The understanding of the risk to humans from exposure to pathogens has been firmly put into a risk assessment framework. A key element of applying this approach is the understanding of the ...relationship between dose and response for particular pathogens. This understanding has progressed from early use of threshold concepts ("minimal infectious dose") thru multiple generations of models. Generation 1 models describe probability of response to exposed dose. Generation 2 models incorporate host factors (e.g., age) and/or pathogen factors (e.g., particle size of inhaled agents). Generation 3 models describe the rate at which effects develop, i.e. the epidemic curve. These (generation 1 through three models) have been developed and used in multiple contexts. Beyond Generation 3 lies an opportunity for the deep incorporation of in vivo physiological responses and the coupling of the individual host dynamics to the dynamics of spread of contagious diseases in the population. This would enable more direct extrapolation from controlled dosing studies to estimate population level effects. There remain also needs to understand broader categories of infectious agents, including pathogenic amoebae and fungi. More advanced models need to be validated against well-characterized human outbreak data.
Quantitative microbial risk assessment has been used to develop criteria for exposure to many microorganisms. In this article, the dose–response curve for Coronavirus 229E is used to develop ...preliminary risk‐based exposure criteria for SARS‐CoV‐2 via the respiratory portals of entry.
Biological fouling occurs on RO membranes when bacteria and nutrients are present in conditions that are conducive to growth and proliferation of the bacteria. Controlling microbial growth on the ...membranes is typically limited to biocide application (i.e., disinfectants) in seawater RO plants. However, biological growth and subsequent fouling has not been well-managed. Pretreatment has not been focused on nutrient limitation. This project used a biological assay, the assimilable organic carbon (AOC) test to evaluate pretreatment effects on the nutrient supply. The AOC test provided a useful surrogate measurement for the biodegradability or biofouling potential of RO feed water. Biofouling observed in controlled conditions at the bench- and pilot-scale resulted in statistically significant correlations between AOC and the operational effects caused by biofouling. Membrane fouling rates are observed through operational changes over time such as increased differential pressure between the membrane feed and concentrate locations and decreased permeate flux through the membrane. In full scale plants there were strong correlations when AOC was used as a predictor variable for increased differential pressure (0.28–0.55 bar from September–December 2012) and decreased specific flux (1.40 L per hour/(m2 · bar)). Increased differential pressure was associated with RO membrane biological fouling when the median AOC was 50 μg/L during pilot testing. Conditions were also evaluated at the bench-scale using a flat sheet RO membrane. In a comparison test using 30 and 1000 μg/L AOC, fouling was detected on more portions of the membrane when AOC was higher. Biofilm and bacterial deposits were apparent from scanning electron microscope imaging and biomass measurements using ATP.
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•A seawater AOC bioassay is applied to full scale and pilot scale desalination.•AOC in seawater correlates to reverse osmosis biological fouling.•Monitoring AOC in seawater is better than other parameters for predicting biofouling potential.•Biofouling may be minimized by monitoring pretreatment AOC levels and defining a control strategy.
A quantitative microbial risk assessment (QMRA) of opportunistic pathogens Legionella pneumophila (LP) and Mycobacterium avium complex (MAC) was undertaken for various uses of roof-harvested ...rainwater (RHRW) reported in Queensland, Australia to identify appropriate usages and guide risk management practices. Risks from inhalation of aerosols due to showering, swimming in pools topped up with RHRW, use of a garden hose, car washing, and toilet flushing with RHRW were considered for LP while both ingestion (drinking, produce consumption, and accidental ingestion from various activities) and inhalation risks were considered for MAC. The drinking water route of exposure presented the greatest risks due to cervical lymphadenitis and disseminated infection health endpoints for children and immune-compromised populations, respectively. It is therefore not recommended that these populations consume untreated rainwater. LP risks were up to 6 orders of magnitude higher than MAC risks for the inhalation route of exposure for all scenarios. Both inhalation and ingestion QMRA simulations support that while drinking, showering, and garden hosing with RHRW may present the highest risks, car washing and clothes washing could constitute appropriate uses of RHRW for all populations, and toilet flushing and consumption of lettuce irrigation with RHRW would be appropriate for non- immune-compromised populations.
•A QMRA of opportunistic pathogens was undertaken for roof-harvested rainwater.•Drinking water, showering, and garden hosing presented the greatest risks.•Drinking untreated rainwater is not recommended for children or immune-compromised.•Car and clothes washing appear to be appropriate uses of rainwater.•Toilet flushing is appropriate for non-immune-compromised populations.
Middle Eastern respiratory syndrome, an emerging viral infection with a global case fatality rate of 35.5%, caused major outbreaks first in 2012 and 2015, though new cases are continuously reported ...around the world. Transmission is believed to mainly occur in healthcare settings through aerosolized particles. This study uses Quantitative Microbial Risk Assessment to develop a generalizable model that can assist with interpreting reported outbreak data or predict risk of infection with or without the recommended strategies. The exposure scenario includes a single index patient emitting virus‐containing aerosols into the air by coughing, leading to short‐ and long‐range airborne exposures for other patients in the same room, nurses, healthcare workers, and family visitors. Aerosol transport modeling was coupled with Monte Carlo simulation to evaluate the risk of MERS illness for the exposed population. Results from a typical scenario show the daily mean risk of infection to be the highest for the nurses and healthcare workers (8.49 × 10−4 and 7.91 × 10−4, respectively), and the lowest for family visitors and patients staying in the same room (3.12 × 10−4 and 1.29 × 10−4, respectively). Sensitivity analysis indicates that more than 90% of the uncertainty in the risk characterization is due to the viral concentration in saliva. Assessment of risk interventions showed that respiratory masks were found to have a greater effect in reducing the risks for all the groups evaluated (>90% risk reduction), while increasing the air exchange was effective for the other patients in the same room only (up to 58% risk reduction).
Legionella spp. occurring in hotel hot water systems, in particular Legionella pneumophila, are causing serious pneumonic infections, and water temperature is a key factor to control their occurrence ...in plumbing systems. We performed a systematic review and meta-analyses of the available evidence on the association between water temperature and Legionella colonization to identify the water temperature in hotel hot water systems required for control of Legionella. Qualitative synthesis and quantitative analysis were performed on 13 studies that met our inclusion criteria to identify the effect of temperature. The Receiver Operating Characteristic (ROC) curve identified 55 °C as a cutoff point for hotel hot water temperature with an Area Under the Curve (AUC) value of 0.914. The odds ratios (OR) for detecting Legionella at temperatures >55 °C compared to lower temperatures from a meta-analysis of three studies was 0.17 95% CI: 0.11, 0.25, which indicates a strong negative association between temperature and Legionella colonization. A logistic regression on results from multiple studies using both molecular and culture methods found a temperature of 59 °C associated with an 8% probability of detectable Legionella. Only two studies reported sufficiently detailed data to allow a model of concentration vs. temperature to be fit, and this model was not statistically significant. Additional research or more detailed reporting of existing datasets is required to assess if Legionella growth can be limited below particular concentration targets at different temperatures.
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•A systematic review of the association between temperature and Legionella in hotels.•The effects of temperature to control Legionella were identified.•55 °C to 59 °C was identified as likely to reduce Legionella to non-detectable levels.•Species of Legionella has a minimal impact, but analytical method affects results.•Identified temperature can be used to calculate the water heater temperature.
The use of reclaimed water brings new challenges for the water industry in terms of maintaining water quality while increasing sustainability. Increased attention has been devoted to opportunistic ...pathogens, especially Legionella pneumophila, due to its growing importance as a portion of the waterborne disease burden in the United States. Infection occurs when a person inhales a mist containing Legionella bacteria. The top three uses for reclaimed water (cooling towers, spray irrigation, and toilet flushing) that generate aerosols were evaluated for Legionella health risks in reclaimed water using quantitative microbial risk assessment (QMRA). Risks are compared using data from nineteen United States reclaimed water utilities measured with culture-based methods, quantitative PCR (qPCR), and ethidium-monoazide-qPCR. Median toilet flushing annual infection risks exceeded 10−4 considering multiple toilet types, while median clinical severity infection risks did not exceed this value. Sprinkler and cooling tower risks varied depending on meteorological conditions and operational characteristics such as drift eliminator performance. However, the greatest differences between risk scenarios were due to 1) the dose response model used (infection or clinical severity infection) 2) population at risk considered (residential or occupational) and 3) differences in laboratory analytical method. Theoretical setback distances necessary to achieve a median annual infection risk level of 10−4 are proposed for spray irrigation and cooling towers. In both cooling tower and sprinkler cases, Legionella infection risks were non-trivial at potentially large setback distances, and indicate other simultaneous management practices could be needed to manage risks. The sensitivity analysis indicated that the most influential factors for variability in risks were the concentration of Legionella and aerosol partitioning and/or efficiency across all models, highlighting the importance of strategies to manage Legionella occurrence in reclaimed water.
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•Legionella risks for toilet models exceeded drinking water benchmarks in some cases.•Legionella risks are non-trivial at potentially large distances for long range models.•Concentration of Legionella was the most influential model parameter in all models.•Other management practices can be applied to reduce theoretical setback distances needed.
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