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Exploring relationships of fecal exposure pathways & (a)symptomatic enteric infections in Vellore

American Society of Tropical Medicine and Hygiene 2019

November 20-24, 2019

Yuke Wang, Sydney Hubbard, Gagandeep Kang, Suraja Raj, Habib Yakubu, Arun Karthikeyan, Senthil Kumar, Venkata R. Mohan, Christine Moe

Emory University, Atlanta, GA, United States, Christian Medical College of Vellore, India, Vellore, India

Rapid urbanization has led to a sanitation crisis in many low- and middle income countries (LMIC). In March 2014, SaniPath in collaboration with the Christian Medical College (CMC) of Vellore, India conducted an exposure assessment in Old Town, a dense, urban unplanned settlement in Vellore. A total of 191 samples were collected from open drains, drinking water, public latrines, soil, raw produce, bathing water, child handrinse, and toy feeding spoon rinse and analyzed for E. coli. From March 2010 - February 2012, the MAL-ED study, a multi-site project examining enteric and growth outcomes enrolled a birth cohort of 190 children in Old Town. Multiple stool samples were collected from each child over two years of follow up and tested for bacterial and viral pathogens. Symptomatic illness was recorded. Each child in the MAL-ED study was linked with the closest environmental samples from the SaniPath study. Spatial variables, like the distance to the closest open defecation site, were generated. Generalized linear models were used with the bacterial infection rate, viral infection rate, and symptomatic illness rate as outcomes and environmental fecal contamination from different pathways and spatial variables as covariates. E. coli concentration from the closest public latrine and the distance to the closest open defecation site were significant predictors of bacterial infection rate in children. The sum of the open drain lengths within a 100-meter radius of the child, as well as the sum of street lengths within a 100-meter radius of the child, were significant predictors of viral infections in children. The E. coli concentration of the closest piped water was the only significant predictor of symptomatic illness in children. These results highlight the need for safe excreta management in dense, urban settings to prevent bacterial infections, while contaminated drinking water seems to be a major driver of symptomatic illness in this population. Human congestion, as proxied by summative surrounding street lengths and open drains, is a key risk factor for viral infection.

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