Abstract
One of the UN sustainable development goals is to achieve universal access to safe and affordable drinking water by 2030. It is locations like Kathmandu, Nepal, a densely populated city in South Asia with endemic typhoid fever, where this goal is most pertinent. Aiming to understand the public health implications of water quality in Kathmandu we subjected weekly water samples from 10 sources for one year to a range of chemical and bacteriological analyses. We additionally aimed to detect the etiological agents of typhoid fever and longitudinally assess microbial diversity by 16S rRNA gene surveying. We found that the majority of water sources exhibited chemical and bacterial contamination exceeding WHO guidelines. Further analysis of the chemical and bacterial data indicated site-specific pollution, symptomatic of highly localized fecal contamination. Rainfall was found to be a key driver of this fecal contamination, correlating with nitrates and evidence of S. Typhi and S. Paratyphi A, for which DNA was detectable in 333 (77%) and 303 (70%) of 432 water samples, respectively. 16S rRNA gene surveying outlined a spectrum of fecal bacteria in the contaminated water, forming complex communities again displaying location-specific temporal signatures. Our data signify that the municipal water in Kathmandu is a predominant vehicle for the transmission of S. Typhi and S. Paratyphi A. This study represents the first extensive spatiotemporal investigation of water pollution in an endemic typhoid fever setting and implicates highly localized human waste as the major contributor to poor water quality in the Kathmandu Valley.
Highlights
Enteric fever is a severe systemic infection and a common cause of community acquired febrile disease in many low-income countries in Asia and Africa [1]
We found that Kathmandu drinking water exhibits longitudinal fecal contamination in excess of World Health Organization (WHO) guidelines
We found that Salmonella Typhi and Salmonella Paratyphi A could be detected throughout the year in every water sampling location, but peaked after the monsoons
Summary
Enteric (typhoid) fever is a severe systemic infection and a common cause of community acquired febrile disease in many low-income countries in Asia and Africa [1]. The infection is triggered by the ingestion of the bacteria Salmonella Typhi Paratyphi A are human restricted pathogens (they have no known animal reservoir) and is it acknowledged that they are transmitted through contaminated food and water or via contact with fecal matter from acute or chronically infected individuals [1]. The predominant route of infection has never been rigorously investigated in an endemic setting outside a conventional case/control study design [2,3]
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