Diarrhoea caused by waterborne pathogens still has a large burden of disease. We introduce a modelling and scenario analysis framework that enables better understanding of sources of and possible future changes in the disease burden due to environmental change and management implementation. The state-of-the-art research that can contribute to the development of the framework at the large scale is analysed, together with research gaps and opportunities for future research. Priorities have been identified and these include implementation of Quantitative Microbial Risk Assessment and application of the models in scenario analyses. The credibility of the model outputs should be central in the analysis, for example by developing stochastic models. Implementation of the framework contributes towards achieving the Sustainable Development Goals.

Cryptosporidium is a leading cause of diarrhoea and infant mortality worldwide. A better understanding of the sources, fate and transport of Cryptosporidium via rivers is important for effective management of waterborne transmission, especially in the developing world. We present GloWPa-Crypto C1, the first global, spatially explicit model that computes Cryptosporidium concentrations in rivers, implemented on a 0.5 × 0.5° grid and monthly time step. To this end, we first modelled Cryptosporidium inputs to rivers from human faeces and animal manure. Next, we use modelled hydrology from a grid-based macroscale hydrological model (the Variable Infiltration Capacity model). Oocyst transport through the river network is modelled using a routing model, accounting for temperature- and solar radiation-dependent decay and sedimentation along the way. Monthly average oocyst concentrations are predicted to range from 10⁻⁶ to 10² oocysts L⁻¹ in most places. Critical regions (‘hotspots’) with high concentrations include densely populated areas in India, China, Pakistan and Bangladesh, Nigeria, Algeria and South Africa, Mexico, Venezuela and some coastal areas of Brazil, several countries in Western and Eastern Europe (incl. The UK, Belgium and Macedonia), and the Middle East. Point sources (human faeces) appears to be a more dominant source of pollution than diffuse sources (mainly animal manure) in most world regions. Validation shows that GloWPa-Crypto medians are mostly within the range of observed concentrations. The model generally produces concentrations that are 1.5–2 log10 higher than the observations. This is likely predominantly due to the absence of recovery efficiency of the observations, which are therefore likely too low. Goodness of fit statistics are reasonable. Sensitivity analysis showed that the model is most sensitive to changes in input oocyst loads. GloWPa-Crypto C1 paves the way for many new opportunities at the global scale, including scenario analysis to investigate the impact of global change and management options on oocysts concentrations in rivers, and risk analysis to investigate human health risk.

Group A rotaviruses (RV) are the major cause of acute gastroenteritis in infants and young children globally. Waterborne transmission of RV and the presence of RV in water sources are of major public health importance. In this paper, we present the Global Waterborne Pathogen model for RV (GloWPa-Rota model) to estimate the global distribution of RV emissions to surface water. To our knowledge, this is the first model to do so. We review the literature to estimate three RV specific variables for the model: incidence, excretion rate and removal during wastewater treatment. We estimate total global RV emissions to be 2 × 10¹⁸ viral particles/grid/year, of which 87% is produced by the urban population. Hotspot regions with high RV emissions are urban areas in densely populated parts of the world, such as Bangladesh and Nigeria, while low emissions are found in rural areas in North Russia and the Australian desert. Even for industrialized regions with high population density and without tertiary treatment, such as the UK, substantial emissions are estimated. Modeling exercises like the one presented in this paper provide unique opportunities to further study these emissions to surface water, their sources and scenarios for improved management.