Tenets of a holistic approach to drinking water-associated pathogen research, management, and communication

Caitlin Proctor, Emily Garner, Kerry A. Hamilton, Nicholas J. Ashbolt, Lindsay J. Caverly, Joseph O. Falkinham, Charles N. Haas, Michele Prevost, D. Rebecca Prevots, Amy Pruden, Lutgarde Raskin, Janet Stout, Sarah Jane Haig

Research output: Contribution to journalReview articlepeer-review

7 Scopus citations


In recent years, drinking water-associated pathogens that can cause infections in immunocompromised or otherwise susceptible individuals (henceforth referred to as DWPI), sometimes referred to as opportunistic pathogens or opportunistic premise plumbing pathogens, have received considerable attention. DWPI research has largely been conducted by experts focusing on specific microorganisms or within silos of expertise. The resulting mitigation approaches optimized for a single microorganism may have unintended consequences and trade-offs for other DWPI or other interests (e.g., energy costs and conservation). For example, the ecological and epidemiological issues characteristic of Legionella pneumophila diverge from those relevant for Mycobacterium avium and other nontuberculous mycobacteria. Recent advances in understanding DWPI as part of a complex microbial ecosystem inhabiting drinking water systems continues to reveal additional challenges: namely, how can all microorganisms of concern be managed simultaneously? In order to protect public health, we must take a more holistic approach in all aspects of the field, including basic research, monitoring methods, risk-based mitigation techniques, and policy. A holistic approach will (i) target multiple microorganisms simultaneously, (ii) involve experts across several disciplines, and (iii) communicate results across disciplines and more broadly, proactively addressing source water-to-customer system management.

Original languageEnglish (US)
Article number117997
JournalWater Research
StatePublished - Mar 1 2022


  • Building plumbing
  • Drinking water
  • Legionella
  • Opportunistic premise plumbing pathogens (OPPs)
  • Pathogens
  • nontuberculous mycobacteria

ASJC Scopus subject areas

  • Environmental Engineering
  • Civil and Structural Engineering
  • Ecological Modeling
  • Water Science and Technology
  • Waste Management and Disposal
  • Pollution


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