Hepatitis A virus in surface water in South Africa: what are the risks?

The aim of this study was to assess the potential risk of infection constituted by HAV to persons using surface dam and river water for domestic and recreational purposes. It estimates the potential risk using a deterministic exponential risk assessment model with mean values and conservative assumptions. Hepatitis A virus was detected in 17.5% of river and 14.9% of dam water samples tested. The number of indicator organisms in these sources exceeded drinking and recreational water quality guidelines set by the United States Environmental Protection Agency (US EPA), indicating possible health risks to recreational water users. Based on the available data and taking all the assumptions into consideration, the probability of infection (Pinf) to the higher socio-economic population using the river water for recreational purposes was 1.1 x 10(-3) per day and 3.3 x 10(-1) per annum if 100 ml was ingested per day. For recreation in the dam water the Pinf value was 1.2 x 10(-4) per day and 4.2 x 10(-2) per annum. For the lower socio-economic population, risk values for drinking purposes (2 L day(-1)) were ten-fold greater. These surface waters therefore did not conform to the US EPA guidelines of 1 infection per 10,000 consumers per year for drinking water or eight gastrointestinal illnesses per 1,000 bathers per day in environmental waters used for recreational purposes. This is the first risk assessment study addressing the risk of infection by HAV in surface water to different socio-economic populations in South Africa.