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.
UNASSIGNED: 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.
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.
UNASSIGNED: 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.
摘要：
背景：在资源有限的地区，依靠个人临床结果来监测社区疾病有时是不可能的。建立废水和非下水道卫生监测系统可以为改善社区健康提供机会。
目的：我们提供了在马拉维建立废水和非下水道卫生监督实验室的经验，资源有限的地区，霍乱弧菌和伤寒沙门氏菌血清型。
方法：研究了布兰太尔区的三个地点（包括总共8个离散的样本收集地点），为期9周，2022年9月6日至11月1日。每周收集抓取样品。我们对废水中的霍乱弧菌和伤寒沙门氏菌进行了当地可用的基于培养的医学诊断方法的试验，然后使用逆转录聚合酶链反应（RT-PCR）对分离物进行确认分析。
结果：霍乱弧菌的细菌计数范围为106个菌落形成单位/mL，伤寒沙门氏菌的菌落形成单位/mL为107个。分离株的RT-PCR表明，可用的基于培养的医学诊断方法在检测霍乱弧菌方面是成功的，但对废水中伤寒沙门氏菌的准确性较低。
■这种经验是开发和验证不完全依赖于RT-PCR的替代废水监测分析方法的催化剂。在非洲进行的实地试验中，开发了新的数据驱动方法，以促进早期废水研究，并在资源有限的环境中扩大分析选择。尽管基于文化的方法是劳动密集型的，并且有一些局限性，我们建议首先利用与当地可用的霍乱弧菌医疗检测能力的重叠，而伤寒沙门氏菌的RT-PCR可能仍然需要。霍乱弧菌和伤寒沙门氏菌的废水分析可能是可以接受的，临床漏报程度很高，粪便脱落，短潜伏期,和明确的疫情趋势，主要在低收入和中等收入国家。
目的：我们提供了在马拉维建立废水和非下水道卫生监督实验室的经验，资源有限的地区，霍乱弧菌和伤寒沙门氏菌血清型。
方法：研究了布兰太尔区的三个地点（包括总共8个离散的样本收集地点），为期9周，2022年9月6日至11月1日。每周收集抓取样品。我们对废水中的霍乱弧菌和伤寒沙门氏菌进行了当地可用的基于培养的医学诊断方法的试验，然后使用逆转录聚合酶链反应（RT-PCR）对分离物进行确认分析。
结果：霍乱弧菌的细菌计数范围为106个菌落形成单位/mL，伤寒沙门氏菌的菌落形成单位/mL为107个。分离株的RT-PCR表明，可用的基于培养的医学诊断方法在检测霍乱弧菌方面是成功的，但对废水中伤寒沙门氏菌的准确性较低。
■这种经验是开发和验证不完全依赖于RT-PCR的替代废水监测分析方法的催化剂。在非洲进行的实地试验中，开发了新的数据驱动方法，以促进早期废水研究，并在资源有限的环境中扩大分析选择。尽管基于文化的方法是劳动密集型的，并且有一些局限性，我们建议首先利用与当地可用的霍乱弧菌医疗检测能力的重叠，而伤寒沙门氏菌的RT-PCR可能仍然需要。霍乱弧菌和伤寒沙门氏菌的废水分析可能是可以接受的，临床漏报程度很高，粪便脱落，短潜伏期,和明确的疫情趋势，主要在低收入和中等收入国家。
