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Eye infections from bacterial contamination of bulk-refillable liquid soap dispensers and artificial tear eye drops continue to occur, resulting in adverse health outcomes that include impaired vision or eye enucleation. Pseudomonas aeruginosa (P. aeruginosa), a common cause of eye infections, can grow in eye drop containers and refillable soap dispensers to high numbers. To assess the risk of eye infection, a quantitative microbial risk assessment for P. aeruginosa was conducted to predict the probability of an eye infection for two potential exposure scenarios: (i) individuals using bacteria-contaminated eye drops and (ii) contact lens wearers washing their hands with bacteria-contaminated liquid soap prior to placing the lens. The median risk of an eye infection using contaminated eye drops and hand soap for both single and multiple exposure events (per day) ranged from 10-1 to 10-4, with contaminated eye drops having the greater risk. The concentration of P. aeruginosa was identified as the parameter contributing the greatest variance on eye infection risk; therefore, the prevalence and level of bacterial contamination of the product would have the greatest influence on health risk. Using eye drops in a single-use container or with preservatives can mitigate bacterial growth, and using non-refillable soap dispensers is recommended to reduce contamination of hand soap. Given the opportunistic nature of P. aeruginosa and its ability to thrive in unique environments, additional safeguards to mitigate bacterial growth and exposure are warranted. IMPORTANCE Pseudomonas aeruginosa (P. aeruginosa) is a pathogen that can persist in a variety of unusual environments and continues to pose a significant risk for public health. This quantitative microbial risk assessment (QMRA) estimates the potential human health risks, specifically for eye infections, associated with exposure to P. aeruginosa in bacteria-contaminated artificial tear eye drops and hand soap. This study applies the risk assessment framework of QMRA to evaluate eye infection risks through both consumer products. The study examines the prevalence of this pathogen in eye drops and soap, as well as the critical need to implement measures that will mitigate bacterial exposure (e.g., single-use soap dispensers and eye drops with preservatives). Additionally, limitations and challenges are discussed, including the need to incorporate data regarding consumer practices, which may improve exposure assessments and health risk estimates. [ABSTRACT FROM AUTHOR]

The border city of El Paso, Texas, and its water utility, El Paso Water, initiated a SARS-CoV-2 wastewater monitoring program to assess virus trends and the appropriateness of a wastewater monitoring program for the community. Nearly weekly sample collection at four wastewater treatment facilities (WWTFs), serving distinct regions of the city, was analyzed for SARS-CoV-2 genes using the CDC 2019-Novel coronavirus Real-Time RT-PCR diagnostic panel. Virus concentrations ranged from 86.7 to 268,000 gc/L, varying across time and at each WWTF. The lag time between virus concentrations in wastewater and reported COVID-19 case rates (per 100,00 population) ranged from 4–24 days for the four WWTFs, with the strongest trend occurring from November 2021 - June 2022. This study is an assessment of the utility of a geographically refined SARS-CoV-2 wastewater monitoring program to supplement public health efforts that will manage the virus as it becomes endemic in El Paso. [ABSTRACT FROM AUTHOR]

Private wells are susceptible to contamination from flooding and are exempt from the federal requirements of the Safe Drinking Water Act. Consequently, well users must manage (e.g., disinfect) and maintain (e.g., regularly test) their own wells to ensure safe drinking water. However, well user practices and perceptions of well water quality in the years following a natural disaster are poorly characterized. An online follow-up survey was administered in October 2020 to private well users who had previously experienced Hurricane Harvey in 2017. The survey was successfully sent to 436 participants, and 69 surveys were returned (15.8% return rate). The survey results indicate that well users who had previously experienced wellhead submersion or a positive bacteria test were more likely to implement well stewardship practices (testing and disinfection) and to report the feeling that their well water was safe. While the majority of well users believed that their water was safe (77.6%), there was a significant decrease in well water being used for drinking, cooking, and for their pets after Hurricane Harvey. Generally, these well users tend to maintain their wells at higher rates than those reported in other communities, but there continues to be a critical need to provide outreach regarding well maintenance practices, especially before natural disaster events occur. [ABSTRACT FROM AUTHOR]

Quantitative microbial risk assessment (QMRA) can be used to evaluate health risks associated with recreational beach use. This study developed a site-specific risk assessment using a novel approach that combined quantitative PCR-based measurement of microbial source tracking (MST) genetic markers (human, dog, and gull fecal bacteria) with a QMRA analysis of potential pathogen risk. Water samples (n = 24) from two recreational beaches were collected and analyzed for MST markers as part of a broader Beach Exposure And Child Health Study that examined child behavior interactions with the beach environment. We report here the measurements of fecal bacteria MST markers in the environmental DNA extracts of those samples and a QMRA analysis of potential health risks utilizing the results from the MST measurements in the water samples. Human-specific Bacteroides was enumerated by the HF183 Taqman qPCR assay, gull-specific Catellicoccus was enumerated by the Gull2 qPCR assay, and dog-specific Bacteroides was enumerated by the DogBact qPCR assay. Derived reference pathogen doses, calculated from the MST marker concentrations detected in recreational waters, were used to estimate the risk of gastrointestinal illness for both children and adults. Dose-response equations were used to estimate the probability of the risk of infection (Pinf) per a swimming exposure event. Based on the QMRA simulations presented in this study, the GI risk from swimming or playing in water containing a mixture of human and non-human fecal sources appear to be primarily driven by the human fecal source. However, the estimated median GI health risk for both beaches never exceeded the U.S. EPA risk threshold of 32 illnesses per 1,000 recreation events. Our research suggests that utilizing QMRA together with MST can further extend our understanding of potential recreational bather risk by identifying the source contributing the greatest risk in a particular location, therefore informing beach management responses and decision-making. [ABSTRACT FROM AUTHOR]

Microbial contamination of private well systems continues to be a prominent drinking water concern, especially for areas impacted by floodwaters. Hurricane Harvey deposited nearly 60 inches of rain, resulting in extensive flooding throughout Houston, Texas, and neighboring counties. A sampling campaign to test private wells for fecal indicator bacteria was initiated in the weeks following flooding. Escherichia coli concentrations measured in wells were utilized in a quantitative microbial risk assessment to estimate the risk of infection for both drinking water and indirect ingestion exposure scenarios. Derived reference pathogen doses indicated that norovirus (1.60 × 10−4 to 8.32 × 10−5) and Cryptosporidium (2.37–7.80 × 10−6) posed the greatest health risk via drinking, with median health risk estimates exceeding the U.S. Environmental Protection Agency's modified daily risk threshold of 1 × 10−6 for a gastrointestinal infection. Bathing (1.78 × 10−6), showering (4.32 × 10−7), and food/dish washing (1.79 × 10−6) were also identified to be exposure pathways of health concern. A post-flood microbial risk assessment of private wells in the Gulf Coast has not previously been conducted. Estimating these health risks can provide scientifically supported guidance regarding which well water practices are safest, especially when well water quality is unknown. Developing this guidance is critical as coastal communities experience increased vulnerability to flooding. [ABSTRACT FROM AUTHOR]

Rapid and accurate diagnosis of infections is fundamental to containment of disease. Several monkeypox virus (MPV) real‐time diagnostic assays have been recommended by the CDC; however, the specificity of the primers and probes in these assays for the ongoing MPV outbreak has not been investigated. We analyzed the primer and probe sequences present in the CDC recommended MPV generic real‐time PCR assay by aligning those sequences against 1730 MPV complete genomes reported in 2022 worldwide. Sequence mismatches were found in 99.08% and 97.46% of genomes for the MPV generic forward and reverse primers, respectively. Mismatch‐corrected primers were synthetized and compared to the generic assay for MPV detection. Results showed that the two primer‐template mismatches resulted in a ~11‐fold underestimation of initial template DNA in the reaction and 4‐fold increase in the 95% LOD. We further evaluated the specificity of seven other real‐time PCR assays used for MPV and orthopoxvirus (OPV) detection and identified two assays with the highest matching score (>99.6%) to the global MPV genome database in 2022. Genetic variations in the primer‐probe regions across MPV genomes could indicate the temporal and spatial emergence pattern of monkeypox disease. Our results show that the current MPV real‐time generic assay may not be optimal to accurately detect MPV, and the mismatch‐corrected assay with full complementarity between primers and current MPV genomes could provide a more sensitive and accurate detection of MPV. [ABSTRACT FROM AUTHOR]

Fecal indicator bacteria are routinely used to assess surface water sanitary quality. The State of Texas uses Total Maximum Daily Loads to address water bodies that exceed the allowable fecal indicator bacteria criteria. The effectiveness of these processes in decreasing the fecal indicator bacteria concentrations has been debated due to the diversity and nature of fecal indicator bacteria sources. We assessed actual and flow‐adjusted trends in measured Escherichia coli (E. coli) concentrations at 721 freshwater stream sites from 2001 through 2021. We also compared odds of statistical improvement of E. coli concentrations at sites before and after the adoption of Total Maximum Daily Loads (adopted from 2008 through 2014). Results indicate non‐significant differences in the odds of statistically detected improvements in E. coli concentration between pre‐Total Maximum Daily Load and post‐Total Maximum Daily Load sites. Although the State of Texas and numerous watershed stakeholders have made efforts to address water quality impairments, these results join a body of evidence that water quality improvements are stagnating in the state. Furthermore, this study leverages water quality data used for state water quality standards assessment purposes and highlights that robust monitoring program design is needed to effectively assess the progress of water quality planning efforts. [ABSTRACT FROM AUTHOR]

Water quality standards are developed to protect and define when waterbodies support their designated uses including public water supply, recreational use, aquatic life use, and others. Recreational use categories include various activities that typically do not occur under similar hydrologic conditions making protection of all uses challenging. This paper presents a case study where Escherichia coli concentrations were grouped by flow rate to demonstrate potential effects of developing use‐specific water quality standards for contact recreation. Adopting this approach requires a shift from current water quality policy which applies to all hydrologic conditions; however, it also requires additional data collection on actual usage types and occurrence before it can be implemented. This paper demonstrates that implementing an alternative water quality standards approach can still reasonably protect human health while minimizing taxpayer cost to restore impaired waterbodies. [ABSTRACT FROM AUTHOR]

Application of public health insecticides for mosquito control has increased dramatically with the recent outbreaks in the continental United States of dengue, chikungunya, and Zika. Mosquito control is often controversial because of the potential impacts on health and the environment due to the chemicals used. The emphasis in this review is to examine the transport, fate, and potential effects of the active ingredients in selected public health insecticides used for mosquito control. Due to the many potential entry points for insecticides, especially in urban areas where use is less monitored and application may be in greater amounts per unit area, this review suggests that a potential focus might be on the prevalence and quantification of the cumulative concentrations of these insecticides in natural systems. Often concentrations resulting from a single application are unlikely to cause mortality, but multiple applications may result in concentrations of environmental concern. Minimizing entrance to waterways and public water supply sources can be achieved by applying insecticides during prime meteorological conditions where drift and volatilization are minimized, using vegetated buffer zones in agricultural areas to prevent runoff, and avoiding application to impervious surfaces in urban areas. [ABSTRACT FROM AUTHOR]

Gastrointestinal (GI) illness risks associated with exposure to waters impacted by human and nonhuman fecal sources were estimated using quantitative microbial risk assessment (QMRA). Microbial source tracking (MST) results had identified Escherichia coli (E. coli) contributors to the waterbody as human and unidentified (10%), cattle and domestic animals (25%), and wildlife (65%) in a rural watershed. The illness risks associated with ingestion during recreation were calculated by assigning reference pathogens for each contributing source and using pathogen dose–response relationships. The risk of GI illness was calculated for a specific sampling site with a geometric mean of E. coli of 163 colony forming units (cfu) 100 mL−1, and the recreational standard of E. coli, 126 cfu 100 mL−1. While the most frequent sources of fecal indicator bacteria at the sampling site were nonhuman, the risk of illness from norovirus, the reference pathogen representing human waste, contributed the greatest risk to human health. This study serves as a preliminary review regarding the potential for incorporating results from library-dependent MST to inform a QMRA for recreational waters. The simulations indicated that identifying the sources contributing to the bacterial impairment is critical to estimate the human health risk associated with recreation in a waterbody. [ABSTRACT FROM AUTHOR]