Quantitative microbial risk assessment for Escherichia Coli O157: H7 via drinking water in the Gaza Strip, Palestine.

Introduction: Microbial contamination of drinking water, particularly by pathogens such as Escherichia coli O157: H7, is a significant public health concern worldwide, especially in regions with limited access to clean water like the Gaza Strip. However, few studies have quantified the disease burden associated with E. coli O157: H7 contamination in such challenging water management contexts. Objective: This study aimed to conduct a comprehensive Quantitative Microbial Risk Assessment to estimate the annual infection risk and disease burden attributed to E. coli O157: H7 in Gaza's drinking water. Methods: Applying the typical four steps of the Quantitative Microbial Risk Assessment technique-hazard identification, exposure assessment, dose-response analysis, and risk characterization-the study assessed the microbial risk associated with E. coli O157: H7 contamination in Gaza's drinking water supply. A total of 1317 water samples from various sources across Gaza were collected and analyzed for the presence of E. coli O157: H7. Using Microsoft ExcelTM and @RISKTM software, a Quantitative Microbial Risk Assessment model was constructed to quantify the risk of infection associated with E. coli O157: H7 contamination. Monte Carlo simulation techniques were employed to assess uncertainty surrounding input variables and generate probabilistic estimates of infection risk and disease burden. Results: Analysis of the water samples revealed the presence of E. coli O157: H7 in 6.9% of samples, with mean, standard deviation, and maximum values of 1.97, 9.74, and 112 MPN/100 ml, respectively. The risk model estimated a median infection risk of 3.21 × 10-01 per person per year and a median disease burden of 3.21 × 10-01 Disability-Adjusted Life Years per person per year, significantly exceeding acceptable thresholds set by the WHO. Conclusion: These findings emphasize the urgent need for proactive strategies to mitigate public health risks associated with waterborne pathogens in Gaza.

Assessment of hydrogeochemical characteristics and quality of groundwater resources in relation to risk of gastric cancer: comparative analysis of high- and low-risk areas in Iran.

The chemical quality of groundwater supplies in two high-risk area (HRA) and low-risk area (LRA) for gastric cancer in Iran was assessed through hydrogeochemical analysis and water quality indices. For this aim, Piper and Schoeller diagrams and water quality index (WQI) were applied. In addition, exposure to nitrate via drinking water and its corresponding risk were also assessed using Monte Carlo simulation technique. Data on physicochemical properties of groundwater resources were obtained from Iran Water Resources Management Company. Sampling and analysis of tap water for nitrate concentration were conducted in two cities of Shiraz (as a representative of LRA) and Ardabil (as a representative of HRA). According to Piper diagrams, the dominant hydrogeochemical facies of groundwater supplies in HRA and LRA were Na-HCO3 (43.75%) and Ca-HCO3 (41.77%), respectively. The predominant cations in groundwater resources of HRA were found to be Na+ (68.06%) and Ca2+ (31.94%). For LRA, the typical cations were in decreasing trend: Ca2+ (39.64%) > Mg2+ (18.35%) > Na+ (17.26%). For two areas, HCO3-, SO42- and Cl- were, respectively, the most frequent anions. Two-sample Wilcoxon test showed that there were statistically significant difference between two areas in terms of anions and cations concentrations (p value < 0.05). The mean of total hardness (Ca2+ + Mg2+) concentration of water supplies in LRA (528.1 mg/L) was higher than HRA (263.1 mg/L), whereas the mean of Na+ concentration was found to be lower in LRA (90.6 mg/L) compared with HRA (108.1 mg/L). The sum of nitrate intake and its risk in LRA was higher than HRA. WQI results showed that drinking water quality in HRA and LRA ranged from excellent to poor and most water resources were of a good quality class. Further studies are suggested to investigate the role of drinking water in the etiology of gastric cancer in Iran.

Tehran environmental and neurodevelopmental disorders (TEND) cohort study: Phase I, feasibility assessment.

PURPOSE: To advance knowledge about childhood neurodevelopmental disorders and study their environmental determinants, we conducted a study in Tehran, Iran to assess the feasibility of prospective birth cohort study. METHODS: We evaluated participation of pregnant women, feasibility of sampling biological material, and health care services availability in Tehran in four steps: (1) first trimester of pregnancy; (2) third trimester of pregnancy; (3) at delivery; and (4) two to three months after delivery. We collected related data through questionnaires, also various biological samples were obtained from mothers (blood, urine, milk and nails-hands and feet) and newborns (umbilical cord blood, meconium, and urine samples) from February 2016 to October 2017. RESULTS: overall 838 eligible pregnant women were approached. The participation rate was 206(25%) in our study and about 185(90%) of subjects were recruited in hospitals. Out of 206 participants in the first trimester, blood, urine, hand nail, and foot nail samples were collected from 206(100%),193(93%), 205(99%), and 205(99%), respectively. These values dropped to 65(54%), 83(69%), 84(70%), and 84(70%) for the remaining participants 120(58%) in the third trimester, respectively. Also, we gathered milk samples from 125(60%) of mothers at two to three months after delivery. CONCLUSION: Our findings suggest that hospitals were better places for recruitment of subjects in a birth cohort in Tehran. We further concluded that birth cohort study recruitment can be improved by choosing appropriate gestational ages. Obtaining the newborn's urine, meconium, and umbilical cord blood were challenging procedures and require good collaboration between hospital staff and researchers.

Comprehensive Risk Assessment of Health-Related Hazardous Events in the Drinking Water Supply System from Source to Tap in Gaza Strip, Palestine.

Background: The traditional approach in the management of the quality drinking water, and relying on end-product testing, has proven ineffective in protecting public health. Therefore, the transition to a systematic approach in drinking water supply systems management from the source to the consumer tap was taken as a water safety plan (WSP). Objective: The study aims to investigate the health-related hazardous events in order to decide on the best risk-reduction strategies in the supply of drinking water in the Gaza strip. Methods: A semiquantitative matrix method for risk assessment was applied. Also, chlorine residual, electrical conductivity, and nitrate concentration further tested in 109 water wells, 109 small-scale water desalination plants, 197 tanker trucks, and 384 households distributed over five governorates of the Gaza strip. Results: The mean of the measured chlorine residual values was less than the recommended national and international limits (0.2-1 mg/liter). The mean of electrical conductivity at catchment points and household municipal water taps was 2165.1 µS·cm-1 and 2000 µS·cm-1, respectively. Furthermore, zero percent of water samples met the recommended criteria, indicating that the groundwater in the Gaza strip is nonpotable. Only 12.8% and 8.8% of water samples met the permissible levels at catchment areas and municipal water at household, respectively, indicating sever health impacts on the public. Moreover, the most hazardous events were related to high levels of groundwater salinity, the low level of disinfection, the effect of electricity outages on the efficiency of the desalination process, and leakage of water from the tanker truck tank reservoirs. Therefore, urgent interventions are required to improve the quality of water and to mitigate the possible health effects. Conclusion: The prioritization of hazardous events that are proportional to the degree of their attributed risk could help guide in making the right risk-reduction decisions. Urgent interventions are required to improve the quality of water and to mitigate the possible health effects.

Health Risk Assessment of Dermal Exposure to Heavy Metals Content of Chemical Hair Dyes.

BACKGROUND: Contamination of hair dyes to heavy metals can threaten consumer's health. We investigated the concentrations of some important heavy metals in hair dyes and evaluates their non-carcinogenic effects. METHODS: The most commonly used hair dyes were determined through questioners and 32 samples were collected from the market of Tehran in 2014. The concentration of 10 heavy metals (Fe, Ag, Co, Cr, Mn, Ba, Cd, Cu, Pb, and Al) was determined using ICP-MS. Based on the obtained data from distributed questionnaires and Monte Carlo simulation, the exposure to the evaluated heavy metals was estimated. Besides, using hazard quotient (HQ) and chronic hazard (HI), the risk of non-carcinogenic effects of investigated hair dyes consumption was specified. RESULTS: Results indicated the average concentrations of Al, Ba, and Fe as 0.54, 0.86, and 1.19 mg kg-1 and those of Cd, Cu, and Pb as 0.45, 61.32, and 185.34 µg kg-1, respectively. Pb with HQ of 7.46e-4 had the highest risk and Fe with HQ of 3.4e-6 had the lowest level of risk. Among the investigated dyes, the ones made by Iran (HI=2.8e-4) and the dark brown color (HI=1.93e-4) had the highest level of risk among all the studied samples. CONCLUSION: Two indices of HI and HQ showed that heavy metal contents in the investigated samples had not probable non-carcinogenic risks for the consumers of these products.

Monitoring and exposure assessment of nitrate intake via fruits and vegetables in high and low risk areas for gastric cancer.

BACKGROUND: Gastric cancer (GC) is the first leading cause of cancer-related deaths in Iran. GC is a multifactorial disease and is caused by the interaction of genetic and environmental factors. The aim of this study was to assess the exposure and risk of nitrate intake through fruits and vegetables (F&V) in high-risk area (HRA) and low-risk area (LRA) of GC in Iran. METHODS: Twenty nine species of F&V were examined for nitrate by reverse-phase HPLC (RP-HPLC) method. Food frequency questionnaire (FFQ) data of 2000 adults participating in Persian cohort were applied to determine consumption patterns of F&V in those areas. A point-estimate daily intake was applied to compare two areas in terms of nitrate intake. Monte-Carlo simulation technique was applied to estimate chronic daily intake (CDI) of nitrate. RESULTS: The results showed that point-estimate daily intake of nitrate for subjects participated in the study was 2.02 ± 1.02 mg kg-1 day-1 in HRA and 1.98 ± 1.05 mg kg-1 day-1 in LRA. 6.53% of the participants in the HRA, and 5.9% of the participants in the LRA had an unacceptable point-estimate daily intake compared with an acceptable limit of 3.7 mg kg-1 day-1 established by FAO/WHO. CDI of nitrate in HRA was 1.94 ± 0.95 mg kg-1 day-1 and in the LRA was 1.93 ± 1.06 mg kg-1 day-1. CONCLUSION: The results showed that there is no difference between HRA and LRA in terms of nitrate intake through F&V.

Optimizing the performance of conventional water treatment system using quantitative microbial risk assessment, Tehran, Iran.

The performance of conventional drinking water treatment plants (WTPs) can be improved using quantitative microbial risk assessment (QMRA). A QMRA study on Cryptosporidium using actual pathogen density was conducted to examine the performance of Jalaliyeh WTP in Tehran, Iran. The infection risk and the burden of disease attributed to the parasite presence in finished water were estimated incorporating physical and chemical log reduction values (LRVs), using stochastic modeling and disinfection profiling. The risk and burden of disease were compared with health-based targets, i.e. one case of infection per 10,000 people or 10-6 DALYs per person per year. The parasite's LRVs were 2.31 and 0.034 log provided by physico-chemical treatment and disinfection processes, respectively. The mean of estimated risk (111 cases per 104 people per year) and the burden of disease (11.7 DALYs per 106 people per year) both exceeded the targets. To control the excess risk, three QMRA-based disinfection scenarios were examined including: (1) employing chlorine dioxide (ClO2) instead of chlorine (2) ozonation with a concentration of 0.75 mg/L (Ct = 22.5 min mg/L) and (3) UV irradiation with a dose of 10 mJ/cm2. The LRV of parasite may be increased to 3.0, 5.1 and 4.9 log by employing ClO2, ozonation and UV irradiation, respectively. The use of ozone or UV as alternative disinfectants, could enhance the disinfection efficacy and provide sufficient additional treatment against the excess risk of parasite. QMRA could make it easier applying appropriate improvement to conventional WTPs in order to increase the system performance in terms of health-based measures.

Carcinogen Risk Assessment of Polycyclic Aromatic Hydrocarbons in Drinking Water, Using Probabilistic Approaches.

BACKGROUND: This study was focused on the probability of carcinogen risk of low-level ingestion and dermal exposure with polycyclic aromatic hydrocarbons (PAHs) from drinking water in Tehran, capital of Iran. METHODS: Concentrations of 16 PAHs were measured in the tap, bottled and heated tap water in four different seasons. Using a questionnaire-based survey, exposure with PAHs from drinking water was evaluated via direct ingestion, swimming, washing and showering. Finally, a comprehensive risk assessment was performed in four age groups. Rank correlation was used to represent variability in risk analysis and obtained coefficients were used for sensitivity analysis. In addition, Monte Carlo simulation was implemented to determine risk probability distributions and to calculate cumulative probability of the total risks in different age groups. RESULTS: The lifetime average daily dose and the dermal absorbed dose were 0.69E-06 and 1.33E-05 mg/kg/day, respectively. The total estimated excess lifetime cancer risk (ELCR) of ingestion and dermal exposure were 1.57E-05 and 17.24E-05. CONCLUSION: Sum of estimated ingestion and dermal ELCR was 18.81E-05, which was higher than the acceptable value recommended by WHO. It means a total of 1504 lifetime cancer cases in residents of Tehran. Monte Carlo simulation indicated that risk probability above the acceptable level was 96.2% in dermal exposure. Moreover, sensitivity analysis indicated that tap water consumption (Pspearman >0.92) and washing activities (Pspearman>0.95) had the greatest correlation on the cancer risk.

Assessment of tetracycline contamination in surface and groundwater resources proximal to animal farming houses in Tehran, Iran.

BACKGROUND: Antibiotics have been increasingly used for veterinary and medical purposes. The overuse of these compounds for these purposes can pollute the environment, water resources in particular. Tetracycline, among other forms of antibiotics, is one of the most applied antibiotic in aquaculture and veterinary medicine. The present study aimed to tack the traces of tetracycline in the effluents of municipal and hospital wastewater treatment plants, surface and groundwater resources and finally the drinking water provided from these water resources. METHODS: The samples were taken from Fasha-Foyeh Dam, wells located at Varamin Plain, and Yaftabad; and also, wastewater samples were collected from the wastewater treatment plant effluents of Emam Khomeini Hospital and a municipal wastewater treatment plant which its effluent is being released to the surface water of the area covered in this work. 24 samples were collected in total during July 2012 to December 2012. The prepared samples were analyzed using high-performance liquid chromatography. RESULTS: Based on the results, mean tetracycline levels in surface and ground water at nearby of animal farms was found to vary from 5.4 to 8.1 ng L(-1). Furthermore, the maximum TC concentration of 9.3 ng L(-1) was found to be at Yaft-Abad sampling station. Although tetracycline traces could not be detected in any investigated Hospital WWTP effluents, it was tracked in MWWTP effluent samples, in the concentration range of 280 to 540 ng l(-1). CONCLUSION: The results showed that the concentration of TC in water resource near the animal farms is higher than the other sampling stations. This is related to the usage of antibiotic for animals. In fact, it caused the contamination of water resources and could contribute to radical changes in the ecology of these regions.

A Bibliometric and Trend Analysis on the Water-Related Risk Assessment Studies for Cryptosporidium Pathogen.

BACKGROUND: The bibliometric methods have been used in many disciplines of sciences to study the scientific production and research trends. In this study, they were used to investigate research trends related to the risk assessment of Cryptosporidium pathogen in water field. METHODS: Data were obtained on the Scopus database from 1993 to 2013. Research tendency was investigated by analyzing the distribution of languages, countries, journals, author keywords, authorship pattern and co-authorship relations. RESULTS: The English language was dominant language of all publications (96.36%). Number of articles in this field increased from 2 in 1993 to 29 papers in 2007 and then received to 19 at the end of 2013. United States produced 35.41% of all pertinent articles followed by United Kingdom with 10.76% and Australia with 9.92%. Water Research Journal published the most papers in this field, taking 11.62% of all, followed by Journal of Water and Health (10.92%) and Water Science and Technology (10.21%). The most productive authors were Ashbolt NJ form Canada that accounts about 1.51% of the total publications followed by Rose JB and Haas CN from United States. Authorship pattern analysis results show that literature does follow Lotka's law (P=0.627). CONCLUSION: A downward trend in the number of publications is likely to occur in future. The results of this bibliometric analysis may help relevant researchers realize the scope of the microbial risk assessment research of Cryptosporidium, and establish the further research direction.

Occurrence of non-steroidal anti-inflammatory drugs in Tehran source water, municipal and hospital wastewaters, and their ecotoxicological risk assessment.

Pharmaceuticals are becoming widely distributed in waters and wastewaters and pose a serious threat to public health. The present study aimed to analyze non-steroidal anti-inflammatory drugs (NSAIDs) in surface waters, drinking water, and wastewater in Tehran, Iran. Thirty-six samples were collected from surface waters, tap water, and influent and effluent of municipal and hospital wastewater treatment plants (WWTP). A solid-phase extraction (SPE) followed by liquid chromatography-tandem mass spectrometry method was used for the determination of pharmaceuticals, namely ibuprofen (IBP), naproxen (NPX), diclofenac (DIC), and indomethacin (IDM). IBP was found in most of the samples and had the highest concentration. The highest concentrations of NSAIDs were found in the municipal WWTP influents and hospital WWTP effluents. In the municipal WWTP influent samples, the concentrations of IBP, NPX, DIC, and IDM were 1.05, 0.43, 0.23, and 0.11 µg/L, respectively. DIC was found only in one river sample. All NSAIDs were detected in tap water samples. However, their concentration was very low and the maximum values for IBP, NPX, DIC, and IDM were 47, 39, 24, and 37 ng/L, respectively, in tap water samples. Results showed that the measured pharmaceuticals were detected in all rivers with low concentrations in nanograms per liter range, except DIC which was found only in one river. Furthermore, this study showed that the aforementioned pharmaceuticals are not completely removed during their passage through WWTPs. A potential environmental risk of selected NSAIDs for the urban wastewater has been discussed. However, given their low measured concentrations, no ecotoxicological effect is suspected to occur.

Evaluation and comparison of aluminum-coated pumice and zeolite in arsenic removal from water resources.

In this research the potential of aluminum-coated pumice and zeolite in arsenic, As (V) removal was investigated and compared. Scanning Electron Microscopy (SEM), X-Ray Diffraction (XRD) and X-Ray Flaorescence Spectrometry (XRF) were carried out to determine the properties of the adsorbents. Several parameters including adsorbent dosage] pH, contact time, and initial As(V) concentration were studied. The optimum pH obtained for both adsorbents was pH = 7. As(V) adsorption by both adsorbents followed the Freundlich isotherm (for aluminum-coated pumice and zeolite respectively with R2 > 0.98 and R2 > 0.99). The obtained data from kinetics showed that the pseudo-second order model could better explain As(V) adsorption for both aluminum-coated pumice and zeolite (R2 > 0.98 and R2 > 0.99 respectively). Because of low cost, both adsorbents may be economically used, but aluminum-coated zeolite showed high efficiency of, due to its porosity and surface area. More than 96% of As(V) with initial concentration of 250 µg/L was removed by 10 g/L aluminum-coated zeolite at pH = 7 and in 60 minutes to achieve As(V) concentration of 10 µg/L, while only 71% of As(V) could be removed by aluminum-coated pumice.