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Am. J. Trop. Med. Hyg., 77(1), 2007, pp. 136-141
Copyright © 2007 by The American Society of Tropical Medicine and Hygiene

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Comparing Serologic Response against Enteric Pathogens with Reported Diarrhea to Assess the Impact of Improved Household Drinking Water Quality

John A. Crump*, Carlos E. Mendoza, Jeffrey W. Priest, Roger I. Glass, Stephan S. Monroe, Leslie A. Dauphin, William F. Bibb, M. Beatriz Lopez, Maricruz Alvarez, Eric D. Mintz, AND Stephen P. Luby
Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases; Division of Parasitic Diseases; Division of Viral and Rickettsial Diseases; National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Centers for Disease Control and Prevention Regional Office for Central America and Panama, Universidad del Valle de Guatemala, Guatemala City, Guatemala

We evaluated enteric infection serology as an alternative outcome measure to diarrhea prevalence in a randomized controlled trial of household-based drinking water treatment; 492 households were randomly assigned to 5 household-based water treatment interventions or control. Individuals were followed weekly over 52 weeks to measure diarrhea prevalence. Study subjects of age ≤ 6 months and < 24 months had blood drawn at entry and exit from the study or age cohort. Serologic assays for Cryptosporidium parvum, Giardia intestinalis, enterotoxigenic Escherichia coli (ETEC), and Norovirus were done. Of 343 subjects eligible for the study, the proportions of subjects experiencing serologic responses were 56% for Norovirus, 24% for C. parvum, 10% for ETEC, and 16% for G. intestinalis. Serologic response was associated with increased diarrhea prevalence only for G. intestinalis (P = 0.0134). Serologic response to the antigens tested for G. intestinalis but not for Norovirus, C. parvum, and ETEC may be a useful health-effect measure. Larger intervention studies that yield a more marked effect on diarrheal disease, use additional and improved serologic assays, and that collect serum samples at more frequent intervals are needed.

Received September 1, 2006. Accepted for publication March 26, 2007.

Acknowledgments: We thank Megan E. Reller, Christy A. Olson, Kathleen G. Baier, and Bruce H. Keswick for their efforts in design and implementation of the intervention study within which this study was nested. We also thank Amanda Newton for performing Norovirus serology and James M. Pruckler and Deborah F. Talkington for assistance with ETEC serology.

Financial support: This study was supported by a cooperative research and development agreement between the Centers for Disease Control and Prevention and the Procter & Gamble Company.

* Address correspondence to John A. Crump, Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, MS A-38, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333. E-mail: jcrump{at}cdc.gov

Presented in part at the International Conference on Emerging Infectious Diseases, Atlanta, GA, March 19–22, 2006.

Authors’ addresses: John A. Crump, William F. Bibb, Eric D. Mintz, and Stephen P. Luby, Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, MS A-38, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, Telephone: +1 (404) 639-2206, Fax: +1 (404) 639-2205, E-mail: jcrump{at}cdc.gov. Carlos E. Mendoza, M. Beatriz Lopez, and Maricruz Alvarez, Centers for Disease Control and Prevention Regional Office for Central America and Panama, Universidad del Valle de Guatemala, Guatemala City, Guatemala. Jeffrey W. Priest, Division of Parasitic Diseases, National Center for Infections Diseases, Mailstop F-13, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333. Roger I. Glass, Stephan S. Monroe, and Leslie Daupin, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Mailstop G-04, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333.

Reprint requests: John A. Crump, Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, MS A-38, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, Telephone: +1 (404) 639-2206, Fax: +1 (404) 639-2205, E-mail: jcrump{at}cdc.gov.






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Copyright © 2007 by the American Society of Tropical Medicine and Hygiene.