International journal of hygiene and environmental health最新文献

{"title":"Comment on Petzke et al. (2026): International Journal of Hygiene and Environmental Health 273 (2026) 114764","authors":"Giorgio Cinciripini","doi":"10.1016/j.ijheh.2026.114801","DOIUrl":"10.1016/j.ijheh.2026.114801","url":null,"abstract":"","PeriodicalId":13994,"journal":{"name":"International journal of hygiene and environmental health","volume":"276 ","pages":"Article 114801"},"PeriodicalIF":4.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148159645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between air temperature and COVID-19 emergency department visits in Ontario, Canada: A population-based case-crossover study","authors":"Nicholas Grubic,&nbsp;Erjia Ge,&nbsp;Zhou Zang,&nbsp;Eric Lavigne,&nbsp;Michael A. Campitelli,&nbsp;Haley Golding,&nbsp;Tariq Cisse,&nbsp;Maria Koh,&nbsp;Brice Batomen,&nbsp;Jane Liu,&nbsp;Xiaolin Wei","doi":"10.1016/j.ijheh.2026.114856","DOIUrl":"10.1016/j.ijheh.2026.114856","url":null,"abstract":"<div><h3>Background</h3><div>The impact of air temperature on COVID-19-related health outcomes, particularly in the context of extreme weather, remains underexplored.</div></div><div><h3>Methods</h3><div>This time-stratified case-crossover study included 200,679 laboratory-confirmed COVID-19 emergency department (ED) visits in Ontario, Canada, from 2020 to 2023. Conditional logistic regression with distributed lag nonlinear models was used to assess the association of mean daily temperature with COVID-19 ED visits. Cumulative 0-5-day lag associations of cold and heat exposure were presented as odds ratios (ORs) with 95% confidence intervals (CIs) at the 1st and 99th percentiles of the temperature distribution, referenced to the minimum risk temperature (MRT).</div></div><div><h3>Results</h3><div>A non-linear, W-shaped relationship was observed between temperature and COVID-19 ED visits, with associations in extreme to very cold (−35.7°C to −21.6°C), cold (−14.1°C to −10.3°C), lightly cold to moderate (−10.2°C to 21.6°C), and warm to very hot (21.7°C to 29.2°C) temperature ranges (MRT: −17.2°C). Notably, heat exposure (24.6°C) showed stronger associations (OR: 1.53, 95% CI: 1.40-1.67) than cold exposure (−17.6°C, OR: 1.00, 95% CI: 0.996-1.005). Risk patterns varied across viral variants, with cold exposure associated with increased ED visits for Omicron and Wild variants, while heat exposure was linked to increased visits for Alpha, Delta, and Gamma variants. Associations were more pronounced for females, individuals aged &lt;65 years, and those with a primary COVID-19 diagnosis.</div></div><div><h3>Conclusion</h3><div>Short-term exposure to non-optimal temperatures significantly increases COVID-19-related emergency healthcare demand, with variant- and demographic-specific differences. Temperature-responsive public health strategies are needed to reduce the burden of COVID-19 and other infectious diseases as climate extremes intensify.</div></div>","PeriodicalId":13994,"journal":{"name":"International journal of hygiene and environmental health","volume":"276 ","pages":"Article 114856"},"PeriodicalIF":4.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148407541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Childhood exposure to traffic-related air pollution and lung function at age 10 years: evidence of nutritional modification in a birth cohort","authors":"Yujin Park,&nbsp;Dong-Wook Lee,&nbsp;Choong Ho Shin,&nbsp;Young Ah Lee,&nbsp;Yun Jeong Lee,&nbsp;Dong In Suh,&nbsp;Yun-Chul Hong,&nbsp;Youn-Hee Lim,&nbsp;Bung-Nyun Kim,&nbsp;Johanna Inhyang Kim,&nbsp;Soontae Kim,&nbsp;Kyoung-Nam Kim","doi":"10.1016/j.ijheh.2026.114853","DOIUrl":"10.1016/j.ijheh.2026.114853","url":null,"abstract":"<div><h3>Background</h3><div>Exposure to traffic-related air pollution has been associated with impaired lung function in children, yet heterogeneity in susceptibility related to nutritional status remains poorly understood.</div></div><div><h3>Methods</h3><div>We analyzed data from a Korean birth cohort with lung function measured at age 10 years. Dietary nutrient intakes were assessed at ages 6 and 8 years using food frequency questionnaires. We applied a three-step analytical framework consisting of elastic net regression to screen nutrient–NO₂ interactions, LightGBM with SHAP values to explore nonlinear patterns, and conventional linear regression models for confirmation.</div></div><div><h3>Results</h3><div>Childhood exposure to nitrogen dioxide (NO₂) was associated with lower forced expiratory volume in 1 s (FEV₁) (β = −0.07, 95% confidence interval [CI]: −0.14, −0.003) and a lower FEV₁/forced vital capacity (FVC) ratio (β = −1.70, 95% CI: −3.31, −0.09). Elastic net screening identified 4 of 33 fatty acid–related nutrients and 2 of 8 B-vitamin–related nutrients with stable interaction signals (selection frequency ≥0.60). In LightGBM–SHAP analyses, contributions of the selected nutrients to lung function varied nonlinearly across intake ranges, showing threshold, plateau, or U-shaped patterns. Only a small subset of interactions, involving eicosadienoic acid and capric acid, remained statistically significant in conventional linear regression models (p-interaction &lt;0.05).</div></div><div><h3>Conclusions</h3><div>Childhood NO₂ exposure was associated with lower lung function at age 10 years. Nutritional status may modify this association in heterogeneous and nonlinear ways, highlighting the value of integrative analytical approaches combining machine learning and conventional epidemiological models to characterize individual susceptibility to environmental exposures.</div></div>","PeriodicalId":13994,"journal":{"name":"International journal of hygiene and environmental health","volume":"276 ","pages":"Article 114853"},"PeriodicalIF":4.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Public health risks from potable water supply disruptions during drought in high-income countries: A scoping review and policy implications for the United Kingdom","authors":"Daniel Mark Blake,&nbsp;Joanna Orr,&nbsp;Kirsty Morrison,&nbsp;Anh Tran,&nbsp;Paul Christopher Coleman,&nbsp;Grace Anne Turner,&nbsp;Lauren Hands,&nbsp;Katya Brooks","doi":"10.1016/j.ijheh.2026.114859","DOIUrl":"10.1016/j.ijheh.2026.114859","url":null,"abstract":"<div><h3>Background</h3><div>Climate change is increasing drought frequency and severity, posing risks to potable water supply and public health including in high-income countries. Evidence on these risks remains fragmented, limiting preparedness and policy development.</div></div><div><h3>Objectives</h3><div>This scoping review synthesises international evidence on health impacts of potable water supply disruptions during drought in high-income countries, with attention to population groups who are most exposed, and with a view to informing policy and practice in the United Kingdom.</div></div><div><h3>Methods</h3><div>Following PRISMA-ScR guidelines, seven databases were searched for English-language studies (1963–2024) addressing health outcomes linked to drought-related potable water disruption in high-income countries. Eligible designs included observational and experimental studies. Data were narratively synthesised and presented by topic theme and direction of health outcome.</div></div><div><h3>Results</h3><div>Of 19,105 citations screened, 33 studies met inclusion criteria. Most evidence originated from Australia, the USA, and Europe. Drought was associated with deterioration in water quality, notably elevated concentrations of arsenic, manganese, and nickel; and occasional bacterial contamination, particularly in private water supplies. Reported health outcomes included gastrointestinal illness, exacerbation of chronic conditions, and mixed evidence for cardiovascular risk. Mental health impacts, such as distress, anxiety, and reduced wellbeing, were consistently observed, especially among rural and farming populations and men. Risk was heightened for households reliant on private water supplies and socioeconomically disadvantaged groups.</div></div><div><h3>Conclusions</h3><div>Potable water supply disruptions during drought represent an under-recognised public health hazard in high-income countries. Strengthening surveillance, infrastructure resilience, and cross-sector preparedness is critical as droughts intensify under climate change. Future research should standardise exposure definitions, quantify health impacts, and evaluate mitigation and adaptation strategies.</div></div>","PeriodicalId":13994,"journal":{"name":"International journal of hygiene and environmental health","volume":"276 ","pages":"Article 114859"},"PeriodicalIF":4.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148457949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing PFAS biomonitoring with a validated high-throughput suspect screening workflow in a longitudinal birth cohort","authors":"Anne San Román,&nbsp;Mikel Musatadi,&nbsp;Juan F. Ayala-Cabrera,&nbsp;Belen González-Gaya,&nbsp;Amaia Irizar,&nbsp;Eunate Abilleira,&nbsp;Nestor Etxebarria","doi":"10.1016/j.ijheh.2026.114855","DOIUrl":"10.1016/j.ijheh.2026.114855","url":null,"abstract":"<div><div>Per- and polyfluoroalkyl substances (PFAS) are synthetic chemicals of increasing global concern due to their environmental persistence, bioaccumulation, and associated health risks. Advances in high-resolution mass spectrometry and suspect/non-target screening (SNTS) have expanded PFAS detection, enabling a deeper understanding of this chemical group. In this study, a PFAS-specific workflow was developed and validated to identify exposome-related PFAS in human plasma from a cohort of children. Limits of identification (LOIs) and true positive rates (TPRs) were evaluated using standards and plasma spiked with 42 PFAS. LOIs of 1–5 ng/mL were achieved for 14% of compounds, 67% ranged from 5 to 10 ng/mL, and 19% were above 20 ng/mL. TPRs were 0.86 for standards and 0.76 for fortified plasma. Forty-five PFAS were annotated at confidence levels 2a–4 in 615 plasma samples from children aged 4, 8, and 14 years in two Basque Country regions (Urola and Goierri). Twenty PFAS families were detected, with sulfonate esters, benzyl halides, amides, esters, and ketones being most frequent. PFAS profiles varied by age, sex, and region. At age 4, girls had more short-chain PFAS and boys had more long-chain ones. By ages 8 and 14, both sexes showed increased short-chain PFAS, particularly in Urola.</div></div>","PeriodicalId":13994,"journal":{"name":"International journal of hygiene and environmental health","volume":"276 ","pages":"Article 114855"},"PeriodicalIF":4.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148341754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unravelling determinants of symptoms associated with environmental factors over time: Results from a representative sample","authors":"Tara Petzke,&nbsp;Ferenc Köteles,&nbsp;Renáta Szemerszky,&nbsp;Ralph C.A. Rippe,&nbsp;Michael Witthöft,&nbsp;Cédric Lemogne,&nbsp;Steven Nordin,&nbsp;Victor Pitron","doi":"10.1016/j.ijheh.2026.114864","DOIUrl":"10.1016/j.ijheh.2026.114864","url":null,"abstract":"<div><div>Symptoms associated with environmental factors (SAEF) are associated with behavioral and emotional reactions towards environmental factors, modern health worries, botheredness with these factors, and heightened somatic symptom burden. While all these constructs play a part in SAEF, it is unclear how they relate to each other over time. The aim of this study was to unravel determinants of SAEF and compare them with those observed in healthy individuals. We used a longitudinal population-based Swedish dataset with three timepoints (<em>N</em> = 1576), in which we conducted lag-2 cross-lagged panel models. Modern health worries (MHWS) and negative behavioral and emotional reactions towards the environment predicted botheredness with environmental factors from Time 1 to Time 2 (from MHWS: <span><math><mrow><mi>β</mi></mrow></math></span> = 0.05, 95% CI = [0.01; 0.10], <em>p</em> = .02; from reactions: <span><math><mrow><mi>β</mi></mrow></math></span> = 0.14, 95% CI = [0.10; 0.19], <em>p</em> &lt; .001) and vice versa (to MHWS: <span><math><mrow><mi>β</mi></mrow></math></span> = 0.07, 95% CI = [0.02; 0.13], <em>p</em> = .009; to reactions: <span><math><mrow><mi>β</mi></mrow></math></span> = 0.14, 95% CI = [0.10; 0.19], <em>p</em> &lt; .001). Physical symptoms were predicted by botheredness with environmental factors and modern health worries at Time 2, but at Time 3 physical symptoms were no longer predicted by any of the other constructs. When testing the model on individuals with SAEF vs. healthy individuals, we found that the paths are mostly equally strong in both groups (<span><math><mrow><msup><mi>χ</mi><mn>2</mn></msup></mrow></math></span> difference = 37.42, df = 27, <span><math><mrow><mi>p</mi></mrow></math></span> = 0.087), but that the clusters differed in their levels of the variables (<span><math><mrow><msup><mi>χ</mi><mn>2</mn></msup></mrow></math></span> difference = 569.52, df = 9, <span><math><mrow><mi>p</mi></mrow></math></span> &lt;0.001). In conclusion, this study suggests that cognitive, emotional and behavioral features of SAEF are mutually dependent, and participate in a vicious circle that perpetuate symptoms, which speaks in favor of nocebo effects contributing to SAEF and opens avenues for treatment.</div></div>","PeriodicalId":13994,"journal":{"name":"International journal of hygiene and environmental health","volume":"276 ","pages":"Article 114864"},"PeriodicalIF":4.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exposure, risk, and potential sources of phthalates, alternative plasticizers, and phenolic compounds in Thai children: A two-region comparison study","authors":"Ah-Reum Jo,&nbsp;Pussadee Laor,&nbsp;Joeun Jung,&nbsp;Na-Youn Park,&nbsp;Subeen Park,&nbsp;Wissanupong Kliengchuay,&nbsp;Sarima Niampradit,&nbsp;Hyunwoong Park,&nbsp;Gowoon Lee,&nbsp;Inae Lee,&nbsp;Adrian Covaci,&nbsp;Younglim Kho,&nbsp;Kraichat Tantrakarnapa,&nbsp;Kyungho Choi","doi":"10.1016/j.ijheh.2026.114861","DOIUrl":"10.1016/j.ijheh.2026.114861","url":null,"abstract":"<div><div>Phthalates and phenolic compounds are ubiquitous consumer chemicals, and children are particularly vulnerable to their potential health effects. In Thailand, however, information on children's exposure and regional variation remains limited. We recruited 250 children from two distinct regions of Thailand (Suphan Buri and Chiang Rai) in 2023, measured urinary concentrations of major metabolites of phthalates and alternative plasticizers as well as parent phenolic compounds, and administered questionnaires. The highest median concentrations were observed for the sum of di(2-ethylhexyl) phthalate metabolites (∑DEHP, 73.2 ng/mL), followed by mono-n-butyl phthalate (MnBP, 72.2 ng/mL) and the sum of diisononyl phthalate metabolites (∑DiNP, 22.6 ng/mL). These levels were 1.4–3.4 times higher than those in German children (GerES V, 2014–2017) and 2.5–5.7 times higher than those in U.S. children (NHANES, 2017–2018). Significant regional differences were identified, with 16 of 26 metabolites showing higher concentrations in Chiang Rai children. These included metabolites of diisobutyl phthalate (DiBP), di-n-butyl phthalate (DnBP), DEHP, DiNP, and di(2-ethylhexyl) terephthalate (DEHTP) as well as benzophenone-3 and bisphenol S. Notably, DiNP metabolite levels in Chiang Rai were 1.9–2.6-fold higher than the highest levels reported elsewhere. Risk assessment showed 69.3% of children in Chiang Rai and 16.4% in Suphan Buri exceeded a cumulative hazard index of 1. Regardless of region, DnBP, DEHP, DiBP, and di(2-ethylhexyl) adipate (DEHA) were the primary contributors to risk. Sauce consumption and medication use were associated with higher phthalate levels. These findings highlight the need to develop targeted exposure-reduction strategies and regulatory interventions for Thai children.</div></div>","PeriodicalId":13994,"journal":{"name":"International journal of hygiene and environmental health","volume":"276 ","pages":"Article 114861"},"PeriodicalIF":4.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148451069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recording and monitoring deaths during heatwaves: a scoping review of mortality attribution and surveillance systems","authors":"Temesgen Yihunie Akalu,&nbsp;Matthew Anthony Borg,&nbsp;Yohannes Tefera Damtew,&nbsp;Susan L. Heatley,&nbsp;Matt Beaty,&nbsp;Vanessa Prescott,&nbsp;Peng Bi","doi":"10.1016/j.ijheh.2026.114858","DOIUrl":"10.1016/j.ijheh.2026.114858","url":null,"abstract":"<div><h3>Background</h3><div>Heatwaves are a significant public health concern linked to substantial excess mortality worldwide. Most deaths during heatwaves arise from the exacerbation of underlying chronic conditions rather than direct heat-related causes, making individual attribution challenging. Improving how heatwave-associated deaths are recorded and monitored is essential for enhancing data quality, comparability, and public health response.</div></div><div><h3>Objective</h3><div>To map and synthesise global practices for recording and monitoring heatwave-related mortality, including attribution methods, ICD coding, and integration of real-time surveillance.</div></div><div><h3>Methods</h3><div>A scoping review was conducted following Joanna Briggs Institute methodology and the Population–Concept–Context framework. Searches were performed in PubMed, Scopus, CINAHL, Embase, and Web of Science from inception. Two reviewers independently screened and extracted data on mortality attribution, ICD coding, recording systems, managing agencies, surveillance approaches, heatwave definitions, limitations, and recommendations. Findings were synthesized using tables, figures, conceptual maps, and narrative summaries. The protocol was registered in the Open Science Framework (OSF) <span><span>https://doi.org/10.17605/OSF.IO/5AX4T</span><svg><path></path></svg></span>.</div></div><div><h3>Results</h3><div>A total of 176 studies from 41 countries were included. Only 8.5% of the included studies used heat-specific ICD codes to identify direct heat-related death; real-time mortality monitoring systems were limited, fragmented, and inconsistent across jurisdictions.</div></div><div><h3>Conclusions</h3><div>Heatwave-associated deaths are rarely coded as direct heat-related, reflecting the indirect and multifactorial pathways linking heat to mortality. Significant gaps in global mortality recording and surveillance systems highlight the need for improved attribution practices, standardised coding, integrated systems, and stronger institutional coordination to support public health preparedness in a warming climate.</div></div>","PeriodicalId":13994,"journal":{"name":"International journal of hygiene and environmental health","volume":"276 ","pages":"Article 114858"},"PeriodicalIF":4.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148440347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrohypersensitivity beyond controversies","authors":"Tara Petzke,&nbsp;Ferenc Köteles,&nbsp;Renáta Szemerszky,&nbsp;Steven Nordin,&nbsp;Michael Witthöft,&nbsp;Cédric Lemogne,&nbsp;Omer Van den Bergh,&nbsp;Victor Pitron","doi":"10.1016/j.ijheh.2026.114817","DOIUrl":"10.1016/j.ijheh.2026.114817","url":null,"abstract":"","PeriodicalId":13994,"journal":{"name":"International journal of hygiene and environmental health","volume":"276 ","pages":"Article 114817"},"PeriodicalIF":4.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148059191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative microbial risk assessment and cost-benefit analysis of Legionella contamination in the water system of a large hospital in Southern Italy","authors":"Valentina Spagnuolo,&nbsp;Paolo Trerotoli,&nbsp;Giusy Diella,&nbsp;Fabrizio Fasano,&nbsp;Letizia Lorusso,&nbsp;Antonella Francesca Savino,&nbsp;Francesco Triggiano,&nbsp;Maria Teresa Montagna,&nbsp;Osvalda De Giglio","doi":"10.1016/j.ijheh.2026.114852","DOIUrl":"10.1016/j.ijheh.2026.114852","url":null,"abstract":"<div><div>Water used in healthcare facilities for human consumption can pose a health risk to patients, healthcare workers, and visitors. Directive (EU) 2020/2184, transposed in Italy by Legislative Decree 18/23 promotes a preventive, risk-based approach along the entire water supply chain through the Water Safety Plans (WSPs). Quantitative Microbial Risk Assessment (QMRA), combined with Cost Benefit Analysis (CBA), allows integrated evaluation of health impacts and economic sustainability of control strategies.This study aimed to develop a decision support method to define a hospital water network surveillance strategy in the Apulia region (Italy) by estimating the risk of <em>Legionella</em> infection and the related costs and benefits under different exposure scenarios. All wards were included, comparing two surveillance strategies: total surveillance (SA) of all water endpoints, and reduced surveillance (SRED), with a limited number of sampling points. Using a Bayesian framework and a dose-response model, the probability of infection and the expected number of Legionnaires’ disease cases were estimated for wards with different risk levels. In parallel, CBA evaluated direct costs, including microbiological analyses, point of use filters, and hospitalization days, economic indicators such as Net Benefit (NB), Willingness to Pay (WP), Incremental Cost Effectiveness Ratio (ICER), and Expected Incremental Benefit (EIB). Results showed lower infection probabilities with SA (2.6×10⁻⁵–2.95 × 10⁻⁷) compared to SRED (3.2×10⁻⁵–3.1 × 10⁻⁶), with expected cases of 0.4 vs 1.7. However, SRED was more cost-effective (€276,700 vs €422,900), showing positive NB (€149,959) and EIB (€ 348,787) and negative ICER (−9621.7). Even assuming a WTP of €25,000 per prevented case, surveillance costs exceeded benefits.</div></div>","PeriodicalId":13994,"journal":{"name":"International journal of hygiene and environmental health","volume":"276 ","pages":"Article 114852"},"PeriodicalIF":4.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}