Direct potable reuse and birth defects prevalence in Texas: An augmented synthetic control method analysis of data from a population-based birth defects registry

Background

Direct potable reuse (DPR) involves adding purified wastewater that has not passed through an environmental buffer into a water distribution system. DPR may help address water shortages and is approved or is under consideration as a source of drinking water for several water-stressed population centers in the United States, however, there are no studies of health outcomes in populations who receive DPR drinking water. Our objective was to determine whether the introduction of DPR for certain public water systems in Texas was associated with changes in birth defect prevalence.

Methods

We obtained data on maternal characteristics for all live births and birth defects cases regardless of pregnancy outcome in Texas from 2003 to 2017 from the Texas Birth Defects Registry and birth and fetal death records. The ridge augmented synthetic control method was used to model changes in birth defect prevalence (per 10,000 live births) following the adoption of DPR by four Texas counties in mid-2013, with county-level data on maternal age, percent women without a high school diploma, percent who identified as Hispanic/Latina or non-Hispanic/Latina Black, and rural-urban continuum code as covariates.

Results

There were nonstatistically significant increases in prevalence of all birth defects collectively (average treatment effect in the treated = 53.6) and congenital heart disease (average treatment effect in the treated = 287.3) since June 2013. The estimated prevalence of neural tube defects was unchanged.

Conclusions

We estimated nonstatistically significant increases in birth defect prevalence following the implementation of DPR in four West Texas counties. Further research is warranted to inform water policy decisions.

Development of a fluorescence EEM-PARAFAC model for potable water reuse monitoring: Implications for inter-component protein-fulvic-humic interactions

Measuring the surrogate parameters total organic carbon and dissolved organic carbon (TOC/DOC) is not adequate, alone, to reveal nuances in organic character for optimizing treatment in potable water reuse. Alternatively, analyzing each organic compound contributing to the surrogate measurement is not possible. As an additional analytical tool applied between these extremes, the use of excitation-emission matrix fluorescence spectroscopy with PARAllel FACtor (EEM-PARAFAC) analysis was investigated in this research to track categories (components) or families of organic compounds during treatment in recycled water schemes. Although not all organic molecules fluoresce, many do, and fluorescence helps track their fate through water treatment processes. The sites investigated in this research were Lake Lanier, in Gwinnett County, Georgia, USA; the F. Wayne Hill Water Resources Center (FWH WRC) advanced wastewater treatment facility; and two pilot facilities operated in parallel representing the current indirect potable reuse (IPR) scheme as well as a pilot that evaluated direct potable reuse (DPR). A four-component nonnegativity PARAFAC model-elucidating protein-like (including tyrosine- and tryptophan-like fluorescence in a single component), soluble microbial product (SMP)-like, fulvic-like, and humic-like components-was fitted to the data. Each of the four components was spectrally and mathematically separated, implying that the fluorescing SMP-like component was not comprised of protein-, fulvic-, or humic-like components. PARAFAC excitation loadings with dual (double) pairs of fluorescing regions centered at the same emission wavelengths but different excitation wavelengths oriented parallel to the excitation axis and perpendicular to the emission axis were attributed to individual PARAFAC components. Significantly, the observation of PARAFAC emission loadings with multiple peaks-where the protein-like component exhibited fluorescence in both protein and fulvic/humic regions-is proposed to signify an intermolecular energy transfer (< 10 nm). Correct identification of EEM-PARAFAC components is fundamental to understanding water treatment.

Pilot testing of direct and indirect potable water reuse using multi-stage ozone-biofiltration without reverse osmosis

Pilot testing of direct potable reuse (DPR) using multi-stage ozone and biological filtration as an alternative treatment train without reverse osmosis (RO) was investigated. This study examined four blending ratios of advanced treated reclaimed water from the F. Wayne Hill Water Resources Center (FWH WRC) in Gwinnett County, Georgia, combined with the existing drinking water treatment plant raw water supply, Lake Lanier, for potable water production. Baseline testing with 100 percent (%) Lake Lanier water was initially conducted; followed by testing blends of 15, 25, 50, and 100% reclaimed water from FWH WRC. Finished water quality from the DPR pilot was compared to drinking water standards, and emerging microbial and chemical contaminants were also evaluated. Results were benchmarked against a parallel indirect potable reuse (IPR) pilot receiving 100% of the raw water from Lake Lanier. Finished water quality from the DPR pilot at the 15% blend complied with the United States primary and secondary maximum contaminant levels (MCLs and SMCLs, respectively). However, exceedances of one or more MCLs or SMCLs were observed at higher blends. Importantly, reclaimed water from FWH WRC was of equal or better quality for all microbiological targets tested compared to Lake Lanier, indicating that a DPR scenario could lower acute risks from microbial pathogens compared to current practices. Finished water from the DPR pilot had no detections of microorganisms, even at the 100% FWH WRC effluent blend. Microbiological targets tested included heterotrophic plate counts, total and fecal coliforms, Escherichia coli, somatic and male-specific coliphage, Clostridium perfringens, Enterococci, Legionella, Cryptosporidium, and Giardia. There were water quality challenges, primarily associated with nitrate originating from incomplete denitrification and bromate formation from ozonation at the FWH WRC. These challenges highlight the importance of upstream process monitoring and control at the advanced wastewater treatment facility if DPR is considered. This research demonstrated that ozone with biological filtration could achieve potable water quality criteria, without the use of RO, in cases where nitrate is below the MCL of 10 mg nitrogen per liter and total dissolved solids are below the SMCL of 500 mg per liter.

Potable Water Reuse: What Are the Microbiological Risks?

PURPOSE OF REVIEW

With the increasing interest in recycling water for potable reuse purposes, it is important to understand the microbial risks associated with potable reuse. This review focuses on potable reuse systems that use high-level treatment and de facto reuse scenarios that include a quantifiable wastewater effluent component.

RECENT FINDINGS

In this article, we summarize the published human health studies related to potable reuse, including both epidemiology studies and quantitative microbial risk assessments (QMRA). Overall, there have been relatively few health-based studies evaluating the microbial risks associated with potable reuse. Several microbial risk assessments focused on risks associated with unplanned (or de facto) reuse, while others evaluated planned potable reuse, such as indirect potable reuse (IPR) or direct potable reuse (DPR). The reported QMRA-based risks for planned potable reuse varied substantially, indicating there is a need for risk assessors to use consistent input parameters and transparent assumptions, so that risk results are easily translated across studies. However, the current results overall indicate that predicted risks associated with planned potable reuse scenarios may be lower than those for de facto reuse scenarios. Overall, there is a clear need to carefully consider water treatment train choices when wastewater is a component of the drinking water supply (whether de facto, IPR, or DPR). More data from full-scale water treatment facilities would be helpful to quantify levels of viruses in raw sewage and reductions across unit treatment processes for both culturable and molecular detection methods.

Impact of blending for direct potable reuse on premise plumbing microbial ecology and regrowth of opportunistic pathogens and antibiotic resistant bacteria

Little is known about how introducing recycled water intended for direct potable reuse (DPR) into distribution systems and premise plumbing will affect water quality at the point of use, particularly with respect to effects on microbial communities and regrowth. The examination of potential growth of opportunistic pathogens (OPs) and spread of antibiotic resistance genes (ARGs), each representing serious and growing public health concerns, by introducing DPR water has not previously been evaluated. In this study, the impact of blending purified DPR water with traditional drinking water sources was investigated with respect to treatment techniques, blending location, and blending ratio. Water from four U.S. utility partners was treated in bench- and pilot-scale treatment trains to simulate DPR with blending. Water was incubated in simulated premise plumbing rigs made of PVC pipe containing brass coupons to measure regrowth of total bacteria (16S rRNA genes, heterotrophic plate count), OPs (Legionella spp., Mycobacterium spp., Pseudomonas aeruginosa), ARGs (qnrA, vanA), and an indicator of horizontal gene transfer and multi-drug resistance (intI1). The microbial community composition was profiled and the resistome (i.e., all ARGs present) was characterized in select samples using next generation sequencing. While regrowth of total bacteria (16S rRNA genes) from the start of the incubation through week eight consistently occurred across tested scenarios (Wilcoxon, p ≤ 0.0001), total bacteria were not more abundant in the water or biofilm of any DPR scenario than in the corresponding conventional potable condition (p ≥ 0.0748). Regrowth of OP marker genes, qnrA, vanA, and intI1 were not significantly greater in water or biofilm for any DPR blends treated with advanced oxidation compared to corresponding potable water (p ≥ 0.1047). This study of initial bacteria colonizing pipes after introduction of blended DPR water revealed little evidence (i.e., one target in one water type) of exacerbated regrowth of total bacteria, OPs, or ARGs in premise plumbing.

Flow cytometry applications in water treatment, distribution, and reuse: A review

Ensuring safe and effective water treatment, distribution, and reuse requires robust methods for characterizing and monitoring waterborne microbes. Methods widely used today can be limited by low sensitivity, high labor and time requirements, susceptibility to interference from inhibitory compounds, and difficulties in distinguishing between viable and non-viable cells. Flow cytometry (FCM) has recently gained attention as an alternative approach that can overcome many of these challenges. This article critically and systematically reviews for the first time recent literature on applications of FCM in water treatment, distribution, and reuse. In the review, we identify and examine nearly 300 studies published from 2000 to 2018 that illustrate the benefits and challenges of using FCM for assessing source-water quality and impacts of treatment-plant discharge on receiving waters, wastewater treatment, drinking water treatment, and drinking water distribution. We then discuss options for combining FCM with other indicators of water quality and address several topics that cut across nearly all applications reviewed. Finally, we identify priority areas in which more work is needed to realize the full potential of this approach. These include optimizing protocols for FCM-based analysis of waterborne viruses, optimizing protocols for specifically detecting target pathogens, automating sample handling and preparation to enable real-time FCM, developing computational tools to assist data analysis, and improving standards for instrumentation, methods, and reporting requirements. We conclude that while more work is needed to realize the full potential of FCM in water treatment, distribution, and reuse, substantial progress has been made over the past two decades. There is now a sufficiently large body of research documenting successful applications of FCM that the approach could reasonably and realistically see widespread adoption as a routine method for water quality assessment.

Wastewater recycling in Antarctica: Performance assessment of an advanced water treatment plant in removing trace organic chemicals

The Australian Antarctic Division (AAD) operates Australia's Davis Station in the Antarctic. In 2005, Davis Station's wastewater treatment plant failed and since then untreated, macerated effluent has been discharged to the ocean. The objectives of this study were to determine whether an advanced water treatment plant (AWTP) commissioned by the AAD and featuring a multi-barrier process involving ozonation, ceramic microfiltration, biologically activated carbon filtration, reverse osmosis, ultraviolet disinfection and chlorination was capable of producing potable water and a non-toxic brine concentrate that can be discharged with minimal environmental impact. The AWTP was tested using water from a municipal wastewater treatment plant in Tasmania, Australia. We used spot water and passive sampling combined with two multi-residue chromatographic-mass spectrometric methods and a range of recombinant receptor-reporter gene bioassays to screen trace organic chemicals (TrOCs), toxicity and receptor activity in the Feed water, in the environmental discharge (reject water), and product water from the AWTP for six months during 2014-15, and then again for three months in 2016. Across the two surveys we unambiguously detected 109 different TrOCs in the feed water, 39 chemicals in the reject water, and 34 chemicals in the product water. Sample toxicity and receptor activity in the feed water samples was almost totally removed in both testing periods, confirming that the vast majority of the receptor active TrOCs were removed by the treatment process. All the NDMA entering the AWTP in the feed and/or produced in the plant (typically < 50 ng/L), was retained into the reject water with no NDMA observed in the product water. In conclusion, the AWTP was working to design, and releases of TrOCs at the concentrations observed in this study would be unlikely cause adverse effects on populations of aquatic organisms in the receiving environment or users of the potable product water.

Direct potable reuse microbial risk assessment methodology: Sensitivity analysis and application to State log credit allocations

Understanding pathogen risks is a critically important consideration in the design of water treatment, particularly for potable reuse projects. As an extension to our published microbial risk assessment methodology to estimate infection risks associated with Direct Potable Reuse (DPR) treatment train unit process combinations, herein, we (1) provide an updated compilation of pathogen density data in raw wastewater and dose-response models; (2) conduct a series of sensitivity analyses to consider potential risk implications using updated data; (3) evaluate the risks associated with log credit allocations in the United States; and (4) identify reference pathogen reductions needed to consistently meet currently applied benchmark risk levels. Sensitivity analyses illustrated changes in cumulative annual risks estimates, the significance of which depends on the pathogen group driving the risk for a given treatment train. For example, updates to norovirus (NoV) raw wastewater values and use of a NoV dose-response approach, capturing the full range of uncertainty, increased risks associated with one of the treatment trains evaluated, but not the other. Additionally, compared to traditional log-credit allocation approaches, our results indicate that the risk methodology provides more nuanced information about how consistently public health benchmarks are achieved. Our results indicate that viruses need to be reduced by 14 logs or more to consistently achieve currently applied benchmark levels of protection associated with DPR. The refined methodology, updated model inputs, and log credit allocation comparisons will be useful to regulators considering DPR projects and design engineers as they consider which unit treatment processes should be employed for particular projects.

Reliability of pathogen control in direct potable reuse: Performance evaluation and QMRA of a full-scale 1 MGD advanced treatment train

To safely progress toward direct potable reuse (DPR), it is essential to ensure that DPR systems can provide public health protection equivalent to or greater than that of conventional drinking water sources. This study collected data over a one-year period from a full-scale DPR demonstration facility, and used both performance distribution functions (PDFs) and quantitative microbial risk assessment (QMRA) to define and evaluate the reliability of the advanced water treatment facility (AWTF). The AWTF's ability to control enterovirus, Giardia, and Cryptosporidium was characterized using online monitoring of surrogates in a treatment train consisting of ozone, biological activated carbon, microfiltration, reverse osmosis, and ultraviolet light with an advanced oxidation process. This process train was selected to improve reliability by providing redundancy, defined as the provision of treatment beyond the minimum needed to meet regulatory requirements. The PDFs demonstrated treatment that consistently exceeded the 12/10/10-log thresholds for virus, Giardia, and Cryptosporidium, as currently required for potable reuse in California (via groundwater recharge and surface water augmentation). Because no critical process failures impacted pathogen removal performance during the yearlong testing, hypothetical failures were incorporated into the analysis to understand the benefit of treatment redundancy on performance. Each unit process was modeled with a single failure per year lasting four different failure durations: 15 min, 60 min, 8 h, and 24 h. QMRA was used to quantify the impact of failures on pathogen risk. The median annual risk of infection for Cryptosporidium was 4.9 × 10^-11 in the absence of failures, and reached a maximum of 1.1 × 10^-5 assuming one 24-h failure per process per year. With the inclusion of free chlorine disinfection as part of the treatment process, enterovirus had a median annual infection risk of 1.5 × 10^-14 (no failures) and a maximum annual value of 2.1 × 10^-5 (assuming one 24-h failure per year). Even with conservative failure assumptions, pathogen risk from this treatment train remains below the risk targets for both the U.S. (10^-4 infections/person/year) and the WHO (approximately 10^-3 infections/person/year, equivalent to 10^-6 DALY/person/year), demonstrating the value of a failure prevention strategy based on treatment redundancy.

Control of nitrification/denitrification in an onsite two-chamber intermittently aerated membrane bioreactor with alkalinity and carbon addition: Model and experiment

Denitrifying membrane bioreactors (MBRs) are being found useful in water reuse treatment systems, including net-zero water (nearly closed-loop), non-reverse osmosis-based, direct potable reuse (DPR) systems. In such systems nitrogen may need to be controlled in the MBR to meet the nitrate drinking water standard in the finished water. To achieve efficient nitrification and denitrification, the addition of alkalinity and external carbon may be required, and control of the carbon feed rate is then important. In this work, an onsite, two-chamber aerobic nitrifying/denitrifying MBR, representing one unit process of a net-zero water, non-reverse osmosis-based DPR system, was modeled as a basis for control of the MBR internal recycling rate, aeration rate, and external carbon feed rate. Specifically, a modification of the activated sludge model ASM2dSMP was modified further to represent the rate of recycling between separate aerobic and anoxic chambers, rates of carbon and alkalinity feed, and variable aeration schedule, and was demonstrated versus field data. The optimal aeration pattern for the modeled reactor configuration and influent matrix was found to be 30 min of aeration in a 2 h cycle (104 m³ air/d per 1 m³/d average influent), to ultimately meet the nitrate drinking water standard. Optimal recycling ratios (inter-chamber flow to average daily flow) were found to be 1.5 and 3 during rest and mixing periods, respectively. The model can be used to optimize aeration pattern and recycling ratio in such MBRs, with slight modifications to reflect reactor configuration, influent matrix, and target nitrogen species concentrations, though some recalibration may be required.

A taxonomy of chemicals of emerging concern based on observed fate at water resource recovery facilities

As reuse of municipal water resource recovery facility (WRRF) effluent becomes vital to augment diminishing fresh drinking water resources, concern exists that conventional barriers may prove deficient, and the upcycling of chemicals of emerging concern (CECs) could prove harmful to human health and aquatic species if more effective and robust treatment barriers are not in place. A multiple month survey, of both primary and secondary effluents, from three (3) WRRFs, for 95 CECs was conducted in 2014 to classify CECs by their persistence through conventional water reclamation processes. By sampling the participating WRRF process trains at their peak performance (as determined by measured bulk organics and particulates removal), a short-list of recalcitrant CECs that warrant monitoring to assess treatment performance at advanced water reclamation and production facilities. The list of identified CECs for potable water reclamation (indirect or direct potable reuse) include a herbicide and its degradants, prescription pharmaceuticals and antibiotics, a female hormone, an artificial sweetener, and chlorinated flame retardants.

Mineralizing urban net-zero water treatment: Field experience for energy-positive water management

An urban net-zero water treatment system, designed for energy-positive water management, 100% recycle of comingled black/grey water to drinking water standards, and mineralization of hormones and other organics, without production of concentrate, was constructed and operated for two years, serving an occupied four-bedroom, four-bath university residence hall apartment. The system comprised septic tank, denitrifying membrane bioreactor (MBR), iron-mediated aeration (IMA) reactor, vacuum ultrafilter, and peroxone or UV/H₂O₂ advanced oxidation, with 14% rainwater make-up and concomitant discharge of 14% of treated water (ultimately for reuse in irrigation). Chemical oxygen demand was reduced to 12.9 ± 3.7 mg/L by MBR and further decreased to below the detection limit (<0.7 mg/L) by IMA and advanced oxidation treatment. The process produced a mineral water meeting 115 of 115 Florida drinking water standards that, after 10 months of recycle operation with ∼14% rainwater make-up, had a total dissolved solids of ∼500 mg/L, pH 7.8 ± 0.4, turbidity 0.12 ± 0.06 NTU, and NO₃-N concentration 3.0 ± 1.0 mg/L. None of 97 hormones, personal care products, and pharmaceuticals analyzed were detected in the product water. For a typical single-home system with full occupancy, sludge pumping is projected on a 12-24 month cycle. Operational aspects, including disinfection requirements, pH evolution through the process, mineral control, advanced oxidation by-products, and applicability of point-of-use filters, are discussed. A distributed, peroxone-based NZW management system is projected to save more energy than is consumed in treatment, due largely to retention of wastewater thermal energy. Recommendations regarding design and operation are offered.

Urban net-zero water treatment and mineralization: experiments, modeling and design

Water and wastewater treatment and conveyance account for approximately 4% of US electric consumption, with 80% used for conveyance. Net zero water (NZW) buildings would alleviate demands for a portion of this energy, for water, and for the treatment of drinking water for pesticides and toxic chemical releases in source water. However, domestic wastewater contains nitrogen loads much greater than urban/suburban ecosystems can typically absorb. The purpose of this work was to identify a first design of a denitrifying urban NZW treatment process, operating at ambient temperature and pressure and circum-neutral pH, and providing mineralization of pharmaceuticals (not easily regulated in terms of environmental half-life), based on laboratory tests and mass balance and kinetic modeling. The proposed treatment process is comprised of membrane bioreactor, iron-mediated aeration (IMA, reported previously), vacuum ultrafiltration, and peroxone advanced oxidation, with minor rainwater make-up and H2O2 disinfection residual. Similar to biological systems, minerals accumulate subject to precipitative removal by IMA, salt-free treatment, and minor dilution. Based on laboratory and modeling results, the system can produce potable water with moderate mineral content from commingled domestic wastewater and 10-20% rainwater make-up, under ambient conditions at individual buildings, while denitrifying and reducing chemical oxygen demand to below detection (<3 mg/L). While economics appear competitive, further development and study of steady-state concentrations and sludge management options are needed.