Resumen
Most of the waterborne disease outbreaks observed in North America are associated with rural drinking water systems. The majority of the reported waterborne outbreaks are related to microbial agents (parasites, bacteria and viruses). Rural areas are characterized by high livestock density and lack of advanced treatment systems for animal and human waste, and wastewater. Animal waste from livestock production facilities is often applied to land without prior treatment. Biosolids (treated municipal wastewater sludge) from large wastewater facilities in urban areas are often transported and applied to land in rural areas. This situation introduces a potential for risk of human exposure to waterborne contaminants such as human and zoonotic pathogens originating from manure, biosolids, and leaking septic systems. This paper focuses on waterborne outbreaks and sources of microbial pollution in rural areas in the US, characterization of the microbial load of biosolids and manure, association of biosolid and manure application with microbial contamination of surface and groundwater, risk assessment and best management practice for biosolids and manure application to protect water quality. Gaps in knowledge are identified, and recommendations to improve the water quality in the rural areas are discussed.