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(table 20).  In the population radiating from the control  location, income-
specific illness differences during this colder period were seen only for
gastrointestinal illnesses in the low and high income groups (table 21).

     Because of the additive characteristic of the information statistic,
summation of education-and income-specific illnesses by distance from the
wastewater treatment plant and control  location was performed.  Summations
over the entire study period are presented in tables 22 and 23 for
individuals dwelling within WWTP and control  location concentric rings.
Significant differences in the population surrounding the  WWTP were seen
for all  illness categories except income-specific gastrointestinal illnesses.
On the other hand, income-specific but not education-specific illness
differences were seen in the population surrounding the control  site.

     The summation of income-and education-specific illnesses during the
warmer months for both study groups is presented in table  24 and 25.  Income
and education-specific differences in total illnesses were seen  in
individuals residing in rings   radiating from the WWTP but not  in those
studied with respect to the control site.  Income-specific respiratory
illness occurrences were found to be significantly different only in the
WWTP study group.

     Tables 26 and 27 show the summation of income-and education-specific
illnesses during the colder months in both study groups.  Education-
specific differences in gastrointestinal illnesses were seen in  both the
WWTP and control location groups.  Income-specific differences in respiratory
illness occurrences were only seen in the WWTP group whereas income-specific
gastrointestinal illness occurrence differences were seen  only in the
control  site group.

     For illustrative purposes, the percent differences of the summed
income-and education-specific illnesses observed over the  number expected
by distance from the wastewater treatment plant and control location are
presented in tables 28 and 29.  For both income-and education-specific
illnesses, the number observed in the WWTP study population exceeded those
expected by the greatest amount in the 600m concentric circle during the
warmer months for respiratory and gastrointestinal illnesses.  Respiratory
illnesses exceeded those expected by 20% and 27% whereas gastrointestinal
illnesses exceeded those expected by 78% and 50% when specified  for income
and education, respectively.  Differences of this magnitude were not
observed during the colder months nor during the entire study period.

     Greater than the expected number of illnesses were consistently
observed within the 2400m WWTP concentric ring for all income-and education-
specific illnesses during the warmer and colder months as  well as during  the
entire study period.  Within the control location concentric rings,
greater than expected illness occurrences were most consistently observed at
the 1200m distance.  During both the warmer and colder months, the expected
number of income and education specific illnesses was exceeded in all
categories.  It is noteworthy that, in many cases, the dwelling units in-
cluded in the WWTP 2400m concentric ring were identical to those in the
1200m control ring.

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ILLNESS INCIDENCE IN SCHOOL CHILDREN

     The illness experience of school children who were on report for 50 or
more weeks during 1965-1971 was examined with respect to school location
relative to the wastewater treatment plant or control location.  The
schools were not evenly distributed throughout the study area.  As shown
in table 30, most of the schools were contained in the 1800m or >3000m
concentric circle boundaries, with one school located within 1200m of
the wastewater treatment plant.  Eight of the eleven schools examined
shared the same WWTP and control location concentric ring.  The experience
of children having five or more total illnesses, four or more respiratory
illnesses, or two or more gastrointestinal illnesses is shown in table 31.
Significant differences in total illness experience were observed in the
school children with regard to school attended relative to both the waste-
water treatment plant and control location.  Since schools are not in
session during the summer months, no seasonal analyses were performed.

METEOROLOGY

     The wind direction, velocity, and atmospheric stability greatly
influence the dispersion of wastewater treatment plant airborne emissions
(Kenline,  1968).   Local data on these parameters were not available from
the Tecumseh area for the study years.  Wind velocity and direction
frequency distribution summaries were, however, obtained for the Detroit
Metropolitan Airport, located approximately 60 miles east of Tecumseh
for the years 1969-1973.  Although these data are not inclusive of the
study dates, they do indicate wind trends in the area over a four year
period.  Figure 6 is a wind rose presentation of these data.  Prevailing
winds of the highest velocity are from the west, but there is substantial
fluctuation in both direction and velocity.  Depending upon the atmospheric
stability, wastewater treatment emissions could be dispersed in any
direction.  Meteorological data by individual study period seasons or
years were not obtainable for this study.

TABLE 30.   STUDY AREA SCHOOLS AND LOCATION RELATIVE TO WASTEWATER TREATMENT
           PLANT AND CONTROL LOCATION	

                            Concentric Circle Boundary (m)
School      	WWTP	        Control Location	

Herrick Park             1200                    2400
Patterson                1800                    1200
St. Elizabeth            1800                    1200
Tecumseh Acres           1800                    1800
Tecumseh Nursery         1800                    1800
West Branch              1800                    1800
Macon                   >3000                   >3000
Ridgeway                >3000                   >3000
Sutton                  >3000                   >3000
Tipton                  >3000                   >3000
Stevens Lutheran        >3000                   >3000
                                    47
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                                  SECTION 6

                                 DISCUSSION
     The Tecumseh, Michigan wastewater treatment plant is small  relative to
those which serve larger metropolitan areas.   This plant was selected for
use in this investigation because of its location within a comprehensive
community health study area and because it was not considered to be
uniquely different from activated sludge plants serving comparably sized
communities.  Consequently, the observations  made in this study  should not
be considered unique to Tecumseh but to represent those made with the
participation of a highly cooperative community.

     Attribution of acute illness occurrence  within a population to a single
source, such as wastewater treatment plant aerosol emissions, is a difficult
problem compounded by many factors.   The exposure and potential  for infection
(EPI) probability of a population to the airborne emissions of a wastewater
treatment plant is dependent upon the concentration, survival, and
dispersion of aerosolized infectious organisms.  The concentrations of
potentially infectious organisms in the Tecumseh sewage during the study
period are not available.  Domestic sewage should, however, be assumed
to contain any material excreted by the contributing community which
survives transport to the wastewater treatment facility.  Potentially
pathogenic bacteria and viruses are among the organisms known to occur in
domestic wastewater (Kabler, 1959; Grabow, 1968).  Studies on the
airborne emissions of bacteria from wastewater treatment plants  have been
reviewed by Hickey and Reist (1975), but conclusive studies concerning
viral emissions from these plants have, however, been hampered by
limitations in methodology, although enteric  viruses have reportedly been
recovered from wastewater spray irrigation aerosols (Johnson et  at. 1977;
Teltsch and Katzenelson, 1978).  While the aerosols from the Tecumseh
plant were not characterized as part of this  study, it is reasonable to
assume that this plant does emit aerosols containing potentially
infectious organisms, as has been observed with the other activated
sludge plants studied.

     The significance of exposure to infectious aerosols is related to
the susceptibility, size, and density of the  population.  All persons
exposed will not develop infection and many infected individuals will not
develop disease.  With the enteroviruses, for example, the ratio of
infection to clinical illness is very high.  Such considerations make
it difficult to determine sources of infection and resulting illnesses
when they occur.  Such determinations require examination of a sufficiently
                                     50
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large population with subgroups sharing similar exposure probabilities.
In this study, acute illness occurrences in 4889 people, living at six
different general locations from a wastewater treatment plant and control
location were observed over a seven year period.

    More than  the expected number of persons living closest to the
wastewater treatment plant (within 600m) appeared to experience income-and
education-specific respiratory and gastrointestinal  illnesses during May
through October.  This experience was not found in the control groups nor
in those persons observed in WWTP concentric rings during the entire
study period or from November through April.  As seen in figures 4 and 5,
persons dwelling within 600m of the wastewater treatment plant had both
less education and lower incomes than those dwelling in either the
concentric rings at greater distances from the plant or in those
rings radiating from the control location.  The larger than expected
number of persons developing illnesses nearest the wastewater treatment
plant during the summer may be attributable to reduced levels of sanitation
within a lower socioeconomic group during a period of higher enterovirus
infection incidence.  Melnick et al.  (1954) demonstrated the seasonal
distribution of enteroviruses while Monto and Cavallaro (1971) confirmed
a higher late summer incidence of enteroviral infection in the Tecumseh
study population.

     Higher than expected illness occurrences were made during both seasons
and the entire study period in the least educated and lowest income
population dwelling within the wastewater treatment plant concentric
ring with 2400m boundary.  Since both income and education were
specified in this study, these observations cannot be explained on the
basis of socioeconomic factors.

     The WWTP population dwelling within the 2400m concentric ring
was found to have a consistently greater than expected incidence of all
education-and income-specific illnesses during the entire study period as
well as during the colder and warmer seasons.  Furthermore, the control
concentric ring showing the most consistent greater than expected
illness incidence is at the 1200m distance that partly overlaps the 2400m
WWTP ring.  The reasons for the greater illness incidence within this
group are not readily explainable with available evidence.  As shown in
figures 4 and 5, persons dwelling within the 2400m concentric ring had
both a slightly higher education and income than did comparison control
populations.  There are no known sources of exposure in these areas which
would increase the likelihood of increased acute illness.

     The dispersion of biological emissions from activated sludge treatment
plants has been estimated by various investigators (Kenline, 1968;
Buchan, 1972; and Lighthart and Frisch, 1973).  The models used for
predicting downwind concentrations of these emissions were based upon
Pasquill's model as described by Turner (1967).  The Tecumseh wastewater
treatment plant aerosol emissions may, however, behave differently than
might be predicted with previously employed models based upon the
                                     51
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theoretical diffusion equations.   The plant is located at a lower elevation
than the portions of the study area containing most of the population and
is surrounded on the east, south,  and west by deciduous trees.   Although
the activated sludge units were treated as zero height emission sources in
predictive models, local airflow disturbances as might occur in the
immediate vicinity of trees or other obstacles were not considered.
Pasquill (1962) indicated that present methods of estimating diffusion
are based upon idealized airflow conditions and that these methods
cannot be expected to give reliable information when there are  local
disturbances of this airflow.

     While the four year wind direction and velocity averages from the
Detroit Metropolitan Airport illustrated in figure 6 indicate general area
trends, the dispersion of emissions from the Tecumseh wastewater treatment
plant is probably more affected by local conditions.  Depending upon
wind direction, velocity, and atmospheric stability, surrounding trees
may act as a partial barrier for persons dwelling nearest the plant while
lofting the airflow, resulting in further downwind dispersion.
                                     52
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                            REFERENCES

Buchan, R.M.  Atmospheric Dispersion of Participate Emissions from an
Activated Sludge Unit.  DrPH Dissertation.  Oklahoma City:  The
University of Oklahoma, 1972.

Fannin, K.F., J.J. Gannon, K.W. Cochran, and J.C. Spendlove.  Field
Studies on Coliphages and Coliforms as Indicators of Airborne
Animal Viral Contamination from Wastewater Treatment Facilities.
Water Research 11:181-188, 1977.

Grabow, W.O.K.  The Virology of VJastewater Treatment.  Water Research
2:675-701, 1968.

Rickey, J.L.S. and P.C. Reist.  Health Significance of Airborne
Microorganisms from Wastewater Treatment Processes.  Part I:  Summary
of Investigations.  J. Water Poll. Cont. Fed.  47:2741-2757.

Johnson, D., D.E. Camann, C.A. Sorber, B.P. Sdgik, J. Glennon.  A
Comprehensive Methodology for the Prediction of Pathogenic Levels in
Wastewater Aerosols.  Proceedings of Conference on Risk Assessment
and Health Effects of Land Application of Municipal Wastewater and
Sludges, San Antonio, Texas, 1977.

Kabler, P.  Removal of Pathogenic Microorganisms  by Sewage Treatment
Processes.  Sew.  Ind. Wastes 31:1373-1382, 1959.

Katzenelson, E.,  I. Buium, and H.I. Shuval.  Risk of Communicable
Disease Infection Associated with Wastewater Irrigation in Agricultural
Settlements.  Science 194:944-946, 1976.

Kenline, P.A.  The Emission, Identification, and Fate of Bacteria from
Activated Sludge  and Extended Aeration Sewage Treatment Plants.
PhD Thesis.   Cincinnati:  University of Cincinnati, 1968.

Kullback, S.  Information Theory and Statistics.  New York:  John
Wiley & Sons, 1959, pp. 155-188.

Kullback, S., M. Kuppeman, and H.H. Ku.  Tests for Contingency Tables
and Markov Chains.  Technometrics 4:573-608, 1962.

Ledbetter, J.O.,  L.M. Hauck, and R. Reynolds,   Health Hazards from
Wastewater Treatment Processes.  Environ.  Letters 4:225-232, 1973.
                                53
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Lighthart, B. and A.S.  Frisch.   A Model  to Evaluate the Airborne
Bacterial Concentration from a  Continuous Source.  In Proceedings of
Workshop/Conference II.  Ecological  Systems Approaches to Aerobiology:
II.  Development, Demonstration and Evaluation of Models, 1973.

Melnick, J.L., J. Emmons, J.H.  Coffey and H. Schoof.   Seasonal
Distribution of Coxsackie Viruses in Urban Sewage and Flies.
Am. J.  Hygiene 59:164-184, 1954.

Monto,  A.S., J.A. Napier, and H.L. Metzner.  The Tecumseh Study of
Respiratory Illness.  I.  Plan of Study and Observations on Syndromes
of Acute Respiratory Disease  Am. J. Epidemic!. 94:269-279, 1971.

Monto,  A.S. and J.J. Cavallaro.  The Tecumseh Study of Respiratory
Illness.  II. Patterns of Occurrence of Infection with Respiratory
Pathogens, 1965-1969.   Am. J. Epidemic!.  94:280-289,  1971.

Napier, J.A.  Field Methods and Response Rates in the Tecumseh
Community Health Study.  Am. J. Pub. Health 52:208-216, 1962.

Pasquill, F. Atmospheric Diffusion.   The Dispersion of Windborne
Material from Industrial  and Other Sources.  D. Van Nostrand Co. Ltd.,
London, 1962, p. 179.

Teltsch, B. and E. Katzenelson.  Airborne Enteric Bacteria and Viruses
from Spray Irrigation with Wastewater.  Appl. Environ. Microbiol. 35:
290-296, 1978.

Turner, B.D. Workshop of Atmospheric Dispersion Estimates.  U.S. Dept.
Health, Education and Welfare.   PHS. Nat. Air Poll. Cont. Admin. PHS
Pub. No. 999-AP-26, 1969.
                                  54
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                                  APPENDIX

                            GEOGRAPHICAL STRATA
                      (As described by Napier (1962)a)
Stratum
   1           Area immediately surrounding Tecumseh city - mixed farm and
               non-farm.

   2           Area outside stratum 1,  but in the Tecumseh study area -
               mostly farm.

   3           Northeast  third of city  - nice homes area (i.e.  more
               expensive  houses)

   4           Southeast  third of city  - business district; older homes

   5           Western third of city -  newer homes; middle class
a
     A sixth stratum was described by Napier to include scattered new
construction found during 1959-1960 study.
                                      55
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                                   TECHNICAL REPORT DATA
                            (Please read [Rtiructions on the reverse be/ore completing)
 1. REPORT NO.
  EPA-600/1-78-062
                                                           3. RECIPIENT'S ACCcSSIOf+NO.
4. TITLE AND SUBTITLE


   HEALTH EFFECTS OF A WASTEWATER TREATMENT SYSTEM
                           5. REPORT DATE
                             October 1978 issuing date
                           6. PERFORMING ORGANIZATION CODE
7. AUTHOR(S)
  Kerby  F.  Fannin, Kenneth W. Cochran,
   Helen  Ross and Arnold S. Monto
                                                           B. PERFORMING ORGANIZATION REPORT NO.
9. PERFORMING ORGANIZATION NAME AND ADDRESS
   University of Michigan
   Ann Arbor, Michigan  48109
   and IIT Research Institute
   Chicago, Illinois  60616
                            10. PROGRAM ELEMENT NO.
                               1BA607
                           11. CONTRACT/GRANT NO.
                               R-804973-01
 12. SPONSORING AGENCY NAME AND ADDRESS
   Health Effects Research Laboratory  - Cinn,  OH
   Office of Research and Development
   U.S.  Environmental Protection Agency
   Cincinnati,  Ohio  45268
                            13. TYPE OF REPORT AND PERIOD COVERED
                                Final  report
                            14. SPONSORING AGENCY CODE
                              EPA/600/10
15. SUPPLEMENTARY NOTES
      Project Officer:  Herbert  R.  Pahren (513)684-7217
16. ABSTRACT
           Data obtained as part of  a  comprehensive community health  study conducted
      during 1965-1971 were utilized to  examine the incidence of acute  illness in a
      population surrounding an activated sludge wastewater treatment plant and a control
      location in Tecumseh, Michigan.  Study participants were classified into concentric
      circles of approximately 600m  each by dwelling unit distance from either site.
      School children were classified  by school attended in a similar manner.   The
      additive minimum discrimination  information statistic was used  to test for signi-
      ficant differences in the incidence of total, respiratory, and  gastrointestinal
      illnesses among individuals  dwelling within concentric circles.

           Differences in  illness  incidence occurred from May through October at varying
      distances from the wastewater  treatment plant and persons dwelling within 600m of
      this plant appeared  to have  a  greater than expected risk of respiratory and
      gastrointestinal illness.  The data do not, however, demonstrate  a causal effect
      and factors other than the wastewater treatment plant, such as  higher rates of
      illness transmission in areas  of higher densities of lower socioeconomic families,
      could have contributed to these  findings.
17.
                  DESCRIPTORS
KEY WORDS AND DOCUMENT ANALYSIS

              |b.IDENTIFIERS/OPEN ENDED TERMS
  Epidemiology, Waste Treatment,  Sewage
  Treatment, Diseases
                  Tecumseh,  Michigan
                  Health Morbidity
   COFATI Field.'Giouu
     57U
19  DISTRIBUTION STATEMENT

      Release to Public
              19 SECURITY CLASS (Tint Report)
                  Unclassified
                                              HO SECURITY CLASS flint page I

                                                 Unclassified	
 21. NO. OF PAGES
!  _ _ 68	»
 22. f'RIC!£          "I
EPA Form 2220-1 (9-73)
             56
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