Changing climate and socio-economic conditions as part of quantitative microbial risk assessment of surface drinking water sources: a review.

Climate and socio-economic changes are expected to significantly impact waterborne pathogens and associated health risks, yet the full extent of these effects remains unclear. Accurate quantification of these risks is crucial for informing effective interventions and policy decisions. Quantitative microbial risk assessment (QMRA) serves as a valuable tool for estimating the risk of infection caused by microorganisms in drinking water. This study reviews existing QMRA studies and tools in the context of surface water and drinking water provision. Most studies have implemented various steps of the QMRA framework but often without the application of specific QMRA tools. Although several QMRA tools address climatic factors, there are currently no tools that integrate socio-economic factors into their risk assessments. This study proposes an approach for incorporating both climatic and socio-economic factors into QMRA tools. Specifically, we suggest enhancements to the Swedish QMRA tool - an open-source tool that currently does not incorporate climate and socio-economic changes. Our proposed advancements aim to systematically account for future climatic and socio-economic impacts on health risks, providing a more comprehensive microbial risk assessment tool. These recommendations are also applicable to other QMRA tools, offering a pathway for their development and improving the overall assessment of microbial health risks.