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Understanding the water consumption patterns within a specific population informs development of increasingly accurate, spatially specific exposure and/or risk assessment of waterborne infection. The current study examined the consumption patterns of private well users in Ontario while considering potentially influential underlying sociodemographics, household characteristics, and experiential factors. A province-wide online survey was circulated between May and August 2018 (n = 1,162). Overall, 81.5% of respondents reported daily well water consumption (i.e., tap water). Results indicate a mean daily well water consumption rate of 1,132 mL/day (SD = 649 mL/day) among well water consumers. Gender was significantly associated with well water consumption, with higher consumption rates found among female respondents. The experience of acute gastrointestinal illness (AGI) symptoms or diagnosis in the past 12 months did not impact the volume of water consumed, suggesting that experiencing previous AGI does not decrease consumption volumes, and therefore exposure over time. Significantly higher rates of well water consumption were found among respondents who reported previous testing or ongoing water treatment. Approximately 45.5% of survey respondents who stated that they do not consume well water selected bottled water as their primary household drinking water supply. Bottled water consumption was also not associated with previous AGI experiences. Findings will inform future quantitative microbial risk assessments associated with private well water use by providing spatially and demographically specific estimates of well water consumption.

Extreme weather events (EWEs) may significantly increase pathogenic contamination of private (unregulated) groundwater supplies. However, due to the paucity of protective guidance, private well users may be ill-equipped to undertake adaptive actions. With rising instances of waterborne illness documented in groundwater-dependent, developed regions such as the Republic of Ireland, a better understanding of well user risk perceptions pertaining to EWEs is required to establish appropriate educational interventions. To this end, the current study employed an online and physical questionnaire to identify current risk perceptions and correspondent predictors among Irish private well users concerning extreme weather. Respondents were elicited via purposive sampling, with 515 private well users elucidating perceived supply contamination risk in the wake of five EWEs between the years 2013-2018 including drought and pluvial flooding. A novel scoring protocol was devised to quantify overall risk perception (i.e. perceived likelihood, severity and consequences) of extreme weather impacts. Overall risk perception of EWEs was found to demonstrate a significant relationship with gender (p = 0.017) and event experience (p 0.001), with female respondents and those reporting prior event experience exhibiting higher median risk perception scores. Risk perception was additionally mediated by perceived self-efficacy in undertaking supply maintenance (p = 0.001), as well users citing confidence in ability scored significantly lower than those citing no confidence. Two-step cluster analysis identified three distinct respondent subsets based on risk perception of EWEs (high, moderate and low perception), with female respondents and those with a third-level education significantly more likely to fall within the high perception cluster. Study findings affirm that certain demographic, experiential and cognitive factors exert a significant influence on private well user risk perceptions of EWE impacts and highlight potential focal points for future educational interventions seeking to reduce the risk of human infection associated with groundwater and extreme weather.

peer-reviewed Verocytotoxin-producing E. coli (VTEC) are important agents of diarrhoeal disease in humans globally. As a noted waterborne disease, emphasis has been given to the study VTEC in surface waters, readily susceptible to microbial contamination. Conversely, the status of VTEC in potable groundwater sources, generally regarded as a “safe” drinking-water supply remains largely understudied. As such, this investigation presents the first scoping review seeking to determine the global prevalence of VTEC in groundwater supply sources intended for human consumption. Twenty-three peer-reviewed studies were identified and included for data extraction. Groundwater sample and supply detection rates (estimated 0.6 and 1.3%, respectively) indicate VTEC is infrequently present in domestic groundwater sources. However, where generic (fecal indicator) E. coli are present, the VTEC to E. coli ratio was found to be 9.9%, representing a latent health concern for groundwater consumers. Geographically, extracted data indicates higher VTEC detection rates in urban (5.4%) and peri–urban (4.9%) environments than in rural areas (0.9%); however, this finding is confounded by the predominance of research studies in lower income regions. Climate trends indicate local environments classified as ‘temperate’ (14/554; 2.5%) and ‘cold’ (8/392; 2%) accounted for a majority of supply sources with VTEC present, with similar detection rates encountered among supplies sampled during periods typically characterized by ‘high’ precipitation (15/649; 2.3%). Proposed prevalence figures may find application in preventive risk-based catchment and groundwater quality management including development of Quantitative Microbial Risk Assessments (QMRA). Notwithstanding, to an extent, a large geographical disparity in available investigations, lack of standardized reporting, and bias in source selection, restrict the transferability of research findings. Overall, the mechanisms responsible for VTEC transport and ingress into groundwater supplies remain ambiguous, representing a critical knowledge gap, and denoting a distinctive lack of integration between hydrogeological and public health research. Key recommendations and guidelines are provided for prospective studies directed at increasingly integrative and multi-disciplinary research.

Approximately 1.5 million individuals in Ontario are supplied by private water wells (private groundwater supplies). Unlike municipal supplies, private well water quality remains unregulated, with owners responsible for testing, treating, and maintaining their own water supplies. The primary goal of this study was to assess the effect of repeat sampling of private well water in Ontario and investigate the efficacy of geographically- and/or temporally specific testing recommendations and health risk assessments. The current study combines the Well Water Information System Dataset and the Well Water Testing Dataset from 2010 to 2017, inclusive. These two large existing province-wide datasets collated over an eight-year period were merged using an integrated spatial fuzzy logic and (next)- nearest neighbour approach. Provincial sampling data from 239,244 wells (702,861 samples) were analyzed for Escherichia coli to study the relationship between sampling frequency and Escherichia coli detection. Dataset variables were delineated based on hydrogeological setting (e.g. aquifer type, overburden depth, well depth, bedrock type) and seasonality to provide an in-depth understanding of Escherichia coli detection in private well water. Findings reveal differences between detection rates in consolidated and unconsolidated aquifers (p = 0.0191), and across seasons (p < 0.0001). The variability associated with Escherichia coli detection rates was explored by estimating sentinel sampling rates for private wells sampled three times, twelve times and twenty-four times per year. As sample size increases on an annual basis, so too does detection rate, highlighting the need to address current testing frequency guidelines. Future health risk assessments for private well water should consider the impact of spatial and temporal factors on the susceptibility of this drinking water source, leading to an increasingly accurate depiction of private well water contamination and the estimated effects on human health.

Wastewater reclamation now represents an effective measure for sustainable water resource management in arid regions, however wastewater components (organic micropollutants) may potentially impact local ecological and/or human health. Previous studies have shown that sodium bentonite/natural clay (BC) mixes may be used to effectively reduce riverbed infiltration in regions characterised by excessively high hydraulic conductivity. Accordingly, the current study sought to investigate the contaminant removal efficiency (Re) of several BC mass ratios in simulated dry riverbeds. Results indicate that the measured Re of NH4 +-N, CODcr and BOD5 increased in concurrence with an increasing sodium bentonite ratio, up to a maximum Re of 97.4% (NH4 +-N), 55.2% (CODcr), and 51.5% (BOD5). The primary contaminant removal site was shown to be the infiltration-reducing (BC) layer, accounting for approximately 40%, 60%, and 70% of NH4 +-N, CODcr and BOD5 removal, respectively. Conversely, the removal efficiency of NO3-N was found to be low (

A significant body of research has focused on the role of domestic wastewater treatment systems (DWWTSs) as sources of human-specific aquatic contaminants in both developed and developing regions. However, to date few studies have sought to investigate the awareness, attitudes and behaviours of DWWTS owners and the efficacy of associated communication initiatives. The current study provides an examination of a public national engagement campaign undertaken in the Republic of Ireland which seeks to minimise the impact of DWWTSs on human and ecological health via concurrent inspection and information dissemination. Overall, 1634 respondents were surveyed using a “before and after” study design to capture if and how awareness, attitudes and behaviours evolved over time. Findings suggest that whilst the campaign provided a modest baseline to raise general awareness associated with the basic operational and maintenance requirements of DWWTS, there has been little or no behavioural engagement as a result, suggesting a significant awareness-behaviour gap. Accordingly, efforts to minimise potential human and ecological impacts have been unsuccessful. Moreover, results suggest that public attitudes towards water-related regulation and policy became increasingly negative over the study period due to parallel political and economic issues, further complicating future engagement. Future strategies, both in Ireland and further afield, should focus on health-based demographically-focused message framing to achieve significant knowledge and attitudinal shifts amongst specific population cohorts, and thus bring about significant behavioural change. Study findings and recommendations may be used by myriad stakeholders including local, provincial and national authorities to effectively engage with individuals and communities prior to and during implementation of legislative and policy-based instruments within numerous spheres including climate change adaptation, environmental quality, hydrological risk, and hydro-ecology.

Groundwater quality monitoring typically employs testing for the presence of E. coli as a fecal indicator of recent ingress of human or animal fecal material. The efficacy of fecal indicator organisms is based on the primary criteria that the organism does not reproduce in the aquatic environment. However, recent studies have reported that E. coli may proliferate (i.e., has adapted to) in the external environment, including soil and surface water. To date, the presence of environmentally-adapted E. coli in groundwater has not been examined. The current study employed Clermont phylotyping and the presence of six accessory genes to identify the likely presence of adapted E. coli in private groundwater sources. E. coli isolates (n = 325) from 76 contaminated private water wells located in a southeastern Ontario watershed were compared with geographically analogous human and animal fecal E. coli isolates (n = 234). Cryptic clades III-V, a well-described environmentally-adapted Escherichia population, were identified in three separate groundwater wells, one of which exclusively comprised this adapted population. Dimensionality reduction (via Principal Component Analysis) was used to develop an “E. coli adaptation model”, comprising three distinct components (groundwater, animal feces, human feces) and suggests adaptation occurs frequently in the groundwater environment. Model findings indicate that 23/76 (30.3%) wells had an entirely adapted community. Accordingly, the use of E. coli as a FIO returned a false positive result in these instances, while an additional 23/76 (30.3%) wells exhibited some evidence of adaptation (i.e., not all isolates were adapted) representing an over-estimate of the magnitude (concentration) of contamination. Study findings highlight the need to further characterize environmentally-adapted E. coli in the groundwater environment and the potential implications with respect to water quality policy, legislation and determinants of human health risk both regionally and internationally.

Globally, approximately 2.2 billion people rely on groundwater for daily consumption. It is widely accepted that groundwater is more pristine than surface water but while this assumption is frequently the case, groundwater is not ubiquitously free of contaminants; accordingly, this presumption can result in an unfounded and potentially hazardous sense of security among owners, operators and users. The current paper presents a review of published literature providing epidemiological evidence of the contribution of groundwater to global human enteric infection. An emphasis is placed on enteric pathogens transmitted via the faecal-oral route, and specifically those associated with acute gastrointestinal illness (AGI). The review identified 649 published groundwater outbreaks globally between 1948 and 2013 and several epidemiological studies that show there is an increased risk of AGI associated with the consumption of untreated groundwater. The review identified that the following five pathogens were responsible for most outbreaks: norovirus, Campylobacter, Shigella, Hepatitis A and Giardia. Crudely, the authors estimate that between 35.2 and 59.4 million cases of AGI per year globally could be attributable to the consumption of groundwater. Although groundwater is frequently presumed to be a microbiologically safe source of water for consumption, this review demonstrates that consumers served by an untreated groundwater supply remain at risk to enteric disease. The authors conclude that collaboration between microbiologists, hydrogeologists and epidemiologists is needed to better understand pathogen occurrence, persistence, detection and transport in groundwater as well as build stronger epidemiological evidence documenting the true magnitude of disease associated with groundwater globally.

Extreme weather events including flooding can have severe personal, infrastructural, and economic consequences, with recent evidence pointing to surface flooding as a pathway for the microbial contamination of private groundwater supplies. There is a pressing need for increasingly focused information and awareness campaigns to highlight the risks posed by extreme weather events and appropriate subsequent post-event actions. To date, little is known about the presence, directionality or magnitude of gender-related differences regarding flood risk awareness and behaviour among private groundwater users, a particularly susceptible sub-population due to an overarching paucity of infrastructural regulation across many regions. The current study investigated gender-related differences in flood risk perception and associated mitigation behaviours via a cross-sectional, national survey of 405 (168 female, 237 male) private groundwater supply users. The developed survey instrument assessed socio-demographic profile, previous flood experience, experiential and conjectural health behaviours (contingent on previous experience), and Risk, Attitude, Norms, Ability, Self-regulation (RANAS) framework questions. Statistically significant gender differences were found between both &lsquo, Norm&mdash, Descriptive&rsquo, and &lsquo, Ability&mdash, Self-efficacy&rsquo, RANAS elements (p &lt, 0.05). Female respondents reported a lower level of awareness of the need for post-flood action(s) (8.9% vs. 16.5%), alongside a perceived &ldquo, lack of information&rdquo, as a reason for not testing their domestic well (4.9% vs. 11.5%). Conversely, male respondents were more likely to report awareness of their well location in relation to possible contamination sources (96.6% vs. 89.9%) and awareness of previous water testing results (98.9% vs. 93.0%). Gender-related gaps exist within the studied private groundwater reliant cohort, a sub-population which has to date remained under-studied within the context of climate change and extreme weather events. Accordingly, findings suggest that gender-focused communication and education may represent an effective tool for protecting current and future generations of global groundwater users.

Groundwater contamination constitutes a significant health risk for private well users residing in rural areas. As the responsibility to safeguard rural private domestic groundwater typically rests with non-expert homeowners, interventions promoting risk mitigation and awareness represent the most viable means of preventing supply contamination. However, no global review or pooled analyses of these interventions has been undertaken to date. The current study sought to identify and quantify the performance of private well interventions from 1990 to 2018 via a global systematised review and pooled analysis. The PICO (Population-Intervention-Comparison-Outcome) approach was employed for literature identification. Relevant studies were statistically analysed across two quantitative outcome (performance) types, namely knowledge and behaviour, controlling for intervention characteristics and country development status. Mean behavioural and knowledge attainment across interventions was 53% and 48%, respectively, with interventions in economically developed regions exhibiting higher behavioural outcomes (56% vs. 45%) than those in developing regions. Geographically, interventions were located in southern or southeast Asia (n = 23), North America (n = 15), Central America (n = 1) and Africa (n = 1), with none identified in Australia/Oceania, Europe, or South America. Behavioural outcomes were significantly associated with presence of educational/research coordinator (p = 0.023), with these interventions attaining higher levels of efficacy (+74%) than those implemented by other coordinator types. Findings indicate that instructor-led, practical interventions allied with both large- and local-scale awareness-raising campaigns represent an optimum approach for future private well risk interventions. Subsequent adoption of such interventions may lead to increased levels of private well maintenance and provide a point of reference for myriad water and health communication contexts.

Cryptosporidiosis is one of the leading causes of diarrhoeal illness and mortality induced by protozoan pathogens worldwide. As a largely waterborne disease, emphasis has been given to the study of Cryptosporidium spp. in surface waters, readily susceptible to pathogenic contamination. Conversely, the status of Cryptosporidium in potable groundwater sources, generally regarded as a pristine and "safe" drinking-water supply owing to (sub)-soil protection, remains largely unknown. As such, this investigation presents the first literature review aimed to ascertain the global prevalence of Cryptosporidium in groundwater supply sources intended for human consumption. Thirty-seven peer-reviewed studies were identified and included in the review. Groundwater sample and supply detection rates (estimated 10-20%) indicate Cryptosporidium is frequently present in domestic groundwater sources, representing a latent health concern for groundwater consumers. Specifically, sample (10.4%) and source (19.1%) detection rates deriving from comprehensive "temporal" investigations are put forward as representative of a contamination 'baseline' for Cryptosporidium in 'domestic' groundwater supplies. Proposed 'baseline' prevalence figures are largely applicable in preventive risk-based catchment and groundwater quality management including the formulation of Quantitative Microbial Risk Assessment (QMRA). Notwithstanding, a large geographical disparity in available investigations and lack of standardized reporting restrict the transferability of research findings. Overall, the mechanisms responsible for Cryptosporidium transport and ingress into groundwater supplies remain ambiguous, representing a critical knowledge gap, and denoting a distinctive lack of integration between groundwater and public-health sub-disciplines among investigations. Key recommendations and guidelines are provided for prospective studies directed at more integrative and multi-disciplinary research.

Groundwater resources are under increasing threats from contamination and overuse, posing direct threats to human and environmental health. The purpose of this study is to better understand drivers of, and relationships between, well and aquifer characteristics, sampling frequencies, and microbiological contamination indicators (specifically E. coli) as a precursor for improving knowledge and tools to assess aquifer vulnerability and well contamination within Ontario, Canada. A dataset with 795, 023 microbiological testing observations over an eight-year period (2010 to 2017) from 253,136 unique wells across Ontario was employed. Variables in this dataset include date and location of test, test results (E. coli concentration), well characteristics (well depth, location), and hydrogeological characteristics (bottom of well stratigraphy, specific capacity). Association rule analysis, univariate and bivariate analyses, regression analyses, and variable discretization techniques were utilized to identify relationships between E. coli concentration and the other variables in the dataset. These relationships can be used to identify drivers of contamination, their relative importance, and therefore potential public health risks associated with the use of private wells in Ontario. Key findings are that: i) bedrock wells completed in sedimentary or igneous rock are more susceptible to contamination events; ii) while shallow wells pose a greater risk to consumers, deep wells are also subject to contamination events and pose a potentially unanticipated risk to health of well users; and, iii) well testing practices are influenced by results of previous tests. Further, while there is a general correlation between months with the greatest testing frequencies and concentrations of E. coli occurring in samples, an offset in this timing is observed in recent years. Testing remains highest in July while peaks in adverse results occur up to three months later. The realization of these trends prompts a need to further explore the bases for such occurrences.

Private well users are responsible for managing and maintaining the quality of their drinking water source. Previous studies in Canada have reported low testing rates among well users, a cornerstone of well stewardship behaviours that can prevent the consumption of contaminated groundwater. To improve well stewardship, it is important to understand the interactions between, and the impacts of, various factors that may influence behaviours. Accordingly, the objective of the current study was to investigate the impact of socio-demographics, property characteristics, and experiences with well construction and acute gastrointestinal illness (AGI) (i.e., previous experiences) on levels of awareness, attitudes, risk perceptions, and beliefs (i.e., risk domains) among private well users in Ontario. A link to a province-wide online survey was circulated between May and August 2018 and novel "risk domain" scoring protocols were developed to classify and summarize response data. The survey was undertaken by 1228 respondents, of which 1030 completed the survey in full. Results indicate a low level of waterborne pathogen awareness, with 50.8% of respondents unaware of any groundwater associated pathogens. Respondents' geographic location, gender, and well type were significantly associated with well users' attitudes and perceptions of risk regarding their personal well water supply and the quality and quantity of local groundwater sources. Higher levels of awareness and lower risk perception scores (i.e., lower perceptions of risk) were associated with residential presence during well construction (p 0.001 and p = 0.017, respectively). Previous case(s) of AGI within the respondent's household were significantly associated with negative attitudes towards their well water (p 0.001) and higher risk perception scores (p = 0.025) with respect to the quantity of local groundwater sources. Results may be used to identify critical experiential control points (e.g., during well construction or after a physician confirmed AGI diagnosis) and develop improved risk management and communication strategies aimed at private well users.

The frequency and severity of flooding events will increase over the coming decades due to global climate change. While close attention has typically been paid to infrastructural and environmental outcomes of flood events, the potential adverse human health consequences associated with post-event consumption from private groundwater sources have received minimal attention, leading to a poor understanding of private well users' preparedness and the drivers of positive behavioural adoption. The current study sought to quantify the capacity of private well users to cope with flood-triggered contamination risks and identify the social psychological determinants of proactive attitudes in the Republic of Ireland, using a cross-sectional questionnaire incorporating two distinct models of health behaviour, the Health Belief Model and Risk-Attitude-Norms-Ability-Self Regulation model. Adoption of healthy behaviours prior to flooding was evaluated with respect to respondents' risk exposure, risk experience and risk perception, in addition to systematic supply stewardship under normal conditions. Associations between adoption of protective behaviours and perception, experience and socio-demographic factors were evaluated through multinomial and multiple logistic regressions, while a multi-model inferential approach was employed with the predictors of health behaviour models. Findings suggest that floods are not considered likely to occur, nor were respondents worried about their occurrence, with 72.5% of respondents who reported previous flooding experience failing to adopt protective actions. Prior experience of well water contamination increased adoption of proactive attitudes when flooding occurred (+47%), with a failure to adopt healthy behaviours higher among rural non-agricultural residents (136%). Low levels of preparedness to deal with flood-related contamination risks are a side-effect of the general lack of appropriate well stewardship under normal conditions; just 10.1% of respondents adopted both water treatment and frequent testing, in concurrence with limited risk perception and poor awareness of the nexus between risk factors (e.g. floods, contamination sources) and groundwater quality. Perceived risk, personal norms and social norms were the best predictors of protective behaviour adoption and should be considered when developing future awareness campaigns.

Reclaimed wastewater reuse represents an effective method for partial resolution of increasing urban water shortages; however, reclaimed water may be characterized by significant contaminant loading, potentially affecting receiving ecosystem (and potentially human) health. The current study examined biofilm growth and nutrient adsorption in Olympic Lake (Beijing), the largest artificial urban lake in the world supplied exclusively by reclaimed wastewater. Findings indicate that solid particulate, extracellular polymeric substance (EPS) and metal oxide (Al, Fe, Mn) constituent masses adhere to a bacterial growth curve during biofilm formation and growth. Peak values were observed after ≈30 days, arrived at dynamic stability after ≈50 days and were affected by growth matrix surface roughness. These findings may be used to inform biofilm cultivation times for future biomonitoring. Increased growth matrix surface roughness (10.0 μm) was associated with more rapid biofilm growth and therefore an increased sensitivity to ecological variation in reclaimed water. Reclaimed water was found to significantly inhibit biofilm nutrient adsorption when compared with a “natural water” background, with elevated levels of metal oxides (Al, Fe, and Mn) and EPS representing the key substances actively influencing biofilm nutrient adsorption in reclaimed water. Results from the current study may be used to provide a quantitative baseline for future studies seeking to assess ecosystem health via monitoring of biofilms in the presence of reclaimed water through an improved quantitative understanding of biofilm kinetics in these conditions.

Approximately 12% of the Canadian population uses private wells for daily water consumption; however, well water testing rates are on the decline, resulting in an increased risk of waterborne acute gastrointestinal illness. To date, limited research has explored the determinants influencing well testing practices. Accordingly, the current study sought to investigate the drivers of “one-off” and repeat well water testing in southern Ontario during the 5-year period 2012–2016, using the worlds largest private groundwater testing data-frame. Data from >400,000 wells were geospatially integrated with all tests conducted by the provincial laboratory in southern Ontario. The Ontario Marginalization Index (ON-Marg) was used as a proxy measure of socioeconomic status (SES), with rurality, based on population density, season, and index (1st) test results assessed as effect modifiers. Multivariate analysis was undertaken using log-binomial regression. Approximately 27.5% of wells (n = 417,406) were tested during the study period, 66.7% of which were sampled more than once; 3% of all samples tested positive for E. coli (>0 colony forming unit/100 mL). In rural regions (400 people/km2) and peri-urban regions (>150 and

Antimicrobial resistance represents one of our most significant global health threats, with increasing incidences noted in both clinical and environmental settings. As such, identifying and understanding the sources and pathways for antimicrobial-resistant bacteria (ARB) is critical. The current study presents the first systematic review and pooled analysis of ARB occurrence in global groundwater supplies, which are used as primary drinking water sources by 2.2 billion people worldwide and are recurrently linked to significant outbreaks of infection. Seventy peer-reviewed studies were identified and included; findings reveal that 80.2% ± 29.0 and 57.2% ± 36.8 of aggregated groundwater isolates were resistant to ≥1 and ≥3 antimicrobials, respectively. Where bacteria were present, ARB were identified in 76.9% ± 33.7 of individual wells and springs. Our results leave little doubt that groundwater represents a major global reservoir for ARB, however significant research is required to establish environmental determinants and mechanisms mediating their occurrence.

Extreme weather events (EWEs) are increasing in frequency, posing a greater risk of adverse human health effects. As such, developing sociological and psychological based interventions is paramount to empowering individuals and communities to actively protect their own health. Accordingly, this study compared the efficacy of two established social-cognitive models, namely the Health Beliefs Model (HBM) and Risks-Attitudes-Norms-Abilities-Self-regulation (RANAS) framework, in predicting health behaviours following EWEs. Surface water flooding was used as the exemplar EWE in the current study, due to the increasing incidence of these events in the Republic of Ireland over the past decade. Levels of prior experience with flooding were considered for analyses and comparative tools included a number of variables predicting health behaviours and intervention potential scores (i.e. measure of impact of targeting each model element). Results suggest that the RANAS model provides a robust foundation for designing interventions for any level of experience with an extreme weather event, however, use of the simpler HBM may be more cost-effective among participants unacquainted with an EWE and in relatively infrequent health threat scenarios. Results provide an evidence base for researchers and policymakers to appropriately engage with populations about such threats and successfully promote spatiotemporally appropriate health behaviours in a changing climate.

Significant volumes of research over the past four decades has sought to elucidate the social, infrastructural, economic, and human health effects of climate change induced surface flooding. To date, epidemiological and public health studies of flooding events have focused on mental health effects, vector-borne diseases, and infectious enteric disease due to floodwater contact (i.e. typically low consumption rates). The inherent nature of groundwater (i.e. out of sight, out of mind) and the widely held belief that aquifers represent a pristine source of drinking water due to natural attenuation may represent the "perfect storm" causing direct consumption of relatively large volumes of surface flood-contaminated groundwater. Accordingly, the current study sought to systematically identify and synthesize all available peer-reviewed literature pertaining to the nexus between surface flooding, groundwater contamination and human gastroenteric outcomes. Just 14 relevant studies were found to have been published during the period 1980-2017, thus highlighting the fact that this potentially significant source of climate-related exposure to environmental infection has remained understudied to date. Studies differed significantly in terms of type and data reporting procedures, making it difficult to discern clear trends and patterns. Approximately 945 confirmed cases of flood-related enteric disease were examined across studies; these concurred with almost 10,000 suspected cases, equating to approximately 20 suspected cases per confirmed case. As such, no regional, national or global estimates are available for the human gastrointestinal health burden of flood-related groundwater contamination. In light of the demonstrable public health significance of the concurrent impacts of groundwater susceptibility and climate change exacerbation, strategies to increase awareness about potential sources of contamination and motivate precautionary behaviour (e.g. drinking water testing and treatment, supply interruptions) are necessary. Mainstreaming climate adaptation concerns into planning policies will also be necessary to reduce human exposure to waterborne sources of enteric infection.

Dissolved organic carbon (DOC) is composed of a diverse array of compounds, predominantly humic substances, and is a near ubiquitous component of natural groundwater, notwithstanding climatic extremes such as arid and hyper-arid settings. Despite being a frequently measured parameter of groundwater quality, the complexity of DOC composition and reaction behaviour means that links between concentration and human health risk are difficult to quantify and few examples are reported in the literature. Measured concentrations from natural/unpolluted groundwater are typically below 4 mg C/l, whilst concentrations above these levels generally indicate anthropogenic influences and/or contamination issues and can potentially compromise water safety. Treatment processes are effective at reducing DOC concentrations, but refractory humic substance reaction with chlorine during the disinfection process produces suspected carcinogenic disinfectant by-products (DBPs). However, despite engineered artificial recharge systems being commonly used to remove DOC from recycled treated wastewaters, little research has been conducted on the presence of DBPs in potable groundwater systems. In recent years, the capacity to measure the influence of organic matter on colloidal contaminants and its influence on the mobility of pathogenic microorganisms has aided understanding of transport processes in aquifers. Additionally, advances in polymerase chain reaction techniques used for the detection, identification, and quantification of waterborne pathogens, provide a method to confidently investigate the behaviour of DOC and its effect on contaminant transfer in aquifers. This paper provides a summary of DOC occurrence in groundwater bodies and associated issues capable of indirectly affecting human health.

In the mid-1800s, Dr. John Snow (1813–1858), an obstetrician and anaesthesiologist, theorised that cholera, a highly infectious gastrointestinal infection associated with extremely high rates of mortality, was caused by faecal contamination of water supplies (Donaldson and Scally 2009). During the summer of 1854, a significant cholera outbreak occurred in the Soho district of London (UK), resulting in the deaths of 616 people. As part of this first modern epidemiological investigation, Dr. Snow noted that “within 250 yards of the spot where Cambridge Street joins Broad Street there were upwards of 500 fatal attacks of cholera in 10 days (…) suspected some contamination of the water of the much-frequented street-pump (a public well) in Broad Street.” Snow subsequently developed what is now referred to as “The Ghost Map”, a geographical grid indicating where and when cholera cases and associated mortalities occurred in relation to the public well (Hempel 2007). Not only did the map confirm that almost all cases related to drinking water from the pump, but also that specific residential clusters were not associated with infection; for example, workers in an adjacent brewery did not contract the illness due to their daily allowance of beer. Later research discovered that the hand-dug well had been constructed just 0.9 m from a defunct septic tank/cesspit (Johnson 2006; Hempel 2007). Thus, it might be said that the science of epidemiology, considered the cornerstone of public health and defined as “the study and analysis of the patterns, causes, and effects of health and disease conditions within a specific population” (Porta 2008), has its very roots in hydrogeology and the subsurface.

Antibiotic-resistant (pathogenic and non-pathogenic) organisms and genes are now acknowledged as significant emerging aquatic contaminants with potentially adverse human and ecological health impacts, and thus require monitoring. This study is the first to investigate levels of resistance among Irish groundwater (private wells) samples; Escherichia coli isolates were examined against a panel of commonly prescribed human and veterinary therapeutic antibiotics, followed by determination of the causative factors of resistance. Overall, 42 confirmed E. coli isolates were recovered from a groundwater-sampling cohort. Resistance to the human panel of antibiotics was moderate; nine (21.4%) E. coli isolates demonstrated resistance to one or more human antibiotics. Conversely, extremely high levels of resistance to veterinary antibiotics were found, with all isolates presenting resistance to one or more veterinary antibiotics. Particularly high levels of resistance (93%) were found with respect to the aminoglycoside class of antibiotics. Results of statistical analysis indicate a significant association between the presence of human (multiple) antibiotic resistance (p = 0.002–0.011) and both septic tank density and the presence of vulnerable sub-populations (

SUMMARYIreland reports the highest incidence of verotoxigenicEscherichia coli(VTEC) infection in Europe. This study investigated potential risk factors for confirmed sporadic and outbreak primary VTEC infections during 2008–2013. Overall, 989 VTEC infections including 521 serogroup O157 and 233 serogroup O26 were geo-referenced to 931 of 18 488 census enumeration areas. The geographical distribution of human population, livestock, unregulated groundwater sources, domestic wastewater treatment systems (DWWTS) and a deprivation index were examined relative to notification of VTEC events in 524 of 6242 rural areas. Multivariate modelling identified three spatially derived variables associated with VTEC notification: private well usage [odds ratio (OR) 6·896,P< 0·001], cattle density (OR 1·002,P< 0·001) and DWWTS density (OR 0·978,P= 0·002). Private well usage (OR 18·727,P< 0·001) and cattle density (OR 1·001,P= 0·007) were both associated with VTEC O157 infection, while DWWTS density (OR 0·987,P= 0·028) was significant within the VTEC O26 model. Findings indicate that VTEC infection in the Republic of Ireland is particularly associated with rural areas, which are associated with a ubiquity of pathogen sources (cattle) and pathways (unregulated groundwater supplies).

Analyses of biofilm community structure may potentially be employed for aquatic ecosystem health assessment, however, to date, biofilm diversity within urban lakes using reclaimed water has not been examined. Accordingly, the microbial community diversity and structure of biofilms from the surface of multiple matrices with varying roughness (0.1, 1.0 and 10.0 μm) were characterized using a suite of molecular techniques including scanning electron microscopy, genetic fingerprinting and phospholipid-derived fatty acid analyses. Samples were largely comprised of inorganic particles, algae and numerous bacterial species; 12 phospholipid-derived fatty acid (PLFA) types were identified, significantly less than typically associated with sewage. Both growth matrix surface roughness and biofilm growth phase were shown to concur with significantly different microbial quantity and community structures. Gram-negative bacteria bacillus i15:03OH and 18:0 were the dominant bacterial genera, collectively comprising ≈75 % of identified PLFA species content. Calculated species diversity (H) and species dominance (D) exhibited identical correlational patterns with measured water quality parameters; significant positive correlations were exhibited with respect to Mg2, while significant negative correlations were found for NO3, TP, BOD, COD, SP, PO4, SO4 and pH. Results indicate that analyses of biofilm formation and structure could be effectively used to undertake integrated assessments of the ecological health of lake systems using reclaimed water. Further work is required to elucidate the optimum conditions for sample collection and analytical interpretation.