Cross-continental comparative experiences of wastewater surveillance and a vision for the 21st century.

The COVID-19 pandemic has brought the epidemiological value of monitoring wastewater into sharp focus. The challenges of implementing and optimising wastewater monitoring vary significantly from one region to another, often due to the array of different wastewater systems around the globe, as well as the availability of resources to undertake the required analyses (e.g. laboratory infrastructure and expertise). Here we reflect on the local and shared challenges of implementing a SARS-CoV-2 monitoring programme in two geographically and socio-economically distinct regions, São Paulo state (Brazil) and Wales (UK), focusing on design, laboratory methods and data analysis, and identifying potential guiding principles for wastewater surveillance fit for the 21st century. Our results highlight the historical nature of region-specific challenges to the implementation of wastewater surveillance, including previous experience of using wastewater surveillance, stakeholders involved, and nature of wastewater infrastructure. Building on those challenges, we then highlight what an ideal programme would look like if restrictions such as resource were not a constraint. Finally, we demonstrate the value of bringing multidisciplinary skills and international networks together for effective wastewater surveillance.

Greenhouse gas mitigation scenarios in the solid waste sector for compliance with the Brazilian NDC: Case study of the Recife metropolitan area, Brazil.

The Intergovernmental Panel on Climate Change (IPCC) indicates that the waste sector is a potential emitter of methane gas (CH4), which has a greenhouse effect up to 28 times greater than that of carbon dioxide (CO2). The management of municipal solid waste (MSW) generates greenhouse gases (GHG) directly through emissions from the process itself as well as indirectly through transportation and energy consumption. The objective of this study was to evaluate the GHG emissions contributed by the waste sector in the Recife metropolitan region (RMR) and to define mitigation scenarios to comply with the Brazilian Nationally Determined Contribution (NDC), a result of the Paris Agreement. To achieve this, an exploratory study was carried out, including a literature review, collection of data, estimation of emissions using the IPCC model (2006), and comparison between the values assumed by the country in 2015 and those estimated in the adopted mitigation scenarios. The RMR is composed of 15 municipalities, has an area of 3,216,262 km2 and a population of 4,054,866 inhabitants (2018), generating approximality 1.4 million t-year of MSW. It was estimated that, in the period from 2006 to 2018, 25.4 million tCO2e were emitted. The comparative analysis between the absolute values defined in the Brazilian NDC and the results from the mitigation scenarios showed that approximately 36 million tCO2e could be avoided through the disposal of MSW in the RMR, equivalent to a 52% reduction in emissions estimated for 2030, a percentage greater than the 47% reduction assumed in the Paris Agreement.

Analyzing the territorial dimensions of work through a comparative study of waste recovery facilities in France and Brazil.

BACKGROUND: Waste production and management from residents and collection for sorting are systems heavily dependent on territorial dimensions. Ergonomic research needs to better integrate such territorial determinants to improve work conditions and design sustainable work systems. OBJECTIVE: Through studies in France and Brazil, this paper analyzes the territorial relations that raise work systems' sustainability challenges for materials recovery facilities (MRFs) and waste management in both countries and examines the links between work activity and territory in MRFs. METHODS: Both studies were based on the principles of activity-oriented ergonomics and used analyses of work activity and sociotechnical systems. The French study focused on interventions conducted over a 42-month period in five MRFs. The Brazilian study was based on a 20-month longitudinal qualitative and quantitative study. RESULTS: In this paper, we argue that territory is a key determining factor in waste production and work. Notably, the consumption patterns of residents and the economic flows within a geographic space determine the waste composition; and the territorially specified public policies, which define technical and social dimensions of waste collection and sorting. However, the territorial dimensions of waste are poorly considered in facility design. Workers' health and sorting system performance are thus affected and negatively compromising plant performance. CONCLUSION: The territory appears as a blind spot in the design of work systems. One of the challenges is to create interfaces and devices that could help to integrate better human activity and waste territorialized anchorage, in a multilevel organization, from local communities to the global recycling chains.

Level of natural fluoride in public water supply: geographical and meteorological factors in Brazil's Northeast.

This study analyzed the relationships between the concentration of natural fluoride in public water supply and meteorological and hydrographic factors in a northeastern region of Brazil. This was a descriptive, analytical, ecological, longitudinal, and field study conducted by collecting water in 23 municipalities (2019 to 2020) of four macroregions of Paraíba (Brazil): coast (1), borborema (2), agreste (3), and outback (4). Four collection sites were selected per municipality: two near and two distant from the water treatment plant. Fluoride concentration was determined using a combined ion-specific electrode and classified according to the Collaborating Center of the Ministry of Health in Oral Health Surveillance. Meteorological, hydrographic, and population characteristics were also collected. All analyzed samples showed natural fluoride; macroregions 2 and 4 showed the highest mean fluoride concentration, macroregion 4 presented the highest mean temperature, and all macroregions showed a similar pattern of precipitation. The mean fluoride concentration of the four macroregions was below the appropriate value to prevent caries. An increase in precipitation would decrease the fluoride concentration in water. In conclusion, the concentration of natural fluoride varied according to meteorological and hydrographic factors. The concentration in surface waters increased during periods of low precipitation. Therefore, this study provided important information to support implementation of community water fluoridation in this region.

Stop treating waste pickers like garbage: An autoethnography on informal waste picking in Brazil.

There are almost 8 billion people on the planet with every single one of them producing some type of waste. The cost of recycling and money made by selling recyclable products has created a strong foundation for informal waste picking to exist. Waste pickers sort through garbage to find recyclable material; it is estimated that there are around 20 million waste pickers worldwide. In 2022, I went to experience life as a waste picker in Brasilia, Brazil for a day to understand issues that may continue to exist in this informal industry. I worked in a triage center and used this experience to inform my autoethnography; even though I have worked in waste picker research for almost a decade, this experience led to a different conclusion. The most interesting issue that I found while working as a waste picker was the lack of uniformity in waste picking, which led to people working on the streets or in co-op triage centers. This population is vulnerable which is worsened from exposure to hazards by nature of the informal environment; this situation contributes to ongoing poor working conditions through lack of governmental oversight, policy development, and change. Ultimately, informality needs to be addressed.

Evidence of waste management impacting severe diarrhea prevalence more than WASH: An exhaustive analysis with Brazilian municipal-level data.

Adequate housing protects from diarrhea, which is a substantial health concern in low- and middle-income countries. The purpose of this study was to quantify the relationship between severe diarrhea and housing features at the municipal level to help in public health planning. Regression analyses were performed on annual (2000-2012) datasets on Brazilian municipalities (5570) in six household feature categories (e.g., waste management) and four severe diarrhea outcomes (e.g., diarrhea deaths of under-5 children). Household data were not available elsewhere of this magnitude and granularity, highlighting the scientific value-add of this study. Municipalities were clustered prior to regression analysis because of data heterogeneity. The compositional household feature data were also subjected to principal component analysis to diminish feature variable multicollinearity. The highest explanatory power was found for diarrhea deaths of under-5 children (R2 = 10-22 %), while those in the over-5 population were the least best explained (R2 = 0.3-7 %). Household features predicted diarrhea outcomes more accurately in the "advanced" housing municipality cluster (R2 = 16-22 %) than in the "mid-level" (R2 = 7-20 %) and "basic" (R2 = 6-12 %) ones (over-5 diarrhea deaths excluded). Under-5 children's diarrhea death prevalence was three times higher in the "basic" cluster than in the "advanced" cluster. Importantly, the impact of waste management was overall the largest of all household features, even larger than those of WASH, i.e., water supply, sanitation, and household drinking water treatment. This is surprising in the context of existing literature because WASH is generally regarded as the most important household factor affecting gastrointestinal health. In conclusion, public health interventions could benefit from customizing interventions for diarrhea outcomes, municipality types, and household features. Waste management's identified stronger association with diarrhea compared to WASH may have important implications beyond the water field and Brazil.

Differences in MCF-7 response to endocrine disruptors in waste, superficial, and treated water from Southern Brazil.

The aim of this study was to evaluate the effect of possible endocrine disruptors in surface and wastewater using a cell proliferation assay in an estrogen-responsive cell line (MCF-7). This study was conducted in the Sinos River (Brazil). The residual water was collected from a Pilot Treatment Plant (using Typha domingensis) and surface waters of the Luis Rau stream, the Sinos River, and the Water Treatment Station (WTS). After exposures (24-120 h), a Sulforhodamine B assay was performed to determine the proliferation rate. The higher increase in proliferation rate was observed with the Luiz Rau stream and the sewage treated by macrophytes in a flotation filter. The results from WTS water remained with a proliferation rate similar to the negative control at all times, suggesting that the conventional treatment is partially effective for the withdrawal of endocrine-disrupting agents. The study demonstrated the efficiency of the MCF-7 line in assessing endocrine disruption caused by wastewater and surface water samples. Our results indicate that conventional water treatment can partially remove the polluting load of endocrine disruptors, minimizing their environmental and public health impacts. Besides, it demonstrates the need to expand sanitary services to improve the population's quality of life.

Risk assessment of a Brazilian urban population due to the exposure to pyrethroid insecticides during the COVID-19 pandemic using wastewater-based epidemiology.

Pyrethroids are synthetic insecticides commonly used in agriculture and homes due to their low toxicity to mammals and effectiveness at low doses. However, exposure to pyrethroids can cause various symptoms, depending on the route of exposure. To measure human exposure to pyrethroids, researchers used wastewater-based epidemiology (WBE) with polar organic chemical integrative samplers (POCIS) sampling. This approach is a cost-effective and efficient way to assess exposure to pyrethroids. The study aimed to evaluate the exposure of an urban population in Brazil to pyrethroids during the COVID-19 pandemic using WBE with POCIS sampling. Researchers analyzed 3-phenoxybenzoic acid (3-PBA) in wastewater using passive sampling with POCIS, which was extracted with methanol and analyzed using UPLC-MS/MS. The range of CTWA concentrations of 3-PBA in wastewater was 24.3-298.2 ng L-1, with a mean value of 134 ± 76.5 ng L-1. The values were used to estimate the exposure of the population to pyrethroid insecticides. Three different conversion factors were applied to determine the range of exposure to at least 20 different pyrethroid insecticides. The exposure values ranged from 18.08 to 1441.49 mg day-1 per 1000 inhabitants. The toxicological risk posed to the exposed population was evaluated by calculating the WBE toxicological level (WBE-TL). Lambda-cyhalothrin was used as a reference for risk assessment, and the WBE-TL values for lambda-cyhalothrin ranged from 0.5 to 8.29 (considering the high CF). We compared mobility trends to 3-PBA exposure during the COVID-19 pandemic. The study highlighted the effectiveness of POCIS sampling in WBE and provided useful information for policymakers and regulatory agencies. POCIS sampling has practical advantages, including analyte pre-concentration, low operational cost, and ease of use. Overall, the study shows the importance of monitoring and understanding the exposure of the population to pyrethroid insecticides, especially during the pandemic when people may be spending more time at home.

Basic Sanitation Policy in Brazil: ideas, institutions and challenges in the Twenty-first Century. / Política Pública de Saneamento Básico no Brasil: ideias, instituições e desafios no Século XXI.

This paper describes the challenges currently facing Brazil's basic sanitation sector. The sector's characteristic profitability and dynamism have brought State-run Water & Sewage (W&S) services into the spotlight of the structural reform agenda on the argument that governments do not have the resources necessary to universalize coverage. There is a pattern of W&S services' operating with a surplus, which helps explain the intense dispute in recent years in favour of legal changes to the market position of CESBs and local providers to favour an expanding role for private agents. Converging with the structural reform agenda, Law 14,026, sanctioned on 15 July 2020, made far-reaching changes to the legal framework for sanitation and provided for the State's complete withdrawal from the sector. The new regulatory framework prohibited programme contracts, required tender processes for sanitation service contracts, encouraged regionalization without CESBs, set out national guidelines for States and municipalities to access federal funding and introduced a national regulation regime under the National Waters and Basic Sanitation Agency. The model of cooperation that operates in the SUS could serve as a reference for constructing a social pact in the sector.

Este trabalho aborda os desafios contemporâneos do setor de saneamento básico brasileiro. As características de rentabilidade e dinamismo setorial puseram os serviços estatais de A & E no foco da agenda das reformas estruturais sob o argumento de que os governos não dispõem de recursos necessários para universalizar a cobertura. A agenda da reforma dos serviços de A & E advoga a concessão a empresas privadas da comercialização do abastecimento de água e do tratamento do esgotamento sanitário. Em convergência com esta agenda de reforma estrutural, a aprovação em 15 de julho de 2020 da Lei 14.026 alterou em profundidade o marco legal do saneamento, adotando integralmente a pauta da desestatização do setor. O novo marco regulatório veta o contrato de programa, torna obrigatória a licitação para contratação do serviço de saneamento, estabelece diretrizes nacionais para que estados e municípios acessem recursos federais e institui o regime de regulação nacional por meio da Agência Nacional de Águas e Saneamento Básico. O modelo cooperativo praticado no Sistema Único de Saúde (SUS) pode servir como referência para a construção de um pacto social no setor.

Política Pública de Saneamento Básico no Brasil: ideias, instituições e desafios no Século XXI / Basic Sanitation Policy in Brazil: ideas, institutions and challenges in the Twenty-first Century

Resumo Este trabalho aborda os desafios contemporâneos do setor de saneamento básico brasileiro. As características de rentabilidade e dinamismo setorial puseram os serviços estatais de A & E no foco da agenda das reformas estruturais sob o argumento de que os governos não dispõem de recursos necessários para universalizar a cobertura. A agenda da reforma dos serviços de A & E advoga a concessão a empresas privadas da comercialização do abastecimento de água e do tratamento do esgotamento sanitário. Em convergência com esta agenda de reforma estrutural, a aprovação em 15 de julho de 2020 da Lei 14.026 alterou em profundidade o marco legal do saneamento, adotando integralmente a pauta da desestatização do setor. O novo marco regulatório veta o contrato de programa, torna obrigatória a licitação para contratação do serviço de saneamento, estabelece diretrizes nacionais para que estados e municípios acessem recursos federais e institui o regime de regulação nacional por meio da Agência Nacional de Águas e Saneamento Básico. O modelo cooperativo praticado no Sistema Único de Saúde (SUS) pode servir como referência para a construção de um pacto social no setor.

Abstract This paper describes the challenges currently facing Brazil's basic sanitation sector. The sector's characteristic profitability and dynamism have brought State-run Water & Sewage (W&S) services into the spotlight of the structural reform agenda on the argument that governments do not have the resources necessary to universalize coverage. There is a pattern of W&S services' operating with a surplus, which helps explain the intense dispute in recent years in favour of legal changes to the market position of CESBs and local providers to favour an expanding role for private agents. Converging with the structural reform agenda, Law 14,026, sanctioned on 15 July 2020, made far-reaching changes to the legal framework for sanitation and provided for the State's complete withdrawal from the sector. The new regulatory framework prohibited programme contracts, required tender processes for sanitation service contracts, encouraged regionalization without CESBs, set out national guidelines for States and municipalities to access federal funding and introduced a national regulation regime under the National Waters and Basic Sanitation Agency. The model of cooperation that operates in the SUS could serve as a reference for constructing a social pact in the sector.

[Schistosomiasis, soil-transmitted helminthiases and sanitation in Latin America and the Caribbean: a systematic reviewRelación entre la prevalencia de esquistosomiasis y geohelmintiasis y las condiciones sanitarias en América Latina y el Caribe: una revisión sistemática]. / Esquistossomose, geo-helmintíases e condições sanitárias na América Latina e Caribe: uma revisão sistemática.

Objective: To investigate the relationship between the prevalence of schistosomiasis and soil-transmitted helminthiasis with variables related to access to water, sanitation and solid waste in Latin American and Caribbean (LAC) countries. Method: A systematic review was performed in the LILACS, PubMed, Web of Science, and SciELO databases. Studies published between 1950 and August 2021, with an ecological design and a focus on population groups (states, municipalities and/or districts), having the prevalence of infection by Schistosoma mansoni, Ancylostoma sp., Necator americanus, Ascaris lumbricoides or Trichuris trichiura as primary variable and access to water, sewage and/or solid waste as explanatory variables were included. Open access articles with full text available in English, Spanish, or Portuguese were considered. The risk of bias and the quality of the studies were assessed according to the Joanna Briggs Institute manual. Results: Of 2 714 articles, nine were eligible, published between 1994 and 2021 and covering 22 LAC countries and 14 350 municipalities. All articles had moderate methodological quality. Environmental variables indicated an association between water supply and solid waste collection with schistosomiasis; water supply with ascariasis, trichuriasis and hookworm; and sewage with ascariasis and hookworm. Except for one article, which had regional coverage for LAC, all the others were developed in Brazil. Conclusion: There is a clear need to expand research on the association between household and collective health conditions and parasitic diseases for all endemic countries in LAC to support environmental strategies to control these diseases.

Objetivo: Investigar la relación entre la prevalencia de esquistosomiasis y geohelmintiasis y las variables de acceso al agua, el saneamiento y el manejo de residuos sólidos en los países de América Latina y el Caribe. Métodos: Se realizó una revisión sistemática en las bases de datos LILACS, PubMed, Web of Science y SciELO. Todos los artículos fueron de calidad metodológica moderada. Se incluyeron estudios publicados entre 1950 y agosto del 2021, con diseño ecológico y atención en agregados demográficos (estados, municipios o distritos), que tuvieran como resultado principal la prevalencia de infección por Schistosoma mansoni, Ancylostoma spp., Necator americanus, Ascaris lumbricoides o Trichuris trichiura y como variable explicativa el acceso al agua, el saneamiento y el manejo de residuos sólidos. Se analizaron artículos de texto completo y acceso libre en español, inglés o portugués. El riesgo de sesgo y la calidad de los estudios se evaluaron según las normas del manual del Instituto Joanna Briggs. Resultados: De los 2 714 artículos, hubo 9 que cumplieron con los requisitos establecidos; estos se publicaron entre 1994 y el 2021 y abarcaron 22 países y 14 350 municipios de América Latina y el Caribe. Las variables ambientales indicaron una relación del abastecimiento de agua y la recolección de residuos sólidos con la esquistosomiasis; del abastecimiento de agua con la ascariasis, la tricuriasis y la anquilostomiasis; y del saneamiento con la ascariasis y la anquilostomiasis. Con excepción de un artículo que abarcó la Región de América Latina y el Caribe, todos los demás se realizaron en Brasil. Conclusiones: Es evidente la necesidad de ampliar las investigaciones sobre la relación entre las condiciones sanitarias domésticas y colectivas y las enfermedades parasitarias en todos los países de América Latina y el Caribe donde son endémicas, con el fin de formular estrategias centradas en el medio ambiente para controlar esas enfermedades.

Pharmaceuticals in hospital wastewaters: an analysis of the UBA's pharmaceutical database.

The presence of pharmaceuticals in hospital wastewaters (HWW) has been a focus of interest for researchers in the last decades. Certain therapeutic classes, such as X-ray contrast media, broad-spectrum antimicrobials and cytotoxics among others, are mainly used in hospitals-health care facilities. This study is focused on available studies monitoring the presence of pharmaceuticals in HWW around the world. To that end, the last available version (v3. 2021) of the "Pharmaceuticals in the Environment" database published by the Federal German Environment Agency (Umweltbundesamt) has been used. Almost half of all studies included (107) have been conducted in Europe. Pharmaceuticals have been monitored in HWW in 38 different countries across all five continents. The country with the greatest number of studies is Brazil (11), followed by Spain (8), China (7), and France (6). Our analysis revealed that 271 different pharmaceuticals have been detected at least once in HWW. The five drugs with more studies showing a positive detection are ciprofloxacin (38), sulfamethoxazole (36), diclofenac (34), ibuprofen (29), and trimethoprim (27). A total of 47 out of 271 drugs are considered in the NIOSH "Hazardous drug" list. However, monitoring data for some widely used drugs in hospital settings such as muscle relaxants, anesthetics, and antidotes is lacking. In conclusion, this study provides the first large-scale metadata analysis for the pharmaceuticals in HWW worldwide.

estimateR: an R package to estimate and monitor the effective reproductive number.

BACKGROUND: Accurate estimation of the effective reproductive number ([Formula: see text]) of epidemic outbreaks is of central relevance to public health policy and decision making. We present estimateR, an R package for the estimation of the reproductive number through time from delayed observations of infection events. Such delayed observations include confirmed cases, hospitalizations or deaths. The package implements the methodology of Huisman et al. but modularizes the [Formula: see text] estimation procedure to allow easy implementation of new alternatives to the currently available methods. Users can tailor their analyses according to their particular use case by choosing among implemented options. RESULTS: The estimateR R package allows users to estimate the effective reproductive number of an epidemic outbreak based on observed cases, hospitalization, death or any other type of event documenting past infections, in a fast and timely fashion. We validated the implementation with a simulation study: estimateR yielded estimates comparable to alternative publicly available methods while being around two orders of magnitude faster. We then applied estimateR to empirical case-confirmation incidence data for COVID-19 in nine countries and for dengue fever in Brazil; in parallel, estimateR is already being applied (i) to SARS-CoV-2 measurements in wastewater data and (ii) to study influenza transmission based on wastewater and clinical data in other studies. In summary, this R package provides a fast and flexible implementation to estimate the effective reproductive number for various diseases and datasets. CONCLUSIONS: The estimateR R package is a modular and extendable tool designed for outbreak surveillance and retrospective outbreak investigation. It extends the method developed for COVID-19 by Huisman et al. and makes it available for a variety of pathogens, outbreak scenarios, and observation types. Estimates obtained with estimateR can be interpreted directly or used to inform more complex epidemic models (e.g. for forecasting) on the value of [Formula: see text].

Esquistossomose, geo-helmintíases e condições sanitárias na América Latina e Caribe: uma revisão sistemática

[RESUMO]. Objetivo. Investigar a relação entre prevalência de esquistossomose e geo-helmintíases e variáveis de acesso a água, esgotamento sanitário e resíduos sólidos em países da América Latina e Caribe (ALC). Métodos. Realizou-se uma revisão sistemática nas bases de dados LILACS, PubMed, Web of Science e SciELO. Foram incluídos estudos publicados entre 1950 e agosto de 2021, com desenho ecológico e foco em agregados populacionais (estados, municípios e/ou distritos), tendo como desfecho primário a prevalên- cia da infecção por Schistosoma mansoni, Ancylostoma sp., Necator americanus, Ascaris lumbricoides ou Trichuris trichiura e como variável explicativa o acesso a água, esgotamento sanitário e/ou resíduos sólidos. Foram considerados artigos com disponibilidade de texto completo e acesso livre nos idiomas inglês, espa- nhol ou português. O risco de viés e a qualidade dos estudos foram avaliados conforme o manual do Instituto Joanna Briggs. Resultados. De 2 714 artigos, nove foram elegíveis, publicados entre 1994 e 2021 e cobrindo 22 países da ALC e 14 350 municípios. A qualidade metodológica de todos os artigos foi moderada. As variáveis ambien- tais apontaram associação de abastecimento de água e coleta de resíduos sólidos com esquistossomose; abastecimento de água com ascaridíase, tricuríase e ancilostomíase; e de esgotamento sanitário com asca- ridíase e ancilostomíase. Exceto por um artigo com abrangência regional para ALC, todos os demais foram desenvolvidos no Brasil. Conclusão. Evidencia-se a necessidade de ampliar a pesquisa sobre a associação entre condições sanitárias domiciliares e coletivas e doenças parasitárias para todos os países endêmicos da ALC para embasar estratégias ambientais para controle dessas doenças.

[ABSTRACT]. Objective. To investigate the relationship between the prevalence of schistosomiasis and soil-transmitted helminthiasis with variables related to access to water, sanitation and solid waste in Latin American and Caribbean (LAC) countries. Method. A systematic review was performed in the LILACS, PubMed, Web of Science, and SciELO databases. Studies published between 1950 and August 2021, with an ecological design and a focus on population groups (states, municipalities and/or districts), having the prevalence of infection by Schistosoma mansoni, Ancylostoma sp., Necator americanus, Ascaris lumbricoides or Trichuris trichiura as primary variable and access to water, sewage and/or solid waste as explanatory variables were included. Open access articles with full text available in English, Spanish, or Portuguese were considered. The risk of bias and the quality of the studies were assessed according to the Joanna Briggs Institute manual. Results. Of 2 714 articles, nine were eligible, published between 1994 and 2021 and covering 22 LAC coun- tries and 14 350 municipalities. All articles had moderate methodological quality. Environmental variables indicated an association between water supply and solid waste collection with schistosomiasis; water supply with ascariasis, trichuriasis and hookworm; and sewage with ascariasis and hookworm. Except for one article, which had regional coverage for LAC, all the others were developed in Brazil. Conclusion. There is a clear need to expand research on the association between household and collective health conditions and parasitic diseases for all endemic countries in LAC to support environmental strategies to control these diseases.

[RESUMEN]. Objetivo. Investigar la relación entre la prevalencia de esquistosomiasis y geohelmintiasis y las variables de acceso al agua, el saneamiento y el manejo de residuos sólidos en los países de América Latina y el Caribe. Métodos. Se realizó una revisión sistemática en las bases de datos LILACS, PubMed, Web of Science y SciELO. Todos los artículos fueron de calidad metodológica moderada. Se incluyeron estudios publicados entre 1950 y agosto del 2021, con diseño ecológico y atención en agregados demográficos (estados, municipios o distritos), que tuvieran como resultado principal la prevalencia de infección por Schistosoma mansoni, Ancylostoma spp., Necator americanus, Ascaris lumbricoides o Trichuris trichiura y como variable explicativa el acceso al agua, el saneamiento y el manejo de residuos sólidos. Se analizaron artículos de texto completo y acceso libre en español, inglés o portugués. El riesgo de sesgo y la calidad de los estudios se evaluaron según las normas del manual del Instituto Joanna Briggs. Resultados. De los 2 714 artículos, hubo 9 que cumplieron con los requisitos establecidos; estos se publi- caron entre 1994 y el 2021 y abarcaron 22 países y 14 350 municipios de América Latina y el Caribe. Las variables ambientales indicaron una relación del abastecimiento de agua y la recolección de residuos sólidos con la esquistosomiasis; del abastecimiento de agua con la ascariasis, la tricuriasis y la anquilostomiasis; y del saneamiento con la ascariasis y la anquilostomiasis. Con excepción de un artículo que abarcó la Región de América Latina y el Caribe, todos los demás se realizaron en Brasil. Conclusiones. Es evidente la necesidad de ampliar las investigaciones sobre la relación entre las condicio- nes sanitarias domésticas y colectivas y las enfermedades parasitarias en todos los países de América Latina y el Caribe donde son endémicas, con el fin de formular estrategias centradas en el medio ambiente para controlar esas enfermedades.

Mostra de Experiências em Saúde Ambiental

Segundo a Organização Mundial da Saúde (OMS), a Saúde Ambiental é formada por todos aqueles aspectos da saúde humana, incluindo a qualidade de vida, que estão determinados por fatores físicos, químicos, biológicos, sociais e psicológicos no meio ambiente. A saúde ambiental também se refere à teoria e à prática de valorar, corrigir, controlar e evitar fatores do meio ambiente que possam prejudicar a saúde de gerações atuais e futuras. No Brasil, o campo da saúde ambiental compreende a área da saúde pública, afeta ao conhecimento científico e à formulação de políticas públicas e às correspondentes intervenções (ações) relacionadas à interação entre a saúde humana e os fatores do meio ambiente natural e antrópico que a determinam, condicio nam e influenciam, com vistas a melhorar a qualidade de vida do ser humano sob o ponto de vista da sustentabilidade. Neste contexto, em celebração ao Dia Mundial da Saúde Ambiental, que se comemora em 26 de setembro, a Organização Pan-Americana da Saúde/Organização Mundial da Saúde (OPAS/ OMS) no Brasil, o Departamento de Saúde Ambiental (Desam) da Funasa e o Ministério da Saúde, lançaram a 1ª Mostra de Experiências em Saúde Ambiental, com o objetivo de identificar, dar visibilidade, reconhecer e promover iniciativas locais, municipais ou regionais, em serviços, que tenham como foco principal o tema da Saúde Ambiental. Foram 86 experiências analisadas que mostraram inovação e potencial para promover a saúde ambiental e contribuir para a melhoria da qualidade de vida da população.

Proposal of a sustainability index for intermunicipal cooperation on waste management.

The management of solid waste is one of the biggest challenges for sustainability. Aiming at gains of scale, guaranteeing universal access and the technical and economic viability of the services, intermunicipal cooperation has been implemented in several countries, and in Brazil, it presents itself as one of the main instruments of public policies in the sector of sanitation. The main objective of this article is to propose a set of indicators and the construction of an index to evaluate the performance of regionalized management of urban solid waste, applying them to intermunicipal public consortia operating in Brazil. Based on the Delphi methodology, a total of 15 indicators were defined, divided into 5 sustainability dimensions, used for the construction of the Regionalized Urban Solid Waste Management Performance Index (IDGRSU). In Brazil, the performance of regionalized management was classified as Regular for most of the operating consortia analysed. The adequacy of the final disposal in regional sanitary landfills is the common practice among the municipalities, and consequently, the reduction of the areas of dumps represents the main advance in the management. The index developed proved to be an important instrument to support municipalities and consortia for waste management, contributing to the implementation of sustainable strategies and to the development of policies, and its application in other countries is feasible, regardless of the size of the municipalities.

Corrigendum to "How, what, and why: housing, water & sanitation and wealth patterns in a cross-sectional study of the Guarani Birth Cohort, the first indigenous birth cohort in Brazil" [The Lancet Regional Health - Americas 2023;21: 100496].

[This corrects the article DOI: 10.1016/j.lana.2023.100496.].

Environmental assessment of on-site source-separated wastewater treatment and reuse systems for resource recovery in a sustainable sanitation view.

Sustainable sanitation solutions are necessary for promoting public health and environmental security. In this study, on-site domestic wastewater treatment (WWT) systems used for households in rural and peri-urban areas of Brazil were compared in different scenarios from a life cycle assessment (LCA) perspective. The evaluated scenarios represented different practices in wastewater management, such as direct discharge into the soil, rudimentary treatment, septic tank, public sewerage system, and source separation of wastewater streams for water, nutrient, and organic matter recovery. The WWT technologies considered in the proposed scenarios of source-separated wastewater streams were as follows: an evapotranspiration tank (TEvap) and composting toilet for blackwater, a modified constructed wetland (EvaTAC) for greywater, and a storage tank for urine. LCA was performed in this study according to the ISO standards to assess the environmental impacts at both midpoint and endpoint levels. The results show that on-site source-separated wastewater treatment systems with resource recovery result in significant reductions in environmental impacts compared to scenarios with precarious conditions or 'end-of-pipe' solutions. For example, regarding the human health damage category, the scenarios involving resource recovery, including systems such as EvaTAC, TEvap, composting toilet, and urine storage tank, demonstrate significantly lower values (-0.0117 to -0.0115 DALY) compared to scenarios with rudimentary cesspits and septic tanks (0.0003 to 0.001 DALY). We conclude that the focus should be beyond mere pollution aspects and instead concentrate on the benefits of the co-products, which are: avoiding the extraction and consumption of valuable and increasingly scarce raw materials, such as potable water, and production of synthetic fertilizer. Furthermore, it is highly recommended that an LCA of sanitation systems synergistically integrates the WWT process, the constructive aspects, and the resource recovery potential.

Zika virus RNA persistence and recovery in water and wastewater: An approach for Zika virus surveillance in resource-constrained settings.

During the 2015-2016 Zika virus (ZIKV) epidemic in the Americas, serological cross-reactivity with other flaviviruses and relatively high costs of nucleic acid testing in the region hindered the capacity for widespread diagnostic testing. In such cases where individual testing is not feasible, wastewater monitoring approaches may offer a means of community-level public health surveillance. To inform such approaches, we characterized the persistence and recovery of ZIKV RNA in experiments where we spiked cultured ZIKV into surface water, wastewater, and a combination of both to examine the potential for detection in open sewers serving communities most affected by the ZIKV outbreak, such as those in Salvador, Bahia, Brazil. We used reverse transcription droplet digital PCR to quantify ZIKV RNA. In our persistence experiments, we found that the persistence of ZIKV RNA decreased with increasing temperature, significantly decreased in surface water versus wastewater, and significantly decreased when the initial concentration of virus was lowered by one order of magnitude. In our recovery experiments, we found higher percent recovery of ZIKV RNA in pellets versus supernatants from the same sample, higher recoveries in pellets using skimmed milk flocculation, lower recoveries of ZIKV RNA in surface water versus wastewater, and lower recoveries from a freeze thaw. We also analyzed samples collected from Salvador, Brazil during the ZIKV outbreak (2015-2016) that consisted of archived samples obtained from open sewers or environmental waters thought to be contaminated by sewage. Although we did not detect any ZIKV RNA in the archived Brazil samples, results from these persistence and recovery experiments serve to inform future wastewater monitoring efforts in open sewers, an understudied and important application of wastewater monitoring.

Saúde e saneamento: uma avaliação das políticas públicas de prevenção, controle e contingência das arboviroses no Brasil / Health and sanitation: an evaluation of public policies for the prevention, control, and contingency of arboviruses in Brazil

Resumo As arboviroses, sobretudo as transmitidas pelo mosquito Aedes aegypti, têm-se constituído em grave problema de saúde pública no Brasil. Com o intuito de analisar como o saneamento básico é abordado em instrumentos norteadores das políticas públicas de controle das arboviroses no país, foi realizada uma análise de conteúdo em oito documentos governamentais de referência. Como resultados, foi possível identificar que aspectos relacionados à comunicação e mobilização social, controle vetorial e gestão são os temas mais abordados nos documentos analisados. Já as componentes do saneamento básico, destacando-se o manejo e a drenagem das águas pluviais e o esgotamento sanitário não são abordados nos instrumentos. A intersetorialidade é mencionada, no entanto, não existem proposições específicas que apontem e assegurem sua implementação. As Diretrizes Nacionais para a Prevenção e Controle de Epidemias de Dengue, do Ministério da Saúde, constitui-se no documento mais completo sobre o assunto. Conclui-se que o saneamento básico não está suficientemente abordado nos instrumentos de enfrentamento às arboviroses o que pode contribuir para a baixa efetividade de intervenção pública e que, portanto, tal contradição precisa ser superada pelas políticas públicas no Brasil.

Abstract Arboviruses, especially those transmitted by the Aedes aegypti mosquito, have become a serious public health problem in Brazil. In order to analyze how sanitation is addressed in the basic guidelines of public policies to control arboviruses in the country, content analysis was performed on eight governmental reference documents. As a result, it was possible to identify that aspects related to communication and social mobilization, vector control, and management are the themes most addressed in the documents analyzed. On the other hand, the components of basic sanitation, especially rainwater management and drainage, and sewage control, are not addressed in the instruments. Intersectorality is mentioned, however, there are no specific proposals to implement the plan and ensure its implementation. The Ministry of Health's National Guidelines for the Prevention and Control of Dengue Epidemics is the most complete document on the subject. The conclusion drawn is that basic sanitation is not sufficiently addressed in the instruments for combatting arboviruses, which can contribute to the low effectiveness of public intervention and, consequently, this discrepancy needs to be focused on by public policies in Brazil.