title: Application of disease burden to quantitative assessment of health hazards for a decentralized water reuse system.
abstract: The aim of this article is to introduce the methodology of disease burden (DB) to quantify the health impact of microbial regrowth during wastewater reuse, using the case study of a decentralized water reuse system in Xi'an Si-yuan University, located in Xi'an, China. Based on field investigation findings, Escherichia coli (E. coli), Salmonella and rotavirus were selected as typical regrowth pathogens causing potential health hazards during the reuse of reclaimed water. Subsequently, major exposure routes including sprinkler irrigation, landscape fountains and toilet flushing were identified. Mathematical models were established to build the relationship between exposure dose and disease burden by calculating the disability adjusted life year (DALY). Results of disease burden for this case study show that DALYs attributed to E. coli were significantly greater than those caused by other pathogens, and DALYs associated with sprinkler irrigation were higher than those originating from other routes. A correlation between exposure dose and disease was obtained by introducing a modified calculation of morbidity, which can extend the assessment endpoint of health risk to disease burden from the conventional infection rate.
authors.affiliation: Key Lab of Northwest Water Resource, Environment and Ecology, MOE, Xi'an University of Architecture and Technology, No.13 Yanta Road, Xi'an 710055, China.
authors.forename: Tingting
authors.initials: T
authors.lastname: Gao
authors.affiliation: Key Lab of Northwest Water Resource, Environment and Ecology, MOE, Xi'an University of Architecture and Technology, No.13 Yanta Road, Xi'an 710055, China; Department of Civil and Environmental Engineering, Graduate School of Engineering, Tohoku University, 6-6-06 Aza-Aoba, Aramaki, Aoba-ku, Sendai, Miyagi 980-8579, Japan. Electronic address: chenrong@xauat.edu.cn.
authors.forename: Rong
authors.initials: R
authors.lastname: Chen
authors.affiliation: Key Lab of Northwest Water Resource, Environment and Ecology, MOE, Xi'an University of Architecture and Technology, No.13 Yanta Road, Xi'an 710055, China.
authors.forename: Xiaochang
authors.initials: X
authors.lastname: Wang
authors.affiliation: School of Civil and Environmental Engineering, Faculty of Engineering and Information Technology, University of Technology Sydney, Broadway, NSW 2007, Australia. Electronic address: h.ngo@uts.edu.au.
authors.forename: Huu Hao
authors.initials: HH
authors.lastname: Ngo
authors.affiliation: Department of Civil and Environmental Engineering, Graduate School of Engineering, Tohoku University, 6-6-06 Aza-Aoba, Aramaki, Aoba-ku, Sendai, Miyagi 980-8579, Japan.
authors.forename: Yu-You
authors.initials: YY
authors.lastname: Li
authors.affiliation: Key Lab of Northwest Water Resource, Environment and Ecology, MOE, Xi'an University of Architecture and Technology, No.13 Yanta Road, Xi'an 710055, China.
authors.forename: Jinhong
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Key Lab of Northwest Water Resource, Environment and Ecology, MOE, Xi'an University of Architecture and Technology, No.13 Yanta Road, Xi'an 710055, China.
authors.forename: Lu
authors.initials: L
authors.lastname: Zhang
mesh_terms: D002681:China / Q000453:epidemiology; D004926:Escherichia coli; D015386:Hazardous Substances; D006801:Humans; D019057:Quality-Adjusted Life Years; D059027:Recycling; D018570:Risk Assessment / Q000379:methods; D012401:Rotavirus; D012475:Salmonella; D014865:Waste Disposal, Fluid / Q000379:methods*; D062065:Wastewater; D014871:Water Microbiology; D000069578:Waterborne Diseases / Q000453:epidemiology*
chemical_list: D015386:Hazardous Substances; D062065:Wastewater
keywords: DALY; Disease burden; Health impact; Morbidity; Pathogen; Water reuse