Quantitative Microbial Risk Assessment as support for bathing waters profiling

Profiling bathing waters supported by Quantitative Microbial Risk Assessment (QMRA) is key to the WHO's recommendations for the 2020/2021 revision of the European Bathing Water Directive. We developed an areaspecific QMRA model on four pathogens, using fecal indicator concentrations (E. coil, enterococci) for calculating pathogen loads. The predominance of illness was found to be attributable to Human Adenovirus, followed by Salmonella, Vibrio, and Norovirus. Overall, the cumulative illness risk showed a median of around 1 case/10000 exposures. The risk estimates were strongly influenced by the indicators that were used, suggesting the need for a more detailed investigation of the different sources of fecal contamination. Area-specific threshold values for fecal indicators were estimated on a risk-basis by modelling the cumulative risk against E. coll. and enterococci concentrations. To improve bathing waters assessment, we suggest considering source apportionment locally estimating of pathogen/indicator ratios, and calculating site-specific indicators thresholds based on risk assessment

Rapporti ISTISAN 20/19 Acqua e salute: elementi di analisi di rischio in nuovi scenari ambientali e climatici Sezione 2. Aspetti emergenti nelle acque destinate al consumo umano e nel riuso delle acque: Acqua e virus: rischi e misure di controllo; Virus enterici emergenti nelle acque ed epidemie di origine virale associate ad acque di piscina

Il volume presenta una rassegna composita di tematiche emergenti sulle complesse interazioni clima-ambienteacqua e salute, con l’obiettivo di offrire conoscenze e proporre azioni rispetto alla prevenzione e gestione dei rischi legati alle pressioni umane sui sistemi naturali e agli utilizzi delle risorse, che stanno compromettendo l’accesso universale all’acqua e ai servizi igienici e, di conseguenza, molti altri obiettivi di sviluppo sostenibile dell’agenda ONU 2030. I contributi raccolti nel volume, molti dei quali presentati nel corso della terza edizione della Summer School “Qualità dell’Acqua e Salute” che si è svolta a Matera e a Bari, dal 24 al 28 giugno 2019, e aggiornati alle conoscenze più recenti, presentano anche iniziative italiane rilevanti che stanno efficacemente affrontando in prevenzione le tematiche clima-ambiente-acqua e salute. Una migliore gestione delle risorse idriche è una componente essenziale per il successo della mitigazione del clima e delle strategie di adattamento

Detection of Monkeypox Virus DNA in Airport Wastewater, Rome, Italy

Environmental surveillance can be a complementary tool for detecting pathogens circulating in communities. We detected monkeypox virus DNA in wastewater from Italy’s largest airport by using real-time PCR assays targeting the G2R region and F3L and N3R genes and sequencing. Wastewater surveillance can be quickly adapted to investigate emerging threats

Surveillance for rat hepatitis E in wastewater networks, Italy

Rat hepevirus is an emerging zoonotic pathogen associated with human hepatitis and distantly related to the hepatitis E virus. By using broadly reactive primers for hepevirus, we detected viral RNA in 68/155 (43.9%) of sewage specimens collected from 14 wastewater treatment plants serving about half of the population of Abruzzo, Italy. On sequence analysis, the 68 strains showed 79.0%-91.6% identities to reference sequences of rodent and human origin, segregating in different genetic groups with a clear geographic/wastewater treatment plant (WWTP)-related pattern

Severe impact of late diagnosis of congenital adrenal hyperplasia on gender identity, sexual orientation and function: case report and review of the literature

Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (21-OHD) represents the most frequent form of CAH and of 46, XX disorder of sex development in female newborns. In the majority of cases, particularly in developed countries, female patients suffering from the classic forms of CAH reach the diagnosis at birth or in the early childhood, allowing a prompt treatment with a correct gender assignment. The current manuscript describes an unusual case of an Italian 46-year-old woman, homeborn in the 60s, receiving an extraordinarily late diagnosis of simple virilising classic form of CAH due to 21-OHD, determining a relevant impairment of both physical and psychosexual development. The patient presented primary amenorrhea, height under target, overweight with visceral adiposity, hypercholesterolemia and insulin resistance, hirsutism with a typical male-pattern hair growth, external genital ambiguity, and a severe impairment in the entire series of psychological dimensions, particularly severe depressive symptoms, together with gender dysphoria relative to the female gender assigned at birth, cross-gender behaviours, and body image discomfort, which were associated with homosexual orientation, and sexual dysfunction. Following diagnosis and glucocorticoid (GC) replacement therapy, the hyperandrogenism control and familial and socio-cultural factors changes, particularly, living alone and the interruption of social isolation, were accompanied by menarche appearance, improvement in hirsutism and metabolic profile, and a resolution in all psychological dimensions, depressive symptoms, and gender dysphoria. The patient began to perceive homosexual orientation without discomfort, and ameliorating sexual function. Few cases of female patients with CAH due to 21-OHD receiving an extremely delayed diagnosis have been published. However, to the best of our knowledge, this is the first case including a complete psychosexual assessment at diagnosis with a detailed re-evaluation after 5 years of disease treatment

Coliphages as indicators of fecal contamination in wastewater treatment (SCA.Re.S. Project)

Bacteriophages are fecal indicators of viral contamination, because they are more similar to human pathogenic viruses than the traditional fecal indicator bacteria, in terms of log-reduction during wastewater treatment and persistence in the aquatic environment. The aim of this study was to evaluate the presence of bacteriophages and enteric viruses: Enterovirus, Adenovirus, Norovirus, Hepatitis A and E, Rotavirus and Pepper mild mottle virus (PMMoV), in the context of SCA.Re.S. (Evaluation of sanitary risk related to the discharge of wastewater to the ground) project. The investigation focused on a wastewater treatment plant located in an area fractured by karst in the Salento peninsula (Apulia, Italy). In autumn (September-November) 2019, water samples were monthly collected from three sites (treated wastewater, infiltration trench and monitoring well). The somatic coliphage were analyzed by standardized culture-based methods, according to BS EN ISO 10705-2:2001. Coliphage density was enumerated using plaque assay method on appropriate host bacteria (E. coli Famp) and expressed as plaque forming units PFU/100mL. Nested RT-PCR assay was used for detection of enteric viruses. The median values of coliphages were 590 PFU/100mL in treated wastewater, 1000 PFU/100mL in infiltration trench while all samples from monitoring well were under the detection limit. All samples were positive for at least one viral pathogen. PMMoV was detected only in monitoring well. The results confirmed the role of coliphages as indicators of viral contamination. Overall, we observed a gradual reduction in the concentration/occurrence of coliphages and viruses across the karst-fissured soil, until the complete removal in the monitoring well. Different soil properties are probably involved in this phenomenon such as straining, soil pores, microorganism size, and adsorption onto soil particle. Moreover, we can also hypothesize natural degradation over time, phototoxicity or ingestion by multicellular organisms in the soil and/or monitoring well water

SARS-CoV-2 in Atmospheric Particulate Matter: An Experimental Survey in the Province of Venice in Northern Italy

Analysis of atmospheric particulate matter (PM) has been proposed for the environmental surveillance of SARS-CoV-2. The aim of this study was to increase the current knowledge about the occurrence of SARS-CoV-2 in atmospheric PM, introduce a dedicated sampling method, and perform a simultaneous assessment of human seasonal coronavirus 229E. Thirty-two PM samples were collected on quartz fiber filters and six on Teflon using a low- and high-volumetric rate sampler, respectively, adopting a novel procedure for optimized virus detection. Sampling was performed at different sites in the Venice area (Italy) between 21 February and 8 March 2020 (n = 16) and between 27 October and 25 November 2020 (n = 22). A total of 14 samples were positive for Coronavirus 229E, 11 of which were collected in October-November 2020 (11/22; positivity rate 50%) and 3 in February-March 2020 (3/16 samples, 19%). A total of 24 samples (63%) were positive for SARS-CoV-2. Most of the positive filters were collected in October-November 2020 (19/22; positivity rate, 86%), whereas the remaining five were collected in February-March 2020 at two distinct sites (5/16, 31%). These findings suggest that outdoor PM analysis could be a promising tool for environmental surveillance. The results report a low concentration of SARS-CoV-2 in outdoor air, supporting a scarce contribution to the spread of infection

Nine-Year Nationwide Environmental Surveillance of Hepatitis E Virus in Urban Wastewaters in Italy (2011–2019)

Hepatitis E virus (HEV) is an emerging causative agent of acute hepatitis worldwide. To provide insights into the epidemiology of HEV in Italy, a large-scale investigation was conducted into urban sewage over nine years (2011–2019), collecting 1374 sewage samples from 48 wastewater treatment plants located in all the 20 regions of Italy. Broadly reactive primers targeting the ORF1 and ORF2 regions were used for the detection and typing of HEV, followed by Sanger and next generation sequencing (NGS). Real-time RT-qPCR was also used to attempt quantification of positive samples. HEV RNA detection occurred in 74 urban sewage samples (5.4%), with a statistically significant higher frequency (7.1%) in central Italy. Fifty-six samples were characterized as G3 strains and 18 as G1. While the detection of G3 strains occurred in all the surveillance period, G1 strains were mainly detected in 2011–2012, and never in 2017–2019. Typing was achieved in 2 samples (3f subtype). Viral concentrations in quantifiable samples ranged from 1.2 × 103 g.c./L to 2.8 × 104 g.c./L. Our results suggest the considerable circulation of the virus in the Italian population, despite a relatively small number of notified cases, a higher occurrence in central Italy, and a noteworthy predominance of G3 strains

Wastewater-based Epidemiology and SARS-CoV-2: Variant Trends in the Apulia Region (Southern Italy) and Effect of Some Environmental Parameters

During the COVID-19 pandemic, wastewater monitoring has been used to monitor the levels of SARS-CoV-2 RNA entering the sewerage system. In Italy, the Istituto Superiore di Sanita coordinated the SARI project (Sorveglianza Ambientale Reflue in Italia) to detect SARS-CoV-2 and its variants. In this study, the concentration of SARS-CoV-2 and its variants in raw wastewater against COVID-19 cases was evaluated together with the effect of temperature and precipitation on virus spread. We validated a predictive model, proposed by De Giglio et al., 2021, to establish the number of COVID-19 cases/100,000 inhabitants. A receiver operating characteristic curve model was applied to predict the number of COVID-19 cases and Poisson regression was applied to study the effect of temperature and rainfall on viral load. In Apulia, from October 2021 to December 2022, we analyzed 1041 samples, of which 985 (94.6%) tested positive for SARS-CoV-2. Median atmospheric temperature was inversely proportional to viral load in wastewater; no correlation was found with precipitation. The predictive model confirmed that at least 11 cases/100,000 inhabitants would occur in the 15 days following the detection of the virus in wastewater. Environmental surveillance of SARS-CoV-2 can be used to map the virus and its variants