Measuring sporadic gastrointestinal illness associated with drinking water - an overview of methodologies

Estimating the risk of gastrointestinal illness associated with drinking tap water in Norway: a prospective cohort study

BACKGROUND

The delivery of safe drinking water has high public health relevance, as reflected in the Sustainable Development Goals (SDG6). Several precautionary actions have reduced the burden associated with infectious diseases in high-income countries; however, pollution in source waters, inadequate disinfection, and premise plumbing, along with an increased awareness that intrusion in the drinking water distribution system, represents risk factors for gastrointestinal illness linked to consume of drinking water. Sporadic cases of waterborne infections are expected to be underreported since a sick person is less likely to seek healthcare for a self-limiting gastrointestinal infection. Hence, knowledge on the true burden of waterborne diseases is scarce. The primary aim with the present study was to estimate the risk of gastrointestinal illness associated with drinking tap water in Norway.

METHODS

We conducted a 12-month prospective cohort study where participants were recruited by telephone interview after invitation based on randomised selection. A start up e-survey were followed by 12 monthly SMS questionnaires to gather information on participants characteristics and drinking tap water (number of 0.2L glasses per day), incidence, duration and symptoms associated with gastrointestinal illness. Associations between the exposure of drinking tap water and the outcome of risk of acute gastrointestinal illness (AGI) were analysed with linear mixed effects models. Age, sex, education level and size of the drinking water supply were identified as potential confounders and included in the adjusted model.

RESULTS

In total, 9,946 persons participated in this cohort study, accounting for 11.5% of all invited participants. According to the data per person and month (99,446 monthly submissions), AGI was reported for 5,508 person-months (5.5 per 100 person-months). Severe AGI was reported in 819 person-months (0.8 per 100 person-months). Our study estimates that 2-4% of AGI in Norway is attributable to drinking tap water.

CONCLUSIONS

This is the largest cohort study in Norway estimating the burden of self-reported gastrointestinal infections linked to the amount of tap water drunk in Norway. The data indicate that waterborne AGI is not currently a burden in Norway, but the findings need to be used with caution. The importance of continued efforts and investments in the maintenance of drinking water supplies in Norway to address the low burden of sporadic waterborne cases and to prevent future outbreaks needs to be emphasised.

Antibacterial and photocatalytic potential of bioactive compounds extracted from freshwater microalgae species (Spirogyra and Ocillatoria): A comparative analysis

Water pollution by pathogenic bacteria and organic dyes poses potential health hazards for human and aquatic life. This study aims to explore the potential of bioactive compounds extracted from two microalgae species (Spirogyra and Ocillatoria) for water pollution control. The optimization of the extraction process for bioactive compounds resulted in the highest yield at 25 min for Spirogyra and 30 min for Ocillatotia species. Further, the extracted bioactive compounds were analyzed using Fourier transform infrared spectroscopy (FTIR) and gas chromatography-mass spectroscopy (GC-MS). The bioactive compounds exhibited significant antibacterial activity against gram-positive and gram-negative bacteria. Notably, Spirogyra species exhibited a higher zone of inhibition (19.5-20.7 mm) than Ocillatoria species (17.0-18.0 mm) against both gram-positive and gram-negative bacterial strains. Furthermore, the photocatalytic potential of these bioactive compounds was examined by assessing the photodegradation of methylene blue (MB) and crystal violet (CV) dyes under different light sources. The findings revealed that Spirogyra species exhibited better photocatalytic activity than Ocillatoria species for MB and CV. For MB, 89.75 %, 77.82 % and 63.54 % were photodegraded when exposed to UV light, sunlight and visible light using Spirogyra extract, compared to 84.90 %, 74.70 % and 58.30 % by Ocillatoria extract. Regarding CV, Spirogyra extract achieved photodegradation efficiency of 88.94 %, 76.59 % and 64.50 % under UV light, sunlight and visible light, higher than 83.60 %, 73.60 % and 57.70 % by Ocillatoria extract. Both Spirogyra and Ocillatoria species demonstrated the best performance for dye photodegradation under UV irradiation, demonstrating great potential for nature-based water treatment.

Evaluation of Cladophora and Chlamydomonas microalgae for environmental sustainability: A comparative study of antimicrobial and photocatalytic dye degradation

The present study emphasizes exploring the potential of bioactive compounds such as polysaccharides, protein, pigments, antioxidants, and vitamins extracted from two microalgae species, Cladophora and Chlamydomonas. The extraction process was optimized for different periods, and the extracted bioactive compounds were characterized. These bioactive compounds showed significant antibacterial activity against gram-positive and gram-negative bacteria. Notably, Cladophora species exhibited a higher zone of inhibition than Chlamydomonas species against both gram-positive and gram-negative bacterial strains. Moreover, the photocatalytic activity of these bioactive compounds was investigated for the degradation of methylene blue and crystal violet dyes under different light conditions. The results demonstrated that Cladophora species exhibited superior photocatalytic activity under natural sunlight, UV light, and visible light sources compared to Chlamydomonas species. Moreover, Cladophora species achieved the highest dye degradation efficiencies of 78% and 72% for methylene blue and crystal violet, respectively, within 150 min compared to UV light and visible light sources.

Associations between extreme precipitation, drinking water, and protozoan acute gastrointestinal illnesses in four North American Great Lakes cities (2009-2014)

Climate change is already impacting the North American Great Lakes ecosystem and understanding the relationship between climate events and public health, such as waterborne acute gastrointestinal illnesses (AGIs), can help inform needed adaptive capacity for drinking water systems (DWSs). In this study, we assessed a harmonized binational dataset for the effects of extreme precipitation events (≥90th percentile) and preceding dry periods, source water turbidity, total coliforms, and protozoan AGIs - cryptosporidiosis and giardiasis - in the populations served by four DWSs that source surface water from Lake Ontario (Hamilton and Toronto, Ontario, Canada) and Lake Michigan (Green Bay and Milwaukee, Wisconsin, USA) from January 2009 through August 2014. We used distributed lag non-linear Poisson regression models adjusted for seasonality and found extreme precipitation weeks preceded by dry periods increased the relative risk of protozoan AGI after 1 and 3-5 weeks in three of the four cities, although only statistically significant in two. Our results suggest that the risk of protozoan AGI increases with extreme precipitation preceded by a dry period. As extreme precipitation patterns become more frequent with climate change, the ability to detect changes in water quality and effectively treat source water of varying quality is increasingly important for adaptive capacity and protection of public health.

System-wide joint-dynamic-response approach to water quality evaluation in distribution networks with multiple service reservoirs and pumps

Rigorous system-wide aggregated water quality performance indices for water distribution networks are lacking in the literature due to complexities associated with high dimensional spatial and temporal water quality data. Water quality considerations unavoidably increase performance evaluation difficulties considerably. The formulation developed in this article addresses the post-extended period simulation high-dimensional data challenges. A system-wide joint-dynamic-response approach to water quality evaluation is introduced that accounts for spatial and temporal variations in nodal demands and the respective time-varying hydraulic and water quality properties of multiple service reservoirs. Effective comparisons of the water quality response of service reservoirs and their effects were achieved. This includes individual reservoirs and the combined effects of multiple reservoirs. Service reservoirs and the nodes they supply were particularly vulnerable from the standpoint of water quality. The role of the network’s topology considering water quality risks was revealed also. The correlation between the medians and flow-weighted daily means of the water quality parameters was very strong (R2 ≥ 0.994) for the service reservoirs considered. Thus, the median could be useful as a practical performance surrogate in design optimization procedures. Finally, there seems to be an association between the flow-weighted daily means and overall hydraulic effectiveness of service reservoirs.

Evaluation of the drinking water quality surveillance system in the metropolitan region of Rio de Janeiro

The present work evaluated the surveillance of the drinking water quality information system database and correlated the findings of the microbiological analysis with the distribution of intestinal protozoa from the metropolitan region of Rio de Janeiro. From the database, we obtained 1,654 georeferenced monitoring stations that were used in the analysis. The results indicate that the minimum number of samples collected per parameter (free residual chlorine, turbidity, counts of total and fecal coliforms (Escherichia coli)) was not fulfilled, the collection of samples throughout the year was irregular and the representability of sampling points considered strategic was low (48% of municipalities). Besides, municipalities with a high prevalence for intestinal parasite protozoa were also the ones that had the highest counts for coliforms and the reverse can also be observed, indicating a transmission through contaminated drinking water. Despite the increased participation of municipalities in water surveillance actions during the studied period, it is necessary to implement managerial measures to improve the system, aiming to correct flaws and inconsistencies in the application of the water quality monitoring protocol.

Implementation of quantitative microbial risk assessment (QMRA) for public drinking water supplies: Systematic review

In the more than 15 years since its introduction, quantitative microbial risk assessment (QMRA) has become a widely used technique for assessing population health risk posed by waterborne pathogens. However, the variation in approaches taken for QMRA in relation to drinking water supply is not well understood. This systematic review identifies, categorises, and critically synthesises peer-reviewed and academic case studies of QMRA implementation for existing distributed public drinking water supplies. Thirty-nine English-language, peer-reviewed and academic studies published from 2003 to 2019 were identified. Key findings were synthesised in narrative form. The overall designs of the included studies varied widely, as did the assumptions used in risk calculation, especially in relation to pathogen dose. There was also substantial variation in the degree to which the use of location-specific data weighed with the use of assumptions when performing risk calculation. In general, the included studies' complexity did not appear to be associated with greater result certainty. Factors relating to pathogen dose were commonly influential on risk estimates whereas dose-response parameters tended to be of low relative influence. In two of the included studies, use of the 'susceptible fraction' factor was inconsistent with recognised guidance and potentially led to the underestimation of risk. While approaches and assumptions used in QMRA need not be standardised, improvement in the reporting of QMRA results and uncertainties would be beneficial. It is recommended that future authors consider the water supply QMRA reporting checklist developed for the current review. Consideration of the broad types of uncertainty relevant to QMRA is also recommended. Policy-makers should consider emergent discussion on acute microbial health-based targets when setting normative guidelines. The continued representation of QMRA case studies within peer-reviewed and academic literature would also enhance future implementation. Further research is needed on the optimisation of QMRA resourcing given the application context.

Effect of the deuterium on efficiency and type of adipogenic differentiation of human adipose-derived stem cells in vitro

In this study, we performed an adipogenic differentiation of human adipose-derived stem cells (ADSCs) in vitro with different deuterium content (natural, low and high) in the culture medium during differentiation process with parallel analysis of the gene expression, metabolic activity and cell viability/toxicity. After ADSCs differentiation into adipocytes we have done the analysis of differentiation process efficiency and determined a type of resulting adipocytes (by morphology, gene expression, UCP1 protein detection and adipokine production analysis). We have found that high (5 × 10⁵ ppm) deuterium content significantly inhibit in vitro adipogenic differentiation of human ADSCs compared to the groups with natural (150 ppm) and low (30 ppm) deuterium content. Importantly, protocol of differentiation used in our study leads to white adipocytes development in groups with natural (control) and high deuterium content, whereas deuterium-depleted differentiation medium leads to brown-like (beige) adipocytes formation. We have also remarked the direct impact of deuterium on the cellular survival and metabolic activity. Interesting, in deuterium depleted-medium, the cells had normal survival rate and high metabolic activity, whereas the inhibitory effect of deuterated medium on ADSCs differentiation at least was partly associated with deuterium cytotoxicity and inhibitory effect on metabolic activity. The inhibitory effect of deuterium on metabolic activity and the subsequent decrease in the effectiveness of adipogenic differentiation is probably associated with mitochondrial dysfunction. Thus, deuterium could be considered as an element that affects the substance chirality. These findings may be the basis for the development of new approaches in the treatment of obesity, metabolic syndrome and diabetes through the regulation of adipose-derived stem cell differentiation and adipocyte functions.

Watershed integrity and associations with gastrointestinal illness in the United States

Gastrointestinal (GI) illnesses are associated with various environmental factors, such as water quality, stormwater runoff, agricultural runoff, sewer overflows, and wastewater treatment plant effluents. However, rather than assessing an individual factor alone, two indices incorporating a combination of ecological and environmental stressors were created to represent (1) overall watershed integrity, Index of Watershed Integrity (IWI) and (2) catchment integrity, Index of Catchment Integrity (ICI). These indices could provide a more comprehensive understanding of how watershed/catchment integrity potentially impact the rates of GI illness, compared to assessing an individual stressor alone. We utilized the IWI and ICI, as well as agricultural and urban land uses, to assess associations at the county level with the rates of GI illness in a population of adults over 65 years of age. Our findings demonstrated that both watershed and catchment integrity are associated with reduced hospitalizations for any GI outcomes, though association varied by urbanicity. We believe that improved versions of the IWI and ICI may potentially be useful indicators for public health analyses in other circumstances, particularly when considering rural areas or to capture the complex stressors impacting the ecological health of a watershed.