The AWARE project is organized into six different but complementary work packages:
The responsible institutions are:
- RIVM: National Institute for Public Health and the Environment (the Netherlands).
- LMU: University of Munich (Germany).
- UB: University of Bucharest (Romania).
- UGOT: University of Gothenborg (Sweden).
This figure shows the succession of work packages and research activities during AWARE- WWTP.
Kick Off (KO), Progress Meeting (PM) and Final Meeting (FM) are indicated and expected to take place in May 2017, September 2018 and November 2019, respectively.
Participants: RIVM, UB
It is currently unknown to what extent environmental exposures to AMR enhance human colonization. WWTPs represent an ideal study case for this question, because due to high amounts of AMR occurring in wastewater, workers and nearby residents are possibly highly exposed.
In WP1, an epidemiological study of carriage of ESBL, CPE and resistance genes in workers working at WWTPs and in residents living in different distances to WWTPs will be conducted.
Relation with objectives
This WP contributes mainly to the objectives 1 and 2 (occupational and environmental health impact of exposure to ARB/ARG).
Participants: LMU, RIVM
The combination of epidemiological studies in WWTP workers and nearby residents with studies of the occurrence and transmission of AMR in the WWTP environment requires careful alignment of sample selection and sampling procedures.
In WP2, sampling plans and protocols will be set up for 3 countries with low and high AMR, including human and environmental sampling.
Participants: RIVM, UB
The link between environmental and workers'/residents' resistomes in WWTP is currently unknown. Full characterization of resistomes and ESBL/CPE isolates in both humans and environmental matrices allows strengthening the link between exposure and carriage.
in WP3, bacterial isolates and metagenomic DNA of environmental and human samples will be characterized in depth (also to identify novel resistance genes), and in addition, the treatment efficiency of different WWTP processes with respect to AMR will be established.
In WP4, exposure models and geospatial analyses will be established that describe WWTP exposure to ESBL and CPE by inhalation and ingestion. In combination with data from WP1, dose-response relations will be generated.
Participants: UB, RIVM, UGOT
Public and professional awareness of the relevance of environmental exposures to AMR is limited.
In WP5, results of AWARE-WWTP are effectively disseminated to relevant stakeholders and the wider public.
WP6 lays out the project management and project coordination.