Date Published: July 24, 2018
Publisher: Public Library of Science
Author(s): Hayley T. Olds, Steven R. Corsi, Deborah K. Dila, Katherine M. Halmo, Melinda J. Bootsma, Sandra L. McLellan, Madeleine Thomson
Abstract: BackgroundPast studies have demonstrated an association between waterborne disease and heavy precipitation, and climate change is predicted to increase the frequency of these types of intense storm events in some parts of the United States. In this study, we examined the linkage between rainfall and sewage contamination of urban waterways and quantified the amount of sewage released from a major urban area under different hydrologic conditions to identify conditions that increase human risk of exposure to sewage.Methods and findingsRain events and low-flow periods were intensively sampled to quantify loads of sewage based on two genetic markers for human-associated indicator bacteria (human Bacteroides and Lachnospiraceae). Samples were collected at a Lake Michigan estuary and at three river locations immediately upstream. Concentrations of indicators were analyzed using quantitative polymerase chain reaction (qPCR), and loads were calculated from streamflow data collected at each location. Human-associated indicators were found during periods of low flow, and loads increased one to two orders of magnitude during rain events from stormwater discharges contaminated with sewage. Combined sewer overflow (CSO) events increased concentrations and loads of human-associated indicators an order of magnitude greater than heavy rainfall events without CSO influence. Human-associated indicator yields (load per km2 of land per day) were related to the degree of urbanization in each watershed. Contamination in surface waters were at levels above the acceptable risk for recreational use. Further, evidence of sewage exfiltration from pipes threatens drinking water distribution systems and source water. While this study clearly demonstrates widespread sewage contamination released from urban areas, a limitation of this study is understanding human exposure and illness rates, which are dependent on multiple factors, and gaps in our knowledge of the ultimate health outcomes.ConclusionsWith the prediction of more intense rain events in certain regions due to climate change, sewer overflows and contamination from failing sewer infrastructure may increase, resulting in increases in waterborne pathogen burdens in waterways. These findings quantify hazards in exposure pathways from rain events and illustrate the additional stress that climate change may have on urban water systems. This information could be used to prioritize efforts to invest in failing sewer infrastructure and create appropriate goals to address the health concerns posed by sewage contamination from urban areas.
Partial Text: Waterborne illness is predicted to increase as climate change alters rainfall patterns [1–4]. In particular, an increased frequency in extreme rain events is predicted for the Northeast, Pacific Northwest, and Great Lakes regions, which can increase exposure to pathogens . Heavy rainfall has been linked with increased waterborne disease outbreaks [4,6]. Most notably, the waterborne outbreaks of Escherichia coli 0157:H7 and Campylobacter jejuni in Walkerton, Ontario [7,8] and Cryptosporidium in Milwaukee, Wisconsin  were preceded by extreme rainfall events, although these outbreaks also involved failures in drinking water treatment, monitoring, and human error [5,7,9]. The most common waterborne disease is gastrointestinal (GI) illness, and endemic occurrence in the community is difficult to quantify because most waterborne cases are sporadic and often not recognized as associated with water exposures . However, studies estimate there are 11 to 19 million cases of GI illness from contaminated drinking water [11–13] and an estimated 90 million cases from exposure to recreational waters  each year.
To understand climate influences on waterborne disease threats, drivers of contamination and exposure pathways need to be better characterized [5,10]. A key component is to understand mechanisms of sewage contamination of waterways and identify “high-risk” rainfall conditions, such as extreme events. Moving past simply measuring concentrations of standard fecal indicator bacteria in water to using highly specific indicators indicative of human fecal sources will allow us to quantitatively assess urban infrastructure vulnerabilities and provide better estimates of potential risk due to waterborne pathogens.