Microbiological safety of drinking water: United States and global perspectives

Wilderness Medical Society Clinical Practice Guidelines on Water Treatment for Wilderness, International Travel, and Austere Situations: 2024 Update

To provide guidance to medical providers, wilderness users, and travelers, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for treating water in situations where the potability of available water is not assured, including wilderness and international travel, areas impacted by disaster, and other areas without adequate sanitation. The guidelines present the available methods for reducing or eliminating microbiological contamination of water for individuals, groups, or households; evaluation of their effectiveness; and practical considerations. The evidence base includes both laboratory and clinical publications. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks/burdens according to the criteria published by the American College of Chest Physicians.

Assessment of bacteriological quality and physico-chemical parameters of domestic water sources in Samaru community, Zaria, Northwest Nigeria

The quality of water supply is assessed by its physico-chemical and bacteriological properties. This study was carried-out with the aim of determining the contamination level of domestic water sources of Samaru community, Zaria, Northcentral Nigeria in order to observed the trend of change in quality of these water sources, if any. This was with a view to safeguard the public health of the riparian users against a possible outbreak of water borne diseases. Water samples were collected and analyzed for bacteriological and physicochemical quality using standard procedures. The results showed that the mean values recorded for physico-chemical parameters among the domestic water sources were within stipulated limits of WHO for safe drinking water except for chloride mean value of 314 ± 142.4 mg/L recorded in borehole water. The total heterotrophic bacterial counts recorded in tap, borehole, well, reservoir and river water samples (3.67 × 10⁶ ± 1.25 × 10⁶, 5.67 × 10⁶ ± 8.49 × 10⁵, 2.60 × 10⁷ ± 6.09 × 10⁶, 5.07 × 10⁶ ± 1.59 × 10⁶ and 6.02 × 10⁷ ± 3.69 × 10⁶) exceeded the WHO permissible limits for drinking water (<500 cfu/ml). High abundance of isolated bacteria genus such as Enterobacter, proteus, Escherichia, Salmonella and Shigella were recorded in well, river and reservoir water systems. There was a strong positive correlation between the total bacteria count and physico-chemical parameters, which suggested that the parameters influenced bacterial growth. The occurrence of these bacterial geniuses in the water sources are considered capable to cause potential health consequences for the consumers. Therefore, proper purification and treatment of domestic water sources of the Samaru community should be ensured before being used by the riparian users.

Wilderness Medical Society Clinical Practice Guidelines for Water Disinfection for Wilderness, International Travel, and Austere Situations

To provide guidance to clinicians, the Wilderness Medical Society convened experts to develop evidence-based guidelines for water disinfection in situations where the potability of available water is not ensured, including wilderness and international travel, areas affected by disaster, and other areas without adequate sanitation. The guidelines present the available methods for reducing or eliminating microbiologic contamination of water for individuals, groups, or households; evaluation of their effectiveness; and practical considerations. The evidence evaluation includes both laboratory and clinical publications. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks or burdens, according to the criteria published by the American College of Chest Physicians.

Early detection of E. coli and total coliform using an automated, colorimetric and fluorometric fiber optics-based device

Lack of access to clean water is a major global issue that affects millions of people worldwide. Drinking contaminated water can be extremely hazardous, so it is imperative that it is tested sufficiently. One method commonly used to determine the quality of water is testing for both E. coli and total coliform. Here, we present a cost-effective and automated device which can concurrently test drinking water samples for both E. coli and total coliform using an EPA-approved reagent. Equipped with a Raspberry Pi microcontroller and camera, we perform automated periodic measurements of both the absorption and fluorescence of the water under test over 24 hours. In each test, 100 mL of the water sample is split into a custom designed 40-well plate, where the transmitted blue light and the fluorescent light (under UV excitation) are collected by 520 individual optical fibers. Images of these fiber outputs are then acquired periodically, and digitally processed to determine the presence of the bacteria in each well of the 40-well plate. We demonstrate that this cost-effective device, weighing 1.66 kg, can automatically detect the presence of both E. coli and total coliform in drinking water within ∼16 hours, down to a level of one colony-forming unit (CFU) per 100 mL. Furthermore, due to its automated analysis, this approach is also more sensitive than a manual count performed by an expert, reducing the time needed to determine whether the water under test is safe to drink or not.

Epidemics caused by contamination of drinking water supplied by public water supply systems in terms of current legislation

OBJECTIVES

This paper describes and comments on contemporary legislation concerning prevention of epidemics caused by contaminated drinking water from public water supplies in the Czech Republic.

METHODS

Suggestions are made for removing existing legislative shortcomings, clarifying diction of existing laws and expanding sanctions and penalties for health injury caused by providers and operators of public drinking water.

RESULTS

The author reflects on improving legislation concerning the compensation of victims of contaminated water with reference to the aftermath of a local epidemic in the Dejvice District of Prague.

CONCLUSION

The issues raised should be addressed since better legislation can significantly contribute to the limitation of water-borne epidemics and their consequences.

Green sol-gel synthesis of novel nanoporous copper aluminosilicate for the eradication of pathogenic microbes in drinking water and wastewater treatment

We used a green sol-gel synthesis method to fabricate a novel nanoporous copper aluminosilicate (CAS) material. Nanoporous CAS was characterized using X-ray powder diffraction (XRD), field emission transmission and scanning electron microscopies (FE-TEM/FE-SEM), Fourier transform infrared (FTIR) spectroscopy, and optical analyses. The CAS was also evaluated for use as a promising disinfectant for the inactivation of waterborne pathogens. The antimicrobial action and minimum inhibitory concentration (MIC) of this CAS disinfectant were determined against eight microorganisms (Escherichia coli, Salmonella enterica, Pseudomonas aeruginosa, Listeria monocytogenes, Staphylococcus aureus, Enterococcus faecalis, Candida albicans, and Aspergillus niger). An antimicrobial susceptibility testing of CAS was measured. Results of disc diffusion method pointed out that the diameters of the zone using well diffusion were wider than disc diffusion methods, and the findings also showed that the MIC of the CAS disinfectant against E. coli, S. enterica, and P. aeruginosa was 100 mg/L within 20 min of contact time. Meanwhile, the MIC of the CAS disinfectant was 100 mg/L within 40 min of contact time for the other strains. The efficacy of antimicrobial action (100%) reached within 20 to 40 min against all tested microbes. Herein, the antimicrobial susceptibility testing of CAS disinfectant showed no toxicity for human and bacterial cells. It can be concluded that nanoporous CAS is a promising, economically, and worthy weapon for water disinfection.

Using the wax moth larva Galleria mellonella infection model to detect emerging bacterial pathogens

Climate change, changing farming practices, social and demographic changes and rising levels of antibiotic resistance are likely to lead to future increases in opportunistic bacterial infections that are more difficult to treat. Uncovering the prevalence and identity of pathogenic bacteria in the environment is key to assessing transmission risks. We describe the first use of the Wax moth larva Galleria mellonella, a well-established model for the mammalian innate immune system, to selectively enrich and characterize pathogens from coastal environments in the South West of the UK. Whole-genome sequencing of highly virulent isolates revealed amongst others a Proteus mirabilis strain carrying the Salmonella SGI1 genomic island not reported from the UK before and the recently described species Vibrio injenensis hitherto only reported from human patients in Korea. Our novel method has the power to detect bacterial pathogens in the environment that potentially pose a serious risk to public health.

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.

Inadequate water treatment quality as assessed by protozoa removal in Sarawak, Malaysia

Providing safe drinking-water to human civilization is indispensable; it is one of the most cost-effective means of reducing the disease burden of diarrhea. Unfortunately, water supply quality monitoring from public water treatment plants (WTPs) is often neglected or taken for granted. To determine the produced water quality, WTPs in Sarawak, Malaysia were assessed for their protozoa removal ability. A self-administered questionnaire based on the regulations in the Drinking-water Standards for New Zealand (DWSNZ) was developed. Optional 10-liter raw water samples were collected from willing WTPs for the detection of protozoan cysts. Routine physical and microbial testing of WTP parameters were also requested for raw water quality overview. Two of the nine assessed WTPs achieved three log credits in the treatment component, one of which belonged to Peninsular Malaysia. No log credits were obtained in the other tested components for any samples. Most of the WTPs employed “Coagulation, Sedimentation, and Filtration” using rapid gravity filters without enhancement (P < 0.05). Giardia cysts were detected in raw water sources used for treatment, and the geographical location was identified as an influencing factor for raw water quality. There is an urgent requirement for active collaboration and holistic approaches to review existing water management policies and interventions. WTPs in Sarawak did not achieve the log credits required to safeguard the microbial quality of the water supplied; however, only Giardia cysts were detected in 10-liter raw water samples despite routine microbial parameter monitoring showing disturbing contamination levels.

Monitoring bacterial contamination of piped water supply in rural coastal Bangladesh

Safe drinking water is scarce in southwest coastal Bangladesh because of unavailability of fresh water. Given the high salinity of both groundwater and surface water in this area, harvested rainwater and rain-fed pond water became the main sources of drinking water. Both the government and non-government organizations have recently introduced pipe water supply in the rural coastal areas to ensure safe drinking water. We assessed the bacteriological quality of water at different points along the piped water distribution system (i.e., the source, treatment plant, household taps, street hydrants, and household storage containers) of Mongla municipality under Mongla Upazila in Bagerhat district. Water samples were collected at 2-month interval from May 2014 to March 2015. Median E. coli and total coliform counts at source, treatment plant, household taps, street hydrants, and household storage containers were respectively 225, 4, 7, 7, and 15 cfu/100 ml and 42,000, 545, 5000, 6150, and 18,800 cfu/100 ml. Concentrations of both of the indicator bacteria reduced after treatment, although it did not satisfy the WHO drinking water standards. However, re-contamination in distribution systems and household storage containers indicate improper maintenance of distribution system and lack of personal hygiene.

Cross-Resistance of UV- or Chlorine Dioxide-Resistant Echovirus 11 to Other Disinfectants

The emergence of waterborne viruses with resistance to disinfection has been demonstrated in the laboratory and in the environment. Yet, the implications of such resistance for virus control remain obscure. In this study we investigate if viruses with resistance to a given disinfection method exhibit cross-resistance to other disinfectants. Chlorine dioxide (ClO₂)- or UV-resistant populations of echovirus 11 were exposed to five inactivating treatments (free chlorine, ClO₂, UV radiation, sunlight, and heat), and the extent of cross-resistance was determined. The ClO₂-resistant population exhibited cross-resistance to free chlorine, but to none of the other inactivating treatments tested. We furthermore demonstrated that ClO₂ and free chlorine act by a similar mechanism, in that they mainly inhibit the binding of echovirus 11 to its host cell. As such, viruses with host binding mechanisms that can withstand ClO₂ treatment were also better able to withstand oxidation by free chlorine. Conversely, the UV-resistant population was not significantly cross-resistant to any other disinfection treatment. Overall, our results indicate that viruses with resistance to multiple disinfectants exist, but that they can be controlled by inactivating methods that operate by a distinctly different mechanism. We therefore suggest to utilize two disinfection barriers that act by different mechanisms in order to control disinfection-resistant viruses.

Eradication of Ebola Based on Dynamic Programming

This paper mainly studies the eradication of the Ebola virus, proposing a scientific system, including three modules for the eradication of Ebola virus. Firstly, we build a basic model combined with nonlinear incidence rate and maximum treatment capacity. Secondly, we use the dynamic programming method and the Dijkstra Algorithm to set up M-S (storage) and several delivery locations in West Africa. Finally, we apply the previous results to calculate the total cost, production cost, storage cost, and shortage cost.

The Bacterial Communities of Full-Scale Biologically Active, Granular Activated Carbon Filters Are Stable and Diverse and Potentially Contain Novel Ammonia-Oxidizing Microorganisms

The bacterial community composition of the full-scale biologically active, granular activated carbon (BAC) filters operated at the St. Paul Regional Water Services (SPRWS) was investigated using Illumina MiSeq analysis of PCR-amplified 16S rRNA gene fragments. These bacterial communities were consistently diverse (Shannon index, >4.4; richness estimates, >1,500 unique operational taxonomic units [OTUs]) throughout the duration of the 12-month study period. In addition, only modest shifts in the quantities of individual bacterial populations were observed; of the 15 most prominent OTUs, the most highly variable population (a Variovorax sp.) modulated less than 13-fold over time and less than 8-fold from filter to filter. The most prominent population in the profiles was a Nitrospira sp., representing 13 to 21% of the community. Interestingly, very few of the known ammonia-oxidizing bacteria (AOB; <0.07%) and no ammonia-oxidizing Archaea were detected in the profiles. Quantitative PCR of amoA genes, however, suggested that AOB were prominent in the bacterial communities (amoA/16S rRNA gene ratio, 1 to 10%). We conclude, therefore, that the BAC filters at the SPRWS potentially contained significant numbers of unidentified and novel ammonia-oxidizing microorganisms that possess amoA genes similar to those of previously described AOB.

Microbial Contamination of Drinking Water and Human Health from Community Water Systems

A relatively short list of reference viral, bacterial and protozoan pathogens appears adequate to assess microbial risks and inform a system-based management of drinking waters. Nonetheless, there are data gaps, e.g. human enteric viruses resulting in endemic infection levels if poorly performing disinfection and/or distribution systems are used, and the risks from fungi. Where disinfection is the only treatment and/or filtration is poor, cryptosporidiosis is the most likely enteric disease to be identified during waterborne outbreaks, but generally non-human-infectious genotypes are present in the absence of human or calf fecal contamination. Enteric bacteria may dominate risks during major fecal contamination events that are ineffectively managed. Reliance on culture-based methods exaggerates treatment efficacy and reduces our ability to identify pathogens/indicators; however, next-generation sequencing and polymerase chain reaction approaches are on the cusp of changing that. Overall, water-based Legionella and non-tuberculous mycobacteria probably dominate health burden at exposure points following the various societal uses of drinking water.

Circuit Rider post-construction support: improvements in domestic water quality and system sustainability in El Salvador

Small piped water supply systems are often unable to provide reliable, microbiologically safe, and sustainable service over time, and this has direct impacts on public health. Circuit Rider (CR) post-construction support (PCS) addresses this through the provision of technical, financial, and operational assistance to these systems. CRPCS operates in low and high-income countries; yet, no rigorous studies of CRPCS exist. We measured the impact of CRPCS on 'water quality' and 'sustainability' indicators (technical and administrative capacity, and water supply protection) in El Salvador. In this field-based study, a case-control design was utilized in 60 randomly selected case (28 CR) and comparable control (32 noCR) communities. Microbiological water quality tests and pre-tested structured key-informant interviews were conducted. The operational costs of CRPCS were also assessed. Data were compared using parametric and non-parametric statistical methods. We found communities with CRPCS had significantly lower microbiological water contamination, better disinfection rates, higher water fee payment rates, greater transparency (measured by auditable banking records), greater rates of household metering, and higher spending for repairs and water treatment than comparable control communities. CRPCS is also a low-cost (<$1 per household/year in El Salvador) drinking water intervention.

Associations between extreme precipitation and gastrointestinal-related hospital admissions in Chennai, India

BACKGROUND

Understanding the potential links between extreme weather events and human health in India is important in the context of vulnerability and adaptation to climate change. Research exploring such linkages in India is sparse.

OBJECTIVES

We evaluated the association between extreme precipitation and gastrointestinal (GI) illness-related hospital admissions in Chennai, India, from 2004 to 2007.

METHODS

Daily hospital admissions were extracted from two government hospitals in Chennai, India, and meteorological data were retrieved from the Chennai International Airport. We evaluated the association between extreme precipitation (≥ 90th percentile) and hospital admissions using generalized additive models. Both single-day and distributed lag models were explored over a 15-day period, controlling for apparent temperature, day of week, and long-term time trends. We used a stratified analysis to explore the association across age and season.

RESULTS

Extreme precipitation was consistently associated with GI-related hospital admissions. The cumulative summary of risk ratios estimated for a 15-day period corresponding to an extreme event (relative to no precipitation) was 1.60 (95% CI: 1.29, 1.98) among all ages, 2.72 (95% CI: 1.25, 5.92) among the young (≤ 5 years of age), and 1.62 (95% CI: 0.97, 2.70) among the old (≥ 65 years of age). The association was stronger during the pre-monsoon season (March-May), with a cumulative risk ratio of 6.50 (95% CI: 2.22, 19.04) for all ages combined compared with other seasons.

CONCLUSIONS

Hospital admissions related to GI illness were positively associated with extreme precipitation in Chennai, India, with positive cumulative risk ratios for a 15-day period following an extreme event in all age groups. Projected changes in precipitation and extreme weather events suggest that climate change will have important implications for human health in India, where health disparities already exist.

CITATION

Bush KF, O'Neill MS, Li S, Mukherjee B, Hu H, Ghosh S, Balakrishnan K. 2014. Associations between extreme precipitation and gastrointestinal-related hospital admissions in Chennai, India. Environ Health Perspect 122:249-254; http://dx.doi.org/10.1289/ehp.1306807.

Extreme precipitation and beach closures in the great lakes region: evaluating risk among the elderly

As a result of climate change, extreme precipitation events are expected to increase in frequency and intensity. Runoff from these extreme events poses threats to water quality and human health. We investigated the impact of extreme precipitation and beach closings on the risk of gastrointestinal illness (GI)-related hospital admissions among individuals 65 and older in 12 Great Lakes cities from 2000 to 2006. Poisson regression models were fit in each city, controlling for temperature and long-term time trends. City-specific estimates were combined to form an overall regional risk estimate. Approximately 40,000 GI-related hospital admissions and over 100 beach closure days were recorded from May through September during the study period. Extreme precipitation (≥90th percentile) occurring the previous day (lag 1) is significantly associated with beach closures in 8 of the 12 cities (p < 0.05). However, no association was observed between beach closures and GI-related hospital admissions. These results support previous work linking extreme precipitation to compromised recreational water quality.

Effects of fluid flow conditions on interactions between species in biofilms

Most microorganisms live in complex communities, where they interact both synergistically and competitively. To explore the relationship between environmental heterogeneity and the spatial structure of well-defined biofilms, single- and mixed-species biofilms of Pseudomonas aeruginosa PAO1 and Flavobacterium sp. CDC-65 was grown in a planar flow cell under highly controlled flow gradients. Both organisms behaved differently in mixed cultures than in single-species cultures due to inter-species interactions, and these interactions were significantly affected by external flow conditions. Pseudomonas and Flavobacterium showed a competitive relationship under slow inflow conditions, where the supply of growth medium was limited. Under such competitive conditions, the faster- specific growth rate of Flavobacterium allowed it to secure access to favorable regions of the biofilm by overgrowing Pseudomonas. In contrast, Pseudomonas was restricted to nutritionally depleted habitat near the base of the biofilm, and its growth was significantly inhibited. Conversely, under higher inflow conditions providing greater influx of growth medium, both organisms accumulated greater biomass in mixed biofilms than in single-species biofilms. Spatial segregation of the two organisms within the biofilms contributed to enhanced overall exploitation of available nutrients and substrates, while morphological changes favored better adherence to the surface under high hydrodynamic shear. These results indicate that synergy and competition in biofilms vary with flow conditions. Limited resource replenishment favors competition under low-flow conditions, while high flow reduces competition and favors synergy by providing greater resources and simultaneously imposing increased hydrodynamic shear that makes it more difficult to accumulate biomass on the surface. Ecological interactions that produce mechanically stronger and more robust biofilms will support more extensive growth on surfaces subject to high hydrodynamic shear, but these interactions are difficult to predict from observations of the behavior of individual organisms.

Change in drinking water quality from source to point-of-use and storage: a case study from Guwahati, India

To ascertain the quality of drinking water being supplied and maintained at Guwahati, the study was conducted on the status of water supply in city through surveillance of drinking water quality for consecutive 7 days at various treatment stages, distribution network and consumer ends. The performance of five water treatment plants (WTPs), viz. Panbazar WTP, Satpukhuri WTP, Kamakhya WTP, PHED WTP and Hegrabari WTP were assessed for summer, piost-post-monsoon and winter seasons. No significant change in raw water quality was observed on day-to-day basis. Residual chlorine was found in the range of nil to 0.2 mg/L in the treated water. During post-monsoon, winter, and summer seasons the thermotolerent TC and FC counts ranged between Nil to 168 CFU/100 ml and Nil to 84 CFU/100 ml; Nil to 3356 CFU/100 ml and Nil to 152 CFU/100 ml; and Nil to 960 CFU/100 ml and Nil to 108 CFU/100 ml respectively. There was variation in bacterial counts among the different service reservoirs and consumer ends, which may be attributed to the general management practices for maintenance of service reservoirs and the possibility of enroute contamination. Evaluation of the raw water quality indicate that the water is suitable for drinking after conventional treatment followed by disinfection. The finished water quality meets the level of standards described as per Bureau of Indian Standard specifications (BIS:10500 1991) for potability in terms of its physico-chemical characteristics.

Water insecurity in 3 dimensions: an anthropological perspective on water and women's psychosocial distress in Ethiopia

Water insecurity is a primary underlying determinant of global health disparities. While public health research on water insecurity has focused mainly on two dimensions, water access and adequacy, an anthropological perspective highlights the cultural or lifestyle dimension of water insecurity, and its implications for access/adequacy and for the phenomenology of water insecurity. Recent work in Bolivia has shown that scores on a water insecurity scale derived from ethnographic observations are associated with emotional distress. We extend this line of research by assessing the utility of a locally developed water insecurity scale, compared with standard measures of water access and adequacy, in predicting women's psychosocial distress in Ethiopia. In 2009-2010 we conducted two phases of research. Phase I was mainly qualitative and designed to identify locally relevant experiences of water insecurity, and Phase II used a quantitative survey to test the association between women's reported water insecurity and the Falk Self-Reporting Questionnaire (SRQ-F), a measure of psychosocial distress. In multiple regression models controlling for food insecurity and reported quantity of water used, women's water insecurity scores were significantly associated with psychosocial distress. Including controls for time required to collect water and whether water sources were protected did not further predict psychosocial distress. This approach highlights the social dimension of water insecurity, and may be useful for informing and evaluating interventions to improve water supplies.

Drinking water quality monitoring and surveillance for safe water supply in Gangtok, India

To ascertain the quality of drinking water being supplied, water quality monitoring and surveillance was conducted in Gangtok city at various treatment stages, service reservoirs, distribution network, public standposts, and households. No significant change in raw water quality was observed on day-to-day basis. Residual chlorine was found in the range of nil to 0.2 mg/l in the sump water/finished water. Throughout the year (i.e., during summer, winter, and monsoon seasons), the total coliform and fecal coliform counts were ranged from nil to 7 CFU/100 ml and nil to 3 CFU/100 ml, respectively, in sump water of Selep and VIP complex water treatment plant; however, at consumer end, those were observed as nil to 210 CFU/100 ml and nil to 90 CFU/100 ml, respectively. These variations in bacterial counts among the different service reservoirs and consumer ends may be attributed to the general management practices for maintenance of service reservoirs and the possibility of enroute contamination. Evaluation of the raw water quality indicates that the water is suitable for drinking after conventional treatment followed by disinfection. The finished water quality meets the level of standards described as per Bureau of Indian Standard specifications (BIS:10500 1991) for potability in terms of its physicochemical characteristics.

Drinking water residence time in distribution networks and emergency department visits for gastrointestinal illness in Metro Atlanta, Georgia

We examined whether the average water residence time, the time it takes water to travel from the treatment plant to the user, for a zip code was related to the proportion of emergency department (ED) visits for gastrointestinal (GI) illness among residents of that zip code. Individual-level ED data were collected from all hospitals located in the five-county metro Atlanta area from 1993 to 2004. Two of the largest water utilities in the area, together serving 1.7 million people, were considered. People served by these utilities had almost 3 million total ED visits, 164,937 of them for GI illness. The relationship between water residence time and risk for GI illness was assessed using logistic regression, controlling for potential confounding factors, including patient age and markers of socioeconomic status (SES). We observed a modestly increased risk for GI illness for residents of zip codes with the longest water residence times compared with intermediate residence times (odds ratio (OR) for Utility 1 = 1.07, 95% confidence interval (CI) = 1.03, 1.10; OR for Utility 2 = 1.05, 95% CI = 1.02, 1.08). The results suggest that drinking water contamination in the distribution system may contribute to the burden of endemic GI illness.

Transmission of foodborne zoonotic pathogens to riparian areas by grazing sheep

The objective of this study was to determine if sheep grazing near riparian areas on pasture in Ontario are an important risk factor for the contamination of water with specific foodborne pathogens. Ten Ontario sheep farms were visited weekly for 12 wk during the summer of 2005. Samples of feces, soil, and water were collected and analyzed for the presence of Escherichia coli O157:H7, Salmonella spp., Campylobacter jejuni and C. coli, and Yersinia enterocolitica, by bacteriological identification and polymerase chain reaction (PCR). The data was analyzed as repeated measures over time using mixed models. No samples were positive for Salmonella, and no samples were confirmed positive for E. coli O157:H7 after PCR. Levels of Campylobacter were highest in the soil, but did not differ between soil where sheep grazed or camped and roadside soil that had never been grazed (P = 0.85). Levels of Yersinia were highest in water samples and were higher in soil where sheep had access (P = 0.01). The prevalence of positive Campylobacter and Yersinia samples were not associated with locations where sheep spent more time (Campylobacter P = 0.46, Yersinia P = 0.99). There was no effect of stocking density on the prevalence of Campylobacter (P = 0.30), but as the stocking density increased the levels of Yersinia increased (P = 0.04). It was concluded that although sheep transmit Yersinia to their environment, pastured sheep flocks are not major risk factors for the transmission of zoonotic pathogens into water.

Frequent occurrence of human-associated microsporidia in fecal droppings of urban pigeons in amsterdam, the Netherlands

Human-associated microsporidia were frequently observed in fecal samples of 331 feral pigeons in Amsterdam, The Netherlands, obtained during high- and low-breeding periods. Thirty-six of 331 samples (11%) contained the human pathogens Enterocytozoon bieneusi (n = 18), Encephalitozoon hellem (n = 11), Encephalitozoon cuniculi (n = 6), and Encephalitozoon intestinalis (n = 1); 5 samples contained other microsporidia. Pigeon feces can be an important source of human microsporidian infection.

Interactions of Cryptosporidium parvum, Giardia lamblia, vaccinal poliovirus type 1, and bacteriophages phiX174 and MS2 with a drinking water biofilm and a wastewater biofilm

Biofilms colonizing surfaces inside drinking water distribution networks may provide a habitat and shelter to pathogenic viruses and parasites. If released from biofilms, these pathogens may disseminate in the water distribution system and cause waterborne diseases. Our study aimed to investigate the interactions of protozoan parasites (Cryptosporidium parvum and Giardia lamblia [oo]cysts) and viruses (vaccinal poliovirus type 1, phiX174, and MS2) with two contrasting biofilms. First, attachment, persistence, and detachment of the protozoan parasites and the viruses were assessed with a drinking water biofilm. This biofilm was allowed to develop inside a rotating annular reactor fed with tap water for 7 months prior to the inoculation. Our results show that viable parasites and infectious viruses attached to the drinking water biofilm within 1 h and persisted within the biofilm. Indeed, infectious viruses were detected in the drinking water biofilm up to 6 days after the inoculation, while viral genome and viable parasites were still detected at day 34, corresponding to the last day of the monitoring period. Since viral genome was detected much longer than infectious particles, our results raise the question of the significance of detecting viral genomes in biofilms. A transfer of viable parasites and viruses from the biofilm to the water phase was observed after the flow velocity was increased but also with a constant laminar flow rate. Similar results regarding parasite and virus attachment and detachment were obtained using a treated wastewater biofilm, suggesting that our observations might be extrapolated to a wide range of environmental biofilms and confirming that biofilms can be considered a potential secondary source of contamination.

The impact of a school-based safe water and hygiene programme on knowledge and practices of students and their parents: Nyanza Province, western Kenya, 2006

Safe drinking water and hygiene are essential to reducing Kenya's diarrhoeal disease burden. A school-based safe water and hygiene intervention in Kenya was evaluated to assess its impact on students' knowledge and parents' adoption of safe water and hygiene practices. We surveyed 390 students from nine schools and their parents at baseline and conducted a final evaluation of 363 students and their parents. From baseline to final evaluation, improvement was seen in students' knowledge of correct water treatment procedure (21-65%, P<0.01) and knowing when to wash their hands. At final evaluation, 14% of parents reported currently treating their water, compared with 6% at baseline (P<0.01). From 2004 to 2005, school absenteeism in the September-November term decreased in nine project schools by 35% and increased in nine neighbouring comparison schools by 5%. This novel programme shows promise for reducing school absenteeism and promoting water and hygiene interventions in the home.

Measurement of biocolloid collision efficiencies for granular activated carbon by use of a two-layer filtration model

Point-of-use filters containing granular activated carbon (GAC) are an effective method for removing certain chemicals from water, but their ability to remove bacteria and viruses has been relatively untested. Collision efficiencies (alpha) were determined using clean-bed filtration theory for two bacteria (Raoutella terrigena 33257 and Escherichia coli 25922), a bacteriophage (MS2), and latex microspheres for four GAC samples. These GAC samples had particle size distributions that were bimodal, but only a single particle diameter can be used in the filtration equation. Therefore, consistent with previous reports, we used a particle diameter based on the smallest diameter of the particles (derived from the projected areas of 10% of the smallest particles). The bacterial collision efficiencies calculated using the filtration model were high (0.8 < or = alpha < or = 4.9), indicating that GAC was an effective capture material. Collision efficiencies greater than unity reflect an underestimation of the collision frequency, likely as a result of particle roughness and wide GAC size distributions. The collision efficiencies for microspheres (0.7 < or = alpha < or = 3.5) were similar to those obtained for bacteria, suggesting that the microspheres were a reasonable surrogate for the bacteria. The bacteriophage collision efficiencies ranged from > or = 0.2 to < or = 0.4. The predicted levels of removal for 1-cm-thick carbon beds ranged from 0.8 to 3 log for the bacteria and from 0.3 to 1.0 log for the phage. These tests demonstrated that GAC can be an effective material for removal of bacteria and phage and that GAC particle size is a more important factor than relative stickiness for effective particle removal.

Evaluation of standardized scored inspections for Legionnaires' disease prevention, during the Athens 2004 Olympics

The study was designed to determine the contribution of standardized scored inspections implemented during the Athens 2004 Pre-Olympic and Olympic period, in assessing the presence of Legionella spp. in water sites. Inspection grading scores of 477 water supply systems, 127 cooling towers and 134 decorative fountains were associated with the corresponding microbiological test results of 2514 samples for Legionella spp. Nine violations of water supply systems and nine of cooling towers significantly associated with positive microbiological test results, and four violations of water supply systems and one of cooling towers were among those designated as 'critical' water safety hazards in the inspection reports. The study documents a strong correlation [water supply systems (RR 1.92), cooling towers (RR 1.94)] between unsatisfactory inspection scoring results and Legionella-positive microbiological test results (in excess of 10,000 c.f.u./l) and suggests the utility of inspection scoring systems in predicting Legionella proliferation of water systems and in preventing Legionnaires' disease.

Comparing Shigella waterborne outbreaks in four different areas in Greece: common features and differences

In Greece the public health surveillance for most infectious diseases, including shigellosis, is not well developed. However, four waterborne outbreaks of shigellosis have been recorded in Greece in the last three decades, in different areas of the country, under different environmental and socioeconomic conditions. This study presents the epidemiological characteristics of these four outbreaks in order to examine common points and differences and to investigate their possible association with environmental and socioeconomic conditions. All four outbreaks were caused by Shigella sonnei and related to drinking water. Epidemic curves, distribution of cases by age and gender, hospitalization rates, environmental conditions and laboratory results were compared. The outbreaks seemed to correspond to two different 'models' presenting two characteristic types of epidemic waves related to specific environmental conditions. The attack rates for the general population varied from about 9 to 13% and were similar for both sexes. Children were affected mostly. In these outbreaks there was a strong suspicion of contamination of the water distribution system from the sewage network, highlighting the importance of environmental health control measures.

Survival of Campylobacter jejuni in waterborne protozoa

The failure to reduce the Campylobacter contamination of intensively reared poultry may be partially due to Campylobacter resisting disinfection in water after their internalization by waterborne protozoa. Campylobacter jejuni and a variety of waterborne protozoa, including ciliates, flagellates, and alveolates, were detected in the drinking water of intensively reared poultry by a combination of culture and molecular techniques. An in vitro assay showed that C. jejuni remained viable when internalized by Tetrahymena pyriformis and Acanthamoeba castellanii for significantly longer (up to 36 h) than when they were in purely a planktonic state. The internalized Campylobacter were also significantly more resistant to disinfection than planktonic organisms. Collectively, our results strongly suggest that protozoa in broiler drinking water systems can delay the decline of Campylobacter viability and increase Campylobacter disinfection resistance, thus increasing the potential of Campylobacter to colonize broilers.

Accumulation and fate of microorganisms and microspheres in biofilms formed in a pilot-scale water distribution system

The accumulation and fate of model microbial "pathogens" within a drinking-water distribution system was investigated in naturally grown biofilms formed in a novel pilot-scale water distribution system provided with chlorinated and UV-treated water. Biofilms were exposed to 1-mum hydrophilic and hydrophobic microspheres, Salmonella bacteriophages 28B, and Legionella pneumophila bacteria, and their fate was monitored over a 38-day period. The accumulation of model pathogens was generally independent of the biofilm cell density and was shown to be dependent on particle surface properties, where hydrophilic spheres accumulated to a larger extent than hydrophobic ones. A higher accumulation of culturable legionellae was measured in the chlorinated system compared to the UV-treated system with increasing residence time. The fate of spheres and fluorescence in situ hybridization-positive legionellae was similar and independent of the primary disinfectant applied and water residence time. The more rapid loss of culturable legionellae compared to the fluorescence in situ hybridization-positive legionellae was attributed to a loss in culturability rather than physical desorption. Loss of bacteriophage 28B plaque-forming ability together with erosion may have affected their fate within biofilms in the pilot-scale distribution system. The current study has demonstrated that desorption was one of the primary mechanisms affecting the loss of microspheres, legionellae, and bacteriophage from biofilms within a pilot-scale distribution system as well as disinfection and biological grazing. In general, two primary disinfection regimens (chlorination and UV treatment) were not shown to have a measurable impact on the accumulation and fate of model microbial pathogens within a water distribution system.

Are waterborne astrovirus implicated in acute digestive morbidity (E.MI.R.A. study)?

BACKGROUND

With rotavirus and Norwalk-like viruses, astroviruses are now recognized as important etiologic agents of viral gastroenteritis in all age groups. However, astrovirus is neither routinely screened for in stool samples, nor in environmental samples, and data on the health impact of waterborne astrovirus are lacking.

OBJECTIVES

To assess the potential impact of astrovirus in drinking water on the incidence of acute digestive conditions (ADC) among a panel of volunteers.

STUDY DESIGN

The Epidemiology and MIcrobial Risk Assessment (E.MI.R.A.) study combined a daily epidemiological follow-up of digestive morbidity among a panel of 544 volunteers supplied by French public water systems, and a microbiological surveillance of drinking water. Cases of digestive morbidity were collected through weekly telephone calls. The bacterial, virological and parasitic quality of tap water was assessed monthly. Additional samples were collected if the incidence of ADC increased. The relationship between incidence of ADC during a 7-day period centered about the water sampling day and astrovirus RNA prevalence in drinking water was modeled by regression techniques, taking into account several confounders.

RESULTS

12% (8/68) of the analyzed water samples were positive for astrovirus, and presence of astrovirus RNA was associated with a significant increased risk of ADC: RR=1.51 (95% CI=[1.17-1.94], P value=0.002).

CONCLUSIONS

This result suggests a role for waterborne astrovirus in the endemic level of digestive morbidity in the general population. Perhaps astrovirus is a candidate test target for viral surveillance of drinking water.

U.S. drinking water challenges in the twenty-first century

The access of almost all 270 million U.S. residents to reliable, safe drinking water distinguishes the United States in the twentieth century from that of the nineteenth century. The United States is a relatively water-abundant country with moderate population growth; nonetheless, current trends are sufficient to strain water resources over time, especially on a regional basis. We have examined the areas of public water infrastructure, global climate effects, waterborne disease (including emerging and resurging pathogens), land use, groundwater, surface water, and the U.S. regulatory history and its horizon. These issues are integrally interrelated and cross all levels of public and private jurisdictions. We conclude that U.S. public drinking water supplies will face challenges in these areas in the next century and that solutions to at least some of them will require institutional changes.

Climate variability and change in the United States: potential impacts on water- and foodborne diseases caused by microbiologic agents

Exposure to waterborne and foodborne pathogens can occur via drinking water (associated with fecal contamination), seafood (due to natural microbial hazards, toxins, or wastewater disposal) or fresh produce (irrigated or processed with contaminated water). Weather influences the transport and dissemination of these microbial agents via rainfall and runoff and the survival and/or growth through such factors as temperature. Federal and state laws and regulatory programs protect much of the U.S. population from waterborne disease; however, if climate variability increases, current and future deficiencies in areas such as watershed protection, infrastructure, and storm drainage systems will probably increase the risk of contamination events. Knowledge about transport processes and the fate of microbial pollutants associated with rainfall and snowmelt is key to predicting risks from a change in weather variability. Although recent studies identified links between climate variability and occurrence of microbial agents in water, the relationships need further quantification in the context of other stresses. In the marine environment as well, there are few studies that adequately address the potential health effects of climate variability in combination with other stresses such as overfishing, introduced species, and rise in sea level. Advances in monitoring are necessary to enhance early-warning and prevention capabilities. Application of existing technologies, such as molecular fingerprinting to track contaminant sources or satellite remote sensing to detect coastal algal blooms, could be expanded. This assessment recommends incorporating a range of future scenarios of improvement plans for current deficiencies in the public health infrastructure to achieve more realistic risk assessments.

Climate variability and change in the United States: potential impacts on water- and foodborne diseases caused by microbiologic agents

Exposure to waterborne and foodborne pathogens can occur via drinking water (associated with fecal contamination), seafood (due to natural microbial hazards, toxins, or wastewater disposal) or fresh produce (irrigated or processed with contaminated water). Weather influences the transport and dissemination of these microbial agents via rainfall and runoff and the survival and/or growth through such factors as temperature. Federal and state laws and regulatory programs protect much of the U.S. population from waterborne disease; however, if climate variability increases, current and future deficiencies in areas such as watershed protection, infrastructure, and storm drainage systems will probably increase the risk of contamination events. Knowledge about transport processes and the fate of microbial pollutants associated with rainfall and snowmelt is key to predicting risks from a change in weather variability. Although recent studies identified links between climate variability and occurrence of microbial agents in water, the relationships need further quantification in the context of other stresses. In the marine environment as well, there are few studies that adequately address the potential health effects of climate variability in combination with other stresses such as overfishing, introduced species, and rise in sea level. Advances in monitoring are necessary to enhance early-warning and prevention capabilities. Application of existing technologies, such as molecular fingerprinting to track contaminant sources or satellite remote sensing to detect coastal algal blooms, could be expanded. This assessment recommends incorporating a range of future scenarios of improvement plans for current deficiencies in the public health infrastructure to achieve more realistic risk assessments.

Rapid detection, identification, and enumeration of Escherichia coli cells in municipal water by chemiluminescent in situ hybridization

A new chemiluminescent in situ hybridization (CISH) method provides simultaneous detection, identification, and enumeration of culturable Escherichia coli cells in 100 ml of municipal water within one working day. Following filtration and 5 h of growth on tryptic soy agar at 35 degrees C, individual microcolonies of E. coli were detected directly on a 47-mm-diameter membrane filter using soybean peroxidase-labeled peptide nucleic acid (PNA) probes targeting a species-specific sequence in E. coli 16S rRNA. Within each microcolony, hybridized, peroxidase-labeled PNA probe and chemiluminescent substrate generated light which was subsequently captured on film. Thus, each spot of light represented one microcolony of E. coli. Following probe selection based on 16S ribosomal DNA (rDNA) sequence alignments and sample matrix interference, the sensitivity and specificity of the probe Eco16S07C were determined by dot hybridization to RNA of eight bacterial species. Only the rRNA of E. coli and Pseudomonas aeruginosa were detected by Eco16S07C with the latter mismatch hybridization being eliminated by a PNA blocker probe targeting P. aeruginosa 16S rRNA. The sensitivity and specificity for the detection of E. coli by PNA CISH were then determined using 8 E. coli strains and 17 other bacterial species, including closely related species. No bacterial strains other than E. coli and Shigella spp. were detected, which is in accordance with 16S rDNA sequence information. Furthermore, the enumeration of microcolonies of E. coli represented by spots of light correlated 92 to 95% with visible colonies following overnight incubation. PNA CISH employs traditional membrane filtration and culturing techniques while providing the added sensitivity and specificity of PNA probes in order to yield faster and more definitive results.