title: Water bags as a potential vehicle for transmitting disease in a West African capital, Bissau.
abstract: BACKGROUND
  Street vendors of chilled packaged water have an increasing role in meeting the drinking water demand of people on the move in developing nations. Hygienic conditions can be questionable, and water quality screening scarce or non-existent.
  
  
  METHODS
  In order to ascertain the quality of the packaged water sold by street vendors in Bissau, the capital of the Western African country Guinea-Bissau, water bags were screened in 2011 and during the 2012 cholera outbreak for key physical, chemical and microbiological parameters.
  
  
  RESULTS
  Water used to fill the hand-filled hand-tied bags originated from communal tap water and melted ice. All samples (n=36) were microbiologically contaminated, although levels showed a pronounced variability (e.g. 7-493 372 cfu 250 ml(-1) for Escherichia coli). In 2012, the fecal contamination levels increased (p<0.05), and Vibrio cholerae was detected in all water bags obtained from the neighborhood where the outbreak started.
  
  
  CONCLUSIONS
  Findings showed that all packaged water samples were unfit for human consumption and during the 2012 cholera outbreak represented a potential vehicle for the spread of the disease. The design of measures to decrease the risk associated to the consumption of highly contaminated chilled water is clearly required.
authors.affiliation: Laboratory of Hydrobiology and Ecology, Institute of Biomedical Sciences, University of Porto (ICBAS-UP), Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal Ciimar-Centre of Marine and Environmental Research, Porto, Portugal bordalo@icbas.up.pt.
authors.forename: Adriano A
authors.initials: AA
authors.lastname: Bordalo
authors.affiliation: Laboratory of Hydrobiology and Ecology, Institute of Biomedical Sciences, University of Porto (ICBAS-UP), Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal Ciimar-Centre of Marine and Environmental Research, Porto, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Machado
mesh_terms: D000293:Adolescent; D000354:Africa, Western / Q000453:epidemiology; D002648:Child; D002771:Cholera / Q000453:epidemiology* / Q000635:transmission; D015169:Colony Count, Microbial; D003132:Commerce / Q000379:methods / Q000706:statistics & numerical data; D004196:Disease Outbreaks; D018562:Disease Transmission, Infectious / Q000706:statistics & numerical data*; D060766:Drinking Water / Q000382:microbiology*; D004926:Escherichia coli / Q000302:isolation & purification / Q000472:pathogenicity; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000635:transmission; D005243:Feces; D005260:Female; D006169:Guinea-Bissau / Q000453:epidemiology; D006801:Humans; D008297:Male; D019064:Product Packaging; D014734:Vibrio cholerae / Q000302:isolation & purification / Q000472:pathogenicity; D014871:Water Microbiology; D060753:Water Quality
chemical_list: D060766:Drinking Water
keywords: Africa; Cholera; Guinea-Bissau; Microbial water quality; Street vendors; Water bags