Water Fingerprinting for community disease surveillance
: (Alternative Format Thesis)

  • Natalie Sims

Student thesis: Doctoral ThesisPhD


Water fingerprinting is an innovative surveillance tool, that can provide key data on both the environment and human health. It has significant relevance for research in the One Health domain, which is based on the concept that human health is closely entwined with animal and environmental health. In this thesis, wastewater epidemiology (WBE) was explored as a route for assessing many aspects of public health, including infectious disease spread and monitoring use of antimicrobials.

The next section of the thesis explored developing novel analytical methods for WBE, focusing on oxidative stress biomarkers as a biomarker for general public health. Liquid chromatography coupled to mass spectrometry was utilised to explore four endogenous biomarkers of public health in wastewater. Application of the developed method resulted in, for the first time, HNE-MA being successfully observed and quantified within wastewater over a study period of a week (displayed average daily loads per capita of 48.9 ± 4.1 mg//day/1000inh). This highlighted that HNE-MA could be used as a potential oxidative stress biomarker in future urban water fingerprinting studies.

The next two chapters explored the potential for WBE to be utilised for AMR surveillance. A longitudinal study of two urban catchment areas (one city and one small town) for a range of antimicrobials and their metabolites were investigated in this study. In total 17 parent antimicrobials and 8 metabolites were  consistently quantifiable in the wastewater of both catchment areas across the 13-month period. ARGs levels in wastewater were also explored in the city of Bath. Data triangulation was undertaken to explore relationships between antimicrobial agents and corresponding ARGs. Results demonstrated that ermB, sul1 and intI1 observed no statistically significant loads in winter versus summer. In the second part of this study, correction factors were applied to antimicrobials to back calculate consumption at the community level and compared with prescription data. This work has demonstrated the potential for WBE to be used to establish baselines for antimicrobial usage in communities, providing community-wide surveillance and evidence for informing public health interventions.

Finally, this thesis explored the environmental aspect of water fingerprinting, investigating river water sampling for global monitoring campaigns. This study explored use of a new integrated powerless, insitu multi-mode extraction (iMME) sampler, with the aim of maintaining the integrity of a diverse range of >100 CECs via immobilization to polymeric and glass fibre materials, without access to a power supply or cold chain.
Date of Award29 Mar 2023
Original languageEnglish
Awarding Institution
  • University of Bath
SupervisorBarbara Kasprzyk-Hordern (Supervisor), Tom Arnot (Supervisor) & Martyn Standage (Supervisor)

Cite this