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Nguyen KH, Smith S, Roundtree A, Feistel DJ, Kirby AE, Levy K, Mattioli MC. Fecal indicators and antibiotic resistance genes exhibit diurnal trends in the Chattahoochee River: Implications for water quality monitoring. Front Microbiol 2022; 13:1029176. [PMID: 36439800 PMCID: PMC9684717 DOI: 10.3389/fmicb.2022.1029176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/19/2022] [Indexed: 11/12/2022] Open
Abstract
Water bodies that serve as sources of drinking or recreational water are routinely monitored for fecal indicator bacteria (FIB) by state and local agencies. Exceedances of monitoring thresholds set by those agencies signal likely elevated human health risk from exposure, but FIB give little information about the potential source of contamination. To improve our understanding of how within-day variation could impact monitoring data interpretation, we conducted a study at two sites along the Chattahoochee River that varied in their recreational usage and adjacent land-use (natural versus urban), collecting samples every 30 min over one 24-h period. We assayed for three types of microbial indicators: FIB (total coliforms and Escherichia coli); human fecal-associated microbial source tracking (MST) markers (crAssphage and HF183/BacR287); and a suite of clinically relevant antibiotic resistance genes (ARGs; blaCTX-M, blaCMY, MCR, KPC, VIM, NDM) and a gene associated with antibiotic resistance (intl1). Mean levels of FIB and clinically relevant ARGs (blaCMY and KPC) were similar across sites, while MST markers and intI1 occurred at higher mean levels at the natural site. The human-associated MST markers positively correlated with antibiotic resistant-associated genes at both sites, but no consistent associations were detected between culturable FIB and any molecular markers. For all microbial indicators, generalized additive mixed models were used to examine diurnal variability and whether this variability was associated with environmental factors (water temperature, turbidity, pH, and sunlight). We found that FIB peaked during morning and early afternoon hours and were not associated with environmental factors. With the exception of HF183/BacR287 at the urban site, molecular MST markers and intI1 exhibited diurnal variability, and water temperature, pH, and turbidity were significantly associated with this variability. For blaCMY and KPC, diurnal variability was present but was not correlated with environmental factors. These results suggest that differences in land use (natural or urban) both adjacent and upstream may impact overall levels of microbial contamination. Monitoring agencies should consider matching sample collection times with peak levels of target microbial indicators, which would be in the morning or early afternoon for the fecal associated indicators. Measuring multiple microbial indicators can lead to clearer interpretations of human health risk associated with exposure to contaminated water.
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Affiliation(s)
| | - Shanon Smith
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Alexis Roundtree
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Dorian J. Feistel
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Amy E. Kirby
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Karen Levy
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, United States
| | - Mia Catharine Mattioli
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
- *Correspondence: Mia Catharine Mattioli,
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Microbial source tracking using metagenomics and other new technologies. J Microbiol 2021; 59:259-269. [DOI: 10.1007/s12275-021-0668-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/08/2021] [Accepted: 01/08/2021] [Indexed: 12/12/2022]
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George CM, Cirhuza LB, Birindwa A, Williams C, Beck S, Julian T, Kuhl J, Coglianese N, Thomas E, Bauler S, François R, Saxton R, Presence AS, Rusanga JCB, Perin J, Mirindi P. Child hand contamination is associated with subsequent pediatric diarrhea in rural Democratic Republic of the Congo (REDUCE Program). Trop Med Int Health 2020; 26:102-110. [PMID: 33151587 DOI: 10.1111/tmi.13510] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The Reducing Enteropathy, Undernutrition, and Contamination in the Environment (REDUCE) program focuses on identifying exposure pathways to faecal pathogens for young children in the Democratic Republic of the Congo (DRC) and on developing scalable interventions to reduce faecal contamination from these pathways. METHODS A prospective cohort study of 690 participants was conducted to investigate the association between hand, food, and environmental faecal contamination and diarrhoeal disease prevalence among young children in Walungu Territory, South Kivu, DRC. A total of 1923 hand rinse, soil, food, object, surface, stored water and water source samples were collected during unannounced spot checks after baseline enrolment and analysed for Escherichia coli. Caregiver reports of diarrhoea were obtained from children < 5 years at a 6-month follow-up. RESULTS E.coli was detected in 73% of child and caregiver hand-rinse samples, 69% of soil samples from child play spaces, 54% of child food samples, 38% of objects and surfaces children were observed putting in their mouths, 74% of stored water samples, and 40% of source water samples. Children < 5 years with E. coli on their hands had significantly higher odds of diarrhoea at the 6-month follow-up (odds ratio: 2.03 (95% confidence interval: 1.05, 3.92)). CONCLUSION The cohort study findings from the REDUCE program have shown that child hand contamination is associated with diarrhoeal disease in rural DRC, and that there is high faecal contamination in child plays spaces and food. These findings provide evidence demonstrating the urgent need to provide clean play spaces for young children and interventions targeting hand hygiene to reduce paediatric exposure to faecal pathogens.
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Affiliation(s)
- Christine Marie George
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, Maryland, USA
| | - Lucien Bisimwa Cirhuza
- Food for the Hungry, Phoenix, Arizona, USA.,URF-ECMI, Microbiology Department, Faculty of Medicine, University of Kinshasa
| | | | - Camille Williams
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, Maryland, USA
| | - Sara Beck
- Department of Environmental Microbiology, Eawag, Swiss Federal Institute of Aquatic Science and Technology, Duebendorf, Switzerland
| | - Timothy Julian
- Food for the Hungry, Phoenix, Arizona, USA.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Jennifer Kuhl
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, Maryland, USA
| | | | - Elizabeth Thomas
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, Maryland, USA
| | - Sarah Bauler
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, Maryland, USA.,Food for the Hungry, Phoenix, Arizona, USA
| | - Ruthly François
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, Maryland, USA
| | - Ronald Saxton
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, Maryland, USA
| | | | | | - Jamie Perin
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, Maryland, USA
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Park GW, Ng TFF, Freeland AL, Marconi VC, Boom JA, Staat MA, Montmayeur AM, Browne H, Narayanan J, Payne DC, Cardemil CV, Treffiletti A, Vinjé J. CrAssphage as a Novel Tool to Detect Human Fecal Contamination on Environmental Surfaces and Hands. Emerg Infect Dis 2020; 26:1731-1739. [PMID: 32511090 PMCID: PMC7392416 DOI: 10.3201/eid2608.200346] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
CrAssphage is a recently discovered human gut–associated bacteriophage. To validate the potential use of crAssphage for detecting human fecal contamination on environmental surfaces and hands, we tested stool samples (n = 60), hand samples (n = 30), and environmental swab samples (n = 201) from 17 norovirus outbreaks for crAssphage by real-time PCR. In addition, we tested stool samples from healthy persons (n = 173), respiratory samples (n = 113), and animal fecal specimens (n = 68) and further sequenced positive samples. Overall, we detected crAssphage in 71.4% of outbreak stool samples, 48%–68.5% of stool samples from healthy persons, 56.2% of environmental swabs, and 60% of hand rinse samples, but not in human respiratory samples or animal fecal samples. CrAssphage sequences could be grouped into 2 major genetic clusters. Our data suggest that crAssphage could be used to detect human fecal contamination on environmental surfaces and hands.
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Guix S, Pintó RM, Bosch A. Final Consumer Options to Control and Prevent Foodborne Norovirus Infections. Viruses 2019; 11:E333. [PMID: 30970561 PMCID: PMC6520945 DOI: 10.3390/v11040333] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/03/2019] [Accepted: 04/05/2019] [Indexed: 12/28/2022] Open
Abstract
Norovirus (NoV) causes about one-fifth of all cases of foodborne diseases and is a foremost cause of domestically acquired foodborne acute gastroenteritis and outbreaks. NoV infections are often associated with the consumption of contaminated fresh and ready-to-eat produce, fresh and frozen berries, raw/undercooked bivalve mollusks and products which become contaminated during handling. Despite many industrial efforts to control and prevent NoV contamination of foods, the prevalence of NoV in high-risk foodstuffs at retail is still significant. Although certain consumer behaviors may even increase the risk of virus transmission, interventions aiming at changing/implementing consumer habits may be considered as opportunities for risk mitigation. This review aims at providing an update on the progress made in characterizing the effect that consumer habits, which are most critical to prevent NoV transmission (food choice and hygiene, disinfection and cooking during food preparation), may have on reducing the risk of NoV infection. A better understanding of the options for NoV control and prevention may be translated into innovative educational, social or even technological tools targeting consumers with the objective of mitigating the risk of NoV transmission.
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Affiliation(s)
- Susana Guix
- Enteric Virus Laboratory, Department of Genetics, Microbiology and Statistics, University of Barcelona, 08028 Barcelona, Spain.
- Institute of Nutrition and Food Safety (INSA·UB), University of Barcelona, 08291 Santa Coloma de Gramenet, Spain.
| | - Rosa M Pintó
- Enteric Virus Laboratory, Department of Genetics, Microbiology and Statistics, University of Barcelona, 08028 Barcelona, Spain.
- Institute of Nutrition and Food Safety (INSA·UB), University of Barcelona, 08291 Santa Coloma de Gramenet, Spain.
| | - Albert Bosch
- Enteric Virus Laboratory, Department of Genetics, Microbiology and Statistics, University of Barcelona, 08028 Barcelona, Spain.
- Institute of Nutrition and Food Safety (INSA·UB), University of Barcelona, 08291 Santa Coloma de Gramenet, Spain.
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Verbyla ME, Pitol AK, Navab-Daneshmand T, Marks SJ, Julian TR. Safely Managed Hygiene: A Risk-Based Assessment of Handwashing Water Quality. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2019; 53:2852-2861. [PMID: 30689351 DOI: 10.1021/acs.est.8b06156] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Sustainable Development Goal (SDG) Indicator 6.2.1 requires household handwashing facilities to have soap and water, but there are no guidelines for handwashing water quality. In contrast, drinking water quality guidelines are defined: water must be "free from contamination" to be defined as "safely managed" (SDG Indicator 6.1.1). We modeled the hypothesized mechanism of infection due to contaminated handwashing water to inform risk-based guidelines for microbial quality of handwashing water. We defined two scenarios that should not occur: (1) if handwashing caused fecal contamination, indicated using Escherichia coli, on a person's hands to increase rather than decrease and (2) if hand-to-mouth contacts following handwashing caused an infection risk greater than an acceptable threshold. We found water containing <1000 E. coli colony-forming units (CFU) per 100 mL removes E. coli from hands with>99.9% probability. However, for the annual probability of infection to be <1:1000, handwashing water must contain <2 × 10-6 focus-forming units of rotavirus, <1 × 10-4 CFU of Vibrio cholerae, and <9 × 10-6 Cryptosporidium oocysts per 100 mL. Our model suggests that handwashing with nonpotable water will generally reduce fecal contamination on hands but may be unable to lower the annual probability of infection risks from hand-to-mouth contacts below 1:1000.
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Affiliation(s)
- Matthew E Verbyla
- Laboratory of Environmental Chemistry, School of Architecture, Civil and Environmental Engineering (ENAC) , École Polytechnique Fédérale de Lausanne (EPFL) , CH-1015 Lausanne , Switzerland
| | - Ana K Pitol
- Laboratory of Environmental Chemistry, School of Architecture, Civil and Environmental Engineering (ENAC) , École Polytechnique Fédérale de Lausanne (EPFL) , CH-1015 Lausanne , Switzerland
- Eawag, Swiss Federal Institute of Aquatic Science and Technology , CH-8600 Dübendorf , Switzerland
| | - Tala Navab-Daneshmand
- School of Chemical, Biological, and Environmental Engineering , Oregon State University , Corvallis , Oregon 97331 , United States
| | - Sara J Marks
- Eawag, Swiss Federal Institute of Aquatic Science and Technology , CH-8600 Dübendorf , Switzerland
| | - Timothy R Julian
- Eawag, Swiss Federal Institute of Aquatic Science and Technology , CH-8600 Dübendorf , Switzerland
- Swiss Tropical and Public Health Institute , P.O. Box, CH-4002 Basel , Switzerland
- University of Basel , P.O. Box, CH-4003 Basel , Switzerland
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Pickering AJ, Ercumen A, Arnold BF, Kwong LH, Parvez SM, Alam M, Sen D, Islam S, Kullmann C, Chase C, Ahmed R, Unicomb L, Colford JM, Luby SP. Fecal Indicator Bacteria along Multiple Environmental Transmission Pathways (Water, Hands, Food, Soil, Flies) and Subsequent Child Diarrhea in Rural Bangladesh. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2018; 52:7928-7936. [PMID: 29902374 PMCID: PMC7705120 DOI: 10.1021/acs.est.8b00928] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/09/2018] [Accepted: 06/14/2018] [Indexed: 05/19/2023]
Abstract
Enteric pathogens can be transmitted through multiple environmental pathways, yet little is known about the relative contribution of each pathway to diarrhea risk among children. We aimed to identify fecal transmission pathways in the household environment associated with prospectively measured child diarrhea in rural Bangladesh. We measured the presence and levels of Escherichia coli in tube wells, stored drinking water, pond water, child hand rinses, courtyard soil, flies, and food in 1843 households. Gastrointestinal symptoms among children ages 0-60 months were recorded concurrently at the time of environmental sample collection and again a median of 6 days later. Incident diarrhea (3 or more loose stools in a 24-h period) was positively associated with the concentration of E. coli on child hands measured on the first visit (incidence rate ratio [IRR] = 1.23, 95% CI 1.06, 1.43 for a log10 increase), while other pathways were not associated. In cross-sectional analysis, there were no associations between concurrently measured environmental contamination and diarrhea. Our findings suggest higher levels of E. coli on child hands are strongly associated with subsequent diarrheal illness rates among children in rural Bangladesh.
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Affiliation(s)
- Amy J. Pickering
- Woods Institute for the Environment, Stanford University, Stanford, California United States
- Civil and Environmental Engineering, Tufts University, Science and Engineering Complex, 200 College Avenue, Medford, Massachusetts United States
- Corresponding Author E-mail: . Phone: 617-627-5163
| | - Ayse Ercumen
- Division of Epidemiology, School of Public Health, University of California, Berkeley, California United States
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, North Carolina United States
| | - Benjamin F. Arnold
- Division of Epidemiology, School of Public Health, University of California, Berkeley, California United States
| | - Laura H. Kwong
- Woods Institute for the Environment, Stanford University, Stanford, California United States
- Civil and Environmental Engineering, Stanford University, Stanford, California United States
| | | | - Mahfuja Alam
- Infectious Disease Division, icddr,b Dhaka 1000, Bangladesh
| | - Debashis Sen
- Infectious Disease Division, icddr,b Dhaka 1000, Bangladesh
| | - Sharmin Islam
- Infectious Disease Division, icddr,b Dhaka 1000, Bangladesh
| | - Craig Kullmann
- Water Global Practice, World Bank, Washington, D.C. 20433, United States
| | - Claire Chase
- Water Global Practice, World Bank, Washington, D.C. 20433, United States
| | - Rokeya Ahmed
- Water Global Practice, World Bank, Dhaka 1207, Bangladesh
| | - Leanne Unicomb
- Infectious Disease Division, icddr,b Dhaka 1000, Bangladesh
| | - John M. Colford
- Division of Epidemiology, School of Public Health, University of California, Berkeley, California United States
| | - Stephen P. Luby
- Woods Institute for the Environment, Stanford University, Stanford, California United States
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Julian TR. Environmental transmission of diarrheal pathogens in low and middle income countries. ENVIRONMENTAL SCIENCE. PROCESSES & IMPACTS 2016; 18:944-955. [PMID: 27384220 DOI: 10.1039/c6em00222f] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Every year, more than half a million children die due to diarrheal diseases. Recent studies have identified the most important etiologies of diarrheal disease are enterotoxigenic and enteropathogenic E. coli, Shigella spp., rotavirus, norovirus and Cryptosporidium spp. These etiologies are unsurprisingly characterized by a combination of high shedding, high infectivity, and transmissibility through multiple environmental reservoirs. The relative importance of the transmission routes is likely site-specific. So the impact of interventions, which typically target only one or two environmental reservoirs, is likely also site-specific. The factors influencing the transmission routes most important for diarrheal disease are complex, including - at a minimum - etiology of endemic disease; and water, sanitation, and hygiene infrastructure and practices. The site-specific nature - and complexity of transmission - helps explain the observed variation in impacts of water, sanitation, and hygiene interventions. It may also render efforts to estimate or quantify global means for interventions' impacts irrelevant. The theme of this Perspective is that greater reductions in diarrheal disease transmission in LMICs can be achieved by designing interventions to interrupt the most important environmental transmission pathways. Intervention choice should be informed by site-specific conditions, most notably: diarrheal etiology and existing water, sanitation, and hygiene infrastructure and practices. The theme is discussed through the lens of the characteristics of the most important diarrheal diseases (shedding, infectivity, growth, and persistence) and the general characteristics of environmental reservoirs (exposure pathways and fecal contamination). The discussion highlights when interventions - and combinations of interventions - will be most effective at reducing diarrheal disease burden.
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Affiliation(s)
- Timothy R Julian
- Pathogens and Human Health, Department of Environmental Microbiology, Swiss Federal Research Institute of Aquatic Science and Technology, Eawag, BU-F08, Überlandstrasse 133, 8600 Dübendorf, Switzerland.
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