Advice to risk assessors modeling viral health risk associated with household graywater.

Quantitative microbial risk assessment (QMRA) is a valuable tool that can be used to predict the risk associated with human exposure to specific microbial contaminants in water sources. The transparency inherent in the QMRA process benefits discussions between multidisciplinary teams because members of such teams have different expertise and their confidence in the risk assessment output will depend upon whether they regard the selected input data and assumptions as being suitable and/or plausible. Selection of input data requires knowledge of the availability of appropriate data sets, the limitations of using a particular data set, and the logic of using alternative approaches. In performing QMRA modeling and in the absence of directly relevant data, compromises must be made. One such compromise made is to use available Escherichia coli data and apply a ratio of enteric viruses to indicator E. coli in wastewater obtained from prior studies to estimate the concentration of enteric viruses in other wastewater types/sources. In this article, we have provided an argument for why we do not recommend the use of a pathogen to E. coli ratio to estimate virus concentrations in single household graywater and additionally suggested circumstances in which use of such a ratio may be justified.

A planetary health model for reducing exposure to faecal contamination in urban informal settlements: Baseline findings from Makassar, Indonesia.

BACKGROUND: The intense interactions between people, animals and environmental systems in urban informal settlements compromise human and environmental health. Inadequate water and sanitation services, compounded by exposure to flooding and climate change risks, expose inhabitants to environmental contamination causing poor health and wellbeing and degrading ecosystems. However, the exact nature and full scope of risks and exposure pathways between human health and the environment in informal settlements are uncertain. Existing models are limited to microbiological linkages related to faecal-oral exposures at the individual level, and do not account for a broader range of human-environmental variables and interactions that affect population health and wellbeing. METHODS: We undertook a 12-month health and environmental assessment in 12 flood-prone informal settlements in Makassar, Indonesia. We obtained caregiver-reported health data, anthropometric measurements, stool and blood samples from children < 5 years, and health and wellbeing data for children 5-14 years and adult respondents. We collected environmental data including temperature, mosquito and rat species abundance, and water and sediment samples. Demographic, built environment and household asset data were also collected. We combined our data with existing literature to generate a novel planetary health model of health and environment in informal settlements. RESULTS: Across the 12 settlements, 593 households and 2764 participants were enrolled. Two-thirds (64·1%) of all houses (26·3-82·7% per settlement) had formal land tenure documentation. Cough, fever and diarrhoea in the week prior to the survey were reported among an average of 34.3%, 26.9% and 9.7% of children aged < 5 years, respectively; although proportions varied over time, prevalence among these youngest children was consistently higher than among children 5-14 years or adult respondents. Among children < 5 years, 44·3% experienced stunting, 41·1% underweight, 12.4% wasting, and 26.5% were anaemic. There was self- or carer-reported poor mental health among 16.6% of children aged 5-14 years and 13.9% of adult respondents. Rates of potential risky exposures from swimming in waterways, eating uncooked produce, and eating soil or dirt were high, as were exposures to flooding and livestock. Just over one third of households (35.3%) had access to municipal water, and contamination of well water with E. coli and nitrogen species was common. Most (79·5%) houses had an in-house toilet, but no houses were connected to a piped sewer network or safe, properly constructed septic tank. Median monthly settlement outdoor temperatures ranged from 26·2 °C to 29.3 °C, and were on average, 1·1 °C warmer inside houses than outside. Mosquito density varied over time, with Culex quinquefasciatus accounting for 94·7% of species. Framed by a planetary health lens, our model includes four thematic domains: (1) the physical/built environment; (2) the ecological environment; (3) human health; and (4) socio-economic wellbeing, and is structured at individual, household, settlement, and city/beyond spatial scales. CONCLUSIONS: Our planetary health model includes key risk factors and faecal-oral exposure pathways but extends beyond conventional microbiological faecal-oral enteropathogen exposure pathways to comprehensively account for a wider range of variables affecting health in urban informal settlements. It includes broader ecological interconnections and planetary health-related variables at the household, settlement and city levels. It proposes a composite framework of markers to assess water and sanitation challenges and flood risks in urban informal settlements for optimal design and monitoring of interventions.

A probabilistic model of norovirus disease burden associated with greywater irrigation of home-produced lettuce in Melbourne, Australia.

The reuse of domestic greywater has become common in Australia, especially during periods of extreme drought. Greywater is typically used in a raw, untreated form, primarily for landscape irrigation, but more than a quarter of greywater users irrigate vegetable gardens with the water, despite government advice against this practice. Greywater can be contaminated with enteric pathogens and may therefore pose a health risk if irrigated produce is consumed raw. A quantitative microbial risk assessment (QMRA) model was constructed to estimate the norovirus disease burden associated with consumption of greywater-irrigated lettuce. The annual disease burdens (95th percentile; DALYs per person) attributed to greywater irrigation ranged from 2 × 10(-8) to 5 × 10(-4), depending on the source of greywater and the existence of produce washing within households. Accounting for the prevalence of produce-washing behaviours across Melbourne, the model predicted annual disease burdens ranging from 4 × 10(-9) for bathroom water use only to 3 × 10(-6) for laundry water use only, and accounting for the proportionate use of each greywater type, the annual disease burden was 2 × 10(-6). We recommend the preferential use of bathroom water over laundry water where possible as this would reduce the annual burden of disease to align with the current Australian recycled water guidelines, which recommend a threshold of 10(-6) DALYs per person. It is also important to consider other exposure pathways, particularly considering the high secondary attack rate of norovirus, as it is highly likely that the estimated norovirus disease burden associated with greywater irrigation of vegetables is negligible relative to household contact with an infected individual.