Water sources and environmental transmission of multiply resistant enteric bacteria in rural Bangladesh

Seasonal host and ecological drivers may promote restricted water as a viral vector

In climates with seasonally limited precipitation, terrestrial animals congregate at high densities at scarce water sources. We hypothesize that viruses can exploit the recurrence of these diverse animal congregations to spread. In this study, we test the central prediction of this hypothesis - that viruses employing this transmission strategy remain stable and infectious in water. Equid herpesviruses (EHVs) were chosen as a model as they have been shown to remain stable and infectious in water for weeks under laboratory conditions. Using fecal data from wild equids from a previous study, we establish that EHVs are shed more frequently by their hosts during the dry season, increasing the probability of water source contamination with EHV. We document the presence of several strains of EHVs present in high genome copy number from the surface water and sediments of waterholes sampled across a variety of mammalian assemblages, locations, temperatures and pH. Phylogenetic analysis reveals that the different EHV strains found exhibit little divergence despite representing ancient lineages. We employed molecular approaches to show that EHVs shed remain stable in waterholes with detection decreasing with increasing temperature in sediments. Infectivity experiments using cell culture reveals that EHVs remain infectious in water derived from waterholes. The results are supportive of water as an abiotic viral vector for EHV.

Child defecation and feces management practices in rural Bangladesh: Associations with fecal contamination, observed hand cleanliness and child diarrhea

Child open defecation is common in low-income countries and can lead to fecal exposure in the domestic environment. We assessed associations between child feces management practices vs. measures of contamination and child diarrhea among households with children <5 years in rural Bangladesh. We visited 360 households quarterly and recorded caregiver-reported diarrhea prevalence, and defecation and feces disposal practices for children <5 years. We examined caregiver and child hands for visible dirt and enumerated E. coli in child and caregiver hand rinse and stored drinking water samples. Safe child defecation (in latrine/potty) and safe feces disposal (in latrine) was reported by 21% and 23% of households, respectively. Controlling for potential confounders, households reporting unsafe child defecation had higher E. coli prevalence on child hands (prevalence ratio [PR] = 1.12, 1.04-1.20) and in stored water (PR = 1.12,1.03-1.21). Similarly, households reporting unsafe feces disposal had higher E. coli prevalence on child hands (PR = 1.11, 1.02-1.21) and in stored water (PR = 1.10, 1.03-1.18). Effects on E. coli levels were similar. Children in households with unsafe defecation and feces disposal had higher diarrhea prevalence but the associations were not statistically significant. Our findings suggest that unsafe child feces management may present a source of fecal exposure for young children.

Bats and bacterial pathogens: a review

The occurrence of emerging infectious diseases and their relevance to human health has increased the interest in bats as potential reservoir hosts and vectors of zoonotic pathogens. But while previous and ongoing research activities predominantly focused on viral agents, the prevalence of pathogenic bacteria in bats and their impact on bat mortality have largely neglected. Enteric pathogens found in bats are often considered to originate from the bats' diet and foraging habitats, despite the fact that little is known about the actual ecological context or even transmission cycles involving bats, humans and other animals like pets and livestock. For some bacterial pathogens common in human and animal diseases (e.g. Pasteurella, Salmonella, Escherichia and Yersinia spp.), the pathogenic potential has been confirmed for bats. Other bacterial pathogens (e.g. Bartonella, Borrelia and Leptospira spp.) provide evidence for novel species that seem to be specific for bat hosts but might also be of disease importance in humans and other animals. The purpose of this review is to summarize the current knowledge of bacterial pathogens identified in bats and to consider factors that might influence the exposure and susceptibility of bats to bacterial infection but could also affect bacterial transmission rates between bats, humans and other animals.

Critical pathway analysis to determine key uncertainties in net impacts on disease burden in Bangladesh of arsenic mitigation involving the substitution of arsenic bearing for groundwater drinking water supplies

It has been increasingly recognised that calculation of the disease burden due to populations, such as in Bangladesh, extensively using hazardous arsenic bearing well waters, must explicitly account for the trade-off between diarrhoeal disease incidence and that of arsenic-related diseases. This is because it is likely that moves to alternative drinking water sources, be they surface waters or even more distant groundwaters, without further mitigation would result in a concurrent increase in diarrhoeal disease. In this paper, we update the model of Lokuge of the effects of such arsenic mitigation on disease burden in Bangladesh, using updated population data and background disease estimates. We run a critical pathway analysis on the model using Standardised Mortality Ratios (SMRs) for diabetes mellitus and ischemic heart disease from different epidemiological studies recently reviewed by Navas-Acien. Our analysis agrees with that of Lokuge that mitigation simply involving the substitution of a range of surface waters for well water sources with As > 50 microg/L would have a net positive impact on disease burden, as determined by deaths and Disability Life Adjusted Years (DALYs). In contrast, however, there is considerable ambiguity in the analogous results for mitigation for all the population exposed to well water with As > 10 microg/L. Depending upon the data source chosen for diabetes mellitus and ischaemic heart disease SMRs, such mitigation is modelled to have either a positive or a negative net impact on overall disease burden. The modelled negative impacts are entirely commensurate with the rationale for seeking groundwater as an alternative to surface waters as a drinking water supply, and highlight the practical requirement for multiple mitigation strategies, including those directed at ensuring the microbiological safety and continued protection of any alternative water supplies. Our study highlights the need for (i) adequate epidemiological studies involving multiple exposure categories, ideally resulting in an accurate dose-response relationship for arsenic uptake and the non-malignant high incidence conditions diabetes mellitus and ischemic heart disease for individuals with the socioeconomic and nutritional status of the Bangladeshi populations, and (ii) refined estimates of the diarrhoel disease burden arising from usage of surface waters.

Water quality deterioration: a study of household drinking water quality in rural Honduras

There is growing awareness that drinking-water can become contaminated following its collection from communal sources such as wells and tap-stands, as well as during its storage in the home. This study evaluated the post-supply drinking-water quality in three rural Honduran communities using either a protected hand-dug well or borehole supply. Water management practices were documented as a basis for further research to improve household drinking-water quality. Membrane filtration was used to compare thermotolerant coliform levels in samples taken from community wells and household drinking-water storage containers. Over a 2-year period, water quality was examined in 43 households and detailed observation made of typical collection, storage and usage practice. Substantial water quality deterioration occurred between the points of supply and consumption. Deterioration occurred regularly and frequently, and was experienced by the majority of study households. Only source water quality appeared to be a significant factor in determining household water quality. None of the storage factors examined, i.e. covering the container, type of container, the material from which the container was made, and hours stored, made any significant difference to the stored water quality. Observation of household water management shows that there are multiple points during the collection to use sequence where pollution could occur. The commonality of water management practice would be an asset in introducing appropriate intervention measures.

Household drinking water in developing countries: a systematic review of microbiological contamination between source and point-of-use

OBJECTIVE

To assess the extent and causes of microbiological contamination of household drinking water between source and point-of-use in developing countries.

METHODS

A systematic meta-analysis of 57 studies measuring bacteria counts for source water and stored water in the home to assess how contamination varied between settings.

RESULTS

The bacteriological quality of drinking water significantly declines after collection in many settings. The extent of contamination after water collection varies considerably between settings, but is proportionately greater where faecal and total coliform counts in source water are low.

CONCLUSIONS

Policies that aim to improve water quality through source improvements may be compromised by post-collection contamination. Safer household water storage and treatment is recommended to prevent this, together with point-of-use water quality monitoring.

Variations in antibiotic resistance profile in Enterobacteriaceae isolated from wild Australian mammals

We carried out a retrospective analysis of 946 strains of Enterobacteriaceae isolated from wild Australian mammals between 1993 and 1997. The prevalence of resistance to fixed concentrations of 32 antimicrobial agents was determined, and the respective roles that taxonomic family of the host, state of origin and bacterial species play in defining prevalence and range of resistance were investigated. Our results demonstrated a low but widespread prevalence of antimicrobial resistance in wild isolates. Only amikacin, ciprofloxacin, meropenem and gentamicin inhibited growth in all 946 samples. There was extensive variation in the combination of antibiotics to which isolates were resistant, and multiple antibiotic resistance was common. Geographical location and host group significantly influenced the antibiotic resistance profile of an isolate, whereas bacterial species influenced both the resistance profile of an isolate and the number of antibiotics it was resistant to. The role of these factors in determining observed antibiotic resistance profiles suggests that any study measuring resistance in wild isolates should include the broadest possible range of bacterial species, host species and sampling locations. As such, this study provides an important new baseline for future measurements of antibiotic resistance in the Australian environment.

Water quality and public health in northern Sudan: a study of rural and peri-urban communities

Access to adequate supplies of good quality drinking water continues to be limited among many rural and peri-urban communities in Africa, despite several decades of water improvement programmes. The present study investigated water quality at the source and point of consumption among rural and peri-urban communities in northern Sudan. Faecal coliform counts were determined by the membrane filtration technique and geometric mean counts compared in different seasons and among the different communities. Among nomadic pastoralists and riverine villages, both water sources and water stored for consumption had faecal coliform counts grossly in excess of WHO standards, with higher counts at the end of the rainy season. In the peri-urban community on the outskirts of Omdurman, while water quality from the distribution system had faecal coliform counts generally below 10 dl - 1, after storage, water was of considerably lower quality, with faecal coliform counts up to 1000 d1 - 1. The highest counts again occurred in the rainy season. Rates of diarrhoeal disease for Khartoum province were also greatest towards the end of the rainy season. The study has shown that poor quality water continues to be a major risk factor for public health in these communities.