Accessibility to abundant sources of high-quality water is integral to the production of safe and wholesome fresh produce. However, access to safe water is becoming increasingly difficult in many parts of the world, and this can lead to the production of fresh produce contaminated with pathogenic microorganisms, resulting in increased risk of human disease. Water, an important raw material in the fresh produce chain, is used in considerable amounts in many operations, including irrigation and application of pesticides and fertilizers, but also as a transport medium and for cooling and washing in postharvest practices. In several reported outbreaks related to uncooked fruit and vegetable products, water has been identified as a likely source of the outbreak. The present study, initiated by the ILSI Europe Emerging Microbiological Issues Task Force in collaboration with 8 other ILSI branches and support of WHO/FAO, was undertaken to review the status of, and provide suggestions for, consideration by different stakeholders on water and sanitation and its impact on food safety and public health. A limited number of guidelines and regulations on water quality for agricultural production are available, and many of them are still heavily based on microbial standards and (debated) parameters such as fecal coliforms. Data gaps have been identified with regard to baseline studies of microbial pathogens in water sources in many regions, the need for agreement on methods and microbial parameters to be used in assessing water quality, the fate of pathogens in water, and their transfer and persistence on irrigated/processed produce.

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The COVID-19 pandemic placed hygiene at the centre of disease prevention. Yet, access to the levels of water supply that support good hand hygiene and institutional cleaning, our understanding of hygiene behaviours, and access to soap are deficient in low-, middle- and high-income countries. This paper reviews the role of water, sanitation and hygiene (WaSH) in disease emergence, previous outbreaks, combatting COVID-19 and in preparing for future pandemics. We consider settings where these factors are particularly important and identify key preventive contributions to disease control and gaps in the evidence base. Urgent substantial action is required to remedy deficiencies in WaSH, particularly the provision of reliable, continuous piped water on-premises for all households and settings. Hygiene promotion programmes, underpinned by behavioural science, must be adapted to high-risk populations (such as the elderly and marginalised) and settings (such as healthcare facilities, transport hubs and workplaces). WaSH must be better integrated into preparation plans and with other sectors in prevention efforts. More finance and better use of financing instruments would extend and improve WaSH services. The lessons outlined justify no-regrets investment by government during recovery from the current pandemic to improve day-to-day lives and as preparedness for future pandemics.

Few studies have assessed risk factors for sporadic cryptosporidiosis in industrialized countries, even though it may be numerically more common than outbreaks of disease. We carried out case-control studies assessing risk factors for sporadic disease in Melbourne and Adelaide, which have water supplies from different ends of the raw water spectrum. In addition to examining drinking water, we assessed several other exposures. 201 cases and 795 controls were recruited for Melbourne and 134 cases and 536 controls were recruited for Adelaide. Risk factors were similar for the two cities, with swimming in public pools and contact with a person with diarrhoea being most important. The consumption of plain tap water was not found to be associated with disease. This study emphasizes the need for regular public health messages to the public and swimming pool managers in an attempt to prevent sporadic cryptosporidiosis, as well as outbreaks of disease.