Quantitative Microbial Risk Assessment for Contaminated Private Wells in the Fractured Dolomite Aquifer of Kewaunee County, Wisconsin

Burch, Tucker R.; Stokdyk, Joel P.; Spencer, Susan K.; Kieke, Burney A.; Firnstahl, Aaron D.; Muldoon, Maureen A.; Borchardt, Mark A.

doi:10.1289/ehp7815

Cited by 24 publications

(39 citation statements)

References 29 publications

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“…Previous estimates for the risk of AGI from groundwater based on QMRA or epidemiology vary from 2.6 × 10 –2 to 4.5 × 10 –1 AGI cases person –1 year –1 and reflect a variety of study scopes and settings, including broad national-level estimates for public groundwater systems in the U.S., 4 , 5 national-level estimates for private wells in Canada, 6 and regional assessments for public groundwater systems and private wells in Wisconsin. 7 , 9 These estimates are similar to ours, though differences in scope and approach may confound comparisons among studies. Lower risk estimates were reported for private wells in Ireland (2.8 × 10 –4 illnesses person –1 year –1 ) and a neighborhood borehole in Argentina (1.1 × 10 –3 infections person –1 year –1 ), 14 , 15 but these estimates were based on single index pathogens (verotoxigenic E. coli and Giardia ), whereas our estimates summed risk across nine pathogens.…”

Section: Discussionsupporting

confidence: 78%

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Statewide Quantitative Microbial Risk Assessment for Waterborne Viruses, Bacteria, and Protozoa in Public Water Supply Wells in Minnesota

Burch

Stokdyk

Rice

et al. 2022

Environ. Sci. Technol.

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Infection risk from waterborne pathogens can be estimated via quantitative microbial risk assessment (QMRA) and forms an important consideration in the management of public groundwater systems. However, few groundwater QMRAs use site-specific hazard identification and exposure assessment, so prevailing risks in these systems remain poorly defined. We estimated the infection risk for 9 waterborne pathogens based on a 2-year pathogen occurrence study in which 964 water samples were collected from 145 public wells throughout Minnesota, USA. Annual risk across all nine pathogens combined was 3.3 × 10 –1 (95% CI: 2.3 × 10 –1 to 4.2 × 10 –1 ), 3.9 × 10 –2 (2.3 × 10 –2 to 5.4 × 10 –2 ), and 1.2 × 10 –1 (2.6 × 10 –2 to 2.7 × 10 –1 ) infections person –1 year –1 for noncommunity, nondisinfecting community, and disinfecting community wells, respectively. Risk estimates exceeded the U.S. benchmark of 10 –4 infections person –1 year –1 in 59% of well-years, indicating that the risk was widespread. While the annual risk for all pathogens combined was relatively high, the average daily doses for individual pathogens were low, indicating that significant risk results from sporadic pathogen exposure. Cryptosporidium dominated annual risk, so improved identification of wells susceptible to Cryptosporidium contamination may be important for risk mitigation.

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Section: Discussionsupporting

confidence: 78%

“… 4 , 5 Few groundwater QMRAs have considered more than one index pathogen with concentrations measured in situ, as was done for a peri-urban region of Argentina and a rural region in Wisconsin, USA. 7 , 15 …”

Section: Introductionmentioning

confidence: 99%

Statewide Quantitative Microbial Risk Assessment for Waterborne Viruses, Bacteria, and Protozoa in Public Water Supply Wells in Minnesota

Burch

Stokdyk

Rice

et al. 2022

Environ. Sci. Technol.

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“…Among studies of the disease burden associated with microbial contamination of drinking water, the bottom-up approach was illustrated by Murphy et al ., 18 Burch et al ., 19 Reynolds et al ., 20 and DeFelice et al . 16 For example, Murphy et al .…”

Section: Resultsmentioning

confidence: 99%

Burden of Disease from Contaminated Drinking Water in Countries with High Access to Safely Managed Water: A Systematic Review

Lee

Gibson

Brown

et al. 2022

Preprint

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BackgroundThe vast majority of residents of high-income countries (>90%) reportedly have high access to safely managed drinking water, the highest level of service under the Sustainable Development Goal (SDG) framework. Owing perhaps to the widely held perception of near universal access to high-quality water services in these countries, the burden of waterborne disease in these contexts is understudied.MethodsWe conducted a systematic review of estimates of the disease burden attributed to drinking water in countries where >90% of the population has access to safely managed drinking water per official SDG monitoring. We searched PubMed, Web of Science, and SCOPUS for articles published before September 10, 2021.FindingsWe identified 24 studies reporting estimates for the disease burden attributable to microbial contaminants. Across these studies, the population-weighted average burden of gastrointestinal illness risks attributed to drinking water was about 3,529 annual cases per 100,000 people. Beyond exposure to infectious agents, we also identified 10 studies reporting disease burden, predominantly, cancer risks, associated with chemical contaminants. Across these studies, the pooled population-weighted average of excess cancer cases attributable to drinking water was 1.8 annual cancer cases per 100,000 people.InterpretationThese estimates exceed WHO-recommended normative targets for disease burden attributable to drinking water and highlight that there remains important preventable disease burden in these contexts. However, the available literature was scant and limited in geographic scope, disease outcomes, range of microbial and chemical contaminants, and inclusion of subpopulations that could most benefit from water infrastructure investments. These subpopulations include rural, low-income communities; Indigenous or Aboriginal peoples; and populations marginalized due to discrimination by race, ethnicity, or socioeconomic status. Studies quantifying drinking water-associated disease burden in countries with reportedly high access to safe drinking water, with a focus on specific subpopulations and promoting environmental justice, are needed.Research in contextEvidence before this studyAlthough the burden of disease associated with unsafe drinking water in low- and middle-income countries has been subject of much research, there is uncertainty about the magnitude and nature of this disease burden in high-income countries and countries where access to safely managed drinking water is >90%. To assess the magnitude of this burden in countries with high levels of access to high quality water, we conducted a systematic review of estimates of the disease burden attributed to drinking water in countries where >90% of the population has access to safely managed drinking water as defined by the WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP). We searched PubMed, Web of Science, and SCOPUS for relevant articles published before September 10, 2021. We searched for articles including “burden of disease” OR “disease burden” OR “gastrointestinal illness” anywhere in the text. From among these articles, we selected those with the terms “drinking water” OR “tap water.” From this reduced set, we selected articles reporting on countries with >90% safe water access and including estimates of cases, hospitalizations, or deaths related to drinking water contamination. Additional articles were identified from consultations with subject-matter experts. Only articles in English were recovered, which may have biased our results towards specific countries.Added value of this studyTo our knowledge, this is the first global review of its kind to identify burden of waterborne disease estimates associated with microbiological contaminants as well as chemical contaminants found in drinking water, specifically in countries with reportedly high access (>90%) to safely managed drinking water. Despite the perception that high quality water is ubiquitous in these countries, we found that burden estimates in these countries exceeded WHO-recommended targets for disease burden attributable to unsafe drinking water. This review also highlighted the gaps in our understanding of waterborne disease burden across and within countries where access to high quality drinking water is common.Implications of all the available evidenceEven though the levels of access to safely managed drinking water are high in many high-income and some middle-income countries, there remains a potentially important preventable disease burden in these high-income countries. Our review suggests that further burden research expanding the scope of contaminants, disease outcomes, geographic area, and vulnerable subpopulations within countries is necessary. Currently, available evidence is insufficient to support rational decision-making and to prioritize public investment to protect the health of marginalized communities. These groups include rural, low-income communities; Indigenous or Aboriginal peoples; and populations marginalized due to discrimination by race, ethnicity, or socioeconomic status.

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“…This aquifer can become contaminated, in whole or in part, leading to a “tragedy of open access” 2 —a subcategory of the classic “tragedy of the commons” defined by ecologist Garrett Hardin. 3 A pair of studies in Environmental Health Perspectives 4 , 5 examined such a scenario among private wells in Kewaunee County, Wisconsin.…”

mentioning

confidence: 99%

“…The authors of the second study 5 used quantitative microbial risk assessment (QMRA) to calculate the health burden from the water contamination quantified in the first study. First, they predicted how many cases of acute gastrointestinal illness (AGI) due to contaminated private wells could be expected in Kewaunee County based on county- and national-level numbers.…”

mentioning

confidence: 99%

Farm to Faucet? Agricultural Waste and Private Well Contamination in Kewaunee County, Wisconsin

Nicole¹

2021

Environ Health Perspect

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Quantitative Microbial Risk Assessment for Contaminated Private Wells in the Fractured Dolomite Aquifer of Kewaunee County, Wisconsin

Cited by 24 publications

References 29 publications

Statewide Quantitative Microbial Risk Assessment for Waterborne Viruses, Bacteria, and Protozoa in Public Water Supply Wells in Minnesota

Statewide Quantitative Microbial Risk Assessment for Waterborne Viruses, Bacteria, and Protozoa in Public Water Supply Wells in Minnesota

Burden of Disease from Contaminated Drinking Water in Countries with High Access to Safely Managed Water: A Systematic Review

Farm to Faucet? Agricultural Waste and Private Well Contamination in Kewaunee County, Wisconsin

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