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Legionella is an opportunistic waterborne pathogen that is difficult to eradicate in colonized drinking water pipes. Legionella control is further challenged by aging water infrastructure and lack of evidence-based guidance for building treatment. This study assessed multiple premise water remediation approaches designed to reduce Legionella pneumophila within a residential building located in an aging, urban drinking water system over a two-year period. Samples (n = 745) were collected from hot and cold-water lines and quantified via most probable number culture. Building-level treatment approaches included three single heat shocks, three single chemical shocks, and continuous low-level chemical disinfection in the potable water system. The building was highly colonized with L. pneumophila with 71 % L. pneumophila positivity. Single heat shocks had a statistically significant L. pneumophila reduction one day post treatment but no significant L. pneumophila reduction at one week, two weeks, and four weeks post treatment. The first two chemical shocks resulted in statistically significant L. pneumophila reduction at two days and four weeks post treatment, but there was a significant L. pneumophila increase at four weeks following the third chemical shock. Continuous low-level chemical disinfection resulted in statistically significant L. pneumophila reduction at ten weeks post treatment implementation. This demonstrates that in a building highly colonized with L. pneumophila, sustained remediation is best achieved using continuous low-level chemical treatment., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Chronic arsenic exposure has been associated with an increased risk of cardiovascular disease; diabetes; cancers of the lung, pancreas and prostate; and all-cause mortality in American Indian communities in the Strong Heart Study., Objective: The Strong Heart Water Study (SHWS) designed and evaluated a multilevel, community-led arsenic mitigation program to reduce arsenic exposure among private well users in partnership with Northern Great Plains American Indian Nations., Methods: A cluster randomized controlled trial (cRCT) was conducted to evaluate the effectiveness of the SHWS arsenic mitigation program over a 2-y period on a ) urinary arsenic, and b ) reported use of arsenic-safe water for drinking and cooking. The cRCT compared the installation of a point-of-use arsenic filter and a mobile Health (mHealth) program (3 phone calls; SHWS mHealth and Filter arm) to a more intensive program, which included this same program plus three home visits (3 phone calls and 3 home visits; SHWS Intensive arm)., Results: A 47% reduction in urinary arsenic [ geometric mean  ( GM ) = 13.2  to  7.0 μ g / g creatinine] was observed from baseline to the final follow-up when both study arms were combined. By treatment arm, the reduction in urinary arsenic from baseline to the final follow-up visit was 55% in the mHealth and Filter arm ( GM = 14.6  to  6.55 μ g / g creatinine) and 30% in the Intensive arm ( GM = 11.2  to  7.82 μ g / g creatinine). There was no significant difference in urinary arsenic levels by treatment arm at the final follow-up visit comparing the Intensive vs. mHealth and Filter arms: GM ratio of 1.21 (95% confidence interval: 0.77, 1.90). In both arms combined, exclusive use of arsenic-safe water from baseline to the final follow-up visit significantly increased for water used for cooking (17% to 53%) and drinking (12% to 46%)., Discussion: Delivery of the interventions for the community-led SHWS arsenic mitigation program, including the installation of a point-of-use arsenic filter and a mHealth program on the use of arsenic-safe water (calls only, no home visits), resulted in a significant reduction in urinary arsenic and increases in reported use of arsenic-safe water for drinking and cooking during the 2-y study period. These results demonstrate that the installation of an arsenic filter and phone calls from a mHealth program presents a promising approach to reduce water arsenic exposure among private well users. https://doi.org/10.1289/EHP12548.

Many rural populations, including American Indian communities, that use private wells from groundwater for their source of drinking and cooking water are disproportionately exposed to elevated levels of arsenic. However, programs aimed at reducing arsenic in American Indian communities are limited. The Strong Heart Water Study (SHWS) is a randomized controlled trial aimed at reducing arsenic exposure among private well users in American Indian Northern Great Plains communities. The community-led SHWS program installed point-of-use (POU) arsenic filters in the kitchen sink of households, and health promoters delivered arsenic health communication programs. In this study we evaluated the efficacy of these POU arsenic filters in removing arsenic during the two-year installation period. Participants were randomized into two arms. In the first arm households received a POU arsenic filter, and 3 calls promoting filter use (SHWS mobile health (mHealth) & filter arm). The second arm received the same filter and phone calls, and 3 in-person home visits and 3 Facebook messages (SHWS intensive arm) for program delivery. Temporal variability in water arsenic concentrations from the main kitchen faucet was also evaluated. A total of 283 water samples were collected from 50 households with private wells from groundwater (139 filter and 144 kitchen faucet samples). Ninety-three percent of households followed after baseline had filter faucet water arsenic concentrations below the arsenic maximum contaminant level of 10 μg/L at the final visit during our 2 year study period with no difference between study arms (98 % in the intensive arm vs. 94 % in the mHealth & filter arm). No significant temporal variation in kitchen arsenic concentration was observed over the study period (intraclass correlation coefficient = 0.99). This study demonstrates that POU arsenic filters installed for the community participatory SHWS program were effective in reducing water arsenic concentration in study households in both arms, even with delivery of the POU arsenic filter and mHealth program only. Furthermore, we observed limited temporal variability of water arsenic concentrations from kitchen faucet samples collected over time from private wells in our study setting., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022. Published by Elsevier B.V.)

Per- and polyfluoroalkyl substances (PFAS) are compounds of emerging concern due to their persistence in the global water cycle and detection in drinking water sources. However, PFAS have been poorly studied in bottled water, especially in the United States. This study investigated the occurrence of PFAS and related factors in 101 uniquely labelled bottled water products for sale in the U.S. Products were screened for 32 target PFAS by solid phase extraction-liquid chromatography-tandem mass spectrometry (SPE-LC-MS/MS). Fifteen of 32 measured analytes were detected, consisting primarily of C3-C10 perfluorocarboxylic acids (PFCA) and C3-C6 and C8 perfluorosulfonic acids (PFSA). PFAS were detected above method detection limits in 39/101 tested products. The Σ 32 PFAS concentrations detected were 0.17-18.87 ng/L with a median of 0.98 ng/L; 97% of samples were below 5 ng/L. PFCA (83%) and short-chain perfluoroalkyl acids (PFAA) containing 5 or less CF 2 groups (67%) were more prevalent on a mass basis than PFSA and longer-chain PFAA, respectively. Ultrashort-chain PFPrA, measured for the first time in bottled water, accounted for the greatest individual fraction of detected PFAS mass (42%) and was found almost exclusively in products labeled as Spring water. Purified water products contained significantly less PFAS than Spring water products, which was attributed to the use of reverse osmosis (RO) treatment in the majority of Purified waters (25/35) compared to Spring waters (1/45). RO-treated products contained significantly lower Σ 32 PFAS, long-chain, short-chain, and PFPrA concentrations than products without RO. Although no enforceable PFAS regulations exist for bottled water in the U.S., the finding that some products approach levels of concern justify a framework for monitoring PFAS in bottled water production., (Copyright © 2021. Published by Elsevier Ltd.)

Purpose of Review: This review examines the effectiveness of drinking water regulations to inform public health during extreme precipitation events. This paper estimates the vulnerability of specific populations to flooding in their public water system, reviews the literature linking precipitation to waterborne outbreaks, examines the role that Safe Drinking Water Act and Public Notification (PN) Rule have in public health emergencies, and reviews the effectiveness of the PN Rule during the 2017 Hurricane Maria in Puerto Rico., Recent Findings: Public water systems in large metropolitan areas have substantial portions of their customer base at risk for a waterborne outbreak during a flooding event. The PN Rule are ambiguous for who is responsible for declaring a "waterborne emergency" following a natural disaster like Hurricane Maria. Revisions to the current PN Rule that mandate public notification and water quality sampling during extreme precipitation events are necessary to ensure the public is aware of their drinking water quality following these events.

Background: Use of engineered nanoparticles (NPs) in consumer products is resulting in NPs in drinking water sources. Subsequent NP breakthrough into treated drinking water is a potential exposure route and human health threat., Objectives: In this study we investigated the breakthrough of common NPs--silver (Ag), titanium dioxide (TiO2), and zinc oxide (ZnO)--into finished drinking water following conventional and advanced treatment., Methods: NPs were spiked into five experimental waters: groundwater, surface water, synthetic freshwater, synthetic freshwater containing natural organic matter, and tertiary wastewater effluent. Bench-scale coagulation/flocculation/sedimentation simulated conventional treatment, and microfiltration (MF) and ultrafiltration (UF) simulated advanced treatment. We monitored breakthrough of NPs into treated water by turbidity removal and inductively coupled plasma-mass spectrometry (ICP-MS)., Results: Conventional treatment resulted in 2-20%, 3-8%, and 48-99% of Ag, TiO2, and ZnO NPs, respectively, or their dissolved ions remaining in finished water. Breakthrough following MF was 1-45% for Ag, 0-44% for TiO2, and 36-83% for ZnO. With UF, NP breakthrough was 0-2%, 0-4%, and 2-96% for Ag, TiO2, and ZnO, respectively. Variability was dependent on NP stability, with less breakthrough of aggregated NPs compared with stable NPs and dissolved NP ions., Conclusions: Although a majority of aggregated or stable NPs were removed by simulated conventional and advanced treatment, NP metals were detectable in finished water. As environmental NP concentrations increase, we need to consider NPs as emerging drinking water contaminants and determine appropriate drinking water treatment processes to fully remove NPs in order to reduce their potential harmful health outcomes.

Innovative solutions are essential to improving global access to potable water for nearly 1 billion people. This study presents an independent investigation of one alternative by examining for-profit water-vending kiosks, WaterHealth Centers (WHCs), in rural Ghana to determine their association with household drinking water quality. WHCs' design includes surface water treatment using filtration and ultraviolet light disinfection along with community-based hygiene education. Analyses of water samples for Escherichia coli and household surveys from 49 households across five villages collected one time per year for 3 years indicate that households using WHCs had improved water quality compared with households using untreated surface water (adjusted incidence rate ratio = 0.07, 95% confidence interval = 0.02, 0.21). However, only 38% of households used WHCs by the third year, and 60% of those households had E. coli in their water. Recontamination during water transport and storage is an obstacle to maintaining WHC-vended water quality.

Over the past two decades, the incidence of legionellosis has been steadily increasing in the United States though there is noclear explanation for the main factors driving the increase. While legionellosis is the leading cause of waterborne outbreaks in the US, most cases are sporadic and acquired in community settings where the environmental source is never identified. This scoping review aimed to summarise the drivers of infections in the USA and determine the magnitude of impact each potential driver may have. A total of 1,738 titles were screened, and 18 articles were identified that met the inclusion criteria. Strong evidence was found for precipitation as a major driver, and both temperature and relative humidity were found to be moderate drivers of incidence. Increased testing and improved diagnostic methods were classified as moderate drivers, and the ageing U.S. population was a minor driver of increasing incidence. Racial and socioeconomic inequities and water and housing infrastructure were found to be potential factors explaining the increasing incidence though they were largely understudied in the context of non-outbreak cases. Understanding the complex relationships between environmental, infrastructure, and population factors driving legionellosis incidence is important to optimise mitigation strategies and public policy. [ABSTRACT FROM AUTHOR]

Tangential-flow ultrafiltration was optimized for the recovery of Escherichia coli, Enterococcus faecalis, Clostridium perfringens spores, bacteriophages MS2 and PRD1, murine norovirus, and poliovirus seeded into 100-liter surface water (SW) and drinking water (DW) samples. SW and DW collected from two drinking water treatment plants were then evaluated for human enteric viruses. [ABSTRACT FROM AUTHOR]

Small water enterprises (SWEs) are water delivery operations that predominantly provide water at the community level. SWEs operate beyond the reach of piped water systems, selling water to households throughout the world. Their ubiquity in the developing world and access to vulnerable populations suggests that these small-scale water vendors may prove valuable in improving potable water availability. This paper assesses the current literature on SWEs to evaluate previous studies and determine gaps in the evidence base. Piped systems and point-of-use products were not included in this assessment. Results indicate that SWEs are active in urban, peri-urban and rural areas of Africa, Asia and Latin America. Benefits of SWEs include: no upfront connection fees; demand-driven and flexible to local conditions; and service to large populations without high costs of utility infrastructure. Disadvantages of SWEs include: higher charges for water per unit of volume compared with infrastructure-based utilities; lack of regulation; operation often outside legal structures; no water quality monitoring; increased potential for conflict with local utilities; and potential for extortion by local officials. No rigorous, evidence-based, peer-reviewed scientific studies that control for confounders examining the effectiveness of SWEs in providing potable water were identified. [ABSTRACT FROM AUTHOR]

Rapidly growing populations and migration to urban areas in developing countries has resulted in a vital need for the establishment of centralized water systems to disseminate potable water to residents. Protected source water and modern, well-maintained drinking water treatment plants can provide water adequate for human consumption. However, ageing, stressed or poorly maintained distribution systems can cause the quality of piped drinking water to deteriorate below acceptable levels and pose serious health risks. This review will outline distribution system deficiencies in developing countries caused by: the failure to disinfect water or maintain a proper disinfection residual; low pipeline water pressure; intermittent service; excessive network leakages; corrosion of parts; inadequate sewage disposal; and inequitable pricing and usage of water. Through improved research, monitoring and surveillance, increased understanding of distribution system deficiencies may focus limited resources on key areas in an effort to improve public health and decrease global disease burden. [ABSTRACT FROM AUTHOR]

To examine the long-term infectivity of human norovirus in water, 13 study subjects were challenged at different time points with groundwater spiked with the prototype human norovirus, Norwalk virus. Norwalk virus spiked in groundwater remained infectious after storage at room temperature in the dark for 61 days (the last time point tested). The Norwalk virus-seeded groundwater was stored for 1,266 days and analyzed, after RNase treatment, by reverse transcription-quantitative PCR (RT-qPCR) to detect Norwalk virus RNA contained within intact capsids. Norwalk virus RNA within intact capsids was detected in groundwater for 1,266 days, with no significant log10 reduction throughout 427 days and a significant 1.10-log10 reduction by day 1266. Purified Norwalk virus RNA (extracted from Norwalk virus virions) persisted for 14 days in groundwater, tap water, and reagent-grade water. This study demonstrates that Norwalk virus in groundwater can remain detectable for over 3 years and can remain infectious for at least 61 days. [ABSTRACT FROM AUTHOR]

Abstract: Carbon nanotubes (CNTs) were investigated for their capability and mechanisms to simultaneously remove colloidal natural organic matter (NOM) and humic substances from natural surface water. Static removal testing was conducted via adsorption experiments while dynamic removal was evaluated by layering CNTs onto substrate membranes and filtering natural water through the CNT-layered membranes. Analyses of treated water samples showed that removal of humic substances occurred via adsorption under both static and dynamic conditions. Removal of colloidal NOM occurred at a moderate level of 36–66% in static conditions, independent of the specific surface area (SSA) of CNTs. Dynamic removal of colloidal NOM increased from approximately 15% with the unmodified membrane to 80–100% with the CNT-modified membranes. Depth filtration played an important role in colloidal NOM removal. A comparison of the static and dynamic removal of humic substances showed that equilibrium static removal was higher than dynamic (p < 0.01), but there was also a significant linear relationship between static and dynamic removal (p < 0.05). Accounting for contact time of CNTs with NOM during filtration, it appeared that CNT mat structure was an important determinant of removal efficiencies for colloidal NOM and humic substances during CNT membrane filtration. [Copyright &y& Elsevier]

Abstract: Microbial monitoring was conducted over a period of more than 1year at three full-scale riverbank filtration (RBF) facilities, located in the United States along the Ohio, Missouri, and Wabash Rivers. Results of this study demonstrated the potential for RBF to provide substantial reductions in microorganism concentrations relative to the raw water sources. Cryptosporidium and Giardia were detected occasionally in the river waters but never in any of the well waters. Average concentrations and log reductions of Cryptosporidium and Giardia could not be accurately determined due to the low and variable concentrations in the river waters and the lack of detectible concentrations in the well waters. Average concentrations of aerobic and anaerobic spore-forming bacteria, which have both been proposed as potential surrogates for the protozoans, were reduced at the three facilities by 0.8 to >3.1 logs and 0.4 to >4.9 logs, respectively. Average concentrations of male-specific and somatic bacteriophage were reduced by >2.1 logs and ⩾3.2 logs, respectively. Total coliforms were rarely detected in the well waters, with 5.5 and 6.1 log reductions in average concentrations at the two wells at one of the sites relative to the river water. Average turbidity reductions upon RBF at the three sites were between 2.2 and 3.3 logs. Turbidity and microbial concentrations in the river waters generally tracked the river discharge; a similar relationship between the well water concentrations and river discharge was not observed, due to the low, relatively constant well water turbidities and lack of a significant number of detections of microorganisms in the well waters. Further research is needed to better understand the relationships among transport of pathogens (e.g., Cryptosporidium, Giardia, viruses) and potential surrogate parameters (including bacterial spores and bacteriophage) during RBF and the effects of water and sediment characteristics on removal efficiency. [Copyright &y& Elsevier]