FORM TITLE - Request for Project Funding Management of Burkholderia pseudomallei

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1 Working title: Management of (B.ps) Problem statement: (B.ps) is a commonly occurring pathogen in Northern Australia that may exist in water sources and water treatment plants requiring a management approach that is not yet well defined. Background/ Description: (B.ps) is a bacterium that occurs in tropical soil, surface and groundwater. It is a causative agent of the human and animal disease melioidosis, with mortality rates up to 40% 1. While melioidosis is endemic in northern Australia and south-east Asia, a recent study suggested it is widely underdiagnosed with an estimated annual 89,000 deaths worldwide 2,3. Climate change was suggested to increase melioidosis incidence not only due to an increase of temperature and suitable habitat for B.ps but also due to more or more severe storm activity and rainfall in some endemic areas4. The bacteria can be transmitted through skin inoculation, ingestion but also aerosolisation. Contamination of drinking water sources and treatment plants has been demonstrated in Northern Australia 5,6. B.ps has also been recovered from a third of tested residential unchlorinated water bores in the Darwin region 7. B.ps presents a significant risk to drinking water management and treatment systems in these regions and the Water Corporation of Western Australia has deemed all localities in their northern Australian region as at risk from B.ps. The potential risk is pertinent to both operators and consumers. In a melioidosis outbreak in a remote community in Western Australia causing three deaths, the source of contamination was traced to the aeration structures in privately owned and operated WTP, servicing a small indigenous community. Aeration has traditionally been used to cost-effectively facilitate oxidation of dissolved metals (E.g. Fe +2, Mn +2 ), remove dissolved gases (E.g. CO2 ph correction) and liberate temperature from groundwater sources. However, it appears these aeration structures provide niche habitats for biofilm/pathogen growth, including growth and persistence of B.ps and Legionella (SG1, SG2-14 and spp). In response, where possible aeration structures in these regions have been either removed or replaced by chemical dosing systems to adjust ph to a range that inhibits B.ps. Known engineering alternatives to conventional aeration systems are membrane diffusion and chemical addition. Both technologies can be complex and costly to operate and maintain in all contexts. Significantly, recent work by Power and Water Corporation in the Northern Territory has identified B.ps in areas other than aeration in WTPs. A conventional coagulation, sedimentation and granular media filtration WTP appears to have been colonised with B.ps and in another a disinfection treatment tank. The conventional WTP positive samples have been collected from the media filter, backwash water, biofilm collecting on clarifier launders and other areas. Repeated recovery of B.ps from these samples suggests they are actively growing in these environments. Based upon the above findings, it is difficult to simply engineer away such areas of a conventional water treatment plant that treats for other pathogens. A balanced approach is required that reduces the B.ps risks while allowing the continuing operation of a WTP capable of removing cryptosporidium hazards. In addition, numerous strains of B.ps have been identified in northern Australia and their virulence differs. The effectiveness of chlorination in inactivating B.ps bacteria has been found to be strain specific and also depends on other contaminants present in the water such as amoeba 9. Most literature to date, and existing operational practice, has been derived from laboratory studies of chlorine contact time performed in the absence of other contaminants and on strains of B.ps collected outside the Northern Territory. This raises doubt about the applicability of existing literature to regional conditions. The water authorities in these regions therefore have a pressing need to develop optimum systems and procedures to monitor and manage B.ps. 1 Page

2 Objectives: The objectives of this project are to: Research the ecology of B ps to inform the Management Tool Identify parameters needed to inform risk assessment and then conduct health risk assessments Develop a Management Tool for water utilities that allows them to design and manage all aspects of water supply treatment system in areas prone to B ps occurrence Develop communication strategies Alignment with strategy: ADWG Primary deliverable: Phased, concurrent approach is considered for the project that allows the development of an interim management guidance document to proceed based on current knowledge while a foundation research project is scoped, funded and delivered. Phase 1. This phase of work would comprise: 1. Develop interim draft Management guidelines based on current knowledge 2. Use existing literature to develop a research program for phase 2 ie B ps. ecology Phase 2. This phase would provide the in-depth information to inform stakeholders on the management of B ps. and other pathogens. 1. Understand the ecology of B ps and other pathogens a. Natural environment b. Engineered environment c. Improved detection tools and sampling strategies d. Biofilm ecology 2. Measure disinfection efficiency (chlorine etc) under a range of physicochemical conditions typical for hotspot regions ie turbidity, iron/manganese 3. Health risk assessment 4. Communication strategies, including the update of the interim Management Guidance document Refer to the Table below for the Detailed Research requirements for Phases 1 and 2. Investigative or Research approach Phase 1 UNSW and Charles Darwin University researchers have expressed interest in completing this phase and have relevant knowledge of topic. Phase 2 - The purpose of the Phase 2 work is to research in depth the ecology of B ps and other identified pathogens to inform the Management Tool. This information, along with further exposure and occurrence research, will be utilised within a Health risk assessment and inform the Communication strategies. The tasks outlined in Phase 2 continue on with much of the ongoing melioidosis research worldwide over the last 10 years. The detailed scope of the research in this Phase will be informed by the research to be conducted in Phase 1. The intention is to complete this phase of the project as part of an ARC Linkage project, led by Charles Darwin University. As well as water utilities, CDU will be seeking partners in this project able to assist with provide research expertise in the different aspects described below, as well as health departments in the 2 Page

3 impacted zones. Communication plan: Aside from the deliverables identified previously, during the execution of the project the following sectors will need to be kept informed of the project as it may impact guidance or documents they are responsible for: Regulators/NHMRC ADWG may require update to include further information regarding B ps; health regulators in effected regions will need to be kept informed of work Customers if research provides any compelling evidence for early messaging of risk otherwise customers and communities will receive appropriate messaging developed by the project Utilities utilities or local councils in potentially affected areas may wish to receive project outputs Other deliverables: Knowledge transfer activities in remote locations, identified as a stakeholder. Budget may need to be considered for cost of travel and training for delivery of project findings Approx $10-20k Knowledge Transfer plan: Project initiation - stakeholder input, identify national stakeholders Project execution engagement with identified stakeholders, review of project progress, development of KT deliverables, Project deliverables shared within the WaterRA network and with key stakeholders. Consider inclusion of budget for travel into remote locations to share findings. Post-project assessment to determine the benefit of this work Interested Stakeholders: State Health / Env Regulators ARC-LP Water utilities and local councils in impacted areas Indicative Funding required: Phase 1 Indicative range approximately $50-75k cash (plus mgt fee), depending on participant in-kind contributions Phase 2 The intent is to pursue ARC Linkage Project funding with the cash contribution to be determined as ARC Linkage proposal is developed. Intention to provide cash and/or in-kind contributions is currently sought from interested stakeholders. Duration: The project duration is expected to be 6-12 month for the phase 1 research component with an additional year for report completion and communication activities. Phase 2 - three years including formal updates and reporting/writing. Intellectual Property: Project IP to be defined What are the anticipated benefits? Utility Benefits Productivity Service Delivery Risk Management Productivity Efficient design, operation and maintenance of treatment systems Risk Management provide the means to effectively manage the risk of B ps (potentially other pathogens of concern E.g. Legionella?) in source and treatment facility Productivity 3 Page

4 Research Partner Benefits Increases exposure Publication outputs Capacity Building Benefits How will this result in practice change, organisational learning or improvements for society What will success look like (KPIs)? Risk Management manage the risk to operators with the risk of exposure Service Delivery ensure that treatment plants continue to operate to maintain service Uptake Foundation research into B ps ecology with opportunity for publishing Organisational learning improved procedures for operators Regulations update to current regulations on B ps management Improvements for society policy and information for the management of systems in B ps affected areas Student potential for research to be completed by industry supported student Efficient management of systems in B ps affected areas Service delivery is maintained Systems audited show compliance with management tool Risk management within utilities accepted and in keeping with established Framework and policies systems?? Community understanding will increase Decrease in melioidosis?? Indicative Funding Name:... Date:. FOR CASH FUNDING AMOUNT OF $... FOR INKIND FUNDING AMOUNT OF $... FOR FINANCIAL YEAR/S 4 Page

5 Detailed Research requirements for Phases 1 and 2 Phase 1 Task Description Why Interim Burkholderia Management Guidelines Literature Review Develop a draft Management Guidelines that covers the following aspects: Design Design specifications, which are based on a review of existing practices and assessment of that which meet environmental conditions associated with B ps and other pathogens of concern. The guidance for the design should be based on an initial assessment of raw water quality and required LRV, combined with an assessment on environmental conditions and temperature Operation Operational aspects to manage Bps should include control, disinfection (see below), training, monitoring, standards, quality acceptance procedures and data management Develop CCP for B ps and other relevant pathogens Maintenance Maintenance aspects to ensure operational performance is met should include maintenance procedures and frequency, Work Health Safety (WHS) requirements for maintenance practices Development of CCP dashboard (Phase 2) Communication o WHS communication specific to managing the WHS risk for operators and managers o Community messaging increase awareness of the risk and incident management Conduct a literature review of current ecological knowledge, which will inform the scope of work required within Phase 2. Water utilities require a documented management approach for B ps. The management approach is the basis of a risk assessment to ensure that the risks associated with B ps are managed. The draft management tool may be completed with the initial work that has been undertaken by utilities and researchers. Gaps in the Guidelines will inform the focus of further research, particularly where reasonable assumptions cannot be made. It is recognised that there has already been a reasonable amount of research into the ecology of B ps and legionella within the natural environment. The review should inform water utilities on the occurrence in drinking water aquifers and surface waters. Phase 2 Task Name Description Why Ecology within Identify what biotic and abiotic factors support Utilities need to understand what the the natural the growth of B ps and associated microbes in conditions which increase the probability of 5 Page

6 environment catchment, source water and ground water B ps in the natural environment which may lead to its presence in a WTP. This will inform the risk assessment applied to a WTP. Ecology within the engineered environment Biofilm ecology Identify what biotic and abiotic factors support the growth of B ps and associated microbes, and biofilm in engineered systems Identify conditions that support the presence or movement of B.ps within engineered environments Detailed assessment of biofilm ecology including their relationship with B ps growth and survival Current understanding of these organisms is not sufficient to specify the design requirements that either limit or prevent the occurrence of the organisms within engineered systems. This research would inform what the risk of exposure is to operators, identify opportunities to reduce the risk within the design and inform monitoring regimes, which increase the confidence that the system is being appropriately managed. Outputs of this will inform the Management Tool. B ps may or might exist within a biofilm which influences its detection and existence. Knowledge is required to understand the extent to which B. ps forms biofilm to inform detection/sampling techniques and management tools. Knowledge is required to determine the potential and actual relevance and importance of biofilm to inform whether eradication is required. Identify which WQ parameters promote biofilm growth and potential, and related factors (both temporal and spatial) which lead to B ps persistence in biofilms, Detection and Sampling Disinfection efficacy Improved detection tools and sampling strategies for B ps and other pathogens or surrogates. Identification of an online surrogate for B ps Identification of B.ps in water and or biofilms Identify the processes to appropriately remove or disinfect B ps; consider a range of processes / treatment options including chlorine, ozone, UV and membrane. Consider processes and operations that are more suitable for remote / regional / rural areas ie consider TSS and Fe interactions. Outputs of this will inform the Management Tool Current monitoring, sampling and detection protocols do not adequately provide the necessary data to inform water utilities on Bps risk. Improvements in these protocols should provide; results that inform on the presence and infectivity of B ps, guidance on sampling and testing regime, clarity on test results, data management protocols and their alignment with operations. There is consideration of whether there exists an online surrogate for B ps to assist with online monitoring techniques. Outputs of this will inform the Management Tool. There is currently uncertainty regarding all disinfection processes against B ps. As a means to manage the risks associated with B ps, water utilities require greater understanding of the factors that impact on disinfection and targets to ensure the treated water is safe. 6 Page

7 Health risk assessment Communication deliverables Update Management Tool Apply this to the design guidelines which will provide specifications for new works. Establish LRV credit control point to ensure efficacy Improved health risk assessment of B ps and opportunistic pathogens of concern Consider whether climate change will impact pathogens to increase or decrease the risk Communicate the awareness of the risks associated with B ps to inform and instruct the public, operators, utilities and regulators. Develop incident management protocols in case of B ps being detected Develop WHS guidance documentation to effectively inform operators of the risk and means to avoid it. Develop Factsheet for the public that are prone to B ps occurrence to inform and instruct on ways to reduce the risk Management Tool is updated with all current information from previous Tasks Current health risk assessments are missing key information, such as national distribution in Australia, ecological information to inform on pathogenicity, dose response modelling (ie inhalation vs inoculation, ingestion; host risk factors), methods of dispersal and how B ps risks relate to other opportunistic pathogens of concern. Without this information a highly conservative approach is needed to manage the risks. Climate change may also impact the geographical distribution of B ps or impact abiotic factors that alter any risk assessment. There is limited formal advice to water utilities, public, regulators on B ps. Communication strategies are required to deal with raising awareness in areas prone to B ps, how to respond to B ps being detected and instruct operators on safe work practices. Output will inform Management Tool. 7 Page

8 Proposal to add Value to the Mapping the Future Project Examine the Occurrence of the Melioidosis Bacterium in Remote Water Background is a soil bacterium that causes the severe disease melioidosis in humans and animals. It is endemic in the Top End and inhabits both the soil and aquatic environments. The incidence of melioidosis is increasing with indications that climate change and changing land management practices contribute to its spread. Although we know B. pseudomallei occurs in unchlorinated water bores, we do not know how the bores get contaminated or how widespread B. pseudomallei is in groundwater across the Top End. The Darwin Prospective Melioidosis Study has documented 1043 confirmed melioidosis cases across the Top End of the NT over the last 27 years, with 121 cases being fatal, including several during an outbreak in a remote community in the 1990s which was traced back to the then unchlorinated water supply. Partnerships The Northern Territory Government s new Mapping the Future project provides an opportunity to access water and soil samples from drills and bores from remote communities in northern Australia. We will partner with the Department of Natural Resources and Management Water Resources team through this initiative to test for B. pseudomallei in communities with recorded melioidosis cases and a variety of aquifers and soil types. Our Request We will apply to the Australian Research Council Linkage Project scheme for funds to analyze the occurrence of B. pseudomallei, biofilms and iron bacteria in water supplies in remote communities. Water Resources will provide in-kind support for a research partnership and access to samples for testing. This proposal is also supported by Water Research Australia and we will invite participation from other partner organisations. Significance This project will help us manage this growing risk to water safety and community sustainability in remote and indigenous communities in our region. This research will support local research collaborations to address current knowledge gaps. A shared understanding of the value of water, how to manage the risks, and training opportunities will be essential components of this research. Contacts Karen Gibb, PhD Professor and Director Research Institute for the Environment and Livelihoods Charles Darwin University P: E: karen.gibb@cdu.edu.au W: Mirjam Kaestli, PhD Research Fellow RIEL & Menzies P: E: mirjam.kaestli@cdu.edu.au W: Mark Mayo Project Manager and Senior Researcher Melioidosis Research Group Menzies School of Health Research P: E: mark.mayo@menzies.edu.au W: