Cross-continental comparative experiences of wastewater surveillance and a vision for the 21st century.

The COVID-19 pandemic has brought the epidemiological value of monitoring wastewater into sharp focus. The challenges of implementing and optimising wastewater monitoring vary significantly from one region to another, often due to the array of different wastewater systems around the globe, as well as the availability of resources to undertake the required analyses (e.g. laboratory infrastructure and expertise). Here we reflect on the local and shared challenges of implementing a SARS-CoV-2 monitoring programme in two geographically and socio-economically distinct regions, São Paulo state (Brazil) and Wales (UK), focusing on design, laboratory methods and data analysis, and identifying potential guiding principles for wastewater surveillance fit for the 21st century. Our results highlight the historical nature of region-specific challenges to the implementation of wastewater surveillance, including previous experience of using wastewater surveillance, stakeholders involved, and nature of wastewater infrastructure. Building on those challenges, we then highlight what an ideal programme would look like if restrictions such as resource were not a constraint. Finally, we demonstrate the value of bringing multidisciplinary skills and international networks together for effective wastewater surveillance.

Microbiological monitoring of coagulase-negative Staphylococcus in public drinking water fountains: Pathogenicity factors, antimicrobial resistance and potential health risks.

The presence of opportunistic bacteria such as coagulase-negative Staphylococcus (CoNS) in drinking water poses public health concerns because of its potential to cause human infection and due to its antimicrobial resistance (AMR) diversity. This study evaluated the occurrence, virulence markers and AMR of CoNS in 468 drinking water samples from 15 public fountains located in four urban parks of São Paulo city (Brazil). Out of 104 samples positive for the presence of Staphylococcus genus, we detected CoNS in 75 of them (16%), which did not meet the Brazilian sanitary standards for residual chlorine. All isolates were of concern to public health for being responsible for infection in humans from low to high severity, nine of them are considered the most of concern due to 63.6% being multiresistant to antimicrobials. The results demonstrated that CoNS in drinking water must not be neglected. It is concluded that the presence of resistant staphylococci in drinking water is a potential health risk, which urges feasible and quick control measures to protect human health, especially in crowded public places.

Assessment microbial risks for the presence of Cryptosporidium spp. and Giardia spp. based on the surveillance of the water supply systems in Colombia, 2014-2018.

Cryptosporidium spp. and Giardia spp. cause gastrointestinal diseases of zoonotic origin as well transmitted from person to person, being various reported outbreaks associated with water. The infecting (oo)cyst forms of these parasites are highly resistant to water treatments such as chlorine disinfection and fast filtration. The objective of this study was to assess the microbial risk of infection and symptomatic illness by the ingestion of Giardia spp. and Cryptosporidium spp. in water for human consumption in Colombia, based on the results of water quality surveillance. The detection method was according to the USEPA method 1623. Concentration data of the different points of distribution were grouped according to the pathogen and type of treatment (no treatment; chlorine treatment; chlorine treatment + coagulant). Annual microbial risks of infection and symptomatic diseases were estimated using the quantitative microbial risk assessment approach that included parasite concentrations, the dose-response model, the ingestion rates of water by children and adults, and the morbidity rate of the diseases. The mean annual microbial risk of infection for Giardia spp. was 29.8% for treated water and 50.4% for untreated water, while being 6.0% and 17.7%, respectively, for Cryptosporidium spp. Microbial risk of symptomatic illness for Giardia spp, was 8.2% for treated water and 13.9% for untreated water, while being 3.6% and 10.6%, respectively, for Cryptosporidium spp. The estimated annual microbial risks of infection exceeded the acceptable value of 10-4 (0.01%) recommended by USEPA. Results obtained in this study suggest the need to reduce the microbial risk of infection to protozoan parasites by improving the water treatment, by adopting better handling practices for livestock manure and treatment processes of human feces. PRACTITIONER POINTS: The presence of Cryptosporidium spp was identified in 28 (6.2%) samples and Giardia spp in 29 (6.4%) in water for human consumption in Colombia. The mean annual risk of symptomatic illness due to infection by Giardia spp or Cryptosporidium spp ranges from 33.6%, for treated water, to 58.1%, for untreated water. Annual risks ingestion of protozoa studying in water for human exceed of 10-4 (0.01%) recommended by USEPA.

Human health risk assessment for (re)emerging protozoan parasites in surface water used for public supply and recreational activities.

Gastrointestinal diseases caused by protozoan parasites remain a major challenge in developing countries and ingestion of contaminated surface water represents one of the main sources by which these diseases are contracted. This study assessed the risk of infection and diseases caused by Cryptosporidium spp. and Giardia sp. due to ingestion of surface water used for public supply and recreational activities, focusing on the southeastern Brazilian Pardo River and applying the USEPA 1623 method to quantify (oo)cyst concentrations. Infection and disease probabilities due to ingestion of drinking water or during recreational activities were estimated using the Quantitative Microbial Risk Assessment (QMRA) approach. Mean concentrations of Cryptosporidium spp. and Giardia sp. in surface water ranged from 0.2 to 0.4 oocysts L-1 and 0.2 to 4.4 cysts L-1, respectively. Considering public water supply, annual infection probabilities were higher for adults than children and exceeded the USEPA limit; also, disease probabilities were higher for adults than children. For recreational activities, annual infection and disease probabilities were higher for children, followed by men and women. The occurrence of both parasites likely reflects raw sewage discharge, effluent from sewage treatment plants, and diffuse sources of pollution, such as runoff from pasture lands and deforested riparian forest corridors. Our results highlight substantial infection risks by both parasite types after conventional treatment of water used for public supply and also call for careful monitoring of water bodies used for recreational purposes.

Detection of DNA from Toxoplasma gondii oocysts in water for reuse.

The absence of a standardized method for detecting oocysts in water samples makes it difficult to characterize them, including in water for reuse. This study aimed to detect Toxoplasma gondii oocysts using two extraction methods. Using method 1693/2014 USEPA, 30 L of water for reuse from two wastewater treatment plants (WWTPs) in the city of São Paulo, Brazil, was concentrated, totaling 20 samples. The supernatant generated from the immunomagnetic separation (IMS) step was collected for detection of T. gondii oocysts. For DNA extraction, two techniques were used: the commercial kit DNeasy PowerSoil Kit® optimized with the enzyme Zymolyase® and with freeze-thaw steps. DNA quantification was performed with the target sequence of gene B1. From 16 samples submitted to enzymatic extraction, four were positive. In freeze-thaw extraction, no DNA was detected. DNA extraction was the essential step for oocyst detection given the resistant nature of their wall.

Exposure to microcystin-LR in tropical reservoirs for water supply poses high risks for children and adults.

While the presence of microcystin-LR (MC-LR) in raw water from eutrophic reservoirs poses human health concerns, the risks associated with the ingestion of MC-LR in drinking water are not fully elucidated. We used a time series of MC-LR in raw water from tropical urban reservoirs in Brazil to estimate the hazard quotients (HQs) for non-carcinogenic health effects and the potential ingestion of MC-LR through drinking water. We considered scenarios of MC-LR removal in the drinking water treatment plants (DWTPs) of two supply systems (Cascata and Guarapiranga). The former uses coagulation/flocculation/sedimentation/filtration/disinfection, while the latter has an additional step of membrane ultrafiltration, with contrasting expected MC-LR removal efficiencies. We considered reference values for infants (0.30 µg L-1), children/adults (1.60 µg L-1), or the population in general (1.0 µg L-1). For most scenarios for Cascata, the 95% upper confidence level of the HQ indicated high risks of exposure for the population (HQ > 1), particularly for infants (HQ = 30.910). The water treatment in Cascata was associated to the potential exposure to MC-LR due to its limited removal capacity, with up to 263 days/year with MC-LR above threshold values. The Guarapiranga system had the lowest MC-LR in the raw water as well as higher expected removal efficiencies in the DWTP, resulting in negligible risks. We reinforce the importance of integrating raw water quality characteristics and treatment technologies to reduce the risks of exposure to MC-LR, especially for vulnerable population groups. Our results can serve as a starting point for risk management strategies to minimize cases of MC-LR intoxication in Brazil and other developing countries.

Characterization of Emerging Pathogens Carrying blaKPC-2 Gene in IncP-6 Plasmids Isolated From Urban Sewage in Argentina.

Untreated wastewater is a reservoir for multidrug-resistant bacteria, but its role in the spread of antibiotic resistance in the human population remains poorly investigated. In this study, we isolated a KPC-2-producing ST2787 Klebsiella quasipneumoniae subsp. quasipneumoniae (WW14A), recovered from raw sewage at a wastewater treatment plant in Argentina in 2018 and determined its complete genome sequence. Strain WW14A was resistant to all ß-lactams, ciprofloxacin and amikacin. A core genome phylogenetic analysis indicated that WW14A was closely related to a GES-5-producing Taiwanese strain isolated from hospital wastewater in 2015 and it was clearly distinct from strains isolated recently in Argentina and Brazil. Interestingly, blaKPC-2 was harbored by a recently described IncP-6 broad-spectrum plasmid which was sporadically reported worldwide and had never been reported before in Argentina. We investigated the presence of the IncP-6 replicon in isolates obtained from the same sampling and found a novel non-typable/IncP-6 hybrid plasmid in a newly assigned ST1407 Enterobacter asburiae (WW19C) also harboring blaKPC-2. Nanopore sequencing and hybrid assembly of strains WW14A and WW19C revealed that both IncP-6 plasmids shared 72% of coverage (~20 kb), with 99.99% of sequence similarity and each one also presented uniquely combined regions that were derived from other plasmids recently reported in different countries of South America, Asia, and Europe. The region harboring the carbapenem resistance gene (~11 kb) in both plasmids contained a Tn3 transposon disrupted by a Tn3-ISApu-flanked element and the core sequence was composed by ΔISKpn6/blaKPC-2/ΔblaTEM-1/ISKpn27. Both strains also carried genes conferring resistance to heavy metals (e.g., arsenic, mercury, lead, cadmium, copper), pesticides (e.g., glyphosate), disinfectants, and several virulence-related genes, posing a potential pathogenic risk in the case of infections. This is the first study documenting blaKPC-2 associated with IncP-6 plasmids in K. quasipneumoniae and Enterobacter cloacae complex from wastewater in Argentina and highlights the circulation of IncP-6 plasmids as potential reservoirs of blaKPC-2 in the environment.

Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (MRSA) in drinking water fountains in urban parks.

The presence of Staphylococcus aureus in drinking water is a concern because of its potential to cause human infection and also because of its multiple antimicrobial resistance. This study evaluated the water quality of drinking water fountains and mist makers in four municipal parks of São Paulo for 13 months. Although all samples met bacteriological water quality criteria according to Brazilian regulations, the absence of residual chlorine (<0.1 mg/L) was observed. These data were significantly correlated with the frequency of S. aureus that was found in 25.2% of the samples. The mecA gene was detected in 36.7% of the isolates demonstrating its potential for resistance to several antimicrobials. Furthermore, 27.3% isolates carrying the mecA gene had methicillin-resistant Staphylococcus aureus (MRSA) phenotypic potential. The presence of S. aureus with characteristics of microbial resistance in water for human consumption is an unprecedented finding. Hence, conducting surveillance for opportunistic bacteria, such as staphylococci in drinking water, is reasonable to take control measures and to protect human health, especially in public places with high attendance.

Culicidae-centric metabarcoding through targeted use of D2 ribosomal DNA primers.

A practical limitation to many metabarcoding initiatives is that sampling methods tend to collect many non-target taxa, which become "amplicon noise" that can saturate Next Generation Sequencing results and lead to both financial and resource inefficiencies. An available molecular tool that can significantly decrease these non-target amplicons and decrease the need for pre-DNA-extraction sorting of bycatch is the design of PCR primers tailored to the taxa under investigation. We assessed whether the D2 extension segment of the 28S ribosomal operon can limit this shortcoming within the context of mosquito (Culicidae) monitoring. We designed PCR primers that are fully conserved across mosquitos and exclude from amplification most other taxa likely to be collected with current sampling apparatuses. We show that, given enough sequencing depth, D2 is an effective marker for the detection of mosquito sequences within mock genomic DNA pools. As few as 3,050 quality-filtered Illumina reads were able to recover all 17 species in a bulk pool containing as little as 0.2% of constituent DNA from single taxa. We also mixed these mosquito DNA pools with high concentrations of non-Culicidae bycatch DNA and show that the component mosquito species are generally still recoverable and faithful to their original relative frequencies. Finally, we show that there is little loss of fidelity in abundance parameters when pools from degraded DNA samples were sequenced using the D2 primers.

Assessment of health risks from recreational exposure to Giardia and Cryptosporidium in coastal bathing waters.

Some Brazilian beaches are impacted by raw or poorly treated sewage. Thus, users (beachgoers, sports people, and children) are exposed to pathogens, which pose health concerns. This study aimed to estimate the probability of infection and disease by Giardia and Cryptosporidium, using the quantitative microbial risk assessment (QMRA), for three groups of bathers: children, adults, and open water swimmers. The concentrations of (oo)cysts were taken from a study run by CETESB (Environmental Company of Sao Paulo State) throughout 2011 and 2012, in which 203 samples were collected monthly and analyzed for (oo)cysts of Giardia and Cryptosporidium. Giardia was present in 43% of the samples, while Cryptosporidium in 13%. Infection probability was higher in beaches with more positive samples for Giardia cysts for the group of open water swimmers. In some cases, the highest annual risk obtained for giardiasis and cryptosporidiosis was 2.4 × 10-1 and 8.9 × 10-3 for open water swimmers, respectively, exceeding the incidence results found in the epidemiological study run in summer of 1999 in São Paulo state coast. The results bring insights to improve environmental quality in order to protect tourists' and residents' wellbeing.

Real-time PCR detection of Toxoplasma gondii in surface water samples in São Paulo, Brazil.

Water is considered an important vehicle for the spread of human toxoplasmosis in several countries. Toxoplasma gondii oocysts can persist in the environment for long periods, being highly resistant to the various chemical inactivation processes commonly used by water supply systems, distinctly from simple filtration and flocculation that are efficient in removing oocysts from drinking water. The existing methodologies for identification and quantification of this parasite in water samples are not standardized and have limitations. This study aimed to evaluate the presence of T. gondii oocysts in surface water samples used as a source for the production of drinking water in the State of São Paulo, through the implementation of a specific methodology using real-time PCR technique (qPCR). Volumes of 20 L of the sample were concentrated by filtration in Envirocheck® HV capsules. For DNA extraction, the PowerSoil DNA isolation® kit (currently DNeasy PowerSoil®) was used. The target sequence selected for qPCR was a 62-base-pair fragment of the B1 gene. In the initial recovery evaluation of the method in four replicates of reverse osmosis water, the mean recovery was 48.5% (SD ± 11.5), while the mean recovery for method performance in matrices was 3.2% (SD ± 3.2) (rainy season) and 62.0% (SD ± 6.2) (dry period), suggesting that the characteristics of the samples and the climatic conditions interfere in the recovery efficiency. Of the 39 samples analyzed (May to December 2015), 7.7% (3/39) were positive for T. gondii, and among the ten sources studied; the occurrence of the oocysts was detected in 30% (3/10).

Detection and molecular characterization of Cryptosporidium species and Giardia assemblages in two watersheds in the metropolitan region of São Paulo, Brazil.

Cryptosporidium and Giardia are associated with cases of water and foodborne outbreaks in the world. This study included 50 samples of surface raw water collected from two watersheds in the state of São Paulo, Brazil. The isolation of (oo)cysts was performed in accordance with the U.S. Environmental Protection Agency's methods 1623 and genotypic characterization and quantification were carried out by Nested PCR and qPCR assays based on 18S rRNA and gdh genes, respectively. U.S. EPA 1623 method showed the presence of (oo)cysts in 40% ([Formula: see text] = 0.10 oocysts/L) and 100% ([Formula: see text] = 7.6 cysts/L) of samples from São Lourenço River, respectively, and 24% ([Formula: see text] = 0.8 oocysts/L) and 60% ([Formula: see text] = 1.64 cysts/L) of Guarapiranga Reservoir, respectively. The qPCR assay detected C. hominis/parvum in 52% (0.06 to 1.85 oocysts/L) of São Lourenço River and 64% (0.09 to 1.4 oocysts/L) of Guarapiranga Reservoir samples. Presence/absence test for Giardia intestinalis was positive in 92% of São Lourenço River and 8% of Guarapiranga Reservoir samples. The assemblage A was detected in 16% (0.58 to 2.67 cysts/L) in São Lourenço River and no positive samples were obtained for assemblage B in both water bodies. The characterization of anthroponotic species C. parvum/hominis, G. intestinalis, and assemblage A was valuable in the investigation of possible sources of contamination in the watersheds studied confirming the need of expanding environmental monitoring measures for protection of these water sources in our country.

Qualidade da Água de Sistema Alternativo Coletivo de Abastecimento para Consumo Humano: Ocorrência de Cistos de Giardiae Oocistos de Cryptosporidiumem Poços de São Paulo-SP / The Quality Of Drinking Water From An Alternative Water Supply System: Occurrence of Giardia Cysts And Cryptosporidium Oocysts In Wells of São Paulo, SP

Objetivo: Analisar a qualidade da água das soluções alternativas coletivas de abastecimento em uma Prefeitura Regional do município de São Paulo,verificando a presença de coliformes termo tolerantes e E. coli, quantificando (oo)cistos de Cryptosporidiumspp. e Giardiaspp. e avaliou-se a qualidade físico-química destas amostras. Materiais e Métodos: Foram realizadas inspeções e coletas de água para realização de exames físico-químicos e bacteriológicos de acordo com os métodos da EPA 2005, MFQAA 2008 e os Standard Methods for Examination of Waterand Wastewater (APHA 2012), respectivamente, totalizando 34 amostras analisadas. Para a pesquisa de oocistosde Cryptosporidiumspp. e cistos de Giardiaspp, foram avaliadas 13 amostras de água, utilizando-se a técnica de filtração/separação imunomagnética/ microscopia de imuno fluorescênciade acordo com o Método 1623.1/EPA 2012, utilizando sistema Filta-Max®. Resultados: Os parâmetros físico-químicos demostraram que 38,2% das amostras não atendiam a portaria 2914/2011 do Ministério da Saúde. Verificouse a presença de coliformes termo tolerantes e de E. coli em uma amostra (2,9%). Os protozoários patogênicos estiveram presentes em uma frequência de 46% para Giardia e 7% para Cryptosporidium. Conclusão: Os padrões de potabilidade recomendados pela legislação vigente não foram atendidos em 41% das amostras, não sendo, portanto, adequadas para o consumo humano. Com relação aos protozoários patogênicos, verificou-se a sua ocorrência em águas subterrâneas utilizadas para consumo humano na cidade de São Paulo, colaborando para a reflexão do papel da vigilância ambiental e para a construção de políticas públicas que visem à qualidade da água distribuída à população a partir desses sistemas alternativos. (AU)

Objective: To analyze the quality of water from water supply alternative sources in a borough of São Paulo city. The presence of ther motolerant coliforms and E. coliwas determined, Giardiaspp. cysts and Cryptosporidium spp. oocysts were quantified, and physicochemical quality of samples was performed. Material and Methods: Inspections and sample collections were carried out for physicochemical analysis as well as bacteriological tests according to EPA 2005, MFQAA 2008 and the Standard Methods for Examination of Water and Wastewater (APHA 2012), respectively, totaling 34 samples. Thirteen samples were tested for Cryptosporidium spp. oocysts and Giardiaspp cysts according to immuno magnetic separation ­ immuno fluorescence assay (IMS-IFA) based on USEPA 1623.1 Method (USEPA, 2012), using Filta-Max® system. Results: The physical-chemical parameters showed that 38.2% of the samples did not meet the Brazilian legislation requirements (MS2914/2011). Ther motolerant coliforms and E. coli were present in one sample (2.9%). Pathogenic protozoa were present at a frequency of 46% for Giardia and 7% for Cryptosporidium. Conclusion: The drinking water standards recommended by current Brazilian legislation were not met in 41% of the samples, and are therefore not suitable for human consumption. Regarding the presence of pathogenic protozoa, Giardia and Cryptosporidium (oo) cysts were found in ground water used for human consumption in the city of São Paulo. This fact brings thoughts referring to the role ofen viron mental surveillance and the development of public policies addressed to water quality, which is distributed from these alternative systems. (AU)

Effective characterization of Salmonella Enteritidis by most probable number (MPN) followed by multiplex polymerase chain reaction (PCR) methods.

Nontyphoidal Salmonella (NTS) is a relevant pathogen involved in gastroenteritis outbreaks worldwide. In this study, we determined the capacity to combine the most probable number (MPN) and multiplex polymerase chain reaction (PCR) methods to characterize the most important Salmonella serotypes in raw sewage. A total of 499 isolates were recovered from 27 raw sewage samples and screened using two previously described multiplex PCR methods. From those, 123 isolates were selected based on PCR banding pattern-identical or similar to Salmonella Enteritidis and Salmonella Typhimurium-and submitted to conventional serotyping. Results showed that both PCR assays correctly serotyped Salmonella Enteritidis, however, they presented ambiguous results for Salmonella Typhimurium identification. These data highlight that MPN and multiplex PCR can be useful methods to describe microbial quality in raw sewage and suggest two new PCR patterns for Salmonella Enteritidis identification.

Assessing the probability of infection by Salmonella due to sewage sludge use in agriculture under several exposure scenarios for crops and soil ingestion.

A deeper understanding about the risks involved in sewage sludge practice in agriculture is required. The aims of the present study were to determine the annual risk of infection of consuming lettuce, carrots and tomatoes cultivated in soil amended with sewage sludge. The risk to agricultural workers of accidental ingestion of sludge or amended soil was also investigated. A Quantitative Microbial Risk Assessment was conducted based on Salmonella concentrations from five WWTPs were used to estimate the probability of annual infection associated with crops and soil ingestion. The risk of infection was estimated for nine exposure scenarios considering concentration of the pathogen, sewage sludge dilution in soil, variation of Salmonella concentration in soil, soil attachment to crops, seasonal average temperatures, hours of post-harvesting exposure, Salmonella regrowth in lettuce and tomatoes, Salmonella inhibition factor in carrots, crop ingestion and frequency of exposure, sludge/soil ingestion by agricultural workers and frequency of exposure. Annual risks values varied across the scenarios evaluated. Highest values of annual risk were found for scenarios in which the variation in the concentration of Salmonella spp. in both soil and crops (scenario 1) and without variation in the concentration of Salmonella spp. in soil and variation in crops (scenario 3) ranging from 10(-3) to 10(-2) for all groups considered. For agricultural workers, the highest annual risks of infection were found when workers applied sewage sludge to agricultural soils (2.26×10(-2)). Sensitivity analysis suggests that the main drivers for the estimated risks are Salmonella concentration and ingestion rate. These risk values resulted from conservative scenarios since some assumptions were derived from local or general studies. Although these scenarios can be considered conservative, the sensitivity analysis yielded the drivers of the risks, which can be useful for managing risks from the fresh products chain with stakeholders' involvement.

Quantification and characterization of Salmonella spp. isolates in sewage sludge with potential usage in agriculture.

BACKGROUND: This study aims to scrutinize Salmonella spp. and its serotypes in sewage sludge samples from wastewater treatment plants, and assesses the presence of virulence genes and antibiotics resistant to the profile. Samples (n = 54) were collected and analyzed in accordance with the EPA Method 1682/2006. For positive serological reaction, 40 strains were selected for PCR analyses and detection of spvC, invA and sseL virulence genes, plasmid presence and resistance to antibiotics. RESULTS: Salmonella spp. was detected in 38.9% of the samples collected (<0.006473 to 12.19 MPN/gTS). The most prevalent serotype was Salmonella Infantis. All Salmonella spp. (n = 35) presented at least one of the three virulence genes mentioned above and 40% harboured plasmids. Salmonella Typhimurium strains were isolated harbouring at least one of the following virulence genes: spvC, invA or sseL. Four Salmonella spp. isolates were resistant to tetracycline; three were resistant to trimethoprim-sulfamethoxazole, and one isolate was resistant to ciprofloxacin. Two Salmonella spp. strains presented multi resistance to antimicrobial agents. CONCLUSIONS: The results obtained demonstrated that Salmonella spp. have been found in sewage sludge, thus it is essential to set measures to mitigate human health risks when it is intended to be applied on agricultural soils.

Significados da água na visão de lideranças de saúde / The meanings of water in the vision of health care leaders

Este estudo apresenta as percepções dos delegados à 13ª Conferência Nacional de Saúde sobre os significados da água, no contexto da saúde pública, e sobre o papel do Estado na garantia do acesso à água tratada. Trata-se de uma pesquisa descritiva, com abordagem qualitativa, utilizando-se como técnica de processamento de depoimentos o Discurso do Sujeito Coletivo. A população de estudo consistiu dos delegados à 13ª Conferência Nacional de Saúde. Ao todo, participaram 310 desses delegados, distribuídos da seguinte maneira: 56 na etapa municipal, em Fortaleza (CE), 143 na estadual (Ceará) e 111 na nacional. Os dados foram coletados por meio de questionários e analisados utilizando-se, como estratégia metodológica, a análise do discurso. Os delegados percebem a água tratada como um bem essencial à saúde e à qualidade de vida, reconhecendo o problema da crescente escassez e degradação dos recursos hídricos, assim como as deficiências no acesso e no tratamento da água. Acreditam, ainda, que o Estado deve ter um papel protetor no provimento de água tratada, garantindo o acesso universal a esse bem. Pelos discursos, detectam-se fragilidades no tratamento da água e na vigilância sanitária, bem como nos mecanismos de informação sobre assuntos relativos à água de abastecimento público, o que aponta para a necessidade de uma participação mais efetiva da sociedade nos espaços deliberativos que lhe são concedidos para o exercício de sua cidadania.

This study presents the delegates to the 13th National Health Conference perceptions on the meanings of water in the context of public health, and of the state's role in ensuring access to clean water. This is a descriptive study of qualitative approach, using the Discourse of Collective Subject as technique for processing the statements. The study population comprised 310 delegates to the 13th National Conference on Health, distributed as follows: 56 in municipal stage, Fortaleza (CE), 143 in the state stage (Ceará) and 111 in national stage. Data were collected by questionnaires and analyzed using discourse analysis as a methodological strategy. The delegates perceive treated water as an essential good for health and quality of life and welfare, whilst recognizing the problem of increasing scarcity and degradation of water resources and the deficiencies in access and treatment of water. They also believe that the state must have a protective role in providing clean water, ensuring universal access to that good. By the speeches, weaknesses could be detected in water treatment and health surveillance, as well as on the mechanisms of information on matters relating to public water supply; these indicatethe need for more effective participation of society in deliberative spaces that are granted for the exercise of their citizenship.

Assessing the infection risk of Giardia and Cryptosporidium in public drinking water delivered by surface water systems in Sao Paulo State, Brazil.

A survey of Giardia and Cryptosporidium was conducted in surface water used as drinking water sources by public water systems in four densely urbanized regions of Sao Paulo State, Brazil. A Quantitative Microbial Risk Assessment, based on protozoa concentrations, was performed to estimate the probability of protozoa infection associated with drinking water ingestion. A total of 206 source water samples were analyzed over a 24 month period using the USEPA Method 1623. The risk of infection was estimated using an exponential dose response model, children and adults exposure and a gamma distribution for (oo)cyst concentrations with three scenarios for treating censored data. Giardia was detected in 102 of the samples, and 19 of them were also positive for Cryptosporidium, with maximum concentrations of 97.0 cysts/L and 6.0 oocysts/L, respectively. Risk distributions were similar for the three scenarios. In the four regions, the estimated risk of Giardia infection per year, for adults and children, ranged from 0.29% to 2.47% and from 0.08% to 0.70%, respectively. Cryptosporidium risk infection varied from 0.15% to 0.29% for adults and from 0.04% to 0.08% for children. In both cases, the calculated risk surpassed the risk of infection of 10(-4) (1:10,000) defined as tolerable by USEPA for a yearly exposure. The probability of Giardia infection was very close to the rates of acute diarrheic disease for adults (1% to 3%) but lower for children (2% to 7%). The daily consumption of drinking water was an important contributing factor for these differences. The Microbiological Risk Assessment carried out in this study provides an indication of infection risks by Giardia and Cryptosporidium in the population served by these source waters. Strategies for source water protection and performance targets for the water treatment should be established to achieve the required level of public health risk.

Detection and quantification of viable Ascaris sp. and other helminth eggs in sewage sludge.

Some epidemiologic studies conducted in developing countries demonstrated a high incidence of enteroparasites, Ascaris sp. being the most prevalent. Therefore, the use of sewage sludge in agriculture may pose risks to human health. In order to protect public health, a Brazilian regulation has established standards regarding its use in rural areas. The objective of this study was to quantify Ascaris sp. and other helminth eggs in sewage sludge from five wastewater treatment plants from a dense metropolitan region, and also to check compliance with the law. The analysis was carried according to USEPA 2003 . A rich parasitological fauna was found, with a prevalence of the eggs of Ascaris sp. (9.55%). The samples analyzed presented a large variety of helminth eggs, and Ascaris sp. proved to be the most prevalent which put in evidence that its application poses public health concerns.