WQRA HealthStream - Issue 53

Issue 53

Public Health Newsletter of Water Quality Research Australia

March 2009

New Look for Health Stream In this Issue: New Look For Health Stream Bushfires And Drinking Water Quality

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EDCs And Pharmaceuticals

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News Items

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From The Literature

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Web Bonus Articles Arsenic Bottled Water Cadmium Cyanobacteria Disinfection Byproducts Emerging Contaminants Household Interventions Lymphoma Outbreak Investigation Rainwater Mailing List Details Editor Assistant Editor

20 Martha Sinclair Pam Hayes

WQRA Internet Address: www.wqra.com.au A searchable Archive of Health Stream articles, literature summaries and news items is available via the WQRA Web page.

HEALTH STREAM

March 2009

Welcome to the first issue of Health Stream to be published under the auspices of Water Quality Research Australia (WQRA); the not-for-profit national scientific research centre established to succeed the CRC for Water Quality and Treatment.

WQRA’s mission is to facilitate collaborative research of national application on behalf of the Australian water industry. WQRA consults with its members in all States to contract research that addresses public health issues in priority areas in water quality – from both traditional drinking water sources and new sources, including recycled water, utilisation of recycled water for industrial and agricultural applications and aspects of wastewater management. The 42 current members of WQRA include 23 organisations involved in the water supply industry, 12 universities, four state government departments with responsibility for regulation of water supplies, two research centres and the peak body representing water professionals in Australia.

While the masthead is new, the content of Health Stream has not changed; we continue in our efforts to bring you timely reports on important issues and events in water quality and public health, and to provide an overview of some of the recent scientific literature in the area. The web version of Health Stream and our searchable Archive of articles and literature summaries will continue to reside on the web page of the CRC until July this year, at which time CRC resources will be moved to the WQRA web page. Health Stream can currently also be accessed from the WQRA web page under the Newsletters section.

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Bushfires and Drinking Water Quality In February this year several rural townships in the state of Victoria, Australia were devastated by major bushfires, resulting in at least 210 fatalities and the destruction of over 2,000 homes. It is estimated that over 300,000 hectares of land in the state have been burnt in 110 separate fires since the beginning of the year. As for most of southeastern Australia, Victoria has been experiencing drought conditions for the past decade, and the fires were preceded by several days of record high temperatures. At the time of going to press, several major bushfires are still burning although none are currently threatening towns. The period of danger from existing or new fires is expected to continue for several more weeks unless significant rainfall occurs.

 long term fire retardants – these are composed of fertiliser-like chemicals (ammonium phosphate and ammonium sulphate) which affect the thermal degradation and/or combustion properties of flammable materials. These chemicals are commonly mixed into water with a thickening agent (usually guar gum) which helps to reduce the dispersion of the fire retardant load when it is dropped from aircraft and also makes it cling more effectively to vegetation and structures.

Other additives include iron oxide (red in colour) which permits visualisation of the treated area, and corrosion inhibitors to prevent damage to storage tanks and pumping equipment. These fire retardants have a long term effect which lasts after the water has evaporated. They may be applied directly to fires but are more commonly dropped ahead of fire fronts to slow their spread.

The fires near Melbourne have affected a number of the water catchments serving the city, triggering public and media interest about potential impacts on drinking water quality. Questions have been raised about the toxicity of fire retardants dropped onto the fires, the effects of ash and sediment washed into reservoirs by subsequent rainfall, and related issues such as contamination of rainwater tanks which serve as drinking water supplies for rural households (2).

Some press reports on the topic have been rather alarmist in nature; describing water from fire-affected catchments as “toxic” and suggesting it will remain unfit to drink for perhaps as long as ten years. These statements are not supported by scientific evidence or the experience of other Australian cities affected by catchment fires in recent years. This article summarises the evidence on these issues.

The toxicity of both categories of fire retardants has been studied in relation to high exposure groups such as firefighters, aircrews and personnel who prepare the chemicals and load firefighting aircraft. Risk assessments carried out for the United States Department of Agriculture Forest Service and the Victorian Department of Natural Resources and Environment have indicated minimal health risks.

The identified risks relate to minor irritant effects of the dry chemicals on the eyes, skin or airways, and the possibility that some individuals may develop an allergic response to the guar gum component. All of these risks can be minimised by use of appropriate protective clothing and handling procedures. No long term risks to human health have been identified from exposure to fire retardants.

Health risks from fire retardants The fire retardants used in fighting bushfires in Australia fall into two main categories:  short term fire retardants – these are foams which are composed of detergents and wetting agents dissolved in water. These additives enhance the action of water by reducing the rate of evaporation and increasing water retention on fuel surfaces. These fire retardants lose effectiveness when the water evaporates. They are generally applied directly to fires during ground operations but may also be dropped from aircraft.

Fire retardant chemicals may enter drinking water sources through overspray of the fire retardant onto the surface of the water body (although this is generally avoided whenever possible) or through runoff after rainfall events. The potential for direct public health impacts from such events is negligible, as the components are of low toxicity to humans and the dilution effect will generally be large. The ammonium and phosphate components of long term fire retardants may stimulate the growth of algal and cyanobacteria in streams and reservoirs, but the strength of this effect is dependent on the amount of

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fire retardant used in an area, the subsequent rainfall patterns, and dilution in the water body. Increased cyanobacterial growth may lead to formation of blooms in reservoirs if suitable water temperatures and stratification conditions also exist. This may potentially lead to public health risks if the bloom produces toxins, and/or the occurrence of taste and odour problems due to the presence of cyanobacterial metabolites in the water.

Impacts of bushfires on drinking water quality When wood is burned the primary component of the resultant ash is calcium carbonate. Ash may also contain a complex mixture of organic compounds depending on the type of wood and the combustion temperature, and trace elements essential for plant growth such as magnesium, phosphorus and potassium. In intense fires, surface growth and litter are completely destroyed, exposing the ground to increased erosion from rain and wind. Therefore bushfires in catchment areas may result in large quantities of sediment and ash entering water courses and reservoirs. However the impacts of individual fire events are highly variable and depend on the topological and geological characteristics of the catchment, the extent and location of the burnt area(s), the intensity of the fire, the rate of vegetation regrowth, and the rainfall patterns after the fire event.

While an influx of sediment and nutrients can have a deleterious effect on river and reservoir ecosystems, these contaminants do not have direct effects on human health. Their impact on drinking water quality is predominantly in terms of the aesthetic properties of the water such as turbidity and colour. They also introduce more nutrients which may increase the risk of cyanobacterial blooms but, as noted above, this also depends on other factors being favourable for bloom formation. In some instances iron and manganese concentrations may also be elevated to levels where aesthetic water quality problems can occur. Excessive amounts of suspended solids can deposit in reservoirs and pipelines, and damage water treatment equipment. Suspended solids may also lead to elevated chlorine demand in water supplies, and this may make it difficult to achieve adequate disinfection in some circumstances, thus having an indirect effect on the microbial quality of drinking

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water. Although runoff from recently burnt areas will not contain a significant contribution of pathogens, microbial contamination from other areas of the catchment will still be present and this may make it necessary to declare a boil water notice.

In contrast to most large cities in the developed world, Melbourne draws most of its water supply from protected forest catchments with no residential or farming activity. The resultant high quality of the raw water supply allows the water to be distributed to consumers after disinfection but without filtration.

Most large cities using surface water draw their water from lower quality sources and therefore need to filter contaminants from the water before as well as disinfecting it before distribution to consumers. The use of unfiltered water makes Melbourne more vulnerable to the variations in raw water quality which may occur following bushfires, as removal of suspended solids is reliant on natural sedimentation in water storages. The city is served by several water catchments, the largest of which are the Thomson (48,700 hectares) and Upper Yarra (33,670 hectares).

Together these two catchments and their reservoirs usually supply about 90% of Melbourne’s annual water use. In addition there are several smaller catchments and four major storage reservoirs.

At the time of going to press, the Thomson catchment was unaffected by the bushfires, while about 2% of the Upper Yarra catchment had been burnt. However significant fire impacts have occurred in some of the smaller catchments, and the large catchments may come under renewed threat if adverse weather conditions cause existing fires to break through control lines. Melbourne Water Corporation is currently working with fire control authorities to expand the existing system of fuel breaks to provide further protection to the catchment areas. In addition, supplies of water have been transferred to storage reservoirs closer to the city which are not threatened by fire. The quantity held in these reservoirs (200,000 ML) is sufficient to supply the city for a period of several months if it becomes necessary to temporarily remove some of the fire-affected catchments from service due to deterioration of water quality.

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Some inferences about the potential impacts of these fires on water quality from Melbourne’s catchments can perhaps be drawn from experiences of two other Australian cities that have been recently affected by catchment fires. Sydney is served by mixed use catchments which include a number of towns and areas of agricultural land, as well as protected “special areas” around major storage reservoirs.

During December 2001 and January 2002 several bushfires occurred in Sydney catchments, burning an area of over 120,000 hectares, including one-third of the protected areas. Subsequent rainfall events resulted in erosion of exposed areas and inflow of sediment to the reservoirs. Research conducted by Sydney Catchment Authority (SCA), CSIRO and university collaborators showed that the timing and intensity of rainfall events was the major determinant of sediment and nutrient inflow. Turbidity levels in streams peaked with each rainfall event and reduced to background levels soon after the flow peak had passed. The overall impact of the bushfires on water quality supplied from SCA storage reservoirs was minimal due to the large size of the storages and long residence time that allowed pollutants to settle out.

The city of Canberra draws water from several sources including a protected 48,000 hectare forest catchment on the Cotter River which is similar in nature to Melbourne’s main catchments. This catchment provided a high quality raw water supply which was chlorinated prior to distribution to consumers but was not filtered. The catchment system has three dams (Corin, Bendora and Cotter), with water at that time being drawn from the Bendora dam. In January 2003 severe bushfires burnt out most of the catchment in the Cotter river system including 98% of the Corin and Bendora sections of the catchment. Heavy rains occurred two months after the fire, leading to significant deterioration of raw water quality with significant increases in turbidity, colour, total phosphorus, iron and manganese at the Bendora dam offtake. The supply was taken out of service and an alternative source was used.

Phosphorus levels rapidly returned to normal within a few months, however levels of the other parameters fluctuated over the following two years, increasing during wet weather and generally declining to prefire levels during dry periods. There was an increase

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in algal growth during the summer of the fire and for two subsequent summers, although this may have been partially due to rising water temperatures (due to continuing drought and low water levels) as well as the effects of the fire. While it was initially predicted that water quality in the Bendora dam might take five to ten years to recover, the significant raw water parameters had returned to normal ranges within 26 months after the bushfires and limited use of the water was possible nine months after the fire.

The impacts of bushfires on long term water yield are another area of concern to water utilities, given the continuing drought conditions across the southeastern region of Australia. Research on previous bushfires has suggested significant regional differences may exist. An initial increase in runoff after a fire has been reported from fire-affected Sydney and Canberra catchments, followed by about two years of depressed yields before a return to normal conditions.

However previous fires in Victoria reportedly caused a much more prolonged depression in water yield(1).

Rainwater tanks Households using rainwater tanks in fire and smoke affected areas have been warned to take precautions to prevent ash, debris and dead animals from contaminating their water supplies. The Department of Human Services has advised that roofs and guttering should be cleaned and first flush rainfall discarded before water is again collected from rooftops(2). In addition to ash from burning vegetation, rooftops in these areas may also be contaminated with ash from copper-chrome-arsenate treated timber from burnt fences, decking and outbuildings. This may pose a health risk if ingested, especially for children. Some roof surfaces may have been contaminated by fire retardant chemicals. As noted above these chemicals are not toxic however they are likely to badly affect the taste of the water.

Concerns have sometimes been raised about the extent to which collected rainwater may be contaminated with other chemicals from smoke, such as poly-aromatic hydrocarbons or volatile organic compounds (VOCs) which may be released during combustion of wood and other materials. However a

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previous study of water quality from 49 rainwater tanks in a bushfire affected area of Victoria failed to detect VOCs (benzene, toluene, ethylbenzene and xylene were below the detection limit of 1micro g/L) or PAHs (total PAHs below detection limit of 8 micro g/L, and benzo(a)pyrene below the detection limit of 1microg l/L). Arsenic levels in the majority of tanks were below the detection limit (0.001 mg/L) and one tank had an arsenic concentration equal to the Australian Drinking Water Guideline value (0.007 mg/L). Although limited, these results suggest that contamination of this nature is unlikely (3).

Health Stream thanks Sydney Catchment Authority and Australian Capital Territory Electricity & Water for information on the impacts of the Sydney and Canberra bushfires on water quality.

1) Wildfire, Catchment Health and Water Quality: a review of knowledge derived from research undertaken in Sydney's Water Supply Catchments 2002-2007. http://www.ewatercrc.com.au/cgi-bin/WebObjects/ NewBushFire.woa/wa/listDownloads 2) Victorian Department of Human Services website: http://www.dhs.vic.gov.au/emergency/ current-events/bushfire/health-and-safety-information 3) Bushfires and tank rainwater quality: A cause for concern? Spinks J, et al. (2006) Journal of Water and Health 4(1) 21-28.

EDCs And Pharmaceuticals A major new report examining the toxicological relevance of trace levels of endocrine disrupting compounds and pharmaceuticals in drinking water supplies will be released this month by the Water Research Foundation (formerly the American Water Works Research Foundation) (1). The report details the findings of a four year project undertaken under the Foundation’s Tailored Collaboration program of industry initiated research. The project involved the identification of a limited number of indicator compounds to represent the vast spectrum of chemicals potentially present in water supplies, establishment of sensitive and robust analytical protocols for the selected compounds, a survey of their occurrence in drinking water and wastewater at 20 sites across the US, and risk evaluations for drinking water exposures relative to acceptable daily intakes or references doses. The project also used bioassays to determine the estrogenic potency of EDC compounds found in drinking water and HEALTH STREAM

compared them to common food and beverage items to provide context for drinking water exposures, and developed risk communication strategies to assist water utilities respond to public concerns over EDCs and pharmaceuticals in drinking water supplies. The methods and outcomes of each component of the project are summarised below.

Selection of indicator compounds For pharmaceuticals and personal care products, several criteria were used to select a subset of compounds for study:  only prescription drugs were considered (on the basis that these are likely to have a higher toxicity index than over the counter drugs or components of personal care products).  the candidate drugs were restricted to about 200 of the most commonly prescribed drugs in the US.  only those drugs considered to have higher potential for adverse heath effects on low level chronic exposure were included, based on existing toxicological data.  consideration was given to drugs found more frequently in occurrence surveys, and those which had provoked public or regulatory interest.  representative compounds for major pharmaceutical groups were included (eg lipid lowering drugs, anticonvulsants, tranquilisers). For some drugs, major metabolites were also included.  the final selection of compounds was also limited by the availability of reliable assay methods and suitable calibration standards.

This screening process resulted in selection of 20 pharmaceuticals and metabolites.

The selection of EDC compounds for study was a more difficult process as it was not feasible to conduct a detailed review of the toxicological and occurrence data for all substances known or suspected to have endocrine effects. The researchers used five criteria in the screening process:  status as an EDC - although regulatory bodies are working together to develop a battery of internationally recognised standardised methods to test suspect chemicals, this will not be available for several years. It was therefore necessary to assess the strength of evidence for the compounds on the basis

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of existing literature, with emphasis given to several recent international reviews and data collations.  occurrence and exposure - preference was given to compounds reported to occur or expected to occur in drinking water in the US or other developed nations.

This included consideration of known or predicted efficiency of removal by water treatment processes and likely bioavailability based on molecular weight.  effects - the available evidence on severity of effects, potency and pharmacokinetics (half-life, bioaccumulation) was assessed. The quality of evidence for effects on humans or in whole animal studies was also considered.  mode of action - emphasis was given to compounds with estrogenic effects as these are the best studied group, but others with reported antiestrogenic, androgenic, anti-androgenic and thyroidrelated effects were also included.  interest in specific contaminants - the level of interest from water utilities, members of the Project Advisory Committee, scientists and the general community was considered.

Analytical capability was also taken into account to generate the final list of selected compounds for inclusion in the study.

The outcome of this process was a list of 42 known or potential EDCs comprising 5 steroid hormones, 11 dietary phytoestrogens and 26 potential EDC chemicals (including antiseptics, herbicides, pesticides, manufacturing chemicals, and flame retardants). Robust analytical techniques for these chemicals and the 20 selected pharmaceutical compounds were developed for this project. An invitro cellular bioassay method (E-screen) was also set up to assess estrogenicity. This assay measures binding of substances to the estrogen receptors in a cultured breast cancer cell line. The results of the bioassay are expressed in terms of equivalence to the steroid hormone 17beta-estradiol.

Survey of occurrence in water A sampling program was carried out at 20 drinking water treatment plants and 4 wastewater treatment plants operated by participating utilities across the US. Eighteen of the drinking water plants used surface water sources, and nine of these had known wastewater inputs to their source waters. Raw water

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and finished drinking water samples were tested, as well as samples from 10 distribution systems. Over 300 field samples and over 100 quality controls samples (blanks, spiked samples) were tested.

Twenty-three of the 62 target compounds were detected at least once in finished drinking water by chemical assay methods, and eleven were detected in more than 20% of drinking water samples. The herbicide atrazine occurred most frequently (83% of drinking water samples), followed by meprobamate (78%, an anti-anxiety drug) and phenytoin (56%, an anti-epileptic drug). Only two finished drinking water samples and one distribution system sample gave a positive response to the E-screen bioassay.

Survey of occurrence in foods and beverages A selection of foods and beverages was tested for the 62 chemicals of interest and for estrogenic activity using the bioassay. Tested items included bottled water, coffee, green tea, milk, beer, soy milk, milkbased infant formula, soy-based infant formula, soy sauce, vegetable juice and apple juice. Samples from two to four brands of each product were tested. As expected, phytoestrogens were commonly detected in the selected foodstuffs, however a range of other compounds was also detected. The authors note that due to the food matrices and more complex preparation methods needed for these tests there was more opportunity for contamination, and a higher likelihood of both interference and false positive results. All foods and beverages other than bottled water gave positive results on the E-screen bioassay.

Only one false positive was seen among 118 blank control samples for this assay.

Developing a risk analysis methodology For most of the target pharmaceuticals potential toxicity was assessed by comparing levels detected in water with calculated Acceptable Daily Intakes (ADIs). This approach is commonly used to determine acceptable levels for chronic term exposure to non-carcinogenic environmental contaminants. The ADI was calculated by taking the highest daily dose for which no adverse effect was observed in a long term animal study, then applying safety factors (usually 100-fold or more) to derive a dose which was expected to be safe for long term exposure in humans. Additional safety factors were

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applied where the quality of data was limited. For several of the pharmaceuticals where there was evidence of carcinogenic effects in animals, an alternative and more conservative approach was used. The ADI for each pharmaceutical (expressed as mg per kg body weight per day) was then converted to an acceptable Drinking Water Equivalent Level (DWEL) assuming a body weight of 70kg and a drinking water intake of 2 litres per day.

Information on existing ADIs or Reference Doses (RfD) for the selected EDC substances was reviewed.

The RfD is defined as a daily oral exposure to the human population (including sensitive subgroups) that is likely to be without an appreciable risk of deleterious effects during a lifetime. Limited literature searches were also done for studies published since these ADIs/RfDs were derived to determine whether new data warranted use of lower values. The researchers note that setting ADIs for endocrine disrupting chemicals is a controversial area with lack of consensus on many aspects. Their methodology was conservative and guided largely by US EPA approaches to this issue. Once an ADI had been set, a DWEL for each EDC was derived in the same manner as for pharmaceuticals.

Relative exposure This section of the report summarises information on maximum EDC concentrations found in water samples tested in this study, the results of the Escreen tests, and literature data on levels of estrogenic hormones measured in human breast milk and dairy cow milk. Some simple comparisons are presented to give an idea of relative exposures from different sources; for example the highest estrogenic activity measured in source water (raw water) by the E-screen assay was similar to that found in green tea and only one-quarter of that found in coffee. Using chemical assay methods, the major estrogenic hormones estrone, estradiol and ethynylestradiol found in wastewater have not been detected in finished drinking water samples in this study or other published studies from the US, yet they can be detected in human breast milk and cows milk.

Comprehensive risk analysis

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Information on levels of pharmaceuticals and EDCs in drinking water was then drawn together with DWEL values to determine how the exposures from drinking water compared to the calculated safe limits.

For this analysis the authors took a conservative approach by using the maximum recorded level for each compound found in finished drinking water or distribution system water. The “minimum margin of safety” was calculated for each substance as the ratio of the DWEL divided by maximum detected concentration. This minimum margin of safety is additional to the conservative safety factors already applied in derivation of the DWEL values.

Among the 11 pharmaceuticals detected in finished drinking water or distribution system water, the antipsychotic drug risperidone had the lowest margin of safety (170), followed by the anticonvulsants phenytoin (210) and carbamazipine (670). The minimum margins of safety for the remaining eight pharmaceuticals which were detected and the nine pharmaceuticals which were not detected ranged from greater than 2,700 to greater than 40 million.

For the three EDCs which were detected in finished drinking water or distribution system water, atrazine had the lowest minimum margin of safety (3), while the herbicide linuron (8400) and the industrial chemicals 4-nonylphenol (16,000) and bisphenol A (72,000) had higher margins. The estimated minimum margins of safety for the nine EDCs which were not detected ranged from greater than 3.5 to greater than 210,000.

Risk communication While public interest in this issue is very high, regulatory agencies have not yet established “safe” exposure limits for the majority of pharmaceuticals, personal care products or endocrine disrupting compounds that might potentially be found in drinking water supplies. In the absence of such limits, knowledge about the relative importance of different sources of exposure can be useful to inform public debate and discussion. A number of suggestions for risk communication were developed based on the findings of this study. These include calculating how many 8-ounce glasses of water a person would need to drink each day to exceed the ADI-DWEL for a particular chemical, or how the estimated daily intake

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from drinking water compares to therapeutic doses of pharmaceuticals. Information is also presented on placing incremental cancer risks from chemical exposure in context with lifetime risks of accidental death from various causes, and lifetime cancer risks from a range of common exposures including trace contaminants in foods.

Conclusions and recommendations Increasingly sensitive detection methods are now making it possible to detect minute quantities of many substances in drinking water. While application of advanced water treatment methods to remove these contaminants might seem to offer a solution, it is inevitable that some compounds that are currently reduced to undetectable levels by advanced treatment will become detectable as analytical methods grow more and more sensitive. The motivation for action on these water contaminants should be protection of health rather than attempting to prevent detections that alarm the public. This study has shown that while trace amounts of some pharmaceuticals and EDCs can sometimes be detected in US drinking water supplies, there is no evidence of health risk from consumption of these waters.

(1) Toxicological relevance of EDCs and Pharmaceuticals in Drinking Water. AwwaRF Project 3085. Order number 91238. www.waterresearchfoundation.org

News Items Dengue Outbreak Continues In Queensland The number of people infected with Dengue fever continues to climb in the current outbreak in Queensland. Between 1 December 2008 and 2 March this year a total of 609 cases had been diagnosed, with the majority occurring in the city of Cairns. The outbreak is believed to be linked to heavy rain and flooding in the north of the state which has provided the mosquitoes carrying the disease to breed in large numbers. The state government has distributed insect repellent to schools in the area and householders are being urged to check their gardens and empty water from potential mosquito breeding sites such as bird baths and other containers. Owners of rainwater tanks have also been reminded that openings to tanks should have mosquito-proof screens.

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Chinese Earthquake Blamed On Dam Researchers in China and the US have reportedly claimed that the devastating earthquake in the Sichuan region of China during May 2008 was caused by a major dam in the region. According to a report in the UK Telegraph, the 315 million tonnes of water in the Zipingpu dam may have caused pressure on an underlying fault line, triggering the quake. The filling of the dam was said to cause a change in stress which was 25 times greater than the annual tectonic movement of the fault. A spokesman for the China Earthquake Administration described any firm conclusions as “premature�, but said that the possible role of the dam is one factor worth examining.

Cryptosporidium Outbreak In Sydney The Department of Health in New South Wales has issued a public warning after an upsurge in cases of cryptosporidiosis was detected. It is suspected that the outbreak is linked to swimming pools, mainly in the western suburbs of Sydney, although testing of pool water samples has not yet shown any positive results. Over 200 cases of laboratory-confirmed cryptosporidiosis were reported in February compared to 105 in January and 45 in December. A total of 19 pools have been potentially implicated by interviewing cases about recent activities and exposures. Pool managers have been instructed to super-chlorinate pools overnight in an effort to stem the outbreak. Sydney last experienced a major swimming pool-related outbreak of cryptosporidiosis in 1998 when more than 1000 laboratory-confirmed cases were diagnosed. Swimmers have been urged to follow good hygiene practices and not to swim for at least two weeks after suffering diarrhoea.

Salad Garden Combats Cyanobacteria Operators of a Queensland mine are using floating gardens of tomato and basil plants to combat cyanobacterial blooms in a dam which supplies drinking water to mine workers. The growing plants compete with the cyanobacteria for essential nutrients in the water, thus suppressing their numbers.

According to the environmental adviser to the mine, the cyanobacterial problem was previously managed with periodic chemical treatments in response to monitoring results, however the garden system is proving to be both simple and cost-effective.

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Arsenic

From the Literature Web-bonus articles Summaries of these additional articles are available in the web page version of Health Stream and are included in the searchable archive at: www.wqra.com.au/WQRA_newsletters Lung cancer and exposure to arsenic in rural Bangladesh. Mostafa MG, McDonald JC and Cherry N. (2008) Occupational and Environmental Medicine, 65(11); 765-768.

Impact of chlorination on the incidence of cancers and miscarriages in two different campus communities in India. Goel S. (2008) Journal of Environmental Science and Engineering, 50(3); 175-178.

Manganese in Madison's drinking water. Schlenker T, Hausbeck J and Sorsa K. (2008) Journal of Environmental Health, 71(5); 12-16.

Environmental health risk assessment of nickel contamination of drinking water in a country town in NSW. Alam N, Corbett SJ and Ptolemy HC. (2008) New South Wales Public Health Bulletin, 19(9-10); 170-173.

The relationship between birth weight, gestational age and perfluorooctanoic acid (PFOA)-contaminated public drinking water. Nolan LA, Nolan JM, et al. (2008) Reproductive Toxicology, In Press, doi: 10.1016/j.reprotox.2008.11.001 Human health risk assessment from the presence of human pharmaceuticals in the aquatic environment.

Cunningham VL, Binks SP and Olson MJ. (2009) Regulatory Toxicology and Pharmacology, 53(1):39-45.

Public views on drinking water standards as risk indicators. Johnson BB. (2008) Risk Analysis, 28(6); 1515-1530.

Hepatitis E, Helicobacter pylori and peptic ulcers in workers exposed to sewage: A prospective cohort study. Tschopp A, Joller H, et al. (2009) Occupational and Environmental Medicine, 66(1); 45-50.

Control of bacterial contamination in microfiltered water dispensers (MWDs) by disinfection. Zanetti F, De Luca G and Sacchetti R. (2009) International Journal of Food Microbiology, 128(3); 446-452.

Effect of water main repairs on water quality. Besner MC, Lavoie J, et al. (2008) Journal / American Water Works Association, 100(7); 95-109.

Levels of perfluorochemicals in water samples from Catalonia, Spain: Is drinking water a significant contribution to human exposure? Ericson I, Nadal M, et al. (2008) Environmental Science and Pollution Research, 15(7); 614-619.

Characterization of drinking water treatment for virus risk assessment. Teunis PFM, Rutjes SA, et al. (2009) Water Research, 43(2); 395-404.

An exploration of factors that influence the regular consumption of water by Irish primary school children.

Molloy CJ, Gandy J, et al. (2008) Journal of Human Nutrition and Dietetics, 21(5); 512-515.

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Arsenic exposure and childhood cancer - A systematic review of the literature.

Engel A and Lamm SH. (2008) Journal of Environmental Health, 71(3); 12-16.

This review examines the current epidemiological literature on childhood cancers and arsenic exposure to assess the strength of the evidence that arsenic may be an etiological risk factor for childhood cancers. Nine relevant studies in three groups were found from an extensive literature search: 1) four studies seeking childhood cancers among arsenicexposed populations, 2) two studies assessing arsenic exposure among childhood cancer cases, and 3) three studies investigating populations with both arsenic exposure and childhood cancers.

In the first category, a study in Southwest Taiwan which included an estimated 22,797 children younger than 20 years found no relationship between skin cancer and arsenic ingestion. A similar study of 2,595 children younger than 12 years in West Bengal also found no association with skin cancer. In Southwest Taiwan there was no evidence of association between levels of arsenic ingestion and bladder or kidney cancer deaths among approximately 45,000 people under the age of 30. A Swedish study of arsenic inhalation including 30,644 children, found childhood cancer types were not different for those living near a smelter, compared to the expected number for the general population. For the two studies of children with cancer, a case-control study of children aged 0-9 years in Quebec, Canada which included 491 cases and 491 controls, found children with acute lymphoblastic leukaemia did not have higher drinking water arsenic exposures either in the prenatal or postnatal period. Similarly, a UK study of deaths from childhood cancer did not find an increased risk of cancers for those exposed to environmental arsenic at an early age. The three studies of areas with high arsenic levels in drinking water and high childhood leukemia rates were conducted in two regions of the US. In Woburn, Massachusetts a study of 72 people younger than 20 years found no difference in mean arsenic concentrations of hair samples among those exposed

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to arsenic from well water and those not exposed. In Fallon, Nevada, family wells were examined and median arsenic concentration was not higher for childhood leukaemia case-family wells than for the remainder of the domestic wells. In another study in Fallon, no dose-response relationship for total childhood cancer and drinking water arsenic strata (low, medium and high) was found and no doseresponse relationship for either leukaemia or all other cancers excluding leukaemia.

lab procedures developed for the reliable analysis of Arctic snow and ice were used throughout this study and sector field ICP-MS (inductively coupled plasma mass spectroscopy). All bottled water were diluted 1+4 with 1% HNO3 for ICP-MS analysis. A 2-mL aliquot from the water leached in each of the metal bottles for 13 days was subsampled, acidified to 1% HNO3 and analysed.

Trace and ultratrace metals in bottled waters: Survey of sources worldwide and comparison with refillable metal bottles.

Krachler M and Shotyk W. (2009) Science of the Total Environment, 407(3); 1089-1096.

The analysis of the 132 brands of bottled water for 23 trace elements found that for several elements a concentration range of only a few hundred (Al, Cd, Cr, Cu, Pb, Sc and Te) to a few thousand (Co, Fe, Mo, Sb and Tl) times was found between minimum and maximum concentrations. Minimum and maximum concentrations of all other elements considered varied between approximately 10-to-4 and approximately 10-to-6 times. The greatest range in concentration was found for Be. Of the four major elements analysed, Ca, Mg and Sr varied between approximately 15,000 times between minimum and maximum concentrations, whereas Na showed a spread of 50,000 times. The maximum concentrations of most elements were well below existing guideline values, however the concentrations of Al, Be, Mn and U in several bottled waters exceeded these values. There are no guideline values existing for Ge, Li, Te and Th, which are all potentially harmful elements that were found in this study.

The main aim of this study was to quantitatively evaluate trace and ultra-trace metals in bottled waters from diverse sources and regions. Leaching of metals from metal bottles was also investigated. The study involved the purchase of 132 brands of bottled water from 28 countries. All waters were bottled in plastic (mainly PET) unless otherwise stated. The reusable bottles included two brands of stainless steel bottles and one brand of aluminium bottle with proprietary coating. Three bottles of each brand were used in the experiments. Also one stainless steel and one pewter pocket hip flask were tested. All metal bottles were cleaned thoroughly and subsequently filled with high-purity water under clean room conditions and left in a U.S. class 100 clean bench for 13 days. The same high purity water was filled into three acidcleaned 15 mL polyethylene (PE) tubes and left for the same period to serve as a control sample. Clean

The concentrations of the 16 selected trace elements from the leaching experiments with the metal bottles, were in general all far below any threshold levels reported for drinking water apart from three elements. The antimony concentration from the pewter pocket flask (24.4 micro g/L) was several-fold higher than the upper limits set by the European Commission (EC) and EPA (6 micro g/L). The EPA guideline level of 300 micro g/L for iron was exceeded by the stainless steel pocket flask (555 micro g/L). Also of great concern is that the Tl (thallium) concentration in the pewter pocket flask (22 micro g/L) exceeds the EPA maximum contaminant level for drinking water (2 micro g/L) by more than an order of magnitude. The aluminium bottle was found to leach the least of the trace elements while the stainless steel bottles leached much higher concentrations.

This literature review found no evidence of an association between arsenic exposure and childhood cancer. The absence of evidence may indicate that cancers occurring during childhood are not induced by arsenic exposure, or that arsenic-induced childhood cancers are too infrequent to have been detected with current study designs, or that the latencies for cancers that are induced in utero or during childhood extend into the post-childhood ages.

Bottled Water

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This study showed great variation in trace metal concentrations in the 132 brands of bottled water examined. The majority of elemental concentration levels found were below national and international guidelines values with the exception of Al, Be, Mn and U (elevated in 15 brands from nine countries).

Lithium was found in concentrations in the low mg/L range which is comparable to blood plasma levels of patients treated with Li-containing drugs against manic depression. Li is not regulated yet by thresholds limits and should possibly be considered for regulation. There were substantial differences in the release of trace elements from metal containers to the bottle water however both coated aluminium and stainless steel bottles released elements at rates which can be considered negligible for the consumer.

Pocket flasks need to be used with great caution however as they might contaminate beverages with substantial amounts of Sb (from stainless steel) or Sb and Tl (from pewter) to a level that may quickly exceed present guideline values for drinking water.

Cadmium Influence of Drinking and/or Cooking with Jinzu River Water on the Development of Itai-Itai Disease.

Kobayashi E, Suwazono Y, Dochi M., Honda R, Kido T and Nakagawa H. (2008) Biological Trace Element Research, 1-12.

There are numerous cadmium (Cd)-polluted regions in Japan, with most caused by irrigation with Cdpolluted river water containing waste discharges from mining. The area most severely polluted is the Jinzu River basin in Toyama Prefecture. In this area there are many inhabitants with renal tubular dysfunction and patients with Itai-itai disease. Itai-itai disease is characterised by renal injury manifested by tubular and glomerular dysfunction and painful bone injury consisting of a combination of osteomalacia and osteoporosis. The influence of Cd intake from rice consumption and renal tubular dysfunction and Itaiitai disease have been previously been investigated, however there have been no studies investigating both Cd-polluted rice consumption and drinking and/or cooking with Jinzu River water on the

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development of these diseases. This study calculated the amount of lifetime Cd intake from these different sources and evaluated the influence of eating Cdpolluted rice and drinking and/or cooking with Jinzu River water on the development of Itai-itai disease.

There were 38 participants out of 60 with Itai-itai disease admitted for the 1977 and 1978 medical examinations who also agreed to participate in a questionnaire survey. Their medical history was determined by direct questioning in addition to various medical testing. Age at ‘mild disease onset’ corresponded most frequently to the age at which the patient started to perceive leg/back pain and age at ‘severe disease onset’ when the patent experienced the severest pain associated with for example disturbance of ambulation and/or bone fractures. The questionnaire survey included two questions concerning the use of Jinzu River water for drinking and cooking.

Cumulative intakes of cadmium from food at different stages of disease (mild onset, severe onset and death) were estimated from recorded cadmium levels in rice samples from different hamlets, estimated cadmium intake from other dietary sources and residential history since birth. The mean lifetime Cd intakes in non-users/users of Jinzu River water for drinking and/or cooking were estimated as 3.46-3.60 g/2.58-2.63 g at mild disease onset and 4.24-4.44 g/3.50-3.54 g at severe disease onset. The difference in values was 0.84-0.98 g and 0.70-0.92 g at mild and severe disease onset, respectively. The differences in mean age in non-users/users of river water were calculated as 6.8-8.2 years at mild disease onset and 4.6-5.9 years at severe disease onset, respectively.

When river water was used for drinking and/or cooking, age and life time Cd intake differed by 7.6 years and 0.9 g at mild disease onset and 5.9 years and 0.92 g at severe disease onset.

Of the patients with Itai-itai disease in this study, the users of Jinzu River water started to perceive leg/back pain earlier and experience the severest pain earlier, even though their lifetime Cd intake from food was smaller than that of non-users. The influence of not only eating Cd-polluted rice but also drinking and/or cooking with Jinzu River water on

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the development of Itai-itai disease was highlighted here. However the results suggest that lifetime Cd intake estimated from eating Cd-polluted rice exerted a greater influence on the development of Itai-itai disease than did drinking and/or cooking with Cdpolluted river water.

Comment Itai-itai disease was first described in the early 1900s but the link with cadmium exposure was not elucidated until the late 1950s. Other factors such as malnutrition and poor calcium metabolism are also thought to contribute to development of the disease. The name literally translates to “OuchOuch� disease - referring to the severe pain experienced by sufferers.

Cyanobacteria Exposure of rural households to toxic cyanobacteria in container-stored water.

Fosso-Kanke E, Jagals P and Du Preez H. (2008) Water SA, 34(5); 631-636.

This study assessed levels of cyanobacteria and microcystins (the most common type of cyanotoxin) in water from household water storage containers in rural South Africa. The study was undertaken in households from rural villages in the semi-tropical Vhembe district of the Limpopo Province. The population in these villages uses untreated surface water from nearby rivers and streams. The study was conducted during the 7 months of high summer when conditions are optimum for cyanobacteria growth.

All households in the area typically use 20 to 25 litre plastic containers to collect and store water. The containers varied in colour mostly being of lightcolour (light-permissible) and dark-coloured (lightlimiting) plastic. There were 20 households randomly selected from 203 households that sourced water directly from two nearby shallow rivers. Households were visited for sampling every 6 to 8 weeks during the 7 summer months, with sampling conducted within 4 hours after the households had collected water from the rivers. Four samples were taken from a household during the visit. Each participating household used both a light-coloured (L) and a darkcoloured (D) container for the collection and storage of water. There were 235 samples taken in total

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during 59 visits. Firstly, samples 1 and 3 were collected from the free volume of water in each container type (L and D) and referred to as the FV sample type. Then, biofilm on the sidewalls of the same containers was dislodged by brushing and the dislodged biofilm particles were suspended in the free volume of the containers by swirling the container and the follow-up Samples 2 and 4 were taken (the DB sample). Ten samples were collected for microcystin assessment from the LDB containers, as these containers were expected to yield higher numbers of cyanobacteria. Eight samples were collected during summer from the two surface water sources where the households collected water.

Cyanobacteria were not found consistently in the container water samples, with an overall 40% of samples testing positive for cyanobacteria (LFV: 43% positive, LDB: 57% positive, DFV: 34% positive, DDB: 26% positive). In positive samples there were three cyanobacterial genera found: Microcystis, Oscillatoria and Anabaena. The dominant genus was Microcystis spp. which constituted between 70 and 80% of the total toxic cyanobacteria in the waters sampled from the containers. The numbers of cyanobacteria in LDB samples were significantly higher (P = 0.004) than in the other sample groups. The turbidity and nutrient levels in the DB samples were significantly higher (P less than 0.001) than in FV samples regardless of container type. At the 95th percentile, the numbers of cyanobacteria in the LDB and DDB samples exceeded the WHO (1999) Health Primary Alert guideline value of 2000 cells/ml. One of the 10 selected containers sampled contained microcystin but at a concentration that did not exceed the WHO guideline value of 1 micro g/l.

From the samples taken from the source waters, 4 genera belonging to the 7 toxic cyanobacteria genera were detected. These were Microcystis, Oscillatoria, Anabaena and Pseudo-anabaena. Microcystis occurred in between 25% and 80% of the samples.

The numbers of cyanobacteria in two samples did not comply at the 95th percentile with the WHO guidelines. Microcystin was detected in 3 of the 8 samples and in two of these the concentrations were

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above the guideline value of 1 micro g/l for drinking water (maximum detected level 2.5 micro g/l).

This study showed that cyanobacteria are transferred from the water source to the plastic containers and then survive and possibly grow in the biofilm in these containers. Microcystis spp. appeared to be the dominant genus of cyanobacteria and suggests that Microcystis might also have the ability to grow in the container and therefore constitute a potential health risk to the consumer. Even though microcystin appeared to be absent from the container waters, the health risk should not be considered negligible as the toxin levels could increase if conditions became favourable. It appears that the source water analysed in this study area is of unacceptable quality for consumption. There is a need for major intervention including low-cost pre-treatment of water, education of users about the need for regular observation of the physical appearance of the water, as well as action to be taken during scum occurrence and the promotion of container hygiene by regular brushing and sanitising of containers to keep them free of biofilm.

live male births in the USA. Hypospadias is where the urethral opening occurs in an abnormal position (on the ventral side of the penis, near the glans, along the shaft or near the base of the penis) as a result of abnormal urethral closure at approximately week 8 to week 14 of gestation. Hypospadias most likely results from a complex interaction between multiple environmental exposures and genetic susceptibilities.

This study evaluated the risk of hypospadias associated with maternal exposure to two groups of DBPs, total trihalomethanes (TTHM) and the sum of the five most prevalent haloacetic acids (HAA).

Maternal exposure to water disinfection byproducts during gestation and risk of hypospadias.

Luben TJ, Nuckols JR, Mosley BS, Hobbs C and Reif JS. (2008) Occupational and Environmental Medicine, 65(6); 420-427.

Birth certificate and birth defect registry data was obtained for 647 cases of hypospadias occurring in Arkansas between 1998 and 2002 and identified by the Arkansas Reproductive Health Monitoring System (ARHMS). Controls (n=1264) were randomly selected from birth certificate records for all male live births of infants without recorded congenital malformations in Arkansas during the same time interval. During the study period monitoring data for quarterly THM and HAA concentrations, including data on six individual species of HAA, were collected from 263 water utilities throughout Arkansas. The residential addresses for each participant were geocoded and linked to the water utility from which they were most likely to receive their tap water. Exposure was estimated by using the average daily DBP concentration for each case and control mother during an exposure window (between 6 and 16 weeks of gestation). Effect estimates were adjusted for race, number of cigarettes smoked per day during pregnancy and maternal education level. Some cases and controls could not be linked to tap water supplies, and some who were linked did not have DBP data to estimate exposure. Data analysis was therefore restricted to 320 cases and 614 controls.

Previous epidemiological studies have provided some evidence of an association between exposure to disinfection by-products (DBPs) and the risk of congenital anomalies. No studies have specifically examined the effect of maternal exposure to DBPs during gestation and risk of hypospadias. This condition is one of the most common congenital anomalies with an estimated prevalence of one in 125

A subset analyses was conducted using data for ARHMS subjects who also participated in the National Birth Defects Prevention Study (NBDPS).

The subset analyses aimed to explore the potential effects of exposures to TTHM and HAA based only on an estimate of ingestion (water consumption), and then for TTHM by adding potential dermal and inhalation exposure based on individual showering

Comment This study did not examine faecal bacterial indicators in household water but it is likely that acute health risks from enteric pathogens in untreated rural surface waters would greatly outweigh the lifetime cancer risk from occasional exposure to microcystin above the WHO chronic exposure guideline level.

Disinfection Byproducts

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and/or bathing data. All NBDPS participants were asked about pregnancy and medical history, diet, lifestyle, occupational and environmental exposures and medication use and also water consumption at home and at work and water use behaviours including showering and bathing. Water utility data and the exposure metrics based on ingestion were used to assess exposure for 40 NBDPS cases and 243 NBDPS controls. Two different metrics were used to explore the effects of exposures due to ingestion and then due to showering and bathing. Dose of TTHM and HAA through personal water consumption was estimated as the product of the average concentration in the distribution system during the exposure window and the number of 8-fluid ounce (about 236 ml) glasses of tap water consumed per day. Exposure from ingestion was categorised into tertiles. Mothers who consumed only bottled water or those with average DBP concentrations below detection limits during the exposure window served as the referents.

Models were adjusted for body mass index, birth weight, maternal race and plurality.

relationship. The results for bathing and showering exposure to TTHM in the subset analysis were imprecise and also did not follow a dose-response pattern. When ingestion, inhalation and dermal routes of exposure to TTHM in tap water were incorporated, the adjusted analyses using one exposure metric resulted in a non-significant OR of 1.96 (95% CI 0.65 to 6.42) for the highest tertile of exposure with a very weak dose-response relationship suggested.

When exposure was classified using a metric that included uptake factors, the risk estimate was slightly lower (OR 1.68, 95% CI 0.55 to 5.13) and there was no evidence of a dose-response relationship.

The prevalence of hypospadias in the study area for the period examined was one per 137 live male births For the ARHMS subjects, there was no evidence that exposure to TTHM, HAA5 or any of the species of HAA was associated with an increase in risk for hypospadias in the unadjusted or adjusted analyses.

In the NBDPS subset analysis when exposure was measured by personal water consumption, mothers in the intermediate tertile of exposure to TTHM had a non-significant increased risk of having an infant with hypospadias in the unadjusted analyses (OR 2.11, 95% CI 0.89 to 5.00) which became barely significant in the adjusted analyses (OR 2.79, 95% CI 1.01 to 7.72) compared to women in the referent group. Mothers in the intermediate tertiles of exposure to HAA5 had a significantly increased risk of having an infant with hypospadias in the unadjusted analyses (OR 2.45, 95% CI 1.06 to 5.67) compared to women in the referent group, but this association became insignificant in the adjusted analyses (OR 2.43, 95% CI 0.94 to 6.28). In contrast, women in the highest exposure tertiles had lower ORs than the intermediate tertile. The risk estimates for these analyses were in general imprecise and there was no evidence for a dose-response

Emerging Contaminants

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The results found here provide little evidence of an association between DBP exposure during gestation and an increased risk of hypospadias. Differences in ORs seen when exposure was estimated from tap water DBP levels versus individual water consumption and water use patterns supports the need to use individual-level data when assessing exposure to DBPs.

Traceability of emerging contaminants from wastewater to drinking water.

Huerta-Fontela M and Ventura F. (2008) Handbook of Environmental Chemistry, 5 S1;143-168.

In recent years, the occurrence of emerging contaminants (i.e., human and veterinary drugs, surfactants, textile dyes, algal toxins, etc) in wastewaters and surface waters and their removal during conventional treatment has been widely assessed. This paper summarises previously published data on the occurrence of these contaminants in drinking water, and the ability of various water treatment processes to remove them.

The paper also describes new data on the occurrence of a range of legal and illegal drugs in wastewater, river water and treated drinking water samples collected in Catalonia, Spain.

In 1993, clofibric acid was found in Berlin tap water at high concentrations above 165 mg/L. There was a direct correlation found between bank filtration and artificial groundwater enrichment and the

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concentrations of this drug in treated water.

Ibuprofen, triclosan, several phthalates and additives were detected in samples of finished drinking water in southern California and higher concentrations were detected in raw waters in the dry season, probably due to lower flow rates. The occurrence of nine pharmaceuticals and personal care products (PPCPs) and endocrine disrupting compounds (EDCs) was examined in drinking water from the USA and Canada and none of these was found in the finished drinking water. In recent years, some hormones and antibiotics were detected in final drinking waters from the USA and Italy. The occurrence of 11 sulphonamide compounds (SAs) was studied in mineral and municipal drinking water from Italy. SAs were founds in four different brands of mineral water while drinking water treatment was found to be effective in the elimination of these compounds with concentrations of SAs in municipal water below the limit of quantification. MTBE, a gasoline additive has been detected in finished drinking water from the USA and Europe.

Algal toxins were found in finished drinking water from Florida at levels higher than those proposed in human health guidelines. A study of 106 organic wastewater-related contaminants and their occurrence in finished treated drinking water found 17 of the selected contaminants in final water samples. A recent survey of 51 contaminants including pharmaceuticals, hormones, phthalates, surfactants and herbicides in surface and drinking waters from Italy found 28 contaminants in the ng/L concentrations range in surface waters from a lake and similar concentration levels in tap water for the 23 detected compounds.

The efficacy of different conventional water treatments in elimination of emerging contaminants has been reviewed. Activated carbon adsorption including powdered activated carbon (PAC) and granular activated carbon (GAC) has been shown to be effective in removing non-ionic compounds with log Kow higher than 3. However some pharmaceuticals such as carbamazepine and some fragrances such as HHCB (galaxolide) persisted throughout treatment. Nanofiltration and Reverse Osmosis membranes were also found to remove

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organic contaminants to a very high degree. Ozone had been shown to be very effective in eliminating several pharmaceuticals, hormones and nonylphenols with percentages higher than 50%, however poorer elimination rates have been found for some pesticides (i.e. lindane, atrazine), fragrances (i.e., musk ketone) and pharmaceuticals (i.e., clofibric acid, meprobamate). Oxidation with chlorine or chlorine dioxide has been shown to be less effective however high reactivates were found when contaminants contained phenolic or amino moieties (i.e., hormones, nonylphenols, sulfonamides). One problem with the oxidation processes is the formation of disinfection by-products (DBPs) which may have toxic effects.

The formation of DBPs from these emerging contaminants along with new disinfection treatments could lead to emerging DBPs. In recent times, a new group of human-use contaminants, illicit drugs, have been detected in aquatic media form the USA, Italy, Germany, Spain and Ireland. It is estimated that around 200 million people have consumed illicit drugs in the last year.

Some of these drugs reach municipal wastewater treatment plants (WWTPs) where, depending on the treatment efficiency they are totally removed, on they persist and can be detected in receiving waters. The occurrence of these substances in water samples from Catalonia (NE Spain) was estimated using an ultraperformance liquid chromatography tandem mass spectrometry (UPLC -MS/MS) method. The analysis of several samples from WWTPs revealed the presence of drugs such as cocaine and amphetamine related compounds in both influent and effluent samples. There were several illicit drugs such as cocaine or MDMA (ecstasy) found in surface waters while nicotine and caffeine were detected in all of the samples analysed.

The presence of these drugs in surface waters prompted the need to investigate the elimination of these compounds during drinking water treatment and their presence in final treated water. The water treatment in the DWTP investigated consisted of perchlorination (with chlorine or chlorine dioxide), sand filtration, flocculation and sedimentation, ozonation, GAC filtration and final postchlorination.

Several drugs such as cocaine, benzoylecgonine

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(cocaine metabolite) and some amphetamine type stimulants were detected in concentrations higher than their limit of quantitation at the intake of the selected DWTP. During water treatment, removals higher than 99.9% were obtained for most of the compounds found at the intake, including cocaine and ecstasy. However, cotinine (a metabolite of nicotine) and caffeine were found in treated water with estimated removal percentages of 74% and 93%, respectively during drinking water treatment. Of the illicit drugs only the inactive metabolite of cocaine was found in treated water with an estimated removal of 89% by drinking water treatment.

Household Interventions Short report: Use of ceramic water filtration in the prevention of diarrheal disease: A randomized controlled trial in rural South Africa and Zimbabwe.

Du Preez M, Conroy RM, Wright JA, Moyo S, Potgieter N and Gundry SW. (2008) The American Journal of Tropical Medicine and Hygiene, 79(5); 696-701.

Diarrhoeal disease is one of the leading causes of morbidity and mortality in developing countries, and is estimated to cause 21% of all deaths in children under 5 years old and a total of 2.5 million deaths per year. Poor water quality is known to be a major contributor to this disease burden, and point of use interventions are seen as one means of improving access to safe water. When used appropriately, point of use ceramic filters provide an immediate source of drinking water with reduced turbidity and up to 99.99% removal of bacteria and protozoan pathogens. There have been only four field trials published that document diarrhoea reduction in households using ceramic filters however these trials did not differentiate between non-bloody and bloody diarrhoea. Bloody diarrhoea is often associated with shigellosis, and this infection is associated with a greater proportion of morbidity and mortality than non-bloody diarrhoea infection.

A controlled trial was conducted to determine how effective point of use ceramic filtration is in preventing non-bloody diarrhoea and bloody

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diarrhoea in children 24-36 months of age in two rural areas in southern Africa. The study was conducted in two districts, Mutale in the Vhembe district, Limpopo province, South Africa and the Zaka district, Masvingo province, Zimbabwe. There were 115 households randomly selected for this study from six villages in each of the two study areas. The selected households were randomised into two groups: The intervention group were provided with a commercially available ceramic water filter whereas the control group continued to use their usual inhouse storage containers. Each intervention household received four ceramic filter candles and were shown how to assemble, fill and clean their filters. Water samples were analysed for the presence of Escherichia coli. Water samples were collected once at the end of the study from the storage containers in the control households and directly from the tap after filtration from the intervention households. Baseline information was collected regarding the type of household, level of education, hygiene practices and access to sanitation, water source and rubbish disposal methods. The children between 24 and 36 months of age were followed in each household to determine the incidence of nonbloody and bloody diarrhoea. Episodes of diarrhoea were recorded using a pictorial diary. The study was not blinded, and control households were provided with a filter at the end of the study.

The results of the water testing for the presence of E. coli were compared with the World Health Organisation’s 2004 drinking water quality guidelines for control and intervention households and percentage compliance assessed. In the South African villages in this study, a higher rate of compliance, 55% and 73.9% was observed for both the control and intervention households, respectively.

In comparison, in the Zimbabwe villages, water complied for 30.2% of the control households and 56.9% of the intervention households. Presence of E. coli in source drinking water was associated with a 6fold increase in risk of E. coli contamination in household water (relative risk [RR] = 6.1; 95% CI =2.4-15.6). Adjusted for source quality, households with the intervention had a lower risk of E. coli in household drinking water, with a relative risk of 0.67 (95% CI = 0.50-0.89; P = 0.006). Using Poisson

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regression, the presence of home filtration had a significant effect on the incidence rates of all forms of diarrhoea, reducing the incidence of both bloody and non-bloody diarrhoea by 80%. The incidence rate ratio for bloody diarrhoea was 0.20 (95% CI = 0.090.43; p less than 0.001) and for non-bloody diarrhoea it was 0.17 (95% CI = 0.08-0.38; P less than 0.001).

Rates are defined as days of diarrhoea per 30 days.

This study showed that the provision of gravity-fed ceramic water filters was associated with a significantly lower incidence of both non-bloody and bloody diarrhoea over the 6-month intervention period in children living in rural South Africa and Zimbabwe. The filters also reduced the prevalence E. coli in the drinking water of intervention households.

Acceptance of the filters was very high during the trial with only one household refusing to use the filter. However, there are still cost barriers with the use of such filters in poor regions.

females with a primary diagnosis of NHL during the period 1 November 1989 to 31 December 1991 and recorded on the Saskatchewan Cancer Agency Registry. Male cases with a primary diagnosis of NHL between 1991 and 1994 were also obtained from the Saskatchewan Cancer Agency Registry.

Control subjects were from the Saskatchewan Health plan and matched to cases by age and gender. For this new study a water questionnaire was administered by interview in the subject’s home and water samples were collected. The water questionnaire obtained detailed information about the water and the environment surrounding private water sources. For private drinking water sources, particularly wells, information was obtained about the well structure and casing composition. Water samples were collected from faucets in the participant’s homes that were used as their drinking water source at the time of interview. Water samples were analysed for 64 chemical elements using inductively coupled plasma mass spectrometry.

Lymphoma An exploratory study of chemical elements in drinking water and non-Hodgkin's lymphoma Witmans, M.R., McDuffie, H.H., Karunanayake, C., Kerrich, R. and Pahwa, P. (2008) Toxicological and Environmental Chemistry, 90(6); 1227-1247.

Non-Hodgkin’s lymphoma (NHL) is one of the five most common types of cancer in Canada. Known risk factors include immune system defects and specific viral infections. Associations have also been reported between NHL and agriculture, agricultural practices, herbicides and insecticide exposure. A previous study reported a significantly higher risk of NHL associated with drinking water from shallow as compared to deep wells among women in Saskatchewan. A case-control study was conducted explore the concentration of chemical elements in drinking water and NHL. Cases and controls in this study had taken part in two previously case-control studies on NHL. Information on demographic, health, family medical history, smoking patterns and pesticide exposures had been collected for these studies by postal questionnaire and was used again for this study. Participants were

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Cases and controls had resided in their current homes for an average of over 20 years. The distributions of the concentrations of most elements in the water sampled were highly skewed. There were 19 elements for which fewer than 15% of the samples had concentrations above the limit of detection. A statistically significant difference in log transformed mean concentration for case compared to control samples was found for 15 elements, and for 14 of these, the mean levels were higher in case water supplies than control water supplies. Five elements where a regulatory target is set by Saskatchewan Municipal Health were found to be elevated in case compared to control samples (B, As, Se, Cd and U).

Some of the 15 chemical elements for which statistically significant differences were found may be active ingredients in pesticides that have been associated with NHL. Some of the chemical elements such as Cr and As are essential for growth and development but are also implicated in the genesis of cancer if exposure is sufficient and in certain forms.

Certain chemical elements may be essential nutrients, toxic, teratogenic or carcinogenic depending on their concentrations. Further studies are required to assess

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the correlation between contaminants in drinking water and their possible association with NHL. Comment The statistically significant differences between concentrations of elements in case and control water supplies were nearly all associated with higher levels in the case supplies, rather than being distributed among higher and lower as would be expected if differences were random. This may suggests that case water supplies are, on average, more vulnerable to a range of contaminants. NB Some tables in this paper appear to erroneously use the abbreviation Ar (argon) to refer to arsenic.

Outbreak Investigation Serological and epidemiological analysis of an outbreak of gastroenteritis among military recruits in Germany caused by Cryptosporidium parvum.

Brockmann SO, Dreweck C, Wagner-Wiening C, Hagen RM, Kimmig P, Petry F and Jakobi V. (2008) Infection, 36(5); 450-457.

In August 2001, 201 of 450 (44.7%) German armed forces recruits became ill with acute gastroenteritis following a 5-day field training exercise. During the training, recruits were stationed in permanent barracks with a permanent kitchen and meals were catered by a cook. Lunch was transported into the field in insulated containers and dinner was eaten in the barracks. Drinks supplied to the recruits included bottled mineral water, syrup concentrate diluted with tap water and tea. The menu included a variety of hot and cold meals including leafy and mixed salads. The weather conditions were very hot and dry, and the training area had been grazed by sheep.

A few recruits reported onset of gastroenteritis on the sixth day after beginning the field training, with peak onset occurring on the ninth day afterwards. Stool specimens were obtained between day 18 and day 30 after the beginning of the exercise from the 201 participants who had recovered or were still suffering from symptoms. Stool specimen analysis showed no positive results for enteropathogenic bacteria, Rotavirus or Norovirus. After hospitalisation of one of the patients, ELISA systems were used to test for

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parasites and Cryptosporidium were detected. An ELISA for Cryptosporidium coproantigens was used and 15 of 217 stool specimens were found to be positive. Cryptosporidium ELISA-positive samples were conformed by an immunofluorescence assay and microscopy of faecal smears.

Food samples were taken from the field kitchen immediately after the onset of the outbreak and analysed for bacterial pathogens and toxins. Food samples were negative for any faecal or bacterial contamination. After Cryptosporidium was identified in the hospitalised patient, analysis of the drinking water storage tank and the kitchen water supply and of 5 litres of mineral water imported for Italy was undertaken. No positive results were found. Six sheep dropping and six environmental samples were also examined by microscopy and ELISA for the presence of Cryptosporidium oocysts. No positive results were found from the environmental samples.

Two weeks after the outbreak, all participants received a questionnaire for assessment of possible risk factors. The questionnaire covered demographic information, duties, work and activities during the field exercise, consumption of tap water and all menu items available during the field exercise. The questionnaire was returned by 314 of the 450 participants. Diarrhoea (77.8%), flatulence (56.3%), and abdominal cramps (53.8%) were the most frequently reported complaints. Correlations between 33 potential risk factors such as consumption of drinks and food items and symptoms of gastroenteritis in the 158 persons were analysed.

Consumption of certain meals and drinks at the beginning of the field exercise were associated with an increased risk for gastroenteritis. DNA was prepared from 14 individuals with positive parasite detection in their stool samples. Of all the DNA samples, C. parvum oocyst wall protein COWP gene fragment could be amplifies in four samples. After re-amplification, six additional samples were positive. The RsaI restriction pattern of the PCR products was consistent with C. parvum.

Beginning 6 weeks after the outbreak, sera were taken from recruits over a period of 3 months. There were 214 serum samples from 214 participants of the

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field training analysed. Sera from 175 solders who did not participate in the training was also taken as a control group. For serum samples from the outbreak group, 72% had IgG titres that were regarded as positive compared with 17% of the sera that were tested positive from the control group. There was a tendency that high titres were more likely to be associated with symptoms than low titres. Analysis of specific IgM levels was less conclusive. Serum samples were available from 6 of the 15 individuals with laboratory-confirmed cryptosporidiosis and all 6 sera had antibodies of the IgG class.

The outbreak of gastroenteritis among the military recruits was considered an epidemic of cryptosporidiosis based results found here from the sera and the stool samples. The epidemiological evidence found an association with consumption of meals and drinking of tap water and the early onset of symptoms in some participants. However, the specific source of the infection was not identified.

Rainwater Characterisation of atmospheric deposition as a source of contaminants in urban rainwater tanks.

Huston R, Chan YC, Gardner T, Shaw G. and Chapman H. (2009) Water Research, In Press.

In recent years in Australia urban households have been encouraged to install rainwater tanks to reduce demands on tap water supplies due to ongoing drought conditions. Tank owners often use tank water for drinking even when treated tap water is available although water authorities do not advise it.

Government and water authorities are concerned that urban and industrial air pollution may adversely affect the water quality in urban tanks from both wet and dry deposition of contaminants. There is limited data however on the relative contribution of atmospheric deposition. This paper examines the current atmospheric deposition of chemicals in a subtropical urban environment in Brisbane, Australia.

At 12 households and 4 Environmental Protection Agency (EPA) air pollution monitoring sites, sampling was conducted of wet plus dry atmospheric deposition using continuously open containers,

HEALTH STREAM

known as bulk deposition (BD) on a monthly basis from April 2007 to March 2008. The sites were spread across greater Brisbane. The samplers consisted of 4 L amber glass bottles and clear glass funnels. Tank water was also sampled, sites were spread across Brisbane with 13 locations having both tank water and BD sampled concurrently. Sample analysis included: total solids, organic analysis (including 122 herbicides and pesticides, 17 Polycyclic aromatic hydrocarbons (PAHs) and 16 phenolic compounds), metal analysis (29-30 metals), anion analysis (eight soluble anions) and total organic and inorganic carbon analysis.

Of the 155 organic compounds analysed in BD at 16 sites in December 2006, there were few above the parts per trillion detection limit. Generally only 1 or 2 sites had some organic compounds detected with concentrations near the detection limit. Low levels of herbicides were the most common finding particularly atrazine, simazine and diuron in both BD and tanks. Fifteen tanks were also sampled in July 2007 to compare with the organics found in BD and analysed for the same set of organic compounds along with 2 additional PAHs. There were even fewer compounds above detection limits for the tank water and none above the guideline levels.

The flux of total solids (TS) increased significantly (P less than 0.05, R2 = 0.49) with the average daily rainfall for the month in a linear fashion. This was mostly due to the increase of the water-soluble components NaCl, carbon, nitrates and sulphates adding to the mass of solids deposited with rain. The concentration of TS decreased exponentially with increasing rainfall suggesting a dilution effect. Sea salt was the major component of the total mass with organic carbon, nitrates, sulphates and inorganic carbon cumulatively explaining 82.4% of the total mass of analysed components. The other major components of flux in decreasing order were Ca, K, Mg, P03-4, N0-2. The fluxes of many of the heavy metals measure in Brisbane were comparable to those reported in other cities.

There was a statistically significant effect of location on the annual mean daily flux of some elements and anions in particular Li, Mn, Fe, Pb and SO2-4 were

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significantly higher in city/heavy traffic/industrial site compared to outer suburban sites. There was also a significant effect of location on flux of K, Sb, Sn, Cu, Zn and Ba but not other metals or anions. The elevated atmospheric deposition of heavy metals may mostly be due to traffic.

The concentrations of metals in BD were compared to ADWG and it was found that Pb, Cd and Fe concentrations in BD exceeded the ADWG in 10.3%, 1.7% and 17.7% of samples respectively. This was generally found in the drier months when there was little wet deposition and therefore no dilution effect.

The concentration of metals in urban rainwater tanks were compared to ADWG values. It was found that in tank water, Pb and Zn exceeded the ADWG in 14% and 6.1%of samples respectively. Of these metals Pb has the most potential for serious health effects especially in children. The importance of atmospheric deposition as a source of heavy metals, particularly Pb, to urban tanks was assessed. The cumulative mean concentration of Pb in deposition was on average only one quarter of that in tank water over the year at a site with high Pb concentrations in the tank water. Additional analysis of sludge from selected tanks showed Pb in the sludge. The results imply that there were other major sources of Pb to the tank than atmospheric deposition found with

potential sources including lead flashing on the roof, old paint and Pb stabilised PVC drain pipes.

This study shows that atmospheric deposition does contribute to contaminants in rainwater in the urban environment. The chemical water quality of the urban rainwater in this study however could still be considered as potable. The quality of water collected in a tank however may not reflect that of rainwater with Pb most commonly exceeding drinking water guidelines. The likely health effects of Pb in tank water need to be assessed. The sources of Pb in tank water need to be identified and quantified and this is currently being undertaken. Also the impact of Pb in sludge and the partitioning between sludge and the water column need to be further studied to assess the usefulness of removing sludge for decontamination.

Comment Use of lead-stabilised PVC is not recommended for rainwater collection systems intended for drinking, however in urban areas tanks are often retro-fitted to existing homes and homeowners may be unaware of potential risks.

Disclaimer Whilst every effort is made to reliably report the data and comments from the journal articles reviewed, no responsibility is taken for the accuracy of articles appearing in Health Stream, and readers are advised to refer to the original papers for full details of the research.

Health Stream is the quarterly newsletter of Water Quality Research Australia. Health Stream provides information on topical issues in health research which are of particular relevance to the water industry, news and updates on the recent literature. This newsletter is available free of charge to the water industry, public health professionals and others with an interest in water quality issues. An electronic version of the newsletter and a searchable archive of Health Stream articles are available via the WQRA Web page.

Summaries of Web-bonus articles are available only in the electronic version.

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