Human health risk assessment of pharmaceuticals in water: issues and challenges ahead

Pharmaceuticals in biota: The impact of wastewater treatment plant effluents on fish in Australia

Globally, pharmaceuticals and personal care products (PPCPs) are detected in surface waters receiving wastewater, yet their presence in biota, remain largely understudied. To address this, we conducted a study that measured 46 PPCPs in spot water samples and fish caught up- and downstream from wastewater treatment plants (WWTPs) in Victoria, Australia. We sampled 15 sites located along four waterways following a 3-site design: WWTP-discharge('hotspot'), 'upstream'(∼2 km) and 'downstream'(∼2 km). Spot water and fish were also sampled at reference sites >100 km from WWTP discharge (n = 3). Additionally, spot water samples were taken from WWTP effluent outflows (n = 3). From each locality, we analysed 3-12 fish (n = 131 total). In waterways, passive samplers (POCIS; ∼28d, n = 19 PPCPs) were also deployed. Individual fish (axial muscle) and water were analysed with LC-MS-MS. We found that PPCP concentrations in environmental surface water ranged from<0.02-0.97 μg/L. In WWTP effluent, the range was <0.02-1.4 μg/L. Of the 46 PPCPs analysed, 12 were detected in spot water samples and five in fish. In water, the highest concentration detected was for antidepressant venlafaxine (3 μg/L). The most frequently detected PPCPs: venlafaxine (54.9%), metoprolol (41.2%), propranolol (29.4%), carbamazepine (29.4%), caffeine (17.6%) and sulfamethoxazole (17.6%). Out of 131 fish analysed, 35 fish had detectable levels of PPCPs in the muscle tissue. The highest muscle concentrations were: venlafaxine (150 μg/kg, redfin perch), and sertraline (100 μg/kg, eel). Bioaccumulation factors ranged from 104 to 341L/kg for venlafaxine in redfins, 21-1,260L/kg for carbamazepine in redfins and eels, and 367-3,333L/kg for sertraline in eels. Based on our human health risk calculations for venlafaxine, carbamazepine, sertraline, triclosan, and caffeine, consumption of fish does not pose a significant risk to human health. Despite this, most of the detected PPCPs in surface waters exceeded 10 ng/L trigger value, which has led to further investigations by EPA. Our study highlights the need for using multiple lines of evidence for estimating risks of PPCPs.

Functional knockout of the Oatp1d1 membrane transporter affects toxicity of diclofenac in zebrafish embryos

Organic anion transporting polypeptides (OATPs) facilitate the cellular uptake of a large number of compounds. Zebrafish Oatp1d1 matches the functional capabilities of human OATP orthologs, particularly in hormone and drug transport. It is highly expressed in the liver and later stages of embryonic development, indicating its critical role in zebrafish physiology and development. Data from previous in vitro analyses have shown a high affinity of zebrafish Oatp1d1 for pharmaceuticals and xenobiotics, providing the basis for further in vivo studies on its defence and developmental functions. Using CRISPR-Cas9 technology, we have generated an Oatp1d1 zebrafish mutant that has highly reduced Oatp1d1 expression in embryos and adult tissues compared to wild type (WT). The absence of Oatp1d1 was confirmed using custom-made antibodies. To evaluate its ecotoxicological relevance, mutant and WT embryos were exposed to increasing concentrations of diclofenac, an NSAID known for its wide and frequent use, environmental pseudo-persistence and ecological implications. WT embryos showed developmental delays and malformations such as spinal curvature, cardiac edema and blood pooling at higher diclofenac concentrations, whereas the Oatp1d1 mutant embryos showed marked resilience, with milder developmental defects and delayed toxic effects. These observations suggest that the absence of Oatp1d1 impedes the efficient entry of diclofenac into hepatocytes, thereby slowing its biotransformation into potentially more toxic metabolites. In addition, the changes in transcript expression of other uptake transporters revealed a highly probable and complex network of compensatory mechanisms. Therefore, the results of this study point to the importance of Oatp1d1-mediated transport of diclofenac, as demonstrated for the first time in vivo using an Oatp1 deficient zebrafish line. Finally, our data indicates that the compensatory role of other transporters with overlapping substrate preferences needs to be considered for a reliable understanding of the physiological and/or defensive role(s) of membrane transporters.

Ecopharmacology: Knowledge, Attitude, and Medication Disposal Practice Among Pharmacy Students

Background

Ecopharmacology, as a form of drug management for the environment, focuses on the impact of drugs on the environment. Pharmacists, and by extension pharmacy students, are expected to play an important role in ecopharmacology. Therefore, this study was conducted to determine the knowledge and attitude towards ecopharmacology and the practice of disposal of leftover or expired medicines among pharmacy students.

Methods

This was a descriptive cross-sectional study among pharmacy students in Northwestern Ethiopia. The study took place from May 1 to June 15, 2023. A self-administered questionnaire was used for data collection.

Results

Four hundred and forty-five students were included in the study. Only 91 (20%) of the students were aware of the term ecopharmacology, 27% knew that excretion from the human or animal body is the major route by which pharmaceutical agents enter the environment, and 42% were aware of the risk of increased antimicrobial resistance due to antibiotic residues in the environment. In addition, only 27% of respondents reported receiving information about the disposal of pharmaceuticals. The most common method of disposing of medications was throwing them away in household trash (61.8%).

Conclusion

Our results suggest that while most pharmacy students in Ethiopia have a positive attitude toward ecopharmacology, they do not know enough about ecopharmacology and dispose of their medicines poorly. More uniform education in ecopharmacology and pharmaceutical pollution might be warranted in the pharmacy curriculum.

Tracking drugged waters from various sources to drinking water-its persistence, environmental risk assessment, and removal techniques

Pharmaceuticals have become a major concern due to their nature of persistence and accumulation in the environment. Very few studies have been performed relating to its toxicity and ill effects on the aquatic/terrestrial flora and fauna. The typical wastewater and water treatment processes are not efficient enough to get these persistent pollutants treated, and there are hardly any guidelines followed. Most of them do not get fully metabolized and end up in rivers through human excreta and household discharge. Various methods have been adopted with the advancement in technology, sustainable methods are more in demand as they are usually cost-effective, and hardly any toxic by-products are produced. This paper aims to illustrate the concerns related to pharmaceutical contaminants in water, commonly found drugs in the various rivers and their existing guidelines, ill effects of highly detected pharmaceuticals on aquatic flora and fauna, and its removal and remediation techniques putting more emphasis on sustainable processes.

Human health risk assessment of pharmaceuticals in the European Vecht River

Active pharmaceutical ingredients (APIs) can reach surface waters used for drinking water extraction and recreational activities, such as swimming and fishing. The aim of the present study was to systematically assess the lifetime human health risks posed by 15 individual APIs and their mixtures occurring in the German-Dutch transboundary Vecht River. An exposure model was developed and used to assess the combined risks of oral and dermal exposure under a variety of exposure conditions. A total of 4500 API uptake values and 165 lifetime risk values were estimated for 15 and 11 APIs, respectively. Overall, the lifetime human health risks posed by the APIs and their mixtures based on modeling results were deemed acceptable under typical exposure conditions. Under very extreme environmental conditions and human behavior, API mixture risks were of potential concern while the risks of individual APIs were negligible, with a few exceptions. The antibiotic doxycycline and analgesic phenazone showed the highest and lowest risks, respectively. The study did not evaluate the potential risks caused by metabolite compounds. Recommendations for water managers are provided to help improve the accuracy and utility of human health risk assessments of pharmaceuticals. Integr Environ Assess Manag 2022;18:1639-1654. © 2022 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Isolation and identification of acetaminophen degrading strain Shinella sp. HZA2

Acetaminophen (APP), frequently used as analgesic and antipyretic drug in our life, is potentially toxic to both animals and humans. A novel acetaminophen degrading strain HZA2, was isolated from the activated sludge, and identified as Shinella sp. based on its 16S rRNA gene sequence analysis, morphological, physiological, and biochemical characterizations. This strain could degrade 100 mg L^-1 acetaminophen completely within 12 h, and it was also a very effective strain for the degradation of high concentration of acetaminophen below 3000 mg L^-1 under the optimal condition. The optimal degrading conditions of acetaminophen by HZA2 were pH 7.5 and 32.7 °C by the analysis of response surface methodology. Exogenous carbon source could enhance the biodegradation of acetaminophen. During the process, the intermediate metabolites were identified as 4-aminophenol and hydroquinone via gas chromatography-mass spectrometry analysis. The results indicated that strain HZA2 may be a promising bacterium for the bioremediation of acetaminophen pollutions.

Pharmaceuticals, hormones, plasticizers, and pesticides in drinking water

Humans are exposed to endocrine disrupting compounds (EDCs) in tap water via drinking water. Currently, most of the analytical methods used to assess a long list of EDCs in drinking water have been made available only for a single group of EDCs and their metabolites, in contrast with other environmental matrices (e.g., surface water, sediments, and biota) for which more robust methods have been developed that allow detection of multiple groups. This study reveals an analytical method of one-step solid phase extraction, incorporated together with liquid chromatography-tandem mass spectrometry for the quantification of multiclass EDCs (i.e., pharmaceuticals, hormones, plasticizers, and pesticides) in drinking water. Fifteen multiclass EDCs significantly varied in amount between field samples (p < 0.05), with a maximum concentration of 17.63 ng/L observed. Daily exposure via drinking water is unlikely to pose a health risk (risk quotient < 1). This method serves as an analytical protocol for tracing multiclass EDC contamination in tap water as part of a multibarrier approach to ensure safe drinking water for good health and well-being. It represents a simpler one-step alternative tool for drinking water analysis, thereby avoiding the time-consuming and expensive multi-extraction steps that are generally needed for analyzing multiclass EDCs.

Occurrence of Pharmaceuticals and Endocrine Disrupting Compounds in Brazilian Water and the Risks They May Represent to Human Health

The risks of pharmaceuticals and endocrine disrupting compounds (P&EDC) to the environment and human health are a current topic of interest. Hundreds of P&EDC may reach the environment, hence, there is a need to rank the level of concern of human exposure to these compounds. Thus, this work aimed at setting a priority list of P&EDC in Brazil, by studying their occurrence in raw and drinking water, calculating health guideline values (GV), and estimating the risks of population exposure to water intake. Data on the Brazilian pharmaceutical market as well as published data of the monitoring of Brazilian natural and drinking water have been collected by means of an exhaustive literature review. Furthermore, many foreign data were also collected to enable a comparison of the values found in Brazilian studies. A list of 55 P&EDC that have the potential to be found in Brazilian water is proposed, and for 41 of these a risk assessment was performed by estimating their margin of exposure (ME), by considering their occurrence in drinking water, and guideline values estimated from reported acceptable daily intake (ADI) data. For seven compounds the risk was deemed high (three estrogens and four anti-inflammatories), whereas for another seven compounds, it was regarded as an 'alert' situation. Although such risk analysis is conservative, since it has been calculated based on the highest reported P&EDC concentration in drinking water, it highlights the need to enhance their monitoring in Brazil to strengthen the database and support decision makers. An analysis of the occurrence of antimicrobial resistance agents (antibiotics, resistant bacteria, and resistance genes) in surface waters was also carried out and confirmed that such agents are present in water sources throughout Brazil, which deserves the attention of policy makers and health agents to prevent dissemination of antimicrobial resistance through water use.

Deterministic and probabilistic health risk assessment for exposure to non-steroidal anti-inflammatory drugs in an Indian river

This study presents deterministic and probabilistic human health risk assessment using Monte Carlo simulations on exposure to an Indian river, Kaveri, which has been contaminated by non-steroidal anti-inflammatory drugs (NSAIDs). The NSAIDs of concern are naproxen, ibuprofen, aspirin, ketoprofen, and diclofenac. We have considered three exposure scenarios (water ingestion, dermal exposure, and fish ingestion) for four different age groups (0-5, 6-10, 11-18, and 19-70 years). Deterministic risk assessment revealed teenagers to be the most sensitive receptors and water ingestion to be the most crucial pathway contributing to maximum health risk (79 to 86%). Based on the results of Monte Carlo simulations, it was found that the probability of exceeding the deterministic mean risks ranged from 17 to 39% for different exposure routes. High end risk estimates such as 95th percentiles and maximum values of HQ for the entire population did not exceed the USEPA allowable risk. This implies that the NSAIDs at the detected concentrations in the Kaveri river may not pose adverse health effects even in the worst-case scenario. Among the five NSAIDs, diclofenac was found to be the major contributor for health risk. Moreover, the concentration of diclofenac was just one order less than the estimated site-specific threshold concentrations. From sensitivity analysis, the most and the least impactful parameters were found to be water ingestion rate and fish ingestion rate respectively.

Influence of ESGC Indicators on Financial Performance of Listed Pharmaceutical Companies

The pharmaceutical industry, concerned about the impact of its activity, has integrated responsible principles and practices with a view to improving its sustainable and financial performance. This study analyzes the relationship between environmental, social, governance, and controversy indicators and financial performance, measured through return on equity (ROA), return on assets (ROE), and Tobin’s Q, which are applied to the listed companies in the Nasdaq US Smart Pharmaceuticals Index. This index is composed of 30 international companies with a presence at the global level. All the data have been extracted from the Thomson Reuters database. The analysis was performed using structural equation modeling implemented with partial least squares. The results confirm the positive relationship between the construct composed of environmental, social, and governance (ESG) indicators and the aforementioned financial ratios. Additionally, a positive relationship of the controversy indicator with Tobin’s Q is supported. This suggests that the pharmaceutical multinationals focus their investments in sustainability on ESG and pay attention to controversies to boost the visibility of the company and thus increase its value. These conclusions confirm that investing in ESG is a profitable strategy. It is also relevant for managers as it increases the profits and the market value of multinational pharmaceutical companies.

Tap water contamination: Multiclass endocrine disrupting compounds in different housing types in an urban settlement

Contamination of endocrine disrupting compounds (EDCs) in tap water is an emerging global issue, and there are abundant influencing factors that have an ambivalent effect on their transportation and fate. Different housing types vary in terms of water distribution system operation and design, water consumption choices, and other hydraulic factors, which potentially affect the dynamics, loadings, and partitioning of pollutants in tap water. Thus, this study analyzed 18 multiclass EDCs in tap water from different housing types (i.e., landed and high-rise) and the associated health risks. Sample analyses revealed the presence of 16 EDCs, namely hormones (5), pharmaceuticals (8), a pesticide (1), and plasticizers (2) in tap water, with the prevalent occurrence of bisphenol A up to 66.40 ng/L in high-rise housing. The presence of caffeine and sulfamethoxazole distribution in tap water was significantly different between landed and high-rise housings (t(152) = -2.298, p = 0.023 and t(109) = 2.135, p = 0.035). Moreover, the salinity and conductivity of tap water in high-rise housings were significantly higher compared to those in landed housings (t(122) = 2.411, p = 0.017 and t(94) = 2.997, p = 0.003, respectively). Furthermore, there were no potential health risks of EDCs (risk quotient < 1) estimated in different age groups via drinking water intake. However, EDC variation in different housing types requires simulation of the occurrence, transport, and fate of EDCs in the distribution system and investigation of the underlying factors for effective mitigation, prevention, and intervention.

Antibiotic resistance development and human health risks during wastewater reuse and biosolids application in agriculture

The reuse of treated wastewater (TWW) and sewage sludge are considered as solutions to the limited water resource and sludge disposal issues, respectively. The associated environmental and human health risks need to be analyzed to assess whether they are safe solutions or not. This paper discusses issues that relate to the accumulation of antibiotics and antibiotic resistance (AR) determinants in agricultural lands and crops, following TWW irrigation and biosolid amendment. Exposure assessment and dose-response assessment are the two important aspects of risk assessment discussed in this paper. Finally, research gaps in current knowledge that are relevant to a comprehensive and quantitative AR risk assessment were identified which includes: 1.) Studies on soil conditions that increase the frequency of horizontal gene transfer (HGT) between native soil resistome and pathogenic microbes in biosolids and TWW 2.) Holistic studies that examine the accumulation or dissipation of antibiotics, antibiotic resistant bacteria (ARB) and antibiotic resistance genes (ARGs) from the irrigation/biosolids application stage to crop consumption stage 3.) The influences of soil environmental conditions (e.g. salinity, nutrients) on the fate of ARB and ARGs in soil and translocation in edible plants 4.) The development of dose-response models that explicitly incorporate the potential for ARGs transfer between microbes when quantifying the risks of infection due to ARB.

Autopsy, thanatopraxy, cemeteries and crematoria as hotspots of toxic organic contaminants in the funeral industry continuum

The occurrence and health risks of toxic organic contaminants (TOCs) in the funeral industry are relatively under-studied compared to other industries. An increasing body of literature reports TOCs including emerging contaminants in the funeral industry, but comprehensive reviews of the evidence are still lacking. Hence, evidence was analysed to address the proposition that, the funeral industry constitutes several hotspot reservoirs of a wide spectrum of TOCs posing ecological and human health risks. TOCs detected include embalming products, persistent organic pollutants, synthetic pesticides, pharmaceuticals, personal care products and illicit drugs. Human cadavers, solid wastes, wastewaters and air-borne particulates from autopsy, thanatopraxy care facilities (mortuaries, funeral homes), cemeteries and crematoria are hotspots of TOCs. Ingestion of contaminated water, and aquatic and marine foods constitutes non-occupational human exposure, while occupational exposure occurs via inhalation and dermal intake. Risk factors promoting exposure to TOCs include unhygienic burial practices, poor solid waste and wastewater disposal, and weak and poorly enforced regulations. The generic health risks of TOCs are quite diverse, and include; (1) genotoxicity, endocrine disruption, teratogenicity and neurodevelopmental disorders, (2) development of antimicrobial resistance, (3) info-disruption via biomimicry, and (4) disruption of ecosystem functions and trophic interactions. Barring formaldehyde and inferential evidence, the epidemiological studies linking TOCs in the funeral industry to specific health outcomes are scarce. The reasons for the lack of evidence, and limitations of current health risk assessment protocols are discussed. A comprehensive framework for hazard identification, risk assessment and mitigation (HIRAM) in the funeral industry is proposed. The HIRAM includes regulatory, surveillance and control systems such as prevention and removal of TOCs. Future directions on the ecotoxicology of mixtures, behaviour, and health risks of TOCs are highlighted. The opportunities presented by emerging tools, including isotopic labelling, genomics, big data analytics (e.g., machine learning), and in silico techniques in toxicokinetic modelling are highlighted.

Photodecomposition of pharmaceuticals and personal care products using P25 modified with Ag nanoparticles in the presence of natural organic matter

The presence of pharmaceuticals and personal care products (PPCPs) in water remains a concern due to their potential threat to environmental and human health. Advanced oxidation processes (AOPs) have been receiving attention in water treatment studies to remove PPCPs. However, most studies have been focused on pure water containing a limited number of substances. In this study, the photocatalytic efficiency of commercially available titanium dioxide nanoparticles (P25) and P25 modified by silver nanoparticles (Ag-P25) were compared for their ability to degrade 23 target PPCPs (2 μg L^-1) in realistic water matrices containing natural organic matter (Suwanee River NOM, 6.12 mg L^-1). The experiments were completed under ultraviolet-light emitting diode (UV-LED) illumination at 365 and 405 nm wavelengths, with the latter representing visible light exposure. Under 365 nm UV-LED treatment, 99% of the PPCPs were removed using both P25 and Ag-P25 photocatalysts within 180 min of the treatment duration. The number of PPCPs removed dropped to 57% and 53% for P25 and Ag-P25 respectively under the 405 nm UV-LED irradiation. Dissolved organic carbon (DOC) and UV absorbance at 254 nm (UV254) measured at the end of the experiment indicated that the aromatic fraction of NOM was preferentially removed from the water matrix. Also, Ag-P25 was more effective in DOC removal than P25. The relationships of removal rate constants with physico-chemical properties of the substances were also determined. The molecular weight and charge were strongly associated with removal, with the former and the latter being positively and negatively correlated with the rate constants. The results of this work indicate that Ag-P25 is a promising photocatalyst to degrade persistent substances such as PPCPs and NOM even if they are present in a complex water matrix. The properties of individual substances can also be employed as an indication of their removal using this technology.

Adding the Mureş River Basin (Transylvania, Romania) to the List of Hotspots with High Contamination with Pharmaceuticals

Background: The Mureș River Basin is a long-term heavily polluted watershed, in a situation of climate changes with decreasing water flow and related decreasing dilution capacity. Here, a mixture of emerging pollutants such as pharmaceuticals were targeted to reveal potential risks regarding the natural lotic ecosystems. Due to the continuous discharge into the environment, pharmaceuticals are gaining persistent organic pollutant characteristics and are considered emerging pollutants. Based on the hazard quotient, this research highlights the dangerous concentrations of carbamazepine, ibuprofen, furosemide, and enalapril in river water. Results: High levels of four pharmaceutical compounds (carbamazepine, ibuprofen, furosemide, and enalapril) and some of their derived metabolites (enalaprilat, carboxyibuprofen, 1-hydroxyibuprofen, and 2-hydroxyibuprofen) were reported in our study in the Mureș River Basin. Overall, pharmaceutical concentrations were found to be highest in the wastewater treatment plant (WWTP) effluent, median downstream of the WWTP, and lowest upstream of the WWTP, as was expected. For all pharmaceutical compounds tested, we recorded concentrations above the limit of quantification (LOQ) in at least one of the sites tested. Carbamazepine exhibited the highest mean values upstream, downstream, and at the WWTP. As expected, the highest concentrations for all the studied pharmaceutical compounds were detected in the WWTP effluent. All Hazard Quotient (HQ) values were below one (on a logarithmic scale in base 10), with the highest values in the WWTP and the lowest in the river upstream of the WWTP. The HQ intervals were in the same range for furosemide, carbamazepine, and ibuprofen at each of the three different sites: upstream WWTP effluent, and downstream. The interval for enalapril stands out as having the lowest HQ at all three sites. Conclusions: Based on these results, the large and complex hydrographical system Mureș River Basin was transformed from a grey area, with little information about pharmaceutical contamination, to a hotspot in terms of contamination with emerging pollutants. Pharmaceutical compound concentrations were found to be the highest in WWTP effluents. The WWTP effluent concentrations were among the highest in Europe, indicating that treatment plants are the primary source of water pollution with pharmaceuticals compounds. The detected levels were higher than the safety limit for carbamazepine and ibuprofen. The determined HQ values imply that the measured levels do pose a threat to the environment for the studied pharmaceuticals. Based on the obtained results, human communities can assess, monitor, predict, and adapt in time to these already-present regional challenges and risks for sustainable use of natural resources, including water and associated products and services.

Occurrence of multiclass endocrine disrupting compounds in a drinking water supply system and associated risks

Contamination by endocrine disrupting compounds (EDCs) concerns the security and sustainability of a drinking water supply system and human exposure via water consumption. This study analyzed the selected EDCs in source (river water, n = 10) and supply (tap water, n = 155) points and the associated risks. A total of 14 multiclass EDCs was detected in the drinking water supply system in Malaysia. Triclosan (an antimicrobial agent) and 4-octylphenol (a plasticizer) were only detected in the tap water (up to 9.74 and 0.44 ng/L, respectively). Meanwhile, chloramphenicol and 4-nonylphenol in the system were below the method detection limits. Bisphenol A was observed to be highest in tap water at 66.40 ng/L (detection: 100%; median concentration: 0.28 ng/L). There was a significant difference in triclosan contamination between the river and tap water (p < 0.001). Overall, the life groups were estimated at no possible risk of EDCs (risk quotient < 1). Nonetheless, the results concern the transport and impact of EDCs on the drinking water supply system regarding treatment sustainability and water security. Further exploration of smart monitoring and management using Big Data and Internet of Things and the need to invent rapid, robust, sensitive, and efficient sensors is warranted.

Public awareness level and occurrence of pharmaceutical residues in drinking water with potential health risk: A study from Kajang (Malaysia)

Studies on the occurrence of pharmaceutical residues in drinking water were conducted especially in developed countries. However, limited studies reported the occurrence of pharmaceutical residues in developing countries. Thus, this study is conducted to fill the knowledge gap of pharmaceutical residue occurrences in developing countries, particularly in Malaysia, along with public awareness level and its potential human health risk. This study investigates public awareness level of drinking water quality and pharmaceutical handling, the occurrence of nine pharmaceutical residues (amoxicillin, caffeine, chloramphenicol, ciprofloxacin, dexamethasone, diclofenac, nitrofurazone, sulfamethoxazole, and triclosan) and potential human health risks in drinking water from Kajang (Malaysia) using commercially competitive enzyme-linked immunosorbent assay kits. In general, the public awareness level of Kajang population showed poor knowledge (82.02%), and less positive attitude (98.88%) with a good practice score (57.3%). Ciprofloxacin was detected at the highest concentration (0.667 ng/L) while amoxicillin was at the lowest concentration (0.001 ng/L) in drinking water from Kajang (Malaysia). Nevertheless, all the reported occurrences were lower than previous studies conducted elsewhere. There was no appreciable potential human health risk for all the pharmaceutical residues as the risk quotient (RQ) values were less than 1 (RQ < 1). The results of this study will provide authorities with quantitative knowledge and resources to improve drinking water risk management and regulation in Malaysia.

Insight into removal of dissolved organic matter in post pharmaceutical wastewater by coagulation-UV/H2O2

The removal of four dissolved organic matter (DOM) fractions, non-acid hydrophobics, hydrophobic acids, hydrophilics and transphilics, was achieved by coagulation-UV/H₂O₂ oxidation in post-pharmaceutical wastewater (PhWW). Coagulation with Polyferric chloride (PFC), Polymeric ferric sulfate (PFS) and Polymeric aluminum ferric chloride (PAFC) was studied separately to evaluate the effects of the initial pH and coagulant dosage. The coagulation-UV/H₂O₂ oxidation method resulted in much higher reduction rates for dissolved organic carbon (DOC) (by 75%) and UV₂₅₄ (by 92%) than coagulation or UV/H₂O₂ oxidation alone. The proportion of non-acid hydrophobics, hydrophobic acids, transphilics and hydrophilics removed by coagulation was 54%, 49%, 27% and 12 %, while the combined treatment removed 92%, 87%, 70% and 39%, respectively. Parallel factor analysis (PARAFAC) of fluorescence measurements revealed that the humic-like fluorescent component C4 showed the highest removal (by 44%) during the coagulation stage. After coagulation-UV/H₂O₂ treatment, the humic-like fluorescent component C3 had the highest removal (by 72%), whereas xenobiotic organic fluorescent components C1 and C4 remained recalcitrant to decomposition. Significant correlations (R² > 0.8) between C1 and the hydrophobic acids and non-acid hydrophobics suggested the possibility of using fluorescence spectroscopy as an effective tool to assess variations in DOM fraction treatment efficacy in coagulation-UV/H₂O₂ systems. After the combined treatment, toxic inhibition of cellular activity by post PhWW decreased from 88% to 47% and biodegradability increased from 0.1 to 0.52.

Human health risk assessment of pharmaceuticals in treated wastewater reused for non-potable applications in Sharjah, United Arab Emirates

Pharmaceuticals and personal care products are an integral part of societal health yet their presence in various environmental compartments, including treated wastewaters, has sparked concerns towards possible human and ecological health effects. The current study aims to characterize human health risks posed by ten pharmaceuticals quantified in wastewater treatment plant effluents where water is reused mainly for landscape irrigation. Receptors were identified as children playing in green areas, adult landscape workers, and adult users of athletic and golf courses irrigated by treated wastewater. The human health risk assessment model exhibited safe exposure (RQ < 1) to all pharmaceuticals for all receptors through both dermal and ingestion exposure pathways. RQs were highest for the landscape worker followed by children playing in green areas and then adult using the athletic fields. RQs were highest to lowest in the following order of pharmaceuticals: acetaminophen, metoprolol, ciprofloxacin, erythromycin, ofloxacin, sulfadiazine, sulfamethoxazole, sulfapyridine, risperidone, and sulfamethazine. Such risk assessment findings aid in supporting decisions to optimize wastewater treatment and reuse strategies, as well as safeguard public and environmental health.

Organic contaminants in African aquatic systems: Current knowledge, health risks, and future research directions

Organic contaminants (OCs) are increasingly being reported in African aquatic systems, yet a critical evaluation of the literature is still lacking. The objectives of this review were to: (1) identify hotspot reservoirs, transfer pathways and ecological and human risks of OCs, (2) identify potential interventions to minimize the health risks, and (3) highlight knowledge gaps and research constraints. OCs widely reported in aquatic systems include pesticides, pharmaceuticals, plasticizers, solvents, endocrine disrupting compounds, and antimicrobial resistance genes, originating from applications in crop protection, veterinary and animal husbandry, human sanitation and hygiene, human vector and disease control. Potential hotspot reservoirs of OCs include wastewaters, on-site sanitation systems, leachates from non-engineered landfills and contaminated recharge of shallow groundwater systems. OCs could be transferred into humans via drinking of contaminated water, consumption of contaminated crops and aquatic foods, and to a lesser extent, inhalation and dermal contact. Ecological effects including intersex, estrogenicity, and acute and chronic toxicity occur in avian and aquatic species. Although the evidence base of human ecotoxicological effects of OC remains weak, pesticides have been reported in human milk, serum and sperms, pointing to potential chronic and acute toxicity and endocrine disruption. The prevalence of antimicrobials and their resistance genes could in turn lead to antimicrobial resistance in humans. The lack of OC monitoring in drinking water, coupled with over-reliance on untreated drinking water vulnerable to OC contamination predisposes humans to OC health risks. Appropriate water treatment methods, were identified, and a conceptual framework developed to minimize the ecological and human health risks. Future research directions on OC hotspot reservoirs, environmental behaviour and fate, ecotoxicology, epidemiology and interventions to minimize health risks are highlighted. However, lack of advanced analytical facilities in most African countries and other developing regions will continue to constrain OC research for now and in the foreseeable future.

Rugged Large Volume Injection for Sensitive Capillary LC-MS Environmental Monitoring

A rugged and high throughput capillary column (cLC) LC-MS switching platform using large volume injection and on-line automatic filtration and filter back-flush (AFFL) solid phase extraction (SPE) for analysis of environmental water samples with minimal sample preparation is presented. Although narrow columns and on-line sample preparation are used in the platform, high ruggedness is achieved e.g., injection of 100 non-filtrated water samples did not result in a pressure rise/clogging of the SPE/capillary columns (inner diameter 300 μm). In addition, satisfactory retention time stability and chromatographic resolution were also features of the system. The potential of the platform for environmental water samples was demonstrated with various pharmaceutical products, which had detection limits (LOD) in the 0.05–12.5 ng/L range. Between-day and within-day repeatability of selected analytes were <20% RSD.

Abundance of Pathogenic Escherichia coli Virulence-Associated Genes in Well and Borehole Water Used for Domestic Purposes in a Peri-Urban Community of South Africa

In the absence of pipe-borne water, many people in Africa, especially in rural communities, depend on alternative water sources such as wells, boreholes and rivers for household and personal hygiene. Poor maintenance and nearby pit latrines, however, lead to microbial pollution of these sources. We evaluated the abundance of Escherichia coli and the prevalence of pathogenic E. coli virulence genes in water from wells, boreholes and a river in a South African peri-urban community. Monthly samples were collected between August 2015 and November 2016. In all, 144 water samples were analysed for E. coli using the Colilert 18 system. Virulence genes (eagg, eaeA, stx1, stx2, flichH7, ST, ipaH, ibeA) were investigated using real-time polymerase chain reaction. Mean E. coli counts ranged between 0 and 443.1 Most Probable Number (MPN)/100 mL of water sample. Overall, 99.3% of samples were positive for at least one virulence gene studied, with flicH7 being the most detected gene (81/140; 57.6%) and the stx2 gene the least detected gene (8/140; 5.7%). Both intestinal and extraintestinal pathogenic E. coli genes were detected. The detection of virulence genes in these water sources suggests the presence of potentially pathogenic E. coli strains and is a public health concern.

Investigating dynamic sources of pharmaceuticals: Demographic and seasonal use are more important than down-the-drain disposal in wastewater effluent in a University City setting

Pharmaceutical pollution in surface waters poses risks to human and ecosystem health. Wastewater treatment facilities are primary sources of pharmaceutical pollutants, but little is known about the factors that affect drugs entering the wastewater stream. This paper investigates the effects of student pharmaceutical use and disposal behaviors and an annual demographic shift on pharmaceutical pollution in a university town. We sampled wastewater effluent during a ten-day annual spring student move-out period at the University of Vermont. We then interpreted these data in light of survey results that investigated pharmaceutical purchasing, use, and disposal practices among the university student population. Surveys indicated that the majority of student respondents purchased pharmaceuticals in the previous year. Many students reported having leftover drugs, though only a small portion disposed of them, mainly in the trash. We detected 51 pharmaceuticals in 80% or more of the wastewater effluent samples collected over the ten-day sampling period. Several increased in concentration after students left the area. Concentrations of caffeine and nicotine decreased weakly. Drug disposal among this university student population does not appear to be a major source of pharmaceuticals in wastewater. Increases in pharmaceutical concentration after the students left campus can be tied to an increase in the seasonal use of allergy medications directly related to pollen, as well as a demographic shift to a year-round older population, which supports national data that older people use larger volumes and different types of pharmaceuticals than the younger student population.

Photocatalytic decomposition of organic micropollutants using immobilized TiO2 having different isoelectric points

Organic micropollutants found in the environment are a diverse group of compounds that includes pharmaceuticals, personal care products, and endocrine disruptors. Their presence in the aquatic environment continues to be a concern as the risk they pose towards both the environment and human health is still inconclusive. Removal of these compounds from water and wastewater is difficult to achieve and often incomplete, but UV-TiO2 is a promising treatment approach. In this study, the efficiency of titanium dioxide (TiO2) immobilized on porous supports were tested for treatment of target pharmaceuticals and their metabolites under UV-LED exposure, a potential low energy and cost effective alternative to conventional UV lamps. Immobilization was completed using two different methods: (1) dip coating of TiO2 onto quartz fiber filters (QFT) or (2) thermal-chemical oxidation of porous titanium sheets (PTT). Comparison against experimental controls (dark QFT, dark PTT, and photolysis using UV-LED only) showed that UV-LED/PTT and UV-LED/QFT treatments have the potential to reduce the concentrations of the target compounds. However, the treatments were found to be selective, such that individual pharmaceuticals were removed well using QFT and PTT but not both. The complementary treatment behavior is likely driven by electrostatic interactions of charged compounds with the membranes. QFT membranes are negatively charged at the experimental pH (4.5-5) while PTT membranes are positively charged. As a result, cationic compounds interact more with QFT while anionic compounds with PTT. Neutral compounds, however, were found to be recalcitrant under any treatment conditions suggesting that ionic interactions were important for reactions to occur. This behavior can be advantageous if specificity is required. The behavior of pharmaceutical metabolites is similar to the parent compounds. However, isomeric metabolites of atorvastatin with functional groups in para and ortho configurations behave differently, suggesting that the positioning of functional groups can have an impact in their interaction with the immobilized TiO2. It was also apparent that PTT can be reused after cleaning by heat treatment. Overall, these newly synthesized membrane materials have potential applications for treatment of trace organic contaminants in water.

Human Exposure to Wastewater-Derived Pharmaceuticals in Fresh Produce: A Randomized Controlled Trial Focusing on Carbamazepine

Fresh water scarcity has led to increased use of reclaimed wastewater as an alternative and reliable source for crop irrigation. Beyond microbiological safety, concerns have been raised regarding contamination of reclaimed wastewater by xenobiotics including pharmaceuticals. This study focuses on carbamazepine, an anticonvulsant drug which is ubiquitously detected in reclaimed wastewater, highly persistent in soil, and taken up by crops. In a randomized controlled trial we demonstrate that healthy individuals consuming reclaimed wastewater-irrigated produce excreted carbamazepine and its metabolites in their urine, while subjects consuming fresh water-irrigated produce excreted undetectable or significantly lower levels of carbamazepine. We also report that the carbamazepine metabolite pattern at this low exposure level differed from that observed at therapeutic doses. This "proof of concept" study demonstrates that human exposure to xenobiotics occurs through ingestion of reclaimed wastewater-irrigated produce, providing real world data which could guide risk assessments and policy designed to ensure the safe use of wastewater for crop irrigation.

Health risk assessment of hazardous metals for population via consumption of seafood from Ogoniland, Rivers State, Nigeria; a case study of Kaa, B-Dere, and Bodo City

This study was designed to investigate the human health risk through consumption of seafood from contaminated sites in Kaa, B-Dere, and Bodo City all in Ogoniland. The potential non-carcinogenic health risk for consumers were investigated by assessing the estimated daily intake and target hazard quotients for Cr, Cd, Zn, Pb, Mn, and Fe while carcinogenic health effect from Cr, Cd, and Pb was also estimated. The estimated daily intake from seafood consumption was below the threshold values for Cr, Mn, and Zn while they exceeded the threshold for Cd, Pb, and Fe. The target hazard quotients for Zn and Cr were below 1. Target hazard quotients values for Cd, Pb, Mn, and Fe were greater than 1 except for Fe level in Liza falcipinis from Kaa. Furthermore, estimation of carcinogenic risk for Cr in all samples under study exceeded the accepted risk level of 10E-4. Also, Cd carcinogenic risk level for L. falcipinis and Callinectes pallidus collected from B-Dere and C. pallidus collected from Bodo City was 1.1E-3 which also exceeded the accepted risk level of 10E-4 for Cd. Estimation of carcinogenic risk for Pb was within the acceptable range of 10E-4. Consumers of seafood from these sites in Ogoniland may be exposed to metal pollution.

Drugs of abuse, cytostatic drugs and iodinated contrast media in tap water from the Madrid region (central Spain):A case study to analyse their occurrence and human health risk characterization

This work analyses the presence of forty-eight emerging pollutants, including twenty-five drugs of abuse and metabolites, seventeen cytostatic drugs and six iodinated contrast media, in tap water from the Madrid Region. Analysis of the target compounds in the tap water was performed by means of (on-line or off-line) solid-phase extraction followed by analysis by liquid chromatography-tandem mass spectrometry. A preliminary human health risk characterization was undertaken for each individual compound and for different groups of compounds with a common mechanism of action found in tap water. The results of the study showed the presence of eight out of the twenty-five drugs of abuse and metabolites analysed, namely, the cocainics cocaine and benzoylecgonine, the amphetamine-type stimulants ephedrine, 3,4-methylenedioxymethamphetamine and methamphetamine, the opioid methadone and its metabolite 2-ethylene-1,5-dimethyl-3,3-diphenylpyrrolidine and, finally caffeine at concentrations ranging from 0.11 to 502 ng L(-1). Four out of the six analysed iodinated contrast media, namely, diatrizoate, iohexol, iomeprol and iopromide, were detected in at least one sample, with concentration values varying between 0.4 and 5 ng L(-1). Cytostatic compounds were not detected in any sample. Caffeine was the substance showing the highest concentrations, up to 502 ng L(-1), mainly in the drinking water sampling point located in Madrid city. Among the other drugs of abuse, the most abundant compounds were cocaine and benzoylecgonine, detected at concentrations ranging from 0.11 to 86 ng L(-1) and from 0.11 to 53 ng L(-1), respectively. Regarding iodinated contrast media, iohexol was the most ubiquitous and abundant compound, with a frequency of detection of 100% and concentrations from 0.5 to 5.0 ng L(-1) in basically the same range in all sampling points. Taking into account the results and types of treatment applied, ozonisation plus granular activated carbon filtration appears to be efficient in the removal of cocaine and benzoylecgonine. For the amphetamine-type stimulants, opioids and caffeine, ozonisation plus granular activated carbon filtration and ultrafiltration plus reverse osmosis showed higher removal efficiency than sand filtration. The human health risk characterization performed indicates that the lifetime consumption of the tap waters analysed has associated a negligible human health concern.

Occurrence of pharmaceuticals in a water supply system and related human health risk assessment

A monitoring study of 31 pharmaceuticals along Lisbon's drinking water supply system was implemented, which comprised the analysis of 250 samples including raw water (surface water and groundwater), and drinking water. Of the 31 pharmaceutical compounds, only sixteen were quantified in the analyzed samples, with levels ranging from 0.005 to 46 ng/L in raw water samples and 0.09-46 ng/L in drinking water samples. The human health risk assessment performed showed that appreciable risks to the consumer's health arising from exposure to trace levels of pharmaceuticals in drinking water are extremely unlikely, as RQs values were all below 0.001. Also, pharmaceuticals were selected as indicators to be used as a tool to control the quality of raw water and the treatment efficiency in the drinking water treatment plants.

Pharmaceuticals, perfluorosurfactants, and other organic wastewater compounds in public drinking water wells in a shallow sand and gravel aquifer

Approximately 40% of U.S. residents rely on groundwater as a source of drinking water. Groundwater, especially unconfined sand and gravel aquifers, is vulnerable to contamination from septic systems and infiltration of wastewater treatment plant effluent. In this study, we characterized concentrations of pharmaceuticals, perfluorosurfactants, and other organic wastewater compounds (OWCs) in the unconfined sand and gravel aquifer of Cape Cod, Massachusetts, USA, where septic systems are prevalent. Raw water samples from 20 public drinking water supply wells on Cape Cod were tested for 92 OWCs, as well as surrogates of wastewater impact. Fifteen of 20 wells contained at least one OWC; the two most frequently-detected chemicals were sulfamethoxazole (antibiotic) and perfluorooctane sulfonate (perfluorosurfactant). Maximum concentrations of sulfamethoxazole (113 ng/L) and the anticonvulsant phenytoin (66 ng/L) matched or exceeded maximum reported concentrations in other U.S. public drinking water sources. The sum of pharmaceutical concentrations and the number of detected chemicals were both significantly correlated with nitrate, boron, and extent of unsewered residential and commercial development within 500 m, indicating that wastewater surrogates can be useful for identifying wells most likely to contain OWCs. Septic systems appear to be the primary source of OWCs in Cape Cod groundwater, although wastewater treatment plants and other sources were potential contributors to several wells. These results show that drinking water supplies in unconfined aquifers where septic systems are prevalent may be among the most vulnerable to OWCs. The presence of mixtures of OWCs in drinking water raises human health concerns; a full evaluation of potential risks is limited by a lack of health-based guidelines and toxicity assessments.

Evaluation of food chain transfer of the antibiotic oxytetracycline and human risk assessment

There has been recent concern regarding the possibility of antibiotics entering the aquatic food chain and impacting human consumers. This work reports experimental results of the bioconcentration of the antibiotic oxytetracycline (OTC) by the Asian watermeal plant (Wolffia globosa Hartog & Plas) and bioaccumulation of OTC in watermeal and water by the seven-striped carp (Probarbus jullieni). They show, for the first time, the extent to which OTC is able to transfer from water to plant to fish and enter the food chain. The mean bioconcentration factor (dry weight basis) with watermeal was 1.28 × 10(3) L kg(-1). Separate experiments were undertaken to characterize accumulation of OTC by carp from water and watermeal. These showed the latter pathway to be dominant under the conditions employed. The bioconcentration and biomagnification factors for these processes were 1.75 L kg(-1) and 2 × 10(-4) kg g(-1) respectively. Using an aqueous concentration range of 0.34-3.0 μg L(-1), hazard quotients for human consumption of contaminated fish of 1.3 × 10(-2) to 1.15 × 10(-1) were derived.

Consumer-perceived risks and choices about pharmaceuticals in the environment: a cross-sectional study

BACKGROUND

There is increasing concern that pollution from pharmaceuticals used in human medicine and agriculture can be a threat to the environment. Little is known, however, if people are aware that pharmaceuticals may have a detrimental influence on the environment. The present study examines people's risk perception and choices in regard to environmental risks of pharmaceuticals used in human medicine and for agricultural purposes.

METHODS

A representative sample of the U.S. population (N = 640) was surveyed. Respondents completed a hypothetical choice task that involved tradeoffs between human and environmental health. In addition, it was examined how much people would support an environment policy related to drug regulation.

RESULTS

For agricultural pharmaceuticals, respondents reported a high level of satisfaction for a policy requiring farms to limit their use of antibiotics. In the domain of pharmaceuticals used in human medicine, we found that people were willing to consider environmental consequences when choosing a drug, but only when choices were made about treatment options for a rather harmless disease. In contrast, when decisions were made about treatment options for a severe disease, the drug's effectiveness was the most important criterion.

CONCLUSIONS

It can be concluded that the environmental impact of a drug will be hardly considered in decisions about pharmaceuticals for severe diseases like cancer, and this may be due to the fact that these decisions are predominantly affective in nature. However, for less severe health risks, people are willing to balance health and environmental considerations.

Screening and human health risk assessment of pharmaceuticals and their transformation products in Dutch surface waters and drinking water

Numerous studies describe the presence of pharmaceuticals in the water cycle, while their transformation products are usually not included. In the current study 17 common pharmaceuticals and 9 transformation products were monitored in the Dutch waters, including surface waters, pre-treated surface waters, river bank filtrates, two groundwater samples affected by surface water and drinking waters. In these samples, 12 pharmaceuticals and 7 transformation products were present. Concentrations were generally highest in surface waters, intermediate in treated surface waters and river bank filtrates and lowest or not detected in produced drinking water. However, the concentrations of phenazone and its environmental transformation product AMPH were significantly higher in river bank filtrates, which is likely due to historical contamination. Fairly constant ratios were observed between concentrations of transformation products and parent pharmaceuticals. This might enable prediction of concentrations of transformation products from concentrations of parent pharmaceuticals. The toxicological relevance of the observed pharmaceuticals and transformation products was assessed by deriving (i) a substance specific provisional guideline value (pGLV) and (ii) a group pGLV for groups of related compounds were under the assumption of additivity of effects within each group. A substantial margin exists between the maximum summed concentrations of these compounds present in different water types and the derived (group) pGLVs. Based on the results of this limited screening campaign no adverse health effects of the studied compounds are expected in (sources of) drinking water in the Netherlands. The presence of transformation products with similar pharmacological activities and concentration levels as their parents illustrates the relevance of monitoring transformation products, and including these in risk assessment. More thorough monitoring yielding information on statistical uncertainty and variability in time and space, and research on possible synergistic effects of low concentration mixtures of compounds belonging to similar pharmacological classes require attention.

Formation of diclofenac and sulfamethoxazole reversible transformation products in aquifer material under denitrifying conditions: batch experiments

Soil-aquifer processes have proven to work as a natural treatment for the attenuation of numerous contaminants during artificial recharge of groundwater. Nowadays, significant scientific effort is being devoted to understanding the fate of pharmaceuticals in subsurface environments, and to verify if such semipersistent organic micropollutants could also be efficiently removed from water. In this context we carried out a series of batch experiments involving aquifer material, selected drugs (initial concentration of 1 μg/L and 1 mg/L), and denitrifying conditions. Diclofenac and sulfamethoxazole exhibited an unreported and peculiar behavior. Their concentrations consistently dropped in the middle of the tests but recovered toward the end, which suggest a complex effect of denitrifying conditions on aromatic amines. The transformation products Nitro-Diclofenac and 4-Nitro-Sulfamethoxazole were detected in the biotic experiments, while nitrite was present in the water. Their concentrations developed almost opposite to those of their respective parent compounds. We conjecture that this temporal and reversible effect of denitrifying conditions on the studied aromatic amines could have significant environmental implications, and could explain at least partially the wide range of removals in subsurface environments reported in literature for DCF and SMX, as well as some apparent discrepancies on SMX behavior.