are found to be weak at capturing the infrequent 'very poor' water quality occasions when Escherichia coli (E. coli) concentration exceeds 610 counts/100 mL. This study uses a classification tree to increase the accuracy in predicting the 'very poor' water quality events at three Hong Kong beaches affected either by non-point source or point source pollution. Binary-output classification trees (to predict whether E. coli concentration exceeds 610 counts/100 mL) are developed over the periods before and after the implementation of the Harbour Area Treatment Scheme, when systematic changes in water quality were observed. Results show that classification trees can capture more 'very poor' events in both periods when compared to the corresponding linear models, with an increase in correct positives by an average of 20%. Classification trees are also developed at two beaches to predict the four-category Beach Water Quality Indices. They perform worse than the binary tree and give excessive false alarms of 'very poor' events. Finally, a combined modelling approach using both MLR model and classification tree is proposed to enhance the beach water quality prediction system for Hong Kong.

To swim or not to swim? A disagreement between microbial indicators on beach water quality assessment in Hong Kong

The USEPA and the WHO now advocate the use of enterococci as indicators for marine water quality. This study investigated the outcomes for Hong Kong beach water quality assessment by comparing enterococcus measures with data from the HKEPD's monitoring programme. Six beaches were tested once every 2-3 months from November 2013 to June 2014 in order to identify the most contaminated sites, followed by intensive water sampling in sites found to have the highest enterococci densities (Clear Water Bay Second and Golden) every five to six days for six sampling events over a 30-day period in 2014. The geometric means of enterococci were found to be 124 and 41 cfu/100 mL at Clear Water Bay Second and Golden respectively, indicating that there may be higher risks of illness associated with swimming at both beaches than previously known. Moreover, beach sediments contained higher concentrations of enterococci than water, and warrant further study.

Modeling the dispersion of viable and total Escherichia coli cells in the artificial semi-enclosed bathing area of Santa Marinella (Latium, Italy)

Coastal areas are strongly affected by episodes of fecal contamination due to polluted water inflows from inadequately treated sewages. The present study aims to investigate the dispersion of Escherichia coli in the artificial semi-enclosed bathing area of Santa Marinella (Latium, Italy) through in situ samplings carried out in summer 2012 and the application of a dynamic model. Collected samples were analyzed by the Culture-Based technique and the Fluorescent Antibody method in order to estimate both the viable culturable cells and the total E. coli population, respectively. The in situ datasets were used to test the proposed modeling approach and simulate the behavior of bacteria as particles subjected, or not, to decay. Next, the flushing time and the computation of the Microbiological Potential Risk Area allowed the evaluation of the contribution of physical and biological processes to coliform dispersion and the related potential risk for bathers.

Assessment of swimming associated health effects in marine bathing beach: an example from Morib beach (Malaysia)

A survey among beachgoers was conducted to determine the swimming associated health effects experienced and its relationship with beach water exposure behaviour in Morib beach. For beach water exposure behaviour, the highest frequency of visit among the respondents was once a year (41.9%). For ways of water exposure, whole body exposure including head was the highest (38.5%). For duration of water exposure, 30.8% respondents prefer to be in water for about 30 min with low possibilities of accidental ingestion of beach water. A total of 30.8% of beachgoers in Morib beach were reported of having dermal symptoms. Bivariate analysis showed only water activity, water contact and accidental ingestion of beach water showed significant association with swimming associated health effects experienced by swimmers. This study output showed that epidemiological study can be used to identify swimming associated health effects in beach water exposed to faecal contamination.

Differential utility of the Bacteroidales DNA and RNA markers in the tiered approach for microbial source tracking in subtropical seawater

Source tracking of fecal pollution is an emerging component in water quality monitoring. It may be implemented in a tiered approach involving Escherichia coli and/or Enterococcus spp. as the standard fecal indicator bacteria (FIB) and the 16S rRNA gene markers of Bacteroidales as source identifiers. The relative population dynamics of the source identifiers and the FIB may strongly influence the implementation of such approach. Currently, the relative performance of DNA and RNA as detection targets of Bacteroidales markers in the tiered approach is not known. We compared the decay of the DNA and RNA of the total (AllBac) and ruminant specific (CF128) Bacteroidales markers with those of the FIB in seawater spiked with cattle feces. Four treatments of light and oxygen availability simulating the subtropical seawater of Hong Kong were tested. All Bacteroidales markers decayed significantly slower than the FIB in all treatments. Nonetheless, the concentrations of the DNA and RNA markers and E. coli correlated significantly in normoxic seawater independent of light availability, and in hypoxic seawater only under light. In hypoxic seawater without light, the concentrations of RNA but not DNA markers correlated with that of E. coli. Generally, the correlations between Enterococcus spp. and Bacteroidales were insignificant. These results suggest that either DNA or RNA markers may complement E. coli in the tiered approach for normoxic or hypoxic seawater under light. When light is absent, either DNA or RNA markers may serve for normoxic seawater, but only the RNA markers are suitable for hypoxic seawater.

Human health risk implications of multiple sources of faecal indicator bacteria in a recreational waterbody

We simulate the influence of multiple sources of enterococci (ENT) as faecal indicator bacteria (FIB) in recreational water bodies on potential human health risk by considering waters impacted by human and animal sources, human and non-pathogenic sources, and animal and non-pathogenic sources. We illustrate that risks vary with the proportion of culturable ENT in water bodies derived from these sources and estimate corresponding ENT densities that yield the same level of health protection that the recreational water quality criteria in the United States seeks (benchmark risk). The benchmark risk is based on epidemiological studies conducted in water bodies predominantly impacted by human faecal sources. The key result is that the risks from mixed sources are driven predominantly by the proportion of the contamination source with the greatest ability to cause human infection (potency), not necessarily the greatest source(s) of FIB. Predicted risks from exposures to mixtures comprised of approximately 30% ENT from human sources were up to 50% lower than the risks expected from purely human sources when contamination is recent and ENT levels are at the current water quality criteria levels (35 CFU 100 mL(-1)). For human/non-pathogenic, human/gull, human/pig, and human/chicken faecal mixtures with relatively low human contribution, the predicted culturable enterococci densities that correspond to the benchmark risk are substantially greater than the current water quality criteria values. These findings are important because they highlight the potential applicability of site specific water quality criteria for waters that are predominantly un-impacted by human sources.

Receiver-operating characteristics analysis: a new approach to predicting the presence of pathogens in surface waters

Fecal indicator microbes are used to monitor the public health risks of recreating in surface waters. However, the importance of indicator tests as predictors of waterborne pathogens has been unclear. Numerous studies have also shown that the survival and growth of indicator organisms may depend on location-specific factors that cannot be broadly generalized. We used receiver-operating characteristic (ROC) methods to determine whether fecal indicator species are capable of predicting the presence of Giardia and Cryptosporidium in fresh surface waters in the Chicago area. We also derived recreational water quality criteria specific to our location with respect to this end point. We considered five fecal indicators: enterococci measured by culture and quantitative polymerase chain reaction (qPCR), Escherichia coli measured by culture, somatic coliphage, and F+ coliphage. All fecal indicators were found to predict the presence and absence of protozoan pathogens. The test for enterococci measured by culture was the poorest predictor of the presence of pathogens. The test for enterococci measured by qPCR was the best predictor of the presence of Giardia, but not an important predictor of the presence of Cryptosporidium. The test for somatic coliphage was a relatively strong predictor of the presence of both pathogens. This analysis supports the use of qPCR-based assays over culture-based assays for predicting the presence of Giardia in fresh surface water. Our criteria were optimized for the prediction of the presence of Giardia and Cryptosporidium in our location and were closely aligned with criteria of the U.S. Environmental Protection Agency derived from epidemiological risk assessment. The ROC approach is flexible and can inform location-specific interpretation of water quality monitoring data and decision making.

Discharge-based QMRA for estimation of public health risks from exposure to stormwater-borne pathogens in recreational waters in the United States

This study is the first to report a quantitative microbial risk assessment (QMRA) on pathogens detected in stormwater discharges-of-concern, rather than relying on pathogen measurements in receiving waters. The pathogen concentrations include seven "Reference Pathogens" identified by the U.S. EPA: Cryptosporidium, Giardia, Salmonella, Norovirus, Rotavirus, Enterovirus, and Adenovirus. Data were collected from 12 sites representative of seven discharge types (including residential, commercial/industrial runoff, agricultural runoff, combined sewer overflows, and forested land), mainly during wet weather conditions during which times human health risks can be substantially elevated. The risks calculated herein therefore generally apply to short-term conditions (during and just after rainfall events) and so the results can be used by water managers to potentially inform the public, even for waters that comply with current criteria (based as they are on a 30-day mean risk). Using an example waterbody and mixed source, pathogen concentrations were used in QMRA models to generate risk profiles for primary and secondary water contact (or inhalation) by adults and children. A number of critical assumptions and considerations around the QMRA analysis are highlighted, particularly the harmonization of the pathogen concentrations measured in discharges during this project with those measured (using different methods) during the published dose-response clinical trials. Norovirus was the most dominant predicted health risk, though further research on its dose-response for illness (cf. infection) is needed. Even if the example mixed-source concentrations of pathogens had been reduced 30 times (by inactivation and mixing), the predicted swimming-associated illness rates - largely driven by Norovirus infections - can still be appreciable. Rotavirus generally induced the second-highest incidence of risk among the tested pathogens while risks for the other Reference Pathogens (Giardia, Cryptosporidium, Adenovirus, Enterovirus and Salmonella) were considerably lower. Secondary contact or inhalation resulted in considerable reductions in risk compared to primary contact. Measurements of Norovirus and careful incorporation of its concentrations into risk models (harmonization) should be a critical consideration for future QMRA efforts. The discharge-based QMRA approach presented herein is particularly relevant to cases where pathogens cannot be reliably detected in receiving waters with detection limits relevant to human health effects.

Microbial source tracking markers for detection of fecal contamination in environmental waters: relationships between pathogens and human health outcomes

Microbial source tracking (MST) describes a suite of methods and an investigative strategy for determination of fecal pollution sources in environmental waters that rely on the association of certain fecal microorganisms with a particular host. MST is used to assess recreational water quality and associated human health risk, and total maximum daily load allocations. Many methods rely on signature molecules (markers) such as DNA sequences of host-associated microorganisms. Human sewage pollution is among the greatest concerns for human health due to (1) the known risk of exposure to human waste and (2) the public and regulatory will to reduce sewage pollution; however, methods to identify animal sources are receiving increasing attention as our understanding of zoonotic disease potential improves. Here, we review the performance of MST methods in initial reports and field studies, with particular emphasis on quantitative PCR (qPCR). Relationships among human-associated MST markers, fecal indicator bacteria, pathogens, and human health outcomes are presented along with recommendations for future research. An integrated understanding of the advantages and drawbacks of the many MST methods targeting human sources advanced over the past several decades will benefit managers, regulators, researchers, and other users of this rapidly growing area of environmental microbiology.

Real-time forecasting of Hong Kong beach water quality by 3D deterministic model

Bacterial level (e.g. Escherichia coli) is generally adopted as the key indicator of beach water quality due to its high correlation with swimming associated illnesses. A 3D deterministic hydrodynamic model is developed to provide daily water quality forecasting for eight marine beaches in Tsuen Wan, which are only about 8 km from the Harbour Area Treatment Scheme (HATS) outfall discharging 1.4 million m(3)/d of partially-treated sewage. The fate and transport of the HATS effluent and its impact on the E. coli level at nearby beaches are studied. The model features the seamless coupling of near field jet mixing and the far field transport and dispersion of wastewater discharge from submarine outfalls, and a spatial-temporal dependent E. coli decay rate formulation specifically developed for sub-tropical Hong Kong waters. The model prediction of beach water quality has been extensively validated against field data both before and after disinfection of the HATS effluent. Compared with daily beach E. coli data during August-November 2011, the model achieves an overall accuracy of 81-91% in forecasting compliance/exceedance of beach water quality standard. The 3D deterministic model has been most valuable in the interpretation of the complex variation of beach water quality which depends on tidal level, solar radiation and other hydro-meteorological factors. The model can also be used in optimization of disinfection dosage and in emergency response situations.

Modeling riverine pathogen fate and transport in Mexican rural communities and associated public health implications

The discharge of untreated or poorly treated wastewater to river systems remains a major problem affecting public and environmental health, particularly in rural communities of less developed countries. One of the primary goals in setting policies for wastewater management is to reduce risks to human health associated with microbial contamination of receiving water. In this study, we apply a surface water quality model to develop an Escherichia coli based indicator that reflects the quality of surface water and the potential impact to recreational users in a large, rural river in northwest Mexico (upper Sonora River). The model assesses the relative importance of streamflow variations and the uncertainty in E. coli removal coefficient parameters for the predictions of E. coli concentrations in the river. Given the sparse information on streamflow, we use a physically-based, distributed hydrologic model to generate tributary contributions to the river. We determined the best estimate and uncertainty of E. coli removal rates to explore the impacts of parameter uncertainty on the transport of E. coli downstream from two wastewater discharge zones. Our results depict the regions in the river that are in noncompliance with fresh water pathogen norms. The impact of streamflow variability and uncertainty in the removal rates of pathogen indicators was used to derive a range of river distances in noncompliance. The comparison between two sites with different streamflow behaviors was used to illustrate the impacts of streamflow spatiotemporal variability on pathogen indicators. We derive a simple relationship that can be used to assess the relative importance of dilution (ratio of wastewater discharge to river discharge) and pathogen removal (ratio of residence time to reaction time).

Seasonal variations in the risk of gastrointestinal illness on a tropical recreational beach

The objectives of this study were to examine the seasonal changes in the risk of gastrointestinal (GI) illness of beachgoers in the tropics, to compare the association between GI illness and water quality using various indicator organisms, and to study other beach health hazards. A prospective cohort study during two seasonal periods (summer and autumn) was conducted in a beach surrounded by intensive residential development. Analyses demonstrated that although densities of indicators were well below water quality standards throughout the study, they were significantly higher during the autumn season. The incidence of GI illness among beachgoers was also higher during the rainy season. A higher incidence of GI illness was observed for bathers during the autumn season when compared to non-bathers, while a somewhat lower incidence was observed during the summer. This study showed that rainfall contributes to higher levels of microbial contaminants and GI risk to beachgoers. The association between GI illness and Enterococcus using culture counts showed the highest odds ratio among all indicator parameters including those using molecular methods. A much higher risk of GI illness among children under 5 years was observed among all beachgoers.

Escherichia coli and Enterococcus spp. in rainwater tank samples: comparison of culture-based methods and 23S rRNA gene quantitative PCR assays

In this study, culture-based methods and quantitative PCR (qPCR) assays were compared with each other for the measurement of Escherichia coli and Enterococcus spp. in water samples collected from rainwater tanks in Southeast Queensland, Australia. Among the 50 rainwater tank samples tested, 26 (52%) and 46 (92%) samples yielded E. coli numbers as measured by EPA Method 1603 and E. coli 23S rRNA gene qPCR assay, respectively. Similarly, 49 (98%) and 47 (94%) samples yielded Enterococcus spp. numbers as measured by EPA Method 1600 and Enterococcus spp. 23S rRNA gene qPCR assay, respectively. The mean E. coli (2.49 ± 0.85) log(10) and Enterococcus spp. (2.72 ± 0.32) log(10) numbers as measured by qPCR assays were significantly (P < 0001) different than E. coli (0.91 ± 0.80) log(10) and Enterococcus spp. (1.86 ± 0.60) log(10) numbers as measured by culture-based method. Weak but significant correlations were observed between both EPA Method 1603 and the E. coli qPCR assay (r = 0.47, P = 0.0009), and EPA Method 1600 and the Enterococcus spp. qPCR assay (r = 0.42, P = 0.002). Good qualitative agreement was found between the culture-based method and the Enterococcus spp. qPCR assay in terms of detecting fecal pollution in water samples from the studied rainwater tanks. More research studies, however, are needed to shed some light on the discrepancies associated with the culture-based methods and qPCR assays for measuring fecal indicator bacteria.

Comparative studies on Enterococcus, Clostridium perfringens and Staphylococcus aureus as quality indicators in tropical seawater at a Pacific Mexican beach resort

Three microorganisms were assayed to evaluate the microbiological quality in the seawater at a resort on the Mexican Pacific coast, and to test for possible associations among the titers of the various bacteria, their possible correlations with environmental conditions, and with the location of potential wastewater outflows. Significant microorganism levels were found (at Caletilla beach, Hornos beach, and Papagayo beach, respectively: for Enterococcus 157, 153, and 149, for C. perfringens 35, 89, and 56, for S. aureus 244,137, and 279CFU/100ml), often in excess of the presently set guideline values. In general, bacterial titers were higher during rainy season than in dry season. For S. aureus, in both seasons, highest concentrations were found at 3pm, the time of highest tourist presence at the beaches. Our results argue for the use of these three microorganisms as part of a set of indicators in the routine microbiological evaluation of Mexican beachwaters.

A multi-beach study of Staphylococcus aureus, MRSA, and enterococci in seawater and beach sand

Incidences of Staphylococcus aureus and methicillin resistant S. aureus (MRSA) have risen worldwide prompting a need to better understand routes of human exposure and whether standard bacterial water quality monitoring practices adequately account for this potential threat. Beach water and sand samples were analyzed during summer months for S. aureus, enterococci, and MRSA at three southern California beaches (Avalon, Doheny, Malibu Surfrider). S. aureus frequently was detected in samples of seawater (59%, n = 328) and beach sand (53%, n = 358). MRSA sometimes was detected in seawater (1.6%, n = 366) and sand (2.7%, n = 366) at relatively low concentrations. Site specific differences were observed, with Avalon Beach presenting the highest concentrations of S. aureus and Malibu Surfrider the lowest in both seawater and sand. S. aureus concentrations in seawater and sand were correlated to each other and to a variety of other parameters. Multiple linear regression on the combined beach data indicated that significant explanatory variables for S. aureus in seawater were S. aureus in sand, water temperature, enterococci in seawater, and the number of swimmers. In sand, S. aureus concentrations were related to S. aureus in seawater, water temperature, enterococci in seawater, and inversely to surf height classification. Only the correlation to water temperature held for individually analyzed beaches and for S. aureus concentrations in both seawater and sand. To provide context for these results, the prevalence of S. aureus in sand was compared to published fomite studies, and results suggested that beach prevalence was similar to that in homes.

Elevated bathing-associated disease risks despite certified water quality: a cohort study

Bacteriological water quality criteria have been recommended to ensure bathers' health. However, this risk-assessment approach is based mainly on routine measurements of fecal pollution indicator bacteria in seawater, and may not be adequate to protect bathers effectively. The aim of this study was to assess the risks of symptoms related to infectious diseases among bathers after exposure to seawater which was of excellent quality according to EU guidelines. This study is a cohort study recruiting bathers and non-bathers. Water samples were collected for estimating bacterial indicators. Univariable and multivariable analysis was performed to compare the risks of developing symptoms/diseases between bathers and non-bathers. A total of 3805 bathers and 572 non-bathers were included in the study. Water analysis results demonstrated excellent quality of bathing water. Significantly increased risks of symptoms related to gastrointestinal infections (OR = 3.60, 95% CI 1.28-10.13), respiratory infections (OR = 1.92, 95% CI 1.00-3.67), eye infections (OR = 2.43, 95% CI 1.27-4.63) and ear infections (OR = 17.21, 95% CI 2.42-122.34) were observed among bathers compared with non-bathers. Increased rates of medical consultation and medication use were also observed among bathers. There was evidence that bathers experienced increased morbidity compared with non-bathers though the bathing waters met bacteriological water quality criteria. These results suggest that risk assessments of recreational seawaters should not only focus on bacteriological water quality criteria.

Waterborne Pathogens

A variety of microorganisms occur in the marine environment which are capable of infecting humans. This chapter, focused on waterborne pathogens, summarizes the types of pathogens that are a threat to human health, as well as the fecal indicator bacteria that are commonly used as surrogates for pathogens in regulatory and research applications. Limitations and alternatives to traditional fecal indicator bacteria are explored, highlighting challenges and policy implications for protecting public health. Methodological advances and challenges are also reviewed, with an emphasis on research designed to fill gaps and provide scientific support for management of marine resources, particularly bathing beaches. Accordingly, recent and previous epidemiology studies linking microbial measures of water quality to health outcomes are discussed in detail. As an alternative to the measurement of individual water samples, modeling of pathogens in marine waters is introduced. Overall, this chapter provides an overview of the pathogens, microbial measures and policy implications important for protecting humans from exposure to pathogens in marine waters.

Bather density as a predominant factor for health effects related to recreational bathing: results from the Greek bathers cohort study

Our aim was to examine the health effects on bathers from exposure to recreational seawater on three beaches with different microbiology quality and bather density through a cohort study. An initial questionnaire and a 10 day follow up were used. Univariate and backward logistic regression analyses were used to asses the risk of developing symptoms or diseases among the bathers. In total, 3805 bathers were included in the study and 149 samples were collected from the three beaches. Despite all the beaches being characterized of high quality the levels of bacterial indicators differed among them. Health effects among bathers were not associated with bacterial indicators. A statistically significant increased risk for symptoms related to respiratory illness, gastroenteritis, medical consultation and use of medication was observed among bathers at the higher bather density beaches. Beach bather numbers should always be taken into account when considering a risk assessment approach.

Microbial water quality of the Georgian coastal zone of the Black Sea

From 2006 to 2008, microbial water quality was monitored along the Georgian coast of the Black Sea. Temperature, pH, salinity, and dissolved oxygen were measured, along with a variety of aquatic microbial parameters, including heterotrophic plate count (HPC), total culturable bacterial count (TCBC), and chlorophyll a (Chl-a) concentration. Total and fecal coliforms and total enterococci counts were recorded as indicators of fecal pollution. Vibrio bacteria, and Escherichia coli- and Vibrio-specific bacteriophages were isolated and enumerated to determine their relationships to standard marine pollution indicators. Persistent microbial pollution was observed, particularly in the summer months, with a higher rate of contamination in estuaries. Microbial indicators generally showed seasonal dependence, suggesting that temperature may influence bacterial dynamics in this environment. No correlation was apparent between fecal pollution indicators and physical-chemical and aquatic microbial parameters, although there were significant relationships amongst the indicators themselves, as well as with the prevalence of Vibrio bacteria and phage.

Comparison of rapid quantitative PCR-based and conventional culture-based methods for enumeration of Enterococcus spp. and Escherichia coli in recreational waters

Recreational water quality is currently monitored using culture-based methods that require 18 to 96 h for results. Quantitative PCR (QPCR) methods that can be completed in less than 2 h have been developed, but they could yield different results than the conventional methods. We present two studies in which samples were processed simultaneously for Enterococcus spp. and Escherichia coli using two culture-based methods (EPA method 1600 and Enterolert/Colilert-18) and QPCR. The proprietary QPCR assays targeted the 23S rRNA (Enterococcus spp.) and uidA (E. coli) genes and were conducted using lyophilized beads containing all reagents. In the first study, the QPCR method developers processed 54 blind samples that were inoculated with sewage or pure cultures or were ambient beach samples. The second study involved 163 samples processed by water quality personnel. The correlation between results of QPCR and EPA 1600 during the first study (r²) was 0.69 for Enterococcus spp., which was less than that observed between the culture-based methods (r², 0.87). During the second study, the correlations were similar. No false positives occurred in either study when QPCR-based assays were used with blank samples. Levels of reproducibility measured through coefficients of variation were similar for results by Enterococcus QPCR and culture-based methods during both studies but were higher for E. coli QPCR results in the first study. Regarding the concentration at which beach management decisions are issued in the State of California, the agreement between results of Enterococcus QPCR and EPA method 1600 was 88%, compared to 94% agreement between EPA method 1600 and Enterolert. The beach management decision agreement between E. coli QPCR and Colilert-18 was 94%. The samples showing disagreement suggested an underestimation bias for QPCR.

Estimated human health risks from exposure to recreational waters impacted by human and non-human sources of faecal contamination

This work was conducted to determine whether estimated risks following exposure to recreational waters impacted by gull, chicken, pig, or cattle faecal contamination are substantially different than those associated with waters impacted by human sources such as treated wastewater. Previously published Quantitative Microbial Risk Assessment (QMRA) methods were employed and extended to meet these objectives. Health outcomes used in the analyses were infection from reference waterborne pathogens via ingestion during recreation and subsequent gastrointestinal (GI) illness. Illness risks from these pathogens were calculated for exposure to faecally contaminated recreational water at the U.S. regulatory limits of 35 cfu 100 mL(-1) enterococci and 126 cfu 100 mL(-1)Escherichia coli. The probabilities of GI illness were calculated using pathogen dose-response relationships from the literature and Monte Carlo simulations. Three scenarios were simulated, representing a range of feasible interpretations of the available data. The primary findings are that: 1) GI illness risks associated with exposure to recreational waters impacted by fresh cattle faeces may not be substantially different from waters impacted by human sources; and 2) the risks associated with exposure to recreational waters impacted by fresh gull, chicken, or pig faeces appear substantially lower than waters impacted by human sources. These results suggest that careful consideration may be needed in the future for the management of recreational waters not impacted by human sources.

Performance of CHROMagar Staph aureus and CHROMagar MRSA for detection of Staphylococcus aureus in seawater and beach sand--comparison of culture, agglutination, and molecular analyses

Beach seawater and sand were analyzed for Staphylococcus aureus and methicillin resistant S. aureus (MRSA) for samples collected from Avalon, and Doheny Beach, CA. Membrane filtration followed by incubation on CHROMagar Staph aureus (SCA) and CHROMagar MRSA (C-MRSA) was used to enumerate S. aureus and MRSA, respectively. Media performance was evaluated by comparing identification via colony morphology and latex agglutination tests to PCR (clfA, 16S, and mecA genes). Due to background color and crowding, picking colonies from membrane filters and streaking for isolation were sometimes necessary. The specificity of SCA and C-MRSA was improved if colony isolates were identified by the presence of a matte halo in addition to mauve color; however routine agglutination testing of isolates did not appear warranted. Using the appearance of a colony on the membrane filter in conjunction with isolate appearance, the positive % agreement, the negative % agreement, and the % positive predictive accuracy for SCA was 84%, 95%, and 99% respectively, and for C-MRSA it was 85%, 98%, and 92%, respectively. Sensitivity and specificity of SCA and C-MRSA with membrane-filtered beach samples were optimized through identification experience, control of filter volume and incubation time, and isolation of colonies needing further identification. With optimization, SCA and C-MRSA could be used for enumeration of S. aureus and MRSA from samples of beach water and sand. For the sites studied here, the frequency of detection of S. aureus ranged from 60 to 76% and 53 to 79% for samples of beach seawater and sand, respectively. The frequency of detection of MRSA ranged from 2 to 9% and 0 to 12% for samples of seawater and sand, respectively.

Viruses in recreational water-borne disease outbreaks: a review

Viruses are believed to be a significant cause of recreationally associated water-borne disease. However, they have been difficult to document because of the wide variety of illnesses that they cause and the limitations in previous detection methods. Noroviruses are believed to be the single largest cause of outbreaks, which have been documented in the published literature 45% (n = 25), followed by adenovirus (24%), echovirus (18%), hepatitis A virus (7%) and coxsackieviruses (5%). Just under half of the outbreaks occurred in swimming pools (49%), while the second largest outbreak occurred in lakes or ponds (40%). The number of reported outbreaks associated with noroviruses has increased significantly in recent years probably because of better methods for virus detection. Inadequate disinfection was related to 69% (n = 18) of swimming pool outbreaks. A lack of required reporting and nonuniform water quality and chlorination/disinfection standards continues to contribute to water-borne recreational disease outbreaks.

Eukaryotic viruses in wastewater samples from the United States

Human fecal matter contains a large number of viruses, and current bacterial indicators used for monitoring water quality do not correlate with the presence of pathogenic viruses. Adenoviruses and enteroviruses have often been used to identify fecal pollution in the environment; however, other viruses shed in fecal matter may more accurately detect fecal pollution. The purpose of this study was to develop a baseline understanding of the types of viruses found in raw sewage. PCR was used to detect adenoviruses, enteroviruses, hepatitis B viruses, herpesviruses, morbilliviruses, noroviruses, papillomaviruses, picobirnaviruses, reoviruses, and rotaviruses in raw sewage collected throughout the United States. Adenoviruses and picobirnaviruses were detected in 100% of raw sewage samples and 25% and 33% of final effluent samples, respectively. Enteroviruses and noroviruses were detected in 75% and 58% of raw sewage samples, respectively, and both viral groups were found in 8% of final effluent samples. This study showed that adenoviruses, enteroviruses, noroviruses, and picobirnaviruses are widespread in raw sewage. Since adenoviruses and picobirnaviruses were detected in 100% of raw sewage samples, they are potential markers of fecal contamination. Additionally, this research uncovered previously unknown sequence diversity in human picobirnaviruses. This baseline understanding of viruses in raw sewage will enable educated decisions to be made regarding the use of different viruses in water quality assessments.

Web-based investigation of water associated illness in marine bathers

Internet-based methods of disease investigation have proven useful for drinking water and foodborne illness but have not been applied to recreational water illness (RWI) in marine bathers. We analyzed responses to a web-based survey posted by Surfrider Foundation over the period 1996-2005. Subjects (n=1895) were recruited by self-selection via website visitation. Complaints were screened to meet inclusion criteria (n=1190). Demographic characteristics of respondents were assessed as well as the types and severity of their symptoms. Geographic information systems (GIS) were used to examine spatial patterns in survey data. Illness complaints were commonly received in summer from heavily used California beaches. A strong correlation was observed between water quality impairment and the number of illness complaints in coastal counties (r=0.96, p<0.01). Respondents most commonly complained of gastrointestinal symptoms, infections of the sinuses and other upper respiratory ailments. Certain severe symptoms, such as high fevers, severe vomiting and/or diarrhea, seizures, swollen glands, and infections that did not heal properly were also reported. Approximately one-third of respondents sought the care of a physician for their symptoms; however, less than 1% reported being hospitalized. Our findings concerning the nature of the described symptoms as well as the observed seasonal and spatial patterns in the data are consistent with previously published findings of RWI in ocean bathers exposed to sewage and urban runoff. This method of rapid RWI data collection over the web could easily be adopted by health agencies for coordinated disease surveillance.

Reduction of pathogen indicator organisms in dairy wastewater using an ecological treatment system

Ecological treatment systems can provide a sustainable, plant-based alternative to traditional wastewater treatment. One factor essential to the success of these systems is ensuring their ability to reduce coliform concentrations in wastewater. Wastewater is the primary source of fecal contamination in aquatic ecosystems, containing total and fecal coliforms on the order of 10(8)-10(10) and 10(7)-10(9) CFU L(-1), respectively. This study assessed the ability of an ecological treatment system to reduce concentrations of total coliforms and Escherichia coli from dairy wastewater. Low strength wastewater was pumped into the system during July of 2005 and high strength in September 2005. Wastewater passes through a series of anaerobic, aerobic, and clarifier reactors and wetland cells before exiting the system. Regardless of wastewater strength, average total coliform and E. coli concentrations were consistently reduced by at least 99% from influent to effluent, with the majority of the reduction (76%) occurring in the first two reactors. Relationships between internal concentrations of solids and coliforms indicated that increased reduction of solids may further reduce coliform concentrations. Although U.S. Environmental Protection Agency discharge requirements for E. coli were not always met, the substantial reductions achieved indicate that ecological treatment systems have the potential to successfully reduce coliforms in wastewater to meet discharge limits. The results from this study will be used to guide design and management of future ecological treatment systems, so that larger and more consistent coliform reductions can be achieved.

Detection and remediation of human-origin pollution at two public beaches in Virginia using multiple source tracking methods

Two public beaches (Anderson and Hilton) in Newport News, Virginia, were frequently closed to swimming in 2004 due to high Enterococcus spp. counts that exceeded the regulatory standard. The microbial source tracking (MST) methods of antibiotic resistance analysis (ARA) and fluorometry (to detect optical brighteners) were used in the summer of 2004 to determine the origins of fecal pollution at the two beaches. Both MST methods detected substantial human-origin pollution at the two beaches, in locations producing consistently high levels of Enterococcus spp. Investigations by municipal officials led to the fluorometric detection and subsequent repair of sewage infrastructure problems at both beaches. The success of the mitigation efforts was confirmed during the summer of 2005 using ARA and fluorometry, with the results cross-validated by pulsed-field gel electrophoresis (PFGE).

Environmental factors in inflammatory bowel disease: a co-twin control study of a Swedish-Danish twin population

BACKGROUND

Genetics and environmental factors are implicated in the etiology of inflammatory bowel disease (IBD). We studied environmental factors in a population-based Swedish-Danish twin cohort using the co-twin control method.

SUBJECTS AND METHODS

A questionnaire was sent to 317 twin pairs regarding markers of exposures in the following areas: infections/colonization and diet as well as smoking, appendectomy, and oral contraceptives. Odds ratios (OR) were calculated by conditional logistic regression. When confounding appeared plausible, multivariate conditional logistic regression was added. The questions were also divided into topic groups, and adjustment was made for multiple testing within each of the groups.

RESULTS

The response rate to the questionnaire was 83%. In consideration of the study design, only discordant pairs were included (Crohn's disease [CD], n = 102; ulcerative colitis [UC], n = 125). Recurrent gastrointestinal infections were associated with both UC (OR, 8.0; 95% confidence interval [CI], 1.0-64) and CD (OR, 5.5; 95% CI, 1.2-25). Hospitalization for gastrointestinal infections was associated with CD (OR, 12; 95% CI, 1.6-92). Smoking was inversely associated with UC (OR, 0.4; 95% CI, 0.2-0.9) and associated with CD (OR, 2.9; 95% CI, 1.2-7.1).

CONCLUSIONS

The observed associations indicate that markers of possible infectious events may influence the risk of IBD. Some of these effects might be mediated by long-term changes in gut flora or alterations in reactivity to the flora. The influence of smoking in IBD was confirmed.