Does the public receive and adhere to boil water advisory recommendations? A cross-sectional study in Newfoundland and Labrador, Canada

A hidden risk: Survival and resuscitation of Escherichia coli O157:H7 in the viable but nonculturable state after boiling or microwaving

We report the existence and resuscitation of viable but nonculturable (VBNC) Escherichia coli O157:H7 cells in drinking water induced by the common point-of-use disinfection treatments of boiling or microwaving. Tap water and saline samples containing E. coli O157:H7 culturable cells from a bovine isolate or two clinical isolates were boiled (1, 10, or 15 min) on a hot plate or microwaved (1.5 min) to reach boiling. No culturable E. coli O157:H7 cells were observed in the treated samples using conventional plating methods. In samples boiled for 1 or 10 min, two viability assays separately detected that 2-5.5% of the cells retained an intact membrane, while 28 to 87 cells out of the initial 10⁸ cells retained both measurable intracellular esterase activity and membrane integrity. In samples boiled for 15 min, no viable cells were detected. The microwaved samples contained 6-10% of cells with an intact membrane, while 21 to 108 cells out of the initial 10⁸ cells retained both membrane integrity and esterase activity. The number of viable cells retaining both metabolic activity and membrane integrity were consistent in all samples, supporting the survival of a small number of E. coli O157:H7 cells in the VBNC state after boiling for 1 or 10 min or microwaving. Furthermore, the VBNC E. coli O157:H7 cells regained growth at 37 °C in culture media containing autoinducers produced by common non-pathogenic E. coli, commonly present in the human intestine, and norepinephrine. The resuscitated cells were culturable on conventional plates and expressed mRNA encoding the E. coli O157 lipopolysaccharide gene (rfbE) and the H7 flagellin gene (fliC). This study highlights potential concerns for public health risk management of VBNC E. coli O157:H7 in drinking water disinfected by heat treatment at point-of-use. The public health significance of these concerns warrants further investigation.

Deriving safe short-term chemical exposure values (STEV) for drinking water

Small and brief exceedances of chemicals above their guideline values in drinking water are unlikely to cause an appreciable increased risk to human health. As a result, short-term exposure values (STEV) can be derived to help decide whether drinking water can still be supplied to consumers without adverse health risks. In this study, three approaches were applied to calculate and compare STEV for pesticides. The three approaches included basing a STEV on the acute reference dose (ARfD) (Approach 1), removing conventional attribution rates and uncertainty factors from current guideline values (Approach 2) and extrapolating 1 d and 7 d no observed adverse effect levels (NOAEL) from existing toxicity data using a log-linear regression (Approach 3). Despite being very different methods, the three approaches produced comparable STEV generally within an order of magnitude, which often overlapped with other existing short-term exposure values such as short-term no adverse response levels (SNARL) and health advisories (HA). The results show that adjusting the current guideline value using standard extrapolation factors (Approach 2) often produced the most conservative values. Approach 2 was then applied to two other chemical classes, disinfection by-products (DBPs) and cyanotoxins, demonstrating the wider applicability of the approach.

Compliance with water advisories after water outages in Norway

Background

Water advisories, especially those concerning boiling drinking water, are widely used to reduce risks of infection from contaminants in the water supply. Since the effectiveness of boil water advisories (BWAs) depends on public compliance, monitoring the public response to such advisories is essential for protecting human health. However, assessments of public compliance with BWAs remain sparse. Thus, this study was aimed at investigating awareness and compliance among residents who had received BWAs in Baerum municipality in Norway.

Method

We conducted a cross-sectional study among 2764 residents who had received water advisories by SMS in the municipality of Baerum between January and September 2017. We analysed data from two focus group discussions and an online survey sent to all residents who had received an advisory. We conducted descriptive analyses and calculated odds ratios (OR) using logistic regression to identify associations of compliance and awareness with demographic characteristics.

Results

Of the 611 respondents, 67% reported that they had received a water advisory notification. Effective compliance rate with safe drinking water practices, either by storing clean drinking water or boiling tap water, after a water outage was 72% among those who remembered receiving a notification. Compliance with safe drinking water advisories was lower among men than women (OR 0.53, 95% CI 0.29–0.96), but was independent of age, education and household type. The main reason for respondents’ non-compliance with safe water practices was that they perceived the water to be safe to drink after letting it flush through the tap until it became clear.

Conclusions

Awareness of advisories was suboptimal among residents who had received notifications, but compliance was high. The present study highlights the need to improve the distribution, phrasing and content of water advisory notifications to achieve greater awareness and compliance. Future studies should include hard-to-reach groups with adequate data collection approaches and examine the use of BWAs in a national context to inform future policies on BWAs.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7504-8) contains supplementary material, which is available to authorized users.