{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T13:19:14Z","timestamp":1788268754139,"version":"build-2803163510"},"reference-count":123,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:00:00Z","timestamp":1760140800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxics"],"abstract":"<jats:p>This study presents a comprehensive Quantitative Microbial Risk Assessment (QMRA) for Escherichia coli in northeastern Greece\u2019s riverine and deltaic aquatic systems, evaluating potential human health risks from recreational water exposure. The analysis integrates seasonal microbiological monitoring data\u2014E. coli, total coliforms, enterococci, Salmonella spp., Clostridium perfringens (spores and vegetative forms), and physicochemical parameters (e.g., pH, temperature, BOD5)\u2014across multiple sites. A beta-Poisson dose\u2013response model within a Monte Carlo simulation framework (10,000 iterations) was applied to five exposure scenarios, simulating varying ingestion volumes for different population groups. Median annual infection risks ranged from negligible to high, with several locations (e.g., Mandra River, Konsynthos South, and Delta Evros) surpassing the World Health Organization (WHO)\u2019s benchmark of 10\u22124 infections per person per year. A Gradient Boosting Regressor (GBR) model was developed to enhance predictive capacity, demonstrating superior accuracy metrics. Permutation Importance analysis identified enterococci, total coliforms, BOD5, temperature, pH, and seasons as critical predictors of E. coli concentrations. Additionally, sensitivity analysis highlighted the dominant role of ingestion volume and E. coli levels across all scenarios and sites. These findings support the integration of ML-based tools and probabilistic modelling in water quality risk governance, enabling proactive public health strategies in vulnerable or high-use recreational zones.<\/jats:p>","DOI":"10.3390\/toxics13100863","type":"journal-article","created":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T14:04:02Z","timestamp":1760537042000},"page":"863","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Quantitative Microbial Risk Assessment of E. coli in Riverine and Deltaic Waters of Northeastern Greece: Monte Carlo Simulation and Predictive Perspectives"],"prefix":"10.3390","volume":"13","author":[{"given":"Agathi","family":"Voltezou","sequence":"first","affiliation":[{"name":"Laboratory of Hygiene and Environmental Protection, Faculty of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3580-4247","authenticated-orcid":false,"given":"Elpida","family":"Giorgi","sequence":"additional","affiliation":[{"name":"Laboratory of Hygiene and Environmental Protection, Faculty of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2459-2963","authenticated-orcid":false,"given":"Christos","family":"Stefanis","sequence":"additional","affiliation":[{"name":"Laboratory of Hygiene and Environmental Protection, Faculty of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Kalentzis","sequence":"additional","affiliation":[{"name":"Laboratory of Hygiene and Environmental Protection, Faculty of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8299-9035","authenticated-orcid":false,"given":"Elisavet","family":"Stavropoulou","sequence":"additional","affiliation":[{"name":"Laboratory of Hygiene and Environmental Protection, Faculty of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agathangelos","family":"Stavropoulos","sequence":"additional","affiliation":[{"name":"School of Social and Political Sciences, University of Glasgow, Glasgow G12 8RT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0381-4715","authenticated-orcid":false,"given":"Evangelia","family":"Nena","sequence":"additional","affiliation":[{"name":"Laboratory of Social Medicine, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8035-1710","authenticated-orcid":false,"given":"Chrysoula (Chrysa)","family":"Voidarou","sequence":"additional","affiliation":[{"name":"Department of Agriculture, School of Agriculture, University of Ioannina, 47100 Arta, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7869-6824","authenticated-orcid":false,"given":"Christina","family":"Tsigalou","sequence":"additional","affiliation":[{"name":"Laboratory of Hygiene and Environmental Protection, Faculty of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3100-0823","authenticated-orcid":false,"given":"Theodoros C.","family":"Konstantinidis","sequence":"additional","affiliation":[{"name":"Laboratory of Hygiene and Environmental Protection, Faculty of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2010-2544","authenticated-orcid":false,"given":"Eugenia","family":"Bezirtzoglou","sequence":"additional","affiliation":[{"name":"Laboratory of Hygiene and Environmental Protection, Faculty of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Angelakis, A.N., Vuorinen, H.S., Nikolaidis, C., Juuti, P.S., Katko, T.S., Juuti, R.P., Zhang, J., and Samonis, G. (2021). Water Quality and Life Expectancy: Parallel Courses in Time. Water, 13.","DOI":"10.3390\/w13060752"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Alexakis, D.E. (2021). Linking DPSIR Model and Water Quality Indices to Achieve Sustainable Development Goals in Groundwater Resources. Hydrology, 8.","DOI":"10.3390\/hydrology8020090"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Angelakis, A.N., Dercas, N., and Tzanakakis, V.A. (2022). Water Quality Focusing on the Hellenic World: From Ancient to Modern Times and the Future. Water, 14.","DOI":"10.3390\/w14121887"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1016\/S0140-6736(16)31012-1","article-title":"Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980\u20132015: A systematic analysis for the Global Burden of Disease Study","volume":"388","author":"Wang","year":"2015","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1007\/s40572-018-0196-x","article-title":"Quantitative Microbial Risk Assessment and Infectious Disease Transmission Modeling of Waterborne Enteric Pathogens","volume":"5","author":"Brouwer","year":"2018","journal-title":"Curr. Environ. Health Rep."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Stauber, C.E., Wedgworth, J.C., Johnson, P., Olson, J.B., Ayers, T., Elliott, M., and Brown, J. (2016). Associations between Self-Reported Gastrointestinal Illness and Water System Characteristics in Community Water Supplies in Rural Alabama: A Cross-Sectional Study. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0148102"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"116204","DOI":"10.1016\/j.watres.2020.116204","article-title":"Fecal indicator bacteria from environmental sources; strategies for identification to improve water quality monitoring","volume":"185","author":"Megan","year":"2020","journal-title":"Water Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1080\/10643380903392718","article-title":"Escherichia coli and Fecal Coliforms in Freshwater and Estuarine Sediments","volume":"41","author":"Pachepsky","year":"2011","journal-title":"Crit. Rev. Environ. Sci. Technol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.mib.2021.09.011","article-title":"The potential of using E. coli as an indicator for the surveillance of antimicrobial resistance (AMR) in the environment","volume":"64","author":"Anjum","year":"2021","journal-title":"Curr. Opin. Microbiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"114200","DOI":"10.1016\/j.envpol.2020.114200","article-title":"Surveillance of antibiotic resistant Escherichia coli in human populations through urban wastewater in ten European countries","volume":"261","author":"Patricia","year":"2020","journal-title":"Environ. Pollut."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Delgado-Blas, J.F., Ovejero, C.M., David, S., Montero, N., Calero-Caceres, W., Garcillan-Barcia, M.P., de la Cruz, F., Muniesa, M., and Aanensen, D.M. (2021). Population genomics and antimicrobial resistance dynamics of Escherichia coli in wastewater and river environments. Commun. Biol., 4.","DOI":"10.1038\/s42003-021-01949-x"},{"key":"ref_12","unstructured":"Mouratidis, A., Perivolioti, T.-M., Vladenidis, P., Nikolaidis, A., Pantazopoulou, Z., Papadopoulos, E., Bobori, D., Vergos, G.S., and Triantafyllou, A. (2022, January 17\u201322). The Contribution of Remote Sensing to the Development of an Observatory System for Integrated Management of the Coastal Zone: The Case Study of Central Macedonia, Greece. Proceedings of the IGARSS 2022 IEEE International Geoscience and Remote Sensing Symposium, Kuala Lumpur, Malaysia."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Vatitsi, K., Siachalou, S., Latinopoulos, D., Kagalou, I., Akratos, C.S., and Mallinis, G. (2024). Monitoring Water Quality Parameters in Small Rivers Using SuperDove Imagery. Water, 16.","DOI":"10.3390\/w16050758"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Perivolioti, T.-M., Zachopoulos, K., Zioga, M., Tompoulidou, M., Katsavouni, S., Kemitzoglou, D., Terzopoulos, D., Mouratidis, A., and Tsiaoussi, V. (2024). Monitoring the Impact of Floods on Water Quality Using Optical Remote Sensing Imagery: The Case of Lake Karla (Greece). Water, 16.","DOI":"10.3390\/w16233502"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Kalaitzidou, K., Ntona, M.M., Zavridou, E., Tzeletas, S., Patsialis, T., Kallioras, A., Zouboulis, A., Virgiliou, C., Mitrakas, M., and Kazakis, N. (2023). Water Quality Evaluation of Groundwater and Dam Reservoir Water: Application of the Water Quality Index to Study Sites in Greece. Water, 15.","DOI":"10.3390\/w15234170"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Ntona, M.M., Chalikakis, K., Busico, G., Mastrocicco, M., Kalaitzidou, K., and Kazakis, N. (2023). Application of Judgmental Sampling Approach for the Monitoring of Groundwater Quality and Quantity Evolution in Mediterranean Catchments. Water, 15.","DOI":"10.3390\/w15224018"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Stefanidis, K., Dimitrellos, G., Sarika, M., Tsoukalas, D., and Papastergiadou, E. (2022). Ecological Quality Assessment of Greek Lowland Rivers with Aquatic Macrophytes in Compliance with the EU Water Framework Directive. Water, 14.","DOI":"10.3390\/w14182771"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Panagopoulos, Y., Alexakis, D.E., Skoulikidis, N.T., Laschou, S., Papadopoulos, A., and Dimitriou, E. (2022). Implementing the CCME Water Quality Index for the Evaluation of the Physicochemical Quality of Greek Rivers. Water, 14.","DOI":"10.3390\/w14172738"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Karamoutsou, L., and Psilovikos, A. (2021). Deep Learning in Water Resources Management: \u03a4he Case Study of Kastoria Lake in Greece. Water, 13.","DOI":"10.3390\/w13233364"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Mamassis, N., Mazi, K., Dimitriou, E., Kalogeras, D., Malamos, N., Lykoudis, S., Koukouvinos, A., Tsirogiannis, I., Papageorgaki, I., and Papadopoulos, A. (2021). OpenHi.net: A Synergistically Built, National-Scale Infrastructure for Monitoring the Surface Waters of Greece. Water, 13.","DOI":"10.3390\/w13192779"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Lyra, A., Loukas, A., Sidiropoulos, P., Tziatzios, G., and Mylopoulos, N. (2021). An Integrated Modeling System for the Evaluation of Water Resources in Coastal Agricultural Watersheds: Application in Almyros Basin, Thessaly, Greece. Water, 13.","DOI":"10.3390\/w13030268"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Pisinaras, V., Paraskevas, C., and Panagopoulos, A. (2021). Investigating the Effects of Agricultural Water Management in a Mediterranean Coastal Aquifer under Current and Projected Climate Conditions. Water, 13.","DOI":"10.3390\/w13010108"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Giakoumatos, S.D.V., Skoulikidis, N.T., Karavoltsos, S., Sakellari, A., and Dimitriou, E. (2024). Spatiotemporal Variations in Water Physicochemical Status in Pinios River Catchment, at Eastern Mediterranean Region. Land, 13.","DOI":"10.20944\/preprints202410.2035.v1"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Zoidou, M., Kokkos, N., and Sylaios, G. (2022). Dynamics of Water, Salt, and Nutrients Exchange at the Inlets of Three Coastal Lagoons. J. Mar. Sci. Eng., 10.","DOI":"10.3390\/jmse10020205"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Tselemponis, A., Stefanis, C., Giorgi, E., Kalmpourtzi, A., Olmpasalis, I., Tselemponis, A., Adam, M., Kontogiorgis, C., Dokas, I.M., and Bezirtzoglou, E. (2023). Coastal Water Quality Modelling Using E. coli, Meteorological Parameters and Machine Learning Algorithms. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20136216"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1007\/s12560-018-9344-6","article-title":"Assessment of the Virological Quality of Marine and Running Surface Waters in NW Greece: A Case Study","volume":"10","author":"Kokkinos","year":"2018","journal-title":"Food Environ. Virol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"357","DOI":"10.4081\/jphr.2014.357","article-title":"Application of chemometric methods for assessment and modelling of microbiological quality data concerning coastal bathing water in Greece","volume":"3","author":"Papaioannou","year":"2014","journal-title":"J. Public Health Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"145857","DOI":"10.1016\/j.scitotenv.2021.145857","article-title":"A critical review of water resources in Greece: The key role of agricultural adaptation to climate-water effects","volume":"775","author":"Kourgialas","year":"2021","journal-title":"Sci. Total Environ."},{"key":"ref_29","unstructured":"(2025, May 30). Consultation, Geneva, Switzerland, 13\u201317 March 1995. Available online: https:\/\/apps.who.int\/iris\/handle\/10665\/58913."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Collineau, L., Chapman, B., Bao, X., Sivapathasundaram, B., Carson, C.A., Fazil, A., Reid-Smith, R.J., and Smith, B.A. (2020). A Farm-to-Fork Quantitative Risk Assessment Model for Salmonella Heidelberg Resistant to Third-Generation Cephalosporins in Broiler Chickens in Canada. Int. J. Food Microbiol., 330.","DOI":"10.1016\/j.ijfoodmicro.2020.108559"},{"key":"ref_31","unstructured":"(2025, September 28). Application of Risk Analysis to Food Standards Issues: Report of the Joint FAO\/WHO Expert. Available online: https:\/\/www.fao.org\/4\/ae922e\/ae922e00.htm."},{"key":"ref_32","unstructured":"Nakashima, A.A., Gonzalez-Barron, U., Bouchriti, N., Hartnett, E., Karunasagar, I., Kiermeier, A., Koutsoumanis, K., Li, F.-Q., Ross, T., and Schaffner, D. (2021). Microbiological Risk Assessment-Guidance for Food, Food & Agriculture Org."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Bevilacqua, A., De Santis, A., Sollazzo, G., Speranza, B., Racioppo, A., Sinigaglia, M., and Corbo, M.R. (2023). Microbiological Risk Assessment in Foods: Background and Tools, with a Focus on Risk Ranger. Foods, 12.","DOI":"10.3390\/foods12071483"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"EFSA Panel on Biological Hazards (2015). Scientific Opinion on the Development of a Risk Ranking Toolbox for the EFSA BIOHAZ Panel. EFSA J., 13, 3939.","DOI":"10.2903\/j.efsa.2015.3939"},{"key":"ref_35","unstructured":"(2025, May 30). Available online: https:\/\/eur-lex.europa.eu\/legal-content\/EN\/TXT\/?uri=CELEX%3A32006L0007&qid=1673547450307."},{"key":"ref_36","unstructured":"(2025, June 01). International Organisation for Standardisation. Available online: https:\/\/www.iso.org\/standard\/55832.html."},{"key":"ref_37","unstructured":"(2025, June 01). International Organisation for Standardisation. Available online: https:\/\/www.iso.org\/obp\/ui\/#iso:std:iso:7899:-2:ed-2:v1:en."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/S0944-5013(11)80107-2","article-title":"Distribution of Clostridium perfringens in different aquatic environments in Greece","volume":"149","author":"Bezirtzoglou","year":"1994","journal-title":"Microbiol. Res."},{"key":"ref_39","unstructured":"(2025, June 01). International Organisation for Standardisation. Available online: https:\/\/fliphtml5.com\/skigm\/anxu\/basic."},{"key":"ref_40","unstructured":"Baird, R., and Bridgewater, L. (2017). Standard Methods for the Examination of Water and Wastewater, Water Environment Federation. [23rd ed.]."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"110370","DOI":"10.1016\/j.ecolind.2023.110370","article-title":"Fecal bacteria in coastal lakes: An anthropogenic contamination or natural element of microbial diversity?","volume":"152","author":"Lew","year":"2023","journal-title":"Ecol. Indic."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1007\/s40710-017-0239-6","article-title":"The Impact of Environmental Variables on Faecal Indicator Bacteria in the Betna River Basin, Bangladesh","volume":"4","author":"Islam","year":"2017","journal-title":"Environ. Process."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1007\/s11270-019-4278-7","article-title":"The Effect of Temperature Oscillations and Sediment Texture on Fecal Indicator Bacteria Survival in Sediments","volume":"230","author":"Smith","year":"2019","journal-title":"Water Air Soil Pollut."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Ahmed, U., Mumtaz, R., Anwar, H., Shah, A.A., Irfan, R., and Garc\u00eda-Nieto, J. (2019). Efficient Water Quality Prediction Using Supervised Machine Learning. Water, 11.","DOI":"10.3390\/w11112210"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"4954","DOI":"10.1021\/acs.chemmater.0c01907","article-title":"Machine learning for materials scientists: An introductory guide toward best practices","volume":"3","author":"Wang","year":"2020","journal-title":"Chem. Mater."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Mogos, R.I., Petrescu, I., Chiotan, R.A., Cret, R.C., Troac\u0103, V.A., and Mogos, P.L. (2023). Greenhouse Gas Emissions and Green Deal in the European Union. Front. Environ. Sci., 11.","DOI":"10.3389\/fenvs.2023.1141473"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"38","DOI":"10.2214\/AJR.18.20224","article-title":"Peering Into the Black Box of Artificial Intelligence: Evaluation Metrics of Machine Learning Methods","volume":"212","author":"Guy","year":"2019","journal-title":"Am. J. Roentgenol."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Altmann, A., Tolo\u015fi, L., Sander, O., and Lengauer, T. (2010). Permutation importance: A corrected feature importance measure. Bioinformatics, 26.","DOI":"10.1093\/bioinformatics\/btq134"},{"key":"ref_49","first-page":"1","article-title":"All Models are Wrong, but Many are Useful: Learning a Variable\u2019s Importance by Studying an Entire Class of Prediction Models Simultaneously","volume":"20","author":"Fisher","year":"2019","journal-title":"J. Mach. Learn. Res."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.artint.2018.07.007","article-title":"Explanation in artificial intelligence: Insights from the social sciences","volume":"267","author":"Miller","year":"2019","journal-title":"Artif. Intell."},{"key":"ref_51","unstructured":"World Health Organization (2016). Quantitative Microbial Risk Assessment: Application for Water Safety Management, World Health Organization. Available online: https:\/\/iris.who.int\/handle\/10665\/246195."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"4674","DOI":"10.1016\/j.watres.2010.06.049","article-title":"Estimated human health risks from exposure to recreational waters impacted by human and non-human sources of faecal contamination","volume":"44","author":"Soller","year":"2010","journal-title":"Water Res."},{"key":"ref_53","first-page":"288","article-title":"Evaluation of the quality of coastal bathing waters in Spain through fecal bacteria Escherichia coli and Enterococcus","volume":"566\u2013567","year":"2016","journal-title":"Sci. Total Environ."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"20503121241258071","DOI":"10.1177\/20503121241258071","article-title":"Quantitative microbial risk assessment for Escherichia coli O157: H7 via drinking water in the Gaza Strip, Palestine","volume":"12","author":"Abuzerr","year":"2024","journal-title":"SAGE Open Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.scitotenv.2013.01.048","article-title":"Application of Quantitative Microbial Risk Assessment to analyze the public health risk from poor drinking water quality in a low-income area in Accra, Ghana","volume":"449","author":"Machdar","year":"2013","journal-title":"Sci. Total Environ."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.ijfoodmicro.2004.11.023","article-title":"Dose response modelling of Escherichia coli O157 incorporating data from foodborne and environmental outbreaks","volume":"103","author":"Strachan","year":"2005","journal-title":"Int. J. Food Microbiol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1007\/s40572-014-0036-6","article-title":"Recreational Water and Infection: A Review of Recent Findings","volume":"2","author":"Fewtrell","year":"2015","journal-title":"Curr. Environ. Health Rep."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Gitter, A., Mena, K.D., Wagner, K.L., Boellstorff, D.E., Borel, K.E., Gregory, L.F., Gentry, T.J., and Karthikeyan, R. (2020). Human Health Risks Associated with Recreational Waters: Preliminary Approach of Integrating Quantitative Microbial Risk Assessment with Microbial Source Tracking. Water, 12.","DOI":"10.3390\/w12020327"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"2020","DOI":"10.1016\/j.watres.2010.12.006","article-title":"Water ingestion during water recreation","volume":"45","author":"Dorevitch","year":"2011","journal-title":"Water Res."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Haas, C.N., Rose, J.B., and Gerba, C.P. (2014). Quantitative Microbial Risk Assessment, John Wiley & Sons, Inc.. [2nd ed.].","DOI":"10.1002\/9781118910030"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"111626","DOI":"10.1016\/j.jenvman.2020.111626","article-title":"Evaluation of recreational risks due to exposure of antibiotic-resistance bacteria from environmental water: A proposed framework","volume":"279","author":"Tyagi","year":"2021","journal-title":"J. Environ. Manag."},{"key":"ref_62","unstructured":"Haas, C.N., Rose, J.B., and Gerba, C.P. (1999). Quantitative Microbial Risk Assessment, John Wiley & Sons."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"131910","DOI":"10.1016\/j.chemosphere.2021.131910","article-title":"Probabilistic framework for assessing ecological risk of Contaminants of Emerging Concern: Application to a Canadian lake system","volume":"287","author":"Rodriguez","year":"2022","journal-title":"Chemosphere"},{"key":"ref_64","unstructured":"Pouillot, R., Kelly, D.L., and Denis, J. (2025, August 01). Tools for Two-Dimensional Monte-Carlo Simulations: The mc2d Package [WWW Document]. Available online: https:\/\/cran.r-project.org\/web\/packages\/mc2d\/vignettes\/docmcEnglish.pdf."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"156849","DOI":"10.1016\/j.scitotenv.2022.156849","article-title":"A probabilistic assessment of microbial infection risks due to occupational exposure to wastewater in a conventional activated sludge wastewater treatment plant","volume":"843","author":"Amoah","year":"2022","journal-title":"Sci. Total Environ."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.jtbi.2008.04.011","article-title":"A methodology for performing global uncertainty and sensitivity analysis in systems biology","volume":"254","author":"Marino","year":"2008","journal-title":"J. Theor. Biol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"967","DOI":"10.2134\/jeq2017.11.0458","article-title":"Variability of Escherichia coli Concentrations in Rivers during Base-Flow Conditions in New Zealand","volume":"47","author":"Muirhead","year":"2018","journal-title":"J. Environ. Qual."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Sarker, S.K., Dapkus, R.T., Byrne, D.M., Fryar, A.E., and Hutchison, J.M. (2025). Quantifying Temporal Dynamics of E. coli Concentration and Quantitative Microbial Risk Assessment of Pathogen in a Karst Basin. Water, 17.","DOI":"10.3390\/w17050745"},{"key":"ref_69","first-page":"9","article-title":"Occurrence of Salmonella spp. in estuarine and coastal waters of Portugal","volume":"78","author":"Joao","year":"2000","journal-title":"Antonie Van Leeuwenhoek"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1046\/j.1365-2672.1997.00143.x","article-title":"Salmonella DNA persistence in natural seawaters using PCR analysis","volume":"82","author":"Dupray","year":"1997","journal-title":"J. Appl. Microbiol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"7700","DOI":"10.1128\/AEM.01852-09","article-title":"Characteristics and dynamics of Salmonella contamination along the coast of Agadir, Morocco","volume":"75","author":"Setti","year":"2009","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.marpolbul.2008.10.003","article-title":"Prediction of Salmonella in seawater by total and faecal coliforms and Enterococci","volume":"58","author":"Efstratiou","year":"2009","journal-title":"Mar. Pollut. Bull."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1016\/j.watres.2019.07.006","article-title":"Impacts of a changing earth on microbial dynamics and human health risks in the continuum between beach water and sand","volume":"162","author":"Weiskerger","year":"2019","journal-title":"Water Res."},{"key":"ref_74","doi-asserted-by":"crossref","unstructured":"Huang, J., Lv, C., Li, M., Rahman, T., Chang, Y.-F., Guo, X., Song, Z., Zhao, Y., Li, Q., and Ni, P. (2024). Carbapenem-resistant Escherichia coli exhibit diverse spatiotemporal epidemiological characteristics across the globe. Commun. Biol., 7.","DOI":"10.1038\/s42003-023-05745-7"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"123621","DOI":"10.1016\/j.watres.2025.123621","article-title":"Evaluation of public health impact risks associated with bacterial antimicrobial resistome in tropical coastal environments","volume":"282","author":"Yuan","year":"2025","journal-title":"Water Res."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"179742","DOI":"10.1016\/j.scitotenv.2025.179742","article-title":"Global distribution of antimicrobial resistance genes in Escherichia coli isolated from wild animals using genomes available in public databases","volume":"985","author":"Assefa","year":"2025","journal-title":"Sci. Total Environ."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"1800497","DOI":"10.2807\/1560-7917.ES.2019.24.37.1800497","article-title":"Population-level surveillance of antibiotic resistance in Escherichia coli through sewage analysis","volume":"24","author":"Hutinel","year":"2019","journal-title":"Euro Surveill."},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"Gomes, L., Bordalo, A.A., and Machado, A. (2024). Characterization of Escherichia coli Isolates in Recreational Waters: Implications for Public Health and One Health Approach. Water, 16.","DOI":"10.3390\/w16182695"},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Fern\u00e1ndez-Trapote, E., Oliveira, M., Cobo-D\u00edaz, J.F., and Alvarez-Ord\u00f3\u00f1ez, A. (2024). The resistome of the food chain: A One Health perspective. Microb. Biotechnol., 17.","DOI":"10.1111\/1751-7915.14530"},{"key":"ref_80","doi-asserted-by":"crossref","unstructured":"Milijasevic, M., Veskovic-Moracanin, S., Babic Milijasevic, J., Petrovic, J., and Nastasijevic, I. (2024). Antimicrobial Resistance in Aquaculture: Risk Mitigation within the One Health Context. Foods, 13.","DOI":"10.20944\/preprints202406.0874.v1"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1016\/j.ecolind.2018.09.024","article-title":"Long-term ecological footprints of a man-made freshwater discharge onto a sandy beach ecosystem","volume":"96","author":"Lercari","year":"2019","journal-title":"Ecol. Indic."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"3978","DOI":"10.1016\/S0043-1354(03)00301-4","article-title":"Fecal indicator bacteria are abundant in wet sand at freshwater beaches","volume":"37","author":"Alm","year":"2003","journal-title":"Water Res."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"e01423-22","DOI":"10.1128\/aem.01423-22","article-title":"Genetic Determinants of Escherichia coli Survival in Beach Sand","volume":"89","author":"Rumball","year":"2023","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"Petersen, F., and Hubbart, J.A. (2020). Physical Factors Impacting the Survival and Occurrence of Escherichia coli in Secondary Habitats. Water, 12.","DOI":"10.3390\/w12061796"},{"key":"ref_85","doi-asserted-by":"crossref","unstructured":"Carrasco-Acosta, M., and Garcia-Jimenez, P. (2024). Development of Multiplex RT qPCR Assays for Simultaneous Detection and Quantification of Faecal Indicator Bacteria in Bathing Recreational Waters. Microorganisms, 12.","DOI":"10.3390\/microorganisms12061223"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"137846","DOI":"10.1016\/j.scitotenv.2020.137846","article-title":"Spatial and temporal distribution of E. coli contamination on three inland lake and recreational beach systems in the upper Midwestern United States","volume":"722","author":"Palmer","year":"2020","journal-title":"Sci. Total Environ."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"113360","DOI":"10.1016\/j.marpolbul.2022.113360","article-title":"Temporal variations in fecal indicator bacteria in bathing water and sediment in a coastal ecosystem (Aytr\u00e9 Bay, Charente-Maritime, France)","volume":"175","author":"Ndione","year":"2022","journal-title":"Mar. Pollut. Bull."},{"key":"ref_88","doi-asserted-by":"crossref","unstructured":"Dritsas, E., and Trigka, M. (2023). Efficient Data-Driven Machine Learning Models for Water Quality Prediction. Computation, 11.","DOI":"10.3390\/computation11020016"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"136814","DOI":"10.1016\/j.scitotenv.2020.136814","article-title":"Prediction of recreational water safety using Escherichia coli as an indicator: Case study of the Passaic and Pompton rivers, New Jersey","volume":"714","author":"Rossi","year":"2020","journal-title":"Sci. Total Environ."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/j.watres.2018.11.058","article-title":"Occurrence of microbial indicators, pathogenic bacteria and viruses in tropical surface waters subject to contrasting land use","volume":"150","author":"Goh","year":"2019","journal-title":"Water Res."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"123516","DOI":"10.1016\/j.watres.2025.123516","article-title":"Chemical and microbiological analysis of urban and associated natural water systems of inhabited volcanic islands of the Galapagos (Ecuador)","volume":"281","author":"Ho","year":"2025","journal-title":"Water Res."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"4752","DOI":"10.3390\/w7094752","article-title":"Integrated River and Coastal Flow, Sediment and Escherichia coli Modelling for Bathing Water Quality","volume":"7","author":"Huang","year":"2015","journal-title":"Water"},{"key":"ref_93","doi-asserted-by":"crossref","unstructured":"Bonamano, S., Madonia, A., Caruso, G., Zappal\u00e0, G., and Marcelli, M. (2021). Development of a New Predictive index (Bathing Water Quality Index, BWQI) Based on Escherichia coli Physiological States for Bathing Waters Monitoring. J. Mar. Sci. Eng., 9.","DOI":"10.3390\/jmse9020120"},{"key":"ref_94","doi-asserted-by":"crossref","unstructured":"Wolska, L., Kowalewski, M., Potrykus, M., Redko, V., and Rybak, B. (2022). Difficulties in the Modeling of E. coli Spreading from Various Sources in a Coastal Marine Area. Molecules, 27.","DOI":"10.3390\/molecules27144353"},{"key":"ref_95","doi-asserted-by":"crossref","unstructured":"Lopes, H.T.L., Baumann, L.R.F., and Scalize, P.S. (2023). A Contamination Predictive Model for Escherichia coli in Rural Communities Dug Shallow Wells. Sustainability, 15.","DOI":"10.3390\/su15032408"},{"key":"ref_96","unstructured":"OECD (2020). OECD Environmental Performance Reviews: Greece 2020, OECD Environmental Performance Reviews. OECD Publishing."},{"key":"ref_97","unstructured":"NCESD (2018). Greece, State of the Environment Report, Summary, National Center of Environment and Sustainable Development."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"100612","DOI":"10.1016\/j.gsd.2021.100612","article-title":"Assessing drinking water quality based on physical, chemical and microbial parameters in the Red Sea State, Sudan using a combination of water quality index and artificial neural network model","volume":"14","author":"Mohamedelfatieh","year":"2021","journal-title":"Groundw. Sustain. Dev."},{"key":"ref_99","doi-asserted-by":"crossref","unstructured":"Anagnostopoulos, D.A., Parlapani, F.F., Natoudi, S., Syropoulou, F., Kyritsi, M., Vergos, I., Hadjichristodoulou, C., Kagalou, I., and Boziaris, I.S. (2022). Bacterial Communities and Antibiotic Resistance of Potential Pathogens Involved in Food Safety and Public Health in Fish and Water of Lake Karla, Thessaly, Greece. Pathogens, 11.","DOI":"10.3390\/pathogens11121473"},{"key":"ref_100","doi-asserted-by":"crossref","unstructured":"Stefanidis, K., Kouvarda, T., Latsiou, A., Papaioannou, G., Gritzalis, K., and Dimitriou, E. (2022). A Comparative Evaluation of Hydromorphological Assessment Methods Applied in Rivers of Greece. Hydrology, 9.","DOI":"10.3390\/hydrology9030043"},{"key":"ref_101","doi-asserted-by":"crossref","unstructured":"Mentzafou, A., Varlas, G., Papadopoulos, A., Poulis, G., and Dimitriou, E. (2021). Assessment of Automatically Monitored Water Levels and Water Quality Indicators in Rivers with Different Hydromorphological Conditions and Pollution Levels in Greece. Hydrology, 8.","DOI":"10.3390\/hydrology8020086"},{"key":"ref_102","doi-asserted-by":"crossref","unstructured":"Charoula, M., Eleni, T., Georgios, S., George, P., Lefteris, L., Lazaros, T., and Elisavet, A. (2020). A Water Quality Assessment Tool for Decision Making, Based on Widely Used Water Quality Indices. Environ. Sci. Proc., 2.","DOI":"10.3390\/environsciproc2020002016"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"106816","DOI":"10.1016\/j.psep.2025.106816","article-title":"Comprehensive assessment of E. coli dynamics in river water using advanced machine learning and explainable AI","volume":"195","author":"Mallik","year":"2025","journal-title":"Process Saf. Environ. Prot."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"119866","DOI":"10.1016\/j.jenvman.2023.119866","article-title":"Optimisation and interpretation of machine and deep learning models for improved water quality management in Lake Loktak","volume":"351","author":"Talukdar","year":"2024","journal-title":"J. Environ. Manag."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"119422","DOI":"10.1016\/j.watres.2022.119422","article-title":"A novel approach for estimating and predicting uncertainty in water quality index model using machine learning approaches","volume":"229","author":"Uddin","year":"2023","journal-title":"Water Res."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"178062","DOI":"10.1016\/j.scitotenv.2024.178062","article-title":"Extreme rainfall disproportionately impacts E. coli concentrations in Texas recreational waterbodies","volume":"958","author":"Liu","year":"2025","journal-title":"Sci. Total Environ."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.3201\/eid2907.230231","article-title":"Estimating Waterborne Infectious Disease Burden by Exposure Route, United States, 2014","volume":"29","author":"Gerdes","year":"2023","journal-title":"Emerg. Infect. Dis."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1016\/j.marpolbul.2019.04.073","article-title":"The application of quantitative microbial risk assessment to natural recreational waters: A review","volume":"144","author":"Federigi","year":"2019","journal-title":"Mar. Pollut. Bull."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"4692","DOI":"10.1016\/j.watres.2010.06.048","article-title":"Predicting pathogen risks to aid beach management: The real value of quantitative microbial risk assessment (QMRA)","volume":"44","author":"Nicholas","year":"2010","journal-title":"Water Res."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"307","DOI":"10.3390\/pathogens4020307","article-title":"Waterborne Pathogens: Detection Methods and Challenges","volume":"4","author":"Jacques","year":"2015","journal-title":"Pathogens"},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1016\/j.scitotenv.2016.01.034","article-title":"Quantitative microbial risk assessment combined with hydrodynamic modelling to estimate the public health risk associated with bathing after rainfall events","volume":"548\u2013549","author":"Eregno","year":"2016","journal-title":"Sci. Total Environ."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1016\/j.scitotenv.2016.10.105","article-title":"Microbial quality of reclaimed water for urban reuses: Probabilistic risk-based investigation and recommendations","volume":"576","author":"Hewage","year":"2017","journal-title":"Sci. Total Environ."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"1812","DOI":"10.1016\/j.watres.2007.11.009","article-title":"Uncertainties in stormwater E. coli levels","volume":"42","author":"McCarthy","year":"2008","journal-title":"Water Res."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1016\/j.jhydrol.2016.01.040","article-title":"Uncertainty in monitoring E. coli concentrations in streams and stormwater runoff","volume":"534","author":"Harmel","year":"2016","journal-title":"J. Hydrol."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"115729","DOI":"10.1016\/j.watres.2020.115729","article-title":"Evaluating health risks associated with exposure to ambient surface waters during recreational activities: A systematic review and meta-analysis","volume":"176","author":"Russo","year":"2020","journal-title":"Water Res."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"1781","DOI":"10.2166\/wh.2024.081","article-title":"Assessing the impact of Escherichia coli on recreational water safety using quantitative microbial risk assessment","volume":"22","author":"Delair","year":"2024","journal-title":"J. Water Health"},{"key":"ref_117","doi-asserted-by":"crossref","unstructured":"Custodio, M., Pe\u00f1aloza, R., Ochoa, S., De la Cruz, H., and Rodr\u00edguez, C. (2023). Microbial and potentially toxic elements risk assessment in high Andean river water based on Monte Carlo simulation, Peru. Sci. Rep., 13.","DOI":"10.1038\/s41598-023-48853-4"},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"2789","DOI":"10.1021\/acsestwater.3c00652","article-title":"Quantitative Microbial Risk Assessment with Microbial Source Tracking for Mixed Fecal Sources Contaminating Recreational River Waters, Iowa, USA","volume":"4","author":"Burch","year":"2024","journal-title":"ACS ES&T Water"},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1111\/jam.12368","article-title":"Quantification of microbial risks to human health caused by waterborne viruses and bacteria in an urban slum","volume":"116","author":"Katukiza","year":"2014","journal-title":"J. Appl. Microbiol."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"114002","DOI":"10.1016\/j.ijheh.2022.114002","article-title":"Microbial contamination in surface water and potential health risks for peri-urban farmers of the Bengal delta","volume":"244","author":"Haldar","year":"2022","journal-title":"Int. J. Hyg. Environ. Health"},{"key":"ref_121","first-page":"100173","article-title":"Quantitative microbial risk assessment to estimate the public health risk from exposure to enterotoxigenic E. coli in drinking water in the rural area of Villapinzon, Colombia","volume":"18","author":"Cuesta","year":"2021","journal-title":"Microb. Risk Anal."},{"key":"ref_122","doi-asserted-by":"crossref","unstructured":"Nikolopoulou, D., Ntzani, E., Kyriakopoulou, K., Anagnostopoulos, C., and Machera, K. (2023). Priorities and Challenges in Methodology for Human Health Risk Assessment from Combined Exposure to Multiple Chemicals. Toxics, 11.","DOI":"10.3390\/toxics11050401"},{"key":"ref_123","doi-asserted-by":"crossref","unstructured":"Stefanidis, K., Oikonomou, A., Stoumboudi, M., Dimitriou, E., and Skoulikidis, N.T. (2021). Do Water Bodies Show Better Ecological Status in Natura 2000 Protected Areas Than Non-Protected Ones?\u2014The Case of Greece. Water, 13.","DOI":"10.3390\/w13213007"}],"container-title":["Toxics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2305-6304\/13\/10\/863\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T14:25:25Z","timestamp":1760538325000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2305-6304\/13\/10\/863"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,11]]},"references-count":123,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["toxics13100863"],"URL":"https:\/\/doi.org\/10.3390\/toxics13100863","relation":{},"ISSN":["2305-6304"],"issn-type":[{"value":"2305-6304","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,11]]}}}