Estimating National Exposures and Potential Bladder Cancer Cases Associated with Chlorination DBPs in U.S. Drinking Water.

BACKGROUND: Disinfection byproducts (DBPs) in public water systems (PWS) are an unintended consequence resulting from reactions between mostly chlorine-based disinfectants and organic and inorganic compounds in source waters. Epidemiology studies have shown that exposure to DBP (specifically trihalomethanes) was associated with an increased risk of bladder cancer. OBJECTIVE: Our goal was to characterize the relative differences in exposures and estimated potential bladder cancer risks for people served by different strata of PWS in the United States and to evaluate uncertainties associated with these estimates. METHODS: We stratified PWS by source water type (surface vs. groundwater) and population served (large, medium, and small) and calculated population-weighted mean trihalomethane-4 (THM4) concentrations for each stratum. For each stratum, we calculated a population attributable risk (PAR) for bladder cancer using odds ratios derived from published pooled epidemiology estimates as a function of the mean THM4 concentration and the fraction of the total U.S. population served by each stratum of systems. We then applied the stratum-specific PARs to the total annual number of new bladder cancer cases in the U.S. population to estimate bladder cancer incidence in each stratum. RESULTS: Our results show that approximately 8,000 of the 79,000 annual bladder cancer cases in the United States were potentially attributable to DBPs in drinking water systems. The estimated attributable cases vary based on source water type and system size. Approximately 74% of the estimated attributable cases were from surface water systems serving populations of >10,000 people. We also identified several uncertainties that may affect the results from this study, primarily related to the use of THM4 as a surrogate measure for DBPs relevant to bladder cancer. DISCUSSION: Despite significant reductions in exposure over the past several decades, our study suggests that ∼10% of the bladder cancer cases in the United States may still be attributed to exposure to DBPs found in drinking water systems. https://doi.org/10.1289/EHP9985.

Characterization of reported legionellosis outbreaks associated with buildings served by public drinking water systems: United States, 2001-2017.

This study examined 184 legionellosis outbreaks in the United States reported to the Centers for Disease Control and Prevention's Waterborne Disease and Outbreak Surveillance System, from 2001 to 2017. Drinking water characteristics examined include source water type, disinfectant type, exposure setting, geographical distribution by U.S. Census Divisions, and the public water system size (population served). This study found that most of the reported drinking water-associated legionellosis outbreaks occurred in eastern United States, including 35% in the South Atlantic, 32% in the Middle Atlantic, and 16% in the East North Central Census Divisions were linked with building water systems in healthcare and hotel settings; and were associated with buildings receiving drinking water from public water systems serving >10,000 people. Targeted evaluations and interventions may be useful to further determine the combination of factors, such as disinfectant residual type and drinking water system size that may lead to legionellosis outbreaks.

Effects of exposure water volume, depuration time, and feeding status on vitellogenin mRNA induction in male medaka (Oryzias latipes) exposed to 17 ß-estradiol.

Bioassays measuring the induction of vitellogenin gene expression in male fish are widely used for revealing estrogenic activity in water samples. Measuring induction of vitellogenin mRNA in males by means of RT-PCR analysis is a sensitive way to detect exposure to estrogenic chemicals. To date, little work has been done to examine variations in exposure conditions for assessing estrogenic activity in water samples using this model system. Here we report the results of experiments investigating the effects of volume of treatment water, time since removal from treatment water (depuration), and short-term food deprivation on vitellogenin mRNA induction in male Japanese medaka (Oryzias latipes). Fish exposed to a single concentration of E(2) while volume was manipulated were found to have similar levels of vitellogenin mRNA, though more E(2) was present at larger volumes. Removal of fish from E(2)-treated-water to clean water after exposures reduced vitellogenin levels in as little 24h, however, the vitellogenin levels of the fish transferred to the clean water remained above those of the control fish for at least 72 h. Depriving fish of food for up to 72 h during exposure to E(2) did not significantly reduce vitellogenin induction. Together these results support the conclusion that real time RT-PCR measurement of vitellogenin in male fish can be used as a robust indicator of exposure to estrogenic contaminants in water.