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.

Assessment microbial risks for the presence of Cryptosporidium spp. and Giardia spp. based on the surveillance of the water supply systems in Colombia, 2014-2018.

Cryptosporidium spp. and Giardia spp. cause gastrointestinal diseases of zoonotic origin as well transmitted from person to person, being various reported outbreaks associated with water. The infecting (oo)cyst forms of these parasites are highly resistant to water treatments such as chlorine disinfection and fast filtration. The objective of this study was to assess the microbial risk of infection and symptomatic illness by the ingestion of Giardia spp. and Cryptosporidium spp. in water for human consumption in Colombia, based on the results of water quality surveillance. The detection method was according to the USEPA method 1623. Concentration data of the different points of distribution were grouped according to the pathogen and type of treatment (no treatment; chlorine treatment; chlorine treatment + coagulant). Annual microbial risks of infection and symptomatic diseases were estimated using the quantitative microbial risk assessment approach that included parasite concentrations, the dose-response model, the ingestion rates of water by children and adults, and the morbidity rate of the diseases. The mean annual microbial risk of infection for Giardia spp. was 29.8% for treated water and 50.4% for untreated water, while being 6.0% and 17.7%, respectively, for Cryptosporidium spp. Microbial risk of symptomatic illness for Giardia spp, was 8.2% for treated water and 13.9% for untreated water, while being 3.6% and 10.6%, respectively, for Cryptosporidium spp. The estimated annual microbial risks of infection exceeded the acceptable value of 10-4 (0.01%) recommended by USEPA. Results obtained in this study suggest the need to reduce the microbial risk of infection to protozoan parasites by improving the water treatment, by adopting better handling practices for livestock manure and treatment processes of human feces. PRACTITIONER POINTS: The presence of Cryptosporidium spp was identified in 28 (6.2%) samples and Giardia spp in 29 (6.4%) in water for human consumption in Colombia. The mean annual risk of symptomatic illness due to infection by Giardia spp or Cryptosporidium spp ranges from 33.6%, for treated water, to 58.1%, for untreated water. Annual risks ingestion of protozoa studying in water for human exceed of 10-4 (0.01%) recommended by USEPA.

Assessment of health risks from recreational exposure to Giardia and Cryptosporidium in coastal bathing waters.

Some Brazilian beaches are impacted by raw or poorly treated sewage. Thus, users (beachgoers, sports people, and children) are exposed to pathogens, which pose health concerns. This study aimed to estimate the probability of infection and disease by Giardia and Cryptosporidium, using the quantitative microbial risk assessment (QMRA), for three groups of bathers: children, adults, and open water swimmers. The concentrations of (oo)cysts were taken from a study run by CETESB (Environmental Company of Sao Paulo State) throughout 2011 and 2012, in which 203 samples were collected monthly and analyzed for (oo)cysts of Giardia and Cryptosporidium. Giardia was present in 43% of the samples, while Cryptosporidium in 13%. Infection probability was higher in beaches with more positive samples for Giardia cysts for the group of open water swimmers. In some cases, the highest annual risk obtained for giardiasis and cryptosporidiosis was 2.4 × 10-1 and 8.9 × 10-3 for open water swimmers, respectively, exceeding the incidence results found in the epidemiological study run in summer of 1999 in São Paulo state coast. The results bring insights to improve environmental quality in order to protect tourists' and residents' wellbeing.

Detection and molecular characterization of Cryptosporidium species and Giardia assemblages in two watersheds in the metropolitan region of São Paulo, Brazil.

Cryptosporidium and Giardia are associated with cases of water and foodborne outbreaks in the world. This study included 50 samples of surface raw water collected from two watersheds in the state of São Paulo, Brazil. The isolation of (oo)cysts was performed in accordance with the U.S. Environmental Protection Agency's methods 1623 and genotypic characterization and quantification were carried out by Nested PCR and qPCR assays based on 18S rRNA and gdh genes, respectively. U.S. EPA 1623 method showed the presence of (oo)cysts in 40% ([Formula: see text] = 0.10 oocysts/L) and 100% ([Formula: see text] = 7.6 cysts/L) of samples from São Lourenço River, respectively, and 24% ([Formula: see text] = 0.8 oocysts/L) and 60% ([Formula: see text] = 1.64 cysts/L) of Guarapiranga Reservoir, respectively. The qPCR assay detected C. hominis/parvum in 52% (0.06 to 1.85 oocysts/L) of São Lourenço River and 64% (0.09 to 1.4 oocysts/L) of Guarapiranga Reservoir samples. Presence/absence test for Giardia intestinalis was positive in 92% of São Lourenço River and 8% of Guarapiranga Reservoir samples. The assemblage A was detected in 16% (0.58 to 2.67 cysts/L) in São Lourenço River and no positive samples were obtained for assemblage B in both water bodies. The characterization of anthroponotic species C. parvum/hominis, G. intestinalis, and assemblage A was valuable in the investigation of possible sources of contamination in the watersheds studied confirming the need of expanding environmental monitoring measures for protection of these water sources in our country.

Assessing the probability of infection by Salmonella due to sewage sludge use in agriculture under several exposure scenarios for crops and soil ingestion.

A deeper understanding about the risks involved in sewage sludge practice in agriculture is required. The aims of the present study were to determine the annual risk of infection of consuming lettuce, carrots and tomatoes cultivated in soil amended with sewage sludge. The risk to agricultural workers of accidental ingestion of sludge or amended soil was also investigated. A Quantitative Microbial Risk Assessment was conducted based on Salmonella concentrations from five WWTPs were used to estimate the probability of annual infection associated with crops and soil ingestion. The risk of infection was estimated for nine exposure scenarios considering concentration of the pathogen, sewage sludge dilution in soil, variation of Salmonella concentration in soil, soil attachment to crops, seasonal average temperatures, hours of post-harvesting exposure, Salmonella regrowth in lettuce and tomatoes, Salmonella inhibition factor in carrots, crop ingestion and frequency of exposure, sludge/soil ingestion by agricultural workers and frequency of exposure. Annual risks values varied across the scenarios evaluated. Highest values of annual risk were found for scenarios in which the variation in the concentration of Salmonella spp. in both soil and crops (scenario 1) and without variation in the concentration of Salmonella spp. in soil and variation in crops (scenario 3) ranging from 10(-3) to 10(-2) for all groups considered. For agricultural workers, the highest annual risks of infection were found when workers applied sewage sludge to agricultural soils (2.26×10(-2)). Sensitivity analysis suggests that the main drivers for the estimated risks are Salmonella concentration and ingestion rate. These risk values resulted from conservative scenarios since some assumptions were derived from local or general studies. Although these scenarios can be considered conservative, the sensitivity analysis yielded the drivers of the risks, which can be useful for managing risks from the fresh products chain with stakeholders' involvement.