Jesser Kelsey J, Zhou Nicolette A, Hemlock Caitlin, Miller-Petrie Molly K, Contreras Jesse D, Ballard April, Sosa-Moreno Andrea, Calvopiña Manuel, Arnold Benjamin F, Cevallos William, Trueba Gabriel, Lee Gwenyth O, Eisenberg Joseph N S, Levy Karen
Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington 98195, United States.
Department of Epidemiology, University of Michigan, Ann Arbor, Michigan 48109, United States.
Environ Sci Technol. 2025 Jan 14;59(1):103-118. doi: 10.1021/acs.est.4c07753. Epub 2024 Dec 30.
Enteropathogens are major contributors to mortality and morbidity, particularly in settings with limited access to water, sanitation, and hygiene infrastructure. To assess transmission pathways associated with enteropathogen infection, we measured household environmental conditions and assayed 22 enteropathogens using TaqMan Array Cards in stool samples from 276 six-month-old children living in communities along a rural-urban gradient in Northern Ecuador. We utilized multivariable models, risk factor importance, and distance-based statistical methods to test factors associated with infection. Most children (89%) carried at least one pathogen, and 72% carried two or more. Bacterial infections (82% of participants) were more common than viruses (58%) or parasites (9.1%). Infants living in the urban site had decreased infection risks compared to those in rural locations. Improved water and sanitation were most predictive of reduced infection risk. Improved water was associated with decreased enterotoxigenic prevalence, and improved sanitation was associated with lower prevalence of any infection and specifically norovirus. Animal exposure was associated with increased prevalence. Children measured during the rainy season had fewer viral and more bacterial infections. Identifying environmental exposures associated with specific pathogen outcomes provides insights into transmission pathways, which contribute critical information for developing effective strategies to improve child health.
肠道病原体是导致死亡和发病的主要因素，尤其是在水、环境卫生和个人卫生基础设施有限的地区。为了评估与肠道病原体感染相关的传播途径，我们测量了家庭环境状况，并使用TaqMan Array Cards对来自厄瓜多尔北部城乡梯度沿线社区的276名六个月大儿童的粪便样本中的22种肠道病原体进行了检测。我们利用多变量模型、风险因素重要性和基于距离的统计方法来测试与感染相关的因素。大多数儿童（89%）携带至少一种病原体，72%携带两种或更多种。细菌感染（占参与者的82%）比病毒感染（58%）或寄生虫感染（9.1%）更常见。与农村地区的婴儿相比，城市地区的婴儿感染风险降低。改善水和环境卫生状况最能预测感染风险的降低。改善供水与产肠毒素菌的流行率降低有关，改善环境卫生与任何感染的较低流行率有关，特别是诺如病毒。接触动物与感染率增加有关。在雨季检测的儿童病毒感染较少，细菌感染较多。确定与特定病原体结果相关的环境暴露有助于深入了解传播途径，这为制定改善儿童健康的有效策略提供了关键信息。
