From a health prospective, it is critical to provide a comprehensive model which integrates all the parameters involved in virus transmission and its consequences on human body. In order to estimate the health risks, for workers and residents, associated with an exposure airborne viruses emitted from a wastewater treatment (WWTP), the concentration levels of viruses in emitted bioaerosols over a twelve-month period were measured by real-time polymerase chain reaction (RT-PCR). A combined Gaussian plum dispersion model and quantitative microbial risk assessment (QMRA) with Monte-Carlo simulation served as suitable explanatory tools to estimate the risk of acquiring gastrointestinal illness (GI) due to exposure to air containing Rotavirus (RoV) and Norovirus (NoV) bioaerosols. Additionally, DALY metric was applied to quantify the disability and mortality for workers and residents. RoV and NoV were detected above aeration tank with annual mean concentration 27 and 3099 (Viruses/m³.h), respectively. The medium calculated DALY indicator based on viral loads in contaminant source (RoV:5.76 × 10⁻² and NoV:1.23 × 10⁻¹) and estimated in different distances away (300–1000 m) (RoV:2.87 × 10⁻²- 2.75 × 10⁻² and NoV:1.14 × 10⁻¹-1.13 × 10⁻¹) were markedly higher than the threshold values recommended by US EPA (10⁻⁴ DALY pppy) and WHO (10⁻⁶ DALY pppy). The sensitivity analysis highlighted dose exposure and disease burden per case (DBPC) as two most influential factors for both workers and residents following exposure to two pathogens of concern. Due to high resistance and high concentration in the environment, the presence of RoV and NoV can intensify the consequences of diarrhea especially for children under five years of age; A comprehensible and transparent presentation of DALYs and QMRA can help decision makers and responsibilities to justify the priorities of exposure to wastewater in comparison with other risks of daily life.

In Ireland, the land application of biosolids is the preferred option of disposing of municipal sewage waste. Biosolids provide nutrients in the form of nitrogen, phosphorus, potassium and increases organic matter. It is also an economic way for a country to dispose of its municipal waste. However, biosolids may potentially contain a wide range of pathogens, and following rainfall events, may be transported in surface runoff and pose a potential risk to human health. Thus, a quantitative risk assessment model was developed to estimate potential pathogens in surface water and the environmental fate of the pathogens following dilution, residence time in a stream, die-off rate, drinking water treatment and human exposure. Surface runoff water quality data was provided by project partners. Three types of biosolids, anaerobically digested (AD), lime stabilised (LS), and thermally dried (TD)) were applied on micro plots. Rainfall was simulated at three time intervals (24, 48 and 360 h) following land application. It was assumed that this water entered a nearby stream and was directly abstracted for drinking water. Consumption data for drinking water and body weight was obtained from an Irish study and assigned distributions. Two dose response models for probability of illness were considered for total and faecal coliform exposure incorporating two different exposure scenarios (healthy populations and immuno-compromised populations). The simulated annual risk of illness for healthy populations was below the US EPA and World Health Organisation tolerable level of risk (10⁻⁴ and 10⁻⁶, respectively). However, immuno-compromised populations may still be at risk as levels were greater than the tolerable level of risk for that subpopulation. The sensitivity analysis highlighted the importance of residence time in a stream on the bacterial die-off rate.

Profiling bathing waters supported by Quantitative Microbial Risk Assessment (QMRA) is key to the WHO's recommendations for the 2020/2021 revision of the European Bathing Water Directive. We developed an area-specific QMRA model on four pathogens, using fecal indicator concentrations (E. coli, enterococci) for calculating pathogen loads. The predominance of illness was found to be attributable to Human Adenovirus, followed by Salmonella, Vibrio, and Norovirus. Overall, the cumulative illness risk showed a median of around 1 case/10000 exposures. The risk estimates were strongly influenced by the indicators that were used, suggesting the need for a more detailed investigation of the different sources of fecal contamination. Area-specific threshold values for fecal indicators were estimated on a risk-basis by modelling the cumulative risk against E. coli and enterococci concentrations. To improve bathing waters assessment, we suggest considering source apportionment, locally estimating of pathogen/indicator ratios, and calculating site-specific indicators thresholds based on risk assessment.

This review examines the aims of and approaches to the Quantitative Microbial Risk Assessment (QMRA) of untreated recreational waters. The literature search was conducted on four databases and yielded 54 papers, which were analyzed on a quantitative (time-trend, geographical distribution, water type) and qualitative (aims, source of microbial data, pathogens and their measurement or estimation, ways to address variability and uncertainty, sensitivity analysis) basis. In addition, the parameters, implications, and limitations were discussed for each QMRA step. Since 2003, the number of papers has greatly increased, highlighting the importance of QMRA for the risk management of recreational waters. Nevertheless, QMRA still exhibits critical issues, above all regarding contamination data and dose-response relationships. To our knowledge, this is the first review to give a wide panoramic view on QMRA in relation to recreational exposure to untreated waters. This could be useful in identifying the current knowledge gaps and research needs.

Urban beaches are frequently impacted from multiple sources of fecal contamination. This along with high beach usage underscores the importance of appropriate management that protects swimmer health. The USEPA has enabled the use of QMRA as a tool for quantifying swimmer health risk and setting site-specific water quality objectives. This study illustrates the challenges associated with human and non-human source identification and how these challenges influence the decision of whether QMRA at typical urban beaches for water quality management is appropriate. In this study, a similar and correlated spatial relationship with elevated Enterococcus and avian-specific markers was observed, suggesting shorebirds as a primary source of FIB. However, human-associated markers were also detected frequently but at low concentrations. Ultimately, a QMRA was not conducted because pathogen loading from potential human sources could not be confidently quantified, having consequences for health risk in receiving waters where recreational contact occurs.

Anthropogenic contamination of beaches in the south of Brazil was assessed by detection of Escherichia coli, human mastadenovirus species C (HAdV-C) and F (HAdV-F) and hepatitis E virus (HEV). Sampling was carried out in October (2016), and in January, April and July (2017). Water, sediment, sea surface microlayer (SML), bivalves, and air sentinel samples were evaluated. Quantitative microbiological risk assessment (QMRA) was used to estimate the probability of swimmer infection. HAdV-C was present in 26% of the samples, for both qPCR and viral isolation. The highest rates of detection in genomic copies (GC) were in water (2.42E+10 GC/L), SML (2.08E+10 GC/L), sediment (3.82E+08 GC/g) and bivalves (3.91E+07 GC/g). QMRA estimated daily and annual risks with a maximum value (9.99E-01) in almost all of the samples. Viable HAdV-C was often detected in the SML, pointing that this is a source of infection for people bathing in these waters.

Marine beaches are important recreational and economic resources in Brazil, but the beaches' water quality is negatively impacted by the discharge of domestic sewage effluent. The occurrence of diarrheagenic Escherichia coli among the E. coli isolated from three Brazilian marine beaches was investigated. Multiplex and single step PCR were used to screen 99 E. coli isolates for ten target toxin genes. Six toxin genes, stx1, eae, estp, esth, astA, and bfpA, were identified in 1% to 35% of the isolates. A quantitative microbial risk assessment (QMRA) of human exposure to diarrheagenic E. coli during marine recreation was carried out. The results indicated that the diarrheagenic E. coli risk is well below the U.S. EPA's recommended daily recreational risk benchmark. However, the overall recreational health risk due to all pathogens in the water could be much higher and exceeded the U.S. EPA's benchmark.

Southern California is an increasingly urbanized hotspot for surfing, thus it is of great interest to assess the human illness risks associated with this popular ocean recreational water sport from exposure to fecal bacteria contaminated coastal waters. Quantitative microbial risk assessments were applied to eight popular Southern California beaches using readily available enterococcus and fecal coliform data and dose-response models to compare health risks associated with surfing during dry weather and storm conditions. The results showed that the level of gastrointestinal illness risks from surfing post-storm events was elevated, with the probability of exceeding the US EPA health risk guideline up to 28% of the time. The surfing risk was also elevated in comparison with swimming at the same beach due to ingestion of greater volume of water. The study suggests that refinement of dose-response model, improving monitoring practice and better surfer behavior surveillance will improve the risk estimation.

This study investigated the human risk of infection due to inadvertent ingestion of water during swimming in a river that receives SARS-CoV-2-containing effluent from a wastewater treatment plant (WWTP). A quantitative microbial risk assessment (QMRA) approach was applied for risk estimation using dose-response models (DRM) of different surrogate coronaviruses (SARS-CoV-1, MERS-CoV) and the virus responsible for most infectious respiratory illnesses (i.e., influenza A H5N1) due to the unavailability of DRM for SARS-CoV-2. The ratio of infectious concentration to genomic copies of SARS-CoV-2 is unknown and also unavailable for other coronaviruses. Therefore, literature-based information on enteric viruses was used for formulating the ratio used for QMRA, although it is acknowledged that identifying this information for SARS-CoV-2 is a priority, and in the absence of information specific to SARS-CoV-2, another coronavirus would be a preferable surrogate to the enteric viruses used here. The calculated concentration of ingested SARS-CoV-2 ranged between 4.6 × 10⁻⁷ and 80.5 genomic copies/dip (one swim = 32 mL). The risk of infection (> 9 × 10⁻¹² to 5.8 × 10⁻¹) was found to be > 1/10,000 annual risk of infection. Moreover, the study revealed that the risk estimation was largely dependent on the value of the molecular concentration of SARS-CoV-2 (gc/mL). Overall immediate attention is required for obtaining information on the (i) ratio of infectious virus to genomic copies, (ii) DRM for SARS-CoV-2, and (iii) virus reduction rate after treatment in the WWTPs. The QMRA structure used in present findings is helpful in analyzing and prioritizing upcoming health risks due to swimming performed in contaminated rivers during the COVID-19 outbreak.

Because of health concerns regarding the presence of enteric viruses in wastewater effluents, this study was designed to investigate the occurrence of human adenovirus (HAdV) in the irrigation water-soil-crop continuum. Viral particles were extracted from wastewater and wastewater- or water-irrigated soil and crop samples and analyzed using real-time PCR. Concentration of fecal indicator bacteria (FIB) were also determined. Quantitative microbial risk assessment was performed to determine the HAdV illness risk associated with the consumption of wastewater-irrigated vegetables. HAdV-F was detected in 74% of wastewater effluent samples with a mean concentration of 38 Genomic Copy (GC)/mL. HAdV was also detected in wastewater-irrigated soil (2 × 10² GC/g) and crop (< 10 GC/g) samples, with no statistically significant difference in concentrations between wastewater- and freshwater-irrigated samples. The results showed no correlation between concentrations of FIB and HAdV in the analyzed samples. Mean probability of illness risk from consumption of wastewater-irrigated vegetables was 4 × 10⁻¹ per person per year (pppy) which was about two orders of magnitude higher than the proposed value by WHO (10⁻³ pppy) for safe reuse of wastewater. This finding suggests that the wastewater reuse for irrigation of vegetables eaten raw could pose a threat to human health with respect to the risk of viral illness, signifying stricter management of wastewater reuse. However, because of uncertainties in the QMRA model, particularly the ratio of infectious to non-infectious virus particles, more data is required to validate the predicted risk. This information is especially important in arid and semi-arid regions where high temperatures, UV radiation intensity, and desiccation can efficiently inactivate microorganisms in the environment.