Predicting norovirus contamination and antimicrobial resistance in coastal waters from community and hospital-derived sources

Hospital-derived wastewater can enter the aquatic environment, posing a serious risk to public health due to the presence of pathogenic viruses and antimicrobial resistant (AMR) organisms. A quantitative understanding of the factors affecting the dispersal and fate of these pathogens in near-shore environments, remains poorly understood. Here we present a real-world exemplar that demonstrates how hydrodynamic modelling can quantify human exposure risk of wastewater-derived pathogens from three hospitals into coastal areas with high-risk receptors (recreational waters, tourist beaches, shellfisheries). The study focused on the dispersal and fate of norovirus (NoV) GI & GII and AMR genes along the freshwater-estuarine-marine continuum over a 1-year period to examine the impact of season, tidal patterns and pathogen loading rate. Our simulations predicted that combined sewer overflow discharges (CSOs) contributed 41% of the total hospital-derived viral load delivered to the coastal zone. Risk analysis revealed significant potential for local exceedances of NoV GI concentrations at designated bathing sites exceeding the infectious dosage threshold, reaching 59% probability in the summer months. The results highlight the significant role of hospital-derived wastewater, particularly during the summer months, coinciding with peak tourist activities and recreational water use. The study also suggested that the bioaccumulation of hospital-derived NoV and AMR in shellfish could pose a significant health risk to consumers. This research highlights the need to implement advanced treatment technologies, predictive water quality modelling, and regulatory adjustments to help protect the public from infectious agents present in hospital-derived wastewater released into the environment.