key: cord-0754189-h20h7mno authors: Nag, Rajat; Whyte, Paul; Markey, Bryan K.; O'Flaherty, Vincent; Bolton, Declan; Fenton, Owen; Richards, Karl G.; Cummins, Enda title: Ranking hazards pertaining to human health concerns from land application of anaerobic digestate date: 2020-03-25 journal: Sci Total Environ DOI: 10.1016/j.scitotenv.2019.136297 sha: 4f978d584b129046e3f2129353f04d04b987a640 doc_id: 754189 cord_uid: h20h7mno Anaerobic digestion (AD) has been identified as one of the cleanest producers of green energy. AD typically uses organic materials as feedstock and, through a series of biological processes, produces methane. Farmyard manure and slurry (FYM&S) are important AD feedstock and are typically mixed with agricultural waste, grass and/or food wastes. The feedstock may contain many different pathogens which can survive the AD process and hence also possibly be present in the final digestate. In this study, a semi-quantitative screening tool was developed to rank pathogens of potential health concern emerging from AD digestate. A scoring system was used to categorise likely inactivation during AD, hazard pathways and finally, severity as determined from reported human mortality rates, number of global human-deaths and infections per 100,000 populations. Five different conditions including mesophilic and thermophilic AD and three different pasteurisation conditions were assessed in terms of specific pathogen inactivation. In addition, a number of scenarios were assessed to consider foodborne incidence data from Ireland and Europe and to investigate the impact of raw FYM&S application (without AD and pasteurisation). A sensitivity analysis revealed that the score for the mortality rate (S3) was the most sensitive parameter (rank coefficient 0.49) to influence the final score S; followed by thermal inactivation score (S1, 0.25) and potential contamination pathways (S2, 0.16). Across all the scenarios considered, the screening tool prioritised Cryptosporidium parvum, Salmonella spp., norovirus, Streptococcus pyogenes, enteropathogenic E. coli (EPEC), Mycobacterium spp., Salmonella typhi (followed by S. paratyphi), Clostridium spp., Listeria monocytogenes and Campylobacter coli as the highest-ranking pathogens of human health concern resulting from AD digestate in Ireland. This tool prioritises potentially harmful pathogens which can emerge from AD digestate and highlights where regulation and intervention may be required. Harmful pathogens can be present in higher concentrations in animal FYM&S (Jones and Martin, 2003; Avery et al., 2004; Nicholson et al., 2005) compared to food waste (Jones and Martin, 2003) , grass and agricultural residues (Seadi and Lukehurst, 2012) . Hutchison et al. (2004) reported high numbers of zoonotic pathogens (E. coli O157, Salmonella, Listeria monocytogenes, Campylobacter, Cryptosporidium parvum, Giardia intestinalis) in both fresh and stored animal waste (cattle, pig, poultry and sheep). The application of raw manure and slurry is standard practice on farms to utilise animal waste while also replenishing nutrients to the soil (Szogi et al., 2015) . AD is a process which can also use FYM&S as a feedstock and, by the action of microorganisms, break down biodegradable organic compounds into simpler molecules in the absence of oxygen to produce methane (Abbasi et al., 2012; Manyi-Loh et al., 2013 . The methane can also be cleaned and use as a fossil fuel replacement for transport and domestic use (Purdy et al., 2018) . Another advantage of AD is that the process itself can inactivate pathogens; however, complete inactivation is not always achieved; for example, Smith et al. (2005) reported a 2 log reduction in E. coli could be achieved by mesophilic AD (M-AD). However, E. coli can be present as high as 6 log CFU g −1 in fresh cattle manure and therefore, there is the potential for E. coli to survive the M-AD process. AD processes typically fall into three types (i) mesophilic (35 to 45°C) AD (or M-AD), (ii) thermophilic (45 to 80°C) AD (or T-AD) and (iii) two-step/phase AD; which is a combination of M-AD and T-AD (Sakar et al., 2009; Abbasi et al., 2012; Manyi-Loh et al., 2013; Vanegas and Bartlett, 2013) . M-AD is the most common system in Ireland (Smyth et al., 2009 ). It has a more stable operation but a lower biogas production rate compared to other types of AD. In contrast, the higher temperature process (T-AD) reduces pathogen numbers even further and provides more rapid reaction rates than M-AD (Mahmud et al., 2016) . Process parameters such as temperature, pH, hydraulic retention time, organic loading rate, carbon-nitrogen ratio and free ammonia presence can also have a significant influence on pathogen inactivation (Sakar et al., 2009; Abbasi et al., 2012; Manyi-Loh et al., 2013) . Waste-to-energy processes can play a role in the transition to a circular economy (European Commission, 2017) . In the future, more consideration should be given to AD of biodegradable waste, where material recycling is combined with energy recovery (European Commission, 2017) . Given the drive for renewable energy sources, the use of AD to process waste streams is likely to increase. There is a concern that several pathogens of significance may survive the process. Therefore, this study examined whether AD process residues (i.e. digestate) could re-enter the circular economy (Longhurst et al., 2019) by exploring issues of potential human, animal and environmental risk; and emphasises the considerable weight of evidence required to inform stakeholders of the safety of digestate. Several additional methods can be used in conjunction with AD to reduce the number of pathogens in the final digestate. These include treatment with lime, chlorine, UV-light, ozone, high internal pressure in the vessel (Alvarez et al., 2003; Erickson and Ortega, 2006) or most commonly an additional heat treatment (pasteurisation) step (Smith et al., 2005) . The European Commission recommends pasteurisation (heat treatment) at 70°C for 1 h for feedstock before the AD process; whereas, there is a national transformative parameter recommendation of 60°C for 48 continuous hours twice (DAFM, 2014) in Ireland. All these processes influence the level of pathogens in the final AD digestate, which is destined for application to agricultural land. Several disease outbreaks have been observed in Europe over the last 20 years (Eurosurveillance, 2019) as highlighted in Fig. 1 . It is understood that Salmonella, influenza virus, measles virus, Cryptosporidium and E. coli are the top five pathogens which have been responsible for several human health outbreaks in Europe; however, influenza virus and measles virus can only be transmitted from person to person (Waring et al., 2005; Li et al., 2009; Borges et al., 2016) . In terms of the application of AD digestate to the agricultural land person to person is a non-critical pathway. Airborne, foodborne, waterborne and animal contact (zoonotic) diseases are of greatest human health concern (Health Service Executive, 2019). Foodborne illness (gastroenteritis) is a particular global health concern (WHO, 2008; Thomas et al., 2013; Torgerson et al., 2015) . Nag et al. (2019) mentioned that the application of raw FYM&S and anaerobic digestate could possibly play a role in pathogen transportation from agricultural land to humans through the food chain (mainly ready to eat RTE crops). According to TIME Health (2017), 351,000 people die of food-poisoning globally every year. Foodborne disease means, according to WHO (2008) , any disease of an infectious or toxic nature caused by consumption of food and a foodborne disease outbreak can be defined in the following ways, a) The observed number of cases of disease exceeds the expected number b) The occurrence of two or more cases of a similar foodborne disease resulting from the ingestion of a common food. The Health Protection Surveillance Centre (HSE, 2019) cited by Nag et al. (2019) suggests that Clostridium, Cryptosporidium, E. coli, Salmonella are the main pathogens of human health concern in Ireland. This highlights the importance of considering the severity (fatality/mortality rate) rather than simply the number of confirmed cases in an outbreak. Tropical diseases; mostly parasites (helminths) and some viral diseases such as yellow fever virus, West Nile virus, dengue virus, tick-borne encephalitis virus, zika virus, ebola virus, lassa virus, marburg virus (Hotez et al., 2007) are not common in Ireland and there is no historical evidence of such outbreaks in Europe. In some countries such as Denmark, animal manure is treated with mixed municipal sewage (Hartmann et al., 2002) . Therefore, pathogens which are present both in animal manure, slurry and human effluent need to be considered in the European context. In contrast, grass, agriculture residues, animal manure and slurry, the organic fraction of municipal solid waste (comprises food and garden waste only) are considered the only feedstock used in AD plants in Ireland (Singh et al., 2010) . The pathogens which have possible transmission pathways such as air, soil or food, water, and animal contact/zoonotic were considered for this study, while diseases which can be spread only by person-to-person contact (HPSC, 2005) or insect bites were excluded. It is widely accepted as good practice in risk assessments to carry out an initial screening to identify hazards of greatest concern. There are two broad methods of risk assessment; qualitative and quantitative. When there are limited data a qualitative approach is recommended for decision making (Lammerding and Fazil, 2000) . A semiquantitative model is a bridge between qualitative and quantitative risk assessment models where risk factor categories are typically given a score and final risk scores calculated (Teunis and Schijven, 2019). The principal hypothesis of this study was "Pathogens have a different propensity to survive the AD process while also potentially affecting humans through different pathways". Hence, the overall aim of this study was to identify the key hazardous pathogens of potential human health concern in Europe and specifically in the Republic of Ireland which can be transmitted through FYM&S and anaerobic digestate using a semi-quantitative screening method. In this study, a semi-quantitative screening method was developed. A framework of the approach is given in Fig. 2 . Five different timetemperature conditions such as M-AD 37°C (4 days), T-AD 55°C (4 days), Irish pasteurisation 60°C (4 days), EU pasteurisation 70°C (60 min), and higher pasteurisation 90°C (60 min) were monitored (Table 1 ) for the baseline model (BM) to assess the likely fate of the pathogens after the AD process. As recommended by Nag et al. (2019) a semi-quantitative model was used in this study to rank the most hazardous pathogens depending on their ability to survive the AD process, the possible routes (aerosol, ingestion and direct contact) of transmission and the potential severity of illness. Indicator organisms are often used as surrogates for pathogens . Table 2 shows the widely accepted indicator organisms for such studies. Assessing the ability of the process to inactivate indicator organisms should provide a high degree of confidence regarding inactivation of comparable pathogens. As a primary qualitative/semi-quantitative screening process for risk assessment, the likelihood-severity (L × S matrix) approach has been used (Shariff and Zaini, 2013) . The likelihood (L) of exposure to pathogens is influenced by two parameters in this model; the first one is the inactivation of pathogens (S1) through the AD process and secondly, the ability of pathogens spreading through different environmental pathways (S2) (such as air, soil attached to food, water or animal contact). The mortality rate (S3) was used to consider the likely severity for humans following infection by a particular pathogen. Using the scientific literature (Carrington, 2001; Jones and Martin, 2003; Lepeuple et al., 2004; WHO, 2008; Longhurst et al., 2013; Torgerson et al., 2015) and the Eurosurveillance (2019) database, data from 300 outbreaks over the last 20 years were analysed (Fig. 2 ). This represents a broad list of hazards (Table S1 of the supplementary note) in the past which potentially represent a human health challenge. According to AFBI and DAFM (2019), gastrointestinal infection, respiratory infections, systemic infection, clostridial infection, cardiac and liver disease are the most common diseases in cattle. Whereas, sheep mortality is predominantly caused by parasitic diseases, respiratory infections, septicaemia, clostridial and enteric disease. Pneumonia, enteric infection, septicaemia and nervous system diseases are the predominant causes of pig mortality. Septicaemia, digestive, musculoskeletal, respiratory and parasitic diseases are common in the poultry industry. The relative frequency of pathogens found in post-mortem analysis on the carcass and faecal samples of dead animals are detailed in Table 3 . The fate and inactivation of pathogens under different process conditions varies greatly (Table S2 ) which makes it difficult to compare their behaviour under standard process conditions detailed in Table 1 . Hence, the 'Z' value concept, which indicates the temperature rise necessary to reduce the decimal reduction time ('D' value) by one log 10 (Juneja and Marmer, 1999; Bertolatti et al., 2001) , was used to compare the inactivation conditions. Thermal inactivation data for each of the pathogens were collected from the available literature with a specific focus on the time-temperature relationship with Z value (reference temperature at which the time-temperature inactivation tests were done) and Dref (duration of heating at Tref for complete inactivation of the pathogen). Songer (2010) indicated that microbial inactivation of spore-forming organisms is difficult as spores are much more heat resistant compared to the parent cells and spores can survive in the soil for many years (Sahlström, 2003) . Therefore, the spore-forming criteria (Table S2) were considered in order to select suitable indicator bacteria. For example, enterohemorrhagic E. coli O157: H7 can be inactivated at 55°C for 40 min; Eq. (1) can investigate whether inactivation occurs at 37°C (4 days), 55°C (4 days), 60°C (4 days), 70°C (60 min), and 90°C (60 min). Most of the references mentioned in Table S3 indicated a linear relationship between pathogen survival or inactivation and temperature at a shorter temperature range (35°C to 90°C). Hence, an appropriate temperature was adopted for the normalization process. For another example, Salmonella enterica spp. can be inactivated by heating at 60°C for 60 mins or 121°C for 15 min (Table S2) ; hence, the lower temperature-time (60°C for 60 mins) was adopted for calculation. Similarly, enterohemorrhagic E. coli O157: H7 can be inactivated by 55°C for 40 min or 45°C for 24 h (Table S2) ; therefore, 55°C for 40 min was adopted for the inactivation reference as it is closer to the mean temperature (62.4°C) of comparable scenarios (Table 1) . where, Score S1 Score pathogens based on inactivation: If inactivated through a process give score 0.001, if not, give the value using Equation 2 (between 0.001 and 1) Final score = S1 × S2 × S3 Compare with indicator pathogens and pathogens found in animal manure and slurry only Tref (°C) = reference temperature from the literature at which the time-temperature inactivation tests were done; for enterohemorrhagic E.coli O157: H7 example, say 55°C (from Table S2 ). Dref (min) = duration of heating at Tref for the experiment considering complete inactivation of the pathogen; for the above example, say 40 min (from Table S2 ). Zvalue (°C) = temperature rise necessary to reduce decimal reduction time by one logarithmic cycle; for the above example, a value of 9.15°C is used which is the average from two studies considered which give a Zvalue of 6°C and 12.3°C for reference temperatures 65°C and 50 to 70°C, respectively. (Table S2) . New Dvalue (min) (for mesophilic condition) = 40 ÷ 10 ((37-55)/ 9.15) = 3709 min (2.57 days). This New Dvalue is used to score (S1) pathogens (Eq. (2)). Similarly, new Dvalue (min) for thermophilic conditions (55°C) was 40 min (0.027 days); and for three pasteurisation conditions (60°C, 70°C, 90°C) it was calculated as 11.36 min, 0.917 min and 0.006 min, respectively. Hence, the bacteria could be fully inactivated through all AD and pasteurisation conditions. There are a lot of studies carried out using bacteria; however, there are gaps in the literature for fungi, Table 2 List of commonly used indicator pathogens. Indicator for Reference Escherichia coli Gram −ve, non-spore forming coliform bacteria (Johansson et al., 2005) Salmonella senftenberg Gram −ve, non-spore forming bacteria (Wheeler et al., 1943; Mocé-llivina et al., 2003) Enterococcus faecalis Gram + ve, non-spore forming bacteria (McFeters et al., 1974; Mocé-llivina et al., 2003; Sahlström, 2003; Anderson et al., 2005; Sidhu and Toze, 2009 ) Clostridium spp. Gram +ve, spore-forming bacteria (Payment and Franco, 1993; Ferguson et al., 1996; Fewtrell and Bartram, 2001 ) Mycobacterium spp. Acid-fast thermoresistant bacteria (Deb et al., 2009 ) Feline calicivirus (FCV) Virus. Non-envelope virus; more heat resistant. Enteric virus (gene levels of noroviruses) (Wong et al., 2010; Cook, 2013; Cromeans et al., 2014) Cryptosporidium parvum Parasites which was adopted for all viruses in the absence of data. The entire calculation for 91 pathogens is presented in Table S4 . A screening score was incorporated depending on the inactivation rate (S1) of the pathogen through the thermal process comparing the process duration (Table 1 ) and time required for full inactivation of the target pathogen (Fig. 2) . If the calculated 'New Dvalue' is lower than the process duration mentioned in Table 1 , S1 is set to 0.001otherwise, Bio-aerosols, water, ingestion of soil through food and direct contact with infected animals were identified as major hazard pathways and the main pathogens which are typically transmitted through those four pathways were identified from the literature (Ashbolt, 2004; Thomas et al., 2013; Arfken et al., 2015; Klous et al., 2016; Van Leuken et al., 2016; Conrad et al., 2017) . Score S2 was given (Table S5) according to their transmission likelihood (L). If a pathogen can travel through four media such as air, soil or food, water, and animal contact it achieved the highest accumulated score of 1 (0.25 for each pathway; for example, Cryptosporidium parvum). Otherwise, a score of 0.25 was given for each pathway (Fig. 2) . The mortality rate was selected to consider the severity on human health following infection; the score S3 represents the mortality rate from 0.1 to 1 (Figs. 2 and 3) where 0.1 stands for 10% and 1 corresponds to 100% mortality in untreated patients. In the absence of a mortality rate, the score was proposed based on the number of annual human deaths globally (Fig. 3) where 0 to 100 deaths were assigned a low score and N10,000 deaths corresponded to a high score. Infection or illness cases per 100,000 population was another alternative approach as mortality rate and global deaths due to all 91 pathogens was not available. A low score was given where infection or illness was b1 per 100,000 population; the value between 1 and 99 was assigned a moderate score; and, a high score was given to 100 or more incidents per 100,000 population (Fig. 3 ). If any of these three criteria were not fulfilled, a low score (0.3) was given for the consistency of the model (Fig. 3 ). This step was introduced to consider the 'severity' of the hazard within likelihood-severity (L × S) matrix. The final score S of the screening process was based on the multiplication of three individual scores S1, S2 and S3 (Eq. (3)). The scores were multiplied so the absence of any one score will result in the elimination of risk. In this part of the study, pathogens with the highest scores were cross-checked with the indicator pathogens. Pathogens were categorised mainly as bacteria, parasites and viruses. During this investigation, the authors considered parameters such as; mortality rate, host and reservoirs of pathogens, identification of vectors (secondary Note: The final score S for baseline model (BM) was calculated as S1 × S2 × S3 (Eq. (3)). source), survival conditions (aerobic/anaerobic/facultative/obligate), classification types (Gram-positive/negative), spore/egg forming potential, time-temperature condition for heat inactivation and incubation period (the period over which eggs, cells, etc. are incubated). Depending on these criteria, the appropriate indicators for the pathogens were assigned to check when indicator pathogens are inactivated through the process and assess the potential of survival of the top-ranked pathogens. Three scenarios were considered, scenario 1 was based on Ireland where pathogens associated with foodborne outbreaks in that country only were evaluated. In scenario 2 pathogens associated with any foodborne outbreak across Europe were incorporated into the model (Table 4) . Scenario 3 looked at the situation where there is no AD inactivation or pasteurisation (S1 = 0), which can be considered as representative of the application of raw FYM&S on to land. The methodology for Scenario A FOODIRE is similar to the BM; the only alteration was made in the S2 score. Instead of four pathways (air, soil or food, water, and animal contact), only the foodborne (including drinking water) pathway was considered (Table 4 ). Drinking water was considered as it is sometimes considered as a part of the food chain. However, 'waterborne' includes vast possibilities such as washing, swimming, drinking (with or without food), game/sports activity etc. (O'Flaherty and Cummins, 2017) . The total number of confirmed cases/100,000 population (notification rates) in Ireland (Table 5) was collected for each target pathogens from the EFSA reports (European Food Safety Authority, 2009 , 2010 , 2011 , 2015a , 2015b . Data for Cryptosporidium was collected from the Health Protection Surveillance Centre (HPSC) (2018). An appropriate relative score S3 IRE (ranging from 0.4 to 0.9; note of Table 5 ) was given depending on the 'confirmed cases/100,000 population' range (note , Table 5 ). Next, the final score (S) was calculated as S1 × S2 × S3 IRE similar to Eq. (3). Comparing to the Scenario A FOODIRE model, an alteration was made to check the scenario in Europe. Hence, the total number of confirmed cases/100,000 population in Europe was determined (Table 6 ) and the same data source (EFSA reports) was used for this scenario (Table 4 ). The relative score S3 EU (ranging from 0.4 to 0.9; note of Table 6 ) was given depending on the 'confirmed cases/100,000 population' range (note, Table 6 referred). Similarly to Eq. (3), the final score (S) was calculated as S1 × S2 × S3 EU . In this scenario (Scenario C RAWFYM&S ), a comparison was made between the digested and raw manure and slurry. This scenario looked at the fate of pathogens if no anaerobic digestion and pasteurisation were used on the pathogens. The S1 score has no influence in this regard as compared to the BM; which means the final score (S) was calculated as S2 multiplied by S3 only (Table 4 ). The list of pathogens and their susceptible host species, source, mortality information, available outbreak data are tabulated in Table S1 . egg forming ability, incubation period, growth/re-growth ability, and infectious dose (organisms) which helped to select indicators (Table 2) for this study. The physical inactivation data (time-temperature) and the 'Z' values were collected from available literature and summarised in Table S2 . Applying Eq. (1), new D values were calculated, and is presented in Table S4 for new temperature (Tnew) conditions (37°C, 55°C, 60°C, 70°C, and 90°C). An appropriate score (S3) was given according to Eq. (2) and the results are listed in Table S6 under the S1 column. Next, the second score S2 was evaluated accumulating the individual scores for different pathways and are described in Table S5 . After this process, the third score (S3 , Table S6 ) which is based on the mortality rate was applied to the pathogens comparing Tables S1 and S2. The three scores (S1, S2 and S3) were multiplied to get the final score (S) as presented in Table S6 and Fig. 4 . The maximum value was obtained for Cryptosporidium parvum (0.9). The highest-ranked 14 pathogens are plotted on a bar chart (Fig. 5) according to their order from high to low as Cryptosporidium parvum, Streptococcus pyogenes, Entamoeba histolytica, Salmonella enterica spp., Ascaris spp., enteropathogenic E. coli (EPEC), Mycobacterium spp., Salmonella typhi (followed by S. paratyphi), Giardia lamblia and Giardia intestinalis, Shigella spp., norovirus, Enterobacter spp., Clostridium spp. and Listeria monocytogenes. Fig. 6 indicated the final score (S) was b0.1 and for 48 pathogens whereas, only 11 pathogens scored N0.4. A comparison between the top-ranked pathogens (BM scenario) and the indicator pathogens is presented in Table 7 . The food scenarios (Scenario A FOODIRE and Scenario B FOODEU ) identified the top-ranked pathogens which are presented in the bar charts Fig. 7a and b , respectively. These pathogens are Cryptosporidium parvum, Salmonella enterica spp., Mycobacterium spp., E. coli enteropathogenic (EPEC), Toxoplasma gondii, Listeria monocytogenes, norovirus, Clostridium spp., Coxiella burnetti, Brucella spp., Yersinia enterocolitica, Echinococcus spp., Trichinella spp., Campylobacter coli, Vibrio spp. and hepatitis A-virus. The top 12 pathogens were ranked for Scenario C RAWFYM&S (Fig. 7c ) and these are, Cryptosporidium parvum, Campylobacter coli, Campylobacter jejuni, E-coli enterohamorrhagic (verotoxin) O157:H7, E. coli invasive & toxigenic, Salmonella enterica spp., norovirus, Salmonella typhi, Streptococcus pneumoniae, Streptococcus pyogenes, Entamoeba histolytica and rotavirus. Comparing the pathogens listed in Table 3 and S1 it can be concluded that pathogens such as Mycobacterium spp., Salmonella enterica spp., Listeria monocytogenes, Enterobacter spp., Clostridium spp. and E. coli are common both in human and animals. The common topranked pathogens which appeared in the BM (Fig. 5) , Scenario A FOODIRE (Fig. 7a) , Scenario B FOODEU (Fig. 7b) , and Scenario C RAWFYM&S (Fig. 7c ) models are Cryptosporidium parvum, Salmonella enterica spp., norovirus, Streptococcus pyogenes, Entamoeba histolytica, enteropathogenic E. coli (EPEC), Mycobacterium spp., Salmonella typhi followed by S. paratyphi, Clostridium spp., Listeria monocytogenes and Campylobacter coli. A comparison between results of A FOODIRE (Fig. 7a) and Scenario B FOODEU (Fig. 7b) highlights the difference between foodborne pathogens in Ireland and those found in the EU, with Cryptosporidium being noted as a greater issue in Ireland. According to the Health Protection Surveillance Centre (HPSC) (2018), there have been 400 to 600 cases (yearly) of cryptosporidiosis in Ireland since 2004. In the last scenario (Scenario C RAWFYM&S ), no heat treatment was applied in terms of AD or pasteurisation; the additional pathogens of concern were Campylobacter jejuni, Vibrio spp., hepatitis A-virus, E. coli O157:H7, E. coli invasive & toxigenic, Streptococcus pneumoniae and rotavirus. A comparison of Fig. 5 and 7c highlights the effect of M-AD in reducing the final risk score for Salmonella typhi (and S. paratyphi) and norovirus. Other pathogens remained unchanged in terms of the ranking score; such as Cryptosporidium parvum, Streptococcus pyogenes, Entamoeba histolytica and Salmonella enterica spp. highlighting their heat resistance. A sensitivity analysis was performed to find out the contribution of three scores S1, S2, and S3 to the final score S. The baseline model (BM) was used for sensitivity analysis (based on the top 14 pathogens). The correlation coefficient (Spearman rank) of three different scores S1, S2 and S3 were found as 0.25, 0.16 and 0.49, respectively (Fig. 8) . Fig. 8 represents a systematic evaluation of the influencing parameters on the final risk score. The bars extending to the right-hand side indicate a positive correlation between these model inputs and the final risk score. Consequently, the score due to the mortality rate (S3) was identified as the most sensitive parameter of the model followed by thermal inactivation (S1) and score for potential contamination pathways (S2). Again, in some pathogens, the final score (S) which was presented in the form of bars, could be visible only in mesophilic conditions (Fig. 4) . Therefore, it reinforces the influence of the inactivation score (Smith et al., 2005) on this screening method. A comparison with indicator pathogens (Table 7) gave confidence as out of seven indicators (Table 2) , six matched (except Enterococcus faecalis) with the top 14 screened pathogens. Enterococcus faecalis is an opportunistic pathogen which generally affects elderly patients with underlying disease and other immunocompromised patients who have been hospitalized for long periods (Public Health Agency of Canada, 2019). According to Oprea and Zervos (2007) , Enterococci are not classic foodborne pathogens. There are some animal pathogens other than those which are mentioned in Table S1 (AFBI and DAFM , 2016) . A list of pathogens (other than Table S1) causing disease in animals and not in humans are presented in be used to assess the pathogens of an animal health concern as a comparison between these pathogen and indicators used in the model can be readily carried out. In the absence of detailed thermal inactivation data (Tref, Dvalue and Zvalue), only a comparison was made to find out the indicators (final column of Table 8 ) and it is noted all indicators were already captured in this model (Table 7) . Feline calicivirus (FCV), which is a non-enveloped virus, is a more heat resistant enteric virus (used as a surrogate for noroviruses) and generally causes illness in cats (Wong et al., 2010; Cook, 2013; Cromeans et al., 2014) . However, it was not considered directly in the list of 91 pathogens as it is not likely to add a cat-carcass in an AD plant in Ireland. Finally, the choice of an indicator is very important and this can be limited to case-specific scenarios; for example, Cryptosporidium is a good indicator of parasites (matured cells); however, Ascaris eggs were found to be more resilient (Kato et al., 2004) Table 9 lists the pathogens (parasites) such as Ascaris, Ancylostoma duodenale, Toxocara spp., Trichinella spp., Entamoeba histolytica, Echinococcus multilocularis, and Echinococcus granulosus and the likely levels in urban wastewater and hospital waste; the presence of these pathogens in FYM&S is rare. It is not recommended to mix urban wastewater with FYM&S in an AD plant, hence limiting the likely presence of these parasites. Finally, this study looked to identify the top-ranked pathogens comparing common pathogens found in different scenarios such as BM, Scenario A FOODIRE (or Scenario B FOODEU ) and Scenario C RAWFYM&S (Table 10) . Table 10 provides a prioritisation of the highest-ranking pathogens likely to be of concern and requiring vigilance. The pathogens which appeared more than once in the scenarios (Table 10) are Cryptosporidium parvum, Salmonella enterica spp., norovirus, Streptococcus pyogenes, Entamoeba histolytica, E. coli enteropathogenic (EPEC), Mycobacterium spp., Salmonella typhi followed by S. paratyphi, Clostridium spp., Listeria monocytogenes and Campylobacter coli (11 in total). In Table 9 Likely levels and sources of parasites can be found in urban wastewater and hospital waste. Likely levels Unit Source Reference Ascaris 0.7 to 13.33 eggs l −1 Wastewater (Amahmid et al., 1999) 10.08 to 24.36 Urban raw wastewater (Maya et al., 2006; Hatam-Nahavandi et al., 2015) 1344 to 4116 Animal wastewater Ancylostoma duodenale 100-150 eggs g −1 Affected human stool (Anderson and Schad, 1985) Mean intensity of infection was 250.1 ± 64.4 Affected human stool (Reynoldson et al., 1997) Toxocara spp. 0-4.35 eggs g −1 Sand sample contaminated with faeces (Uga, 1993) Note: Highlighted pathogens are present in municipal wastewater only (Table 9 ) and therefore not considered. Ireland, the co-digestion of urban wastewater and FYM&S is unlikely (Singh et al., 2010) . Hence, Entamoeba histolytica may be excluded at this final stage of the hazard identification for Ireland. i. Plant pathogens were not considered. ii. Detailed thermal inactivation data (Tref, Dvalue and Zvalue) of animal pathogens (which cause illness to animals only, not human) is unavailable; hence, comparison with indicators was the only possible way to investigate them. iii. The model can be improved in the future when the mortality rate for all 91 pathogens will be available and S3 score could be based on the mortality rate only. This study developed a simple risk ranking methodology based upon inactivation of pathogens during AD, hazard pathway routes and human mortality rates. Cryptosporidium parvum, Salmonella spp., norovirus, Streptococcus pyogenes, E. coli enteropathogenic (EPEC), Mycobacterium spp., Salmonella typhi (followed by S. paratyphi), Clostridium spp., Listeria monocytogenes and Campylobacter coli were found to be the most relevant (top 10) pathogens in relation to potential risk from spreading anaerobic digestate on agricultural land, specifically in Ireland. The score corresponding to the mortality rate (S3) was the most sensitive parameter (rank coefficient 0.49) to the final score S; followed by thermal inactivation score S1 (0.25) and potential contamination pathways S2 (0.16). A complete risk assessment of top-ranked pathogens can unify the data collected from the laboratory and field experiments into comprehensible statistics and predict potential risk which could help relevant agencies and government authorities to take the necessary steps to identify the most sensitive pathways or processes responsible for the overall risk and thus, act to minimise potential risk. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. 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Supplementary data to this article can be found online at https://doi. org/10.1016/j.scitotenv.2019.136297.