Dual system of water safety plan auditing in Hungary: benefits and lessons learnt.

A risk-based approach is recognised worldwide as the most reliable means for the provision of safe drinking water. Efficient implementation of the water safety plan (WSP) approach, recommended by the World Health Organization (WHO), is facilitated by an auditing framework. In Hungary, development of WSPs is a legal obligation for water suppliers. WSPs are subject to a two-stage regulatory audit, a consultative central technical audit and a formal local audit. In 2019, a survey was conducted in cooperation with WHO to evaluate audit experiences of over 1,200 WSPs. Recommendations from the central audit significantly improved coherence and compliance of WSPs, confirming the efficiency of the dual approach. The use of a WSP template provided by the national authority further increased consistency and reduced time and work demand of the audit. Both water suppliers and public health authorities indicated a need for further capacity building on WSP development and auditing. The main challenge for water suppliers is the identification and risk assessment of hazards associated with the water source and distribution within premises. The recast European Union drinking water regulation is expected to accelerate the uptake of WSP and strengthen linkages to water catchment management and water safety in buildings.

Carbapenem-resistant Escherichia coli in Black-headed gulls, the Danube, and human clinical samples: A One Health comparison of contemporary isolates.

OBJECTIVES: Our aim was to characterize and compare contemporary carbapenem-resistant Enterobacterales (CRE) isolates from gulls, the River Danube, and humans in Hungary, Budapest. METHODS: Multiresistant Enterobacterales were sought for in 227 gull faecal and 24 Danube water samples from 2019 to 2020. Eosin-methylene blue agar containing 2 mg/L cefotaxime and Colilert-test containing 10 mg/L cefotaxime were used for gull and water samples, respectively. Isolates were characterized by polymerase chain reactions (PCRs); acquired carbapenemase producers were further analysed by whole-genome sequencing, together with 21 Hungarian human CR Escherichia coli (CREc) isolates. RESULTS: Gull and water samples exhibited a CRE prevalence of 7.4% (9/122) and 6.7% (7/105), none and 5/12 water samples yielded CRE from 2019 and 2020, respectively; CRE were found only in samples taken downstream of Budapest. The dominant species was Escherichia coli and the most prevalent carbapenemase was blaNDM-1. High-risk CREc clones were found both in gulls (ST224, ST372, ST744) and the Danube (ST10, ST354, ST410); the closest associations were between ST410 from humans and the Danube, among ST1437 among gulls, and between ST1437 in gulls and the Danube (46, 0, and 22-24 allelic distances, respectively). Direct links between human and gull isolates were not demonstrated. CONCLUSION: The study demonstrates potential epidemiological links among humans, a river crossing a city, and urbanised birds, suggesting a local transmission network. Water bodies receiving influent wastewater, together with animals using such habitats, may serve as a local reservoir system for CRE, highlighting the importance of One Health in CRE transmission, even in a country with a low CRE prevalence in humans.

Planktonic and epilithic prokaryota community compositions in a large temperate river reflect climate change related seasonal shifts.

In freshwaters, microbial communities are of outstanding importance both from ecological and public health perspectives, however, they are threatened by the impact of global warming. To reveal how different prokaryotic communities in a large temperate river respond to environment conditions related to climate change, the present study provides the first detailed insight into the composition and spatial and year-round temporal variations of planktonic and epilithic prokaryotic community. Microbial diversity was studied using high-throughput next generation amplicon sequencing. Sampling was carried out monthly in the midstream and the littoral zone of the Danube, upstream and downstream from a large urban area. Result demonstrated that river habitats predominantly determine the taxonomic composition of the microbiota; diverse and well-differentiated microbial communities developed in water and epilithon, with higher variance in the latter. The composition of bacterioplankton clearly followed the prolongation of the summer resulting from climate change, while the epilithon community was less responsive. Rising water temperatures was associated with increased abundances of many taxa (such as phylum Actinobacteria, class Gammaproteobacteria and orders Synechococcales, Alteromonadales, Chitinophagales, Pseudomonadales, Rhizobiales and Xanthomonadales), and the composition of the microbiota also reflected changes of several further environmental factors (such as turbidity, TOC, electric conductivity, pH and the concentration of phosphate, sulphate, nitrate, total nitrogen and the dissolved oxygen). The results indicate that shift in microbial community responding to changing environment may be of crucial importance in the decomposition of organic compounds (including pollutants and xenobiotics), the transformation and accumulation of heavy metals and the occurrence of pathogens or antimicrobial resistant organisms.

Wastewater-based modeling, reconstruction, and prediction for COVID-19 outbreaks in Hungary caused by highly immune evasive variants.

(MOTIVATION): Wastewater-based epidemiology (WBE) has emerged as a promising approach for monitoring the COVID-19 pandemic, since the measurement process is cost-effective and is exposed to fewer potential errors compared to other indicators like hospitalization data or the number of detected cases. Consequently, WBE was gradually becoming a key tool for epidemic surveillance and often the most reliable data source, as the intensity of clinical testing for COVID-19 drastically decreased by the third year of the pandemic. Recent results suggests that the model-based fusion of wastewater measurements with clinical data and other indicators is essential in future epidemic surveillance. (METHOD): In this work, we developed a wastewater-based compartmental epidemic model with a two-phase vaccination dynamics and immune evasion. We proposed a multi-step optimization-based data assimilation method for epidemic state reconstruction, parameter estimation, and prediction. The computations make use of the measured viral load in wastewater, the available clinical data (hospital occupancy, delivered vaccine doses, and deaths), the stringency index of the official social distancing rules, and other measures. The current state assessment and the estimation of the current transmission rate and immunity loss allow a plausible prediction of the future progression of the pandemic. (RESULTS): Qualitative and quantitative evaluations revealed that the contribution of wastewater data in our computational epidemiological framework makes predictions more reliable. Predictions suggest that at least half of the Hungarian population has lost immunity during the epidemic outbreak caused by the BA.1 and BA.2 subvariants of Omicron in the first half of 2022. We obtained a similar result for the outbreaks caused by the subvariant BA.5 in the second half of 2022. (APPLICABILITY): The proposed approach has been used to support COVID management in Hungary and could be customized for other countries as well.

SARS-CoV-2 variant detection from wastewater: rapid spread of B.1.1.7 lineage in Hungary.

Wastewater-based epidemiology (WBE) is a recognised tool for tracking community transmission of COVID-19. From the second half of 2020, the emergence of new, highly infective, more pathogenic or vaccine-escape SARS-CoV-2 variants is the major public health concern. Variant analysis in sewage might assist the early detection of new mutations. Weekly raw sewage samples from 22 wastewater treatment plants (WWTPs) in Hungary (representing 40% of the population) were analysed between December 2020 and March 2021 for signature mutations N501Y and del H69/V70 of B.1.1.7 lineage by melting point genotyping and RT-digital droplet PCR (RT-ddPCR). The latter method proved to be more efficient in parallel detection of different variants and also provides quantitative information. Wastewater surveillance indicated that the B.1.1.7 variant first emerged in Budapest in early January 2021 and rapidly became dominant in the entire country. Results are in close agreement with the available clinical data (Pearson's correlation coefficient, R = 0.9153). RT-ddPCR was confirmed to be a reliable tool for tracking emerging variant ratios in wastewaters. It is a rapid and cost-effective method compared to whole-genome sequencing, but only applicable for the detection of known mutations. Efficient variant surveillance might require the combination of multiple methods.

Health and economic gain attributable to the introduction of the World Health Organization's drinking water standard on arsenic level in Hungary: A nationwide retrospective study on cancer occurrence and ischemic heart disease mortality.

The World Health Organization (WHO) estimates that 140 million individuals are at risk from consumption of drinking water containing arsenic at concentrations above the WHO guideline value of 10 µg/l. Arsenic mitigation is considered to be the most effective way to prevent arsenic related diseases. After joining the European Union, Hungary implemented a Drinking Water Quality Improvement Programme (DWQIP) to reduce levels of arsenic in drinking water below the WHO guideline value. But what impact did this have on health? We estimated the change in lifetime excess skin, lung, and bladder cancer risks and mortality from ischaemic heart disease (IHD) associated with chronic arsenic intake among those exposed before (2004-2007) and after (2014-2017) the implementation of DWQIP. A population-based risk assessment approach was used to assess lifetime excess cancer risk applying two scenarios for lung and bladder cancers. The economic benefits of the DWQIP were estimated by the combination of cost of illness and value per statistical life methods. Compared to the period before the DWQIP, its implementation was associated with a significant reduction in arsenic in drinking water [median: 3.0 µg/l interquartile range (IQR): 1.5-12.0 µg/l to median: 2.15 µg/l IQR: 1.0-5.79 µg/l]. The two scenarios were estimated to be associated with 225.2 and 35.9 fewer cancer cases each year. The number of annually prevented IHD deaths was estimated to be 88.9. It was estimated that the benefits of the DWQIP will outweigh its costs. We conclude that reducing arsenic levels in drinking water to 10.0 µg/l resulted in significant health and economic benefits. Our study goes beyond the existing research, offering both new insights into the impact of arsenic mitigation and providing a methodological template for similar studies in the many parts of the world that have yet to reduce arsenic exposure.

Disinfection of therapeutic water - balancing risks against benefits: case study of Hungarian therapeutic baths on the effects of technological steps and disinfection on therapeutic waters.

Thermal therapeutic pools in most countries are operated in a manner similar to swimming pools: with water circulation, filtration and disinfection. However, in some countries, including Hungary, therapeutic pools are traditionally not treated this way, in order to preserve the therapeutic qualities of the water. However, dilution and frequent water replacement applied in these pools are often insufficient to ensure adequate microbial water quality, posing a risk of infection to the bathers. In the present case study, the impact of water treatment (including chemical disinfection by hypochlorite or hydrogen peroxide) was investigated on the therapeutic components of the water in seven Hungarian spas of various water composition. Microbial quality was improved by both disinfectants, but hypochlorite reduced the concentration of the therapeutic components sulfide, bromide, and iodide ions by 40-99%, and high levels of disinfection by-products were observed. Hydrogen peroxide only affected sulfide ion (91% reduction). Other technological steps (e.g., transport or cooling by dilution) were found to have significant impact on composition, often outweighing the effect of disinfection. The current case study demonstrated that thermal waters may be treated and disinfected with minimal loss of the therapeutic compounds, if an adequate treatment procedure is selected based on the water composition.

Investigation of the association between lithium levels in drinking water and suicide mortality in Hungary.

BACKGROUND: In recent decades, a series of ecological studies from various countries have attempted to reveal whether there is an association between trace amounts of lithium in drinking water and suicide mortality. With some notable exceptions, results have indicated that there is an inverse association between these two variables. Since Hungary had extremely high rates of suicide with a persistent spatial pattern, we consider that our country is ideal to investigate this research question. METHODS: We carried out our research on Hungarian data at the level of districts (n = 197). The dependent variable was the age- and gender-standardized mortality ratio for suicide (sSMR). Our main explanatory variable was the tap water lithium level (Li) from public drinking water supply systems using their own water source (n = 1 325). Those data, which give full national coverage, were aggregated to the level of districts. Confounding factors were religiosity, alcohol consumption and income. Various regression models were used for statistical calculations. RESULTS: Findings from our most appropriate regression model - adjusted for relevant confounding variables and able to handle spatial autocorrelation and heteroscedasticity - suggest a significant (p < 0.05) and a trend-like (p < 0.1) negative association between Li and sSMR in the total population and among males, respectively. However, such an association was not found between these two variables among females. CONCLUSION: In line with the majority of findings from other countries, our results indicate that the intake of lithium with drinking water may have a gender-dependent suicide-protective effect.

Mycological Investigation of Bottled Water Dispensers in Healthcare Facilities.

The usage of bottled water dispensers (BWDs) has spread worldwide. Despite their popularity, few studies have dealt with their microbial contaminants, and little attention is given to their fungal contamination. To our knowledge this is the first mycological study of BWDs in Europe. 36 devices have been examined in Budapest, Hungary. Despite of the strictly regulated water hygiene system in Hungary, molds and yeasts were detected in 86.8% of the samples, 56.76% were highly contaminated. Elevated heterotrophic plate counts were also observed in all samples compared to that of Hungarian drinking water. As all physical and chemical water quality characteristics have met the relevant national and European parametric values and neither totally explained the results of microbial counts, the effect of usage and maintenance habits of the devices were examined. Fungal concentrations were affected by the time elapsed since disinfection, days remaining until expiration of bottles, month of sampling and exposure to sunlight during storage. Microbes are able to proliferate in the bottled water and disperse inside the BWDs. Many of the detected fungal species (Sarocladium kiliense, Acremonium sclerotigenum/egyptiacum, Exophiala jeanselmei var. lecanii-corni, Exophiala equina, Meyerozyma guilliermondii, Cystobasidium slooffiae, Aspergillus jensenii, Bisifusarium biseptatum) are opportunistic pathogens for subpopulations of sensitive age groups and patients with immunodeficient conditions, including cystic fibrosis. Thus BWDs may pose a health risk to visitors of healthcare institutions, especially to patients with oral lesions in dental surgeries. The study draws attention to the need to investigate microbial contamination of these devices in other countries as well.

SARS-CoV-2 detection in wastewater using multiplex quantitative PCR.

A multiplex reverse transcription quantitative PCR (RT-qPCR)-based method was designed for the simultaneous detection of different SARS-CoV-2 genes. In this study, we used three target genes encoding for the nucleocapsid 1 and 3 (N1, N3), and the spike (S) proteins, all commonly used in the detection of SARS-CoV-2 in human and environmental samples. The performance of the multiplex assay, compared to the single assay was assessed for the standard calibration curve, required for absolute quantification, and then, for the real environmental samples to detect SARS-CoV-2. For this latter, four environmental samples were collected at a local wastewater treatment plant (WWTP). The results showed that the cycle threshold (Ct) values of the multiplex were comparable to the values obtained by the singleplex PCR. The amplification of the three target genes indicated the presence of SARS-CoV-2 in the four water samples with an increasing trend in February and these results were confirmed in the multiplex approach, showing the robustness of this method and its applicability for the relative abundance analysis among the samples. Overall, both the laboratory and field work results demonstrated that the multiplex PCR assay developed in this study could provide a method for SARS-CoV-2 detection as robust as the single qPCR, but faster and cost-effective, reducing by three times the number of reactions, and consequently the handling time and reagents.

Ahead of the second wave: Early warning for COVID-19 by wastewater surveillance in Hungary.

Wastewater based epidemiology is a potential early warning tool for the detection of COVID-19 outbreak. Sewage surveillance for SARS-CoV-2 RNA was introduced in Hungary after the successful containment of the first wave of the pandemic to forecast the resurge of infections. Three wastewater treatment plants servicing the entire population (1.8 million) of the capital, Budapest were sampled weekly. 24 h composite (n = 44) and grab samples (n = 21) were concentrated by an in-house flat sheet membrane ultrafiltration method. The efficiency and reproducibility of the method was comparable to those previously published. SARS-CoV-2 RNA was quantified using RT-qPCR of the N gene. The first positive signal in sewage was detected 2 weeks before the rise in case numbers. Viral concentration and volume-adjusted viral load correlated to the weekly new cases from the same week and the rolling 7-day average of active cases in the subsequent week. The correlation was more pronounced in the ascending phase of the outbreak, data was divergent once case numbers plateaued. Wastewater surveillance was found to be effective in predicting the second wave of the outbreak in Hungary. Data indicated that even relatively low frequency (weekly) sampling is useful and at the same time, cost effective tool in outbreak detection.

Trihalomethanes in Drinking Water and Bladder Cancer Burden in the European Union.

BACKGROUND: Trihalomethanes (THMs) are widespread disinfection by-products (DBPs) in drinking water, and long-term exposure has been consistently associated with increased bladder cancer risk. OBJECTIVE: We assessed THM levels in drinking water in the European Union as a marker of DBP exposure and estimated the attributable burden of bladder cancer. METHODS: We collected recent annual mean THM levels in municipal drinking water in 28 European countries (EU28) from routine monitoring records. We estimated a linear exposure-response function for average residential THM levels and bladder cancer by pooling data from studies included in the largest international pooled analysis published to date in order to estimate odds ratios (ORs) for bladder cancer associated with the mean THM level in each country (relative to no exposure), population-attributable fraction (PAF), and number of attributable bladder cancer cases in different scenarios using incidence rates and population from the Global Burden of Disease study of 2016. RESULTS: We obtained 2005-2018 THM data from EU26, covering 75% of the population. Data coverage and accuracy were heterogeneous among countries. The estimated population-weighted mean THM level was 11.7µg/L [standard deviation (SD) of 11.2]. The estimated bladder cancer PAF was 4.9% [95% confidence interval (CI): 2.5, 7.1] overall (range: 0-23%), accounting for 6,561 (95% CI: 3,389, 9,537) bladder cancer cases per year. Denmark and the Netherlands had the lowest PAF (0.0% each), while Cyprus (23.2%), Malta (17.9%), and Ireland (17.2%) had the highest among EU26. In the scenario where no country would exceed the current EU mean, 2,868 (95% CI: 1,522, 4,060; 43%) annual attributable bladder cancer cases could potentially be avoided. DISCUSSION: Efforts have been made to reduce THM levels in the European Union. However, assuming a causal association, current levels in certain countries still could lead to a considerable burden of bladder cancer that could potentially be avoided by optimizing water treatment, disinfection, and distribution practices, among other possible measures. https://doi.org/10.1289/EHP4495.

Transient nature of riverbank filtered drinking water supply systems - A new challenge of natural radioactivity assessment.

In Hungary the drinking water supply is mainly based on groundwater, in which radionuclides are common components. Since the mobility of the most common radionuclides, uranium and radium, is strongly influenced by the geochemical conditions, knowledge on the geochemical parameters of water is required. This depends on the flow system and the flow regime. Therefore, hydrogeology has a crucial role in revealing the origin of elevated activity concentrations. This research presents a case study in Hungary where the drinking water supply is provided by bank filtered and karst wells. In most of the wells of the research area the gross alpha values are above the screening level, 0.1 Bq L-1. The aim of this study is to determine which radionuclides may cause the elevated radioactivity and explain their occurrence using the hydrogeological approach. All samples of the study were analysed for (U-238+U-234), Ra-226, Rn-222. Alpha spectrometry applied on Nucfilm discs was used to measure the uranium and radium activity while radon activity was determined by liquid scintillation. The study revealed the correlation between the river water level fluctuation and the uranium content of the wells. The results of this study highlighted the transient nature of river bank filtered systems, which should be taken into account in the monitoring and water supply strategy.

Health risk of swimming pool disinfection by-products: a regulatory perspective.

While disinfection of swimming pools is indispensable for microbiological safety, it may lead to the formation of disinfection by-products. Most studies agree that inhalation exposure is the predominant pathway of the associated health risks, but assumptions are based on concentrations measured in water and evaporation models. Pool water and air were sampled in 19 swimming pools. Trihalomethanes were detected in all sites; chloroform being the most abundant species. Concentrations ranged between 12.8-71.2 µg/L and 11.1-102.2 µg/m3 in pool water and air, respectively. The individual lifetime carcinogenic risk associated with chloroform in swimming pools exceeded 10-6 in all age groups for recreational swimmers and 10-5 for elite swimmers and staff, even if the pool complied with the national standards. Inhalation exposure was estimated and found to be the most relevant, however, different mass transfer models from water measurements significantly under- or overestimated the health burden compared to direct calculation from the concentration in air. The observed health risks call for defining regulatory values and monitoring requirement of indoor air quality in swimming pools.

Uranium in groundwater - The importance of hydraulic regime and groundwater flow system's understanding.

Uranium and other natural radionuclides are common components in groundwater, but they are not routinely measured. In drinking water their total activity is screened, but in the evaluation of the measured values usually the aquifer material is only considered. However, the occurrence of radionuclides in groundwater is strongly affected by flow systems and their geochemical characteristics. Therefore hydrogeology and flow system's evaluation is crucial to understand natural radioactivity. Areas of different hydraulic regimes - recharge, throughflow and discharge - even within the same aquifer are characterized by different geochemical environment. In the present study pressure-elevation profiles were generated based on existing basic hydraulic data of wells in order to determine the flow regimes and associated vertical groundwater flow directions. 24-753 mBq L-1 uranium activity concentrations were found in groundwater and surface water showing great areal variability. High uranium values correspond to recharge regimes with downward flow directions. Uranium mobility is enhanced by high bicarbonate content and circumneutral pH. The study emphasize the importance of groundwater flow system's understanding in those areas, where elevated background radioactivity may exist.

Investigation of estrogen activity in the raw and treated waters of riverbank infiltration using a yeast estrogen screen and chemical analysis.

Exposure to various endocrine disrupting chemicals (EDCs) can lead to adverse effects on reproductive physiology and behavior in both animals and humans. An adequate strategy for the prevention of environmental contamination and eliminating the effects of them must be established. Chemicals with estrogenic activity were selected, and the effectiveness of their removal during the purification processes in two drinking water treatment plants (DWTPs) using riverbank infiltrated water was determined. Thirty-five water samples in two sampling campaigns throughout different seasons were collected and screened with a yeast estrogen test; furthermore, bisphenol A (BPA), 17ß-estradiol (E2) and ethinyl-estradiol (EE2) content were measured using high-performance liquid chromatography-mass spectrometry (HPLC-MS). Our results confirm that estrogenic compounds are present in sewage effluents and raw surface river water of DWTPs. Very low estrogen activity and pg/L concentrations of BPA and E2 were detected during drinking water processing and occasionally in drinking water. Based on this study, applied riverbank filtration and water treatment procedures do not seem to be suitable for the total removal of estrogenic chemicals. Local contamination could play an important role in increasing the BPA content of the drinking water at the consumer endpoint.

[Investigation of the association between arsenic levels in drinking water and suicide rate of Hungarian settlements between 2005 and 2011. A preliminary study]. / A hazai települések ivóvfzénekarzénszennezettsége és öngilkosságirátajának kapcsolata 2005 és 2011 között. A terülleti eltérések egyik lehetséges oka?

INTRODUCTION: Both suicidal behaviour and consumption of arsenic-contaminated drinking-water represent major public health problems. Previous epidemiological and animal studies showed that high arsenic intake may also be associated with the elevated risk for depression. Since untreated depression is the most powerful risk factor for suicidal behaviour, we postulated that the consumption of arsenic-contaminated tap drinking-water may also be related to suicide. METHOD: Based on the level of arsenic in their drinking water Hungarian settlements with more then 500 inhabitants (n=1639) were divided into four groups. Then average age-standardized suicide rates of the four groups were compared. RESULTS AND DISCUSSION: We found that the higher is the arsenic level in the drinking water the higher is the suicide rate of the settlements. In addition to the practical consequences of our preliminary results (e.g. in the suicide prevention) they also suggest that high level of arsenic in drinking water might contribute, at least in part, to the well-known and stable in time regional differences in suicide mortality of Hungary since the highest arsenic levels in drinking water have been found in counties with traditionally high suicide rates, such as Bacs-Kiskun, Csongrad, Bekes and Hajdu- Bihar.

Viruses Surveillance Under Different Season Scenarios of the Negro River Basin, Amazonia, Brazil.

The Negro River is located in the Amazon basin, the largest hydrological catchment in the world. Its water is used for drinking, domestic activities, recreation and transportation and water quality is significantly affected by anthropogenic impacts. The goals of this study were to determine the presence and concentrations of the main viral etiological agents of acute gastroenteritis, such as group A rotavirus (RVA) and genogroup II norovirus (NoV GII), and to assess the use of human adenovirus (HAdV) and JC polyomavirus (JCPyV) as viral indicators of human faecal contamination in the aquatic environment of Manaus under different hydrological scenarios. Water samples were collected along Negro River and in small streams known as igarapés. Viruses were concentrated by an organic flocculation method and detected by quantitative PCR. From 272 samples analysed, HAdV was detected in 91.9%, followed by JCPyV (69.5%), RVA (23.9%) and NoV GII (7.4%). Viral concentrations ranged from 10(2) to 10(6) GC L(-1) and viruses were more likely to be detected during the flood season, with the exception of NoV GII, which was detected only during the dry season. Statistically significant differences on virus concentrations between dry and flood seasons were observed only for RVA. The HAdV data provides a useful complement to faecal indicator bacteria in the monitoring of aquatic environments. Overall results demonstrated that the hydrological cycle of the Negro River in the Amazon Basin affects the dynamics of viruses in aquatic environments and, consequently, the exposure of citizens to these waterborne pathogens.

Prevalence of Legionella in premise plumbing in Hungary.

Legionella is one of the emerging concerns of water quality in built water environments. Premise plumbing systems are among the recognised sources of infection. In the present study, colonisation of hot water networks in health care facilities, schools, hotels, private residences, office and industrial buildings was investigated. Data was analysed in connection with building and premise plumbing characteristics. Over 60% of all buildings were colonised by Legionella; counts were over 1000 CFU/L in 49%. The most prevalent type was Legionella pneumophila serogroup 2-14, isolated from 75% of the positive samples. Centrally produced hot water was found to be a key risk factor (46% of the samples were positive vs. 16% in individual systems); within this group the type of the building was less relevant. Colonisation levels in schools were similar to hotels or hospitals, representing a previously underestimated risk setting. Systems supplied by water from deep groundwater sources were significantly less likely to be colonised than more vulnerable sources (bank-wall filtration, surface water abstraction or karstic water; 28% vs. 51% positive), regardless of the type of treatment applied, including the presence of disinfection. The aggravating effect of larger, more complex and older buildings on colonisation was also confirmed. The present study represents the first baseline analysis, pre-empting regulation or monitoring requirements for Legionella. The prevalence of legionellae and the identified risk factors are indicative for other settings lacking targeted interventions. The statistically confirmed risk factors can serve as indicators for preliminary risk assessment and the prioritisation of interventions.

Повышение приоритетности образования, здоровья и благополучия школьников: водоснабжение, санитария и гигиена в школах в Общеевропейском регионе

Невозможно гарантировать хорошее здоровье, благополучие, образование и соблюдение человеческого достоинства школьников, если у них в школе не будет доступа к воде и средствам санитарии и гигиены (WASH) приемлемого качества. Обеспечение всем детям здоровых условий окружающей среды в школах в Общеевропейском регионе является одним из фундаментальных положений Пармской декларации по окружающей среде и охране здоровья 2010 г. Все страны региона обязались к 2020 году обеспечить все центры по уходу за детьми, детские сады и школы безопасной питьевой водой и средствами санитарии и возродить здоровую практику соблюдения правил гигиены. Вне всякого сомнения, именно исходя из прав человека на воду и санитарию и на образование в Повестке дня в области устойчивого развития на период до 2030 г. поставлена цель добиться всеобщего и справедливого доступа к безопасным услугам WASH и создать такие учреждения образования, в которых для всех будет обеспечена безопасная среда для учебы. В сфере WASH главным инструментом политики в Общеевропейском регионе является Протокол по проблемам воды и здоровья 1999 г., цель которого заключается в обеспечении доступа к питьевой воде и санитарии для всех – включая детей в школах. Негативное влияние неудовлетворительного качества системы WASH в школах не ограничивается рамками одного сектора. Здоровье, образование, питание и весь комплекс WASH тесно взаимосвязаны и дополняют друг друга. Эта мысль нашла свое отражение в рамочной основе европейской политики в области здравоохранения – Здоровье-2020, где подчеркивается необходимость улучшения сотрудничества между сектором здравоохранения и другими стратегическими секторами, такими как сектор образования, и осуществления совместных инвестиций этими секторами. Подчеркивая, как неудовлетворительное качество услуг WASH в школах подрывает учебу, здоровье и благополучие школьников, авторы данной публикации настаивают на том, что лица, формирующие политику во всех заинтересованных секторах, должны вынести эту проблему в число приоритетных в контексте Протокола и постепенно реализовывать устремления, сформулированные в Повестке дня в области устойчивого развития на период до 2030 г. и в Пармской декларации по окружающей среде и охране здоровья.