PREVALENCE OF INFECTION WITH WATERBORNE PATHOGENS: A SEROEPIDEMIOLOGIC STUDY IN CHILDREN 6–36 MONTHS OLD IN SAN JUAN SACATEPEQUEZ, GUATEMALA

ELLEN B. STEINBERG Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, Division of Viral and Rickettsial Diseases, Medical Entomology Research and Training Unit/Guatemala, Division of Parasitic Diseases, Division of Viral Hepatitis, National Center for Infectious Diseases, and Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Center for Health Studies, Universidad del Valle de Guatemala; Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia

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CARLOS E. MENDOZA Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, Division of Viral and Rickettsial Diseases, Medical Entomology Research and Training Unit/Guatemala, Division of Parasitic Diseases, Division of Viral Hepatitis, National Center for Infectious Diseases, and Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Center for Health Studies, Universidad del Valle de Guatemala; Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia

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ROGER GLASS Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, Division of Viral and Rickettsial Diseases, Medical Entomology Research and Training Unit/Guatemala, Division of Parasitic Diseases, Division of Viral Hepatitis, National Center for Infectious Diseases, and Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Center for Health Studies, Universidad del Valle de Guatemala; Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia

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BYRON ARANA Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, Division of Viral and Rickettsial Diseases, Medical Entomology Research and Training Unit/Guatemala, Division of Parasitic Diseases, Division of Viral Hepatitis, National Center for Infectious Diseases, and Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Center for Health Studies, Universidad del Valle de Guatemala; Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia

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M. BEATRIZ LOPEZ Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, Division of Viral and Rickettsial Diseases, Medical Entomology Research and Training Unit/Guatemala, Division of Parasitic Diseases, Division of Viral Hepatitis, National Center for Infectious Diseases, and Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Center for Health Studies, Universidad del Valle de Guatemala; Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia

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MARICRUZ MEJIA Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, Division of Viral and Rickettsial Diseases, Medical Entomology Research and Training Unit/Guatemala, Division of Parasitic Diseases, Division of Viral Hepatitis, National Center for Infectious Diseases, and Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Center for Health Studies, Universidad del Valle de Guatemala; Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia

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BENJAMIN D. GOLD Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, Division of Viral and Rickettsial Diseases, Medical Entomology Research and Training Unit/Guatemala, Division of Parasitic Diseases, Division of Viral Hepatitis, National Center for Infectious Diseases, and Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Center for Health Studies, Universidad del Valle de Guatemala; Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia

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JEFFREY W. PRIEST Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, Division of Viral and Rickettsial Diseases, Medical Entomology Research and Training Unit/Guatemala, Division of Parasitic Diseases, Division of Viral Hepatitis, National Center for Infectious Diseases, and Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Center for Health Studies, Universidad del Valle de Guatemala; Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia

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WILLIAM BIBB Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, Division of Viral and Rickettsial Diseases, Medical Entomology Research and Training Unit/Guatemala, Division of Parasitic Diseases, Division of Viral Hepatitis, National Center for Infectious Diseases, and Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Center for Health Studies, Universidad del Valle de Guatemala; Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia

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STEPHAN S. MONROE Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, Division of Viral and Rickettsial Diseases, Medical Entomology Research and Training Unit/Guatemala, Division of Parasitic Diseases, Division of Viral Hepatitis, National Center for Infectious Diseases, and Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Center for Health Studies, Universidad del Valle de Guatemala; Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia

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CARYN BERN Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, Division of Viral and Rickettsial Diseases, Medical Entomology Research and Training Unit/Guatemala, Division of Parasitic Diseases, Division of Viral Hepatitis, National Center for Infectious Diseases, and Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Center for Health Studies, Universidad del Valle de Guatemala; Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia

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BETH P. BELL Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, Division of Viral and Rickettsial Diseases, Medical Entomology Research and Training Unit/Guatemala, Division of Parasitic Diseases, Division of Viral Hepatitis, National Center for Infectious Diseases, and Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Center for Health Studies, Universidad del Valle de Guatemala; Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia

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ROBERT M. HOEKSTRA Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, Division of Viral and Rickettsial Diseases, Medical Entomology Research and Training Unit/Guatemala, Division of Parasitic Diseases, Division of Viral Hepatitis, National Center for Infectious Diseases, and Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Center for Health Studies, Universidad del Valle de Guatemala; Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia

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ROBERT KLEIN Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, Division of Viral and Rickettsial Diseases, Medical Entomology Research and Training Unit/Guatemala, Division of Parasitic Diseases, Division of Viral Hepatitis, National Center for Infectious Diseases, and Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Center for Health Studies, Universidad del Valle de Guatemala; Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia

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ERIC D. MINTZ Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, Division of Viral and Rickettsial Diseases, Medical Entomology Research and Training Unit/Guatemala, Division of Parasitic Diseases, Division of Viral Hepatitis, National Center for Infectious Diseases, and Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Center for Health Studies, Universidad del Valle de Guatemala; Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia

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STEPHEN LUBY Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, Division of Viral and Rickettsial Diseases, Medical Entomology Research and Training Unit/Guatemala, Division of Parasitic Diseases, Division of Viral Hepatitis, National Center for Infectious Diseases, and Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Center for Health Studies, Universidad del Valle de Guatemala; Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia

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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.

Author Notes

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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