Abstract
Waterborne viral epidemics are a major threat to public health. Increasing interest in wastewater reclamation highlights the importance of understanding the health risks associated with potential microbial hazards, particularly for reused water in direct contact with humans. This study focused on identifying viral epidemic patterns in municipal wastewater reused for recreational applications based on long-term, spatially explicit global literature data during 2000-2021, and modelled human health risks from multiple exposure pathways using a well-established quantitative microbial risk assessment methodology. Global median viral loads in municipal wastewater ranged from 7.92 × 10(4) to 1.4 × 10(6) GC L(-1) in the following ascending order: human adenovirus (HAdV), norovirus (NoV) GII, enterovirus (EV), NoV GI, rotavirus (RV), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Following secondary or tertiary wastewater treatment, NoV GI, NoV GII, EV, and RV showed a relatively higher and more stable log reduction value with medians all above 0.8 (84%), whereas SARS-CoV-2 and HAdV showed a relatively lower reduction, with medians ranging from 0.33 (53%) to 0.55 (72%). A subsequent disinfection process effectively enhanced viral removal to over 0.89-log (87%). The predicted event probability of virus-related gastrointestinal illness and acute febrile respiratory illnesses in reclaimed recreational water exceeded the World Health Organization recommended recreational risk benchmark (5% and 1.9%, respectively). Overall, our results provided insights on health risks associated with reusing wastewater for recreational purposes and highlighted the need for establishing a regulatory framework ensuring the safety management of reclaimed waters.