Scientists at the University of Bath’s Water Innovation and Research Centre are developing new ways of monitoring public health at home and in low-income countries by analysing wastewater

Rising antimicrobial resistance and fast-spreading epidemics like Ebola and the Zika virus are well-publicised threats to global health. Now, scientists at the University of Bath’s Water Innovation and Research Centre (WIRC @ Bath) are working out how big data and wastewater-based epidemiology (WBE) could help combat these issues and keep people around the world healthy.

The World Health Organisation (WHO) stated in 2016 that antimicrobial resistance (also known as AMR or drug resistance) is a major threat to health and human development. AMR is the ability of a microorganism (like bacteria, viruses, and some parasites) to stop an antimicrobial (such as antibiotics, antivirals and antimalarials) from working against it. As a result, standard treatments become ineffective, infections persist and may spread to others.

Now, studies being carried out by WIRC @ Bath staff could point to how wastewater monitoring could contribute to fighting both AMR and the spread of aggressive epidemics by reducing the level of pharmaceuticals reaching wastewater treatment works, and creating an early warning system aimed at safeguarding public health.

Barbara Kasprzyk-Hordern, Professor in Environmental and Analytical Chemistry, is based in the University of Bath’s Department of Chemistry and is a member of its Water Innovation and Research Centre, WIRC @ Bath. Prof Kasprzyk-Hordern says that instead of monitoring the health of individuals through blood or urine samples, more can be learned about a community’s health at a ‘birds eye’ level when wastewater is monitored.

Doing do over wide geographic areas and in long-term studies will give public health bodies new tools in understanding a population’s health, the risks it is facing, and the possibility of developing early warning systems to highlight potential threats before they become crises.

She says: “We have been studying for several years how water systems form a critical part of the public health landscape.

“It’s thanks to this that current research focused on safeguarding people’s health both in the UK and internationally is progressing rapidly, on several fronts.”

ReNEW – developing early warning systems in urban wastewater systems

A project managed jointly with South Africa’s Stellenbosch University seeks to develop an early-warning system to quickly highlight emerging public health issues in the Stellenbosch area. Following a year’s study of the underlying geographic conditions and seasonal variabilities, the team is now using state-of-the-art tools to target more than 200 biomarkers, including genes, proteins and chemicals that help paint a picture of local community health.

Prof Kasprzyk-Hordern says: ““We hope that monitoring of selected biomarkers over long periods will speed up the evaluation of public health status, prediction of future crises, and development of mitigation strategies for rapid- or slow-onset hazards, even before they manifest characteristic end points, such as death in the case of pandemics.”

By engineering new integrated sensors for on-site monitoring and building a big data approach to modelling markers within the urban water system in Stellenbosch, the team hopes that urban water profiling can provide real-time responses when certain biomarkers are detected and reduce the burden on public health worldwide.

Urban water fingerprinting

Developed from a Europe-wide study that used wastewater sampling to determine levels of illicit drug use in cities, Urban Water 

Fingerprinting (or UWF) is a recent concept in water science.

Anyone working in the water industry will know that urban water is complex and ever-changing.

A mixture of substances, it includes a wide range of human excretion products, all of which have different levels of exposure to stressors (e.g. toxicants and infectious agents) and physiological processes (e.g. specific disease-linked proteins, genes and metabolites). The quantitative measurement of these residues continuously pooled by sewerage systems can provide evidence of the quantity and type of chemical, biological or physical stressors to which the population is exposed and can profile the effects of this exposure, anonymously, at low cost and in real time.

Results of UWF studies so far are very promising and therefore it is anticipated that use of the technique will become more widespread. UWF capable of collating and analysing long term datasets has the potential to unravel complexities behind key 21st century public health issues focused on non-communicable and communicable disease epidemics which are rapidly spreading globally.

For example, only one daily urban water sample is needed to evaluate more than 300 biomarkers that can determine the state of community-wide health for a community of 100 thousand people, served by one wastewater treatment works – or in lower- and middle-income countries, disposing directly to the local river or open sewer.

If undertaken every day for a year, changes in public exposure over time, as well as infectious disease spread and the appearance of new pathogenic strains, could be surveyed for the whole community at a relatively low cost. As yet, such a tool does not exist. However, Kasprzyk-Hordern says that if developed, it would have the potential to vastly improve health outcomes, provide quality-of-life benefits and reduce cost of healthcare globally. “Most importantly it could benefit all community members, irrespective of their socioeconomic status,” she adds.

Further work is critically needed to develop a system that is recognised internationally to influence regulatory and political decisions both of localised importance (e.g. air pollution in urban areas or infectious disease spread in low resource settings) and at an international scale (e.g. antimicrobial resistance). Several aspects – including accurate measurement of population sizes, work into identifying biomarkers and crucially the development of low-cost sensors, require further investigation.