Risk‐Based Decision Making for Reoccupation of Contaminated Areas Following a Wide‐Area Anthrax Release

This article presents an analysis of postattack response strategies to mitigate the risks of reoccupying contaminated areas following a release of Bacillus anthracis spores (the bacterium responsible for causing anthrax) in an urban setting. The analysis is based on a hypothetical attack scenario in which individuals are exposed to B. anthracis spores during an initial aerosol release and then placed on prophylactic antibiotics that successfully protect them against the initial aerosol exposure. The risk from reoccupying buildings contaminated with spores due to their reaerosolization and inhalation is then evaluated. The response options considered include: decontamination of the buildings, vaccination of individuals reoccupying the buildings, extended evacuation of individuals from the contaminated buildings, and combinations of these options. The study uses a decision tree to estimate the costs and benefits of alternative response strategies across a range of exposure risks. Results for best estimates of model inputs suggest that the most cost‐effective response for high‐risk scenarios (individual chance of infection exceeding 11%) consists of evacuation and building decontamination. For infection risks between 4% and 11%, the preferred option is to evacuate for a short period, vaccinate, and then reoccupy once the vaccine has taken effect. For risks between 0.003% and 4%, the preferred option is to vaccinate only. For risks below 0.003%, none of the mitigation actions have positive expected monetary benefits. A sensitivity analysis indicates that for high‐infection‐likelihood scenarios, vaccination is recommended in the case where decontamination efficacy is less than 99.99%.     

Bounding Analysis of Drinking Water Health Risks from a Spill of Hydraulic Fracturing Flowback Water

A bounding risk assessment is presented that evaluates possible human health risk from a hypothetical scenario involving a 10,000‐gallon release of flowback water from horizontal fracturing of Marcellus Shale. The water is assumed to be spilled on the ground, infiltrates into groundwater that is a source of drinking water, and an adult and child located downgradient drink the groundwater. Key uncertainties in estimating risk are given explicit quantitative treatment using Monte Carlo analysis. Chemicals that contribute significantly to estimated health risks are identified, as are key uncertainties and variables to which risk estimates are sensitive. The results show that hypothetical exposure via drinking water impacted by chemicals in Marcellus Shale flowback water, assumed to be spilled onto the ground surface, results in predicted bounds between 10⁻¹⁰ and 10⁻⁶ (for both adult and child receptors) for excess lifetime cancer risk. Cumulative hazard indices (HI_CUMULATIVE) resulting from these hypothetical exposures have predicted bounds (5th to 95th percentile) between 0.02 and 35 for assumed adult receptors and 0.1 and 146 for assumed child receptors. Predicted health risks are dominated by noncancer endpoints related to ingestion of barium and lithium in impacted groundwater. Hazard indices above unity are largely related to exposure to lithium. Salinity taste thresholds are likely to be exceeded before drinking water exposures result in adverse health effects. The findings provide focus for policy discussions concerning flowback water risk management. They also indicate ways to improve the ability to estimate health risks from drinking water impacted by a flowback water spill (i.e., reducing uncertainty).     

Potential Airborne Asbestos Exposure and Risk Associated with the Historical Use of Cosmetic Talcum Powder Products

Over time, concerns have been raised regarding the potential for human exposure and risk from asbestos in cosmetic‐talc–containing consumer products. In 1985, the U.S. Food and Drug Administration (FDA) conducted a risk assessment evaluating the potential inhalation asbestos exposure associated with the cosmetic talc consumer use scenario of powdering an infant during diapering, and found that risks were below levels associated with background asbestos exposures and risk. However, given the scope and age of the FDA's assessment, it was unknown whether the agency's conclusions remained relevant to current risk assessment practices, talc application scenarios, and exposure data. This analysis updates the previous FDA assessment by incorporating the current published exposure literature associated with consumer use of talcum powder and using the current U.S. Environmental Protection Agency's (EPA) nonoccupational asbestos risk assessment approach to estimate potential cumulative asbestos exposure and risk for four use scenarios: (1) infant exposure during diapering; (2) adult exposure from infant diapering; (3) adult exposure from face powdering; and (4) adult exposure from body powdering. The estimated range of cumulative asbestos exposure potential for all scenarios (assuming an asbestos content of 0.1%) ranged from 0.0000021 to 0.0096 f/cc‐yr and resulted in risk estimates that were within or below EPA's acceptable target risk levels. Consistent with the original FDA findings, exposure and corresponding health risk in this range were orders of magnitude below upper‐bound estimates of cumulative asbestos exposure and risk at ambient levels, which have not been associated with increased incidence of asbestos‐related disease.     

Aggregate Human Health Risk Assessment from Dust of Daily Life in the Urban Environment of Beijing

Because of the high emissions of polycyclic aromatic hydrocarbons (PAHs) into the environment by the increasing number of vehicles in Beijing and the absorption of these PAHs onto particulates, the performance of a preliminary health risk assessment of the aggregate exposure to PAHs of urban citizens in daily life is very important. Urban dust can be used to examine the aggregation of atmospheric particulates from local pollution sources over a long time period and the direct exposure of the urban human population. The environment's correlative with clothing, dining, residing, and traveling in urban daily life was assessed using exposure‐receptor‐oriented analysis. The multipathway exposure model was used to simulate the lifetime exposure of a female citizen to PAHs in dust. All of the PAH concentrations in dust for each behavior and its correlative environment in Beijing were acceptable because all of the carcinogenic risks of PAHs in the dust were approximately 1.0 × 10^–6. The dominant induced carcinogenic risks in the dust were Benzo(a)pyrene and Dibenzo(a,h)anthracene. The main carcinogenic risk routes for humans were dermal contact and oral intake, which contributed on average 99.78% of the risk. Indoor risk is especially important, as the decoration and height within the building were important impact factors for carcinogenic risk induced by indoor PAHs. For people living in an urban area, a healthy lifestyle includes less decoration per room, living on a low floor, wearing a respirator, and reducing exposed skin area when traveling.     

Urban risks due to climate change in the Andean municipality of Pasto,Colombia: A Bayesian network approach

The current trends of climate change will increase people's exposure to urban risks related to events such as landslides, floods, forest fires, food production, health, and water availability, which are stochastic and very localized in nature. This research uses a Bayesian network (BN) approach to analyze the intensity of such urban risks for the Andean municipality of Pasto, Colombia, under climate change scenarios. The stochastic BN model is linked to correlational models and local scenarios of representative concentration trajectories (RCP) to project the possible risks to which the municipality of Pasto will be exposed in the future. The results show significant risks in crop yields, food security, water availability and disaster risks, but no significant risks on the incidence of acute diarrheal diseases (ADD) and acute respiratory infections (ARI), whereas positive outcomes are likely to occur in livestock production, influenced by population growth. The advantage of the BN approach is the possibility of updating beliefs in the probabilities of occurrence of events, especially in developing, intermediate cities with information-limited contexts.     

A Risk Assessment Model to Evaluate the Role of Fecal Contamination in Recreational Water on the Incidence of Cryptosporidiosis at the Community Level in Ontario

A quantitative microbial risk assessment model was developed to simulate the role of recreational water contact in the transmission of cryptosporidiosis in a model Ontario community. Stochastic simulations were based on plausible modes of contamination of a pool (literature derived), river (site-specific), and recreational lakes (literature derived). The highest estimated risks of infection were derived from the (highly contaminated) recreational lake scenario, considered the upper end for risk of infection for both children (10 infections per 1,000 swims [5‰: two infections per 1,000 swims; 95‰: three infections per 100 swims]) and adults (four infections per 1,000 swims [5‰: four infections per 1,000 swims; 95‰: one infection per 100 swims]). Simulating the likely  Cryptosporidium  oocyst concentration in a lane pool that a child would be exposed to following a diarrheal fecal release event resulted in the third highest mean risk of infection (four infections per 10,000 swims [5‰: three infections per 100,000; 95‰: 10 infections per 10,000 swims]). The findings from this study illustrate the need for systematic and standardized research to quantify  Cryptosporidium  oocyst levels in Canadian public pools and recreational beaches. There is also a need to capture the swimming practices of the Canadian public, including most common forms and frequency measures. The study findings suggest that swimming in natural swim environments and in pools following a recent fecal contamination event pose significant public health risks. When considering these risks relative to other modes of cryptosporidiosis transmission, they are significant.     

Assessments of Direct Human Exposure—The Approach of EU Risk Assessments Compared to Scenario-Based Risk Assessment

The awareness of potential risks emerging from the use of chemicals in all parts of daily life has increased the need for risk assessments that are able to cover a high number of exposure situations and thereby ensure the safety of workers and consumers. In the European Union (EU), the practice of risk assessments for chemicals is laid down in a Technical Guidance Document; it is designed to consider environmental and human occupational and residential exposure. Almost 70 EU risk assessment reports (RARs) have been finalized for high-production-volume chemicals during the last decade. In the present study, we analyze the assessment of occupational and consumer exposure to trichloroethylene and phthalates presented in six EU RARs. Exposure scenarios in these six RARs were compared to scenarios used in applications of the scenario-based risk assessment approach to the same set of chemicals. We find that scenarios used in the selected EU RARs to represent typical exposure situations in occupational or private use of chemicals and products do not necessarily represent worst-case conditions. This can be due to the use of outdated information on technical equipment and conditions in workplaces or omission of pathways that can cause consumer exposure. Considering the need for exposure and risk assessments under the new chemicals legislation of the EU, we suggest that a transparent process of collecting data on exposure situations and of generating representative exposure scenarios is implemented to improve the accuracy of risk assessments. Also, the data sets used to assess human exposure should be harmonized, summarized in a transparent fashion, and made accessible for all risk assessors and the public.     

Awareness of Bad News, Environmental Attitudes, and Subjective Estimates of Coastal Pollution

Questionnaires distributed to 154 holiday-makers on beaches in Southwest England assessed awareness of local hazards or incidents associated with either the electricity supply industry or the water and sewage industry and examined the relationship between awareness and evaluations of the industry, current and future levels of pollution on the beach in question, and general levels of concern about environmental pollution. With respect to electricity, those respondents who were more aware of reports claiming a higher incidence of childhood leukemia in the vicinity of a nearby nuclear plant evaluated the electricity industry as less competent or trustworthy, showed higher levels of environmental concern, and were more pessimistic in their estimates of present and future levels of specific pollutants on their beach. With respect to the water industry, similar effects were associated with greater awareness of an accident at a water treatment plant and agricultural pollution of a nearby estuary. These findings are interpreted as suggesting a cyclical relationship between risk awareness and concern. On the one hand, reports about environmental hazards may lead to generalized concern across specific contexts; on the other hand, greater levels of concern may sensitize individuals to such reports.     

Consumption of Fish and Shrimp from Southeast Louisiana Poses No Unacceptable Lifetime Cancer Risks Attributable to High‐Priority Polycyclic Aromatic Hydrocarbons

Following oil spills such as the Deepwater Horizon accident (DWH), contamination of seafood resources and possible increased health risks attributable to consumption of seafood in spill areas are major concerns. In this study, locally harvested finfish and shrimp were collected from research participants in southeast Louisiana and analyzed for polycyclic aromatic hydrocarbons (PAHs). PAHs are some of the most important chemicals of concern regarding oil‐spill‐contaminated seafood resources during and following oil spills. Some PAHs are considered carcinogens for risk assessment purposes, and currently, seven of these can be combined in lifetime cancer risk assessments using EPA approaches. Most PAHs were not detected in these samples (minimum detection limits ranged from 1.2 to 2.1 PPB) and of those that were detected, they were generally below 10 PPB. The pattern of detected PAHs suggested that the source of these chemicals in these seafood samples was not a result of direct contact with crude oil. Lifetime cancer risks were assessed using conservative assumptions and models in a probabilistic framework for the seven carcinogenic PAHs. Lifetime health risks modeled using this framework did not exceed a 1/10,000 cancer risk threshold. Conservative, health‐protective deterministic estimates of the levels of concern for PAH chemical concentration and seafood intake rates were above the concentrations and intake rates modeled under this probabilistic framework. Taken together, consumption of finfish and shrimp harvested from southeast Louisiana following the DWH does not pose unacceptable lifetime cancer risks from these seven carcinogenic PAHs even for the heaviest possible consumers.     

An Ecological Risk Assessment of Nonnative Boas and Pythons as Potentially Invasive Species in the United States

The growing international trade in live wildlife has the potential to result in continuing establishment of nonnative animal populations in the United States. Snakes may pose particularly high risks as potentially invasive species, as exemplified by the decimation of Guam's vertebrate fauna by the accidentally introduced brown tree snake. Herein, ecological and commercial predictors of the likelihood of establishment of invasive populations were used to model risk associated with legal commercial imports of 23 species of boas, pythons, and relatives into the United States during the period 1989-2000. Data on ecological variables were collected from multiple sources, while data on commercial variables were collated from import records maintained by the U.S. Fish and Wildlife Service. Results of the risk-assessment models indicate that species including boa constrictors (Boa constrictor), ball pythons (Python regius), and reticulated pythons (P. reticulatus) may pose particularly high risks as potentially invasive species. Recommendations for reducing risk of establishment of invasive populations of snakes and/or pathogens include temporary quarantine of imports to increase detection rates of nonnative pathogens, increasing research attention to reptile pathogens, reducing the risk that nonnative snakes will reach certain areas with high numbers of federally listed species (such as the Florida Keys), and attempting to better educate individuals purchasing reptiles.     

Multimedia Benchmarking Analysis for Three Risk Assessment Models: RESRAD, MMSOILS, and MEPAS

This paper is one in a series that describes results of a benchmarking analysis initiated by the Department of Energy (DOE) and the United States Environmental Protection Agency (EPA). An overview of the study is provided in a companion paper by Laniak et al. presented in this journal issue. The three models used in the study—RESRAD (DOE), MMSOILS (EPA), and MEPAS (DOE)—represent analytically-based tools that are used by the respective agencies for performing human exposure and health risk assessments. Both single media and multimedia benchmarking scenarios were developed and executed. In this paper, the multimedia scenario is examined. That scenario consists of a hypothetical landfill that initially contained uranium-238 and methylene chloride. The multimedia models predict the fate of these contaminants, plus the progeny of uranium-238, through the unsaturated zone, saturated zone, surface water, and atmosphere. Carcinogenic risks are calculated from exposure to the contaminants via multiple pathways. Results of the tests show that differences in model endpoint estimates arise from both differences in the models' mathematical formulations and assumptions related to the implementation of the scenarios.     

A Bayesian Belief Network Model Assessing the Risk to Wastewater Workers of Contracting Ebola Virus Disease During an Outbreak

During an outbreak of Ebola virus disease (EVD), hospitals’ connections to municipal wastewater systems may provide a path for patient waste bearing infectious viral particles to pass from the hospital into the wastewater treatment system, potentially posing risks to sewer and wastewater workers. To quantify these risks, we developed a Bayesian belief network model incorporating data on virus behavior and survival along with structural characteristics of hospitals and wastewater treatment systems. We applied the model to assess risks under several different scenarios of workers’ exposure to wastewater for a wastewater system typical of a mid‐sized U.S. city. The model calculates a median daily risk of developing EVD of approximately 6.1×10⁻¹² (90% confidence interval: 1.0×10⁻¹² to 5.4×10⁻⁹; mean 1.8×10⁻⁶) when no prior exposure conditions are specified. Under a worst‐case scenario in which a worker stationed in the sewer adjacent to the hospital accidentally ingests several drops (0.35 mL) of wastewater, median risk is 5.8×10⁻⁴ (90% CI: 8.8×10⁻⁷ to 9.5×10⁻²; mean 3.2×10⁻²) . Disinfection of patient waste with peracetic acid for 15 minutes prior to flushing decreases the estimated median risk to 3.8×10⁻⁷ (90% CI: 4.1×10⁻⁹ to 8.6×10⁻⁵; mean 2.9×10⁻⁵). The results suggest that requiring hospitals to disinfect EVD patient waste prior to flushing may be advisable. The modeling framework can provide insight into managing patient waste during future outbreaks of highly virulent infectious pathogens.     

Regional Risk Assessment for Point Source Pollution Based on a Water Quality Model of the Taipu River,China

Point source pollution is one of the main threats to regional environmental health. Based on a water quality model, a methodology to assess the regional risk of point source pollution is proposed. The assessment procedure includes five parts: (1) identifying risk source units and estimating source emissions using Monte Carlo algorithms; (2) observing hydrological and water quality data of the assessed area, and evaluating the selected water quality model; (3) screening out the assessment endpoints and analyzing receptor vulnerability with the Choquet fuzzy integral algorithm; (4) using the water quality model introduced in the second step to predict pollutant concentrations for various source emission scenarios and analyzing hazards of risk sources; and finally, (5) using the source hazard values and receptor vulnerability scores to estimate overall regional risk. The proposed method, based on the Water Quality Analysis Simulation Program (WASP), was applied in the region of the Taipu River, which is in the Taihu Basin, China. Results of source hazard and receptor vulnerability analysis allowed us to describe aquatic ecological, human health, and socioeconomic risks individually, and also integrated risks in the Taipu region, from a series of risk curves. Risk contributions of sources to receptors were ranked, and the spatial distribution of risk levels was presented. By changing the input conditions, we were able to estimate risks for a range of scenarios. Thus, the proposed procedure may also be used by decisionmakers for long‐term dynamic risk prediction.     

Estimating Contaminant Dose for Intermittent Dermal Contact: Model Development, Testing, and Application

Assessments of aggregate exposure to pesticides and other surface contamination in residential environments are often driven by assumptions about dermal contacts. Accurately predicting cumulative doses from realistic skin contact scenarios requires characterization of exposure scenarios, skin surface loading and unloading rates, and contaminant movement through the epidermis. In this article we (1) develop and test a finite-difference model of contaminant transport through the epidermis; (2) develop archetypal exposure scenarios based on behavioral data to estimate characteristic loading and unloading rates; and (3) quantify 24-hour accumulation below the epidermis by applying a Monte Carlo simulation of these archetypal exposure scenarios. The numerical model, called Transient Transport through the epiDERMis (TTDERM), allows us to account for variable exposure times and time between exposures, temporal and spatial variations in skin and compound properties, and uncertainty in model parameters. Using TTDERM we investigate the use of a macro-activity parameter (cumulative contact time) for predicting daily (24-hour) integrated uptake of pesticides during complex exposure scenarios. For characteristic child behaviors and hand loading and unloading rates, we find that a power law represents the relationship between cumulative contact time and cumulative mass transport through the skin. With almost no loss of reliability, this simple relationship can be used in place of the more complex micro-activity simulations that require activity data on one- to five-minute intervals. The methods developed in this study can be used to guide dermal exposure model refinements and exposure measurement study design.     

Sensitivity of Concentration and Risk Predictions in the PRESTO and MMSOILS Multimedia Models: Regression Technique Assessment

This paper describes the application of two multimedia models, PRESTO and MMSOILS, to predict contaminant migration from a landfill that contains an organic chemical (methylene chloride) and a radionuclide (uranium-238). Exposure point concentrations and human health risks are predicted, and distributions of those predictions are generated using Monte Carlo techniques. Analysis of exposure point concentrations shows that predictions of uranium-238 in groundwater differ by more than one order of magnitude between models. These differences occur mainly because PRESTO simulates uranium-238 transport through the groundwater using a one-dimensional algorithm and vertically mixes the plume over an effective mixing depth, whereas MMSOILS uses a three-dimensional algorithm and simulates a plume that resides near the surface of the aquifer.A sensitivity analysis, using stepwise multiple linear regression, is performed to evaluate which of the random variables are most important in producing the predicted distributions of exposure point concentrations and health risks. The sensitivity analysis shows that the predicted distributions can be accurately reproduced using a small subset of the random variables. Simple regression techniques are applied, for comparison, to the same scenarios, and results are similar. The practical implication of this analysis is the ability to distinguish between important versus unimportant random variables in terms of their sensitivity to selected endpoints.     

Hazard Perception, Risk Perception, and the Need for Decontamination by Residents Exposed to Soil Pollution: The Role of Sustainability and the Limits of Expert Knowledge

This case study examines the hazard and risk perception and the need for decontamination according to people exposed to soil pollution. Using an ecological-symbolic approach (ESA), a multidisciplinary model is developed that draws upon psychological and sociological perspectives on risk perception and includes ecological variables by using data from experts' risk assessments. The results show that hazard perception is best predicted by objective knowledge, subjective knowledge, estimated knowledge of experts, and the assessed risks. However, experts' risk assessments induce an increase in hazard perception only when residents know the urgency of decontamination. Risk perception is best predicted by trust in the risk management. Additionally, need for decontamination relates to hazard perception, risk perception, estimated knowledge of experts, and thoughts about sustainability. In contrast to the knowledge deficit model, objective and subjective knowledge did not significantly relate to risk perception and need for decontamination. The results suggest that residents can make a distinction between hazards in terms of the seriousness of contamination on the one hand, and human health risks on the other hand. Moreover, next to the importance of social determinants of environmental risk perception, this study shows that the output of experts' risk assessments—or the objective risks—can create a hazard awareness rather than an alarming risk consciousness, despite residents' distrust of scientific knowledge.     

Validation of a Novel Air Toxic Risk Model with Air Monitoring

Three modeling systems were used to estimate human health risks from air pollution: two versions of MNRiskS (for Minnesota Risk Screening), and the USEPA National Air Toxics Assessment (NATA). MNRiskS is a unique cumulative risk modeling system used to assess risks from multiple air toxics, sources, and pathways on a local to a state‐wide scale. In addition, ambient outdoor air monitoring data were available for estimation of risks and comparison with the modeled estimates of air concentrations. Highest air concentrations and estimated risks were generally found in the Minneapolis‐St. Paul metropolitan area and lowest risks in undeveloped rural areas. Emissions from mobile and area (nonpoint) sources created greater estimated risks than emissions from point sources. Highest cancer risks were via ingestion pathway exposures to dioxins and related compounds. Diesel particles, acrolein, and formaldehyde created the highest estimated inhalation health impacts. Model‐estimated air concentrations were generally highest for NATA and lowest for the AERMOD version of MNRiskS. This validation study showed reasonable agreement between available measurements and model predictions, although results varied among pollutants, and predictions were often lower than measurements. The results increased confidence in identifying pollutants, pathways, geographic areas, sources, and receptors of potential concern, and thus provide a basis for informing pollution reduction strategies and focusing efforts on specific pollutants (diesel particles, acrolein, and formaldehyde), geographic areas (urban centers), and source categories (nonpoint sources). The results heighten concerns about risks from food chain exposures to dioxins and PAHs. Risk estimates were sensitive to variations in methodologies for treating emissions, dispersion, deposition, exposure, and toxicity.     

Validation of Multimedia Models Assessing Exposure to PAHs—The SOLEX Study

Polluted soils have become a public health problem. While population exposure to soil pollutants is generally quantified using multimedia models, their estimations have not been validated, and studies that attempted to do so are scarce. The objective of the SOLEX study was to compare the predictions of pyrene exposure levels (converted into 1 hydroxypyrene) computed by several models with the results of urinary 1-hydropyrene (1-HOP) assays among 110 employees working at three sites polluted during their past use as manufactured gas plants. Four models were used: AERIS (Canada), CalTOX (California, USA), CLEA (UK), and HESP (The Netherlands). Three occupational exposure scenarios--with office, mixed, and outdoor workers--were constructed, based upon job activities during two measurement campaigns, one in winter and one in summer. The exposure levels estimated by the four models could differ markedly (from 7 up to 80 times) according to the exposure scenario. Also, the predominant exposure routes differed according to the model (direct soil ingestion for HESP and CalTOX, inhalation for AERIS, and dermal absorption for CLEA). The predictions of CalTOX are consistent with the 1-HOP measurements for all the scenarios. For HESP, the consistency is observed for the scenarios, office and mixed, for which the pyrene level in the soil is low. AERIS and CLEA yield results that are systematically above the 1-HOP measurements. This study confirms that validation of the models is crucial and points out to the need to proceed to assess components of the models that are the most influential using appropriate statistical analysis in combination with true field data.     

Effect of Climate Change on the Concentration and Associated Risks of Vibrio Spp. in Dutch Recreational Waters

Currently, the number of reported cases of recreational‐ water‐related Vibrio illness in the Netherlands is low. However, a notable higher incidence of Vibrio infections has been observed in warm summers. In the future, such warm summers are expected to occur more often, resulting in enhanced water temperatures favoring Vibrio growth. Quantitative information on the increase in concentration of Vibrio spp. in recreational water under climate change scenarios is lacking. In this study, data on occurrence of Vibrio spp. at six different bathing sites in the Netherlands (2009–2012) were used to derive an empirical formula to predict the Vibrio concentration as a function of temperature, salinity, and pH. This formula was used to predict the effects of increased temperatures in climate change scenarios on Vibrio concentrations. For Vibrio parahaemolyticus, changes in illness risks associated with the changed concentrations were calculated as well. For an average temperature increase of 3.7 °C, these illness risks were calculated to be two to three times higher than in the current situation. Current illness risks were, varying per location, on average between 10^?4 and 10^?2 per person for an entire summer. In situations where water temperatures reached maximum values, illness risks are estimated to be up to 10^?2 and 10^?1. If such extreme situations occur more often during future summers, increased numbers of ill bathers or bathing‐water‐related illness outbreaks may be expected.