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Environ Sci Technol. 2019 Jun 18;53(12):7055-7067. doi: 10.1021/acs.est.9b01092. Epub 2019 May 28.

Health Risks for Sanitation Service Workers along a Container-Based Urine Collection System and Resource Recovery Value Chain.

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School of Architecture, Civil, and Environmental Engineering (ENAC) , École Polytechnique Fédérale de Lausanne (EPFL) , CH 1015 Lausanne , Switzerland.
Department of Civil & Environmental Engineering , University of California at Davis , Davis , California 95616 , United States.
Eawag , Swiss Federal Institute of Aquatic Science and Technology , CH 8600 Dübendorf , Switzerland.
Swiss Tropical and Public Health Institute , CH 4002 Basel , Switzerland.
University of Basel , CH 4003 Basel , Switzerland.


Container-based sanitation (CBS) within a comprehensive service system value chain offers a low-cost sanitation option with potential for revenue generation but may increase microbial health risks to sanitation service workers. This study assessed occupational exposure to rotavirus and Shigella spp. during CBS urine collection and subsequent struvite fertilizer production in eThekwini, South Africa. Primary data included high resolution sequences of hand-object contacts from annotated video and measurement of fecal contamination from urine and surfaces likely to be contacted. A stochastic model incorporated chronological surface contacts, pathogen concentrations in urine, and literature data on transfer efficiencies of pathogens to model pathogen concentrations on hands and risk of infection from hand-to-mouth contacts. The probability of infection was highest from exposure to rotavirus during urine collection (∼10-1) and struvite production (∼10-2), though risks from Shigella spp. during urine collection (∼10-3) and struvite production (∼10-4) were non-negligible. Notably, risk of infection was higher during urine collection than during struvite production due to contact with contaminated urine transport containers. In the scale-up of CBS, disinfection of urine transport containers is expected to reduce pathogen transmission. Exposure data from this study can be used to evaluate the effectiveness of measures to protect sanitation service workers.

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