Construction of a Dose–Illness Relationship via Modeling Morbidity and Application to Risk Assessment of Wastewater Reuse

Tingting Gao, Rong Chen, Yanzheng Liu, Xiaochang C. Wang, Yuyou Li

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


A disease burden (DB) evaluation for environmental pathogens is generally performed using disability-adjusted life years with the aim of providing a quantitative assessment of the health hazard caused by pathogens. A critical step in the preparation for this evaluation is the estimation of morbidity between exposure and disease occurrence. In this study, the method of a traditional dose–response analysis was first reviewed, and then a combination of the theoretical basis of a “single-hit” and an “infection-illness” model was performed by incorporating two critical factors: the “infective coefficient” and “infection duration.” This allowed a dose–morbidity model to be built for direct use in DB calculations. In addition, human experimental data for typical intestinal pathogens were obtained for model validation, and the results indicated that the model was well fitted and could be further used for morbidity estimation. On this basis, a real case of a water reuse project was selected for model application, and the morbidity as well as the DB caused by intestinal pathogens during water reuse was evaluated. The results show that the DB attributed to Enteroviruses was significant, while that for enteric bacteria was negligible. Therefore, water treatment technology should be further improved to reduce the exposure risk of Enteroviruses. Since road flushing was identified as the major exposure route, human contact with reclaimed water through this pathway should be limited. The methodology proposed for model construction not only makes up for missing data of morbidity during risk evaluation, but is also necessary to quantify the maximum possible DB.

Original languageEnglish
Pages (from-to)1672-1684
Number of pages13
JournalRisk Analysis
Issue number8
Publication statusPublished - 2018 Aug


  • Disease burden
  • enteric pathogen
  • morbidity analysis
  • water reuse


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