Abstract
Increasing flooding frequencies enhance the likelihood of exposures to water-associated infectious diseases (via direct exposures and indirectly via impacts on source drinking, irrigation, and recreational waters). The application of quantitative microbial risk assessment (QMRA) is described here with a view to aid in the prioritization of flood planning, mitigation, and control strategies. Likely key hazards are described that can be used as reference pathogens, with exposure estimates aided by use of fecal indicator microorganisms and surrogates for treatment reduction performance. Known dose-response models are then applied to characterize risks from various exposure scenarios to fecal and environmental (saprozoic) pathogens. The importance of respiratory and wound infectious agents is highlighted (such as saprozoic Legionella pneumophila, nontuberculous mycobacteria, and Pseudomonas aeruginosa), as is the use of sensitivity analyses to prioritize pathways and scenarios. Immerging issues such as antimicrobial-resistant (AMR) pathogens and resistance genes within environmental bacteria are also being considered within a QMRA framework, but specific dose-response information is still lacking to fully quantify these threats and some groups of pathogens described in this chapter.
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