Environmental Transmission of Diarrheal Pathogens in Low and Middle Income Countries. Environmental Science: Processes & Impacts, June 2016.
Author: Timothy R. Julian. Pathogens and Human Health, Department of Environmental Microbiology, Swiss Federal Research Institute of Aquatic Science and Technology (Eawag), 8600 Dübendorf, Switzerland.
Globally, more than half a million children die every year from diarrheal diseases. Recent studies have identified the diarrheal disease agents most responsible for moderate-to-severe diarrheal disease and diarrhea-related mortality. The agents – enterotoxigenic and enteropathogenic E. coli, Shigella spp., rotavirus, norovirus, and Cryptosporidium spp. – are characterized by high infectivity, high fecal shedding, and transmission through a wide range of environmental reservoirs.
This Perspective provides insight into the ecology of the diarrheal disease agents with emphasis on their relationship to environmental reservoirs. Based on this insight, the Perspective advocates for comprehensive interventions targeting exposure reductions across multiple environmental reservoirs. Single interventions are often inadequate, and this may be partly attributed to their failure to reduce environmental exposures below thresholds needed to initiate infection.