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Objectives

The specific objectives of our study are:

  • to study the occupational and environmental health impact of exposure to resistant bacteria and resistance genes stemming from WWTP through epidemiological studies of their carriage in exposed versus unexposed controls,
  • to study human waterborne and airborne exposure through models for uptake through ingestion and inhalation,
  • to assess the efficiency of different WWTP treatment technologies,
  • to investigate selection and emergence of resistance in WWTP through studying relative changes in resistance genes and exploring putative novel resistance genes,
  • to disseminate the results of this project


AWARE-WWTP is an observational, cross-sectional, and multicentric study to be carried out by teams in Germany, the Netherlands, Romania, and Sweden. Within this project, data on ESBL, CPE, and resistance gene prevalence gathered in air and water samples as well as in workers and residents of 80-100 different WWTPs in three countries enable us to assess the health impact of exposure in and around WWTPs. Through quantifying the contribution of different wastewater treatment processes to the ARB/ARG removal efficiency, we will provide evidence-based support for possible mitigations. This project addresses transmission of resistant bacteria and resistance genes resulting from human exposure within and around wastewater treatment plants (WWTP).