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Holcomb DA, Monteiro V, Capone D, António V, Chiluvane M, Cumbane V, Ismael N, Knee J, Kowalsky E, Lai A, Linden Y, Mataveia E, Nala R, Rao G, Ribeiro J, Cumming O, Viegas E, Brown J. Long-term impacts of an urban sanitation intervention on enteric pathogens in children in Maputo city, Mozambique: study protocol for a cross-sectional follow-up to the Maputo Sanitation (MapSan) trial 5 years postintervention. BMJ Open 2023; 13:e067941. [PMID: 37290945 PMCID: PMC10254709 DOI: 10.1136/bmjopen-2022-067941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 05/24/2023] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION We previously assessed the effect of an onsite sanitation intervention in informal neighbourhoods of urban Maputo, Mozambique on enteric pathogen detection in children after 2 years of follow-up (Maputo Sanitation (MapSan) trial, ClinicalTrials.gov: NCT02362932). We found significant reductions in Shigella and Trichuris prevalence but only among children born after the intervention was delivered. In this study, we assess the health impacts of the sanitation intervention after 5 years among children born into study households postintervention. METHODS AND ANALYSIS We are conducting a cross-sectional household study of enteric pathogen detection in child stool and the environment at compounds (household clusters sharing sanitation and outdoor living space) that received the pour-flush toilet and septic tank intervention at least 5 years prior or meet the original criteria for trial control sites. We are enrolling at least 400 children (ages 29 days to 60 months) in each treatment arm. Our primary outcome is the prevalence of 22 bacterial, protozoan, and soil transmitted helminth enteric pathogens in child stool using the pooled prevalence ratio across the outcome set to assess the overall intervention effect. Secondary outcomes include the individual pathogen detection prevalence and gene copy density of 27 enteric pathogens (including viruses); mean height-for-age, weight-for-age, and weight-for-height z-scores; prevalence of stunting, underweight, and wasting; and the 7-day period prevalence of caregiver-reported diarrhoea. All analyses are adjusted for prespecified covariates and examined for effect measure modification by age. Environmental samples from study households and the public domain are assessed for pathogens and faecal indicators to explore environmental exposures and monitor disease transmission. ETHICS AND DISSEMINATION Study protocols have been reviewed and approved by human subjects review boards at the Ministry of Health, Republic of Mozambique and the University of North Carolina at Chapel Hill. Deidentified study data will be deposited at https://osf.io/e7pvk/. TRIAL REGISTRATION NUMBER ISRCTN86084138.
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Affiliation(s)
- David A Holcomb
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Vanessa Monteiro
- Centro de Investigação e Treino em Saúde da Polana Caniço, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Drew Capone
- Department of Environmental and Occupational Health, School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - Virgílio António
- Division of Biotechnology and Genetics, Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Márcia Chiluvane
- Centro de Investigação e Treino em Saúde da Polana Caniço, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Victória Cumbane
- Centro de Investigação e Treino em Saúde da Polana Caniço, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Nália Ismael
- Division of Biotechnology and Genetics, Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Jackie Knee
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Erin Kowalsky
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Amanda Lai
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Yarrow Linden
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Elly Mataveia
- Centro de Investigação e Treino em Saúde da Polana Caniço, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Rassul Nala
- Division of Parasitology, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Gouthami Rao
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jorge Ribeiro
- Centro de Investigação e Treino em Saúde da Polana Caniço, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Oliver Cumming
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Edna Viegas
- Centro de Investigação e Treino em Saúde da Polana Caniço, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Joe Brown
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
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Grube AM, Coleman CK, LaMontagne CD, Miller ME, Kothegal NP, Holcomb DA, Blackwood AD, Clerkin TJ, Serre ML, Engel LS, Guidry VT, Noble RT, Stewart JR. Detection of SARS-CoV-2 RNA in wastewater and comparison to COVID-19 cases in two sewersheds, North Carolina, USA. Sci Total Environ 2023; 858:159996. [PMID: 36356771 PMCID: PMC9639408 DOI: 10.1016/j.scitotenv.2022.159996] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/28/2022] [Accepted: 11/02/2022] [Indexed: 06/16/2023]
Abstract
Wastewater surveillance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be useful for monitoring population-wide coronavirus disease 2019 (COVID-19) infections, especially given asymptomatic infections and limitations in diagnostic testing. We aimed to detect SARS-CoV-2 RNA in wastewater and compare viral concentrations to COVID-19 case numbers in the respective counties and sewersheds. Influent 24-hour composite wastewater samples were collected from July to December 2020 from two municipal wastewater treatment plants serving different population sizes in Orange and Chatham Counties in North Carolina. After a concentration step via HA filtration, SARS-CoV-2 RNA was detected and quantified by reverse transcription droplet digital polymerase chain reaction (RT-ddPCR) and quantitative PCR (RT-qPCR), targeting the N1 and N2 nucleocapsid genes. SARS-CoV-2 RNA was detected by RT-ddPCR in 100 % (24/24) and 79 % (19/24) of influent wastewater samples from the larger and smaller plants, respectively. In comparison, viral RNA was detected by RT-qPCR in 41.7 % (10/24) and 8.3 % (2/24) of samples from the larger and smaller plants, respectively. Positivity rates and method agreement further increased for the RT-qPCR assay when samples with positive signals below the limit of detection were counted as positive. The wastewater data from the larger plant generally correlated (⍴ ~0.5, p < 0.05) with, and even anticipated, the trends in reported COVID-19 cases, with a notable spike in measured viral RNA preceding a spike in cases when students returned to a college campus in the Orange County sewershed. Correlations were generally higher when using estimates of sewershed-level case data rather than county-level data. This work supports use of wastewater surveillance for tracking COVID-19 disease trends, especially in identifying spikes in cases. Wastewater-based epidemiology can be a valuable resource for tracking disease trends, allocating resources, and evaluating policy in the fight against current and future pandemics.
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Affiliation(s)
- Alyssa M Grube
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599, United States
| | - Collin K Coleman
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599, United States
| | - Connor D LaMontagne
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599, United States
| | - Megan E Miller
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599, United States
| | - Nikhil P Kothegal
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599, United States
| | - David A Holcomb
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599, United States; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599, United States
| | - A Denene Blackwood
- Institute of Marine Sciences, Department of Earth, Marine, and Environmental Sciences, University of North Carolina at Chapel Hill, 3431 Arendell Street, Morehead City, NC 28557, United States
| | - Thomas J Clerkin
- Institute of Marine Sciences, Department of Earth, Marine, and Environmental Sciences, University of North Carolina at Chapel Hill, 3431 Arendell Street, Morehead City, NC 28557, United States
| | - Marc L Serre
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599, United States
| | - Lawrence S Engel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599, United States
| | - Virginia T Guidry
- Occupational and Environmental Epidemiology Branch, NC Department of Health and Human Services, 5505 Six Forks Road, Raleigh, NC 27609, United States
| | - Rachel T Noble
- Institute of Marine Sciences, Department of Earth, Marine, and Environmental Sciences, University of North Carolina at Chapel Hill, 3431 Arendell Street, Morehead City, NC 28557, United States
| | - Jill R Stewart
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599, United States.
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Kotlarz N, Holcomb DA, Tanvir Pasha ABM, Reckling S, Kays J, Lai YC, Daly S, Palani S, Bailey E, Guidry VT, Christensen A, Berkowitz S, Hoppin JA, Mitasova H, Engel LS, Reyes FLDL, Harris A. Timing and Trends for Municipal Wastewater, Lab-Confirmed Case, and Syndromic Case Surveillance of COVID-19 in Raleigh, North Carolina. Am J Public Health 2023; 113:79-88. [PMID: 36356280 PMCID: PMC9755929 DOI: 10.2105/ajph.2022.307108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 11/12/2022]
Abstract
Objectives. To compare 4 COVID-19 surveillance metrics in a major metropolitan area. Methods. We analyzed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in wastewater influent and primary solids in Raleigh, North Carolina, from April 10 through December 13, 2020. We compared wastewater results with lab-confirmed COVID-19 cases and syndromic COVID-like illness (CLI) cases to answer 3 questions: (1) Did they correlate? (2) What was the temporal alignment of the different surveillance systems? (3) Did periods of significant change (i.e., trends) align? Results. In the Raleigh sewershed, wastewater influent, wastewater primary solids, lab-confirmed cases, and CLI were strongly or moderately correlated. Trends in lab-confirmed cases and wastewater influent were observed earlier, followed by CLI and, lastly, wastewater primary solids. All 4 metrics showed sustained increases in COVID-19 in June, July, and November 2020 and sustained decreases in August and September 2020. Conclusions. In a major metropolitan area in 2020, the timing of and trends in municipal wastewater, lab-confirmed case, and syndromic case surveillance of COVID-19 were in general agreement. Public Health Implications. Our results provide evidence for investment in SARS-CoV-2 wastewater and CLI surveillance to complement information provided through lab-confirmed cases. (Am J Public Health. 2023;113(1):79-88. https://doi.org/10.2105/AJPH.2022.307108).
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Affiliation(s)
- Nadine Kotlarz
- Nadine Kotlarz and Jane A. Hoppin are with the Department of Biological Sciences, North Carolina State University, Raleigh. David A. Holcomb and Lawrence S. Engel are with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. A. B. M. Tanvir Pasha, Judith Kays, Yi-Chun Lai, Sean Daly, Francis L. de los Reyes III, and Angela Harris are with the Department of Civil, Construction, and Environmental Engineering, North Carolina State University. Stacie Reckling and Helena Mitasova are with the Center for Geospatial Analytics, North Carolina State University. Sivaranjani Palani is with the Department of Plant and Microbial Biology, North Carolina State University. Erika Bailey is with Raleigh Water, Raleigh, NC. Virginia T. Guidry, Ariel Christensen, and Steven Berkowitz are with the Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - David A Holcomb
- Nadine Kotlarz and Jane A. Hoppin are with the Department of Biological Sciences, North Carolina State University, Raleigh. David A. Holcomb and Lawrence S. Engel are with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. A. B. M. Tanvir Pasha, Judith Kays, Yi-Chun Lai, Sean Daly, Francis L. de los Reyes III, and Angela Harris are with the Department of Civil, Construction, and Environmental Engineering, North Carolina State University. Stacie Reckling and Helena Mitasova are with the Center for Geospatial Analytics, North Carolina State University. Sivaranjani Palani is with the Department of Plant and Microbial Biology, North Carolina State University. Erika Bailey is with Raleigh Water, Raleigh, NC. Virginia T. Guidry, Ariel Christensen, and Steven Berkowitz are with the Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - A B M Tanvir Pasha
- Nadine Kotlarz and Jane A. Hoppin are with the Department of Biological Sciences, North Carolina State University, Raleigh. David A. Holcomb and Lawrence S. Engel are with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. A. B. M. Tanvir Pasha, Judith Kays, Yi-Chun Lai, Sean Daly, Francis L. de los Reyes III, and Angela Harris are with the Department of Civil, Construction, and Environmental Engineering, North Carolina State University. Stacie Reckling and Helena Mitasova are with the Center for Geospatial Analytics, North Carolina State University. Sivaranjani Palani is with the Department of Plant and Microbial Biology, North Carolina State University. Erika Bailey is with Raleigh Water, Raleigh, NC. Virginia T. Guidry, Ariel Christensen, and Steven Berkowitz are with the Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Stacie Reckling
- Nadine Kotlarz and Jane A. Hoppin are with the Department of Biological Sciences, North Carolina State University, Raleigh. David A. Holcomb and Lawrence S. Engel are with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. A. B. M. Tanvir Pasha, Judith Kays, Yi-Chun Lai, Sean Daly, Francis L. de los Reyes III, and Angela Harris are with the Department of Civil, Construction, and Environmental Engineering, North Carolina State University. Stacie Reckling and Helena Mitasova are with the Center for Geospatial Analytics, North Carolina State University. Sivaranjani Palani is with the Department of Plant and Microbial Biology, North Carolina State University. Erika Bailey is with Raleigh Water, Raleigh, NC. Virginia T. Guidry, Ariel Christensen, and Steven Berkowitz are with the Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Judith Kays
- Nadine Kotlarz and Jane A. Hoppin are with the Department of Biological Sciences, North Carolina State University, Raleigh. David A. Holcomb and Lawrence S. Engel are with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. A. B. M. Tanvir Pasha, Judith Kays, Yi-Chun Lai, Sean Daly, Francis L. de los Reyes III, and Angela Harris are with the Department of Civil, Construction, and Environmental Engineering, North Carolina State University. Stacie Reckling and Helena Mitasova are with the Center for Geospatial Analytics, North Carolina State University. Sivaranjani Palani is with the Department of Plant and Microbial Biology, North Carolina State University. Erika Bailey is with Raleigh Water, Raleigh, NC. Virginia T. Guidry, Ariel Christensen, and Steven Berkowitz are with the Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Yi-Chun Lai
- Nadine Kotlarz and Jane A. Hoppin are with the Department of Biological Sciences, North Carolina State University, Raleigh. David A. Holcomb and Lawrence S. Engel are with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. A. B. M. Tanvir Pasha, Judith Kays, Yi-Chun Lai, Sean Daly, Francis L. de los Reyes III, and Angela Harris are with the Department of Civil, Construction, and Environmental Engineering, North Carolina State University. Stacie Reckling and Helena Mitasova are with the Center for Geospatial Analytics, North Carolina State University. Sivaranjani Palani is with the Department of Plant and Microbial Biology, North Carolina State University. Erika Bailey is with Raleigh Water, Raleigh, NC. Virginia T. Guidry, Ariel Christensen, and Steven Berkowitz are with the Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Sean Daly
- Nadine Kotlarz and Jane A. Hoppin are with the Department of Biological Sciences, North Carolina State University, Raleigh. David A. Holcomb and Lawrence S. Engel are with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. A. B. M. Tanvir Pasha, Judith Kays, Yi-Chun Lai, Sean Daly, Francis L. de los Reyes III, and Angela Harris are with the Department of Civil, Construction, and Environmental Engineering, North Carolina State University. Stacie Reckling and Helena Mitasova are with the Center for Geospatial Analytics, North Carolina State University. Sivaranjani Palani is with the Department of Plant and Microbial Biology, North Carolina State University. Erika Bailey is with Raleigh Water, Raleigh, NC. Virginia T. Guidry, Ariel Christensen, and Steven Berkowitz are with the Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Sivaranjani Palani
- Nadine Kotlarz and Jane A. Hoppin are with the Department of Biological Sciences, North Carolina State University, Raleigh. David A. Holcomb and Lawrence S. Engel are with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. A. B. M. Tanvir Pasha, Judith Kays, Yi-Chun Lai, Sean Daly, Francis L. de los Reyes III, and Angela Harris are with the Department of Civil, Construction, and Environmental Engineering, North Carolina State University. Stacie Reckling and Helena Mitasova are with the Center for Geospatial Analytics, North Carolina State University. Sivaranjani Palani is with the Department of Plant and Microbial Biology, North Carolina State University. Erika Bailey is with Raleigh Water, Raleigh, NC. Virginia T. Guidry, Ariel Christensen, and Steven Berkowitz are with the Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Erika Bailey
- Nadine Kotlarz and Jane A. Hoppin are with the Department of Biological Sciences, North Carolina State University, Raleigh. David A. Holcomb and Lawrence S. Engel are with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. A. B. M. Tanvir Pasha, Judith Kays, Yi-Chun Lai, Sean Daly, Francis L. de los Reyes III, and Angela Harris are with the Department of Civil, Construction, and Environmental Engineering, North Carolina State University. Stacie Reckling and Helena Mitasova are with the Center for Geospatial Analytics, North Carolina State University. Sivaranjani Palani is with the Department of Plant and Microbial Biology, North Carolina State University. Erika Bailey is with Raleigh Water, Raleigh, NC. Virginia T. Guidry, Ariel Christensen, and Steven Berkowitz are with the Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Virginia T Guidry
- Nadine Kotlarz and Jane A. Hoppin are with the Department of Biological Sciences, North Carolina State University, Raleigh. David A. Holcomb and Lawrence S. Engel are with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. A. B. M. Tanvir Pasha, Judith Kays, Yi-Chun Lai, Sean Daly, Francis L. de los Reyes III, and Angela Harris are with the Department of Civil, Construction, and Environmental Engineering, North Carolina State University. Stacie Reckling and Helena Mitasova are with the Center for Geospatial Analytics, North Carolina State University. Sivaranjani Palani is with the Department of Plant and Microbial Biology, North Carolina State University. Erika Bailey is with Raleigh Water, Raleigh, NC. Virginia T. Guidry, Ariel Christensen, and Steven Berkowitz are with the Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Ariel Christensen
- Nadine Kotlarz and Jane A. Hoppin are with the Department of Biological Sciences, North Carolina State University, Raleigh. David A. Holcomb and Lawrence S. Engel are with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. A. B. M. Tanvir Pasha, Judith Kays, Yi-Chun Lai, Sean Daly, Francis L. de los Reyes III, and Angela Harris are with the Department of Civil, Construction, and Environmental Engineering, North Carolina State University. Stacie Reckling and Helena Mitasova are with the Center for Geospatial Analytics, North Carolina State University. Sivaranjani Palani is with the Department of Plant and Microbial Biology, North Carolina State University. Erika Bailey is with Raleigh Water, Raleigh, NC. Virginia T. Guidry, Ariel Christensen, and Steven Berkowitz are with the Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Steven Berkowitz
- Nadine Kotlarz and Jane A. Hoppin are with the Department of Biological Sciences, North Carolina State University, Raleigh. David A. Holcomb and Lawrence S. Engel are with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. A. B. M. Tanvir Pasha, Judith Kays, Yi-Chun Lai, Sean Daly, Francis L. de los Reyes III, and Angela Harris are with the Department of Civil, Construction, and Environmental Engineering, North Carolina State University. Stacie Reckling and Helena Mitasova are with the Center for Geospatial Analytics, North Carolina State University. Sivaranjani Palani is with the Department of Plant and Microbial Biology, North Carolina State University. Erika Bailey is with Raleigh Water, Raleigh, NC. Virginia T. Guidry, Ariel Christensen, and Steven Berkowitz are with the Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Jane A Hoppin
- Nadine Kotlarz and Jane A. Hoppin are with the Department of Biological Sciences, North Carolina State University, Raleigh. David A. Holcomb and Lawrence S. Engel are with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. A. B. M. Tanvir Pasha, Judith Kays, Yi-Chun Lai, Sean Daly, Francis L. de los Reyes III, and Angela Harris are with the Department of Civil, Construction, and Environmental Engineering, North Carolina State University. Stacie Reckling and Helena Mitasova are with the Center for Geospatial Analytics, North Carolina State University. Sivaranjani Palani is with the Department of Plant and Microbial Biology, North Carolina State University. Erika Bailey is with Raleigh Water, Raleigh, NC. Virginia T. Guidry, Ariel Christensen, and Steven Berkowitz are with the Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Helena Mitasova
- Nadine Kotlarz and Jane A. Hoppin are with the Department of Biological Sciences, North Carolina State University, Raleigh. David A. Holcomb and Lawrence S. Engel are with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. A. B. M. Tanvir Pasha, Judith Kays, Yi-Chun Lai, Sean Daly, Francis L. de los Reyes III, and Angela Harris are with the Department of Civil, Construction, and Environmental Engineering, North Carolina State University. Stacie Reckling and Helena Mitasova are with the Center for Geospatial Analytics, North Carolina State University. Sivaranjani Palani is with the Department of Plant and Microbial Biology, North Carolina State University. Erika Bailey is with Raleigh Water, Raleigh, NC. Virginia T. Guidry, Ariel Christensen, and Steven Berkowitz are with the Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Lawrence S Engel
- Nadine Kotlarz and Jane A. Hoppin are with the Department of Biological Sciences, North Carolina State University, Raleigh. David A. Holcomb and Lawrence S. Engel are with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. A. B. M. Tanvir Pasha, Judith Kays, Yi-Chun Lai, Sean Daly, Francis L. de los Reyes III, and Angela Harris are with the Department of Civil, Construction, and Environmental Engineering, North Carolina State University. Stacie Reckling and Helena Mitasova are with the Center for Geospatial Analytics, North Carolina State University. Sivaranjani Palani is with the Department of Plant and Microbial Biology, North Carolina State University. Erika Bailey is with Raleigh Water, Raleigh, NC. Virginia T. Guidry, Ariel Christensen, and Steven Berkowitz are with the Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Francis L de Los Reyes
- Nadine Kotlarz and Jane A. Hoppin are with the Department of Biological Sciences, North Carolina State University, Raleigh. David A. Holcomb and Lawrence S. Engel are with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. A. B. M. Tanvir Pasha, Judith Kays, Yi-Chun Lai, Sean Daly, Francis L. de los Reyes III, and Angela Harris are with the Department of Civil, Construction, and Environmental Engineering, North Carolina State University. Stacie Reckling and Helena Mitasova are with the Center for Geospatial Analytics, North Carolina State University. Sivaranjani Palani is with the Department of Plant and Microbial Biology, North Carolina State University. Erika Bailey is with Raleigh Water, Raleigh, NC. Virginia T. Guidry, Ariel Christensen, and Steven Berkowitz are with the Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
| | - Angela Harris
- Nadine Kotlarz and Jane A. Hoppin are with the Department of Biological Sciences, North Carolina State University, Raleigh. David A. Holcomb and Lawrence S. Engel are with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. A. B. M. Tanvir Pasha, Judith Kays, Yi-Chun Lai, Sean Daly, Francis L. de los Reyes III, and Angela Harris are with the Department of Civil, Construction, and Environmental Engineering, North Carolina State University. Stacie Reckling and Helena Mitasova are with the Center for Geospatial Analytics, North Carolina State University. Sivaranjani Palani is with the Department of Plant and Microbial Biology, North Carolina State University. Erika Bailey is with Raleigh Water, Raleigh, NC. Virginia T. Guidry, Ariel Christensen, and Steven Berkowitz are with the Division of Public Health, North Carolina Department of Health and Human Services, Raleigh
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Holcomb DA, Quist AJL, Engel LS. Exposure to industrial hog and poultry operations and urinary tract infections in North Carolina, USA. Sci Total Environ 2022; 853:158749. [PMID: 36108846 PMCID: PMC9613609 DOI: 10.1016/j.scitotenv.2022.158749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 06/15/2023]
Abstract
An increasing share of urinary tract infections (UTIs) are caused by extraintestinal pathogenic Escherichia coli (ExPEC) lineages that have also been identified in poultry and hogs with high genetic similarity to human clinical isolates. We investigated industrial food animal production as a source of uropathogen transmission by examining relationships of hog and poultry density with emergency department (ED) visits for UTIs in North Carolina (NC). ED visits for UTI in 2016-2019 were identified by ICD-10 code from NC's ZIP code-level syndromic surveillance system and livestock counts were obtained from permit data and aerial imagery. We calculated separate hog and poultry spatial densities (animals/km2) by Census block with a 5 km buffer on the block perimeter and weighted by block population to estimate mean ZIP code densities. Associations between livestock density and UTI incidence were estimated using a reparameterized Besag-York-Mollié (BYM2) model with ZIP code population offsets to account for spatial autocorrelation. We excluded metropolitan and offshore ZIP codes and assessed effect measure modification by calendar year, ZIP code rurality, and patient sex, age, race/ethnicity, and health insurance status. In single-animal models, hog exposure was associated with increased UTI incidence (rate ratio [RR]: 1.21, 95 % CI: 1.07-1.37 in the highest hog-density tertile), but poultry exposure was associated with reduced UTI rates (RR: 0.86, 95 % CI: 0.81-0.91). However, the reference group for single-animal poultry models included ZIP codes with only hogs, which had some of the highest UTI rates; when compared with ZIP codes without any hogs or poultry, there was no association between poultry exposure and UTI incidence. Hog exposure was associated with increased UTI incidence in areas that also had medium to high poultry density, but not in areas with low poultry density, suggesting that intense hog production may contribute to increased UTI incidence in neighboring communities.
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Affiliation(s)
- David A Holcomb
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Arbor J L Quist
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lawrence S Engel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Quist AJL, Holcomb DA, Fliss MD, Delamater PL, Richardson DB, Engel LS. Exposure to industrial hog operations and gastrointestinal illness in North Carolina, USA. Sci Total Environ 2022; 830:154823. [PMID: 35341848 PMCID: PMC9133154 DOI: 10.1016/j.scitotenv.2022.154823] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/21/2022] [Accepted: 03/21/2022] [Indexed: 06/14/2023]
Abstract
With 9 million hogs, North Carolina (NC) is the second leading hog producer in the United States. Most hogs are housed at concentrated animal feeding operations (CAFOs), where millions of tons of hog waste can pollute air and water with fecal pathogens that can cause diarrhea, vomiting, and/or nausea (known as acute gastrointestinal illness (AGI)). We used NC's ZIP code-level emergency department (ED) data to calculate rates of AGI ED visits (2016-2019) and swine permit data to estimate hog exposure. Case exposure was estimated as the inverse distances from each hog CAFO to census block centroids, weighting with Gaussian decay and by manure amount per CAFO, then aggregated to ZIP code using population weights. We compared ZIP codes in the upper quartile of hog exposure ("high hog exposed") to those without hog exposure. Using inverse probability of treatment weighting, we created a control with similar demographics to the high hog exposed population and calculated rate ratios using quasi-Poisson models. We examined effect measure modification of rurality and race using adjusted models. In high hog exposed areas compared to areas without hog exposure, we observed a 11% increase (95% CI: 1.06, 1.17) in AGI rate and 21% increase specifically in rural areas (95% CI: 0.98, 1.43). When restricted to rural areas, we found an increased AGI rate among American Indian (RR = 4.29, 95% CI: 3.69, 4.88) and Black (RR = 1.45, 95% CI: 0.98, 1.91) residents. The association was stronger during the week after heavy rain (RR = 1.41, 95% CI: 1.19, 1.62) and in areas with both poultry and swine CAFOs (RR = 1.52, 95% CI: 1.48, 1.57). Residing near CAFOs may increase rates of AGI ED visits. Hog CAFOs are disproportionally built near rural Black and American Indian communities in NC and are associated with increased AGI most strongly in these populations.
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Affiliation(s)
- Arbor J L Quist
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA.
| | - David A Holcomb
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Mike Dolan Fliss
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27514, USA
| | - Paul L Delamater
- Department of Geography, University of North Carolina, Chapel Hill, NC 27514, USA
| | - David B Richardson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Lawrence S Engel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
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6
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Barua VB, Juel MAI, Blackwood AD, Clerkin T, Ciesielski M, Sorinolu AJ, Holcomb DA, Young I, Kimble G, Sypolt S, Engel LS, Noble RT, Munir M. Tracking the temporal variation of COVID-19 surges through wastewater-based epidemiology during the peak of the pandemic: A six-month long study in Charlotte, North Carolina. Sci Total Environ 2022; 814:152503. [PMID: 34954186 PMCID: PMC8697423 DOI: 10.1016/j.scitotenv.2021.152503] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 05/05/2023]
Abstract
The global spread of SARS-CoV-2 has continued to be a serious concern after WHO declared the virus to be the causative agent of the coronavirus disease 2019 (COVID-19) a global pandemic. Monitoring of wastewater is a useful tool for assessing community prevalence given that fecal shedding of SARS-CoV-2 occurs in high concentrations by infected individuals, regardless of whether they are asymptomatic or symptomatic. Using tools that are part of wastewater-based epidemiology (WBE) approach, combined with molecular analyses, wastewater monitoring becomes a key piece of information used to assess trends and quantify the scale and dynamics of COVID-19 infection in a specific community, municipality, or area of service. This study investigates a six-month long SARS-CoV-2 RNA quantification in influent wastewater from four municipal wastewater treatment plants (WWTP) serving the Charlotte region of North Carolina (NC) using both RT-qPCR and RT-ddPCR platforms. Influent wastewater was analyzed for the nucleocapsid (N) genes N1 and N2. Both RT-qPCR and RT-ddPCR performed well for detection and quantification of SARS-CoV-2 using the N1 target, while for the N2 target RT-ddPCR was more sensitive. SARS-CoV-2 concentration ranged from 103 to 105 copies/L for all four plants. Both RT-qPCR and RT-ddPCR showed a significant positive correlation between SARS-CoV-2 concentrations and the 7-day rolling average of clinically reported COVID-19 cases when lagging 5 to 12 days (ρ = 0.52-0.92, p < 0.001-0.02). A major finding of this study is that RT-qPCR and RT-ddPCR generated SARS-CoV-2 data that was positively correlated (ρ = 0.569, p < 0.0001) and can be successfully used to monitor SARS-CoV-2 signals across the WWTP of different sizes and metropolitan service functions without significant anomalies.
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Affiliation(s)
- Visva Bharati Barua
- Department of Civil and Environmental Engineering, University of North Carolina Charlotte, 9201 University City Boulevard, Charlotte, NC 28223, USA
| | - Md Ariful Islam Juel
- Department of Civil and Environmental Engineering, University of North Carolina Charlotte, 9201 University City Boulevard, Charlotte, NC 28223, USA
| | - A Denene Blackwood
- Institute of Marine Sciences, The University of North Carolina at Chapel Hill, Morehead City, NC 28557, USA
| | - Thomas Clerkin
- Institute of Marine Sciences, The University of North Carolina at Chapel Hill, Morehead City, NC 28557, USA
| | - Mark Ciesielski
- Institute of Marine Sciences, The University of North Carolina at Chapel Hill, Morehead City, NC 28557, USA
| | - Adeola Julian Sorinolu
- Department of Civil and Environmental Engineering, University of North Carolina Charlotte, 9201 University City Boulevard, Charlotte, NC 28223, USA
| | - David A Holcomb
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Isaiah Young
- Department of Civil and Environmental Engineering, University of North Carolina Charlotte, 9201 University City Boulevard, Charlotte, NC 28223, USA
| | - Gina Kimble
- Charlotte Water, 5100 Brookshire Blvd., Charlotte, NC 28216, USA
| | - Shannon Sypolt
- Charlotte Water, 5100 Brookshire Blvd., Charlotte, NC 28216, USA
| | - Lawrence S Engel
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Rachel T Noble
- Institute of Marine Sciences, The University of North Carolina at Chapel Hill, Morehead City, NC 28557, USA
| | - Mariya Munir
- Department of Civil and Environmental Engineering, University of North Carolina Charlotte, 9201 University City Boulevard, Charlotte, NC 28223, USA.
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7
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Holcomb DA, Knee J, Capone D, Sumner T, Adriano Z, Nalá R, Cumming O, Brown J, Stewart JR. Impacts of an Urban Sanitation Intervention on Fecal Indicators and the Prevalence of Human Fecal Contamination in Mozambique. Environ Sci Technol 2021; 55:11667-11679. [PMID: 34382777 PMCID: PMC8429117 DOI: 10.1021/acs.est.1c01538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Fecal source tracking (FST) may be useful to assess pathways of fecal contamination in domestic environments and to estimate the impacts of water, sanitation, and hygiene (WASH) interventions in low-income settings. We measured two nonspecific and two human-associated fecal indicators in water, soil, and surfaces before and after a shared latrine intervention from low-income households in Maputo, Mozambique, participating in the Maputo Sanitation (MapSan) trial. Up to a quarter of households were impacted by human fecal contamination, but trends were unaffected by improvements to shared sanitation facilities. The intervention reduced Escherichia coli gene concentrations in soil but did not impact culturable E. coli or the prevalence of human FST markers in a difference-in-differences analysis. Using a novel Bayesian hierarchical modeling approach to account for human marker diagnostic sensitivity and specificity, we revealed a high amount of uncertainty associated with human FST measurements and intervention effect estimates. The field of microbial source tracking would benefit from adding measures of diagnostic accuracy to better interpret findings, particularly when FST analyses convey insufficient information for robust inference. With improved measures, FST could help identify dominant pathways of human and animal fecal contamination in communities and guide the implementation of effective interventions to safeguard health.
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Affiliation(s)
- David A. Holcomb
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States of America
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States of America
| | - Jackie Knee
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States of America
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Drew Capone
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States of America
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States of America
| | - Trent Sumner
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States of America
| | | | - Rassul Nalá
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Joe Brown
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States of America
| | - Jill R. Stewart
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States of America
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Abstract
PURPOSE OF REVIEW Fecal contamination of water is a major public health concern. This review summarizes recent developments and advancements in water quality indicators of fecal contamination. RECENT FINDINGS This review highlights a number of trends. First, fecal indicators continue to be a valuable tool to assess water quality and have expanded to include indicators able to detect sources of fecal contamination in water. Second, molecular methods, particularly PCR-based methods, have advanced considerably in their selected targets and rigor, but have added complexity that may prohibit adoption for routine monitoring activities at this time. Third, risk modeling is beginning to better connect indicators and human health risks, with the accuracy of assessments currently tied to the timing and conditions where risk is measured. Research has advanced although challenges remain for the effective use of both traditional and alternative fecal indicators for risk characterization, source attribution and apportionment, and impact evaluation.
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Affiliation(s)
- David A Holcomb
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr., Chapel Hill, NC, 27599-7435, USA
| | - Jill R Stewart
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr., Chapel Hill, NC, 27599-7431, USA.
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9
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Holcomb DA, Knee J, Sumner T, Adriano Z, de Bruijn E, Nalá R, Cumming O, Brown J, Stewart JR. Human fecal contamination of water, soil, and surfaces in households sharing poor-quality sanitation facilities in Maputo, Mozambique. Int J Hyg Environ Health 2020; 226:113496. [PMID: 32135507 PMCID: PMC7174141 DOI: 10.1016/j.ijheh.2020.113496] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/09/2020] [Accepted: 02/20/2020] [Indexed: 12/12/2022]
Abstract
Identifying the origin of fecal contamination can support more effective interventions to interrupt enteric pathogen transmission. Microbial source tracking (MST) assays may help to identify environmental routes of pathogen transmission although these assays have performed poorly in highly contaminated domestic settings, highlighting the importance of both diagnostic validation and understanding the context-specific ecological, physical, and sociodemographic factors driving the spread of fecal contamination. We assessed fecal contamination of compounds (clusters of 2-10 households that share sanitation facilities) in low-income neighborhoods of urban Maputo, Mozambique, using a set of MST assays that were validated with animal stool and latrine sludge from study compounds. We sampled five environmental compartments involved in fecal microbe transmission and exposure: compound water source, household stored water and food preparation surfaces, and soil from the entrance to the compound latrine and the entrances to each household. Each sample was analyzed by culture for the general fecal indicator Escherichia coli (cEC) and by real-time PCR for the E. coli molecular marker EC23S857, human-associated markers HF183/BacR287 and Mnif, and GFD, an avian-associated marker. We collected 366 samples from 94 households in 58 compounds. At least one microbial target (indicator organism or marker gene) was detected in 96% of samples (353/366), with both E. coli targets present in the majority of samples (78%). Human targets were frequently detected in soils (59%) and occasionally in stored water (17%) but seldom in source water or on food surfaces. The avian target GFD was rarely detected in any sample type but was most common in soils (4%). To identify risk factors of fecal contamination, we estimated associations with sociodemographic, meteorological, and physical sample characteristics for each microbial target and sample type combination using Bayesian censored regression for target concentration responses and Bayesian logistic regression for target detection status. Associations with risk factors were generally weak and often differed in direction between different targets and sample types, though relationships were somewhat more consistent for physical sample characteristics. Wet soils were associated with elevated concentrations of cEC and EC23S857 and odds of detecting HF183. Water storage container characteristics that expose the contents to potential contact with hands and other objects were weakly associated with human target detection. Our results describe a setting impacted by pervasive domestic fecal contamination, including from human sources, that was largely disconnected from the observed variation in socioeconomic and sanitary conditions. This pattern suggests that in such highly contaminated settings, transformational changes to the community environment may be required before meaningful impacts on fecal contamination can be realized.
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Affiliation(s)
- David A Holcomb
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jackie Knee
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Trent Sumner
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Zaida Adriano
- We Consult, Maputo, Mozambique; Departamento de Geografia, Universidade Eduardo Mondlane, Maputo, Mozambique
| | | | - Rassul Nalá
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Joe Brown
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Jill R Stewart
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
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10
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Capone D, Adriano Z, Berendes D, Cumming O, Dreibelbis R, Holcomb DA, Knee J, Ross I, Brown J. A localized sanitation status index as a proxy for fecal contamination in urban Maputo, Mozambique. PLoS One 2019; 14:e0224333. [PMID: 31652287 PMCID: PMC6814227 DOI: 10.1371/journal.pone.0224333] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 10/10/2019] [Indexed: 11/24/2022] Open
Abstract
Sanitary surveys are used in low- and middle-income countries to assess water, sanitation, and hygiene conditions, but have rarely been compared with direct measures of environmental fecal contamination. We conducted a cross-sectional assessment of sanitary conditions and E. coli counts in soils and on surfaces of compounds (household clusters) in low-income neighborhoods of Maputo, Mozambique. We adapted the World Bank's Urban Sanitation Status Index to implement a sanitary survey tool specifically for compounds: a Localized Sanitation Status Index (LSSI) ranging from zero (poor sanitary conditions) to one (better sanitary conditions) calculated from 20 variables that characterized local sanitary conditions. We measured the variation in the LSSI with E. coli counts in soil (nine locations/compound) and surface swabs (seven locations/compound) in 80 compounds to assess reliability. Multivariable regression indicated that a ten-percentage point increase in LSSI was associated with 0.05 (95% CI: 0.00, 0.11) log10 fewer E. coli/dry gram in courtyard soil. Overall, the LSSI may be associated with fecal contamination in compound soil; however, the differences detected may not be meaningful in terms of public health hazards.
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Affiliation(s)
- Drew Capone
- Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
| | - Zaida Adriano
- WE Consult, Maputo, Mozambique
- Departamento de Geografia, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - David Berendes
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Robert Dreibelbis
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David A. Holcomb
- Department of Environmental Sciences and Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Jackie Knee
- Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
| | - Ian Ross
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Joe Brown
- Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
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11
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Holcomb DA, Messier KP, Serre ML, Rowny JG, Stewart JR. Geostatistical Prediction of Microbial Water Quality Throughout a Stream Network Using Meteorology, Land Cover, and Spatiotemporal Autocorrelation. Environ Sci Technol 2018; 52:7775-7784. [PMID: 29886747 DOI: 10.1021/acs.est.8b01178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Predictive modeling is promising as an inexpensive tool to assess water quality. We developed geostatistical predictive models of microbial water quality that empirically modeled spatiotemporal autocorrelation in measured fecal coliform (FC) bacteria concentrations to improve prediction. We compared five geostatistical models featuring different autocorrelation structures, fit to 676 observations from 19 locations in North Carolina's Jordan Lake watershed using meteorological and land cover predictor variables. Though stream distance metrics (with and without flow-weighting) failed to improve prediction over the Euclidean distance metric, incorporating temporal autocorrelation substantially improved prediction over the space-only models. We predicted FC throughout the stream network daily for one year, designating locations "impaired", "unimpaired", or "unassessed" if the probability of exceeding the state standard was ≥90%, ≤10%, or >10% but <90%, respectively. We could assign impairment status to more of the stream network on days any FC were measured, suggesting frequent sample-based monitoring remains necessary, though implementing spatiotemporal predictive models may reduce the number of concurrent sampling locations required to adequately assess water quality. Together, these results suggest that prioritizing sampling at different times and conditions using geographically sparse monitoring networks is adequate to build robust and informative geostatistical models of water quality impairment.
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Affiliation(s)
- David A Holcomb
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health , University of North Carolina , Chapel Hill , North Carolina 27599-7431 , United States
| | - Kyle P Messier
- Department of Civil, Architectural, and Environmental Engineering , University of Texas , Austin , Texas 78712 , United States
| | - Marc L Serre
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health , University of North Carolina , Chapel Hill , North Carolina 27599-7431 , United States
| | - Jakob G Rowny
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health , University of North Carolina , Chapel Hill , North Carolina 27599-7431 , United States
| | - Jill R Stewart
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health , University of North Carolina , Chapel Hill , North Carolina 27599-7431 , United States
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