Fundamentals of Wastewater-Based Epidemiology

Biomonitoring of Bacteria, Protozoa, COVID-19, and Other Viruses

Frank R. Spellman

• Publisher: CRC Press
• Year: 2021
• Print ISBN:
  9780367758066
• eBook ISBN:
  9781000383768
• Topic: Technology & Engineering
• Subtopic: Epidemiology
• Index: Technology & Engineering

It is common practice to evaluate wastewater to understand drug consumption, from antibiotics to illegal narcotics, and even to analyze dietary habits and trends. Evaluating contaminants in wastewater enables researchers, environmental scientists, and water quality experts to gain valuable information and data. Wastewater-based epidemiology is an emerging science that has proven to be a cost- and time-effective biomonitoring tool. This book provides a roadmap for detecting wastewater-borne pathogenic contaminants such as viruses, bacteria, fungi, and others. It provides a basic, fundamental discussion of how sampling and monitoring of wastewater using epidemiological concepts and practices can aid in determining the presence of the COVID-19 virus in a community, for example, and may help predict future outbreaks.

Features

• Offers a unique discussion of the detection of bacteria, fungi, and COVID-19, and other viruses in wastewater

• Presents the fundamentals of wastewater chemistry and microbiology

• Explains biomonitoring, sampling, testing, and health surveillance in a practical manner

Fundamentals of Wastewater-Based Epidemiology: Biomonitoring of Bacteria, Fungi, COVID-19, and Other Viruses is an invaluable resource to a wide array of readers with varying interests and backgrounds in water science and public health.

Part 1

Setting the Stage

1 And What’s in the Pipes Will Tell

“And I believe that truth is mighty and shines by its own light.”

—Vincent Bugliosi

“It can be said that Wastewater-Based Epidemiologists are the modern-day Sherlock Holmes of disease detection based on investigation and analysis of the biological contents contained in raw sewage … including emerging studies of COVID-19” (see Figure 1.1).

—Frank R. Spellman

Introduction^*

He wandered the foggy, filthy, corpse-ridden streets of 1854 London, searching, making notes, always looking, seeking a murdering villain—and find the miscreant, he did. He acted; he removed the handle from a water pump. And, fortunately for untold thousands of lives, his was the correct action—the lifesaving action.

* From F.R. Spellman (2020) The Science of Water, 4th ed. Boca Raton, FL: CRC Press.

He was a detective—of sorts. No, not Sherlock Holmes but absolutely as clever, as skillful, as knowledgeable, as intuitive, and definitely as driven. His real name: Dr. John Snow. His middle name? Common Sense. Snow’s master criminal? His target—a mindless, conscienceless, brutal killer: cholera.

Let’s take a closer look at this medical super sleuth and, at his quarry, the deadly killer cholera—and at Doctor Snow’s actions to contain the spread of cholera. More to the point, let’s look at Dr. Snow’s subsequent impact on the treatment (disinfection) of potable water and raw water used for other purposes.

Dr. John Snow

An unassuming—and creative—London obstetrician, Dr. John Snow (1813–1858) achieved prominence in the mid-nineteenth century for proving his theory (in his On the Mode of Communication of Cholera) that cholera is a contagious disease caused by a “poison” that reproduces in the human body and is found in the vomitus and stools of cholera patients. He theorized that the main (though not the only) means of transmission was water contaminated with this poison. His theory was not held in high regard at first, because a commonly held and popular countertheory stated that diseases are transmitted by inhalation of vapors. Many theories of cholera’s cause were expounded. In the beginning, Snow’s argument did not cause a great stir; it was only one of the many hopeful theories proposed during a time when cholera was causing great distress. Eventually, Snow was able to prove his theory. We describe how Snow accomplished this later, but for now, let’s take a look at Snow’s target: cholera.

FIGURE 1.1 COVID-19. Illustration by Kat Welsh-Ware and F. Spellman.

Cholera

According to the U.S. Centers for Disease Control (CDC), cholera is an acute, diarrheal illness caused by infection of the intestine with the bacterium Vibrio cholera. The infection is often mild or without symptoms but sometimes can be severe. Approximately 1 in 20 infected persons have severe disease symptoms characterized by profuse watery diarrhea, vomiting, and leg cramps. In these persons, rapid loss of body fluids leads to dehydration and shock. Without treatment, death can occur within hours.

• Note: You don’t need to be a rocket scientist to figure out just how deadly cholera was during the London cholera outbreak of 1854. Comparing the state of “medicine” at that time to ours is like comparing the speed potential of a horse and buggy to a state-of-the-art NASCAR race car today. Simply stated: cholera was the classic epidemic disease of the nineteenth century, as the Plague had been for the fourteenth. Its defeat reflected both common sense and progress in medical knowledge—and of the enduring changes in European and American social thought.

How does a person contract cholera? Good question. Again, we refer to the CDC for our answer. A person may contract cholera (even today) by drinking water or eating food contaminated with the cholera bacterium. In an epidemic, the source of the contamination is usually feces of an infected person. The disease can spread rapidly in areas with inadequate treatment of sewage and drinking water. Disaster areas often pose special risks. The aftermath of Hurricane Katrina in New Orleans, for example, caused concern for a potential cholera problem.

Cholera bacterium also lives in brackish rivers and coastal waters. Shellfish eaten raw have been a source of cholera, and a few people in the United States have contracted cholera after eating raw shellfish from the Gulf of Mexico. The disease is not likely to spread directly from one person to another; therefore, casual contact with an infected person is not a risk for transmission of the disease.

Flashback to 1854 London

The information provided in the preceding section was updated and provided by CDC in 1996. Basically, for our purposes, CDC confirms the fact that cholera is a waterborne disease. Today, we know quite a lot about cholera and its transmission, how to prevent infection, and how to treat it. But what did they know about cholera in the 1850s? Not much—however, one thing is certain: they knew cholera was a deadly killer. That was just about all they knew—until Dr. John Snow proved his theory. Recall that Snow theorized that cholera is a contagious disease caused by a poison that reproduces in the human body and is found in the vomitus and stools of cholera victims. He also believed that the main means of transmission was water contaminated with this poison.

Dr. Snow’s theory was correct, of course, as we know it today. The question is, how did he prove his theory correct? The answer to this provides us with an account of one of the all-time legendary quests for answers in epidemiological research—and an interesting story.

Dr. Snow proved his theory in 1854, during yet another severe cholera epidemic in London. Though ignorant of the concept of bacteria carried in water, Snow traced an outbreak of cholera to a water pump located at an intersection of Cambridge and Broad Street (London).

How did he isolate this particular pump as the source? He accomplished this by mapping the location of deaths from cholera. His map indicated that the majority of the deaths occurred within 250 yards of that water pump. The water pump was used regularly by most of the area residents. Those who did not use the pump remained healthy. Suspecting the Broad Street pump as the plague’s source, Snow had the water pump handle removed and ended the cholera epidemic.

Sounds like a rather simple solution, doesn’t it? For us, it is simple, but recall in that era aspirin had not yet been formulated, to say nothing of other medical miracles we take for granted—antibiotics, for example. Dr. John Snow, by the methodical process of elimination and linkage (Sherlock Holmes would have been impressed—and he was), proved his point, his theory. Specifically, through painstaking documentation of cholera cases and correlation of the comparative incidence of cholera among subscribers to the city’s two water companies, Snow showed that cholera occurred much more frequently in customers of the water company that drew its water from the lower Thames, where the river had become contaminated with London sewage. The other company obtained water from the upper Thames. Snow tracked and pinpointed the Broad Street pump’s water source. You guessed it: the contaminated lower Thames, of course.

Dr. Snow, the obstetrician, became the first effective practitioner of scientific epidemiology. His creative use of logic, common sense, and scientific information enabled him to solve a major medical mystery—to discern the means by which cholera was transmitted.

Pump Handle Removal—to Water Treatment (Disinfection)

Dr. John Snow’s major contribution to the medical profession, to society, and to humanity in general can be summarized rather succinctly: he determined and proved that the deadly disease cholera is a waterborne disease (Dr. John Snow’s second medical accomplishment was being the first person to administer anesthesia during childbirth).

What does all of this have to do with water treatment (disinfection)? Actually, Dr. Snow’s discovery—his stripping of a mystery to its barest bones—has quite a lot to do with water treatment. Combating any disease is rather difficult without a determination on how the disease is transmitted—how it travels from vector or carrier to receiver. Dr. Snow established this connection, and from his work, and the work of others, progress was made in understanding and combating many different waterborne diseases.

Today, sanitation problems in developed countries (those with the luxury of adequate financial and technical resources) deal more with the consequences that arise from inadequate commercial food preparation, and the results of bacteria becoming resistant to disinfection techniques and antibiotics. We simply flush our toilets to rid ourselves of unwanted wastes and turn on our taps to take in high-quality drinking water supplies, from which we’ve all but eliminated cholera and epidemic diarrheal diseases. This is generally the case in most developed countries today—but it certainly wasn’t true in Dr. Snow’s time.

The progress in water treatment from that notable day in 1854 (when Snow made the “connection” [actually the “disconnection” of handle from pump] between deadly cholera and its means of transmission) to the present reads like a chronology of discovery leading to our modern water treatment practices. This makes sense, of course, because with the passage of time, pivotal events and discoveries occur—events that have a profound effect on how we live today. Let’s take a look at a few elements of the important chronological progression that evolved from the simple removal of a pump handle to the advanced water treatment (disinfection) methods we employ today to treat our water supplies.

After Snow’s discovery (that cholera is a waterborne disease emanating primarily from human waste), events began to drive the water/wastewater treatment process. In 1859, four years after Snow’s discovery, the British Parliament was suspended during the summer because the stench coming from the Thames was unbearable. According to one account, the river began to “seethe and ferment under a burning sun.” As was the case in many cities at this time, storm sewers carried a combination of storm water, sewage, street debris, and other wastes to the nearest body of water. In the 1890s, Hamburg, Germany, suffered a cholera epidemic. Detailed studies by Koch tied the outbreak to the contaminated water s...

Table of contents

• Cover
• Half-Title
• Title
• Copyright
• Contents
• Preface
• Author Bio
• PART 1 Setting the Stage
• PART 2 Statistical Methods
• PART 3 Wastewater
• PART 4 Wastewater-Based Epidemiology
• Index