U.S. military and allied contingency operations are increasingly occurring in locations with limited, unstable or compromised fresh water supplies. Non-potable graywater reuse is currently under assessment as a viable means to increase mission sustainability while significantly reducing the resources, logistics and attack vulnerabilities posed by transport of fresh water. Development of health-based (non-potable) exposure guidelines for the potential microbial components of graywater would provide a logical and consistent human-health basis for water reuse strategies. Such health-based strategies will support not only improved water security for contingency operations, but also sustainable military operations.Dose-response assessment of Vibrio cholerae based on adult human oral exposure data were coupled with operational water exposure scenario parameters common to numerous military activities, and then used to derive health risk-based water concentrations. The microbial risk assessment approach utilized oral human exposure V. cholerae dose studies in open literature. Selected studies focused on gastrointestinal illness associated with experimental infection by specific V. cholerae serogroups most often associated with epidemics and pandemics (O1 and O139). Nonlinear dose-response model analyses estimated V. cholerae effective doses (EDs) aligned with gastrointestinal illness severity categories characterized by diarrheal purge volume. The EDs and water exposure assumptions were used to derive Risk-Based Water Concentrations (CFU/100 mL) for mission-critical illness severity levels over a range of water use activities common to military operations.Human dose-response studies, data and analyses indicate that ingestion exposures at the estimated ED₁ (50 CFU) are unlikely to be associated with diarrheal illness while ingestion exposures at the lower limit (200 CFU) of the estimated ED₁₀ are not expected to result in a level of diarrheal illness associated with degraded individual capability. The current analysis indicates that the estimated ED₂₀ (approximately 1000 CFU) represents initiation of a more advanced stage of diarrheal illness associated with clinical care.

中文翻译：

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霍乱弧菌基于健康的摄入物摄入指南：中水回用应用的技术基础^☆

美国军事和相关的应急行动越来越多地在淡水供应有限，不稳定或受损的地区进行。目前正在评估非饮用水的灰水回用，作为增加任务的可持续性，同时大大减少淡水运输造成的资源，后勤和攻击脆弱性的可行手段。为灰水的潜在微生物成分制定基于健康（非饮用水）的接触准则，将为水回用战略提供合理且一致的人类健康基础。这种基于健康的战略将不仅支持为应急行动改善水安全，而且还将支持可持续的军事行动。霍乱弧菌的剂量反应评估基于成人口腔暴露数据的数据，结合许多军事活动共有的可操作水暴露情景参数，然后用于得出基于健康风险的水浓度。微生物风险评估方法利用公开文献中口服人类霍乱弧菌的剂量研究。选定的研究侧重于与特定霍乱弧菌血清群的实验性感染相关的胃肠道疾病，这些特定的霍乱弧菌血清群最常与流行病和大流行病相关（O1和O139）。非线性剂量反应模型分析估计的霍乱弧菌有效剂量（ED）与胃肠道疾病的严重程度类别一致，其特征为腹泻清除量。EDs和水暴露假设用于得出军事行动常见的一系列用水活动中关键任务疾病严重程度的基于风险的水浓度（CFU / 100 mL）。估计的ED ₁（50 CFU）的摄入暴露不太可能与腹泻疾病相关，而估计的ED _10的下限（200 CFU）的摄入暴露预计不会导致与降级相关的腹泻疾病水平个人能力。当前分析表明，估计的ED ₂₀ （大约1000 CFU）代表了与临床护理有关的腹泻疾病的更晚期阶段的开始。