Influenza A virus (IAV) causes significant morbidity and mortality in the United States and has pandemic potential. Identifying IAV epidemic patterns is essential to inform the timing of vaccinations and nonpharmaceutical interventions. In a prospective, longitudinal study design, we measured IAV RNA in wastewater settled solids at 163 wastewater treatment plants across 33 states to characterize the 2022-2023 influenza season at the state, health and human services (HHS) regional, and national scales. Influenza season onset, offset, duration, peak, and intensity using IAV RNA in wastewater were compared with those determined using laboratory-confirmed influenza hospitalization rates and outpatient visits for influenza-like illness (ILI). The onset for HHS regions as determined by IAV RNA in wastewater roughly corresponded with those determined using ILI when the annual geometric mean of IAV RNA concentration was used as a baseline (i.e., the threshold that triggers onset), although offsets between the two differed. IAV RNA in wastewater provided early warning of onset, compared to the ILI estimate, when the baseline was set at twice the limit of IAV RNA detection in wastewater. Peak when determined by IAV RNA in wastewater generally preceded peak determined by IAV hospitalization rate by 2 weeks or less. IAV RNA in wastewater settled solids is an IAV-specific indicator that can be used to augment clinical surveillance for seasonal influenza epidemic timing and intensity.

Managing the water-energy-nutrient nexus for the built environment requires, in part, a full system analysis of energy consumption, global warming and eutrophication potentials of municipal water services. As an example, we evaluated the life cycle energy use, greenhouse gas (GHG) emissions and aqueous nutrient releases of the whole anthropogenic municipal water cycle starting from raw water extraction to wastewater treatment and reuse/discharge for five municipal water and wastewater systems. The assessed options included conventional centralized services and four alternative options following the principles of source-separation and water fit-for-purpose. The comparative life cycle assessment identified that centralized drinking water supply coupled with blackwater energy recovery and on-site greywater treatment and reuse was the most energy- and carbon-efficient water service system evaluated, while the conventional (drinking water and sewerage) centralized system ranked as the most energy- and carbon-intensive system. The electricity generated from blackwater and food residuals co-digestion was estimated to offset at least 40% of life cycle energy consumption for water/waste services. The dry composting toilet option demonstrated the lowest life cycle eutrophication potential. The nutrients in wastewater effluent are the dominating contributors for the eutrophication potential for the assessed system configurations. Among the parameters for which variability and sensitivity were evaluated, the carbon intensity of the local electricity grid and the efficiency of electricity production by the co-digestion with the energy recovery process were the most important for determining the relative global warming potential results.

Onsite non-potable reuse (NPR) is being increasingly considered as a viable option to address water scarcity and infrastructure challenges, particularly at the building scale. However, there are a range of possible treatment technologies, source water options, and treatment system sizes, each with its unique costs and benefits. While demonstration projects are proving that these systems can be technologically feasible and protective of public health, little guidance exists for identifying systems that balance public health protection with environmental and economic performance. This study uses quantitative microbial risk assessment, life cycle assessment and life cycle cost analysis to characterize the human health, environmental and economic aspects of onsite NPR systems. Treatment trains for both mixed wastewater and source-separated graywater were modeled using a core biological process—an aerobic membrane bioreactor (AeMBR), an anaerobic membrane bioreactor (AnMBR) or recirculating vertical flow wetland (RVFW)—and additional treatment and disinfection unit processes sufficient to meet current health-based NPR guidelines. Results show that the graywater AeMBR system designed to provide 100% of onsite non-potable demand results in the lowest impacts across most environmental and human health metrics considered but costs more than the mixed-wastewater version due to the need for a separate collection system. The use of multiple metrics also allows for identification of weaknesses in systems that lead to burden shifting. For example, although the RVFW process requires less energy than the AeMBR process, the RVFW system is more environmentally impactful and costly when considering the additional unit processes required to protect human health. Similarly, we show that incorporation of thermal recovery units to reduce hot water energy consumption can offset some environmental impacts but result in increases to others, including cumulative energy demand. Results demonstrate the need for additional data on the pathogen treatment performance of NPR systems to inform NPR health guidance.