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Joel P. Stokdyk

Publications and source records attributed to Joel P. Stokdyk.

At least 19 recordsLinked to original sources

Quantitative microbial risk assessment with microbial source tracking for enteric pathogens in southwest Wisconsin private wells

Private wells supply drinking water for many households, and their contamination by fecal microbes presents a risk of acute gastrointestinal illness (AGI). Risk is thought to vary by contaminating fecal source, but specific associations with fecal source are unknown for most private wells in the United States. This study characterizes AGI risk in Grant, Iowa, and Lafayette counties in southwestern Wisconsin. AGI risk was assessed for 10 viral, bacterial, and protozoan pathogens detected in private wells using quantitative microbial risk assessment. Exposure assessment was based on sampling 138 private wells in the study area, and risk was associated with fecal source by microbial source tracking (MST). Median Monte Carlo estimates indicated 4450 AGI cases/year in the study area associated with drinking water from contaminated private wells (95% confidence interval: 90–37,990). Most annual cases were associated with detection of human MST markers, including median estimates of 2550 associated with only human markers and 880 with human and livestock MST markers detected together. Note that 50 AGI cases/year were associated with detection of only livestock markers, and nearly 1000 cases were estimated to occur in the absence of detectable MST markers. This study characterizes AGI risk for households served by private wells in southwestern Wisconsin. It illustrates that human fecal sources can predominate risk associated with drinking water from private wells, even in a rural region characterized by substantial agricultural activity. MST can characterize the relationship between risk and fecal source; contributions of fecal sources to risk cannot be assumed from land use.

Wisconsin↗

Detection of viral, bacterial, and protozoan pathogens and microbial source tracking markers in paired large- and small-volume water samples

When sampling for waterborne microbes, researchers may need to diverge from recommended sample volumes due to logistical constraints, novel targets, or challenging matrices, with little guidance about the potential impact on results. In field studies, we measured bacteria, viruses, and protozoa (15 quantitative polymerase chain reaction assays) in paired large- and small-volume samples to evaluate method performance and relevant factors. Concordance between methods was low. Large-volume ultrafiltration yielded more detections than small-volume sampling, especially for pathogens in groundwater. Greater microbial concentrations were associated with more frequent detections in small-volume samples and greater concordance between paired samples. Large-volume samples appeared to be more susceptible to diminished sensitivity from complex sample matrices. In laboratory studies, recovery of microbes was poorer for large- than small-volume methods, although large-volume methods more reliably detected low-concentration targets. Large-volume samples were less stable than small-volume samples during storage. Overall, large-volume sampling was superior for detecting pathogens but may underestimate concentrations; small-volume sampling was more prone to false negatives but was adequate when concentrations were relatively high, like we observed for microbial source tracking in surface waters.

Wisconsin↗

Laboratory assessment for recovery of porcine circovirus 2 and porcine reproductive and respiratory syndrome virus using two types of commercially available hollow-fiber ultrafilters

Groundwater near swine farms is an uninvestigated reservoir for porcine reproductive and respiratory syndrome virus (PRRSV) and porcine circoviruses (PCVs). Enteric microorganisms are often collected from groundwater via dead-end ultrafiltration, but recovery of PRRSV and PCV with this method has not been assessed. We recovered PRRSV2 and PCV2 by dead-end ultrafiltration followed by polyethylene glycol (PEG) precipitation, nucleic acid extraction, and reverse-transcription quantitative real-time PCR. We also compared 2 commercial hemodialysis ultrafilters (Asahi Kasei Rexeed-25A, Nipro Elisio-25H) and compared PRRSV2 recovery in these filters to other waterborne microorganisms. On average, 8 ± 1% of PRRSV2 was recovered by dead-end ultrafiltration and PEG precipitation, compared to 25 ± 6% for adenovirus 41. Full-process recovery of bacteria in the same filters was 5–15%; Cryptosporidium parvum recovery was 42 ± 12%. PCV2 was detected in 4 of 12 replicate filters, but low stock concentrations precluded quantitative recovery estimates. Elisio-25H ultrafilters performed similarly to Rexeed-25A filters for all organisms tested and is an effective replacement for the Rexeed-25A, which is no longer available in the United States. Our recovery of PRRSV2 and PCV2 by dead-end ultrafiltration in the laboratory suggests that PRRSV2 detection limits are as low as 3–50 genomic copies/L in sample volumes of 100–1,500 L. Based on quantitative microbial risk assessment, these concentrations are relevant to PRRSV2 infection rates in the U.S. swine herd.

Journal of Veterinary Diagnostic Investigation↗

Sources and risk factors for nitrate, pathogens, and fecal contamination of private wells in rural southwestern Wisconsin, USA

Household well water can be degraded by contaminants from the land's surface, but private well owners lack means to protect the source water from neighboring disturbances. Rural residents of southwestern Wisconsin, USA, rely on private well water, and the combination of land use and fractured carbonate bedrock makes groundwater vulnerable to contamination. To identify the extent, sources, and risk factors of private well contamination, randomly selected wells sampled during two-day periods in fall (n = 301) and spring (n = 529) were analyzed for nitrate and indicator bacteria, and a subset (n = 138) was sampled across four seasonal events for analysis of pathogens and microbial source tracking markers by quantitative polymerase chain reaction. Risk factors representing land use, hydrology, geology, and well construction were analyzed for associations with contamination in multivariable models. The importance of risk factors varied by contaminant, illustrating the multifaceted nature of rural groundwater quality. Nitrate contamination was associated with agricultural land use, and wells with casings that extended below a shale aquitard accessed less contaminated water than those drawing water from above it. Human fecal microbes were detected in 64 wells (46%), and rainfall was the key risk factor for contamination, indicating that wastewater from septic systems was available to contaminate wells when transport conditions were favorable. Manure microbes from cattle/ruminants and pigs were detected in 33 and 13 wells, respectively, and concentrations increased with the hectarage of cultivated land near wells. Pathogen genes for viruses, bacteria, and protozoa were detected in 66 wells (48%), including more detections of zoonotic than human-specific pathogens, and human Bacteroides , an indicator of wastewater, was an equivocal predictor of pathogen presence in private wells. Characterizing important elements of the setting, like geology, and identifying sources and risk factors for contaminants can inform landscape-level policies to protect groundwater quality.

Wisconsin↗

Groundwater surveillance of swine pathogens from private wells supplying swine farms in Iowa

Biosecurity practices are essential for maintaining pig health and productivity. Despite these measures, pathogen spread still occurs. Water is one of the largest daily inputs on swine farms by volume and is not routinely tested or disinfected before it is consumed by the animals [1-3], making it a poorly understood biosecurity risk. Groundwater from privately-owned wells is a common water source for swine farms. Pathogens in the landscape, such as bacteria, viruses, and protozoa, can reach groundwater more rapidly through soil macropores, maintaining viability and facilitating transmission of pathogens into aquifers [3-13].

Iowa↗

Quantitative microbial risk assessment with microbial source tracking for mixed fecal sources contaminating recreational river waters, Iowa, USA

Fecal contamination of surface water can cause acute gastrointestinal illness (AGI) among recreators. AGI risk varies among human, livestock, and wildlife fecal sources, but the prevalence of individual sources is unknown for most recreational sites. We estimated AGI risk for six sites near Des Moines, Iowa, using quantitative microbial risk assessment combined with microbial source-tracking (MST). Water samples ( n = 147) collected over two years were tested for 36 qPCR assays quantifying waterborne pathogens and MST markers specific to avian, bovine, human, and porcine fecal sources. Average swimming risk across all sites was 5 (95% CI: 0.0030–142) to 67 (16–215) AGI cases per 1,000 recreators. Individual fecal sources were rarely associated with swimming exposures where risk was >36 AGI cases per 1,000 recreators; most high-risk exposures were associated with simultaneous occurrence of multiple fecal sources. Iowa’s beach action value for Escherichia coli (235 MPN/100 mL) identified >90% of high-risk exposures at five of six sites, so was generally protective of public health in this setting. For sites influenced by mixed fecal sources, results illustrate that identifying a single dominant source of risk is less important than recognizing the number of unique fecal sources that impact AGI risk.

Iowa↗

Quantitative microbial risk assessment for ingestion of antibiotic resistance genes from private wells contaminated by human and livestock fecal sources

We used quantitative microbial risk assessment to estimate ingestion risk for intI1 , erm (B), sul1 , tet (A), tet (W), and tet (X) in private wells contaminated by human and/or livestock feces. Genes were quantified with five human-specific and six bovine-specific microbial source-tracking (MST) markers in 138 well-water samples from a rural Wisconsin county. Daily ingestion risk (probability of swallowing ≥1 gene) was based on daily water consumption and a Poisson exposure model. Calculations were stratified by MST source and soil depth over the aquifer where wells were drilled. Relative ingestion risk was estimated using wells with no MST detections and >6.1 m soil depth as a referent category. Daily ingestion risk varied from 0 to 8.8 × 10 −1 by gene and fecal source (i.e., human or bovine). The estimated number of residents ingesting target genes from private wells varied from 910 ( tet (A)) to 1,500 ( intI1 and tet (X)) per day out of 12,000 total. Relative risk of tet (A) ingestion was significantly higher in wells with MST markers detected, including wells with ≤6.1 m soil depth contaminated by bovine markers (2.2 [90% CI: 1.1–4.7]), wells with >6.1 m soil depth contaminated by bovine markers (1.8 [1.002–3.9]), and wells with ≤6.1 m soil depth contaminated by bovine and human markers simultaneously (3.1 [1.7–6.5]). Antibiotic resistance genes (ARGs) were not necessarily present in viable microorganisms, and ingestion is not directly associated with infection. However, results illustrate relative contributions of human and livestock fecal sources to ARG exposure and highlight rural groundwater as a significant point of exposure.

Wisconsin↗

A multi-marker assessment of sewage contamination in streams using human-associated indicator bacteria, human-specific viruses, and pharmaceuticals

Human sewage contaminates waterways, delivering excess nutrients, pathogens, chemicals, and other toxic contaminants. Contaminants and various sewage indicators are measured to monitor and assess water quality, but these analytes vary in their representation of sewage contamination and the inferences about water quality they support. We measured the occurrence and concentration of multiple microbiological ( n = 21) and chemical ( n = 106) markers at two urban stream locations in Milwaukee, Wisconsin, USA over two years. Five-day composite water samples ( n = 98) were collected biweekly, and sewage influent samples ( n = 25) were collected monthly at a Milwaukee, WI water reclamation facility. We found the vast majority of markers were not sensitive enough to detect sewage contamination. To compare analytes for monitoring applications, five consistently detected human sewage indicators were used to evaluate temporal patterns of sewage contamination, including microbiological (pepper mild mottle virus, human Bacteroides , human Lachnospiraceae ) and chemical (acetaminophen, metformin) markers. The proportion of human sewage in each stream was estimated using the mean influent concentration from the water reclamation facility and the mean concentration of all stream samples for each sewage indicator marker. Estimates of instream sewage pollution varied by marker, differing by up to two orders of magnitude, but four of the five sewage markers characterized Underwood Creek (mean proportions of human sewage ranged 0.0025 % - 0.075 %) as less polluted than Menomonee River (proportions ranged 0.013 % - 0.14 %) by an order of magnitude more. Chemical markers correlated with each other and yielded higher estimates of sewage pollution than microbial markers, which exhibited greater temporal variability. Transport, attenuation, and degradation processes can influence chemical and microbial markers differently and cause variation in human sewage estimates. Given the range of potential human and ecological health effects of human sewage contamination, robust characterization of sewage contamination that uses multiple lines of evidence supports monitoring and research applications.

Wisconsin↗

Two risk assessments: Evaluating the use of indicator HF183 Bacteroides versus pathogen measurements for modelling recreational illness risks in an urban watershed

The purpose of this study was to evaluate the performance of HF183 Bacteroides for estimating pathogen exposures during recreational water activities. We compared the use of Bacteroides -based exposure assessment to exposure assessment that relied on pathogen measurements. We considered two types of recreational water sites: those impacted by combined sewer overflows (CSOs) and those not impacted by CSOs. Samples from CSO-impacted and non-CSO-impacted urban creeks were analysed by quantitative polymerase chain reaction (qPCR) for HF183 Bacteroides and eight human gastrointestinal pathogens. Exposure assessment was conducted two ways for each type of site (CSO-impacted vs. non-CSO impacted): 1) by estimating pathogen concentrations from HF183 Bacteroides concentrations using published ratios of HF183 and pathogens in sewage and 2) by estimating pathogen concentrations from qPCR measurements. QMRA (quantitative microbial risk assessment) was then conducted for swimming, wading, and fishing exposures. Overall, mean risk estimates varied from 0.27 to 53 illnesses per 1,000 recreators depending on exposure assessment, site, activity, and norovirus dose-response model. HF183-based exposure assessment identified CSO-impacted sites as higher risk, and the recommended HF183 risk-based threshold of 525 genomic copies per 100 mL was generally protective of public health at the CSO-impacted sites but was not as protective at the non-CSO-impacted sites. In the context of our urban watershed, HF183-based exposure assessment over- and under-estimated risk relative to exposure assessment based on pathogen measurements and the etiology of predicted pathogen-specific illnesses differed significantly. Across all sites, the HF183 model overestimated risk for norovirus, adenovirus, and Campylobacter jejuni , and it underestimated risk for E. coli and Cryptosporidium . To our knowledge, this study is the first to directly compare health risk estimates using HF183 and empirical pathogen measurements from the same waterways. Our work highlights the importance of site-specific hazard identification and exposure assessment to decide whether HF183 is applicable for monitoring risk.

Pennsylvania↗

Study design and methods of the Wells and Enteric disease Transmission (WET) Trial, a randomised controlled trial

Introduction: The burden of disease attributed to drinking water from private wells is not well characterised. The Wells and Enteric disease Transmission trial is the first randomised controlled trial to estimate the burden of disease that can be attributed to the consumption of untreated private well water. To estimate the attributable incidence of gastrointestinal illness (GI) associated with private well water, we will test if the household treatment of well water by ultraviolet light (active UV device) versus sham (inactive UV device) decreases the incidence of GI in children under 5 years of age. Methods and analysis: The trial will enrol (on a rolling basis) 908 families in Pennsylvania, USA, that rely on private wells and have a child 3 years old or younger. Participating families are randomised to either an active whole-house UV device or a sham device. During follow-up, families will respond to weekly text messages to report the presence of signs and symptoms of gastrointestinal or respiratory illness and will be directed to an illness questionnaire when signs/symptoms are present. These data will be used to compare the incidence of waterborne illness between the two study groups. A randomly selected subcohort submits untreated well water samples and biological specimens (stool and saliva) from the participating child in both the presence and absence of signs/symptoms. Samples are analysed for the presence of common waterborne pathogens (stool and water) or immunoconversion to these pathogens (saliva). Ethics: Approval has been obtained from Temple University’s Institutional Review Board (Protocol 25665). The results of the trial will be published in peer-reviewed journals. Trial registration number: NCT04826991.

Pennsylvania↗

Microbial source tracking and land use associations for antibiotic resistance genes in private wells influenced by human and livestock fecal sources

Antimicrobial resistance is a growing public health problem that requires an integrated approach among human, agricultural, and environmental sectors. However, few studies address all three components simultaneously. We investigated the occurrence of five antibiotic resistance genes (ARGs) and the class 1 integron gene ( intI1 ) in private wells drawing water from a vulnerable aquifer influenced by residential septic systems and land-applied dairy manure. Samples ( n = 138) were collected across four seasons from a randomized sample of private wells in Kewaunee County, Wisconsin. Measurements of ARGs and intI1 were related to microbial source tracking (MST) markers specific to human and bovine feces; they were also related to 54 risk factors for contamination representing land use, rainfall, hydrogeology, and well construction. ARGs and intI1 occurred in 5–40% of samples depending on target. Detection frequencies for ARGs and intI1 were lowest in the absence of human and bovine MST markers (1-30%), highest when co-occurring with human and bovine markers together (11-78%), and intermediate when co-occurring with just one type of MST marker (4-46%). Gene targets were associated with septic system density more often than agricultural land, potentially because of the variable presence of manure on the landscape. Determining ARG prevalence in a rural setting with mixed land use allowed an assessment of the relative contribution of human and bovine fecal sources. Because fecal sources co-occurred with ARGs at similar rates, interventions intended to reduce ARG occurrence may be most effective if both sources are considered.

Wisconsin↗

Creek and quarry water quality at Pipestone National Monument and pilot study of pathogen detection methods in waterfall mist at Winnewissa Falls, Pipestone, Minnesota, 2018–19

Pipestone National Monument is a 301-acre site sacred to many Native American Tribes, providing cultural exhibits and walking trails to Pipestone Creek, Winnewissa Falls, and historical pipestone quarries for numerous visitors each year. However, the Minnesota Pollution Control Agency has determined turbidity and fecal coliform bacteria occur in Pipestone Creek in high enough numbers to be a potential health hazard. Concerns also were raised about exposure risk from waterfall mist to visitors and staff. The U.S. Geological Survey and the National Park Service collaborated on a study to collect 21 water-quality samples from 8 creek sites and 3 quarries in 2018 and analyzed them for over 250 water-quality parameters and contaminants. Additional samples were collected in August 2019 to assess the waterfall mists from Winnewissa Falls. Nutrient concentrations in the creek and quarries were elevated in 2018, indicating they are affected by agricultural inputs. All sample concentrations for nitrate and total nitrogen in Pipestone Creek exceeded Minnesota standards and U.S. Environmental Protection Agency nutrient criteria. Minnesota standards and U.S. Environmental Protection Agency nutrient criteria for total phosphorus also were exceeded in some of the quarry samples. Twenty of 210 micropollutants had measurable concentrations: 13 pesticides, 5 pharmaceuticals, and 2 other types of micropollutants. Atrazine, deethylatrazine, and metolachlor ethanesulfonic acid were detected in all 21 samples collected during the study. The five pharmaceuticals detected were acetaminophen, gabapentin, gemfibrozil, metformin, and oxycodone. Gabapentin (10 of 21 samples) and metformin (8 of 21 samples) were the most commonly detected pharmaceuticals. None of the detected micropollutant concentrations exceeded any Minnesota standards or U.S. Environmental Protection Agency aquatic life benchmarks, except the acute toxicity benchmark for nonvascular plants for atrazine. Two cyanotoxins, anatoxin-a and microcystin, were detected, but concentrations were below U.S. Environmental Protection Agency guidelines for swimming or recreation. Notably, total coliform, fecal coliform, and Escherichia coli were detected in all creek samples, and concentrations generally decreased downstream, suggesting contamination potentially occurred upstream from the monument. Mycobacterium avium ssp. paratuberculosis was not detected in any creek sediment samples but was detected in three water samples from the creek. Three organisms were detected in the 2019 water and mist sampling from Winnewissa Falls. Two of these organisms can cause illness in humans ( Cryptosporidium and Legionella ), and a third (ruminant Bacteroides ) is an indicator of manure contamination. Despite few samples, pathogen-positive water samples and air sampling demonstrated the feasibility and utility of the mist sampling approach outlined in this report.

Minnesota↗

Statewide quantitative microbial risk assessment for waterborne viruses, bacteria, and protozoa in public water supply wells in Minnesota

Infection risk from waterborne pathogens can be estimated via quantitative microbial risk assessment (QMRA) and forms an important consideration in the management of public groundwater systems. However, few groundwater QMRAs use site-specific hazard identification and exposure assessment, so prevailing risks in these systems remain poorly defined. We estimated the infection risk for 9 waterborne pathogens based on a 2-year pathogen occurrence study in which 964 water samples were collected from 145 public wells throughout Minnesota, USA. Annual risk across all nine pathogens combined was 3.3 × 10 –1 (95% CI: 2.3 × 10 –1 to 4.2 × 10 –1 ), 3.9 × 10 –2 (2.3 × 10 –2 to 5.4 × 10 –2 ), and 1.2 × 10 –1 (2.6 × 10 –2 to 2.7 × 10 –1 ) infections person –1 year –1 for noncommunity, nondisinfecting community, and disinfecting community wells, respectively. Risk estimates exceeded the U.S. benchmark of 10 –4 infections person –1 year –1 in 59% of well-years, indicating that the risk was widespread. While the annual risk for all pathogens combined was relatively high, the average daily doses for individual pathogens were low, indicating that significant risk results from sporadic pathogen exposure. Cryptosporidium dominated annual risk, so improved identification of wells susceptible to Cryptosporidium contamination may be important for risk mitigation.

Minnesota↗

Assessing private well contamination in Grant, Iowa, and Lafayette Counties, Wisconsin: The southwest Wisconsin groundwater and geology study

Rural residents of Grant, Iowa, and Lafayette Counties in Wisconsin rely on private wells for their water. Contaminants like nitrate and bacteria from septic systems, fertilizer, and manure can contaminate the groundwater that residents use. Groundwater is vulnerable to contamination where the soil layer is thin and the bedrock is fractured, which is the case for much of the study region. This study includes five objectives that were designed to assess and understand private well water contamination in the three counties.

Wisconsin↗

Sources and risk factors for nitrate and microbial contamination of private household wells in the fractured dolomite aquifer of northeastern Wisconsin

Background: Groundwater quality in the Silurian dolomite aquifer in northeastern Wisconsin, USA, has become contentious as dairy farms and exurban development expand. Objectives: We investigated private household wells in the region, determining the extent, sources, and risk factors of nitrate and microbial contamination. Methods: Total coliforms, Escherichia coli , and nitrate were evaluated by synoptic sampling during groundwater recharge and no-recharge periods. Additional seasonal sampling measured genetic markers of human and bovine fecal-associated microbes and enteric zoonotic pathogens. We constructed multivariable regression models of detection probability (log-binomial) and concentration (gamma) for each contaminant to identify risk factors related to land use, precipitation, hydrogeology, and well construction. Results: Total coliforms and nitrate were strongly associated with depth-to-bedrock at well sites and nearby agricultural land use, but not septic systems. Both human wastewater and cattle manure contributed to well contamination. Rotavirus group A, Cryptosporidium , and Salmonella were the most frequently detected pathogens. Wells positive for human fecal markers were associated with depth-to-groundwater and number of septic system drainfield within 229 m "> 229 m 229m . Manure-contaminated wells were associated with groundwater recharge and the area size of nearby agricultural land. Wells positive for any fecal-associated microbe, regardless of source, were associated with septic system density and manure storage proximity modified by bedrock depth. Well construction was generally not related to contamination, indicating land use, groundwater recharge, and bedrock depth were the most important risk factors. Discussion: These findings may inform policies to minimize contamination of the Silurian dolomite aquifer, a major water supply for the U.S. and Canadian Great Lakes region.

Wisconsin↗

Quantitative microbial risk assessment for contaminated private wells in the fractured dolomite aquifer of Kewaunee County, Wisconsin

Background: Private wells are an important source of drinking water in Kewaunee County, Wisconsin. Due to the region’s fractured dolomite aquifer, these wells are vulnerable to contamination by human and zoonotic gastrointestinal pathogens originating from land-applied cattle manure and private septic systems. Objective: We determined the magnitude of the health burden associated with contamination of private wells in Kewaunee County by feces-borne gastrointestinal pathogens. Methods: This study used data from a year-long countywide pathogen occurrence study as inputs into a quantitative microbial risk assessment (QMRA) to predict the total cases of acute gastrointestinal illness (AGI) caused by private well contamination in the county. Microbial source tracking was used to associate predicted cases of illness with bovine, human, or unknown fecal sources. Results: Results suggest that private well contamination could be responsible for as many as 301 AGI cases per year in Kewaunee County, and that 230 and 12 cases per year were associated with a bovine and human fecal source, respectively. Furthermore, Cryptosporidium parvum was predicted to cause 190 cases per year, the most out of all 8 pathogens included in the QMRA. Discussion: This study has important implications for land use and water resource management in Kewaunee County and informs the public health impacts of consuming drinking water produced in other similarly vulnerable hydrogeological settings.

Wisconsin↗

Septic systems and rainfall influence human fecal markers and indicator organisms occurrence in private wells in southeastern Pennsylvania

In the United States approximately 48 million people are served by private wells. Unlike public water systems, private well water quality is not monitored and there are few studies on the extent and sources of contamination of private wells. We extensively investigated five private wells to understand the variability in microbial contamination, the role of septic systems as sources of contamination, and the effect of rainfall on well water quality. From 2016-2017, weekly or biweekly samples (n= 105) were collected from 5 private wells in rural Pennsylvania. Samples were tested for general water quality parameters, conventional and sewage-associated microbial indicators, and human pathogens. Total coliforms, human Bacteroides (HF183), and pepper mild mottle virus were detected at least once in all wells. Regression revealed significant relationships between HF183 and rainfall 8-14 days prior to sampling and between total coliforms and rainfall 8-14 or 0-14 days prior to sampling. Dye tracer studies at 3 wells confirmed the impact of household septic systems on well contamination. Microbiological measurements, chemical water quality data, and dye tracer tests provide evidence of human fecal contamination in the private wells studied, suggesting that household septic systems are the source of this contamination.

Pennsylvania↗