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Water and sanitation interventions in developing countries have historically been difficult to evaluate. We conducted a seroepidemiologic study with the following goals: 1) to determine the feasibility of using antibody markers as indicators of waterborne pathogen infection in the evaluation of water and sanitation intervention projects; 2) to characterize the epidemiology of waterborne diarrheal infections in rural Guatemala, and 3) to measure the age-specific prevalence of antibodies to waterborne pathogens. Between September and December 1999, all children 6–36 months of age in 10 study villages were invited to participate. We collected sufficient serum from 522 of 590 eligible children, and divided them into six-month age groups for analysis (6–12, 13–18, 19–24, 25–30, and 31–36 months). The prevalence of antibodies was lowest in children 6–12 months old compared with the four older age groups for the following pathogens: enterotoxigenic Escherichia coli (48%, 81%, 80%, 77%, and 83%), Norwalk virus (27%, 61%, 83%, 94%, and 94%), and Cryptosporidium parvum (27%, 53%, 70%, 67%, and 73%). The prevalence of total antibody to hepatitis A virus increased steadily in the three oldest age groups (40%, 28%, 46%, 60%, and 76%). In contrast, the prevalence of antibody to Helicobacter pylori was relatively constant in all five age groups (20%, 19%, 21%, 25%, and 25%). Serology appears to be an efficient and feasible approach for determining the prevalence of infection with selected waterborne pathogens in very young children. Such an approach may provide a suitable, sensitive, and economical alternative to the cumbersome stool collection methods that have previously been used for evaluation of water and sanitation projects.
Received April 29, 2003. Accepted for publication August 5, 2003.
Acknowledgments: We thank the communities of San Juan Sacatepéquez for participating in the study, all of our colleagues who have worked on the safe water system projects, Michael Purdy for his work on the HAV serology, and Richard Dicker for his assistance with data analysis.
Financial support: This research was supported in part by the Proctor and Gamble Company.
Authors’ addresses: Ellen Steinberg Stevenson, Department of Pediatrics, Emory University School of Medicine, Egelston Children’s Hospital, 1405 Clifton Road, Annex 3C, Atlanta, GA 30322, Telephone: 404-325-6104, Fax: 404-315-2067, E-mail: ellen.stevenson{at}choa.org. William Bibb, Eric D. Mintz, and Stephen Luby, Food-borne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mailstop A-38, 1600 Clifton Road, Atlanta, GA, 30333. Carlos E Mendoza, Byron Arana, M. Beatriz Lopez, and Maricruz Mejia, Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala. Roger Glass and Stephan S. Monroe, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mailstop G-04, Atlanta, GA, 30333. Benjamin D. Gold, Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322. Jeffrey W. Priest and Caryn Bern, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mailstop F-13, Atlanta, GA 30341. Beth P. Bell, Division of Viral Hepatitis, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mailstop G-37, Atlanta, GA 30333. Robert M. Hoekstra, Biostatistics and Information Management Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333. Robert Klein, Medical Entomology Research and Training Unit/Guatemala, Division of Parasitic Diseases, Centers for Diseases Control and Prevention, Mailstop F-22, Atlanta, GA 30341.
Reprint requests: Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mailstop A-38, 1600 Clifton Road, Atlanta, GA 30333.
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