Fluoroquinolones are a valuable synthetic antibacterial class widely used in the treatment of infectious diseases both in humans and animals. Until recently, it has been thought that bacterial resistance to fluoroquinolones develops very slowly. Nowadays, there are multiple studies that reveal the alarming occurrence of bacterial resistance and there is a high risk of becoming therapeutically useless. The emergence of this phenomenon comes from injudicious usage in therapy, the presence of residues and their metabolites in food of animal origin and also in sewage, compost and domestic waste, which end up in soil and water sources. In the present paper, we reviewed important issues regarding fluoroquinolones impact on the environment in connection with the development of bacterial resistance: (1) the presence of fluoroquinolones as pollutants in soil, surface waters, and food. Fluoroquinolones are persistent with high specificity to interact with soil compared to other antibiotics. Pollution of water sources raises concerns regarding the effects of small concentrations (ng L⁻¹) on human health and also of the environment. The non-therapeutic use in animal farms conducts to food pollution; the cultivated plants could concentrate the fluoroquinolones (over 100 μg L⁻¹); (2) the increase of bacterial resistance to fluoroquinolones occurring with specific mutations in the target enzymes as well by the plasmid-mediated resistance and active efflux of the cell; (3) international regulations of the fluoroquinolone residues in food that are far to encompass all compounds; (4) fluoroquinolones residues analysis with standardized methods should provide limits of detection lower than maximum residue limit values; and (5) trends and perspectives: (a) a wider process of harmonization of regulations; (b) the fluoroquinolones restriction, necessary for low levels of bacterial resistance; (c) the soil and waste water purification methods; (d) the practice of soil planting scheme as an alternative; and (e) an environmental label in order to facilitate the selection of drugs.

Composite health measures are increasingly applied in studies aiming at describing the burden of diseases, and food and water-borne diseases (FWDs) are no exception. The Burden of Communicable Diseases in Europe (BCoDE) is a project led and funded by the European Centre for Disease Prevention and Control (ECDC) with the purpose of encouraging and empowering public health experts in the estimation of the impact of communicable diseases expressed in Disability Adjusted Life Years (DALYs). Calculation of DALYs and a critical assessment of burden of disease outputs require a thorough consideration of a number of methodological and epidemiological decisions ranging from modelling (e.g. incidence versus prevalence), disease model parameters (e.g. risks of developing complications or death) and the data feeding the number of cases.Burden of disease studies produce useful results for public health decision-making, in particular when they aim at informing preventive strategies. For this purpose, we attributed FWDs results from the BCoDE 2015 study to different exposure routes. We discuss these in the more general perspective of generating burden of disease evidence for planning and prioritisation, including the potentials and limitations of its methodology.

The high number of people moving around by ferries and cruise ships in conjunction with great amounts of food and potable water transported (occasionally overloaded) and consumed by passengers constitute a possible risk for communicable diseases. Another issue of equally great importance is the food handlers who come from diverse origin and have a different mentality, habits, and background. In this paper an attempt is made to present comparatively EU and US legislation that could be potentially applicable to passenger ships food premises and potable water supplies. Moreover, food and water related hazards, not currently covered by EU legislation, were assessed together with US legislation and other guidelines for cruise ships.

This paper provides a view of the major facts and figures related to infectious diseases with a focus on food-borne and water-borne diseases and their link with environmental factors and climate change. The global burden of food-borne diseases for 31 selected hazards was estimated by the World Health Organization at 33 million disability-adjusted life years (DALYs) in 2010 with 40% of this burden concentrated among children under 5 years of age. The highest burden per population of food-borne diseases is found in Africa, followed by Southeast Asia and the Eastern Mediterranean sub-regions. Unsafe water used for the cleaning and processing of food is a key risk factors contributing to food-borne diseases. The role of quality and quantity of water to the general burden of infectious diseases deserves attention, particularly in low- and middle-income countries, as its effects go beyond the food chain. Water-related infectious diseases are a major cause of mortality and morbidity worldwide, and climate change effects will exacerbate the challenges for the public health sector for both food-borne and water-borne diseases. Selected case studies from Africa and Asia show that (i) climate change extreme events, such as floods, may exacerbate the risks for infectious diseases spreading through water systems, and (ii) improvements related to drinking water, sanitation and hygiene could result in a significant reduction of intestinal parasitic infections among school-aged children. There is a need to better anticipate the impacts of climate change on infectious diseases and fostering multi-stakeholder engagement and multi-sectoral collaborations for integrated interventions at schools, community and household levels. The paper calls for giving priority to improving the environmental conditions affecting food-borne and water-borne infectious diseases under climate change.