Vibrio cholerae and Salmonella Typhi culture-based wastewater or non-sewered sanitation surveillance in a resource ... - Nature.com

Abstract

Background

In resource-limited regions, relying on individual clinical results to monitor community diseases is sometimes not possible. Establishing wastewater and non-sewered sanitation surveillance systems can offer opportunities to improve community health.

Objective

We provide our experience of establishing a wastewater and non-sewered sanitation surveillance laboratory in Malawi, a resource-limited region, for Vibrio cholerae and Salmonella serotype Typhi.

Methods

Three locations (inclusive of 8 discrete sample collection sites in total) in the Blantyre District were studied for nine weeks, from September 6 to November 1, 2022. Grab samples were collected weekly. We piloted locally available culture-based medical diagnostic methods for V. cholerae and S. Typhi in wastewater, followed by confirmation analysis of the isolates using reverse transcription polymerase chain reaction (RT-PCR).

Results

Bacterial counts ranged from up to 106 colony-forming units/mL for V. cholerae and up to 107 colony-forming units/mL for S. Typhi. RT-PCR of the isolates showed that the available culture-based medical diagnostic methods were successful in detecting V. cholerae but were less accurate for S. Typhi in wastewater.

Impact statement

This experience serves as a catalyst for the development and validation of alternative wastewater surveillance analytical methods that are not dependent solely on RT-PCR. In this field trial conducted in Africa, new data-driven approaches were developed to promote early-level wastewater research and expand analysis options in resource-limited settings. Although culture-based methods are labor-intensive and have some limitations, we suggest initially leveraging the overlap with the locally available medical testing capacity for V. cholerae, whereas S. Typhi with RT-PCR may still be required. Wastewater analysis may be acceptable for V. cholerae and S. Typhi, which have a high degree of clinical case underreporting, fecal shedding, short incubation periods, and clear outbreak trends, predominantly in low- and middle-income countries.

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Fig. 1: Sanitation system hospital manhole sampling site in Blantyre, Malawi.

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Data availability

Data generated in this study can be found in the article and its supplementary files.

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Funding

This work was supported by grants from the Rockefeller Foundation, James Graham Brown Foundation, Owsley Brown II Family Foundation, and the Jon Rieger Seed Grant. The funders had no role in the study design, data collection and analysis, decision to publish, or manuscript preparation.

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