The role of water use patterns and sewage pollution in incidence of water-borne/enteric diseases along the Ganges river in Varanasi, India

Mechanisms of cholera transmission via environment in India and Bangladesh: state of the science review

OBJECTIVES

Cholera has a long history in India and Bangladesh, the region where six out of the past seven global pandemics have been seeded. The changing climate and growing population have led to global cholera cases remaining high despite a consistent improvement in the access to clean water and sanitation. We aim to provide a holistic overview of variables influencing environmental cholera transmission within the context of India and Bangladesh, with a focus on the mechanisms by which they act.

CONTENT

We identified 56 relevant texts (Bangladesh n = 40, India n = 7, Other n = 5). The results of the review found that cholera transmission is associated with several socio-economic and environmental factors, each associated variable is suggested to have at least one mediating mechanism. Increases in ambient temperature and coastal sea surface temperature support cholera transmission via increases in plankton and a preference of Vibrio cholerae for warmer waters. Increased rainfall can potentially support or reduce transmission via several mechanisms.

SUMMARY AND OUTLOOK

Common issues in the literature are co-variance of seasonal factors, limited access to high quality cholera data, high research bias towards research in Dhaka and Matlab (Bangladesh). A specific and detailed understanding of the relationship between SST and cholera incidence remains unclear.

Characterization of a hemolytic and antibiotic-resistant Pseudomonas aeruginosa strain S3 pathogenic to fish isolated from Mahananda River in India

Virulent strain Pseudomonas aeruginosa isolated from Mahananda River exhibited the highest hemolytic activity and virulence factors and was pathogenic to fish as clinical signs of hemorrhagic spots, loss of scales, and fin erosions were found. S3 was cytotoxic to the human liver cell line (WRL-68) in the trypan blue dye exclusion assay. Genotype characterization using whole genome analysis showed that S3 was similar to P. aeruginosa PAO1. The draft genome sequence had an estimated length of 62,69,783 bp, a GC content of 66.3%, and contained 5916 coding sequences. Eight genes across the genome were predicted to be related to hemolysin action. Antibiotic resistance genes such as class C and class D beta-lactamases, fosA, APH, and catB were detected, along with the strong presence of multiple efflux system genes. This study shows that river water is contaminated by pathogenic P. aeruginosa harboring an array of virulence and antibiotic resistance genes which warrants periodic monitoring to prevent disease outbreaks.

Emerging organic contaminants in the River Ganga and key tributaries in the middle Gangetic Plain, India: Characterization, distribution & controls

The presence and distribution of emerging organic contaminants (EOCs) in freshwater environments is a key issue in India and globally, particularly due to ecotoxicological and potential antimicrobial resistance concerns. Here we have investigated the composition and spatial distribution of EOCs in surface water along a ∼500 km segment of the iconic River Ganges (Ganga) and key tributaries in the middle Gangetic Plain of Northern India. Using a broad screening approach, in 11 surface water samples, we identified 51 EOCs, comprising of pharmaceuticals, agrochemicals, lifestyle and industrial chemicals. Whilst the majority of EOCs detected were a mixture of pharmaceuticals and agrochemicals, lifestyle chemicals (and particularly sucralose) occurred at the highest concentrations. Ten of the EOCs detected are priority compounds (e.g. sulfamethoxazole, diuron, atrazine, chlorpyrifos, perfluorooctane sulfonate (PFOS), perfluorobutane sulfonate, thiamethoxam, imidacloprid, clothianidin and diclofenac). In almost 50% of water samples, sulfamethoxazole concentrations exceeded predicted no-effect concentrations (PNECs) for ecological toxicity. A significant downstream reduction in EOCs was observed along the River Ganga between Varanasi (Uttar Pradesh) and Begusarai (Bihar), likely reflecting dilution effects associated with three major tributaries, all with considerably lower EOC concentrations than the main Ganga channel. Sorption and/or redox controls were observed for some compounds (e.g. clopidol), as well as a relatively high degree of mixing of EOCs within the river. We discuss the environmental relevance of the persistence of several parent compounds (notably atrazine, carbamazepine, metribuzin and fipronil) and associated transformation products. Associations between EOCs and other hydrochemical parameters including excitation emission matrix (EEM) fluorescence indicated positive, significant, and compound-specific correlations between EOCs and tryptophan-, fulvic- and humic-like fluorescence. This study expands the baseline characterization of EOCs in Indian surface water and contributes to an improved understanding of the potential sources and controls on EOC distribution in the River Ganga and other large river systems.

Waterborne exposure during non-consumptive domestic use of surface water: a population study across WASH service levels in rural India

Exposure to pathogens from domestic use of surface water is understudied. In many low- and middle-income countries, surface water is used for hygiene, sanitation, amenity, and recreational purposes. In this study, self-reported use of and structured observations at community ponds were collected to measure waterborne exposure across water and sanitation service levels in a rural population of Khorda District, India. Overall, 86% of households (n = 200) reported using ponds on a regular basis. Among observed people (n = 765), 82% put water into their mouth at least once, with a median frequency of five occurrences per visit. Reported and observation data were combined to estimate the proportion (p) of the population that put water in their mouth at least once per day, and their mean daily rate of oral exposure (OE). These were highest for individuals with neither safely managed water nor basic sanitation access (p = 93%, OE = 14 day^-1), but still high among those with both (p = 67%, OE = 6 day^-1). The results suggest widespread exposure to waterborne pathogens in settings where non-potable surface water bodies continue to be used for domestic purposes, even among households with access to safely managed drinking water.

A systematic approach to understand hydrogeochemical dynamics in large river systems: Development and application to the River Ganges (Ganga) in India

Large river systems, such as the River Ganges (Ganga), provide crucial water resources for the environment and society, yet often face significant challenges associated with cumulative impacts arising from upstream environmental and anthropogenic influences. Understanding the complex dynamics of such systems remains a major challenge, especially given accelerating environmental stressors including climate change and urbanization, and due to limitations in data and process understanding across scales. An integrated approach is required which robustly enables the hydrogeochemical dynamics and underpinning processes impacting water quality in large river systems to be explored. Here we develop a systematic approach for improving the understanding of hydrogeochemical dynamics and processes in large river systems, and apply this to a longitudinal survey (> 2500 km) of the River Ganges (Ganga) and key tributaries in the Indo-Gangetic basin. This framework enables us to succinctly interpret downstream water quality trends in response to the underpinning processes controlling major element hydrogeochemistry across the basin, based on conceptual water source signatures and dynamics. Informed by a 2019 post-monsoonal survey of 81 river bank-side sampling locations, the spatial distribution of a suite of selected physico-chemical and inorganic parameters, combined with segmented linear regression, reveals minor and major downstream hydrogeochemical transitions. We use this information to identify five major hydrogeochemical zones, characterized, in part, by the inputs of key tributaries, urban and agricultural areas, and estuarine inputs near the Bay of Bengal. Dominant trends are further explored by investigating geochemical relationships (e.g. Na:Cl, Ca:Na, Mg:Na, Sr:Ca and NO₃:Cl), and how water source signatures and dynamics are modified by key processes, to assess the relative importance of controls such as dilution, evaporation, water-rock interactions (including carbonate and silicate weathering) and anthropogenic inputs. Mixing/dilution between sources and water-rock interactions explain most regional trends in major ion chemistry, although localized controls plausibly linked to anthropogenic activities are also evident in some locations. Temporal and spatial representativeness of river bank-side sampling are considered by supplementary sampling across the river at selected locations and via comparison to historical records. Limitations of such large-scale longitudinal sampling programs are discussed, as well as approaches to address some of these inherent challenges. This approach brings new, systematic insight into the basin-wide controls on the dominant geochemistry of the River Ganga, and provides a framework for characterising dominant hydrogeochemical zones, processes and controls, with utility to be transferable to other large river systems.

Assessing Waterborne Disease Vulnerabilities in the Blocks of Kalahandi District of Odisha, India

Background:

Outbreaks of waterborne diseases caused by the contamination of water in the rural and tribal regions have become an area of prime concern in the research arena. The impact and intensity of waterborne diseases are expected to increase in these socioeconomic backward regions.

Objective:

The purpose of the study is to calculate the waterborne disease vulnerability index (DVI) for 13 blocks of the Kalahandi district of Odisha. Diarrhea and typhoid are two major diseases prevailing in each block of the district.

Materials and Methods:

Livelihood vulnerability index has been applied with some modifications to calculate the DVI for each block. In the DVI calculation, diseases are taken as an indicator for the exposure section. The sensitivity and adaptive capacity sections are categorized into two subcomponents to study the vulnerability of each block.

Results:

We have observed uneven distribution of diarrhea and typhoid among the blocks of Kalahandi. The result indicates that vulnerable populations and infrastructure play an important role in enhancing vulnerability whereas educational and health-care capacity reduces its impact. We have found that more than 50% of blocks in the district are categorized in moderate to high vulnerable zones.

Conclusion:

This study is done to understand the relationship between disease exposure, related vulnerability, and adaptive capacity. It is unique in the way the indicators have been chosen in the proposed method for the calculation of DVI and will have a higher degree of practical applicability.

Prevalence of human pathogenic viruses in wastewater: A potential transmission risk as well as an effective tool for early outbreak detection for COVID-19

Millions of human pathogenic viral particles are shed from infected individuals and introduce into wastewater, subsequently causing waterborne diseases worldwide. These viruses can be transmitted from wastewater to human beings via direct contact and/or ingestion/inhalation of aerosols. Even the advanced wastewater treatment technologies are unable to remove pathogenic viruses from wastewater completely, posing a serious health risk. Recently, coronavirus disease 2019 (COVID-19) has been urged globally due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which has resulted in >4.1 million deaths until July 2021. A rapid human-to-human transmission, uncertainties in effective vaccines, non-specific medical treatments, and unclear symptoms compelled the world into complete lockdown, social distancing, air-travel suspension, and closure of educational institutions, subsequently damaging the global economy and trade. Although, few medical treatments, rapid detection tools, and vaccines have been developed so far to curb the spread of COVID-19; however, several uncertainties exist in their applicability. Further, the acceptance of vaccines among communities is lower owing to the fear of side effects such as blood-clotting and heart inflammation. SARS-CoV-2, an etiologic agent of COVID-19, has frequently been detected in wastewater, depicting a potential transmission risk to healthy individuals. Contrarily, the occurrence of SARS-CoV-2 in wastewater can be used as an early outbreak detection tool via water-based epidemiology. Therefore, the spread of SARS-CoV-2 through fecal-oral pathway can be reduced and any possible outbreak can be evaded by proper wastewater surveillance. In this review, wastewater recycling complications, potential health risks of COVID-19 emergence, and current epidemiological measures to control COVID-19 spread have been discussed. Moreover, the viability of SARS-CoV-2 in various environments and survival in wastewater has been reviewed. Additionally, the necessary actions (vaccination, face mask, social distancing, and hand sanitization) to limit the transmission of SARS-CoV-2 have been recommended. Therefore, wastewater surveillance can serve as a feasible, efficient, and reliable epidemiological measure to lessen the spread of COVID-19.

Effectiveness of solar water disinfection in the era of COVID-19 (SARS-CoV-2) pandemic for contaminated water/wastewater treatment considering UV effect and temperature

Long is the way and hard, that out of COVID-19 leads up to light. The virus is highly contagious and spread rapidly and the number of infections increases exponentially. The colossal number of infections and presence of the novel coronavirus RNA in human wastes (e.g. Excreta/urine) even after the patients recovered and the RT-PCR tests were negative, results in massive load of the viral in water environments. Numerous studies reported the presence of SARS-CoV-2 in wastewater samples. The risk of contaminating water bodies in the regions which suffer from the lack of proper sanitation system and wastewater treatment plants (mostly in developing countries) is higher. Since solar water disinfection (SODIS) is usually used by people in developing countries, there is a concern about using this method during the pandemic. Because the SARS-CoV-2 can be eliminated by high temperature (>56 °C) and UVC wavelength (100-280 nm) while SODIS systems mainly work at lower temperature (<45 °C) and use the available UVA (315-400 nm). Thus, during a situation like the ongoing pandemic using SODIS method for wastewater treatment (or providing drinking water) is not a reliable method. It should be reminded that the main aim of the present study is not just to give insights about the possibilities and risks of using SODIS during the ongoing pandemic but it has broader prospect for any future outbreak/pandemic that results in biological contamination of water bodies. Nevertheless, some experimental studies seem to be necessary by all researchers under conditions similar to developing countries.

Reliability of thermal desalination (solar stills) for water/wastewater treatment in light of COVID-19 (novel coronavirus "SARS-CoV-2") pandemic: What should consider?

The COVID-19 pandemic disturbed the world from the beginning of 2020. The high excessive number of patients and the presence of the SARS-CoV-2 in human excreta and urine even after the infected person's respiratory tests were negative, results in a heavy load of viral in various water bodies and mostly untreated wastewaters. In the present study, the reliability of using small-scale solar thermal desalination systems (solar stills) during a situation like the COVID-19 pandemic is discussed. Pollution of water bodies through the SARS-CoV-2 via numerous routes increases the risk of contaminating the feed water and subsequently the whole structure of solar stills. Since the transmission of pathogens (particle size: 0.5-3 μm) via droplets of water in solar still is reported before, transmitting of SARS-CoV-2 via droplets of water which multiple times smaller (particle size: 60-140 nm) than those pathogens is a concern. The most important issue which must be highlighted is that solar stills worked at low-temperature while the viability and survival of the SARS-CoV-2 in various water matrices in the temperature range (4-37 °C) for several days is reported. In this regard, using solar stills during the COVID-19 pandemic need further consideration by all researchers and people around the world.

Development of a multiclass method to quantify phthalates, pharmaceuticals, and personal care products in river water using ultra-high performance liquid chromatography coupled with quadrupole hybrid Orbitrap mass spectrometry

RATIONALE

The organic micropollutants such as phthalates, pharmaceuticals, and personal care products (PPPCPs) enter the surface water through various routes. The aim of this study is to develop a sensitive and efficient method to identify and quantify 26 PPPCPs found in river water with acceptable accuracy and precision using a liquid chromatograph hyphenated with quadrupole hybrid Orbitrap mass spectrometry (Q-Orbitrap-MS) in a single chromatographic run.

METHOD

The organic micropollutants were extracted from river water by solid-phase extraction (SPE) using hydrophilic-lipophilic balance sorbent and analyzed using an ultra-high performance liquid chromatograph (UHPLC) equipped with C18 stationary phase for chromatographic separation. The targeted mass experiments were conducted in a Q-Orbitrap-MS system in positive and negative electrospray ionization mode.

RESULTS

The method was found to be linear in the concentration range of 1-125 ng/L with coefficient of determination lying in the range of 0.995-0.999. The method achieved limit of quantification in the range of 0.41-1.72 ng/L, and method recovery measured at three different concentrations was found to be in the range of 75-115%. Intra- and interday precision expressed as percent relative standard deviation was found to be <15%. Matrix effect was found to be in the range of 83.5-109.79%. The matrix match calibration was used for quantification of PPPCPs in river water sample. The method performance was evaluated by analyzing real samples collected from Ganga River, and the concentrations of 21 analytes were found to be in the range of 0.76-9.49 ng/L for pharmaceuticals, 1.49-8.67 ng/L for phthalates, and 0.9-7.58 ng/L for personal care products.

CONCLUSIONS

The present method was found to be precise, sensitive, and rapid to determine 26 PPPCPs including phthalates in river water samples using SPE-UHPLC-Q-Orbitrap-MS.

Review of Methods Suitable for Environmental Surveillance of Salmonella Typhi and Paratyphi

Typhoid fever is an enteric disease caused by the pathogens Salmonella Typhi and Salmonella Paratyphi. Clinical surveillance networks are lacking in many affected areas, thus presenting a need to understand transmission and population prevalence. Environmental surveillance (ES) has been suggested as a potentially effective method in the absence of (or in supplement to) clinical surveillance. This review summarizes methods identified in the literature for sampling and detection of typhoidal Salmonella from environmental samples including drinking water, wastewater, irrigation water, and surface waters. Methods described use a trap or grab sampling approach combined with various selective culture and molecular methods. The level to which the performance of identified methods is characterized for ES in the literature is variable, thus arguing for the optimization and standardization of ES techniques.

Cholera Outbreak in Hadhramout, Yemen: The Epidemiological Weeks 2019

Background and aims: Cholera is a disease of acute watery diarrhea caused by Vibrio cholerae usually transmitted through contaminated water. In this study, we collected and analyzed the related epidemiological data to determine cholera outbreak in Hadhramout, Yemen during the disease epidemic in 2019. Methods: A cross-sectional study was conducted according to screening rapid diagnostic and confirmatory laboratory culture testing methods for diagnosing clinically cholera cases. Results: Suspected cholera cases were tested by rapid diagnostic test (RDT) and 399 (50.5%) out of 794 cases were determined positive, and 76(9.6%) of them were confirmed by laboratory culture test (LCT) with statistically significant difference. Serotype V. cholerae O1 was also detected in patients’ diarrhea. Females were the most affected by the disease manifested in 201 (25.3%) and 43 (5.4%) when tested by RDT and LCT, respectively, with no statistically significant difference. The highest proportion of cholera cases (224) were reported in the age group less than 15 years (56.1%) with statistically significant difference when tested by RDT, and 45(13.3%) when tested by LCT with insignificant statistics difference. Hajr directorate was revealed to be the most affected with 242 (30.47%) followed by Mukalla city directorate with 108 (13.60%) when the cases were tested by RDT; while Hajr and Mukalla city directorates reported 55 (7.0%) and 15 (2.0%), respectively, when it was confirmed by LCT with a statistically significant difference. Conclusion: Severe cholera outbreak occurred during the epidemiological weeks in 2019 in Hadhramout coast. V. cholerae O1 serotype was the causative agent of cholera. Females and age group less than 15 years were the most affected by the disease. Hajr and Mukalla city directorates reported serious outbreak cholera cases.

Nature rejuvenation: Long-term (1989-2016) vs short-term memory approach based appraisal of water quality of the upper part of Ganga River, India

The deteriorating water quality (WQ) of the sacred north-flowing perennial Indian River, Ganga was a serious concern in recent decades for population adjoining to the river and policy planners. The present evaluation attempts to assess the long-term (1989-2016) physiochemical characteristics of WQ of river Ganga at five upstream locations (Uttarkashi, Tehri, Rudraprayag, Devprayag, and Rishikesh) of Uttarakhand, India using comprehensive pollution index (CPI) and environmetrics (PCA and CA). These methods were used to categorize, summarize expensive datasets, and grouping the similar polluted areas along the river stretches. The WQ of river at all the locations were within the good category and most of the physiochemical parameters were well within their acceptable limit for drinking WQ. Considerably, CPI demonstrated the river WQ was in slight pollution range (CPI: 0.40-1.00) in the year 2007 and 2015 at all the five locations. The positive correlation coefficient (R² > 0.50) among NO₂ + NO₃, Ca, Na, B, and K indicates the significant contribution of organic and inorganic salts through runoffs from catchments due to weathering of rocks. PCA confirmed the input source of nutrients in the river from both natural and anthropogenic sources. Moreover, the upstream WQ assessed was found to be good as compared to the severely polluted downstream region. Due to COVID-19 and shutdown in the country, reduction of pollution load in the river was observed due to the rejuvenation capability of river Ganga. This information can assist the environmentalist, policymaker, and water resources planners & managers to prepare strategic planning in advance to maintain the aesthetic and cultural value of Ganga river in future.

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.

Effective data convergence, mapping, and pollution categorization of ghats at Ganga River Front in Varanasi

Rivers support life of Indian population but water pollution threatens human health. There is no consensus data for water quality (WQ) of rivers in India including River Ganga. For robust stakeholder participation and community involvement and governance, a consolidation of WQ parameters for River Ganga from different data sources is essentially needed. The priority to combat environmental, economic, and social dislocations due to river pollution also necessitates WQ data convergence, its availability in public domain for policy makers, citizens, researchers, etc, and mapping with respect to the flowing river. Lack of real-time data limits civic involvement in river management. This paper is a novel attempt to consolidate the WQ data available in literature for River Ganga at Varanasi during 1992-2016. Results indicate water of River Ganga to have high coliform and BOD levels due to direct discharge of sewage waste from Varuna and that from Varanasi city. Categorization of ghats based on WQ parameters reveal pollution status of ghats to vary from low to highly polluted (coliform data excluded as it changes the category of all the ghats to highly polluted). More urban population with lack of readiness of authorities to follow the law appear to be major contributors towards failure of river management strategies. The consolidated information mapped with demographic data can be used as data management tools for sustenance of River Ganga. A need for change in policy framework and publicizing the real-time data seem key solutions for improving water quality of River Ganga at Varanasi.

Assessment of Water Quality Across Irrigation Schemes: A Case Study of Wetland Agriculture Impacts in Kilombero Valley, Tanzania

Coupled change in land and water use due to increased farming intensity is a main factor affecting water quality and quantity, ecological functions and biodiversity globally. Prolonging growing seasons and increasing productivity in wetlands through irrigation have been targeted for increasing food security, particularly in developing countries. Nevertheless, irrigation and drainage have often been associated with degradation of water quality through increased agrochemical and fertiliser runoff and leaching at local scales. In this study, we investigated water quality in streams used for irrigation in a wetland area in Kilombero Valley, Tanzania. We measured physical-chemical water parameters and collected macroinvertebrates with different sensitivity to water quality across several small irrigation schemes covering various conditions. Turbidity, temperature, nitrate-N, and ammonium-N were significantly higher at sampling sites downstream of irrigation compared to upstream. Macroinvertebrate diversity, richness and average score per taxa (ASPT) were higher in general in sampling sites upstream of irrigation, with more sensitive macroinvertebrates decreasing in abundance downstream. There was a positive correlation between physical-chemical parameters and macroinvertebrate indices across the sites. We demonstrate that macroinvertebrate indices can be used as a quick assessment of water quality in response to irrigation schemes in small-scale farming systems of Tanzania. This in turn can allow us to track changes affecting wetland ecosystem function and biodiversity at higher trophic levels and across larger scales, thereby providing useful early warnings to help avoid widespread degradation under widespread agricultural intensification.

Role of Environmental Factors in Shaping Spatial Distribution of Salmonella enterica Serovar Typhi, Fiji

Fiji recently experienced a sharp increase in reported typhoid fever cases. To investigate geographic distribution and environmental risk factors associated with Salmonella enterica serovar Typhi infection, we conducted a cross-sectional cluster survey with associated serologic testing for Vi capsular antigen–specific antibodies (a marker for exposure to Salmonella Typhi in Fiji in 2013. Hotspots with high seroprevalence of Vi-specific antibodies were identified in northeastern mainland Fiji. Risk for Vi seropositivity increased with increased annual rainfall (odds ratio [OR] 1.26/quintile increase, 95% CI 1.12–1.42), and decreased with increased distance from major rivers and creeks (OR 0.89/km increase, 95% CI 0.80–0.99) and distance to modeled flood-risk areas (OR 0.80/quintile increase, 95% CI 0.69–0.92) after being adjusted for age, typhoid fever vaccination, and home toilet type. Risk for exposure to Salmonella Typhi and its spatial distribution in Fiji are driven by environmental factors. Our findings can directly affect typhoid fever control efforts in Fiji.

Deep urban groundwater vulnerability in India revealed through the use of emerging organic contaminants and residence time tracers

Demand for groundwater in urban centres across Asia continues to rise with ever deeper wells being drilled to avoid shallow contamination. The vulnerability of deep alluvial aquifers to contaminant migration is assessed in the ancient city of Varanasi, India, using a novel combination of emerging organic contaminants (EOCs) and groundwater residence time tracers (CFC and SF₆). Both shallow and intermediate depth private sources (<100 m) and deep (>100 m) municipal groundwater supplies were found to be contaminated with a range of EOCs including pharmaceuticals (e.g. sulfamethoxazole, 77% detection frequency, range <0.0001-0.034 μg L^-1), perfluoroalkyl substances (e.g. PFOS, range <0.0001-0.033 μg L^-1) as well as a number of pesticides (e.g. phenoxyacetic acid, range <0.02-0.21 μg L^-1). The profile of EOCs found in groundwater mirror those found in surface waters, albeit at lower concentrations, and reflect common waste water sources with attenuation in the subsurface. Mean groundwater residence times were found to be comparable between some deep groundwater and shallow groundwater sources with residence times ranging from >70 to 30 years. Local variations in aquifer geology influence the extent of modern recharge at depth. Both tracers provide compelling evidence of significant inputs of younger groundwater to depth >100 m within the aquifer system.

Ganga water pollution: A potential health threat to inhabitants of Ganga basin

BACKGROUND

The water quality of Ganga, the largest river in Indian sub-continent and life line to hundreds of million people, has severely deteriorated. Studies have indicated the presence of high level of carcinogenic elements in Ganga water.

OBJECTIVES

We performed extensive review of sources and level of organic, inorganic pollution and microbial contamination in Ganga water to evaluate changes in the level of various pollutants in the recent decade in comparison to the past and potential health risk for the population through consumption of toxicant tainted fishes in Ganga basin.

METHODS

A systematic search through databases, specific websites and reports of pollution regulatory agencies was conducted. The state wise level of contamination was tabulated along the Ganga river. We have discussed the major sources of various pollutants with particular focus on metal/metalloid and pesticide residues. Bioaccumulation of toxicants in fishes of Ganga water and potential health hazards to humans through consumption of tainted fishes was evaluated.

RESULTS

The level of pesticides in Ganga water registered a drastic reduction in the last decade (i.e. after the establishment of National Ganga River Basin Authority (NGRBA) in 2009), still the levels of some organochlorines are beyond the permissible limits for drinking water. Conversely the inorganic pollutants, particularly carcinogenic elements have increased several folds. Microbial contamination has also significantly increased. Hazard quotient and hazard index indicated significant health risk due to metal/metalloid exposure through consumption of tainted fishes from Ganga. Target cancer risk assessment showed high carcinogenic risk from As, Cr, Ni and Pb as well as residues of DDT and HCHs.

CONCLUSION

Current data analysis showed that Ganga water quality is deteriorating day by day and at several places even in upper stretch of Ganga the water is not suitable for domestic uses. Although there is positive impact of ban on persistent pesticides with decreasing trend of pesticide residues in Ganga water, the increasing trend of trace and toxic elements is alarming and the prolong exposure to polluted Ganga water and/or consumption of Ganga water fishes may cause serious illness including cancer.

A Perspective on the Global Pandemic of Waterborne Disease

Waterborne diseases continue to take a heavy toll on the global community, with developing nations, and particularly young children carrying most of the burden of morbidity and mortality. Starting with the historical context, this article explores some of the reasons why this burden continues today, despite our advances in public health over the past century or so. While molecular biology has revolutionized our abilities to define the ecosystems and etiologies of waterborne pathogens, control remains elusive. Lack of basic hygiene and sanitation, and failing infrastructure, remain two of the greatest challenges in the global fight against waterborne disease. Emerging risks continue to be the specter of multiple drug resistance and the ease with which determinants of virulence appear to be transmitted between strains of pathogens, both within and outside the human host.

Multiplex PCR based genotypic characterization of pathogenic vancomycin resistant Enterococcus faecalis recovered from an Indian river along a city landscape

BACKGROUND

Enterococci are normal commensals of human gut, but vancomycin-resistant enterococci (VRE) are a severe threat to human health. Antimicrobial-resistant enterococci have been reported previously from Indian surface waters. However, the presence of antimicrobial resistance and virulence markers in Enterococcus faecalis, the most dominant enterococci is yet to be investigated.

OBJECTIVES

The goal of this study was to analyse concentration of enterococci and distribution of antimicrobial resistance and virulence markers in E. faecalis isolates from river waters along an important north Indian city landscape.

METHODS

We enumerated enterococci in river water samples (n = 60) collected from five sites across the Lucknow city landscape using the most probable number and membrane-filtration methods. The antimicrobial sensitivity profile of E. faecalis isolate was generated with the Kirby-Bauer antimicrobial disc diffusion assay. The multiplex PCR was used for genotypic characterization of vancomycin-resistance and virulence in E. faecalis isolates.

RESULTS

Enterococci density (p < 0.0001) increased from up-to-down-stream sites. Multiplex PCR based genotypic characterization has shown a significant distribution of virulence-markers gelE, ace or efaA in the E. faecalis isolates (p < 0.05). The range of antimicrobial-resistance varied from 5 to 12 in the landscape with the frequency of vancomycin-resistant E. faecalis (VRE) ranging from 22 to 100 %.

CONCLUSION

The occurrence of pathogenic VRE in river Gomti surface water is an important health concern. The observed high background pool of resistance and virulence in E. faecalis in river waters has the potential to disseminate more alarming antimicrobial resistance in the environment and poses serious health risk in developing countries like India as VRE infections could lead to increased cost of healthcare.

Antibiotics and Antibiotic Resistance in Agroecosystems: State of the Science

We propose a simple causal model depicting relationships involved in dissemination of antibiotics and antibiotic resistance in agroecosystems and potential effects on human health, functioning of natural ecosystems, and agricultural productivity. Available evidence for each causal link is briefly summarized, and key knowledge gaps are highlighted. A lack of quantitative estimates of human exposure to environmental bacteria, in general, and antibiotic-resistant bacteria, specifically, is a significant data gap hindering the assessment of effects on human health. The contribution of horizontal gene transfer to resistance in the environment and conditions that might foster the horizontal transfer of antibiotic resistance genes into human pathogens also need further research. Existing research has focused heavily on human health effects, with relatively little known about the effects of antibiotics and antibiotic resistance on natural and agricultural ecosystems. The proposed causal model is used to elucidate gaps in knowledge that must be addressed by the research community and may provide a useful starting point for the design and analysis of future research efforts.

[Risk of contamination from exposure to Rio Doce water: a case study on the population's perceptions in Tumiritinga, Minas Gerais State, Brazil]

The close relationship between local residents and the Rio Doce and the river's recurrent flooding lead to continuous exposure of the population to waterborne diseases. Given the epidemiological importance of such diseases in the region, this study analyzes the association between risk perception of contamination and river water use, as well as the heuristic mechanisms used by individuals to shape their personal perception of risk. Regression models coupled with thematic network analysis were applied to primary data from 352 households in 2012. The data are representative of urban residents of Tumiritinga, Minas Gerais State, Brazil. The results show that while 92.6% of respondents perceived high risk of waterborne diseases, only 11.4% reported not making direct use of the river. This apparent paradox is explained by the lack of information on transmission mechanisms, underestimating the perception of contamination. Public campaigns to promote preventive behavior should stress how waterborne diseases are transmitted, using simple examples to reach a wider local audience.

Spatial Variability of Escherichia coli in Rivers of Northern Coastal Ecuador

The use of contaminated surface water continues to be a pressing issue in areas of the world where people lack improved drinking water sources. In northern coastal Ecuador, many communities rely on untreated surface water as their primary source of drinking water. We undertook a study to explore how microscale river hydrodynamics affect microbial water quality at community water collection locations at three rivers with varying stream velocity and turbidity profiles. To examine how the distance from river shore and physiochemical water quality variables affect microbial contamination levels in the rivers; we collected a total of 355 water samples within six villages on three rivers; and tested for Escherichia coli concentrations using the IDEXX Quanti-tray method. We found that log₁₀E. coli concentrations decreased with increasing distance from shore (β = −0.017; p = 0.003). Water in the main channel had E. coli concentrations on average 0.12 log₁₀ lower than within eddies along the river shore and 0.27 log₁₀ lower between the sample closest to shore and any sample >6 m from the shore. Higher E. coli concentrations were also significantly associated with increased turbidity (β = 0.003; p < 0.0001) and decreased dissolved oxygen levels (β = −0.310; p < 0.0001). The results of this study can help inform community members about the safest locations to collect drinking water and also provide information on watershed scale transport of microbial contaminants between villages.

Midichlorians--the biomeme hypothesis: is there a microbial component to religious rituals?

Background

Cutting edge research of human microbiome diversity has led to the development of the microbiome-gut-brain axis concept, based on the idea that gut microbes may have an impact on the behavior of their human hosts. Many examples of behavior-altering parasites are known to affect members of the animal kingdom. Some prominent examples include Ophiocordyceps unilateralis (fungi), Toxoplasma gondii (protista), Wolbachia (bacteria), Glyptapanteles sp. (arthropoda), Spinochordodes tellinii (nematomorpha) and Dicrocoelium dendriticum (flat worm). These organisms belong to a very diverse set of taxonomic groups suggesting that the phenomena of parasitic host control might be more common in nature than currently established and possibly overlooked in humans.

Presentation of the hypothesis

Some microorganisms would gain an evolutionary advantage by encouraging human hosts to perform certain rituals that favor microbial transmission. We hypothesize that certain aspects of religious behavior observed in the human society could be influenced by microbial host control and that the transmission of some religious rituals could be regarded as the simultaneous transmission of both ideas (memes) and parasitic organisms.

Testing the hypothesis

We predict that next-generation microbiome sequencing of samples obtained from gut or brain tissues of control subjects and subjects with a history of voluntary active participation in certain religious rituals that promote microbial transmission will lead to the discovery of microbes, whose presence has a consistent and positive association with religious behavior. Our hypothesis also predicts a decline of participation in religious rituals in societies with improved sanitation.

Implications of the hypothesis

If proven true, our hypothesis may provide insights on the origin and pervasiveness of certain religious practices and provide an alternative explanation for recently published positive associations between parasite-stress and religiosity. The discovery of novel microorganisms that affect host behavior may improve our understanding of neurobiology and neurochemistry, while the diversity of such organisms may be of interest to evolutionary biologists and religious scholars.

Reviewers

This article was reviewed by Prof. Dan Graur, Dr. Rob Knight and Dr. Eugene Koonin

Cholera outbreaks in India

Cholera is a global health problem as several thousands of cases and deaths occur each year. The unique epidemiologic attribute of the disease is its propensity to occur as outbreaks that may flare-up into epidemics, if not controlled. The causative bacterial pathogen Vibrio cholerae prevails in the environment and infects humans whenever there is a breakdown in the public health component. The Indian subcontinent is vulnerable to this disease due its vast coastlines with areas of poor sanitation, unsafe drinking water, and overcrowding. Recently, it was shown that climatic conditions also play a major role in the persistence and spread of cholera. Constant change in the biotypes and serotypes of V. cholerae are also important aspects that changes virulence and survival of the pathogen. Such continuous changes increase the infection ability of the pathogen affecting the susceptible population including the children. The short-term carrier status of V. cholerae has been studied well at community level and this facet significantly contributes to the recurrence of cholera. Several molecular tools recognized altering clonality of V. cholerae in relation with the advent of a serogroup or serotype. Rapid identification systems were formulated for the timely detection of the pathogen so as to identify and control the outbreak and institute proper treatment of the patients. The antimicrobials used in the past are no longer useful in the treatment of cholera as V. cholerae has acquired several mechanisms for multiple antimicrobial resistance. This upsurge in antimicrobial resistance directly influences the management of the disease. This chapter provides an overview of cholera prevalence in India, possible sources of infection, and molecular epidemiology along with antimicrobial resistance of V. cholerae.

Potential human pathogenic bacteria in a mixed urban watershed as revealed by pyrosequencing

Current microbial source tracking (MST) methods for water depend on testing for fecal indicator bacterial counts or specific marker gene sequences to identify fecal contamination where potential human pathogenic bacteria could be present. In this study, we applied 454 high-throughput pyrosequencing to identify bacterial pathogen DNA sequences, including those not traditionally monitored by MST and correlated their abundances to specific sources of contamination such as urban runoff and agricultural runoff from concentrated animal feeding operations (CAFOs), recreation park area, waste-water treatment plants, and natural sites with little or no human activities. Samples for pyrosequencing were surface water, and sediment collected from 19 sites. A total of 12,959 16S rRNA gene sequences with average length of ≤400 bp were obtained, and were assigned to corresponding taxonomic ranks using ribosomal database project (RDP), Classifier and Greengenes databases. The percent of total potential pathogens were highest in urban runoff water (7.94%), agricultural runoff sediment (6.52%), and Prado Park sediment (6.00%), respectively. Although the numbers of DNA sequence tags from pyrosequencing were very high for the natural site, corresponding percent potential pathogens were very low (3.78–4.08%). Most of the potential pathogenic bacterial sequences identified were from three major phyla, namely, Proteobacteria, Bacteroidetes, and Firmicutes. The use of deep sequencing may provide improved and faster methods for the identification of pathogen sources in most watersheds so that better risk assessment methods may be developed to enhance public health.

Waterborne disease-related risk perceptions in the Sonora River basin, Mexico

Waterborne disease is estimated to cause about 10% of all diseases worldwide. However, related risk perceptions are not well understood, particularly in the developing world where waterborne disease is an enormous problem. We focus on understanding risk perceptions related to these issues in a region within northern Mexico. Our findings show how waterborne disease problems and solutions are understood in eight small communities along a highly contaminated river system. We found major differences in risk perceptions between health professionals, government officials, and lay citizens. Health professionals believed that a high level of human-waste-related risk existed within the region. Few officials and lay citizens shared this belief. In addition, few officials and lay citizens were aware of poor wastewater-management-related disease outbreaks and water contamination. Finally, aside from health professionals, a few interviewees understood the importance of basic hygiene and water treatment measures that could help to prevent disease. Our results add to the literature on environmentally-related risk perceptions in the developing world. We discuss recommendations for improving future human-wastewater-related risk communication within the region.

Megacities as sources for pathogenic bacteria in rivers and their fate downstream

Poor sanitation, poor treatments of waste water, as well as catastrophic floods introduce pathogenic bacteria into rivers, infecting and killing many people. The goal of clean water for everyone has to be achieved with a still growing human population and their rapid concentration in large cities, often megacities. How long introduced pathogens survive in rivers and what their niches are remain poorly known but essential to control water-borne diseases in megacities. Biofilms are often niches for various pathogens because they possess high resistances against environmental stress. They also facilitate gene transfers of antibiotic resistance genes which become an increasing health problem. Beside biofilms, amoebae are carriers of pathogenic bacteria and niches for their survival. An overview about our current understanding of the fate and niches of pathogens in rivers, the multitude of microbial community interactions, and the impact of severe flooding, a prerequisite to control pathogens in polluted rivers, is given.

A survey of perfluorinated compounds in surface water and biota including dolphins from the Ganges River and in other waterbodies in India

Despite the reports of the occurrence of perfluorochemicals (PFCs) in industrialized nations, information on PFCs in less industrialized countries is meager. In the present study, concentrations and profiles of PFCs were investigated in surface waters (rivers, lakes, coastal seas and untreated sewage; n=42) including the Ganges River water, and biota such as shrimp (n=2), fish (n=28), and Ganges River dolphin (Platanista gangetica; n=15). PFOS was the dominant PFC found in most of the samples analyzed including water samples except untreated sewage (water: <0.04-3.91 ng L(-1); biota: 0.248-27.9 ng g(-1) ww). Long-chain (C11-C18) perfluorocarboxylates (PFCAs) were not detected in the water samples (<0.2 ng L(-1)), although PFDA (0.061-0.923 ng g(-1) ww) and PFUnDA (0.072-0.998 ng g(-1) ww) were found in biological samples The arithmetic mean PFOS concentration found in the liver of Ganges River dolphin was 27.9 ng g(-1) ww. Bioconcentration and biomagnifications factors of PFCs were estimated in the Ganges River basin food web. The highest concentration of PFOA, 23.1 ng L(-1), was found in untreated sewage samples. Overall, concentrations of PFCs of water and biological samples from India are lower than the concentrations reported for other countries so far. PFC profiles in Indian waters are dominated by PFOS, followed by PFOA, which is different from the pattern reported for other countries such as Korea, Japan and USA, where PFOA was the predominant compound in waters. The flux estimates for PFOS, PFOA and PFNA from the Ganges River in India to the Bay of Bengal were in the range of several hundreds of kilograms per year.

Two sequential outbreaks in two villages illustrate the various modes of transmission of cholera

We investigated two sequential outbreaks of severe diarrhoea in two neighbouring villages of Orissa, in 2005. We conducted descriptive and matched case-control studies. The attack rates were 5·6% (n=62) and 5·2% (n=51), respectively, in the first and second villages. One death was reported in the second village (case fatality 2%). We identified that consumption of milk products prepared in the household of the index case [matched odds ratio (mOR) 5·7, 95% confidence interval (CI) 1·7–30] in the first village, and drinking well water in the second village were associated with the illness (mOR 4·7, 95% CI 1·6–19). We isolated Vibrio cholerae El Tor O1 Ogawa from stool samples from both the villages. Mishandling of milk products led to a cholera outbreak in the first village, which led to sewerage contamination of a well and another outbreak in the second village. Environmental contamination should be expected and prevented during cholera outbreaks.

Bibliography of environmental studies in natural characteristics and anthropogenic influences on the Ganga River

During the second half of the 20th century, the Ganga River ecosystem has been continuously altered by several ongoing anthropogenic processes, accommodating multi-dimensional pressure due to increase of nearly four-fold human population. For solution of any environmental issues of the river, the Earth System Science approach is required to have maximum socio-economic benefits to millions of people living in Indian and Bangladesh. A bibliography containing more than 250 references on environmental studies of the Ganga River was prepared to preserve its ecosystem by providing the baseline support in this regard.

Urban as a determinant of health

Cities are the predominant mode of living, and the growth in cities is related to the expansion of areas that have concentrated disadvantage. The foreseeable trend is for rising inequities across a wide range of social and health dimensions. Although qualitatively different, this trend exists in both the developed and developing worlds. Improving the health of people in slums will require new analytic frameworks. The social-determinants approach emphasizes the role of factors that operate at multiple levels, including global, national, municipal, and neighborhood levels, in shaping health. This approach suggests that improving living conditions in such arenas as housing, employment, education, equality, quality of living environment, social support, and health services is central to improving the health of urban populations. While social determinant and multilevel perspectives are not uniquely urban, they are transformed when viewed through the characteristics of cities such as size, density, diversity, and complexity. Ameliorating the immediate living conditions in the cities in which people live offers the greatest promise for reducing morbidity, mortality, and disparities in health and for improving quality of life and well being.

Isolation of potentially pathogenic Escherichia coli O157:H7 from the Ganges River

Escherichia coli serotype O157:H7 was detected among bacteria collected from the Ganges River. O157:H7 isolates tested positive for stx(1), stx(2), and eae gene sequences. Identification of potentially pathogenic isolates from extensively used source water indicates that O157:H7 may be a significant but as yet underacknowledged public health concern in India.