Sewage Analyses as an Early Detection System for Diseases and Indicator of Various Public Health Aspects


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GRF 2nd One Health Summit 2013: Presentation by Christoph ORT, Swiss Federal Institute of Aquatic Science and Technology (Eawag) Switzerland

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Sewage Analyses as an Early Detection System for Diseases and Indicator of Various Public Health Aspects

  1. 1. 2nd GRF One Health Summit Davos, 17‐20 November 2013 Sewage Analyses as an Early Detection System for Diseases  and Indicator of Various Public Health Aspects Caleb BANTA‐GREEN, Frédéric BÉEN, Lubertus BIJLSMA, Sara CASTIGLIONI, Erik EMKE, Jennifer FIELD, Coral GARTNER,  Barbara KASPRZYK‐HORDERN, Foon Yin LAI, Jeremy PRICHARD, Malcolm REID, Martina KINZIG, Alexander VAN NUIJS Christoph ORT 2nd GRF One Health Summit Davos  17‐20 November 2013 Eawag: Swiss Federal Institute of Aquatic Science and Technology Is wastewater better than a GPS? Christoph Ort, Eawag 1
  2. 2. 2nd GRF One Health Summit Davos, 17‐20 November 2013 GPS = Global Population Survey Christoph Ort, Eawag 2
  3. 3. 2nd GRF One Health Summit Davos, 17‐20 November 2013 Concept, approach Drug consumption Dose d Metabolism e losses ? system-dependent transformation/adsorption Sewer pipes alcohol/other drugs Excretion ? current research  t dynamics hydraulics Sewage treatm. plant sampling analytics  C flow measurements volume  Q Catchment number of people normalization P env. engineer analytical chemist  Transdisciplinary STP operator C(S)·Q 1 1 1 · · · e d t P census pharmacologist env. engineer forensic sc.  Substance load in sewer [mg 1000p-1 d-1] Christoph Ort, Eawag 3
  4. 4. 2nd GRF One Health Summit Davos, 17‐20 November 2013 Sampling from a very dynamic system («sum» of toilet flushes/pumps) t=2min 30 400 25 20 300 15 200 10 0 10:10 10:20 10:30 10:40 10:50 11:00 11:10 11:20 11:30 11:40 11:50 12:00 5 0 09:00 09:10 09:20 09:30 09:40 09:50 10:00 100 BZE [mg/2min] BE [mg/2min] 35 500 flow [l/s] STP [L/s] 600  Collect samples at high frequency  (i.e. every 5‐10 minutes)  Pool samples for analysis (typically 24h)  Get information about catchment Ort et al. (in preparation) Castiglioni et al. (2013) Environmental Science and Technology 47 (3) , pp. 1452‐1460 Diurnal variations (caffeine and creatinine)  Collect samples in a flow/volume  proportional manner Brewer et al. (2012) Environmental Science and Technology 46 (15) , pp. 8305‐8314  Christoph Ort, Eawag 4
  5. 5. 2nd GRF One Health Summit Davos, 17‐20 November 2013 Cocaine consumption* in Belgium (individual days in 2007/08) Wednesday WINTER  2007‐2008 van Nuijs et al. (2009) Environmental Pollution 157 (1) , pp. 123‐129 * back‐calculated from benzoylecgonine Cocaine consumption* in Belgium (individual days in 2007/08) Sunday WINTER  2007‐2008  Weekend effect  depending on use  pattern and  pharmacokinetics van Nuijs et al. (2009) Environmental Pollution 157 (1) , pp. 123‐129 * back‐calculated from benzoylecgonine Christoph Ort, Eawag 5
  6. 6. 2nd GRF One Health Summit Davos, 17‐20 November 2013 Benzoylecgonine (one 1‐week period)  EU: 355kg cocaine/d 30% purity CHF 100/g  43 Mrd. CHF/y Thomas et al. (2012) Science of the Total Environment 432 , pp. 432‐439 Ort and van Nuijs et al. (in preparation) MDMA (one 1‐week period) Thomas et al. (2012) Science of the Total Environment 432 , pp. 432‐439 Ort and van Nuijs et al. (in preparation) Emke et al. (accepted) Science of the Total Environment Christoph Ort, Eawag 6
  7. 7. 2nd GRF One Health Summit Davos, 17‐20 November 2013 Asia (2009‐2011)  other substances  epidemiological data  not available to the  same extent Lai et al. (2013) Forensic Science International 233 (1‐3) , pp. 126‐132 graph Covaci et al. (in preparation) Cocaine* consumption in small community (~7000 people, n=1369 days) Working days  605mgCOC/d Weekend (p < 10-4) +161mgCOC/d Frost (p = 0.039) +114mgCOC/d Snow (p = 0.005) +150mgCOC/d  monitoring design   external factors  annual average Ort et al. (asap) Addiction * back‐calculated from benzoylecgonine Christoph Ort, Eawag 7
  8. 8. 2nd GRF One Health Summit Davos, 17‐20 November 2013 Antihistamine Cetirizine […] corresponds almost exactly to the period when 95% of the yearly total for the two most significant sources of pollen was registered in the Oslo region and associated seasonal allergic rhinitis among the population. […] total amount of cetirizine that passed through the system in 2010 (∼30 kg). As 50% of cetirizine is excreted unchanged and the dose rate is 10 mg per person per day, then this results in an estimation in the total number of defined daily doses (DDD) of 5 947 327 in 2010, which is within 10% of the known DDD (SI Table S2). Harman et al. (2011) Environmental Science and Technology 45 (13) , pp. 5676‐5682  Is wastewater better than GPS? Neither yes nor no: different, complementary + - Christoph Ort, Eawag Anonymous  No selection bias Substance‐specific  Near real‐time No number of users No type of users No prevalence 8
  9. 9. 2nd GRF One Health Summit Davos, 17‐20 November 2013 Take home messages • No ethical issues in large populations i.e.  negligible risk of (in)direct harm to residents; not  monitoring individuals! • Quantifying baseline and trends and effects of  interventions and also special events, e.g.  festivals … • Valuable complementary tool providing  quantitative aggregate, near real‐time  information • Early warning system for new drugs and  potentially for diseases • Transdisciplinary research involving engineer,  chemists, pharmacologists, epidemiologists,  sociologists, police, forensic scientists, etc.) Hall et al. (2012) Addiction 107 (10) , pp. 1767‐1773  Network expanded in 2013 (and further expanding)     21 countries 42 cities 47 sewage treatm. plants 24.74m people New COST action: Sewage biomarker analysis for community health assessment Ort and van Nuijs et al. (in preparation) Christoph Ort, Eawag 9
  10. 10. 2nd GRF One Health Summit Davos, 17‐20 November 2013 Acknowledgments Adriano Joss, Adrian Covaci, Alan Kleinschmidt, Alex Brewer, Alex Heisele, Alexander Van Nuijs, Ana Deletic, Ana Esposo, Andreas Hartmann, Andreas Scheidegger, Andreas Schiller, Anja Herlyn, Arthur Wanner, AWMC, Axel Meierjohann, Axel Wahl, Barbara Kasprzik‐Hordern, Beat Rohrbach, Beate Escher, Beatrice Gadmer, Benjamin Tan, Bernard Cloetta, Bernd Nowack, Brigitte Pfister, Caleb Banta‐Green, Canan Aglamaz, Carsten Uemann, Christa McArdell, Christian Abegglen, Christian Braun, Christian Fux, Christian Götz, Christian Schaffner, Christian Stamm, Claude‐Alain Jaquerod, Claudi Bänninger‐Werfeli, Coral Gartner, Cornelia Buchwalder, Damian Dominguez, Daniel Braun, Daniel Field, Daniel Pfund, Daniel Probst, Daniel Rensch, Daniel Streit, Daniele Scrugli, David Dürrenmatt, David Fillmore, David Makaz, David McCarthy, David Sedlak, Dieter Sennhauser, Dirk Muschalla, Dominic Sydler, Don Begbie, Dongbin Huang, Doris Jermann, Eawag, Erik Emke, ETH, Etienne Vermeirssen, Fadri Gottschalk, Felix Buehler, Félix Hernández, Foon Yin Lai, Frank Blumensaat, Fredi Bichsel, Frédéric Béen, Frederik Verdonck, Fritz Sörgel, Geoff Eaglesham, Gerd Hüttmann, Geri Koch, Geri Ryhiner, Glen Daigger, Greg Jackson, Hans Lamp, Hanspeter Bauer, Hansruedi Siegrist, Heather Chapman, Heinz Frömelt, Heinz Singer, Helen Stratton, Helge Daebel, Hugo Koller, Irene Steimen, Irene Wittmer, Jack Eugster, Jaqueline Traber, Jakob Helbing, Jan Mazacek, Janet Cumming, Janet Hering, Jean‐Daniel Berset, Jean‐Daniel Rosselet, Jean‐Luc Bertrand‐Krajewski, Jelena Radjenovic, Jennifer Field, Jeremey Prichard, Jessica Nott, Jimmy Coonan, Jo Martens, Jochen Mueller, John Doonan, John Elec, John Paulger, Jonas Maria Eppler, Jörg Rieckermann, José Quintana, Josef Asmin, Juliane Hollender, Julien Reungoat, Jurg Keller, Kai Udert, Karin Rottermann, Kathrin Fenner, Kevin Thomas, Klaus Heimburger, Kristell Le Corre, Leiv Rieger, Lieven Clement, Lluís Corrominas, Loïc Lombard, Lubertus Bijlsma, Luc Demontigny, Luca Rossi, Malcolm Reid, Marc Böhler, Marc Neumann, Marc Suter, Marcel Dettling, Maria José Farré‐Olalla, Marja Furrer, Marina Peter, Mario Keusen, Mariska Ronteltap, Markus Boller, Markus Gresch, Markus Koch, Martin Krauss, Martina Kinzig, Mary Donlevy, Mary Hodge, Max Maurer, Maxime Rattier, Michael Burkhard, Michael Eugster, Michael Lawrence, Michael Schärer, Michael Thomann, Michele Steiner, Miren Lopez de Alda, Miriam Münchbach, Oliver Kracht, Olivier Delémont, Oskar Wanner, Paul Liechti, Pascal Wunderlin, Peter Bühlmann, Peter Gäumann, Peter Krebs, Peter Liechti, Peter Reichert, Peter Schär, Peter Schwilch, Peter Steen Mikkelsen, Peter Vanrolleghem, Philipp Beutler, Philipp Staufer, Philippe Vioget, Pim de Voogt, Pierre Esseiva, Pius Niederhauser, Ralf Kägi, Ralf Rosenstiel, René Gälli, Reto Manser, Richard Lindberg, Röbi Schmid, Roger Küenzi, Roman Grabic, Rosi Sieber, Ross Kleinschmidt, Ruedi Moser, Sabine Burger, Saskia Zimmermann, Samuel Twerenbold, Sandra, Hall, Sara Castiglioni, Sara Karolak, Senka Terzic, Sepp Poreccia, Shane Batchler, Shaun Corrie, Silvana Velten, Simon Toze, Stefan Truong, Stefano Gianella, Steve Carter, Steven Kenway, SNF, Thomas Hug, Thomas Néfau, Tony Wong, Torsten Wind, Ueli Sieber, UWSRA, Urs von Gunten, Ursi Schönenberger, Veronique Vandeberghe, Vivienne Clayton, Walter Giger, Wayne Batchler, Wayne Hall, Wendy Mahon, Werner Pletscher, Willi Gujer, Wolfgang Gernjak, Wolfgang Rauch, Xavier Flores, Yolanda Pico Thank you A new paradigm in drug use and human health risk assessment: Sewage profiling at the community level Christoph Ort, Eawag Sewage biomarker analysis for community health assessment Skype: christoph.ort Phone: +41 (0)58 765 52 77  10