Private well users in Ontario are responsible for ensuring the potability of their own private drinking water source through protective actions (i.e., water treatment, well maintenance, and regular water quality testing). In the absence of regulation and limited surveillance, quantitative microbial risk assessment (QMRA) represents the most practical and robust approach to estimating the human health burden attributable to private wells. For an increasingly accurate estimation, QMRA of private well water should be represented by a coupled model, which includes both the socio-cognitive and physical aspects of private well water contamination and microbial exposure. The objective of the current study was to determine levels of waterborne exposure via well water consumption among three sub-groups (i.e., clusters) of private well users in Ontario and quantify the risk of waterborne acute gastrointestinal illness (AGI) attributed to Giardia, shiga-toxin producing E. coli (STEC) and norovirus from private drinking water sources in Ontario. Baseline simulations were utilized to explore the effect of varying socio-cognitive scenarios on model inputs (i.e., increased awareness, protective actions, aging population). The current study uses a large spatio-temporal groundwater quality dataset and cross-sectional province-wide survey to create socio-cognitive-specific QMRA simulations to estimate the risk of waterborne AGI attributed to three enteric pathogens in private drinking waters source in Ontario. Findings suggest significant differences in the level of exposure among sub-groups of private well users. Private well users within Cluster 3 are characterised by higher levels of exposure and annual illness attributable to STEC, Giardia and norovirus than Clusters 1 and 2. Provincial incidence rates of 520.9 (1522 illness per year), 532.1 (2211 illness per year) and 605.5 (5345 illness per year) cases/100,000 private well users per year were predicted for private well users associated with Clusters 1 through 3. Established models will enable development of necessary tools tailored to specific groups of at-risk well users, allowing for preventative public health management of private groundwater sources.

Waterborne organisms in marine water generally originate from untreated wastewater discharged into the sea. The presence of numerous leisure beaches in Mahmoudabad city, Iran, annually attracts thousands of tourists from all over the country to participate in recreational swimming activities. This study probabilistically characterized the health risks associated with recreational swimming engendered by waterborne pathogens, such as intestinal enterococci and Escherichia coli (E. coli) at 15 sampling points along the beaches of the study using quantitative microbial risk assessment (QMRA). The mean annual infection risk of E. coli in children and adults was 0.424 and 0.229, respectively. The respective risk in terms of enterococci was 0.999 and 0.997, which were higher than the level recommended by the WHO and EPA. The results show that the risk of infection for children was higher than adults. Related authorities have to consider measures to improve environmental quality to protect tourists\' and residents\' well-being.

Shared sanitation facilities have been hailed as an innovative approach to solve the challenge with sanitation access. However, these facilities may act as hotspots for disease transmission due to unhygienic conditions. In this study we used quantitative (based on Escherichia coli contamination) techniques to assess the health risks associated with the use of community ablution blocks (CABs). The most contaminated surfaces were the cistern handle (5.7 Log10 cfu/cm2) and internal pull latch (5.8 Log10 cfu/cm2). Based on the E. coli contamination, at least two people out of 100 CAB users might be potentially infected when they touch \"hot\" surfaces. These risks were modelled assuming transfer of potentially pathogenic E. coli from these surfaces to the mouth. The incorporation of risk-reduction measures, such as wiping of these surfaces or washing of hands, could potentially result in significant reduction of infection risks. The most significant risk-reduction intervention was determined to be wiping of the contact surfaces, especially twice prior to contact. A combination of risk-reduction interventions could further reduce the risks. This study shows that contamination of contact surfaces within shared CABs could lead to increased risks of infections, requiring measures aimed at reducing the associated risks. The risk assessment framework used in this study could therefore be applied in similar settings to estimate associated health risks with the use of such facilities.

The application of high-throughput DNA sequencing technologies (WGS) data remain an increasingly discussed but vastly unexplored resource in the public health domain of quantitative microbial risk assessment (QMRA). This is due to challenges including high dimensionality of WGS data and heterogeneity of microbial growth phenotype data. This study provides an innovative approach for modeling the impact of population heterogeneity in microbial phenotypic stress response and integrates this into predictive models inputting a high-dimensional WGS data for increased precision exposure assessment using an example of Listeria monocytogenes. Finite mixture models were used to distinguish the number of sub-populations for each of the stress phenotypes, acid, cold, salt and desiccation. Machine learning predictive models were selected from six algorithms by inputting WGS data to predict the sub-population membership of new strains with unknown stress response data. An example QMRA was conducted for cultured milk products using the strains of unknown stress phenotype to illustrate the significance of the findings of this study. Increased resistance to stress conditions leads to increased growth, the likelihood of higher exposure and probability of illness. Neglecting within-species genetic and phenotypic heterogeneity in microbial stress response may over or underestimate microbial exposure and eventual risk during QMRA.

Wastewater irrigation is a common practice in developing countries due to water scarcity and increasing demand for food production. However, there are health risks and ecological risks associated with this practice. Small-scale wastewater treatment plants (WWTPs) intend to decrease these risks but still face management challenges. This study assessed how the management status of five small-scale WWTPs in Cochabamba, Bolivia affects health risks associated with consumption of lettuce and ecological risks due to the accumulation of nutrients in the soil for lettuce and maize crops. Risk simulations for three wastewater irrigation scenarios were: raw wastewater, actual effluent and expected effluent. Results showed that weak O&M practices can increase risk outcomes to higher levels than irrigating with raw wastewater. Improving O&M to achieve optimal functioning of small-scale WWTPs can reduce human health risks and ecological risks up to 2 log10 DALY person-1 year-1 and to 2 log10 kg nitrogen ha-1 accumulated in soil, respectively.