Enteric Virus Infection Risk from Intrusion of Sewage into a Drinking Water Distribution Network

Teunis, Peter; Xu, Minhua; Fleming, Kala K.; Yang, Jian; Moe, Christine L.; LeChevallier, Mark W.

doi:10.1021/es101266k

Cited by 66 publications

(59 citation statements)

References 19 publications

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“…The pathogen densities in sewage were not quantified in this study; therefore, the pathogen dose was estimated using norovirus densities from the literature. Norovirus density in raw sewage was modeled as a lognormal distribution with parameters ( ϭ 10.8; ϭ 6 [genome copies liter Ϫ1 ]) corresponding to a median density of 4.94 ϫ 10 4 genome copies liter Ϫ1 and censored at 10 8 genome copies liter Ϫ1 (46). The volume of water ingested was also modeled as a lognormal distribution with parameters ( ϭ 2.92 ml; ϭ 1.43 ml) corresponding to a mean volume of 18.6 ml.…”

Section: Methodsmentioning

confidence: 99%

Performance of Two Quantitative PCR Methods for Microbial Source Tracking of Human Sewage and Implications for Microbial Risk Assessment in Recreational Waters

Staley

Gordon

Schoen

et al. 2012

Appl Environ Microbiol

139

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Before new, rapid quantitative PCR (qPCR) methods for assessment of recreational water quality and microbial source tracking (MST) can be useful in a regulatory context, an understanding of the ability of the method to detect a DNA target (marker) when the contaminant source has been diluted in environmental waters is needed. This study determined the limits of detection and quantification of the human-associated Bacteroides sp. (HF183) and human polyomavirus (HPyV) qPCR methods for sewage diluted in buffer and in five ambient, Florida water types (estuarine, marine, tannic, lake, and river). HF183 was quantifiable in sewage diluted up to 10 ؊6 in 500-ml ambient-water samples, but HPyVs were not quantifiable in dilutions of >10 ؊4 . Specificity, which was assessed using fecal composites from dogs, birds, and cattle, was 100% for HPyVs and 81% for HF183. Quantitative microbial risk assessment (QMRA) estimated the possible norovirus levels in sewage and the human health risk at various sewage dilutions. When juxtaposed with the MST marker detection limits, the QMRA analysis revealed that HF183 was detectable when the modeled risk of gastrointestinal (GI) illness was at or below the benchmark of 10 illnesses per 1,000 exposures, but the HPyV method was generally not sensitive enough to detect potential health risks at the 0.01 threshold for frequency of illness. The tradeoff between sensitivity and specificity in the MST methods indicates that HF183 data should be interpreted judiciously, preferably in conjunction with a more host-specific marker, and that better methods of concentrating HPyVs from environmental waters are needed if this method is to be useful in a watershed management or monitoring context. Fecal indicator bacteria (FIB), including fecal coliforms, Escherichia coli, and enterococci, have been approved indicators of sewage contamination in recreational waters for decades (49, 51). Swimmers exposed to waters contaminated with sewage are at a greater risk of infection by human pathogens, and subsequent gastrointestinal or other illnesses, than those exposed to unimpacted waters (57). The use of FIB to detect sewage contamination, however, relies on the assumptions that elevated FIB concentrations are representative of pathogen presence and that the fate of these bacteria mimics that of pathogens. Unfortunately, previous studies have shown that concentrations of FIB do not necessarily correlate well with bacterial, protozoan, and viral pathogens (2,20).To address the limitations of FIB, microbial source tracking (MST) methods have been developed to identify human fecal contamination (e.g., sewage) in recreational waters (7, 32). These methods are culture independent and are therefore more rapid than FIB methodologies that require a culture step. The potential for same-day results provides the possibility of advisories that reflect current conditions, rather than day-old ones, which allows more-immediate action to protect against public health risks posed by recreational water use (12, 56). The selecti...

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Section: Methodsmentioning

confidence: 99%

Performance of Two Quantitative PCR Methods for Microbial Source Tracking of Human Sewage and Implications for Microbial Risk Assessment in Recreational Waters

Staley

Gordon

Schoen

et al. 2012

Appl Environ Microbiol

139

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“…In contrast, the contribution of distribution systems to waterborne illness under non-outbreak conditions is not well understood. Risk assessment models have suggested distribution system problems as a potential risk factor for sporadic gastrointestinal illness (GII) (Lambertini et al 2012; McInnis 2004; Teunis et al 2010). Such models, however, typically rely on several assumptions.…”

Section: Introductionmentioning

confidence: 99%

Water Distribution System Deficiencies and Gastrointestinal Illness: A Systematic Review and Meta-Analysis

Ercümen

Gruber

Colford

2014

Environ Health Perspect

104

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Background: Water distribution systems are vulnerable to performance deficiencies that can cause (re)contamination of treated water and plausibly lead to increased risk of gastrointestinal illness (GII) in consumers.Objectives: It is well established that large system disruptions in piped water networks can cause GII outbreaks. We hypothesized that routine network problems can also contribute to background levels of waterborne illness and conducted a systematic review and meta-analysis to assess the impact of distribution system deficiencies on endemic GII.Methods: We reviewed published studies that compared direct tap water consumption to consumption of tap water re-treated at the point of use (POU) and studies of specific system deficiencies such as breach of physical or hydraulic pipe integrity and lack of disinfectant residual.Results: In settings with network malfunction, consumers of tap water versus POU-treated water had increased GII [incidence density ratio (IDR) = 1.34; 95% CI: 1.00, 1.79]. The subset of nonblinded studies showed a significant association between GII and tap water versus POU-treated water consumption (IDR = 1.52; 95% CI: 1.05, 2.20), but there was no association based on studies that blinded participants to their POU water treatment status (IDR = 0.98; 95% CI: 0.90, 1.08). Among studies focusing on specific network deficiencies, GII was associated with temporary water outages (relative risk = 3.26; 95% CI: 1.48, 7.19) as well as chronic outages in intermittently operated distribution systems (odds ratio = 1.61; 95% CI: 1.26, 2.07).Conclusions: Tap water consumption is associated with GII in malfunctioning distribution networks. System deficiencies such as water outages also are associated with increased GII, suggesting a potential health risk for consumers served by piped water networks.Citation: Ercumen A, Gruber JS, Colford JM Jr. 2014. Water distribution system deficiencies and gastrointestinal illness: a systematic review and meta-analysis. Environ Health Perspect 122:651–660; http://dx.doi.org/10.1289/ehp.1306912

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“…During short-term drought conditions accompanied by increased water demand by tourists (Challenge 5), all options were vulnerable to possible drinking water shortage, saltwater ingress to groundwater, and ingress contamination in distribution water (Charles et al, 2010;Teunis et al, 2010), depending on the degree of drought. However, the impacts may be less severe for the alternative options due to the reduced water demand from the WW/RR elements (Kinstedt, 2012;The Green Centre, 2014).…”

Section: Vulnerabilities and Robustnessmentioning

confidence: 99%

Technologic resilience assessment of coastal community water and wastewater service options

Schoen¹,

Hawkins²,

Xue

et al. 2015

Sustainability of Water Quality and Ecology

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Enteric Virus Infection Risk from Intrusion of Sewage into a Drinking Water Distribution Network

Cited by 66 publications

References 19 publications

Performance of Two Quantitative PCR Methods for Microbial Source Tracking of Human Sewage and Implications for Microbial Risk Assessment in Recreational Waters

Performance of Two Quantitative PCR Methods for Microbial Source Tracking of Human Sewage and Implications for Microbial Risk Assessment in Recreational Waters

Water Distribution System Deficiencies and Gastrointestinal Illness: A Systematic Review and Meta-Analysis

Technologic resilience assessment of coastal community water and wastewater service options

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