The coronavirus disease 2019 pandemic highlighted the need for more rapid and routine application of modeling approaches such as quantitative microbial risk assessment (QMRA) for protecting public health. QMRA is a transdisciplinary science dedicated to understanding, predicting, and mitigating infectious disease risks. To better equip QMRA researchers to inform policy and public health management, an Advances in Research for QMRA workshop was held to synthesize a path forward for QMRA research. We summarize insights from 41 QMRA researchers and experts to clarify the role of QMRA in risk analysis by (1) identifying key research needs, (2) highlighting emerging applications of QMRA; and (3) describing data needs and key scientific efforts to improve the science of QMRA. Key identified research priorities included using molecular tools in QMRA, advancing dose–response methodology, addressing needed exposure assessments, harmonizing environmental monitoring for QMRA, unifying a divide between disease transmission and QMRA models, calibrating and/or validating QMRA models, modeling co-exposures and mixtures, and standardizing practices for incorporating variability and uncertainty throughout the source-to-outcome continuum. Cross-cutting needs identified were to: develop a community of research and practice, integrate QMRA with other scientific approaches, increase QMRA translation and impacts, build communication strategies, and encourage sustainable funding mechanisms. Ultimately, a vision for advancing the science of QMRA is outlined for informing national to global health assessments, controls, and policies.@en

Faecal contamination across the lettuce value chain was assessed in Maputo, Mozambique. Escherichia coli was used as an indicator of faecal contamination, with concentrations ranging from 3.4 to 5.7 log units/100 ml in groundwater, river water and partially treated wastewater. Municipal tap water used to wash lettuce heads in the markets had lower than 1 log unit/100 ml. Irrespective of the source of irrigation water, the lettuce heads were contaminated throughout the value chain, with concentrations ranging between 6.5 and 7.8 log units/100 g. Interventions and awareness raising should be applied at every stage of the value chain.

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Short-term fecal pollution events are a major challenge for managing microbial safety at recreational waters. Long turn-over times of current laboratory methods for analyzing fecal indicator bacteria (FIB) delay water quality assessments. Data-driven models have been shown to be valuable approaches to enable fast water quality assessments. However, a major barrier towards the wider use of such models is the prevalent data scarcity at existing bathing waters, which questions the representativeness and thus usefulness of such datasets for model training. The present study explores the ability of five data-driven modelling approaches to predict short-term fecal pollution episodes at recreational bathing locations under data scarce situations and imbalanced datasets. The study explicitly focuses on the potential benefits of adopting an innovative modeling and risk-based assessment approach, based on state/cluster-based Bayesian updating of FIB distributions in relation to different hydrological states. The models are benchmarked against commonly applied supervised learning approaches, particularly linear regression, and random forests, as well as to a zero-model which closely resembles the current way of classifying bathing water quality in the European Union. For model-based clustering we apply a non-parametric Bayesian approach based on a Dirichlet Process Mixture Model. The study tests and demonstrates the proposed approaches at three river bathing locations in Germany, known to be influenced by short-term pollution events. At each river two modelling experiments (“longest dry period”, “sequential model training”) are performed to explore how the different modelling approaches react and adapt to scarce and uninformative training data, i.e., datasets that do not include event pollution information in terms of elevated FIB concentrations. We demonstrate that it is especially the proposed Bayesian approaches that are able to raise correct warnings in such situations (> 90 % true positive rate). The zero-model and random forest are shown to be unable to predict contamination episodes if pollution episodes are not present in the training data. Our research shows that the investigated Bayesian approaches reduce the risk of missed pollution events, thereby improving bathing water safety management. Additionally, the approaches provide a transparent solution for setting minimum data quality requirements under various conditions. The proposed approaches open the way for developing data-driven models for bathing water quality prediction against the reality that data scarcity is common problem at existing and prospective bathing waters.

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Drinking water distribution systems are increasingly vulnerable to sewage intrusion due to aging water infrastructure and intensifying water stress. While the health risks associated with sewage intrusion have been extensively studied, little is known about the impacts of intruded bacteria and dissolved organic matter (DOM) on microbiology in drinking water. In this dynamic study, we demonstrate that the intrusion of 1 % sewage into tap water resulted in immediate contamination, including an 8-fold increase in biomass (TCC), a 48.9 % increase in bacterial species (ASVs), a 12.5 % increase in organic carbon content (DOC), and a 13.5 % increase in unique DOM molecular formulae. Over time, sewage intrusion altered tap water microbiology by accelerating bacterial growth rates (5-fold faster), selectively promoting ASVs in community succession, and producing 998 more unique DOM formulae. More significantly, statistical analysis revealed that the intrusion of 1 % sewage shifted the driving force of bacterial and DOM composition covariance from a DOM-dependent process in tap water to a bacterial-governed process post-intrusion. Our results clearly demonstrate the disruptive effects of sewage intrusion into tap water, emphasizing the urgent need to consider the long-lasting impacts of sewage intrusion in drinking water distribution systems, in addition to its immediate health risks.

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Escherichia coli (E. coli) plays a central role as an indicator for fecal contamination to predict the possible presence of microbial pathogens in drinking water. Current detection methods for E. coli are based on time-consuming culture-based techniques. There is a strong need for methods to detect fecal contamination rapidly in distributed drinking water to prevent outbreaks of waterborne disease and support water utilities to efficiently manage their operations like actions to repair or maintain distribution pipes, to minimize impact on consumers. This study describes the validation and application of a qualitative real time reverse transcription PCR (RT-PCR) method targeting 16S ribosomal RNA (rRNA) for rapid detection of E. coli in distributed drinking water. The RT-PCR assay targets 16S rRNA, a highly abundant RNA in viable cells, enabling robust detection at the required sensitivity of 1 CFU/100 ml. The validation was performed by comparing the RT-PCR method with the culture-based chromogenic reference method (CCA) using the protocol and criteria described in ISO 16,140–2:2016. The validation demonstrated that this RT-PCR method can be used to specifically detect E. coli in a broad range of drinking water samples with at least the same limit of detection as the culture method (Relative Limit Of Detection = 0.75, range 0.43–1.43). The inclusivity study showed that the RT-PCR method was able to detect a broad range of E. coli strains derived from different sources and geographic areas, including pathogenic serotype O157 strains that are not detected with the culture method. The exclusivity study determined that other bacterial genera are not detected with this RT-PCR. However, Escherichia fergusonii was detected and, based on “in silico” analysis, it is expected that also E. albertii and E. marmotae and Shigella species will be detectable using this RT-PCR. An interlaboratory study confirmed that the RT-PCR and culture method have comparable sensitivities when tested by different participants at different laboratories. The application of RT-PCR to confirm the hygienic quality of distributed drinking water after actions to repair or maintain distribution pipes was compared with the culture method on 8076 routine samples, analyzed by the drinking water laboratories in the Netherlands. This comparison study showed a 96.4 % agreement between RT-PCR and culture. In 3.3 % of the samples E. coli was detected with RT-PCR and not with the culture method and in 0.1 % of the samples E. coli was only detected by culture confirming either a higher sensitivity for RT-PCR or the detection of RNA from uncultivable cells. Finally, the application of RT-PCR was highlighted during a contamination event in Belgium where we demonstrate the potency of RT-PCR as a tool to rapidly monitor the spread of microbial contamination and to monitor the effect of measures to remove the contamination This is the first fully validated rapid nucleic based method for detection of E. coli in distributed drinking water. These results demonstrate that this RT-PCR method can be used as a rapid alternative to the culture method to monitor E. coli in distributed drinking water. However, it should be emphasized that nucleic acid based detection methods rely on highly different detection principles (detection of captured nucleic acids present in a sample) than culture base methods (presence of cells cultivable on a selective medium) resulting in occasional different analysis results. Varying treatment and disinfection steps (UV, chlorine, monochloramine, Ozone) or environmental factors (decay) can influence the results and cause differences between RT-PCR and culture methods.@en

Pathogen intrusion in drinking water systems can pose severe health risks. To better prepare in planning and responding to such events, computational models that capture the intrusion and health impact dynamics are needed. This study presents a novel benchmark testbed that integrates current knowledge on pathogen transport and fate in chlorinated systems and can assess infection risk from contamination events. The model considers organic matter degradation, chlorine decay mechanisms, pathogen inactivation kinetics, as well as stochastic water demands. We studied modeling of wastewater intrusion events that can occur anywhere within a chlorinated and non-chlorinated network. We applied the Quantitative Microbial Risk Assessment framework focusing on three pathogens: enterovirus, Campylobacter, and Cryptosporidium, and their respective dose-response models. Synthetic household-level water demand time series were used to model the individual water consumption timing and calculate the infection risk (exposure via ingestion). Model outcomes indicate that while chlorination aids mitigation, larger contaminations can still lead to infections due to chlorine resistance (for Cryptosporidium) and chlorine depletion at the contamination point. In our example scenarios, chlorine-susceptible pathogens infected 0.78–26.6% of the downstream population, while chlorine-resistant ones infected the entire downstream population. Enterovirus infection risk is higher, despite the concentrations in the contamination source being lower, due to the lower susceptibility to chlorine than Campylobacter. In non-chlorinated networks, the modeled wastewater contamination events led to 11–46% infection risk in the total population, depending on the contamination location. Hydraulic uncertainty had a limited influence on infection risk. Furthermore, Campylobacter's infection risk is more sensitive to the initial concentration in the contamination source whereas enterovirus infection risk to the inactivation rate. The model further indicates that the time window for effective mitigation of the magnitude of a waterborne outbreak is short (within hours).

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Background
Wastewater surveillance may support early and comprehensive detection of infectious diseases’ community transmission, particularly in settings where other health surveillance systems provide biased or limited information. Amid the SARS-CoV-2 pandemic, deploying passive samplers to monitor targeted populations gained importance. Evaluation of the added public health value of this approach in the field can support its broader adoption.

Aim
We aimed to assess the feasibility and utility of on-demand wastewater surveillance, employing passive samplers, for SARS-CoV-2 and monkeypox virus (MPXV) in small/targeted populations, also considering ethical aspects.

Methods
Pilot case studies in the Rotterdam-Rijnmond region were used for a systematic assessment of the feasibility and utility of wastewater monitoring of SARS-CoV-2 (variants) and MPXV using passive sampling. Each case study was instigated by actual questions from the Public Health Service about disease transmission.

Results
Case study results demonstrated the feasibility and utility of on-demand wastewater surveillance with successful identification of a local peak in SARS-CoV-2 transmission, early detection of wider Omicron variant transmission after the first case was reported, as well as indication of no emerging local MPXV transmission. Ethical considerations led to the abandonment of one case study involving a displaced population.

Conclusions
The study confirms the feasibility and utility of passive sampling for real-time infectious disease surveillance, at desired spatiotemporal resolution. Ethical concerns and operational challenges were identified, highlighting the need for early stakeholder engagement and ethical guideline adherence. The method could be used to study under-surveyed populations and be extended beyond SARS-CoV-2 and MPXV to other pathogens.@en

Although simulated studies have provided valuable knowledge regarding the communities of planktonic bacteria and biofilms, the lack of systematic field studies have hampered the understanding of microbiology in real-world service lines and premise plumbing. In this study, the bacterial communities of water and biofilm were explored, with a special focus on the lifetime development of biofilm communities and their key influencing factors. The 16S rRNA gene sequencing results showed that both the planktonic bacteria and biofilm were dominated by Proteobacteria. Among the 15,084 observed amplicon sequence variants (ASVs), the 33 core ASVs covered 72.8 %, while the 12 shared core ASVs accounted for 62.2 % of the total sequences. Remarkably, it was found that the species richness and diversity of biofilm communities correlated with pipe age. The relative abundance of ASV2 (f_Sphingomonadaceae) was lower for pipe ages 40–50 years (7.9 %) than for pipe ages 10–20 years (59.3 %), while the relative abundance of ASV10 (f_Hyphomonadaceae) was higher for pipe ages 40–50 years (19.5 %) than its presence at pipe ages 20–30 years (1.9 %). The community of the premise plumbing biofilm had significantly higher species richness and diversity than that of the service line, while the steel-plastics composite pipe interior lined with polyethylene (S-PE) harbored significantly more diverse biofilm than the galvanized steel pipes (S-Zn). Interestingly, S-PE was enriched with ASV27 (g_Mycobacterium), while S-Zn pipes were enriched with ASV13 (g_Pseudomonas). Moreover, the network analysis showed that five rare ASVs, not core ASVs, were keystone members in biofilm communities, indicating the importance of rare members in the function and stability of biofilm communities. This manuscript provides novel insights into real-world service lines and premise plumbing microbiology, regarding lifetime dynamics (pipe age 10–50 years), and the influences of pipe types (premise plumbing vs. service line) and pipe materials (S-Zn vs. S-PE).

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Despite high vaccination rates in the Netherlands, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to circulate. Longitudinal sewage surveillance was implemented along with the notification of cases as two parts of the surveillance pyramid to validate the use of sewage for surveillance, as an early warning tool, and to measure the effect of interventions. Sewage samples were collected from nine neighborhoods between September 2020 and November 2021. Comparative analysis and modeling were performed to understand the correlation between wastewater and case trends. Using high resolution sampling, normalization of wastewater SARS-CoV-2 concentrations, and ‘normalization’ of reported positive tests for testing delay and intensity, the incidence of reported positive tests could be modeled based on sewage data, and trends in both surveillance systems coincided. The high collinearity implied that high levels of viral shedding around the onset of disease largely determined SARS-CoV-2 levels in wastewater, and that the observed relationship was independent of variants of concern and vaccination levels. Sewage surveillance alongside a large-scale testing effort where 58 % of a municipality was tested, indicated a five-fold difference in the number of SARS-CoV-2-positive individuals and reported cases through standard testing. Where trends in reported positive cases were biased due to testing delay and testing behavior, wastewater surveillance can objectively display SARS-CoV-2 dynamics for both small and large locations and is sensitive enough to measure small variations in the number of infected individuals within or between neighborhoods. With the transition to a post-acute phase of the pandemic, sewage surveillance can help to keep track of re-emergence, but continued validation studies are needed to assess the predictive value of sewage surveillance with new variants. Our findings and model aid in interpreting SARS-CoV-2 surveillance data for public health decision-making and show its potential as one of the pillars of future surveillance of (re)emerging viruses.

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A year since the declaration of the global coronavirus disease 2019 (COVID-19) pandemic, there were over 110 million cases and 2.5 million deaths. Learning from methods to track community spread of other viruses such as poliovirus, environmental virologists and those in the wastewater-based epidemiology (WBE) field quickly adapted their existing methods to detect SARS-CoV-2 RNA in wastewater. Unlike COVID-19 case and mortality data, there was not a global dashboard to track wastewater monitoring of SARS-CoV-2 RNA worldwide. This study provides a 1-year review of the “COVIDPoops19” global dashboard of universities, sites, and countries monitoring SARS-CoV-2 RNA in wastewater. Methods to assemble the dashboard combined standard literature review, Google Form submissions, and daily, social media keyword searches. Over 200 universities, 1400 sites, and 55 countries with 59 dashboards monitored wastewater for SARS-CoV-2 RNA. However, monitoring was primarily in high-income countries (65%) with less access to this valuable tool in low- and middle-income countries (35%). Data were not widely shared publicly or accessible to researchers to further inform public health actions, perform meta-analysis, better coordinate, and determine equitable distribution of monitoring sites. For WBE to be used to its full potential during COVID-19 and beyond, show us the data.

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Biofilm detachment contributes to water quality deterioration. However, the contributions of biofilm detachment from different pipes have not been quantified or compared. Following the introduction of partial reverse osmosis (RO) in drinking water production, this study analyzed particles at customers’ ends and tracked their origins to water distribution mains and service lines. For doing so, filter bags were installed in front of water meters to capture upstream detached particles, while biofilm from water main and service line were sampled by cutting pipe specimens. The results showed that elemental concentrations of the biofilm in mains were higher than those of service lines (54.3–268.5 vs. 27.1–44.4 μg/cm2), both dominated by Ca. Differently, filter bags were dominated by Fe/Mn (77.5–98.1%). After introducing RO, Ca significantly decreased in biofilms of mains but not service lines, but the released Fe/Mn rather than Ca arrived at customers’ ends. The ATP concentrations of service lines were higher than mains, which decreased on mains but increased in service lines after introducing RO. For the core ASVs, 13/24 were shared by service lines (17), mains (21), and filter bags (17), which were assigned mainly to Nitrospira spp., Methylomagnum spp., Methylocytis spp., and IheB2–23 spp. According to source tracking results, service lines contributed more than mains to the particulate material collected by filter bags (57.6 ± 13.2% vs. 13.0 ± 11.6%). To the best of our knowledge, the present study provides the first evidence of service lines’ direct and quantitative contributions to potential water quality deterioration at customers’ ends. This highlights the need for the appropriate management of long-neglected service line pipes, e.g., regarding material selection, length optimization, and proper regulation.@en

Agricultural aquifer storage recovery and transfer (ASTR) stores excess fresh water for later reuse in irrigation. Moreover, water quality improves because chemical pollutants and pathogens will be removed by degradation and attachment to the aquifer material. The source water may contain the bacterial plant pathogen Ralstonia solanacearum which causes plant infections and high yield losses. We used quantitative microbial risk assessment (QMRA) to investigate the removal of R. solanacearum during ASTR to predict infection risks of potato plants after irrigation with the recovered water. Laboratory experiments analyzed the ASTR treatment by investigating the bacterial die-off in the water phase and the removal by attachment to the aquifer sediment. Die-off in the water phase depends on the residence time and ranged between 1.3 and 2.7 log₁₀ after 10 or 60 days water storage, respectively. A subpopulation of the bacteria persisted for a prolonged time at low concentrations which may pose a risk if the water is recovered too early. However, the natural aquifer sand filtration proofed to be highly effective in removing R. solanacearum by attachment which depends on the distance between injection and abstraction well. The high removal by attachment alone (18 log₁₀ after 1 m) would reduce bacterial concentrations to negligible numbers. Upscaling to longer soil passages is discussed in the paper. Infection risks of potato plants were calculated using a dose-response model and ASTR treatment resulted in negligible infection risks of a single plant, but also when simulating the irrigation of a 5 ha potato field. This is the first QMRA that analyzed an agricultural ASTR and the fate of a plant pathogen focusing on plant health. QMRA is a useful (water) management tool to evaluate the treatment steps of water reclamation technologies with the aim to provide safe irrigation water and reduce risks disseminating plant diseases.

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Monitoring of SARS-CoV-2 in wastewater (WW) is a promising tool for epidemiological surveillance, correlating not only viral RNA levels with the infection dynamics within the population, but also to viral diversity. However, the complex mixture of viral lineages in WW samples makes tracking of specific variants or lineages circulating in the population a challenging task. We sequenced sewage samples of 9 WW-catchment areas within the city of Rotterdam, used specific signature mutations from individual SARS-CoV-2 lineages to estimate their relative abundances in WW and compared them against those observed in clinical genomic surveillance of infected individuals between September 2020 and December 2021. We showed that especially for dominant lineages, the median of the frequencies of signature mutations coincides with the occurrence of those lineages in Rotterdam's clinical genomic surveillance. This, along with digital droplet RT-PCR targeting signature mutations of specific variants of concern (VOCs), showed that several VOCs emerged, became dominant and were replaced by the next VOC in Rotterdam at different time points during the study. In addition, single nucleotide variant (SNV) analysis provided evidence that spatio-temporal clusters can also be discerned from WW samples. We were able to detect specific SNVs in sewage, including one resulting in the Q183H amino acid change in the Spike gene, that was not captured by clinical genomic surveillance. Our results highlight the potential use of WW samples for genomic surveillance, increasing the set of epidemiological tools to monitor SARS-CoV-2 diversity.@en

Natural organic matter (NOM) is present in water matrix that serves as a drinking water source. This study examined the effect of low and high NOM concentrations on inactivation kinetics of a model RNA virus (MS2) and a model DNA virus (PhiX 174) by copper (Cu²⁺) and/or silver (Ag⁺) ions. Cu and Ag are increasingly applied in household water treatment (HHWT) systems. However, the impact of NOM on their inactivation kinetics remains elusive despite its importance for their application. The presence of NOM in water led to faster virus inactivation by Cu²⁺ but slower by Ag⁺. The fastest inactivation kinetics of MS2 (K_obs = 4.8 h⁻¹) were observed by Cu in water containing high NOM (20 mg C/L). Meanwhile, for PhiX 174, the fastest inactivation kinetics (av. K_obs = 3.5 h⁻¹) were observed by Cu and Ag synergism in water containing high NOM. Altogether, it can be concluded that the combination of Cu and Ag is promising as a virus disinfectant in treatment options allowing for multiple hours of residence time such as safe water storage tanks.

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Over the course of the Corona Virus Disease-19 (COVID-19) pandemic in 2020–2022, monitoring of the severe acute respiratory syndrome coronavirus 2 ribonucleic acid (SARS-CoV-2 RNA) in wastewater has rapidly evolved into a supplementary surveillance instrument for public health. Short term trends (2 weeks) are used as a basis for policy and decision making on measures for dealing with the pandemic. Normalisation is required to account for the dilution rate of the domestic wastewater that can strongly vary due to time- and location-dependent sewer inflow of runoff, industrial discharges and extraneous waters. The standard approach in sewage surveillance is normalisation using flow measurements, although flow based normalisation is not effective in case the wastewater volume sampled does not match the wastewater volume produced. In this paper, two alternative normalisation methods, using electrical conductivity and crAssphage have been studied and compared with the standard approach using flow measurements. For this, a total of 1116 24-h flow-proportional samples have been collected between September 2020 and August 2021 at nine monitoring locations. In addition, 221 stool samples have been analysed to determine the daily crAssphage load per person. Results show that, although crAssphage shedding rates per person vary greatly, on a population-level crAssphage loads per person per day were constant over time and similar for all catchments. Consequently, crAssphage can be used as a quantitative biomarker for populations above 5595 persons. Electrical conductivity is particularly suitable to determine dilution rates relative to dry weather flow concentrations. The overall conclusion is that flow normalisation is necessary to reliably determine short-term trends in virus circulation, and can be enhanced using crAssphage and/or electrical conductivity measurement as a quality check.

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Premise plumbing plays an essential role in determining the final quality of drinking water consumed by customers. However, little is known about the influences of plumbing configuration on water quality changes. This study selected parallel premise plumbing in the same building with different configurations, i.e., laboratory and toilet plumbing. Water quality deteriorations induced by premise plumbing under regular and interrupted water supply were investigated. The results showed that most of the water quality parameters did not vary under regular supply, except Zn, which was significantly increased by laboratory plumbing (78.2 to 260.7 µg/l). For the bacterial community, the Chao1 index was significantly increased by both plumbing types to a similar level (52 to 104). Laboratory plumbing significantly changed the bacterial community, but toilet plumbing did not. Remarkably, water supply interruption/restoration led to serious water quality deterioration in both plumbing types but resulted in different changes. Physiochemically, discoloration was observed only in laboratory plumbing, along with sharp increases in Mn and Zn. Microbiologically, the increase in ATP was sharper in toilet plumbing than in laboratory plumbing. Some opportunistic pathogen-containing genera, e.g., Legionella spp. and Pseudomonas spp., were present in both plumbing types but only in disturbed samples. This study highlighted the esthetic, chemical, and microbiological risks associated with premise plumbing, for which system configuration plays an important role. Attention should be given to optimizing premise plumbing design for managing building water quality.

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Irrigation with surface water carrying plant pathogens poses a risk for agriculture. Managed aquifer recharge enhances fresh water availability while simultaneously it may reduce the risk of plant diseases by removal of pathogens during aquifer passage. We compared the transport of three plant pathogenic bacteria with Escherichia coli WR1 as reference strain in saturated laboratory column experiments filled with quartz sand, or sandy aquifer sediments. E. coli showed the highest removal, followed by Pectobacterium carotovorum, Dickeya solani and Ralstonia solanacearum. Bacterial and non-reactive tracer breakthrough curves were fitted with Hydrus-1D and compared with colloid filtration theory (CFT). Bacterial attachment to fine and medium aquifer sand under anoxic conditions was highest with attachment rates of max. k _att1 = 765 day ^-1 and 355 day ^-1, respectively. Attachment was the least to quartz sand under oxic conditions (k _att1 = 61 day ^-1). In CFT, sticking efficiencies were higher in aquifer than in quartz sand but there was no differentiation between fine and medium aquifer sand. Overall removal ranged between < 6.8 log ₁₀ m ⁻¹ in quartz and up to 40 log ₁₀ m ⁻¹ in fine aquifer sand. Oxygenation of the anoxic aquifer sediments for two weeks with oxic influent water decreased the removal. The results highlight the potential of natural sand filtration to sufficiently remove plant pathogenic bacteria during aquifer storage.

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Norovirus infections are among the major causes of acute gastroenteritis worldwide. In Germany, norovirus infections are the most frequently reported cause of gastroenteritis, although only laboratory confirmed cases are officially counted. The high infectivity and environmental persistence of norovirus, makes the virus a relevant pathogen for water related infections. In the 2017 guidelines for potable water reuse, the World Health Organization proposes Norovirus as a reference pathogen for viral pathogens for quantitative microbial risk assessment (QMRA). A challenge for QMRA is, that norovirus data are rarely available over long monitoring periods to assess inter-annual variability of the associated health risk, raising the question about the relevance of this source of variability regarding potential risk management alternatives. Moreover, norovirus infections show high prevalence during winter and early spring and lower incidence during summer. Therefore, our objective is to derive risk scenarios for assessing the potential relevance of the within and between year variability of norovirus concentrations in municipal wastewater for the assessment of health risks of fieldworkers, if treated wastewater is used for irrigation in agriculture. To this end, we use the correlation between norovirus influent concentration and reported epidemiological incidence (R²=0.93), found at a large city in Germany. Risk scenarios are subsequently derived from long-term reported epidemiological data, by applying a Bayesian regression approach. For assessing the practical relevance for wastewater reuse we apply the risk scenarios to different irrigation patterns under various treatment options, namely “status-quo” and “irrigation on demand”. While status-quo refers to an almost all-year irrigation, the latter assumes that irrigation only takes place during the vegetation period from May - September. Our results indicate that the log-difference of infection risks between scenarios may vary between 0.8 and 1.7 log given the same level of pre-treatment. They also indicate that under the same exposure scenario the between-year variability of norovirus infection risk may be > 1log, which makes it a relevant factor to consider in future QMRA studies and studies which aim at evaluating safe water reuse applications. The predictive power and wider use of epidemiological data as a suitable predictor variable should be further validated with paired multi-year data.

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An outbreak of SARS-CoV-2 Alpha variant (Pango lineage B.1.1.7) was detected at a primary school (School X) in Lansingerland, the Netherlands, in December 2020. The outbreak was studied retrospectively, and population-based screening was used to assess the extent of virus circulation and decelerate transmission. Cases were SARS-CoV-2 laboratory confirmed and were residents of Lansingerland (November 16th 2020 until February 22th 2021), or had an epidemiological link with School X or neighbouring schools. The SARS-CoV-2 variant was determined using variant PCR or whole genome sequencing. A questionnaire primarily assessed clinical symptoms. A total of 77 Alpha variant cases were found with an epidemiological link to School X, 16 Alpha variant cases linked to the neighbouring schools, and 146 Alpha variant cases among residents of Lansingerland without a link to the schools. The mean number of self-reported symptoms was not significantly different among Alpha variant infected individuals compared to non-Alpha infected individuals. The secondary attack rate (SAR) among Alpha variant exposed individuals in households was 52% higher compared to non-Alpha variant exposed individuals (p = 0.010), with the mean household age, and mean number of children and adults per household as confounders. Sequence analysis of 60 Alpha variant sequences obtained from cases confirmed virus transmission between School X and neighbouring schools, and showed that multiple introductions of the Alpha variant had already taken place in Lansingerland at the time of the study. The alpha variant caused a large outbreak at both locations of School X, and subsequently spread to neighbouring schools, and households. Population-based screening (together with other public health measures) nearly stopped transmission of the outbreak strain, but did not prevent variant replacement in the Lansingerland municipality.

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The aperiodic changes in the quantity and community of planktonic and particle-associated bacteria have hampered the understanding and management of microbiological water quality in drinking water distribution systems. In this study, online sampling was combined with the microbial fingerprint-based SourceTracker2 to capture and trace the spatiotemporal variations in planktonic and particle-associated bacteria in an unchlorinated distribution system. The results showed that spatially, the particle load significantly increased, while in contrast, the quantity of particle-associated bacteria decreased sharply from the treatment plant to the distribution network. Similar to the trend of particle-associated bacterial diversity, the number of observed OTUs first slightly decreased from the treatment plant to the transportation network and then sharply increased from the transportation network to the distribution network. The SourceTracker2 results revealed that the contribution of particle-associated bacteria from the treatment plant decreased along the distribution distance. The spatial results indicate the dominant role of sedimentation of particles from the treatment plant, while the observed increases in particles and the associated bacteria mainly originated from the distribution network, which were confirmed directly by the increased contributions of loose deposits and biofilm. Temporally, the daily peaks of particle-associated bacterial quantity, observed OTU number, and contributions of loose deposits and biofilms were captured during water demand peaks (e.g., 18–21 h). The temporal results reveal clear linkages between the distribution system harboring bacteria (e.g., within loose deposits and biofilms) and the planktonic and particle-associated bacteria flowing through the distribution system, which are dynamically connected and interact. This study highlights that the spatiotemporal variations in planktonic and particle-associated bacteria are valuable and unneglectable for the widely on-going sampling campaigns required by water quality regulations and/or drinking water microbiological studies.

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