Water Emergency Team (WET): Community-Driven Rapid Response Team to Evaluate Antibiotic-Resistant Bacteria Exposures and Household Environmental Health Risks from Sewer Overflows and Basement Flooding

抗生素耐药(AR)细菌感染是一个日益严重的威胁，在美国造成了大约35,000-48,000人。 每年的死亡人数。耐甲氧西林金黄色葡萄球菌(MRSA)和万古霉素- 耐药肠球菌(VRE)被疾控中心认为是严重的威胁。黑人和非裔美国人社区 经历AR细菌的不成比例的高感染率，包括MRSA(ARR，2.78；95%CI， 与白人相比，2.30-3.37)。传统上与医疗保健环境有关，最近的几项研究 确定AR细菌的环境来源，如废水。由于下水道基础设施老化和 气候变化导致的极端降水频率增加，废水有时会溢出到 未经处理的房屋和水体，称为卫生下水道溢流(SSO)。SSO是一种长期的、研究不足的 公共健康威胁，对美国和许多国家的低收入和少数族裔人口造成不成比例的影响 国际城市。AR细菌感染与废水暴露有关，但尚未有研究 已经评估了这些感染来自SSO或由此产生的家庭地下室备份的风险 (“备份”)。应对这些事件造成的AR细菌感染的风险将对 预防疾病和促进健康，这是美国国立卫生研究院的一项优先研究事项，并改善少数民族健康和减少 健康差距，这是美国国立卫生研究院《2021-2025年战略计划》的一个贯穿各领域的主题。我们的初步研究发现 在巴尔的摩受SSO或备份影响的家庭中，30%和20%的家庭表面分别有MRSA和E.Coli， 分别进行了分析。然而，我们的试点研究的一个主要限制是，我们预先计划的抽样天数与 最近的SSO或地下室备份。我们建议建立一个社区主导的水应急小组 (湿)以应对马里兰州巴尔的摩家庭发生的SSO和备份。在巴尔的摩，63%的 居民是黑人或非裔美国人，18.9%生活在贫困中。我们将采用创新的混合方法 方法：1)与社区组织和当地组织合作，开发快速反应湿润环境 领导从SSO和备份收集环境样本；2)分析水和地表水拭子 MRSA和VRE的样本，比较以前的传统技术和新的协议；3)进行 对巴尔的摩居民进行调查和采访，以检查备份对他们身心的影响 健康，以及对地方政府的看法；4)将研究成果转化为创新的宣传材料 赋予社区成员权力并通知当地政府官员。快速响应，缩短时间 样本收集和结果分发之间的关系将使社区成员能够减少污染 并更快地获得应急资源。由此获得的关于公共健康风险的新见解 这项研究可以广泛应用，因为美国每年都会发生≥75,000起SSO。社区驱动的快速反应 暴露评估与社会科学数据相结合可以创建一种有效的方法来降低AR 在服务不足的社区中暴露细菌，面临不成比例的更高感染率。

Antibiotic-resistant (AR) bacterial infections are a growing threat causing approximately 35,000-48,000 U.S. deaths per year. The AR bacteria, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin- resistant Enterococci (VRE) are considered serious threats by CDC. Black and African American communities experience disproportionately higher infection rates from AR bacteria, including MRSA (aRR, 2.78; 95% CI, 2.30–3.37) compared to whites. Traditionally associated with healthcare settings, several recent studies have identified environmental sources of AR bacteria, such as wastewater. Due to aging sewer infrastructure and increasing frequency of extreme precipitation from climate change, wastewater sometimes overflows into homes and waterbodies untreated, called sanitary sewer overflow (SSOs). SSOs are a chronic, under-studied public health threat that disproportionately impact low-income and minority populations in many U.S. and international cities. AR bacterial infections have been linked to wastewater exposures, yet no studies have evaluated the risk of these infections from SSOs nor the resultant household basement backups (“backups”). Addressing the risk of AR bacterial infections from these events will have a major impact on preventing disease and promoting health, an NIH research priority, and improving minority health and reducing health disparities, a crosscutting theme in the NIH-wide 2021-2025 Strategic Plan. Our pilot study detected MRSA and E. coli on 30% and 20% of surfaces in Baltimore homes impacted by SSOs or backups, respectively. Yet, a major limitation to our pilot study was that our pre-planned sampling days did not align with recent SSOs or basement backups. We propose to create a community-driven Water Emergency Team (WET) to respond to SSOs and backups in Baltimore, MD homes as they occur. In Baltimore, 63% of residents are Black or African American and 18.9% live in poverty. We will use innovative mixed method approaches to: 1) Develop a rapid-response WET in collaboration with community organizations and local leaders to collect environmental samples from SSOs and backups; 2) Analyze water and surface swab samples for MRSA and VRE, comparing previous traditional techniques with new protocols; 3) Conduct surveys and interviews with Baltimore residents to examine the impact of backups on their physical and mental health, and perceptions of local government; 4) Translate research findings into innovative outreach materials to empower community members and inform local government officials. Rapid responses and reduced time between sample collection and results distribution will enable community members to mitigate contaminated areas and access emergency resources more quickly. New insights on public health risks achieved from this study can be applied widely, as ≥75,000 SSOs occur yearly across the U.S. Community-driven rapid-response exposure assessments combined with social science data can create an effective approach to reducing AR bacteria exposure in underserved communities facing disproportionately higher infection rates.