ArticlePLoS medicine2018
High levels of sewage contamination released from urban areas after storm events: A quantitative survey with sewage specific bacterial indicators.
Article in PLoS medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
38 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Pooled it
- A Review of Combined Sewer Overflows and Gastrointestinal Illness in a Changing Climate.Current epidemiology reports · 2025Article
- An environmental sampling and community-driven methodology to understand and address risks from sanitary sewer overflows and basement backups.Journal of water and health · 2025Article
- Impacts of environmentally relevant concentrations of antibiotic cocktails on the skin microbiome of Eurasian carp (Cyprinus carpio).Animal microbiome · 2025Article
- An Urban Stormwater Contaminant Signature: Defining Priority Contaminants for Urban Stormwater Research.Water environment research : a research publication of the Water Environment Federation · 2025Article
- Article
- Photocatalytic Disinfection of Selected Waterborne Pathogens by Visible Light-Active Nano Iron-Doped TiOACS applied nano materials · 2025Article
- Climate change will amplify the impacts of harmful microorganisms in aquatic ecosystems.Nature microbiology · 2025Review
- Application of a microbial and pathogen source tracking toolbox to identify infrastructure problems in stormwater drainage networks: a case study.Microbiology spectrum · 2024Article
- Association between Combined Sewer Overflow Events and Gastrointestinal Illness in Massachusetts Municipalities with and without River-Sourced Drinking Water, 2014-2019.Environmental health perspectives · 2024Article
- The mediatory role of water quality on the association between extreme precipitation events and infectious diarrhea in the Yangtze River Basin, China.Fundamental research · 2024Article
- Fecal Bacteria Contamination of Floodwaters and a Coastal Waterway From Tidally-Driven Stormwater Network Inundation.GeoHealth · 2024Article
- Article
- Article
- Article
- A stitch in time: The importance of water and sanitation services (WSS) infrastructure maintenance for cholera risk. A geospatial analysis in Harare, Zimbabwe.PLoS neglected tropical diseases · 2023Article
- Article
- Genetic fecal source identification in urban streams impacted by municipal separate storm sewer system discharges.PloS one · 2023Article
- Quantifying the land and population risk of sewage spills overland using a fine-scale, DEM-based GIS model.PeerJ · 2023Article
- Prioritizing Pharmaceutical Contaminants in Great Lakes Tributaries Using Risk-Based Screening Techniques.Environmental toxicology and chemistry · 2022Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
backgroundPast studies have demonstrated an association between waterborne disease and heavy precipitation, and climate change is predicted to increase the frequency of these types of intense storm events in some parts of the United States. In this study, we examined the linkage between rainfall and sewage contamination of urban waterways and quantified the amount of sewage released from a major urban area under different hydrologic conditions to identify conditions that increase human risk of exposure to sewage. METHODS AND
findingsRain events and low-flow periods were intensively sampled to quantify loads of sewage based on two genetic markers for human-associated indicator bacteria (human Bacteroides and Lachnospiraceae). Samples were collected at a Lake Michigan estuary and at three river locations immediately upstream. Concentrations of indicators were analyzed using quantitative polymerase chain reaction (qPCR), and loads were calculated from streamflow data collected at each location. Human-associated indicators were found during periods of low flow, and loads increased one to two orders of magnitude during rain events from stormwater discharges contaminated with sewage. Combined sewer overflow (CSO) events increased concentrations and loads of human-associated indicators an order of magnitude greater than heavy rainfall events without CSO influence. Human-associated indicator yields (load per km2 of land per day) were related to the degree of urbanization in each watershed. Contamination in surface waters were at levels above the acceptable risk for recreational use. Further, evidence of sewage exfiltration from pipes threatens drinking water distribution systems and source water. While this study clearly demonstrates widespread sewage contamination released from urban areas, a limitation of this study is understanding human exposure and illness rates, which are dependent on multiple factors, and gaps in our knowledge of the ultimate health outcomes.
conclusionsWith the prediction of more intense rain events in certain regions due to climate change, sewer overflows and contamination from failing sewer infrastructure may increase, resulting in increases in waterborne pathogen burdens in waterways. These findings quantify hazards in exposure pathways from rain events and illustrate the additional stress that climate change may have on urban water systems. This information could be used to prioritize efforts to invest in failing sewer infrastructure and create appropriate goals to address the health concerns posed by sewage contamination from urban areas.
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