Waterborne outbreaks in the Nordic countries, 1998 to 2012.

A total of 175 waterborne outbreaks affecting 85,995 individuals were notified to the national outbreak surveillance systems in Denmark, Finland and Norway from 1998 to 2012, and in Sweden from 1998 to 2011. Between 4 and 18 outbreaks were reported each year during this period. Outbreaks occurred throughout the countries in all seasons, but were most common (n = 75/169, 44%) between June and August. Viruses belonging to the Caliciviridae family and Campylobacter were the pathogens most frequently involved, comprising n = 51 (41%) and n = 36 (29%) of all 123 outbreaks with known aetiology respectively. Although only a few outbreaks were caused by parasites (Giardia and/or Cryptosporidium), they accounted for the largest outbreaks reported during the study period, affecting up to 53,000 persons. Most outbreaks, 124 (76%) of those with a known water source (n = 163) were linked to groundwater. A large proportion of the outbreaks (n = 130/170, 76%) affected a small number of people (less than 100 per outbreak) and were linked to single-household water supplies. However, in 11 (6%) of the outbreaks, more than 1,000 people became ill. Although outbreaks of this size are rare, they highlight the need for increased awareness, particularly of parasites, correct water treatment regimens, and vigilant management and maintenance of the water supply and distribution systems.

Energy forest irrigated with wastewater: a comparative microbial risk assessment.

In this study, risks for human infection associated with irrigation of municipal wastewater on short rotation willow coppice (Salix) were evaluated in three countries. The aim was also to determine the reduction of indicator organisms and pathogens in the treatment plants. Two of the field sites were chosen for further evaluation by QMRA (quantitative microbial risk assessment) applied to three scenarios: accidental ingestions of wastewater, exposure to aerosols and ingestion of groundwater. The risks of infection for bacteria (Salmonella), virus (rotavirus) and protozoa (Giardia, Cryptosporidium) were characterised as probability of infections per exposure and number of infections per year.The highest risk for infection was associated with exposure to rotavirus in Culmore (Northern Ireland), by either accidental ingestion of wastewater or ingestion of groundwater (P(inf) 8 x 10(-1)). For Kvidinge (Sweden) the risk for virus infection by ingestion of wastewater were in the same range (P(inf) 7 x 10(-1)). The risk for Giardia infection differed between the two sites due to differences in concentration of this pathogen in the wastewater. The groundwater was found to have suffered faecal contamination due to the wastewater irrigation. Use of partially treated wastewater for irrigation of energy crops could be a sustainable option if site-specific recommendations are developed.

Legionellosis acquired through a dental unit: a case study.

In 2012, an elderly immunocompromised man died from legionellosis at a hospital in Uppsala, Sweden. The patient had visited a dental ward at the hospital during the incubation period. Legionella spp. at a concentration of 2000 colony-forming units/L were isolated from the cupfiller outlet providing water for oral rinsing. Isolates from the patient and the dental unit were Legionella pneumophila serogroup 1, subgroup Knoxville and ST9. Pulsed-field gel electrophoresis and whole-genome sequencing strongly suggested that the isolates were of common origin. This report presents one of few documented cases of legionellosis acquired through a dental unit.

Recycling of wastewater-derived phosphorus in Swedish agriculture--a proposal.

In 2001 the Swedish Government commissioned the Swedish Environmental Protection Agency (Swedish EPA) (i) to examine the need for stricter human health and environmental regulations governing the agricultural use of sewage sludge and (ii) to propose national targets for the agricultural recycling of phosphorus (P) originating from wastewater. The Swedish EPA may propose: (i) stricter regulations on sludge treatment to limit the risk of spreading pathogens in the environment and transmission of infectious diseases; (ii) recycling of 20-30% of wastewater-P to agriculture by 2015 and recycling of 35-50% of wastewater-P to agriculture by 2025.

QMRA (quantitative microbial risk assessment) and HACCP (hazard analysis and critical control points) for management of pathogens in wastewater and sewage sludge treatment and reuse.

Hazard Analysis and Critical Control Points (HACCP) was applied for identifying and controlling exposure to pathogenic microorganisms encountered during normal sludge and wastewater handling at a 12,500 m3/d treatment plant utilising tertiary wastewater treatment and mesophilic sludge digestion. The hazardous scenarios considered were human exposure during treatment, handling, soil application and crop consumption, and exposure via water at the wetland-area and recreational swimming. A quantitative microbial risk assessment (QMRA), including rotavirus, adenovirus, haemorrhagic E. coli, Salmonella, Giardia and Cryptosporidium, was performed in order to prioritise pathogen hazards for control purposes. Human exposures were treated as individual risks but also related to the endemic situation in the general population. The highest individual health risk from a single exposure was via aerosols for workers at the belt press for sludge dewatering (virus infection risk = 1). The largest impact on the community would arise if children ingested sludge at the unprotected storage site, although in the worst-case situation the largest number of infections would arise through vegetables fertilised with sludge and eaten raw (not allowed in Sweden). Acceptable risk for various hazardous scenarios, treatment and/or reuse strategies could be tested in the model.