Public Health Risks of Pathogenic Bacteria in Freshwater Bodies: A Review of Quantitative Microbial Risk Assessment Approaches and Applications

Freshwater ecosystems play an important role in human survival, ecosystem functioning, and biodiversity conservation, yet industrialisation and urbanisation dump over 80% of untreated sewage into them. This inadequate wastewater management leads to enteric pathogens like Escherichia coli, Salmonella, Shigella, Campylobacter, Vibrio cholerae, Pseudomonas aeruginosa, and Legionella pneumophila that are responsible for a wide range of waterborne human diseases globally with extensive morbidity and mortality. The World Health Organization (WHO) estimates that at least 2 billion individuals drink water contaminated with pathogens, resulting in illnesses like cholera, dysentery, and diarrhoea, and approximately 50,000 diarrheal deaths annually. Classical epidemiology approaches are the basis for determining disease burden in public health, but they are limited in their capacity to predict future health risks. Quantitative microbial risk assessment (QMRA) addresses this by estimating the potential health risks of any exposure to microbial pathogens in any environment using four key elements, which include the identification of the microbial hazards, human exposure to the hazard through diverse activities, dose–response relationships, and the estimated risk of the infection. This review summarises information on freshwater pathogens, their occurrence, sources and health implications. The methodological approaches of QMRA in freshwater systems are reviewed with examples drawn from recreational activities, drinking water, and wastewater-impacted environments. Global QMRA studies indicate a wide range of infection risk estimates, reflecting differences in water sources, pathogens, and exposure conditions. Thus, QMRA is known to be a valuable public health tool for freshwater ecosystems, linking microbial contamination dynamics to health risk estimates that support proactive management and policy-relevant decision-making.