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Baraka V, Andersson T, Makenga G, Francis F, Minja DTR, Overballe-Petersen S, Tang MHE, Fuursted K, Lood R. Unveiling Rare Pathogens and Antibiotic Resistance in Tanzanian Cholera Outbreak Waters. Microorganisms 2023; 11:2490. [PMID: 37894148 PMCID: PMC10609457 DOI: 10.3390/microorganisms11102490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
The emergence of antibiotic resistance is a global health concern. Therefore, understanding the mechanisms of its spread is crucial for implementing evidence-based strategies to tackle resistance in the context of the One Health approach. In developing countries where sanitation systems and access to clean and safe water are still major challenges, contamination may introduce bacteria and bacteriophages harboring antibiotic resistance genes (ARGs) into the environment. This contamination can increase the risk of exposure and community transmission of ARGs and infectious pathogens. However, there is a paucity of information on the mechanisms of bacteriophage-mediated spread of ARGs and patterns through the environment. Here, we deploy Droplet Digital PCR (ddPCR) and metagenomics approaches to analyze the abundance of ARGs and bacterial pathogens disseminated through clean and wastewater systems. We detected a relatively less-studied and rare human zoonotic pathogen, Vibrio metschnikovii, known to spread through fecal--oral contamination, similarly to V. cholerae. Several antibiotic resistance genes were identified in both bacterial and bacteriophage fractions from water sources. Using metagenomics, we detected several resistance genes related to tetracyclines and beta-lactams in all the samples. Environmental samples from outlet wastewater had a high diversity of ARGs and contained high levels of blaOXA-48. Other identified resistance profiles included tetA, tetM, and blaCTX-M9. Specifically, we demonstrated that blaCTX-M1 is enriched in the bacteriophage fraction from wastewater. In general, however, the bacterial community has a significantly higher abundance of resistance genes compared to the bacteriophage population. In conclusion, the study highlights the need to implement environmental monitoring of clean and wastewater to inform the risk of infectious disease outbreaks and the spread of antibiotic resistance in the context of One Health.
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Affiliation(s)
- Vito Baraka
- Tanga Centre, National Institute for Medical Research, Tanga P.O. Box 5004, Tanzania; (V.B.); (G.M.); (F.F.); (D.T.R.M.)
| | - Tilde Andersson
- Department of Clinical Sciences, Lund University, 221 84 Lund, Sweden;
| | - Geofrey Makenga
- Tanga Centre, National Institute for Medical Research, Tanga P.O. Box 5004, Tanzania; (V.B.); (G.M.); (F.F.); (D.T.R.M.)
| | - Filbert Francis
- Tanga Centre, National Institute for Medical Research, Tanga P.O. Box 5004, Tanzania; (V.B.); (G.M.); (F.F.); (D.T.R.M.)
| | - Daniel T. R. Minja
- Tanga Centre, National Institute for Medical Research, Tanga P.O. Box 5004, Tanzania; (V.B.); (G.M.); (F.F.); (D.T.R.M.)
| | | | - Man-Hung Eric Tang
- Department of Bacteria, Statens Serum Institut, Parasites and Fungi, 2300 Copenhagen, Denmark;
| | - Kurt Fuursted
- Bacterial Reference Center, Statens Serum Institut, 2300 Copenhagen, Denmark; (S.O.-P.); (K.F.)
| | - Rolf Lood
- Department of Clinical Sciences, Lund University, 221 84 Lund, Sweden;
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Nascimento Santos NG, Silva LC, Guidone GHM, Montini VH, Dias Oliva BH, Nascimento AB, de Sousa DNR, Kuroda EK, Rocha SPD. Water quality monitoring in southern Brazil and the assessment of risk factors related to contamination by coliforms and Escherichia coli. JOURNAL OF WATER AND HEALTH 2023; 21:1550-1561. [PMID: 37902208 PMCID: wh_2023_182 DOI: 10.2166/wh.2023.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
The potability of water, including underground sources, is constantly affected by human activities. To assess water quality and water security in rural and urban areas of southern Brazil, a quantitative, retrospective analysis of water samples collected monthly by the Brazilian health authorities (19,687 samples from 2013 to 2021) was performed. In rural areas, 5,979 water samples (77.54%) were found to be contaminated by coliform bacteria and 3,431 (44.50%) by Escherichia coli. In addition, 1,616 (20.95%) of the contaminated samples were significantly correlated with rainfall amount. In urban areas, 1,268 (10.95%) of the samples contained coliform bacteria and 293 (2.53%) of these samples contained E. coli, with the factor of rainfall associated with 1,081 samples (9.33%) with bacterial contamination. In terms of physicochemical parameters, turbidity exceeded the national standard (5 uT) in 448 (2.32%) samples and fluoride fell below the required level (0.8 mg/L) in 106 samples (0.54%). The presence of free residual chlorine (0.2-2.0 mg/L) was verified in 846 samples (14.38%) in rural areas and in 10,825 samples (56.13%) in urban areas. These results suggest a strong association between rainfall factors and physicochemical alterations, as well as the risk of greater microbial contamination of water for human consumption.
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Affiliation(s)
- Nathalia Geovana Nascimento Santos
- Laboratory of Bacteriology, Department of Microbiology, Center of Biological Sciences, Universidade Estadual de Londrina, Londrina, Brazil E-mail:
| | - Luana Carvalho Silva
- Laboratory of Bacteriology, Department of Microbiology, Center of Biological Sciences, Universidade Estadual de Londrina, Londrina, Brazil
| | | | - Victor Hugo Montini
- Laboratory of Bacteriology, Department of Microbiology, Center of Biological Sciences, Universidade Estadual de Londrina, Londrina, Brazil
| | - Bruno Henrique Dias Oliva
- Laboratory of Bacteriology, Department of Microbiology, Center of Biological Sciences, Universidade Estadual de Londrina, Londrina, Brazil
| | - Arthur Bossi Nascimento
- Laboratory of Bacteriology, Department of Microbiology, Center of Biological Sciences, Universidade Estadual de Londrina, Londrina, Brazil
| | | | - Emília Kiyomi Kuroda
- Department of Civil Construction, Center of Technology and Urbanization, Universidade Estadual de Londrina, Londrina, Brazil
| | - Sergio Paulo Dejato Rocha
- Laboratory of Bacteriology, Department of Microbiology, Center of Biological Sciences, Universidade Estadual de Londrina, Londrina, Brazil
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Jabeen S, Saha UR, van Wesenbeeck CFA, Mushtaq K. An overview of diarrhea among infants and under-five in Punjab-Pakistan. J Pediatr Nurs 2023:S0882-5963(23)00095-7. [PMID: 37105867 DOI: 10.1016/j.pedn.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 04/12/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Diarrhea, pneumonia, malnutrition, tuberculosis, measles, and fever are the leading causes of mortality in children under five-years of age (0-59 months), whereas diarrhea alone is the world's second-biggest cause of mortality in this population. This study is particularly important for Pakistan as it focuses on one of the main causes of infant mortality, diarrhea, which is a major challenge for Pakistan to achieve the Sustainable Development Goals to reduce infant mortality to 12/1000 live births by 2030. AIM This study was planned to investigate the various household, parental, environmental, and child-related factors causing diarrheal diseases in children aged 0-59 months in Punjab Pakistan. METHODS The study used the data of 38,405 households from the Multiple Indicator Cluster Survey (MICS) 2017-18, directed by the Punjab Bureau of Statistics. Comprehensive descriptive statistics, i.e., cross-tabulations and logistic regression were used for the detailed analysis. FINDINGS The results showed that infants are more probable to get diarrhea than older children. A wide range of influences were found to affect the probability of a child getting diarrhea, including child-specific, mother-specific and environment-specific ones. One prominent finding was that, at the mother level, the education of the mother played a significant role in reducing diarrhea among children under five-years of age (0-59 months). DISCUSSION The results of the study contribute to the literature by highlighting that it is an interplay of factors that result in diarrhea. Hence, improving the source of drinking water, e.g., tap water and bottled water, can decrease the occurrence of diarrhea, especially in poor households. It was also revealed that households with a toilet facility of flush have less probability of their children being diagnosed with diarrhea than toilet facilities in open drains and fields. On the child level, results suggested that birth order matters as well, with the firstborn child having a lower probability of contracting diarrhea than siblings born after. APPLICATION TO PRACTICE Interventions targeting infants and mothers of infants aimed at reducing diarrhea are expected to be very effective to reduce child mortality, one of the main child health challenges faced by Pakistan.
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Affiliation(s)
- Saher Jabeen
- Ph.D. Student in Economics at Institute of Agricultural and Resource Economics, University of Agriculture Faisalabad, Punjab, Pakistan.
| | - Unnati Rani Saha
- Scientific Researcher, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
| | - C F A van Wesenbeeck
- Associate Professor of Development Economics, School of Business and Economics Director, Amsterdam Centre for World Food Studies, the Netherlands.
| | - Khalid Mushtaq
- Professor at Institute of Agricultural and Resource Economics, University of Agriculture Faisalabad, Punjab, Pakistan.
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Hernández-Vásquez A, Visconti-Lopez FJ, Vargas-Fernández R. Escherichia coli Contamination of Water for Human Consumption and Its Associated Factors in Peru: A Cross-Sectional Study. Am J Trop Med Hyg 2023; 108:187-194. [PMID: 36509044 PMCID: PMC9833058 DOI: 10.4269/ajtmh.22-0240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 09/13/2022] [Indexed: 12/15/2022] Open
Abstract
The objective of the study was to determine the factors associated with the presence of Escherichia coli contamination in water supplies for human consumption in Peru. A secondary analysis of the Food and Nutrition Surveillance by Life Stages survey (VIANEV) of 2017-2018 was performed. The presence of E. coli contamination in the water samples for human consumption of the households evaluated was defined as a dependent variable. A supply was considered contaminated when there was at least 1 colony-forming unit of E. coli in 100 mL of water for human consumption. Data from 886 participants were analyzed. It was found that 25.2% of household water supply sources for human consumption had E. coli at the time of sampling. Water reservoirs such as buckets or other containers (adjusted prevalence ratio [aPR]: 1.15; 95% confidence interval [CI]: 1.18-1.93), households belonging to a poor wealth quintile (aPR: 1.82; 95% CI: 1.01-3.25), residing in a rural area (aPR: 1.36; 95% CI: 1.01-1.83), and having a low human development index (aPR: 2.12; 95% CI: 1.15-3.91) were more likely to contain E. coli in water supplies for human consumption. However, households with chlorine concentrations of 0.5 mg/L or more in water (aPR: 0.20; 95% CI: 0.11-0.33) and with household members with a higher education (aPR: 0.67; 95% CI: 0.45-0.99) were less likely to contain E. coli in drinking-water supplies. From 2017 to 2018, one in four Peruvians had contamination by E. coli in the water supply to their homes, which was associated with sociodemographic factors, management, and water treatment.
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Affiliation(s)
- Akram Hernández-Vásquez
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
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Khaliq A, Amreen, Jameel N, Krauth SJ. Knowledge and Practices on the Prevention and Management of Diarrhea in Children Under-2 Years Among Women Dwelling in Urban Slums of Karachi, Pakistan. Matern Child Health J 2022; 26:1442-1452. [PMID: 35247160 PMCID: PMC9174301 DOI: 10.1007/s10995-022-03391-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2022] [Indexed: 11/28/2022]
Abstract
Background Diarrhea is the second leading cause of death especially among children. The age-proportionate mortality of diarrheal disease in infants under 2 years is 72%, among children under 5 years of age. Children living in urban slums are more prone to develop diarrhea. Although the disease can be prevented by many simple cost-effective interventions, i.e. proper sanitation and hygiene, appropriate feeding, and timely vaccination, poverty and lack of basic life amenities often potentiate diarrhea mortality. Gadap town is the largest town of Karachi with a deprived health system. This study aims to assess pediatric diarrhea prevalence and related knowledge-practice gaps in the slums of Gadap Town, Karachi, Pakistan. Method A community-based cross-sectional study was conducted from November 2016 to May 2017 among mothers of children under 2 years, who were residents of Gadap Town, Karachi, Pakistan. The participants were approached by a multistage sampling method. A validated dichotomous questionnaire, piloted on 40 participants, translated into local language Urdu was used for data collection and the data was analyzed by SPSS® version 20.0. Results 51.8% (n = 199) of participants were aged between 25 and 34 years. Among all participants, 68% (n = 261) had primary level education or less, compared to 4.7% (n = 18) of women who had graduate-level education. The mean number of children per woman was 2.52 ± 1.62. Self-reported pediatric diarrhea incidence was 72.1% (n = 277). More than half (55.2% n = 149) of participants reported frequent diarrhea episodes during the 2nd year of their child’s life. In this survey, we found the knowledge of women regarding diarrhea management and how to reduce diarrhea morbidity to be inadequate (p > 0.05). However, many women reported appropriate practices which can significantly reduce diarrhea morbidity (p < 0.05). Conclusion While the knowledge among women on preventive measures for pediatric diarrhea was insufficient, the translation of the right knowledge into appropriate practices showed promising outcomes for reducing diarrhea morbidity. An integrated approach for improving feeding, sanitation, and hygiene practices along with continuous health education could curtail the burden of diarrhea among infants living in urban slums.
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Affiliation(s)
- Asif Khaliq
- Department of Community Medicines, Baqai Medical University, Karachi, Pakistan. .,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia. .,Department of Paediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan.
| | - Amreen
- Department of Psychiatry, Dow University of Health Sciences, Karachi, Pakistan
| | - Nazia Jameel
- Department of Community Medicines, Baqai Medical University, Karachi, Pakistan
| | - Stefanie J Krauth
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK.
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Graham JP, Amato H, Mendizabal-Cabrera R, Alvarez D, Ramay B. Waterborne Urinary Tract Infections: Have We Overlooked an Important Source of Exposure? Am J Trop Med Hyg 2021; 105:12-17. [PMID: 33939640 DOI: 10.4269/ajtmh.20-1271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 02/16/2021] [Indexed: 11/07/2022] Open
Abstract
The presence of intestinal pathogenic Escherichia coli in drinking water is well recognized as a risk for diarrhea. The role of drinking water in extraintestinal infections caused by E. coli-such as urinary tract infections (UTIs)-remains poorly understood. Urinary tract infections are a leading cause of outpatient infections globally, with a lifetime incidence of 50-60% in adult women. We reviewed the scientific literature on the occurrence of uropathogenic E. coli (UPEC) in water supplies to determine whether the waterborne route may be an important, overlooked, source of UPEC. A limited number of studies have assessed whether UPEC isolates are present in drinking water supplies, but no studies have measured whether their presence in water may increase UPEC colonization or the risk of UTIs in humans. Given the prevalence of drinking water supplies contaminated with E. coli across the globe, efforts should be made to characterize UTI-related risks associated with drinking water, as well as other pathways of exposure.
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Affiliation(s)
- Jay P Graham
- 1Berkeley School of Public Health, University of California Berkeley, Berkeley, California
| | - Heather Amato
- 2Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | | | - Danilo Alvarez
- 2Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Brooke Ramay
- 2Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala.,3Paul G. Allen School for Global Animal Health, Washington State University Pullman, Guatemala City, Guatemala
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