1. Case Study Presentation by Dr. T. G. Rupa Ms. Kamayani Barshilia Mr. Harshit Mishra Mentors: Prof. Marquez Prof. Arun Kumar QMRA Summer School-2014

2. Yamuna river Drinking water Recreational bathing Field irrigation Waste water discharge Village BB Village DD 5 km downstream Stream AA Animal droppings Stream “AA” is discharging polluted water (sewage & surface runoff) into the Yamuna river. Objective: To assess microbial risks to residents of village “DD” using the water for drinking, swimming and irrigation activities. QMRA Summer School-2014

3. Steps for Microbial Risk Assessment Risk Management Hazard Identification Risk Characterization Dose Response Assessment Exposure Assessment (Source: Adopted from Penningroth, 2010) QMRA Summer School-2014

4. Assumptions 1.The river has capability of natural treatment of waste water. 2.The ratio of indicator organism to pathogen organism remains constant. 3.Only three pathogens present in wastewater are: Salmonella sp. Shigella sp Vibrio cholerae 4. Survival of ingested pathogens is cent percent. 5. Only Oral pathway has been considered. QMRA Summer School-2014

5. Data Requirement QMRA StepsParameter to be considered Hazard Identification Selection of pathogens, Ratio of indicator organism to pathogen organism, Microbial concentration Exposure Assessment Exposure pathway, Type of population (Adults, Children), Water intake, Exposure frequency, Exposure duration Dose Response Assessment Dose response model Risk Characterization Calculation of risk (Point estimation, Monte- Carlo Simulation), Sensitivity Analysis QMRA Summer School-2014

6. Salmonella sp Rod-shaped, gram-negative, non-spore forming, predominantly motile enterobacteria Lives in animal and human intestines and are shed through feces. Infection occurs through through contaminated water or food. Some common species - Salmonella Anatum and Salmonella Meleagridis. Causes gastroenteritis. Possible signs and symptoms include nausea, vomiting, abdominal cramps, diarrhea, fever, chills, headache, blood in the stool Incubation period is 12 to 72 hours. Vulnerable groups - The elderly, infants and those with impaired immune systems QMRA Summer School-2014

7. Vibrio cholerae Comma shaped, gram-negative bacillus Occurs in both marine and freshwater habitats associated with algal blooms (plankton) and aquatic animals It is endemic or epidemic in areas with poor sanitation. Infection through fecal-oral transmission by food or water supply; multiply within the intestines Incubation period is 24 to 48 hours Symptoms - diarrhoea, dehydration, hypovolemic shock/death, abdominal cramping, nausea, vomiting, fever and chills Vulnerable groups – Children and pregnant women Mortality <1% if treated with rehydration therapy. The disease typically lasts from 4–6 days. Not communicable QMRA Summer School-2014

8. Shigella sp. Rod-shaped, gram-negative bacteria Transmission route is fecal-oral; bacteria is present in the stools of infected persons while they are sick and for up to a week or two afterwards Infection spreads through poor hand hygiene, ingestion of contaminated food or water, inadequate sanitation and toileting, overcrowding, contact with a contaminated inanimate object, vectors like the housefly. 80% of all infection is the result of person-to-person transmission. Common symptoms – diarrhea, fever, nausea, vomiting, stomach cramps, and flatulence, large and painful bowel movements. The stool may contain blood, mucus or pus. Incubation period varies from 12 hours to 7 days but is typically 2-4 days. Mortality rate <1% in developed countries; 20-25% in the east and middle east. QMRA Summer School-2014

9. Concentration Of Pathogens fecal coliforms=1.5*10 7 ±8*10 2 MPN/100 mL (given) QMRA Summer School-2014 Source: Pant, Anju & Mittal, Atul K. (2007). Monitoring of Pathogenicity of Effluents from the UASB based Sewage Treatment Plant

10. Exposure Assessment Source: Modified from Exposure factors handbook: 2011 edition, U.S. Environmental Protection Agency Washington, DC. a. Gerba.C.P., Risk Assessment. b. Mara, D.D. Quantifying health risks in wastewater irrigation SCENARIOS: I.Drinking water (without treatment) II.Bathing recreational activities 2 times/week (May-Aug) III.Irrigation for spinach and cucumber crops QMRA Summer School-2014

11. Response Model Parameters for selected pathogens QMRA Summer School-2014

12. Risk Calculation QMRA Summer School-2014

13. ADULT CHILDREN SalmonellaShigellaVibrio SalmonellaShigellaVibrio Daily infection risk 0.4070.560.819 0.220.420.76 Annual infection risk 111111 Tolreable Risk1/10000 Risk reduction (%) 99.9799.98 99.9599.9799.98 Reduction FC(%) 99.9996.87 99.99 --- 117 Daily and Annual risk of infection from Salmonella pathogen (maximum Concentration) QMRA Summer School-2014

18. Monte-Carlo Simulation for Salmonella infection QMRA Summer School-2014

19. Drinking water Bathing recreational activities QMRA Summer School-2014

20. Risk Management  Maximum allowable annual risk of microbial infection : 10 -4 per year (USEPA)  Risk communication and reduction at two levels: Village BB Mobilizing people to adopt waste reduction techniques: Training local leaders to disseminate information and monitor the progress Waste control/reduction at village BB through 2-pit latrines, sulabh shauchalayas, biogas plants Installing water treatment plant Yamuna

21. Village DD Mobilize people to adopt healthful practices – e.g., boil drinking water, wash hands properly, wash spinach and cucumber well before consumption Protective gears for farmers Chlorination of water Training health workers from local population to disseminate information on healthful practices, distribution of chlorine tablets, detect any disease (water related) and recommend severe cases to hospital Follow up  Cost-effect analysis of using different strategies for risk reduction and using the most suitable method

22. REFERENCES Gerba, C.P. (1999). Risk Assessment. 212-219. Retrieved from web.iitd.ac.in/~arunku/files/CEL899.../Gerba%20Risk%20Assessment.pdf. Singh, D. and Kumar, A. Virus Pollution of Indian Surface Water: Health Risk Estimation and Issues Identification. Retrieved from https://piazza.com/drexel/summer2014/iheraii_delhiindia/resources. Mara, D.D. (2008). Quantifying health risks in wastewater irrigation. In: UNESCO Encyclopedia of Life Support Systems. EOLSS Publishers, Oxford. Morris, Robert D. and Levin, R. 1995. Estimating the incidence of waterborne infectious disease related to drinking water in the United States in Assessing and Managing Health Risks from Drinking Water Contamination: Approaches and Applications (Proceedings of the Rome Symposium, September 1994). IAHS Publ. no. 233, 1995. 75. NCEA (2011). Exposure Factors Handbook. (2011 Ed.). EPA/600/R-09/052F. U.S. Environmental Protection Agency Washington, DC. Pant, Anju & Mittal, Atul K. (2007). Monitoring of Pathogenicity of Effluents from the UASB based Sewage Treatment Plant in Environment Monitoring Assessment, 133:43–51.

23. Thank You QMRA Summer School-2014