E. Sylvestre
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1
Monitoring Legionella in Drinking Water
Should We Focus on L. pneumophila or All Species to Effectively Protect Public Health?
Review
(2026)
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Émile Sylvestre, Frank I.H.M. Oesterholt, Frederik Hammes, Paul W.J.J. van der Wielen
Legionella pneumophila is responsible for the majority of reported Legionnaires' disease cases worldwide. However, environmental monitoring of building plumbing systems often targets a broad range of Legionella species, raising the question of whether monitoring should focus exclusively on L. pneumophila or include all Legionella species. This review examines the policy and public health implications of both strategies by assessing case attribution data for Legionnaires' disease, the environmental prevalence of Legionella species, and the validity of using non-pneumophila counts as indicators for L. pneumophila. Although over 30 species can cause illness, L. pneumophila dominates culture-confirmed cases despite the frequent detection of L. non-pneumophila species in building plumbing and other known sources. Ecological differences between species, including growth temperatures and disinfection resistance, arguably limit the suitability of L. non-pneumophila species as reliable indicators for L. pneumophila. As a result, using all Legionella species counts to inform risk management may lead to excessive interventions without proportional public health benefits. We conclude that routine monitoring should prioritize L. pneumophila to ensure targeted, cost-effective, and health-relevant risk management. Broader monitoring may be warranted in high-risk settings or where local epidemiological data justify a more inclusive approach. These findings support risk-based regulatory frameworks that align monitoring targets with public health outcomes.
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Legionella pneumophila is responsible for the majority of reported Legionnaires' disease cases worldwide. However, environmental monitoring of building plumbing systems often targets a broad range of Legionella species, raising the question of whether monitoring should focus exclusively on L. pneumophila or include all Legionella species. This review examines the policy and public health implications of both strategies by assessing case attribution data for Legionnaires' disease, the environmental prevalence of Legionella species, and the validity of using non-pneumophila counts as indicators for L. pneumophila. Although over 30 species can cause illness, L. pneumophila dominates culture-confirmed cases despite the frequent detection of L. non-pneumophila species in building plumbing and other known sources. Ecological differences between species, including growth temperatures and disinfection resistance, arguably limit the suitability of L. non-pneumophila species as reliable indicators for L. pneumophila. As a result, using all Legionella species counts to inform risk management may lead to excessive interventions without proportional public health benefits. We conclude that routine monitoring should prioritize L. pneumophila to ensure targeted, cost-effective, and health-relevant risk management. Broader monitoring may be warranted in high-risk settings or where local epidemiological data justify a more inclusive approach. These findings support risk-based regulatory frameworks that align monitoring targets with public health outcomes.
Monitoring Frequencies for On-Site Water Reuse
A Risk-Based Framework Applied to Greywater Reuse
On-site water reuse can provide water for nonpotable applications, but ensuring long-term performance and managing treatment failures is challenging without dedicated monitoring personnel. This study proposes a risk-based framework to determine enteric pathogen log-removal targets (LRTs) as a function of operational monitoring frequency. The framework integrates (i) quantitative microbial risk assessment, (ii) modeled pathogen concentrations at three collection scales, and (iii) failure models for three treatment configurations. As an example, LRTs were calculated considering different monitoring frequencies for greywater reuse. Results show that smaller systems require less frequent monitoring due to lower pathogen occurrence compared to larger systems, e.g., >1 day at a 5-people scale vs <500 s for a 1000-people system to meet norovirus risk with a bimodal treatment barrier failing up to four times per year. Incorporating a residual disinfectant or multiple barriers extends the required monitoring intervals. While LRTs are comparable across collection scales, this study highlights a key advantage of small systems─reduced monitoring requirements─contrasting prior work that found no benefits of downsizing in terms of treatment train design. This framework can support technology developers in quantifying trade-offs between treatment and monitoring and aid regulators in establishing monitoring requirements for on-site water reuse.
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On-site water reuse can provide water for nonpotable applications, but ensuring long-term performance and managing treatment failures is challenging without dedicated monitoring personnel. This study proposes a risk-based framework to determine enteric pathogen log-removal targets (LRTs) as a function of operational monitoring frequency. The framework integrates (i) quantitative microbial risk assessment, (ii) modeled pathogen concentrations at three collection scales, and (iii) failure models for three treatment configurations. As an example, LRTs were calculated considering different monitoring frequencies for greywater reuse. Results show that smaller systems require less frequent monitoring due to lower pathogen occurrence compared to larger systems, e.g., >1 day at a 5-people scale vs <500 s for a 1000-people system to meet norovirus risk with a bimodal treatment barrier failing up to four times per year. Incorporating a residual disinfectant or multiple barriers extends the required monitoring intervals. While LRTs are comparable across collection scales, this study highlights a key advantage of small systems─reduced monitoring requirements─contrasting prior work that found no benefits of downsizing in terms of treatment train design. This framework can support technology developers in quantifying trade-offs between treatment and monitoring and aid regulators in establishing monitoring requirements for on-site water reuse.
Journal article
(2026)
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Lizhan Tang, Émile Sylvestre, Kerry A. Hamilton, Frederik Hammes, Timothy R. Julian
L. pneumophila is a waterborne respiratory pathogen that causes Pontiac Fever and Legionnaires' disease, two clinically significant diseases with increasing incidence in Europe. In this study, we develop a Quantitative Microbial Risk Assessment (QMRA) framework on the risks of infection from showering in L. pneumophila-contaminated water supplies to inform health-based concentration targets and water quality monitoring programs. The developed QMRA model extends on previous work investigating the relationships between concentrations of L. pneumophila in water sources and infection, illness, and disease burden by incorporating dynamic pathogen concentrations in water and aerosol concentrations, extending the prior reliance on assumptions of constant, average concentrations over the exposure duration. When applying this approach to data collected from within a building in Switzerland at risk for legionellosis cases, we show that initial high concentrations of L. pneumophila in water and aerosols from hot showers contribute to risks above a commonly used benchmark for the acceptable infection risk (10–4 infections per person per year) within the first 1–2 min of showers. Extending the model to estimate critical concentrations of L. pneumophila suggests concentrations at or above 2.5 × 103 CFU/L to 1.6 × 106 CFU/L for first draw samples and 2.5 × 101 CFU/L to 1.0 × 103 CFU/L for samples obtained after flushing would increase infection risks above the benchmark, dependent on site-specific conditions including water temperature and shower head type. These critical values align with, but are less stringent than, values reported by previous studies for showers due to our consideration of dynamic aerosol concentrations. Sensitivity analysis suggests that controlling L. pneumophila concentrations in water is the most effective risk mitigation strategy. Ventilation to reduce risks is dependent on shower conditions but may be less effective. The QMRA model finds that consideration of dynamic L. pneumophila concentrations in water improves exposure estimates and therefore improve the risk assessment, informing the benefits of sampling strategies that assess both first draw and flush samples in routine water monitoring programs.
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L. pneumophila is a waterborne respiratory pathogen that causes Pontiac Fever and Legionnaires' disease, two clinically significant diseases with increasing incidence in Europe. In this study, we develop a Quantitative Microbial Risk Assessment (QMRA) framework on the risks of infection from showering in L. pneumophila-contaminated water supplies to inform health-based concentration targets and water quality monitoring programs. The developed QMRA model extends on previous work investigating the relationships between concentrations of L. pneumophila in water sources and infection, illness, and disease burden by incorporating dynamic pathogen concentrations in water and aerosol concentrations, extending the prior reliance on assumptions of constant, average concentrations over the exposure duration. When applying this approach to data collected from within a building in Switzerland at risk for legionellosis cases, we show that initial high concentrations of L. pneumophila in water and aerosols from hot showers contribute to risks above a commonly used benchmark for the acceptable infection risk (10–4 infections per person per year) within the first 1–2 min of showers. Extending the model to estimate critical concentrations of L. pneumophila suggests concentrations at or above 2.5 × 103 CFU/L to 1.6 × 106 CFU/L for first draw samples and 2.5 × 101 CFU/L to 1.0 × 103 CFU/L for samples obtained after flushing would increase infection risks above the benchmark, dependent on site-specific conditions including water temperature and shower head type. These critical values align with, but are less stringent than, values reported by previous studies for showers due to our consideration of dynamic aerosol concentrations. Sensitivity analysis suggests that controlling L. pneumophila concentrations in water is the most effective risk mitigation strategy. Ventilation to reduce risks is dependent on shower conditions but may be less effective. The QMRA model finds that consideration of dynamic L. pneumophila concentrations in water improves exposure estimates and therefore improve the risk assessment, informing the benefits of sampling strategies that assess both first draw and flush samples in routine water monitoring programs.
Journal article
(2025)
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Chaojie Li, Tamar Kohn, Shotaro Torii, Htet Kyi Wynn, Alexander J. Devaux, Charles Gan, Timothy R. Julian, Émile Sylvestre
As more data on virus concentrations in influent water from wastewater treatment plants (WWTPs) becomes available, establishing best practices for virus measurements, monitoring, and statistical modelling can improve the understanding of virus concentration distributions in wastewater. To support this, we assessed the temporal variability of norovirus, adenovirus, enterovirus, and rotavirus concentrations in influent water across multiple WWTPs in Switzerland, the USA, and Japan. Our findings demonstrate that the lognormal distribution accurately describes temporal variations in concentrations for all viruses at all sites, outperforming the gamma and Weibull distributions, which fail to capture high variability. However, notable differences in variability and uncertainty were observed across systems, underscoring the need for site-specific assessments. Using lognormal parameters, we identified optimal monitoring frequencies that balance cost-effectiveness and precision. For most sites, weekly monitoring was sufficient to estimate the annual average concentration of enteric viruses within a 95% confidence interval of 0.5 log10. We further examined the mechanistic basis of the lognormal distribution, highlighting processes that drive its prevalence and shape the behavior of its upper tail. By integrating these insights, this study provides a statistical foundation for optimizing virus monitoring frameworks and informing public health interventions targeting wastewater systems.
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As more data on virus concentrations in influent water from wastewater treatment plants (WWTPs) becomes available, establishing best practices for virus measurements, monitoring, and statistical modelling can improve the understanding of virus concentration distributions in wastewater. To support this, we assessed the temporal variability of norovirus, adenovirus, enterovirus, and rotavirus concentrations in influent water across multiple WWTPs in Switzerland, the USA, and Japan. Our findings demonstrate that the lognormal distribution accurately describes temporal variations in concentrations for all viruses at all sites, outperforming the gamma and Weibull distributions, which fail to capture high variability. However, notable differences in variability and uncertainty were observed across systems, underscoring the need for site-specific assessments. Using lognormal parameters, we identified optimal monitoring frequencies that balance cost-effectiveness and precision. For most sites, weekly monitoring was sufficient to estimate the annual average concentration of enteric viruses within a 95% confidence interval of 0.5 log10. We further examined the mechanistic basis of the lognormal distribution, highlighting processes that drive its prevalence and shape the behavior of its upper tail. By integrating these insights, this study provides a statistical foundation for optimizing virus monitoring frameworks and informing public health interventions targeting wastewater systems.
Quantification of Legionella pneumophila in building potable water systems
A meta-analysis comparing qPCR and culture-based detection methods
Quantitative polymerase chain reaction (qPCR) offers a rapid, automated, and potentially on-site method for quantifying L. pneumophila in building potable water systems, complementing and potentially replacing traditional culture-based techniques. However, its application in assessing human health risks is complicated by a tendency to overestimate risks due to the detection of genomic copies unassociated with viable, infectious bacteria. This study examines the relationship between L. pneumophila measurements via qPCR and culture-based methods, aiming to establish qPCR-to-culture concentration ratios needed to inform associated health risks. Eligible studies collected quantitative data on L. pneumophila concentrations using molecular and culture-based methods within paired water samples. We developed a Poisson lognormal ratio model and a random-effects meta-analysis model to analyze variations in qPCR-to-culture ratios within and across sites. Of the 17 studies in the systematic review, seven, including 23 site-specific data sets, were used for meta-analysis. Our findings indicate these ratios typically vary from 1:1 to 100:1, with ratios close to 1:1 predicted at all sites. Consequently, adopting a default 1:1 conversion factor appears necessary as a cautious approach to convert qPCR concentrations to culturable concentrations for use in health risk models, such as quantitative microbial risk assessment (QMRA). Where this approach may be too conservative, viability-qPCR could improve the accuracy of qPCR-based QMRA. Standardizing qPCR and culture-based methods and reporting site-specific environmental factors affecting L. pneumophila culturability would improve understanding of the relationship between the two methods. The ratio model introduced here advances beyond simple correlation analyses, facilitating investigations of temporal and spatial heterogeneities in the relationship. This analysis is a step forward in the integration of QMRA and molecular biology, and the framework demonstrated for L. pneumophila is applicable to other pathogens monitored in the environment.
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Quantitative polymerase chain reaction (qPCR) offers a rapid, automated, and potentially on-site method for quantifying L. pneumophila in building potable water systems, complementing and potentially replacing traditional culture-based techniques. However, its application in assessing human health risks is complicated by a tendency to overestimate risks due to the detection of genomic copies unassociated with viable, infectious bacteria. This study examines the relationship between L. pneumophila measurements via qPCR and culture-based methods, aiming to establish qPCR-to-culture concentration ratios needed to inform associated health risks. Eligible studies collected quantitative data on L. pneumophila concentrations using molecular and culture-based methods within paired water samples. We developed a Poisson lognormal ratio model and a random-effects meta-analysis model to analyze variations in qPCR-to-culture ratios within and across sites. Of the 17 studies in the systematic review, seven, including 23 site-specific data sets, were used for meta-analysis. Our findings indicate these ratios typically vary from 1:1 to 100:1, with ratios close to 1:1 predicted at all sites. Consequently, adopting a default 1:1 conversion factor appears necessary as a cautious approach to convert qPCR concentrations to culturable concentrations for use in health risk models, such as quantitative microbial risk assessment (QMRA). Where this approach may be too conservative, viability-qPCR could improve the accuracy of qPCR-based QMRA. Standardizing qPCR and culture-based methods and reporting site-specific environmental factors affecting L. pneumophila culturability would improve understanding of the relationship between the two methods. The ratio model introduced here advances beyond simple correlation analyses, facilitating investigations of temporal and spatial heterogeneities in the relationship. This analysis is a step forward in the integration of QMRA and molecular biology, and the framework demonstrated for L. pneumophila is applicable to other pathogens monitored in the environment.
Foresight 2035
A perspective on the next decade of research on the management of Legionella spp. in engineered aquatic environments
Review
(2025)
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Frederik Hammes, Marco Gabrielli, Émile Sylvestre, More authors..., Alessio Cavallaro, Antonia Eichelberg, Sofia Barigelli, Melina Bigler, Sebastien P. Faucher, Hans P Füchslin, Valeria Gaia, Laura Gomez-Valero
The disease burden from Legionella spp. infections has been increasing in many industrialized countries and, despite decades of scientific advances, ranks amongst the highest for waterborne diseases. We review here several key research areas from a multidisciplinary perspective and list critical research needs to address some of the challenges of Legionella spp. management in engineered environments. These include: (i) a consideration of Legionella species diversity and cooccurrence, beyond Legionella pneumophila only; (ii) an assessment of their environmental prevalence and clinical relevance, and how that may affect legislation, management, and intervention prioritization; (iii) a consideration of Legionella spp. sources, their definition and prioritization; (iv) the factors affecting Legionnaires' disease seasonality, how they link to sources, Legionella spp. proliferation and ecology, and how these may be affected by climate change; (v) the challenge of saving energy in buildings while controlling Legionella spp. with high water temperatures and chemical disinfection; and (vi) the ecological interactions of Legionella spp. with other microbes, and their potential as a biological control strategy. Ultimately, we call for increased interdisciplinary collaboration between multiple research domains, as well as transdisciplinary engagement and collaboration across government, industry, and science as the way toward controlling and reducing Legionella-derived infections.
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The disease burden from Legionella spp. infections has been increasing in many industrialized countries and, despite decades of scientific advances, ranks amongst the highest for waterborne diseases. We review here several key research areas from a multidisciplinary perspective and list critical research needs to address some of the challenges of Legionella spp. management in engineered environments. These include: (i) a consideration of Legionella species diversity and cooccurrence, beyond Legionella pneumophila only; (ii) an assessment of their environmental prevalence and clinical relevance, and how that may affect legislation, management, and intervention prioritization; (iii) a consideration of Legionella spp. sources, their definition and prioritization; (iv) the factors affecting Legionnaires' disease seasonality, how they link to sources, Legionella spp. proliferation and ecology, and how these may be affected by climate change; (v) the challenge of saving energy in buildings while controlling Legionella spp. with high water temperatures and chemical disinfection; and (vi) the ecological interactions of Legionella spp. with other microbes, and their potential as a biological control strategy. Ultimately, we call for increased interdisciplinary collaboration between multiple research domains, as well as transdisciplinary engagement and collaboration across government, industry, and science as the way toward controlling and reducing Legionella-derived infections.
Quantitative microbial risk assessment for drinking water intake threat prioritization
A comparison of vulnerability and threat assessment according to source water protection regulations of two Canadian provinces
Journal article
(2025)
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Milad Taghipour, Émile Sylvestre, Ahmad Shakibaeinia, Samira Tolouei, Raja Kammoun, Michèle Prévost, Sarah Dorner
Source Water Protection in Canada is regulated primarily by provincial governments, leading to a variety of approaches for characterizing threats to drinking water. This paper compares the key elements of vulnerability and threat assessments for microbial contaminants for two Canadian provinces. Drinking water intakes of two municipalities in Quebec and Ontario, Canada, located on opposite sides of a large transboundary river impacted by Combined Sewer Overflow (CSO) discharges were used as a case study to evaluate the two provincial approaches. Québec’s vulnerability classification for microbial contaminants is data driven based on regulatory monitoring (concentrations of Escherichia coli) at the drinking water intake) while that of Ontario’s is model driven and dependent on the physical and hydraulic characteristics of zones around an intake. To establish a quantitative criterion to compare these two threat assessment frameworks, the impacts of a series of CSO events upstream of the drinking water intakes were simulated using a calibrated hydrodynamic and water quality model. Corresponding enteric pathogen concentrations in the intakes were estimated and used as input for Quantitative Microbial Risk Assessment (QMRA) to calculate treatment requirement levels to meet human health targets. Unlike Ontario’s threat assessment approach, Quebec’s approach provides an opportunity to investigate the effectiveness of risk reduction strategies such as an adjustment of the frequency of CSO events or corrective actions to improve treatment. Considering the influence of CSO events on log removal requirements to remain compliant with human health targets permitted the differentiation of CSO risk levels for threat prioritization.
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Source Water Protection in Canada is regulated primarily by provincial governments, leading to a variety of approaches for characterizing threats to drinking water. This paper compares the key elements of vulnerability and threat assessments for microbial contaminants for two Canadian provinces. Drinking water intakes of two municipalities in Quebec and Ontario, Canada, located on opposite sides of a large transboundary river impacted by Combined Sewer Overflow (CSO) discharges were used as a case study to evaluate the two provincial approaches. Québec’s vulnerability classification for microbial contaminants is data driven based on regulatory monitoring (concentrations of Escherichia coli) at the drinking water intake) while that of Ontario’s is model driven and dependent on the physical and hydraulic characteristics of zones around an intake. To establish a quantitative criterion to compare these two threat assessment frameworks, the impacts of a series of CSO events upstream of the drinking water intakes were simulated using a calibrated hydrodynamic and water quality model. Corresponding enteric pathogen concentrations in the intakes were estimated and used as input for Quantitative Microbial Risk Assessment (QMRA) to calculate treatment requirement levels to meet human health targets. Unlike Ontario’s threat assessment approach, Quebec’s approach provides an opportunity to investigate the effectiveness of risk reduction strategies such as an adjustment of the frequency of CSO events or corrective actions to improve treatment. Considering the influence of CSO events on log removal requirements to remain compliant with human health targets permitted the differentiation of CSO risk levels for threat prioritization.
PFAS drinking water treatment trade-offs
Comparing the health burden of GAC treatment to the health benefits of reduced PFAS exposure
Journal article
(2025)
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Sanne J. Smith, Émile Sylvestre, Anne Marieke Motelica-Wagenaar, Beatrice Cantoni, Parvathi Suresh Nair, Mar Palmeros Parada
To protect human health, limits for the concentrations of per- and polyfluoroalkyl substances (PFAS) in drinking water are decreasing in many countries. However, the required treatment to achieve these lower concentrations is more resource and energy intensive than conventional drinking water treatment. Consequently, this intensified water treatment has an indirect negative impact on human health. For example, treatment with granular activated carbon (GAC), commonly used for PFAS removal, can lead to particulate matter emissions and additional global warming. These negative impacts partly off-set the health benefit achieved by lower PFAS exposure via drinking water. In this study, we quantified health impacts of both the increased treatment and the reduced PFAS exposure in disability-adjusted life years (DALYs), to assess whether PFAS removal from drinking water to specified targets with GAC results in a net health benefit. We selected the prospective Dutch drinking water guideline for PFAS of 4.4 ng PFOA-equivalent (PEQ) L−1, as this guideline is amongst the more conservative concentration targets globally. We first conducted a Life Cycle Assessment (LCA) to quantify the health cost associated with the increased reactivation frequency of an existing GAC system in the Netherlands, required to achieve PFAS concentrations below 4.4 ng PEQ L−1. Then, we quantified the health benefit obtained by the corresponding lower PFAS exposure, using pharmacokinetic modelling combined with published dose–response relationships. For the treatment plant investigated in the current study, which uses reactivated wood-based GAC, increasing the reactivation frequency to remove more PFAS was found to result in a net health benefit of 6.9–300 DALYs per 106 persons per year. However, when single-use rather than reactivated GAC would be used for PFAS treatment, the health losses from the GAC production were in the same range as the health benefits from lower PFAS exposure. Overall, the negative health impacts associated with more intensive water treatment should be considered when developing strategies to reduce PFAS exposure.
...
To protect human health, limits for the concentrations of per- and polyfluoroalkyl substances (PFAS) in drinking water are decreasing in many countries. However, the required treatment to achieve these lower concentrations is more resource and energy intensive than conventional drinking water treatment. Consequently, this intensified water treatment has an indirect negative impact on human health. For example, treatment with granular activated carbon (GAC), commonly used for PFAS removal, can lead to particulate matter emissions and additional global warming. These negative impacts partly off-set the health benefit achieved by lower PFAS exposure via drinking water. In this study, we quantified health impacts of both the increased treatment and the reduced PFAS exposure in disability-adjusted life years (DALYs), to assess whether PFAS removal from drinking water to specified targets with GAC results in a net health benefit. We selected the prospective Dutch drinking water guideline for PFAS of 4.4 ng PFOA-equivalent (PEQ) L−1, as this guideline is amongst the more conservative concentration targets globally. We first conducted a Life Cycle Assessment (LCA) to quantify the health cost associated with the increased reactivation frequency of an existing GAC system in the Netherlands, required to achieve PFAS concentrations below 4.4 ng PEQ L−1. Then, we quantified the health benefit obtained by the corresponding lower PFAS exposure, using pharmacokinetic modelling combined with published dose–response relationships. For the treatment plant investigated in the current study, which uses reactivated wood-based GAC, increasing the reactivation frequency to remove more PFAS was found to result in a net health benefit of 6.9–300 DALYs per 106 persons per year. However, when single-use rather than reactivated GAC would be used for PFAS treatment, the health losses from the GAC production were in the same range as the health benefits from lower PFAS exposure. Overall, the negative health impacts associated with more intensive water treatment should be considered when developing strategies to reduce PFAS exposure.
Journal article
(2025)
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Hao Wang, Anouk Blauw, Jos van Gils, Eline Boelee, Émile Sylvestre, Gertjan Medema
The risk of infection by enteric pathogens in bathing waters is generally monitored by using fecal indicator bacteria (FIB). Mechanistic models are efficient tools to predict FIB concentrations in bathing waters, both in near-future forecasting and in long-term climate change projections. However, most existing mechanistic FIB models are limited by the availability of observations for validation and incorporation of all relevant physical, biological, and chemical (physico-biochemical) processes. Therefore, the quantitative influence of different physio-biochemical processes and impact factors is missing. To enhance the understanding of FIB fate in different aquatic systems, we developed a comprehensive yet generically applicable physico-biochemical model, focused on Escherichia coli (E. coli). It includes a die-off module and a sediment interaction module. Separate validation of the two sub-modules demonstrated the reliability of our modeling approach. The die-off module shows a higher R2 value (0.88) and lower RMSE value (1.1 day-1) than the existing models (0.48–0.79, and 1.8–7.2 day -1). This demonstrated an improvement by adding Ultraviolet-A and Ultraviolet-B (UVB) inactivation and UV spectrum extinction due to colored dissolved organic matter (CDOM) absorption. According to our sediment module validation, considering the impact of sediment composition on E. coli attachment can improve the allocation of E. coli between waters and sediments. Sensitivity analysis showed that 1) photo-inactivation is important in low CDOM waters, but not in high CDOM waters, where the UV penetration is limited; 2) the impact of sediment interaction can extend the duration of a peak event in high turbid waters. This work demonstrated the dominant impact factors in different aquatic systems for E. coli prediction. The new generic model enables better simulation of bathing water quality across different types of aquatic environments, which can be a useful tool to inform management at bathing sites. Future applications can choose processes selectively from the new FIB physico-biochemical model and couple it with appropriate hydrological/hydrodynamic models to address specific environmental conditions and research purposes.
...
The risk of infection by enteric pathogens in bathing waters is generally monitored by using fecal indicator bacteria (FIB). Mechanistic models are efficient tools to predict FIB concentrations in bathing waters, both in near-future forecasting and in long-term climate change projections. However, most existing mechanistic FIB models are limited by the availability of observations for validation and incorporation of all relevant physical, biological, and chemical (physico-biochemical) processes. Therefore, the quantitative influence of different physio-biochemical processes and impact factors is missing. To enhance the understanding of FIB fate in different aquatic systems, we developed a comprehensive yet generically applicable physico-biochemical model, focused on Escherichia coli (E. coli). It includes a die-off module and a sediment interaction module. Separate validation of the two sub-modules demonstrated the reliability of our modeling approach. The die-off module shows a higher R2 value (0.88) and lower RMSE value (1.1 day-1) than the existing models (0.48–0.79, and 1.8–7.2 day -1). This demonstrated an improvement by adding Ultraviolet-A and Ultraviolet-B (UVB) inactivation and UV spectrum extinction due to colored dissolved organic matter (CDOM) absorption. According to our sediment module validation, considering the impact of sediment composition on E. coli attachment can improve the allocation of E. coli between waters and sediments. Sensitivity analysis showed that 1) photo-inactivation is important in low CDOM waters, but not in high CDOM waters, where the UV penetration is limited; 2) the impact of sediment interaction can extend the duration of a peak event in high turbid waters. This work demonstrated the dominant impact factors in different aquatic systems for E. coli prediction. The new generic model enables better simulation of bathing water quality across different types of aquatic environments, which can be a useful tool to inform management at bathing sites. Future applications can choose processes selectively from the new FIB physico-biochemical model and couple it with appropriate hydrological/hydrodynamic models to address specific environmental conditions and research purposes.
The Role of Aspiration in Legionnaires’ Disease
A Quantitative Microbial Risk Assessment (QMRA)-Based Comparison with Inhalation Exposures
Legionellosis is generally attributed to the inhalation of aerosolized Legionella pneumophila from engineered water systems and/or soils. However, aspiration of contaminated water─a known cause of aspiration pneumonia─is seldom modeled in L. pneumophila risk assessment. Here, we develop a quantitative microbial risk assessment model to estimate the risks associated with aspiration exposures. Monte Carlo simulations, incorporating the aspiration water volume, the aspiration frequency, and the alveolar deposition fraction, reveal that low L. pneumophila concentrations in water can yield an appreciable infection risk in populations prone to aspiration. Under equal L. pneumophila concentrations, we find that an aspiration event can pose a higher infection risk than aerosol inhalation from showers or faucets. Sensitivity analyses identify the aspiration volume as a driver of risk. Our findings highlight the need for risk management strategies that address not only aerosol generation but also the aspiration of contaminated water.
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Legionellosis is generally attributed to the inhalation of aerosolized Legionella pneumophila from engineered water systems and/or soils. However, aspiration of contaminated water─a known cause of aspiration pneumonia─is seldom modeled in L. pneumophila risk assessment. Here, we develop a quantitative microbial risk assessment model to estimate the risks associated with aspiration exposures. Monte Carlo simulations, incorporating the aspiration water volume, the aspiration frequency, and the alveolar deposition fraction, reveal that low L. pneumophila concentrations in water can yield an appreciable infection risk in populations prone to aspiration. Under equal L. pneumophila concentrations, we find that an aspiration event can pose a higher infection risk than aerosol inhalation from showers or faucets. Sensitivity analyses identify the aspiration volume as a driver of risk. Our findings highlight the need for risk management strategies that address not only aerosol generation but also the aspiration of contaminated water.
Journal article
(2025)
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Émile Sylvestre, Dominique Charron, Xavier Lefebvre, Emilie Bedard, Michèle Prévost
Cooling towers are critical engineered water systems for air conditioning and refrigeration but can create favorable conditions for Legionella pneumophila growth and aerosolization. Human exposure to L. pneumophila-contaminated aerosols can cause Legionnaire's disease. Routine monitoring of L. pneumophila in cooling towers offers possibilities to develop quantitative microbial risk assessment (QMRA) models to guide system design, operation, control, and maintenance. Here, we used the regulatory monitoring database from Quebec, Canada, to develop statistical models for predicting L. pneumophila concentration variability in cooling towers and integrate these models into a screening-level QMRA model to predict human health risks. Analysis of 105,463 monthly L. pneumophila test results revealed that the exceedance rate of the 104 colony-forming unit (CFU) per liter threshold was constant at 10 % from 2016 to 2020, emphasizing the need to better validate the efficacy of corrective measures following the threshold exceedances. Among 2852 cooling towers, 51.2 % reported no detections, 38.5 % had up to nine positives, and 10.2 % over ten. The gamma or the lognormal distributions adequately described site-specific variations in L. pneumophila concentrations, but parametric uncertainty was very high for the lognormal distribution. We showed that rigorous model comparison is essential to predict peak concentrations accurately. Using QMRA, we found that an average L. pneumophila concentration below 1.4 × 104 CFU L−1 should be maintained in cooling towers to meet a health-based target of 10−6 DALY/pers.-year for clinical severity infections. We identified 137 cooling towers at risk of exceeding this limit, primarily due to the observation or prediction of rare peak concentrations above 105 CFU L−1. Effective mitigation of those peaks is critical to controlling public health risks associated with L. pneumophila.
...
Cooling towers are critical engineered water systems for air conditioning and refrigeration but can create favorable conditions for Legionella pneumophila growth and aerosolization. Human exposure to L. pneumophila-contaminated aerosols can cause Legionnaire's disease. Routine monitoring of L. pneumophila in cooling towers offers possibilities to develop quantitative microbial risk assessment (QMRA) models to guide system design, operation, control, and maintenance. Here, we used the regulatory monitoring database from Quebec, Canada, to develop statistical models for predicting L. pneumophila concentration variability in cooling towers and integrate these models into a screening-level QMRA model to predict human health risks. Analysis of 105,463 monthly L. pneumophila test results revealed that the exceedance rate of the 104 colony-forming unit (CFU) per liter threshold was constant at 10 % from 2016 to 2020, emphasizing the need to better validate the efficacy of corrective measures following the threshold exceedances. Among 2852 cooling towers, 51.2 % reported no detections, 38.5 % had up to nine positives, and 10.2 % over ten. The gamma or the lognormal distributions adequately described site-specific variations in L. pneumophila concentrations, but parametric uncertainty was very high for the lognormal distribution. We showed that rigorous model comparison is essential to predict peak concentrations accurately. Using QMRA, we found that an average L. pneumophila concentration below 1.4 × 104 CFU L−1 should be maintained in cooling towers to meet a health-based target of 10−6 DALY/pers.-year for clinical severity infections. We identified 137 cooling towers at risk of exceeding this limit, primarily due to the observation or prediction of rare peak concentrations above 105 CFU L−1. Effective mitigation of those peaks is critical to controlling public health risks associated with L. pneumophila.
To Treat or Not to Treat
Comparing Health Impacts of PFAS Exposure to Health Impacts of PFAS Removal Technologies
Associations between PFAS and adverse health effects have led to the global introduction of drinking water concentration limits in the low ng/L range. PFAS exposure has been shown to contribute considerably to disease burden, so interventions are clearly necessary to reduce exposure. However, to adequately quantify the health benefits of intensified drinking water treatment, the health effects of the treatment technologies should be considered as well. Therefore, the aim of this study was to estimate both types of human health impacts, i.e. the health gained by reduced PFAS exposure via drinking water and the health lost due to the drinking water treatment technologies, and quantify these in disability -adjusted life years (DALYs).
We performed a life cycle assessment to quantify the health lost (in DALYs) due to an increased regeneration frequency of granular activated carbon (GAC), which is used at a local drinking water producer to meet recent PFAS guidelines. To quantify the health gained by lower PFAS exposure, we fir st used the existing physiologically based pharmacokinetic model by EFSA to relate ?EFSA4 concentrations in drinking water to those in blood serum. Serum concentrations were then used in exposure response relationships from literature to relate them to an increase in disease occurrence, which was subsequently related to DALYs.
For all endpoints considered, we found that the gain in human health by removing PFAS from drinking water was in the same range as the loss of human health from the increased GAC regeneration. While the high uncertainty in PFAS health effects limits our ability to make a reliable comparison, it is likely that other interventions that limit PFAS exposure have a higher net benefit than drinking water treatment. For example, phasing out all non-essential uses of PFAS will lead to a decreased exposure via multiple routes, including diet. Altogether, PFAS limits in drinking water may need to be determined on a case-by-case basis, that considers the current concentration levels in addition to the secondary impact of the required treatment technologies. This study mainly serves to start a dialogue about this complex issue, which is particularly important as increasingly many PFAS are added to drinking water guidelines, most of which are even more challenging to remove than those currently included. ...
We performed a life cycle assessment to quantify the health lost (in DALYs) due to an increased regeneration frequency of granular activated carbon (GAC), which is used at a local drinking water producer to meet recent PFAS guidelines. To quantify the health gained by lower PFAS exposure, we fir st used the existing physiologically based pharmacokinetic model by EFSA to relate ?EFSA4 concentrations in drinking water to those in blood serum. Serum concentrations were then used in exposure response relationships from literature to relate them to an increase in disease occurrence, which was subsequently related to DALYs.
For all endpoints considered, we found that the gain in human health by removing PFAS from drinking water was in the same range as the loss of human health from the increased GAC regeneration. While the high uncertainty in PFAS health effects limits our ability to make a reliable comparison, it is likely that other interventions that limit PFAS exposure have a higher net benefit than drinking water treatment. For example, phasing out all non-essential uses of PFAS will lead to a decreased exposure via multiple routes, including diet. Altogether, PFAS limits in drinking water may need to be determined on a case-by-case basis, that considers the current concentration levels in addition to the secondary impact of the required treatment technologies. This study mainly serves to start a dialogue about this complex issue, which is particularly important as increasingly many PFAS are added to drinking water guidelines, most of which are even more challenging to remove than those currently included. ...
Associations between PFAS and adverse health effects have led to the global introduction of drinking water concentration limits in the low ng/L range. PFAS exposure has been shown to contribute considerably to disease burden, so interventions are clearly necessary to reduce exposure. However, to adequately quantify the health benefits of intensified drinking water treatment, the health effects of the treatment technologies should be considered as well. Therefore, the aim of this study was to estimate both types of human health impacts, i.e. the health gained by reduced PFAS exposure via drinking water and the health lost due to the drinking water treatment technologies, and quantify these in disability -adjusted life years (DALYs).
We performed a life cycle assessment to quantify the health lost (in DALYs) due to an increased regeneration frequency of granular activated carbon (GAC), which is used at a local drinking water producer to meet recent PFAS guidelines. To quantify the health gained by lower PFAS exposure, we fir st used the existing physiologically based pharmacokinetic model by EFSA to relate ?EFSA4 concentrations in drinking water to those in blood serum. Serum concentrations were then used in exposure response relationships from literature to relate them to an increase in disease occurrence, which was subsequently related to DALYs.
For all endpoints considered, we found that the gain in human health by removing PFAS from drinking water was in the same range as the loss of human health from the increased GAC regeneration. While the high uncertainty in PFAS health effects limits our ability to make a reliable comparison, it is likely that other interventions that limit PFAS exposure have a higher net benefit than drinking water treatment. For example, phasing out all non-essential uses of PFAS will lead to a decreased exposure via multiple routes, including diet. Altogether, PFAS limits in drinking water may need to be determined on a case-by-case basis, that considers the current concentration levels in addition to the secondary impact of the required treatment technologies. This study mainly serves to start a dialogue about this complex issue, which is particularly important as increasingly many PFAS are added to drinking water guidelines, most of which are even more challenging to remove than those currently included.
We performed a life cycle assessment to quantify the health lost (in DALYs) due to an increased regeneration frequency of granular activated carbon (GAC), which is used at a local drinking water producer to meet recent PFAS guidelines. To quantify the health gained by lower PFAS exposure, we fir st used the existing physiologically based pharmacokinetic model by EFSA to relate ?EFSA4 concentrations in drinking water to those in blood serum. Serum concentrations were then used in exposure response relationships from literature to relate them to an increase in disease occurrence, which was subsequently related to DALYs.
For all endpoints considered, we found that the gain in human health by removing PFAS from drinking water was in the same range as the loss of human health from the increased GAC regeneration. While the high uncertainty in PFAS health effects limits our ability to make a reliable comparison, it is likely that other interventions that limit PFAS exposure have a higher net benefit than drinking water treatment. For example, phasing out all non-essential uses of PFAS will lead to a decreased exposure via multiple routes, including diet. Altogether, PFAS limits in drinking water may need to be determined on a case-by-case basis, that considers the current concentration levels in addition to the secondary impact of the required treatment technologies. This study mainly serves to start a dialogue about this complex issue, which is particularly important as increasingly many PFAS are added to drinking water guidelines, most of which are even more challenging to remove than those currently included.
Modelling exposure to aerosols from showers
Implications for microbial risk assessment
Journal article
(2025)
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Lizhan Tang, Antonia Eichelberg, Franziska Böni, Kerry A. Hamilton, Émile Sylvestre, Frederik Hammes, Timothy R Julian
Inhalation of aerosols produced during showering exposes people to chemical and microbial contaminants present in the water. To improve quantitative estimates of exposure and to inform the efficacy of potential interventions to reduce exposures, the number and size distributions of aerosols generated during showering events were monitored and a mass balance model of the generated aerosols was developed. The aerosol generation rates were calculated through calibrating the model with the measured aerosol data. Specifically, aerosol count concentrations and size distributions were measured with an aerodynamic particle sizer over the duration of mock showering events under various conditions, including different water temperatures and different showerhead types (conventional and rain showers). The empirical data were then used to fit a mass balance model to obtain aerosol generation rates and decay rates for each aerosol size class through least square fitting. An initial high peak concentration of aerosols was observed under hot water conditions relative to cold water conditions which resulted in a rapid increase in aerosol exposure during the first 1–2 min of showering. This suggests that people showering in hot water conditions will have a potentially increased exposure during the first 1–2 min. The model-fitted values suggest large inter-experiment variation in estimated aerosol generation and decay rates, even among triplicates of the same showering conditions. Current exposure assessment approaches assume constant aerosol concentrations during showers which might lead to miscalculated cumulative risk for microbial hazards because of their uneven distribution in building plumbing systems and biofilm detachment process during flushing. Thus, considering aerosol dynamics is beneficial during shower exposure assessments to inform risk management interventions. The data set and associated modeling results provided can support this, as they can be readily integrated into microbial risk assessments for waterborne pathogens such as Legionella spp., nontuberculous Mycobacteria (NTM) and Pseudomonas aeruginosa.
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Inhalation of aerosols produced during showering exposes people to chemical and microbial contaminants present in the water. To improve quantitative estimates of exposure and to inform the efficacy of potential interventions to reduce exposures, the number and size distributions of aerosols generated during showering events were monitored and a mass balance model of the generated aerosols was developed. The aerosol generation rates were calculated through calibrating the model with the measured aerosol data. Specifically, aerosol count concentrations and size distributions were measured with an aerodynamic particle sizer over the duration of mock showering events under various conditions, including different water temperatures and different showerhead types (conventional and rain showers). The empirical data were then used to fit a mass balance model to obtain aerosol generation rates and decay rates for each aerosol size class through least square fitting. An initial high peak concentration of aerosols was observed under hot water conditions relative to cold water conditions which resulted in a rapid increase in aerosol exposure during the first 1–2 min of showering. This suggests that people showering in hot water conditions will have a potentially increased exposure during the first 1–2 min. The model-fitted values suggest large inter-experiment variation in estimated aerosol generation and decay rates, even among triplicates of the same showering conditions. Current exposure assessment approaches assume constant aerosol concentrations during showers which might lead to miscalculated cumulative risk for microbial hazards because of their uneven distribution in building plumbing systems and biofilm detachment process during flushing. Thus, considering aerosol dynamics is beneficial during shower exposure assessments to inform risk management interventions. The data set and associated modeling results provided can support this, as they can be readily integrated into microbial risk assessments for waterborne pathogens such as Legionella spp., nontuberculous Mycobacteria (NTM) and Pseudomonas aeruginosa.
Journal article
(2024)
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Mounia Hachad, Jean-Baptiste Burnet, Émile Sylvestre, Sung Vo Duy, Richard Villemur, Sébastien Sauvé, Michèle Prévost, Judy Y. Qiu, Xiaoli Pang, Sarah Dorner
Intense rainfall and snowmelt events may affect the safety of drinking water, as large quantities of fecal material can be discharged from storm or sewage overflows or washed from the catchment into drinking water sources. This study used β-d-glucuronidase activity (GLUC) with microbial source tracking (MST) markers: human, bovine, porcine mitochondrial DNA markers (mtDNA) and human-associated Bacteroidales HF183 and chemical source tracking (CST) markers including caffeine, carbamazepine, theophylline and acetaminophen, pathogens (Giardia, Cryptosporidium, adenovirus, rotavirus and enterovirus), water quality indicators (Escherichia coli, turbidity) and hydrometeorological data (flowrate, precipitation) to assess the vulnerability of 3 drinking water intakes (DWIs) and identify sources of fecal contamination. Water samples were collected under baseline, snow and rain events conditions in urban and agricultural catchments (Québec, Canada). Dynamics of E. coli, HF183 and WWMPs were similar during contamination events, and concentrations generally varied over 1 order of magnitude during each event. Elevated human-associated marker levels during events demonstrated that urban DWIs were impacted by recent contamination from an upstream municipal water resource recovery facility (WRRF). In the agricultural catchment, mixed fecal pollution was observed with the occurrences and increases of enteric viruses, human bovine and porcine mtDNA during peak contaminating events. Bovine mtDNA qPCR concentrations were indicative of runoff of cattle-derived fecal pollutants to the DWI from diffuse sources following rain events. This study demonstrated that the suitability of a given MST or CST indicator depend on river and catchment characteristics. The sampling strategy using continuous online GLUC activity coupled with MST and CST markers analysis was a more reliable source indicator than turbidity to identify peak events at drinking water intakes.
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Intense rainfall and snowmelt events may affect the safety of drinking water, as large quantities of fecal material can be discharged from storm or sewage overflows or washed from the catchment into drinking water sources. This study used β-d-glucuronidase activity (GLUC) with microbial source tracking (MST) markers: human, bovine, porcine mitochondrial DNA markers (mtDNA) and human-associated Bacteroidales HF183 and chemical source tracking (CST) markers including caffeine, carbamazepine, theophylline and acetaminophen, pathogens (Giardia, Cryptosporidium, adenovirus, rotavirus and enterovirus), water quality indicators (Escherichia coli, turbidity) and hydrometeorological data (flowrate, precipitation) to assess the vulnerability of 3 drinking water intakes (DWIs) and identify sources of fecal contamination. Water samples were collected under baseline, snow and rain events conditions in urban and agricultural catchments (Québec, Canada). Dynamics of E. coli, HF183 and WWMPs were similar during contamination events, and concentrations generally varied over 1 order of magnitude during each event. Elevated human-associated marker levels during events demonstrated that urban DWIs were impacted by recent contamination from an upstream municipal water resource recovery facility (WRRF). In the agricultural catchment, mixed fecal pollution was observed with the occurrences and increases of enteric viruses, human bovine and porcine mtDNA during peak contaminating events. Bovine mtDNA qPCR concentrations were indicative of runoff of cattle-derived fecal pollutants to the DWI from diffuse sources following rain events. This study demonstrated that the suitability of a given MST or CST indicator depend on river and catchment characteristics. The sampling strategy using continuous online GLUC activity coupled with MST and CST markers analysis was a more reliable source indicator than turbidity to identify peak events at drinking water intakes.
Greywater recycling for diverse collection scales and appliances
Enteric pathogen log-removal targets and treatment trains
Journal article
(2024)
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Eva Reynaert, Émile Sylvestre, Eberhard Morgenroth, Timothy R. Julian
In light of increasingly diverse greywater reuse applications, this study proposes risk-based log-removal targets (LRTs) to aid the selection of treatment trains for greywater recycling at different collection scales, including appliance-scale reuse of individual greywater streams. An epidemiology-based model was used to simulate the concentrations of prevalent and treatment-resistant reference pathogens (protozoa: Giardia and Cryptosporidium spp., bacteria: Salmonella and Campylobacter spp., viruses: rotavirus, norovirus, adenovirus, and Coxsackievirus B5) in the greywater streams for collection scales of 5-, 100-, and a 1000-people. Using quantitative microbial risk assessment (QMRA), we calculated LRTs to meet a health benchmark of 10–4 infections per person per year over 10′000 Monte Carlo iterations. LRTs were highest for norovirus at the 5-people scale and for adenovirus at the 100- and 1000-people scales. Example treatment trains were designed to meet the 95 % quantiles of LRTs. Treatment trains consisted of an aerated membrane bioreactor, chlorination, and, if required, UV disinfection. In most cases, rotavirus, norovirus, adenovirus and Cryptosporidium spp. determined the overall treatment train requirements. Norovirus was most often critical to dimension the chlorination (concentration × time values) and adenovirus determined the required UV dose. Smaller collection scales did not generally allow for simpler treatment trains due to the high LRTs associated with viruses, with the exception of recirculating washing machines and handwashing stations. Similarly, treating greywater sources individually resulted in lower LRTs, but the lower required LRTs nevertheless did not generally allow for simpler treatment trains. For instance, LRTs for a recirculating washing machine were around 3-log units lower compared to LRTs for indoor reuse of combined greywater (1000-people scale), but both scenarios necessitated treatment with a membrane bioreactor, chlorination and UV disinfection. However, simpler treatment trains may be feasible for small-scale and application-scale reuse if: (i) less conservative health benchmarks are used for household-based systems, considering the reduced relative importance of treated greywater in pathogen transmission in households, and (ii) higher log-removal values (LRVs) can be validated for unit processes, enabling simpler treatment trains for a larger number of appliance-scale reuse systems.
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In light of increasingly diverse greywater reuse applications, this study proposes risk-based log-removal targets (LRTs) to aid the selection of treatment trains for greywater recycling at different collection scales, including appliance-scale reuse of individual greywater streams. An epidemiology-based model was used to simulate the concentrations of prevalent and treatment-resistant reference pathogens (protozoa: Giardia and Cryptosporidium spp., bacteria: Salmonella and Campylobacter spp., viruses: rotavirus, norovirus, adenovirus, and Coxsackievirus B5) in the greywater streams for collection scales of 5-, 100-, and a 1000-people. Using quantitative microbial risk assessment (QMRA), we calculated LRTs to meet a health benchmark of 10–4 infections per person per year over 10′000 Monte Carlo iterations. LRTs were highest for norovirus at the 5-people scale and for adenovirus at the 100- and 1000-people scales. Example treatment trains were designed to meet the 95 % quantiles of LRTs. Treatment trains consisted of an aerated membrane bioreactor, chlorination, and, if required, UV disinfection. In most cases, rotavirus, norovirus, adenovirus and Cryptosporidium spp. determined the overall treatment train requirements. Norovirus was most often critical to dimension the chlorination (concentration × time values) and adenovirus determined the required UV dose. Smaller collection scales did not generally allow for simpler treatment trains due to the high LRTs associated with viruses, with the exception of recirculating washing machines and handwashing stations. Similarly, treating greywater sources individually resulted in lower LRTs, but the lower required LRTs nevertheless did not generally allow for simpler treatment trains. For instance, LRTs for a recirculating washing machine were around 3-log units lower compared to LRTs for indoor reuse of combined greywater (1000-people scale), but both scenarios necessitated treatment with a membrane bioreactor, chlorination and UV disinfection. However, simpler treatment trains may be feasible for small-scale and application-scale reuse if: (i) less conservative health benchmarks are used for household-based systems, considering the reduced relative importance of treated greywater in pathogen transmission in households, and (ii) higher log-removal values (LRVs) can be validated for unit processes, enabling simpler treatment trains for a larger number of appliance-scale reuse systems.
Journal article
(2024)
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Émile Sylvestre, Michael A. Jahne, Eva Reynaert, Eberhard Morgenroth, Timothy R. Julian
Greywater reuse is a strategy to address water scarcity, necessitating the selection of treatment processes that balance cost-efficiency and human health risks. A key aspect in evaluating these risks is understanding pathogen contamination levels in greywater, a complex task due to intermittent pathogen occurrences. To address this, faecal indicator organisms like E. coli are often monitored as proxies to evaluate faecal contamination levels and infer pathogen concentrations. However, the wide variability in faecal indicator concentrations poses challenges in their modelling for quantitative microbial risk assessment (QMRA). Our study critically assesses the adequacy of parametric models in predicting the variability in E. coli concentrations in greywater. We found that models that build on summary statistics, like medians and standard deviations, can substantially underestimate the variability in E. coli concentrations. More appropriate models may provide more accurate estimations of, and uncertainty around, peak E. coli concentrations. To demonstrate this, a Poisson lognormal distribution model is fit to a data set of E. coli concentrations measured in shower and laundry greywater sources. This model estimated arithmetic mean E. coli concentrations in laundry waters at approximately 1.0E + 06 MPN 100 mL−1. These results are around 2.0 log10 units higher than estimations from a previously used hierarchical lognormal model based on aggregated summary data from multiple studies. Such differences are considerable when assessing human health risks and setting pathogen reduction targets for greywater reuse. This research highlights the importance of making raw monitoring data available for more accurate statistical evaluations than those based on summary statistics. It also emphasizes the crucial role of model comparison, selection, and validation to inform policy-relevant outcomes.
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Greywater reuse is a strategy to address water scarcity, necessitating the selection of treatment processes that balance cost-efficiency and human health risks. A key aspect in evaluating these risks is understanding pathogen contamination levels in greywater, a complex task due to intermittent pathogen occurrences. To address this, faecal indicator organisms like E. coli are often monitored as proxies to evaluate faecal contamination levels and infer pathogen concentrations. However, the wide variability in faecal indicator concentrations poses challenges in their modelling for quantitative microbial risk assessment (QMRA). Our study critically assesses the adequacy of parametric models in predicting the variability in E. coli concentrations in greywater. We found that models that build on summary statistics, like medians and standard deviations, can substantially underestimate the variability in E. coli concentrations. More appropriate models may provide more accurate estimations of, and uncertainty around, peak E. coli concentrations. To demonstrate this, a Poisson lognormal distribution model is fit to a data set of E. coli concentrations measured in shower and laundry greywater sources. This model estimated arithmetic mean E. coli concentrations in laundry waters at approximately 1.0E + 06 MPN 100 mL−1. These results are around 2.0 log10 units higher than estimations from a previously used hierarchical lognormal model based on aggregated summary data from multiple studies. Such differences are considerable when assessing human health risks and setting pathogen reduction targets for greywater reuse. This research highlights the importance of making raw monitoring data available for more accurate statistical evaluations than those based on summary statistics. It also emphasizes the crucial role of model comparison, selection, and validation to inform policy-relevant outcomes.
Monitoring ESBL- Escherichia coli in Swiss wastewater between November 2021 and November 2022
insights into population carriage
Journal article
(2024)
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Sheena Conforti, Aurélie Holschneider, Émile Sylvestre, Timothy R. Julian
Antimicrobial resistance (AMR) poses a global health threat, causing millions of deaths annually, with expectations of increased impact in the future. Wastewater surveillance offers a cost-effective, non-invasive tool to understand AMR carriage trends within a population. We monitored extended-spectrum β-lactamase producing Escherichia coli (ESBL-E. coli) weekly in influent wastewater from six wastewater treatment plants (WWTPs) in Switzerland (November 2021 to November 2022) to investigate spatio-temporal variations, explore correlations with environmental variables, develop a predictive model for ESBL-E. coli carriage in the community, and detect the most prevalent ESBL-genes. We cultured total and ESBL-E. coli in 300 wastewater samples to quantify daily loads and percentage of ESBL-E. coli. Additionally, we screened 234 ESBL-E. coli isolates using molecular methods for the presence of 18 ESBL-gene families. We found a population-weighted mean percentage of ESBL-E. coli of 1.9% (95% confidence interval: 1.8–2%) across all sites and weeks, which can inform ESBL-E. coli carriage. Concentrations of ESBL-E. coli varied across WWTPs and time, with higher values observed in WWTPs serving larger populations. Recent precipitations (previous 24/96 h) showed no significant association with ESBL-E. coli, while temperature occasionally had a moderate impact (P < 0.05, correlation coefficients approximately 0.40) in some locations. We identified blaCTX-M-1, blaCTX-M-9, and blaTEM as the predominant ESBL-gene families. Our study demonstrates that wastewater-based surveillance of culturable ESBL-E. coli provides insights into AMR trends in Switzerland and may also inform resistance. These findings establish a foundation for long term, nationally established monitoring protocols and provide information that may help inform targeted public health interventions.
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Antimicrobial resistance (AMR) poses a global health threat, causing millions of deaths annually, with expectations of increased impact in the future. Wastewater surveillance offers a cost-effective, non-invasive tool to understand AMR carriage trends within a population. We monitored extended-spectrum β-lactamase producing Escherichia coli (ESBL-E. coli) weekly in influent wastewater from six wastewater treatment plants (WWTPs) in Switzerland (November 2021 to November 2022) to investigate spatio-temporal variations, explore correlations with environmental variables, develop a predictive model for ESBL-E. coli carriage in the community, and detect the most prevalent ESBL-genes. We cultured total and ESBL-E. coli in 300 wastewater samples to quantify daily loads and percentage of ESBL-E. coli. Additionally, we screened 234 ESBL-E. coli isolates using molecular methods for the presence of 18 ESBL-gene families. We found a population-weighted mean percentage of ESBL-E. coli of 1.9% (95% confidence interval: 1.8–2%) across all sites and weeks, which can inform ESBL-E. coli carriage. Concentrations of ESBL-E. coli varied across WWTPs and time, with higher values observed in WWTPs serving larger populations. Recent precipitations (previous 24/96 h) showed no significant association with ESBL-E. coli, while temperature occasionally had a moderate impact (P < 0.05, correlation coefficients approximately 0.40) in some locations. We identified blaCTX-M-1, blaCTX-M-9, and blaTEM as the predominant ESBL-gene families. Our study demonstrates that wastewater-based surveillance of culturable ESBL-E. coli provides insights into AMR trends in Switzerland and may also inform resistance. These findings establish a foundation for long term, nationally established monitoring protocols and provide information that may help inform targeted public health interventions.
Journal article
(2023)
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Chaojie Li, Émile Sylvestre, Xavier Fernandez-Cassi, Timothy R. Julian, Tamar Kohn
Waterborne enteric viruses in lakes, especially at recreational water sites, may have a negative impact on human health. However, their fate and transport in lakes are poorly understood. In this study, we propose a coupled water quality and quantitative microbial risk assessment (QMRA) model to study the transport, fate and infection risk of four common waterborne viruses (adenovirus, enterovirus, norovirus and rotavirus), using Lake Geneva as a study site. The measured virus load in raw sewage entering the lake was used as the source term in the water quality simulations for a hypothetical scenario of discharging raw wastewater at the lake surface. After discharge into the lake, virus inactivation was modeled as a function of water temperature and solar irradiance that varied both spatially and temporally during transport throughout the lake. Finally, the probability of infection, while swimming at a popular beach, was quantified and compared among the four viruses. Norovirus was found to be the most abundant virus that causes an infection probability that is at least 10 times greater than the other viruses studied. Furthermore, environmental inactivation was found to be an essential determinant in the infection risks posed by viruses to recreational water users. We determined that infection risks by enterovirus and rotavirus could be up to 1000 times lower when virus inactivation by environmental stressors was accounted for compared with the scenarios considering hydrodynamic transport only. Finally, the model highlighted the role of the wind field in conveying the contamination plume and hence in determining infection probability. Our simulations revealed that for beaches located west of the sewage discharge, the infection probability under eastward wind was 43% lower than that under westward wind conditions. This study highlights the potential of combining water quality simulation and virus-specific risk assessment for a safe water resources usage and management.
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Waterborne enteric viruses in lakes, especially at recreational water sites, may have a negative impact on human health. However, their fate and transport in lakes are poorly understood. In this study, we propose a coupled water quality and quantitative microbial risk assessment (QMRA) model to study the transport, fate and infection risk of four common waterborne viruses (adenovirus, enterovirus, norovirus and rotavirus), using Lake Geneva as a study site. The measured virus load in raw sewage entering the lake was used as the source term in the water quality simulations for a hypothetical scenario of discharging raw wastewater at the lake surface. After discharge into the lake, virus inactivation was modeled as a function of water temperature and solar irradiance that varied both spatially and temporally during transport throughout the lake. Finally, the probability of infection, while swimming at a popular beach, was quantified and compared among the four viruses. Norovirus was found to be the most abundant virus that causes an infection probability that is at least 10 times greater than the other viruses studied. Furthermore, environmental inactivation was found to be an essential determinant in the infection risks posed by viruses to recreational water users. We determined that infection risks by enterovirus and rotavirus could be up to 1000 times lower when virus inactivation by environmental stressors was accounted for compared with the scenarios considering hydrodynamic transport only. Finally, the model highlighted the role of the wind field in conveying the contamination plume and hence in determining infection probability. Our simulations revealed that for beaches located west of the sewage discharge, the infection probability under eastward wind was 43% lower than that under westward wind conditions. This study highlights the potential of combining water quality simulation and virus-specific risk assessment for a safe water resources usage and management.
Hands Are Frequently Contaminated with Fecal Bacteria and Enteric Pathogens Globally
A Systematic Review and Meta-analysis
Journal article
(2023)
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Molly E. Cantrell, Émile Sylvestre, Hannah C. Wharton, Rahel Scheidegger, Lou Curchod, David M. Gute, Jeffrey Griffiths, Timothy R. Julian, Amy J. Pickering
Enteric pathogen infections are a leading cause of morbidity and mortality globally, with the highest disease burden in low-income countries. Hands act as intermediaries in enteric pathogen transmission, transferring enteric pathogens between people and the environment through contact with fomites, food, water, and soil. In this study, we conducted a systematic review of prevalence and concentrations of fecal indicator microorganisms (i.e., E. coli, fecal coliform) and enteric pathogens on hands. We identified 84 studies, reporting 35,440 observations of hand contamination of people in community or household settings. The studies investigated 44 unique microorganisms, of which the most commonly reported indicators were E. coli and fecal coliforms. Hand contamination with 12 unique enteric pathogens was reported, with adenovirus and norovirus as the most frequent. Mean E. coli prevalence on hands was 62% [95% CI 40%–82%] and mean fecal coliform prevalence was 66% [95% CI 22%–100%]. Hands were more likely to be contaminated with E. coli in low/lower-middle-income countries (prevalence: 69% [95% CI 48%–88%]) than in upper-middle/high-income countries (6% [95% CI 2%–12%]). The Review also highlights the importance of standardizing hand sampling methods, as hand rinsing was associated with greater fecal contamination compared to other sampling methods.
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Enteric pathogen infections are a leading cause of morbidity and mortality globally, with the highest disease burden in low-income countries. Hands act as intermediaries in enteric pathogen transmission, transferring enteric pathogens between people and the environment through contact with fomites, food, water, and soil. In this study, we conducted a systematic review of prevalence and concentrations of fecal indicator microorganisms (i.e., E. coli, fecal coliform) and enteric pathogens on hands. We identified 84 studies, reporting 35,440 observations of hand contamination of people in community or household settings. The studies investigated 44 unique microorganisms, of which the most commonly reported indicators were E. coli and fecal coliforms. Hand contamination with 12 unique enteric pathogens was reported, with adenovirus and norovirus as the most frequent. Mean E. coli prevalence on hands was 62% [95% CI 40%–82%] and mean fecal coliform prevalence was 66% [95% CI 22%–100%]. Hands were more likely to be contaminated with E. coli in low/lower-middle-income countries (prevalence: 69% [95% CI 48%–88%]) than in upper-middle/high-income countries (6% [95% CI 2%–12%]). The Review also highlights the importance of standardizing hand sampling methods, as hand rinsing was associated with greater fecal contamination compared to other sampling methods.
Journal article
(2023)
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Alessio Cavallaro, William J. Rhoads, Émile Sylvestre, Thierr y Marti, Jean-Claude Walser, Frederik Hammes
Legionella are natural inhabitants of building plumbing biofilms, where interactions with other microorganisms influence their survival, proliferation, and death. Here, we investigated the associations of Legionella with bacterial and eukaryotic microbiomes in biofilm samples extracted from 85 shower hoses of a multiunit residential building. Legionella spp. relative abundance in the biofilms ranged between 0–7.8%, of which only 0–0.46% was L. pneumophila. Our data suggest that some microbiome members were associated with high (e.g. Chthonomonas, Vrihiamoeba) or low (e.g. Aquabacterium, Vannella) Legionella relative abundance. The correlations of the different Legionella variants (30 Zero-Radius OTUs detected) showed distinct patterns, suggesting separate ecological niches occupied by different Legionella species. This study provides insights into the ecology of Legionella with respect to: (i) the colonization of a high number of real shower hoses biofilm samples; (ii) the ecological meaning of associations between Legionella and co-occurring bacterial/eukaryotic organisms; (iii) critical points and future directions of microbial-interaction-based-ecological-investigations.
...
Legionella are natural inhabitants of building plumbing biofilms, where interactions with other microorganisms influence their survival, proliferation, and death. Here, we investigated the associations of Legionella with bacterial and eukaryotic microbiomes in biofilm samples extracted from 85 shower hoses of a multiunit residential building. Legionella spp. relative abundance in the biofilms ranged between 0–7.8%, of which only 0–0.46% was L. pneumophila. Our data suggest that some microbiome members were associated with high (e.g. Chthonomonas, Vrihiamoeba) or low (e.g. Aquabacterium, Vannella) Legionella relative abundance. The correlations of the different Legionella variants (30 Zero-Radius OTUs detected) showed distinct patterns, suggesting separate ecological niches occupied by different Legionella species. This study provides insights into the ecology of Legionella with respect to: (i) the colonization of a high number of real shower hoses biofilm samples; (ii) the ecological meaning of associations between Legionella and co-occurring bacterial/eukaryotic organisms; (iii) critical points and future directions of microbial-interaction-based-ecological-investigations.