Adegoke Anthony A, Amoah Isaac D, Stenström Thor A, Verbyla Matthew E, Mihelcic James R
SARChI, Institute for Water and Wastewater Technology, Durban University of Technology, Durban, South Africa.
Department of Microbiology, Faculty of Science, University of Uyo, Uyo, Nigeria.
Front Public Health. 2018 Dec 6;6:337. doi: 10.3389/fpubh.2018.00337. eCollection 2018.
The use of partially treated and untreated wastewater for irrigation is beneficial in agriculture but may be associated with human health risks. Reports from different locations globally have linked microbial outbreaks with agricultural reuse of wastewater. This article reviews the epidemiological evidence and health risks associated with this practice, aiming toward evidence-based conclusions. Exposure pathways that were addressed in this review included those relevant to agricultural workers and their families, consumers of crops, and residents close to areas irrigated with wastewater (partially treated or untreated). A meta-analysis gave an overall odds ratio of 1.65 (95% CI: 1.31, 2.06) for diarrheal disease and 5.49 (95% CI: 2.49, 12.10) for helminth infections for exposed agricultural workers and family members. The risks were higher among children and immunocompromised individuals than in immunocompetent adults. Predominantly skin and intestinal infections were prevalent among individuals infected mainly via occupational exposure and ingestion. Food-borne outbreaks as a result of crops (fruits and vegetables) irrigated with partially or untreated wastewater have been widely reported. Contamination of crops with enteric viruses, fecal coliforms, and bacterial pathogens, parasites including soil-transmitted helminthes (STHs), as well as occurrence of antibiotic residues and antibiotic resistance genes (ARGs) have also been evidenced. The antibiotic residues and ARGs may get internalized in crops along with pathogens and may select for antibiotic resistance, exert ecotoxicity, and lead to bioaccumulation in aquatic organisms with high risk quotient (RQ). Appropriate mitigation lies in adhering to existing guidelines such as the World Health Organization wastewater reuse guidelines and to Sanitation Safety Plans (SSPs). Additionally, improvement in hygiene practices will also provide measures against adverse health impacts.
使用部分处理和未经处理的废水进行灌溉在农业中是有益的，但可能与人类健康风险相关。全球不同地区的报告已将微生物暴发与农业废水回用联系起来。本文综述了与此做法相关的流行病学证据和健康风险，旨在得出基于证据的结论。本综述涉及的接触途径包括与农业工人及其家人、作物消费者以及靠近用废水（部分处理或未经处理）灌溉地区的居民相关的途径。一项荟萃分析得出，接触废水的农业工人及其家庭成员患腹泻病的总体比值比为1.65（95%置信区间：1.31, 2.06），患蠕虫感染的总体比值比为5.49（95%置信区间：2.49, 12.10）。儿童和免疫功能低下个体的风险高于免疫功能正常的成年人。主要通过职业接触和摄入而感染的个体中，皮肤和肠道感染最为普遍。已广泛报道了用部分处理或未经处理的废水灌溉的作物（水果和蔬菜）导致的食源性疾病暴发。还证实了作物被肠道病毒、粪大肠菌群、细菌病原体、包括土壤传播蠕虫（STH）在内的寄生虫污染，以及存在抗生素残留和抗生素抗性基因（ARG）。抗生素残留和ARG可能与病原体一起在作物中内化，并可能选择产生抗生素抗性，发挥生态毒性，并导致在风险商数（RQ）高的水生生物中生物累积。适当的缓解措施在于遵守现有指南，如世界卫生组织的废水回用指南和卫生安全计划（SSP）。此外，改善卫生习惯也将提供预防不利健康影响的措施。
