This paper applies a semi-quantitative approach to review the diversity, environmental controls, detection methods, human health risks, and mitigation of cyanotoxins in drinking water systems (DWSs). It discusses the environmental factors controlling the occurrence of cyanotoxins, presents the merits and limitations of emerging methods of their detection (qPCR, liquid chromatography–mass spectrometry, and electrochemical biosensors), and outlines the human exposure pathways and health outcomes with identification of high-risk groups and settings. High-risk groups include (1) communities relying on untreated drinking water from unsafe, polluted water sources and (2) low-income countries where cyanotoxins are not routinely monitored in DWSs. The fate and behavior processes are discussed, including removing cyanotoxins in DWSs based on conventional and advanced treatment processes. The available methods for cyanotoxin removal presented in this paper include (1) polymer-based adsorbents, (2) coagulation/flocculation, (3) advanced oxidation processes, (4) ultra- and nanofiltration, and (5) multi-soil layer systems. Future research should address (1) detection and fate in storage and conveyance facilities and at the point of consumption, (2) degradation pathways and toxicity of by-products or metabolites, (3) interactive health effects of cyanotoxins with legacy and emerging contaminants, (4) removal by low-cost treatment techniques (e.g., solar disinfection, boiling, bio-sand filtration, and chlorination), (5) quantitative health risk profiling of high-risk groups, and (6) epidemiological studies to link the prevalence of human health outcomes (e.g., cancer) to cyanotoxins in DWSs.

Emerging organic contaminants (EOCs) of anthropogenic origins are ubiquitous in environmental compartments, including aquatic systems. Thus, EOCs have attracted considerable research and public attention due to their potential human and ecological health risks. However, compared to other aquatic environments such as wastewater systems, comprehensive reviews focussing on the occurrence and human health risks of EOCs in drinking water systems are still lacking. Therefore, to address this knowledge gap, the current review posits that drinking water systems harbour a cocktail of toxic EOCs, which pose public health risks via multiple exposure routes. In the present review, global evidence is examined to track EOCs along the source-pathway-receptor-impact-mitigation (SPRIM) continuum. Evidence shows that, various groups of EOCs, including pharmaceuticals and personal care products, solvents, plasticizers, endocrine disrupting compounds, gasoline additives, per- and polyfluoroalkyl substances (PFAS), food colourants, artificial sweeteners, and musks and fragrances, have been detected in drinking water systems. The anthropogenic sources of EOCs detected in drinking water systems, including wastewater systems and industrial emissions, are summarized. Further, the behaviour and fate of EOCs in the drinking water systems, including removal processes are discussed. Once in drinking water systems, human exposure to EOCs may occur via ingestion of contaminated drinking water and cooked foods, and possibly dermal contact and inhalation. The high-risk environments, and risk factors and behaviours predisposing humans to EOC exposure are discussed. Evidence on the human health risks of the various EOCs and a critique of the data are presented. Notably, besides inferential data, quantitative epidemiological evidence directly relating the occurrence of EOCs in drinking water systems to specific adverse human health outcomes is still scarce. Lastly, future research directions, including the need for quantitative public health risk assessment, and the application of emerging detection tools are discussed.