Volume 70, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


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 (48%, 81%, 80%, 77%, and 83%), Norwalk virus (27%, 61%, 83%, 94%, and 94%), and (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 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.


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  1. WHO, 2000. Water Supply and Sanitation Council, Global Water Supply and Sanitation Assessment 2000 Report. New York: UNICEF.
  2. Prüss A, Kay D, Fewtrell L, Bartram J, 2002. Estimating the burden of disease from water, sanitation, and hygiene at the global level. Environ Health Perspect 110: 537–542. [Google Scholar]
  3. Esrey SA, Potash JB, Roberts L, Shiff C, 1991. Effects of improved water supply and sanitation on ascariasis, diarrhea, dracunculiasis, hookworm infection, schistosomiasis, and trachoma. Bull World Health Organ 69 : 609–621. [Google Scholar]
  4. Feachem RG, 1984. Interventions for control of diarrheal diseases among young children: promotion of personal and domestic hygiene. Bull World Health Organ 62 : 467–476. [Google Scholar]
  5. Khalil K, Lindblom GB, Mazhar K, Khan SR, Kajiser B, 1993. Early child health in Lahore, Pakistan: VIII. Microbiology. Acta Paediatr 82 (suppl 390): 87–94. [Google Scholar]
  6. Bhan MK, Bhandari N, Sazawal S, Clemens J, Raj P, Levine M, Kaper J, 1989. Descriptive epidemiology of persistent diarrhoea among young children in rural northern India. Bull World Health Organ 67 : 281–288. [Google Scholar]
  7. Punyaratabandhu P, Vathanophas K, Vardrithya W, Sangchai R, Athipanyakom S, Echeverria P, Wasi C, 1991. Childhood diarrhoea in a low-income urban community in Bangkok: incidence, clinical features, and child caretaker’s behaviors. J Diarrhoeal Dis Res 9 : 244–249. [Google Scholar]
  8. Cravioto A, Reyes RE, Ortega R, Fernandez G, Hernandez R, Lopez D, 1988. Prospective study of diarrhoeal disease in a cohort of rural Mexican children: incidence and isolated pathogens during the first two years of life. Epidemiol Infect 101 : 123–134. [Google Scholar]
  9. Smit TK, Steele AD, Peenze I, Jiang X, Estes MK, 1997. Study of Norwalk virus and Mexico virus infections at Ga-Rankuwa Hospital, Ga-Rankuwa, South Africa. J Clin Microbiol 35 : 2381–2385. [Google Scholar]
  10. Brussow H, Sidoti J, Link H, Hoang YK, Barclay D, Dirren H, Freire WB, 1990. Age-specific prevalence of antibody to enterotoxigenic Escherichia coli in Ecuadorian and German children. J Infect Dis 162 : 974–977. [Google Scholar]
  11. Ungar BL, Gilman RH, Lanata CF, Perez-Schael, 1988. Seroepi-demiology of Cryptosporidium infection in two Latin American populations. J Infect Dis 157 : 551–556. [Google Scholar]
  12. Vitral CL, Yoshida CF, Lemos ER, Teixera CS, Gaspar AM, 1998. Age-specific prevalence of antibodies to hepatitis A in children and adolescents from Rio de Janeiro, Brazil, 1978 and 1995: relationship of prevalence to environmental factors. Mem Inst Oswaldo Cruz 93 : 1–5. [Google Scholar]
  13. Khanna B, Cutler A, Israel NR, Perry M, Lastovica A, Fields PI, Gold BD, 1998. Use caution with serologic testing for Helicobacter pylori infection in children. J Infect Dis 178 : 460–465. [Google Scholar]
  14. Lindkvist P, Asrat D, Nilsson I, 1996. Age at acquisition of Helicobacter pylori infection: comparison of a high and a low prevalence country. Scan J Infect Dis 28 : 181–184. [Google Scholar]
  15. Cogill B, 2001. Anthropometric Indicators Measurement Guide. Food and Nutrition Technical Assistance Project. Washington, DC: Academy for Educational Development, 39–42.
  16. WHO, 2001. Iron Deficiency Anemia Assessment, Prevention, and Control: A guide for program managers. Geneva: World Health Organization, 33.
  17. Pei ZH, Ellison RT, Blaser MJ, 1991. Identification, purification, and characterization of major antigenic proteins of Campylobacter jejuni. J Biol Chem 266 : 16363–16369. [Google Scholar]
  18. Perez-Perez GI, Dworkin BM, Chodos JE, Blaser MJ, 1988. Campylobacter pylori antibodies in humans. Ann Intern Med 109 : 11–17. [Google Scholar]
  19. Gold BD, Khanna B, Huang LM, Lee CY, Banatvala N, 1997. Helicobacter pylori acquisition in infancy after decline of maternal passive immunity. Pediatr Res 41 : 641–646. [Google Scholar]
  20. Perez-Perez GI, Brown WR, Cover TL, Dunn BE, Cao P, Blaser MJ, 1994. Correlation between serological and mucosal inflammatory responses to Helicobacter pylori. Clin Diagn Lab Immunol 1 : 325–329. [Google Scholar]
  21. Priest JW, Li A, Khan M, Arrowood MJ, Lammie PJ, Ong CS, Roberts JM, Isaac-Renton J, 2001. Enzyme immunoassay detection of antigen-specific immunoglobulin G antibodies in longitudinal serum samples from patients with cryptosporidiosis. Clin Diag Lab Immunol 8 : 415–423. [Google Scholar]
  22. Noel JS, Ando T, Leite JP, Green KY, Dingle KE, Estes MK, Seto Y, Monroe SS, Glass RI, 1997. Correlation of patient immune responses with genetically characterized small round-structured viruses involved in outbreaks of non-bacterial acute gastroenteritis in the United States, 1990 to 1995. J Med Virol 53 : 372–383. [Google Scholar]
  23. Bardhan PK, 1997. Epidemiological features of Helicobacter pylori infection in developing countries. Clin Infect Dis 25 : 973–978. [Google Scholar]
  24. Sathar MA, Gouws E, Simjee AE, Mayat AM, 1997. Seroepidemiological study of Helicobacter pylori infection in South African children. Trans R Soc Trop Med Hyg 91 : 393–395. [Google Scholar]
  25. Qureshi H, Hafiz S, Medhi I, 1999. Helicobacter pylori IgG antibodies in children. J Pak Med Assoc 49 : 143–144. [Google Scholar]
  26. Bodhidatta L, Hoge CW, Churnrathanakul, Nirdnoy W, Sampathanukul P, Tungtaem C, Raktham S, Smith CD, Echeverria P, 1993. Diagnosis of Helicobacter pylori infection in a developing country: comparison of two ELISAs and a seroprevalence study. J Infect Dis 168 : 1549–1553. [Google Scholar]
  27. Glynn MK, Friedman CR, Gold BD, Khanna B, Hutwagner L, Iihoshi N, Revollo C, Quick R, 2002. Seroincidence of Helicobacter pylori infection in a cohort of rural Bolivian children: acquisition and analysis of possible risk factors. Clin Infect Dis 35 : 1059–1065. [Google Scholar]
  28. Parkinson AJ, Gold BD, Bulkow L, Wainright RB, Swaminathan B, Kanna B, Petersen KM, Fitzgerald MA, 2000. High prevalence of Helicobacter pylori in the Alaska native population and association with low serum ferritin levels in young adults. Clin Diag Lab Immunol 7 : 885–888. [Google Scholar]
  29. Centers for Disease Control and Prevention, 1999. Iron deficiency anemia in Alaska native children - Hooper Bay, Alaska. MMWR Morb Mortal Wkly Rep 48 : 714–716. [Google Scholar]

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  • Received : 29 Apr 2003
  • Accepted : 05 Aug 2003

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