Abstract
Sewage surveillance is increasingly used in public health applications: metabolites, biomarkers, and pathogens are detectable in wastewater and can provide useful information about community health. Work on this topic has been limited to wastewaters in mainly high-income settings, however. In low-income countries, where the burden of enteric infection is high, non-sewered sanitation predominates. In order to assess the utility of fecal sludge surveillance as a tool to identify the most prevalent enteric pathogens circulating among at-risk children, we collected 95 matched child stool and fecal sludge samples from household clusters sharing latrines in urban Maputo, Mozambique. We analyzed samples for 20 common enteric pathogens via multiplex real-time quantitative PCR. Among the 95 stools matched to fecal sludges, we detected the six most prevalent bacterial pathogens (Enteroaggregative E. coli, Shigella/Enteroinvasive E. coli, Enterotoxigenic E. coli, Enteropathogenic E. coli, shiga-toxin producing E. coli, Salmonella) and all three protozoan pathogens (Giardia duodenalis, Cryptosporidium parvum, Entamoeba histolytica) in the same rank order in both matrices. We did not observe the same trend for viral pathogens or soil-transmitted helminths, however. Our results suggest that sampling fecal sludges from onsite sanitation offers potential for localized pathogen surveillance in low-income settings where enteric pathogen prevalence is high.
Highlights
Wastewater monitoring is increasingly used in community health surveillance; as a composite sample of a population’s fecal waste, sewage has been shown to provide useful community-level information on biomarkers of illicit drug use,[1] antimicrobial resistance,[2,3] and chronic disease.[4]
Apart from poliovirus monitoring to complement eradication efforts,[12−14] the method has not been widely used in low- and middle-income countries (LMICs), despite the need for better surveillance of enteric infections in high-burden settings.[15,16]
We sought to assess whether analysis of fecal sludges from shared latrines can reliably identify which enteric pathogens are most common among children living in households served by them
Summary
Wastewater monitoring is increasingly used in community health surveillance; as a composite sample of a population’s fecal waste, sewage has been shown to provide useful community-level information on biomarkers of illicit drug use,[1] antimicrobial resistance,[2,3] and chronic disease.[4]. Wastewater is the focus of most efforts in this area, and even lends its name to the emerging field of “wastewaterbased epidemiology” (WBE),[17] onsite sanitation systems predominate in the lowest income settings.[18] Such systems serve at least 1.8 billion people in LMICs,[19] where sewerage has not kept pace with rapidly densifying cities.[20,21] Where sewers are absent, analysis of fecal sludges from onsite systems, including shared systems which serve 630 million people,[18] offers a compelling method for infection surveillance. Applying the concept of fecal waste monitoring to onsite systems in LMICs requires initial testing and validation using fecal sludges, including comparison with community infection prevalence. We sought to assess whether analysis of fecal sludges from shared latrines can reliably identify which enteric pathogens are most common among children living in households served by them
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