RISE (Revitalising Informal Settlements and their Environments)
RISE is a transdisciplinary research program working at the intersections of health, environment, and water and sanitation.
RISE is trialling a new water sensitive approach to water and sanitation management in 24 informal settlements across Makassar, Indonesia and Suva, Fiji.
Working with communities, governments, local leaders and partner institutions, RISE is co-designing location-specific solutions that integrate green infrastructure, such as constructed wetlands, to strengthen the whole-of-life water and sanitation cycle.
Underpinned by the emerging discipline of ‘planetary health’, RISE success will be measured by the health and well-being of residents – particularly children under five years of age – and the ecological diversity of the surrounding environment.
Coronavirus in Victorian Healthcare and Aged care workers study (COVID-HA Study)
The COVID-19 pandemic has significantly impacted all Victorians, given the prolonged lockdowns that have been required. Since the start of the pandemic, individuals working in health care and aged care have shouldered a large burden, making it crucial to monitor and support their health and wellbeing.
The COVIC-HA project commenced in March 2021 and has now enrolled more than 1000 Victorian health care workers (HCW)s across hospital, ambulance, aged care and primary care settings. Extending into the year 2022, survey data is being collected over time to monitor mental health changes, impacts on physical health, and workplace responses to support HCWs. Workplace preparedness and responses are also being investigated in order to identify strategies that mitigate adverse outcomes.
Findings are being communicated to the Victorian Department of Jobs, Precincts and Regions, WorkSafe Victoria, Workers Union, Australian Nursing & Midwifery Federation and other key stakeholders to inform evidence-based responses that are matched to the needs of HCWs and safeguard their health and wellbeing in the context of COVID-19 and future health threats.
Assessing exposure pathways for pathogens causing gastrointestinal infection acquisition among children living in informal coastal settlements
Disproportionally affecting children in low income countries, diarrhoeal diseases represent the second leading cause of death for children under the age of five. Pathogens are spread via the environment through multiple pathways including food, drinking water, hands and objects. This study to be performed in urban, informal communities in Fiji and Indonesia, will examine the importance of each pathway in the spread of diarrhoeal diseases in vulnerable children living in urban slums.
Influenza Complications Alert Network (FluCAN)
The Influenza Complications Alert Network (FluCAN) was established in 2009. This network provides real time surveillance data on influenza cases to quantify the transmission, severity and impact of influenza. Since 2011, FluCAN has expanded to provide data to estimate the effectiveness of influenza vaccine against hospitalisation. In 2017, FluCAN again expanded to include all major paediatric hospitals nationally to allow us to estimate vaccine effectiveness in children. In the next five years a number of distinct but complementary projects will be conducted to define the most effective interventions to reduce the burden of respiratory infections, by using vaccines more effectively and finding the best treatments for pneumonia that minimise mortality and reduce antimicrobial resistance.
Australian Study of Travel-Related Infectious Disease Epidemiology (ASTRIDE)
The ASTRIDE study will describe the epidemiology of notifiable infectious diseases in Australia over the last decade, focusing on select travel-related infections. This study will estimate the burden and risks of travel-related infectious disease by country/region, including an assessment of the impact of COVID-19 on the epidemiology of disease notifications.
Travel Related-Illness: Prevention and Perceptions of Risk (the TRIPPER study)
This study is using a mixed methods approach to better understand past and current attitudes towards travel and travel-related health risks in the COVID-19 era.
Review of Legionella in Water Systems
In recent decades there has been increasing concern about health risks associated with opportunistic microbial pathogens, such as Legionella bacteria, in tap water supplies. These environmental microorganisms seldom cause illness in healthy people, however severe infections may occur in those who have underlying conditions which compromise the normal defences of the body. This project involves a review of the current knowledge on Legionella species and human health risks in relation to engineered water systems (for both potable and non-potable water) and associated water-using devices and end uses. Specific scenarios of interest will be identified by consultation with water industry partners, and a qualitative risk assessment framework to evaluate health risks for each of the selected scenarios will be developed. This is a collaborative Water Research Australia project.
Management of Environmental E. coli
The bacterium E. coli has traditionally been regarded solely as an inhabitant of the gastrointestinal tract of warm-blooded animals, and has therefore been used as an indicator of recent faecal pollution in water supplies. However, it is now well established that free-living E. coli populations exist worldwide in soil and water in the absence of faecal input. These environmental E. coli strains have significant genetic differences from faecal E. coli, but most are indistinguishable by tests commonly used to assess water quality. Some environmental E. coli strains can form high density “blooms” in water storages and their presence triggers the same initial public health response as E. coli from faecal pollution events. This collaborative Water Research Australia project addressed key knowledge gaps and developed an evidence-based approach for the management of environmental E. coli blooms in Australian water supply systems.
Establishing Australian Health Based Targets For Microbial Water Quality
It is of great public health importance to ensure that our drinking water supplies are safe. This is true both for conventional drinking water supplies and for supplies derived from alternative water sources, including water derived from recycled sewage. This project involved a number of steps to develop national consensus on health targets for microbial water quality and has provided important inputs for the revision of Australian Drinking Water Guidelines.
Health Services Utilisation and Urban Dual Reticulation Systems
Funded by: CRC for Water Quality and Treatment
This study examined selected health outcomes of residents of an area supplied by a dual water reticulation system, and compared them to an otherwise similar area with a conventional reticulation system. The study was carried out in the Rouse Hill area of Sydney, which is the largest existing dual reticulation system in Australia with about 15,000 households occupied as of late 2004.
This project provided additional assurance of the safety of supplying recycled water for non-potable purposes. Output from this study is important given the proposed future scale of implementation of dual reticulation system in Australia whereby larger numbers of people hitherto unexposed, will be exposed to recycled water in the domestic and urban context. Recycled water is supplied to these homes for flushing toilets, watering gardens, washing cars and other outdoor uses.
The study was carried out in partnership with the Hawkesbury-Hills Division of General Practice which covers General Practitioners in the recycled water area and adjacent suburbs. Almost 36,000 patient records covering a two year period from eleven General Practices were examined to measure how commonly patients presented to their GP with acute gastroenteritis, acute skin complaints or acute respiratory conditions. All three medical conditions are plausibly related to exposure to pathogens or bacterial toxins in recycled water, if the water is not adequately treated. No significant difference in presentation rates for the three conditions was found between residents living in houses connected to the Rouse Hill Recycled Water Scheme, compared to residents from surrounding suburbs connected to the conventional water supply.
Health status of residents of an urban dual reticulation systemSinclair, M., O'Toole, J., Forbes, A., Carr, D. and Leder, K. (2010) International Journal of Epidemiology, 39(6); 1667-1675.
Health Services Utilisation and Urban Dual Reticulation Systems. Research Report 81Sinclair, M. O'Toole, J. Leder, K. Forbes, A. Carr, D. CRC for Water Quality and Treatment & Water Quality Research Australia
Greywater use in the backyard: what are the health risks?
This project involved administering a survey to Melbourne householders asking them about their greywater use and monitoring greywater quality at selected households. Results have fed into a mathematical model to predict greywater related infection risk and disease burden.
Report to Participants (PDF)
Exposure assessment using cyanuric acid
This project demonstrated that it is feasible to measure actual water ingestion during activities such as car washing by spiking the water with a non-toxic chemical (cyanuric acid) and measuring the amount of the chemical subsequently excreted in urine. Cyanuric acid is widely used in outdoor swimming pools to "stabilise" chlorine by protecting it from UV degradation. When ingested, this compound is not metabolised but is 100% excreted in the urine within 24 hours. This successful pilot study showed that the methodology was practical and we now have a way to actually measure water ingestion from spray exposures instead of using “expert opinion”.
Report to Participants (PDF)
Improving access to safe water using Riverbank Filtration Technology
Diarrhoea is a leading cause of death and disease globally, with 90% of diarrhoea-related deaths annually being due to unsafe water, inadequate sanitation and poor hygiene. River water is a common water source, but water quality is often compromised by contamination with raw sewage and industrial effluent. In developing countries, technical water treatment solutions are unaffordable so simple, sustainable solutions are needed. Riverbank Filtration technology (RBF) uses natural, auto-regenerative treatment processes, so properly engineered RBF systems can remain effective indefinitely. RBF is inexpensive and can substantially reduce contaminant levels to improve water quality. The primary aim of this project was to investigate the effect of improving water quality via installation of RBF systems on diarrhoea incidence in rural Indian communities. Project outcomes have been reported McGuinness (2020).
Emerging pathogens of concern to the water industry
This project is a review of knowledge on several environmental pathogens which may occur in water supplies. Such pathogens differ in several ways from the enteric pathogens from faecal waste that have traditionally been the focus of water quality management. In particular, environmental pathogens have the capacity to grow in water supplies and in the plumbing of buildings. They seldom cause serious infections in healthy people, and often occur in other environmental sources such as food and soil. Therefore the relative importance of water as a source of human infections is uncertain.
Exposure Assessment in Urban Reticulation Systems
Funded by: CRC for Water Quality and Treatment
This project surveyed the practices of residents supplied with recycled water via a dual reticulation system (Rouse Hill, NSW) and a comparison area with conventional water supply to ascertain the frequency and duration of exposure to recycled water, particularly in relation to external household use. It also compared and verified the relevance of indoor usage data (laundry and/or toilet flushing) collected for conventional reticulation throughout Australia, for Australian dual reticulation systems. This will enable refinement of exposure estimates and allow more accurate health risk assessment of the implications of supplying recycled water for non-potable uses via dual reticulation systems in the Australian context. Data obtained will provide input into the Quantitative Microbial Risk Assessment process, which has been employed for the development of the National Water Recycling Guidelines.
Collecting household water usage data: telephone questionnaire or diary?
O'Toole, J.E., Sinclair, M.I. and Leder, K. (2009) BMC Medical Research Methodology, 9(72)
Study of Water Usage in Urban Areas. Research Report No.53
O'Toole, J. Leder, K. Sinclair, M. Cooperative Research Centre for Water Quality and Treatment & Water Quality Research Australia. p 1-119.
A series of exposure experiments – recycled water and alternative water sources
Funded by: CRC for Water Quality and Treatment
This project addressed data deficits regarding the exposure profile of users of recycled and alternative water sources in both the domestic and urban context, through the conduct of a series of four experiments. Issues addressed comprised:
- potential exposure to pathogens through use of recycled water for laundry purposes
- required witholding periods before public contact after irrigation of parks with Class B and C recycled water
- characterisation of aerosol exposure from conventional and high efficiency spray devices
- preliminary assessment of the endotoxin content of recycled water and potential for adverse health effects
The project provided relevant data to enable the refinement of exposure estimates and permit more accurate health risk assessment of the implications associated with the supply of recycled and alternative water for a variety of non-potable uses. Data from the study will provide input into the design of Australian National Water Recycling Guidelines and assist water and health regulators decide on safe uses of recycled water for a variety of purposes.
Transfer Rates of Enteric Microorganisms in Recycled Water during Machine Clothes Washing.
O'Toole, J., Sinclair, M. and Leder, K. (2009) Applied & Environmental Microbiology, 75(5); 1256-1263.
Comparative survival of enteric indicators, E. coli and somatic and F-RNA bacteriophages on turf-grass irrigated with recycled water.O'Toole, J., Sinclair, M., Diaper, C. and Leder, K. (2008) Water Science & Technology, 58(3); 513-518.
Alternative water sources and endotoxinO'Toole, J., Sinclair, M., Jeavons, T. and Leder, K. (2008) Water Science & Technology, 58(3); 603-607.
Risk in the mist? Deriving data to quantify microbial health risks associated with aerosol generation by water-efficient devices during typical domestic water-using activities.O'Toole, J., Keywood, M., Sinclair, M. and Leder, K. (2009) Water Science & Technology, 60(11); 2913-2920.
Using bacteriophages in recycled water exposure assessment studies.O'Toole, J., Sinclair, M. and Leder, K. (2009) Food and Environmental Virology, 1(1); 23-30.
A Series of Exposure Experiments - Recycled Water and Alternative Water Sources: Part A - Aerosol-sizing and Endotoxin Experiments. Research Report 45 CRCWQT
O'Toole, J., Leder, K. and Sinclair, M. (2008) 1-79.
A Series of Exposure Experiments - Recycled Water and Alternative Water Sources: Part B - Microbial transfer efficiency during machine clothes washing and microbial survival turf-grass experiments.Research Report 46 CRCWQT
O'Toole, J., Leder, K. and Sinclair, M. (2008) 1-82.
Health Effects of Rainwater Consumption
Funded by: NHMRC and CRC for Water Quality and Treatment
This project used methodology previously developed for a study of tap water in Melbourne to determine whether microorganisms in untreated rainwater contributed to gastroenteritis in consumers of the water. The study was carried out in Adelaide where more than 12% of households use rainwater as their usual source of drinking water. 300 households who already drink untreated rainwater were recruited and randomly allocated to receive either a real or sham water treatment unit for treating rainwater. The real units removed microorganisms from water while the sham units did not. Neither the households nor the researchers knew which type of unit had been allocated (double blind design). The health of household members was followed for 12 months, then rates of gastroenteritis in the two groups were compared to determine whether removal of microorganisms from water was associated with a detectable change in illness rates.
The results showed that rates of gastroenteritis were very similar in the two groups. People who drank untreated rainwater displayed no measurable increase in illness compared to those who drank filtered rainwater.
Drinking rainwater: a double-blinded, randomised controlled study of water treatment filters and gastroenteritis incidence
Rodrigo, S., Sinclair, M., Forbes, A., Cunliffe, D. and Leder, K. (2011) American Journal of Public Health, 101(5); 842-847.
Effectiveness and cost of recruitment strategies for a community-based randomised controlled trial among rainwater drinkers.Rodrigo, S., Sinclair, M., Cunliffe, D. and Leder, K. (2009) BMC Medical Research Methodology, 9(51);
Developing evidence-based strategic water quality monitoring systems
Dr Martha Sinclair
Prof Steve Hrudey
Funded by: Cooperative Research Centre for Water Quality and Treatment
At present, there is a lack of a fully informed strategic basis in the design of water quality monitoring programs or interpretation of monitoring results, typically resulting in the collection of large volumes of data that do not create knowledge or improve understanding of a water supply system. Furthermore, much of the data collected fails to facilitate interpretation and the decisions that must be made. Particularly since we are often dealing with reduced resources, a change of focus is required towards more directed, strategic monitoring and making better use of available evidence.
This research proposes applications of the well-established logic of diagnostic screening and evidence based decision making from the field of medical sciences to monitoring for drinking water quality hazards, interpretation of monitoring results and development of appropriate responses. To date the considerable insights available from this rationale have not been explicitly recognized, nor applied in the environmental sciences. This project further evolves the philosophy set out in the Framework for Management of Drinking Water Quality and uses diagnostic screening as a rationale to guide drinking water quality monitoring and diagnosing water quality hazards.
Expected outcomes for the project include guidance on designing cost-effective monitoring programs, and better use of monitoring information to increase understanding and improve management of individual water supply systems. Industry and regulators will be better informed about the capabilities, potentials, and limitations of monitoring systems for managing drinking water systems.
The effect of coagulation with MF/UF membrane filtration for the removal of virus in drinking water.Fiksdal, L. and Leiknes, T. (2006) Journal of Membrane Science, 279(1-2); 364-71.
Drinking-water safety: challenges for community-managed systemsRizak, S. and Hrudey, S.E. (2008) Journal of Water & Health, 6 Suppl 1(33-41).
Achieving safe drinking water - Risk management based on experience and realityRizak, S. and Hrudey, S.E. (2007) Environmental Reviews, 15(1); 169-174.
The Water Quality Study
Prof Christopher Fairley
Dr Martha Sinclair
Dr Margaret Hellard
Assoc Prof Andrew Forbes
Funded by: Cooperative Research Centre for Water Quality and Treatment, The Water Services Association of Australia, Melbourne Water Corporation, South East Water Limited, Yarra Valley Water Limited, City West Water Limited, Department of Human Services Victoria
The Water Quality Study was a randomised double blinded controlled trial to determine whether microorganisms in drinking water were contributing to community gastroenteritis in the city of Melbourne.
Melbourne's primary water supply originates from highly protected forest catchments, and is chlorinated but not filtered prior to distribution to consumers. Most large cities have less well-protected water sources but a higher degree of water treatment including filtration. The study area consisted of several suburbs on the southeast of the city which were chosen for their combination of demographic and water supply characteristics (new homes, high rate of home ownership, young families, unfiltered water).
Six hundred families were recruited and randomly allocated to receive a real or sham water treatment unit. Real units consisted of a 1 micron absolute filter cartridge and a UV treatment chamber, and greatly reduced the microbiological content of the water. Sham units were identical in outward appearance and normal use characteristics but were altered internally so that they had no microbiocidal effect.
Participating families recorded details of gastrointestinal illness, medical treatment, travel, recreational water activities and other relevant information in weekly Health Diaries. Additional questionnaires were administered at intervals to assess water intake and food consumption. Adult participants provided blood samples for serological testing, and both adults and children provided faecal specimens for pathogen analysis at baseline and following episodes of gastroenteritis.
Conventional water quality parameters in the study area were monitored by the water supply utility, and composite mains samples were tested weekly for a range of pathogens including protozoa.
A successful 6 week Pilot study of 50 families was conducted in June /July 1997, and the Main study commenced in September 1997. Data was collected for 15 months (68 weeks) with a 4 week break over each Christmas holiday period. The data collection phase was completed in March 1999, and the results of the study were announced in April 2000.
No difference in the rate of gastroenteritis was detected between the two groups of families, demonstrating that waterborne pathogens do not make a significant contribution to community gastroenteritis in Melbourne. This result is likely to apply to other water supplies with similar characteristics. The same methodology is now being used to assess waterborne disease risks in the US.
Hellard ME, Sinclair MI, Forbes AB and Fairley CK. A randomized blinded controlled trial investigating the gastrointestinal health effects of drinking water quality. Environmental Health Perspectives 109 (8) August 2001.
This paper can be downloaded as a PDF file from the Environmental Health Perspectives journal (http://ehis.niehs.nih.gov/).
The Water Quality Study Team received the 2000 Department of Human Services Award for Excellence for Public Health Research for its work on the study.