Quality of rainwater and reclaimed water used in buildings and selection of appropriate indicators.

OBJECTIVES: The use of alternative water sources such as rainwater or greywater (i.e., wastewater excluding water from toilets) for non-potable purposes may save water but, on the other hand, can also pose health risks to users. The main health risks come from microorganisms (such as bacteria, viruses, fungi, and protozoa). This work aims to analyse especially microbiological quality of rainwater and greywater used inside buildings in detail and to expand the existing knowledge about the potential health risks associated with these alternative water sources. It also considers methodological problems during E. coli and coliform bacteria detection. The final objective is to discuss requirements and appropriate indicators for monitoring recycled water quality. METHODS: We examined 30 buildings with non-potable water systems in the Czech Republic and analysed a total of 137 samples of rainwater and 120 samples of greywater. From these 30 buildings, eleven, 5 of which used rainwater and 6 of which used greywater, were sampled regularly for 1-2 years for basic chemical parameters, various faecal indicators, C. perfringens, Legionella spp. and P. aeruginosa. Occasionally, samples were analysed also for the presence of environmental mycobacteria, amoebas, viruses, and selected pathogens. RESULTS: Nearly three quarters of rainwater samples contained the faecal indicators E. coli or enterococci, or both, and in samples from several buildings also Clostridium perfringens was repeatedly detected. Untreated and treated rainwater were in respect to microbiological quality similar, suggesting that treatment processes were not very efficient. In greywater samples, beside faecal indicators, also P. aeruginosa and thermotolerant amoebas were repeatedly detected. Treatment technologies used for greywater were more efficient than those for rainwater systems. CONCLUSION: Based on the results we evaluated appropriate indicators for monitoring recycled water quality and drafted the first Czech regulation for non-potable water.

The mechanism of spoilage of a bottled soft drink leading to health problem of consumer.

The case of spoilage of flavoured and sweetened soft drink occurred in the Czech Republic in 2019. After drinking it, the consumer was admitted to a hospital with sickness. The spoilage was caused by mould and an odorous substance, 1,3-pentadiene. The mechanism of food spoilage, with the formation of 1,3-pentadiene arising from the decarboxylation of sorbic acid and mould growth, is described. This could be the second case history reported worldwide of an allergic reaction to penicillin explaining how penicillin might get into the beverage. We hypothesise three possible causes of the health problem experienced with allergic reaction to penicillin or other mycotoxin produced by Penicillium mould as the most probable one.

Monitoring of pesticides in drinking water: finding the right balance between under- and over-monitoring - experience from the Czech Republic.

The modern, risk-based approach requires that only those pollutants which are likely to be present in a given water supply should be monitored in drinking water. From this perspective, defining an adequate approach to the monitoring of pesticides in areas with intensive agriculture is currently one of the greatest issues of regulation. This article shows the development and detailed results of pesticide monitoring in drinking water in the Czech Republic (CR). More than 4000 water supply zones serving around a 9.5 million population are routinely monitored, with nearly 250 thousand analyses of over 200 different pesticides and their metabolites being performed every year, with a non-compliance rate of ca. 0.3%. In 2017, pesticides accounted for most derogations in the CR, concerning a total of 64 water supply systems serving more than a 250 thousand population. A representative survey targeting 21 selected chemicals showed that 75% of water supply systems contained up to 11 pesticides per sample. The most commonly found were metabolites of the herbicides used to protect oilseed rape, maize, and sugar beet: acetochlor ESA, alachlor ESA, metazachlor OA, and chloridazon-desphenyl. The health risk assessment did not reveal any risks from these chemicals, even at the highest levels detected or in the most abundant mixtures, to the most vulnerable population (infants). Nevertheless, the increased presence of pesticides undermines the public's trust in drinking water safety.

Differences in health status of Slovak municipalities supplied with drinking water of different hardness values.

This epidemiological study of ecological type deals with the analysis of relationship between drinking water hardness and health status of inhabitants of the Slovak Republic. This relationship was investigated in two groups of more than 50,000 inhabitants living in 53 different municipalities. The first group was supplied with drinking water with low hardness, and the second group was supplied with drinking water with increased hardness. The health status of the population of both groups was monitored by means of health indicators, which represented 15-year average values, for 1994-2008. We investigated four major causes of death, namely cardiovascular, oncological, gastrointestinal and respiratory tract mortality, and evaluated the average life expectancy. The health status of inhabitants supplied with drinking water with increased hardness was significantly better than the health status of people supplied with drinking water with low hardness. For example, the relative mortality for cardiovascular diseases, oncological diseases, digestive tract diseases and respiratory diseases was 56%, 62%, 128% and 121% higher in the population supplied with soft drinking water compared to the population supplied with hard water, respectively. In addition, life expectancy was more than 4.5 years higher in the population supplied with hard drinking water. Our observation confirms the findings of previous studies on relationship between the water hardness and human health.

Proposal of New Health Risk Assessment Method for Deficient Essential Elements in Drinking Water-Case Study of the Slovak Republic.

The US EPA health risk assessment method is currently widely used to assess human health risks for many environmental constituents. It is used for risk assessment from the exposure to various contaminants exceeding tolerable or safe reference doses, determined e.g., for drinking water, soil, air and food. It accepts widely that excess contents of non-essential elements (e.g., As, Pb or Sb) in environmental compartments represent a general risk to human health. However, contrary to toxic trace elements, deficient contents of essential (biogenic) elements e.g., F, I, Se, Zn, Fe, Ca or Mg may represent even higher health risk. Therefore, we propose to extend the human health risk assessment by calculating the health risk for deficient content and intake of essential elements, and to introduce the terms Average Daily Missing Dose (ADMD), Average Daily Required Dose (ADRD) and Average Daily Accepted Dose (ADAD). We propose the following equation to calculate the Hazard Quotient (HQ) of health risk from deficient elements: HQd = ADRD/ADAD. At present, there are no reference concentrations or doses of essential elements in each environmental compartment in world databases (Integrated Risk Information System IRIS, The Risk Assessment Information System RAIS). ADRD and ADMD can be derived from different regulatory standards or guidelines (if they exist) or calculated from actual regional data on the state of population health and content of essential elements in the environment, e.g., in groundwater or soil. This methodology was elaborated and tested on inhabitants of the Slovak Republic supplied with soft drinking water with an average Mg content of 5.66 mg·L-1. The calculated ADMD of Mg for these inhabitants is 0.314 mg·kg-1·day-1 and HQd is equal to 2.94, indicating medium risk of chronic diseases. This method extending traditional health risk assessment is the first attempt to quantify deficient content of essential elements in drinking water. It still has some limitations but also has potential to be further developed and refined through its testing in other countries.

Regulations for calcium, magnesium or hardness in drinking water in the European Union member states.

Very low or very high concentrations of calcium (Ca) and magnesium (Mg) or total hardness in drinking water have been empirically recognized as the cause of the problems with corrosion, scaling, or taste of water. A large body of scientific evidence over the last 60 years has also attributed health problems to both extremes of these minerals in water. For example, drinking water low in Mg significantly increases the likelihood of cardiovascular mortality. This knowledge is not properly considered in the drinking water quality regulations, especially as more and more water is now produced by desalination disturbing its natural mineral composition. Although the current EU Drinking Water Directive does not include limits for hardness, Ca or Mg, most member states regulate these parameters either through law (12 countries) or technical guidance (7 countries), and several countries have issued educational information for the public. However, the regulations in most countries are not based on current research and not comparable because some provide a recommended range while others provide mandatory minimum or maximum limit values. This summary of the situation in 28 European Union countries is intended to provide information that can contribute to the implementation of the revised EU Directive.

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.

High serological response to Cryptosporidium-specific antigens in the Czech Republic and its association with water supply.

A survey was conducted in the Czech Republic to determine whether serological responses to the 15/17-kDa and 27-kDa Cryptosporidium antigens had changed since the end of the communist era and if these responses were associated with drinking water sources. Sera from 301 blood donors residing in six areas served by various sources of drinking water were analysed by Western Blot (mini-immunoblots) to measure the IgG response. The intensity of response and percentage of persons with a strong response to the 27-kDa, but not the 15/17-kDa, antigen were higher than found 20 years earlier. A strong response to both the 15/17- and 27-kDa-antigens was higher than reported in other countries, and the probability of persons having a strong response was greater in areas with surface water sources than river-bank infiltration. Few cases of cryptosporidiosis were reported in spite of these high responses to Cryptosporidium antigens. These responses suggest a chronic low-level exposure from several sources that may be affording protection against symptoms and illness. Although strong serological responses were associated with surface water sources, drinking water is not likely to be the most important exposure for Cryptosporidium in the Czech Republic.

Состояние маломасштабных систем водоснабжения в Европейском регионе ВОЗ: результаты опроса, проведенного в соответствии с Протоколом по проблемам воды и здоровья

Маломасштабные системы являются важным компонентом водоснабжения в Европейском регионе ВОЗ. С целью расширения базы фактических данных о маломасштабных системах водоснабжения и получения более полного представления о положении дел в Регионе, Европейское региональное бюро ВОЗ и Европейская экономическая комиссия ООН провели опросное исследование, участникам которого предлагалось представить конкретную информацию по их странам за 2012–2013 гг. в соответствии с Протоколом по проблемам воды и здоровья к Конвенции об охране и использовании трансграничных водотоков и международных озер, принятой в 1992 г. Данное опросное исследование отличалось высоким показателем доли ответивших респондентов (81%), и при анализе результатов были рассмотрены ответы 43 из 53 стран Европейского региона ВОЗ. В настоящем докладе подытожены выводы, сделанные по итогам опроса, который показал, что источником питьевой воды для 23% населения в Регионе служат маломасштабные системы водоснабжения. Результаты показывают, что в странах Региона на национальном уровне, как правило, бывает сложно найти комплексную информацию о маломасштабных системах водоснабжения, что препятствует проведению систематической оценки наиболее характерных условий. Создание национальных реестров маломасштабных систем водоснабжения и механизмов планового сбора данных позволит расширить доказательную базу, что, в свою очередь, будет способствовать приоритизации улучшений. Результаты оценки призваны обеспечить информационную основу для формирования политики и разработки стратегий проведения вмешательств, а также помочь определить дальнейшие действия в рамках Протокола.

Status of small-scale water supplies in the WHO European Region: results of a survey conducted under the Protocol on Water and Health

Small-scale systems are an important component of water supplies in the WHO European Region. To improve the evidence base on small-scale water supplies and to gain a better overview of the status quo throughout the Region, the WHO Regional Office for Europe and the United Nations Economic Commission for Europe made a survey requesting country-specific information in 2012–2013 under the Protocol on Water and Health to the 1992 Convention on the Protection and Use of Transboundary Watercourses and International Lakes. The survey had a high response rate (81%), and this analysis of the results includes responses from 43 of the 53 countries in the WHO European Region. This report summarizes the findings of the survey, which showed that about 23% of the population of the Region receive their drinking-water from small-scale systems. The results reveal that comprehensive information on small-scale water supplies is typically not readily available at the national level across the Region, which hampers systematic assessment of the prevailing conditions. Establishing national registers of small-scale water supplies and routine data collection mechanisms would improve the evidence base and thus support the prioritization of improvements. The findings of the assessment are intended to inform policy-making and the formulation of intervention strategies and to help identify further action under the Protocol.

Survey of human pharmaceuticals in drinking water in the Czech Republic.

The first large-scale assessment of pharmaceuticals in drinking water in the Czech Republic (CR) focused on the detection of five substances. Samples were collected from public water systems supplying 5.3 million people, 50.5% of the Czech population. In the initial survey of tap water from 92 major supply zones using mostly surface water, no pharmaceutical exceeded the limit of quantification (LOQ = 0.5 ng/L). In a second survey, samples were collected from the outlet of 23 water treatment plants (WTPs) considered of high risk because they use surface waters influenced by wastewater. Ibuprofen was the most frequently found pharmaceutical (19 samples), followed by carbamazepine (12), naproxen (8), and diclofenac (3); concentrations ranged from 0.5 to 20.7 ng/L, with medians below 6 ng/L. Concentrations of 17α-ethinylestradiol were below the LOQ. A follow-up survey included tap and outlet samples from eight of the 23 WTPs with the highest concentrations. Pharmaceuticals were quantified in only three tap water samples. Regarding risks to consumers, these results suggest that a relatively small population (<10%) in the CR is exposed to quantifiable concentrations of pharmaceuticals in tap water and that an extremely high margin of safety (several thousand-fold to several million-fold) is associated with these exposures.

[Methods for assessing the potential health risks of traces of pharmaceuticals in drinking water]. / Metody hodnocení zdravotních rizik stopových mnozství Iéciv v pitné vode.

Increasing consumption of pharmaceuticals leads also to higher release of its non-metabolized residues into environment, mostly hydrosphere. Some of these substances may reach also processed drinking water. Although it is found in traces, it causes public concern as it can represent a non-targeted and unwanted medication. Toxicologists and public health authorities are appealed to assess potential health risks carefully and to communicate the risk adequately to public. As health risks assessment of environmental exposure to pharmaceuticals is a new field of expertise, its methodology has not been unified and standardized yet, but several different procedures have been proposed and used. The paper provides overview of these methods.

Incidence of nontuberculous mycobacteria in four hot water systems using various types of disinfection.

The objective of this study was to determine the incidence of nontuberculous mycobacteria (NTM) in hot water systems of 4 selected hospital settings. The hospitals provided the following types of disinfection for their hot water systems: hydrogen peroxide and silver, thermal disinfection, chlorine dioxide, and no treatment (control). In each building, 6 samples were collected from 5 sites during a 3 month period. NTM were detected in 56 (46.7%) of 120 samples; the CFU counts ranged from 10 to 1625 CFU/L. The detected NTM species were the pathogens Mycobacterium kansasii, Mycobacterium xenopi, and Mycobacterium fortuitum and the saprophyte Mycobacterium gordonae. The most common to be isolated was M. xenopi, which was present in 51 samples. The hot water systems differed significantly in the incidence of NTM. NTM were not detected in the system treated by thermal disinfection, and a relatively low incidence (20% positive samples) was found in the system disinfected with chlorine dioxide. However, a high incidence was found in the control system with no additional disinfection (70% positives) and in the system using hydrogen peroxide and silver (97% positives). Water temperatures above 50 degrees C significantly limited the occurrence of NTM.