Sludge Watch ==> Sewage Sludge, Reclaimed Water, Antibiotic Resistance and Public Health

[Maureen Reilly]

>From Dr Edo McGowan
California
Dialogue pertinent to the Boxer Hearings - Drugs in the Water, Drugs in the 
Sludge


The issue of this communication centers on the advancement of antibiotic 
resistance, its impacts on public health and health care costs, and the role 
that sewage byproducts may play in
the distribution of antibiotic resistance.

We have two major issues related to sewage byproducts and the spread of
antibiotic resistance; one relates to the land application of sewage sludge, 
the
other is the rapidly growing use of reclaimed (recycled) water. Reclaimed 
water
is the presumably cleaned-up effluent from sewage plants and is being
increasingly used for irrigation of park lawns, golf courses, and school 
playing
fields as well as used for irrigation of crops consumed raw.

We have looked at this latter product (reclaimed water) and we note that it
contains pathogens and multi-antibiotic resistant bacteria. Others producing
peer reviewed papers in the scientific literature have also noted that this
reclaimed water contains pathogens and that the lab tests designated by the
regulatory community (state) do not reflect the true loads of pathogens. 
Thus
the conclusions that can be drawn are that the standards are not protecting 
the
public health and that reclaimed water (or sewage sludge) may be the 
mechanisms
that promote the spread of antibiotic resistance. There are two disparate
regulatory systems involved in this. EPA and its Part 503 rules for the
solids-----sewage sludge or what industry called biosolids, but reclaimed 
water
is regulated not by EPA but by the individual states.

>From an old news release, we have this---------


FOR IMMEDIATE RELEASE
Thursday, Jan. 18, 2001

------------“HHS TODAY UNVEILED AN ACTION PLAN, DEVELOPED BY AN
INTERDEPARTMENTAL TASK FORCE, THAT PROVIDES THE UNITED STATES WITH A
COMPREHENSIVE APPROACH TO COMBAT ANTIMICROBIAL RESISTANCE. THE PLAN 
DESIGNATES
PRIORITIES, IDENTIFIES RESPONSIBLE AGENCIES AND CREATES TIMELINES.”

THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC), THE NATIONAL 
INSTITUTES OF
HEALTH (NIH), AND THE FOOD AND DRUG ADMINISTRATION (FDA) LED A TASK FORCE OF 
10
AGENCIES AND DEPARTMENTS THAT INCLUDED THE AGENCY FOR HEALTHCARE RESEARCH 
AND
QUALITY, THE HEALTH CARE FINANCING ADMINISTRATION, AND THE HEALTH RESOURCES 
AND
SERVICES ADMINISTRATION AT HHS, AS WELL AS REPRESENTATIVES FROM THE 
DEPARTMENT
OF AGRICULTURE, THE DEPARTMENT OF DEFENSE, THE DEPARTMENT OF VETERANS 
AFFAIRS,
AND THE ENVIRONMENTAL PROTECTION AGENCY.


Some questions warrant review. What is and has been the response of EPA to 
this?
This question is critical because it has been well established for some time
that in the making of sewage sludge, the process generates antibiotic
resistance. Thus EPA, should logically, have had a very active role in this
above noted action plan. Since this is not a new group (established in 
1999),
there must be some considerable record of the effort and accomplishments of 
EPA
in all this. This record should be brought forward and reviewed.

------“THE TASK FORCE, CREATED IN 1999, DEVELOPED THE PLAN, WHICH PROVIDES 
A
BLUEPRINT FOR SPECIFIC, COORDINATED FEDERAL ACTIONS TO ADDRESS THE EMERGING
THREAT OF ANTIMICROBIAL RESISTANCE.------------“

It would thus be interesting to see an organization chart of functions for 
the
various interacting agencies, especially for EPA because of its controls 
over
sewage sludge (biosolids) and on top of that, the challenge by Dr. Rubin. It 
is
also interesting to look back at some of the statements by Dr. Rubin on
illnesses that were attributed to sewage sludge.

Agendas & Minutes Minutes For January 21, 2003 - Special Meeting on
Biosolids BeforeThe Solano County Board of Supervisors


Dr. Rubin noted he would fully expect for
                              the public to see in the April 2, 2003 
proposed
                              response to the NRC report, a proposed action
                              plan. It is reasonable for the public, when 
they
                              see this laid out for comment, to suggest to 
the
                              EPA that in the interim perhaps the EPA should
                              consider some sort of additional interim
                              requirements. I do not know how the EPA will
                              respond to that, but the public can bring that 
up
                              and send comments into the EPA. The EPA will 
have
                              to deal with that public comment. Dr. Rubin
                              suggested getting some activity going as soon 
as
                              possible for somebody, either EPA, CDC, state
                              health agencies, or local health agencies 
getting
                              out there and seriously beginning to document 
what
                              is happening in communities. I believe that 
the
                              reports we are getting are real, in that 
people
                              feel sick out there. I read 4-5 reports 
everyday,
                              and I have a stack that is almost 2 feet tall. 
The
                              EPA is taking the NRC recommendations very
                              seriously particularly in going back and 
looking
                              and tracking incidents.



Thus as part of this educational effort in microbiology, it would be well to
review the progress and accomplishments of EPA as noted above by Dr Rubin 
and
thus to evaluate its contributions in this area. Since Senator Boxer will be
looking at the impacts of land application of sewer sludge in her 
examinations,
I would suspect that much of this information will have been gathered by her
staff preparatory to that series of inquiries or hearings. Perhaps,
Congresswomen Capps office can obtain this material for further review. Also
since the NAS/NRC 2002 report on land applied sewage sludge admonished EPA 
to
look at antibiotic resistance and off-site movement issues related to land
applied sewage sludge, there should by now be ample data and studies 
gathered by
EPA. Again, these need to be pulled out and again I assume that Boxer’s 
staff
has done much of this by now.

Now, as to the state’s responsibility for review of reclaimed (recycled) 
water.
I would like to discuss obtaining a “member’s request” through 
Legislative
Counsel by Assembly Nava’s office, for the following.

The question to LC might be summed as the following: With respect to 
recycled
water, can the citizens of this state be protected under current operations 
of
the Water Boards and Department of Public Health (DPH)? Is the state 
breaking
its own laws as to enforcement of the Water Codes (WC) and Health and Safety
Codes (H&SC) as discussed below?

The water boards have no capacity to independently ascertain public health
aspects or standards designed for protecting public health. That function 
rests
with DPH. Nonetheless, the Water Boards can trump the DPH if there are no 
TMDLs
and the public health is impaired.  For the most part, however, the water 
boards
merely enforce the standards and criteria. Notwithstanding this disjointed
incremental aspect of presuming to protect public health, statutory 
directives
indicate that public health shall be protected. California Water Code 
Section
13550 (a)(3) states that use of recycled water will not be detrimental to 
public
health. This is echoed in WC 13521, which controls Title 22, the regulatory
language that specifies how recycled water is to be produced and the various 
lab
tests.

Included within the directives to state agencies and districts are the 
following
that tie back to the Water Codes. The Health and Safety Codes note that-----

H&SC 5410 (f)----nuisance means anything which: 1) is injurious to health, 
2)
affects at the same time an entire community or neighborhood or any 
considerable
number of persons, and 3) occurs during, or as a result of, the treatment or
disposal of wastes.

5410 (d)-----contamination means impairment of the quality of the waters of 
the
state by waste to a degree which creates a hazard to the public health 
through
poisoning or the spread of disease. H&SC 5410 indicates contamination means
impairment of the quality of the waters of the state by waste. The waters of 
the
state include any water within the boundary of the state.

As used in this chapter: (a) "Waste" includes sewage and any and all other 
waste
substances, liquid, solid, gaseous, or radioactive, associated with human
habitation, or of human or animal origin, or from any producing, 
manufacturing,
or processing operation of whatever nature.

5411---No person shall discharge sewage or other waste, or the effluent of
treated sewage or other waste, in any manner which will result in 
contamination,
pollution or a nuisance.

Thus, for LC, does the above, when taken together impose a responsibility 
upon
the Water Boards and DPH to assure that recycled water contains no 
materials,
including pathogens and antibiotic resistant genes that can be transferred 
to
man or his animals that could confer antibiotic resistance?

We then bring in antibiotic resistance pathogens as well as genetic material 
as
components of disease, hence falling within the above statutes and their
definitions.

Since Title 22 was put together in 1977, much of the then available science 
did
not and could not consider later scientific findings that have vastly 
changed
the landscape. Thus Title 22 does not consider antibiotic resistance nor
antibiotic resistant genes (ARGs) or virulence islands (VI) which are not
amenable to chlorine disinfection at levels used by the wastewater industry.
These genetic fragments also go through many of the current filter systems. 
This
was confirmed by the work of Amy Pruden (see note 5 infra). Title 22 also 
does
not consider pathogens that are in the viable but non-culturable state 
(VBNC),
hence these are not picked up by tests currently dictated by standards. 
These
VBNC and some of the newly emerging infectious diseases are thus not on the
regulatory radar. Nor for that matter, do the standards consider 
interactions of
heavy metals and pharmaceuticals which may foster the development of 
resistance.

However, several scientific papers from the peer-reviewed literature over 
the
last few decades have questioned the safety of sewage byproduct usage where
there is high public contact . These papers further question the efficacy of 
the
underlying standards controlling that usage . Other papers, such that of the
Water Environment research foundation, the research arm of the wastewater
industry also note these inconsistencies between standards and the reality 
of
disease.

These papers and independent analyses have raised several compelling 
questions
as to the efficacy of the standards to appreciate newly emerging water born
diseases, pathogens and their genetic material. Thus the question must be 
raised
as to whether or not the current standards can in fact protect public 
health.
The more recent readings over the last decade tend to show that the 
standards do
not protect public health .

Recycled water can be used for a variety of uses mainly designed to allow 
for an
offsetting in the use of potable water. While this makes strong economic 
sense,
especially within drought-prone areas, that water must not compromise public
health. At issue thus are thus the inputs to an economic analysis for 
looking at
risk. The U.S. EPA has not entered the picture with respect to recycled or
reclaimed water. EPA has left that subject to the states. EPA does however
regulate the land application of sewer sludge (biosolids), but it is
experiencing increasing difficulty in justifying that use as health impacts 
are
becoming increasingly well known.

There are a variety of definitions relating to what reclaimed or recycled 
water
actually is. The following list of uses to which recycled water may be put
includes: irrigation of public access greenscape such as parks, playing 
fields,
golf courses, and roadway mediums. It may also be used for irrigation of 
food
crops, including those consumed raw. Additionally recycled water may be used 
in
fire fighting, cooling towers, and flushing toilets and urinals within 
public
access restrooms. Further there are myriad industrial uses for this water. 
In
certain areas, this water is injected into aquifers to create a water mound 
and
is thus is used to control seawater intrusion, or to offset overdraft.

The state statutes (California’s Water Code and California’s Health and 
Safety
Code) also allow municipal governments to produce recycled water and to 
force
its use upon the community . That this has happened will be noted through an
analysis of court records. The forced use at the Montecito Country Club for 
its
golf course is a local example. The Club fought this on liability issue in 
court
but lost the case against the City of Santa Barbara. Thus, there seems to be 
a
built-in conflict within the state statutes---the state must protect its
citizens from unreasonable risk of contamination while at the same time 
allowing
cities to force questionable water upon those citizens. There are several
statutory directives that deal with recycled water that were signed into law 
by
prior legislative sessions. Many of these extant laws and their promulgated
regulations predate an adequate understanding of the potential public health
implications of using inadequately disinfected recycled water. A digest of 
these
code sections is beyond the scope of this paper. Nonetheless, these are the
extant directives to those producing such water. Additionally, the 
directives in
state law dictating what knowledge levels are needed to obtain a sewer plant
operator’s license also fail to appreciate this more current information .
Accordingly, those operating sewer plants often fail to appreciate the more
current scientific findings as provided by the literature. This disconnect 
may
thus allow sufficient slippage to adversely impact public health yet remain
within the dictates of the statutory requirements. This then is seen as a 
flaw
in the administration of the public health requirements, nonetheless a 
reality
of the current political and bureaucratic process.

Thus, if an activity of dealing with pathogens and of disease entities is in
fact inherently dangerous, in spite of meeting all requisite 
standards---there
is either something wrong with the standards, or that activity is one that 
can
be classified as ultrahazardous. If ultrahazardous, then presumably strict
liability would come into play. The section WC 13550 (a) (3) may set that
up---use of recycled water will not be detrimental to public health.

With the apparent current level of released antibiotic resistant pathogens, 
the
establishment of environmental niches containing this genetic material would
thus provide avenues for establishment of lending libraries and potentially
movement of resistance into and throughout the environment.



Dr Edo McGowan