title: Hands and water as vectors of diarrheal pathogens in Bagamoyo, Tanzania.
abstract: Diarrheal disease is a leading cause of under-five childhood mortality worldwide, with at least half of these deaths occurring in sub-Saharan Africa. Transmission of diarrheal pathogens occurs through several exposure routes including drinking water and hands, but the relative importance of each route is not well understood. Using molecular methods, this study examines the relative importance of different exposure routes by measuring enteric bacteria (pathogenic Escherichia coli) and viruses (rotavirus, enterovirus, adenovirus) in hand rinses, stored water, and source waters in Bagamoyo, Tanzania. Viruses were most frequently found on hands, suggesting that hands are important vectors for viral illness. The occurrence of E. coli virulence genes (ECVG) was equivalent across all sample types, indicating that both water and hands are important for bacterial pathogen transmission. Fecal indicator bacteria and turbidity were good predictors of ECVG, whereas turbidity and human-specific Bacteroidales were good predictors of viruses. ECVG were more likely found in unimproved water sources, but both ECVG and viral genes were detected in improved water sources. ECVG were more likely found in stored water of households with unimproved sanitation facilities. The results provide insights into the distribution of pathogens in Tanzanian households and offer evidence that hand-washing and improved water management practices could alleviate viral and bacterial diarrhea.
authors.affiliation: Environmental and Water Studies, Department of Civil and Environmental Engineering, Stanford University, Stanford, California 94305, United States.
authors.forename: Mia Catharine
authors.initials: MC
authors.lastname: Mattioli
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Pickering
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Gilsdorf
authors.forename: Jennifer
authors.initials: J
authors.lastname: Davis
authors.forename: Alexandria B
authors.initials: AB
authors.lastname: Boehm
mesh_terms: D000293:Adolescent; D000328:Adult; D002675:Child, Preschool; D003967:Diarrhea; D060766:Drinking Water / Q000382:microbiology*; D004926:Escherichia coli / Q000235:genetics; D004927:Escherichia coli Infections / Q000382:microbiology / Q000635:transmission*; D005260:Female; D005798:Genes, Bacterial; D005814:Genes, Viral; D006225:Hand / Q000382:microbiology*; D006801:Humans; D008875:Middle Aged; D009391:Nephelometry and Turbidimetry; D013636:Tanzania; D014777:Virus Diseases / Q000382:microbiology / Q000635:transmission*; D014780:Viruses / Q000235:genetics; D014871:Water Microbiology; D014873:Water Pollutants / Q000302:isolation & purification; D055815:Young Adult
chemical_list: D060766:Drinking Water; D014873:Water Pollutants