International Public Health Laboratory Twinning: An Innovative Approach to Strengthen the National Health Laboratory System in Uganda, 2014-2017.

International initiatives to strengthen national health laboratory systems in resource-poor countries are often hampered by unfamiliarity with the country's health laboratory environment and turnover of international partners during the initiative. This study provides an overview of, and lessons learned from, the use of a laboratory long-term partnership approach (ie, "twinning") to strengthen the national public health laboratory system in an international setting. We focused on the partnering of the Uganda Ministry of Health Central Public Health Laboratory (CPHL) with the New Mexico State Public Health Laboratory to help the CPHL become Uganda's national public health reference laboratory (Uganda National Health Laboratory Services [UNHLS] Institute) and leader of its nascent Uganda National Health Laboratory Network (UNHLN). Via twinning, CPHL leadership received training on laboratory leadership and management, quality systems, facility management, and the One Health environmental strategy (ie, that the health of persons is connected to the health of animals and the environment), and drafted a National Health Laboratory Policy, UNHLS Institute business plan, and strategic and operating plans for the UNHLS Institute and UNHLN. The CPHL is now responsible for the UNHLS Institute and coordinates the UNHLN. Lessons learned include (1) twinning establishes stable long-term collaborations and (2) success requires commitment to a formal statement of activities and objectives, as well as clear and regular communication among partners.

High serological response to Cryptosporidium-specific antigens in the Czech Republic and its association with water supply.

A survey was conducted in the Czech Republic to determine whether serological responses to the 15/17-kDa and 27-kDa Cryptosporidium antigens had changed since the end of the communist era and if these responses were associated with drinking water sources. Sera from 301 blood donors residing in six areas served by various sources of drinking water were analysed by Western Blot (mini-immunoblots) to measure the IgG response. The intensity of response and percentage of persons with a strong response to the 27-kDa, but not the 15/17-kDa, antigen were higher than found 20 years earlier. A strong response to both the 15/17- and 27-kDa-antigens was higher than reported in other countries, and the probability of persons having a strong response was greater in areas with surface water sources than river-bank infiltration. Few cases of cryptosporidiosis were reported in spite of these high responses to Cryptosporidium antigens. These responses suggest a chronic low-level exposure from several sources that may be affording protection against symptoms and illness. Although strong serological responses were associated with surface water sources, drinking water is not likely to be the most important exposure for Cryptosporidium in the Czech Republic.

Cryptosporidium infection, onsite wastewater systems and private wells in the arid Southwest.

Few prior studies have examined the potential health risks from transmission of enteric parasites via aquifers contaminated by wastewater from onsite systems. A cross-sectional study of 600 residents in households served with either onsite wastewater systems and private wells or city sewer/water systems in three different sites in central New Mexico compared serological responses to Cryptosporidium, a common waterborne infections agent. Study participants completed a short self-administered questionnaire with questions on demographic characteristics, characteristics of the onsite wastewater system and private well, and common risk factors associated with cryptosporidiosis. A sample of household tap water was collected, as well as a blood sample from each study participant to measure IgG responses to antigen groups for Cryptosporidium. Logistic regression analysis showed a significant association between having an onsite wastewater system and private well and the 27-kDa marker for Cryptosporidium in the River Valley site after adjusting for covariates (OR = 1.98; 95% CI = 1.11-3.55). This study, together with one prior study, suggests that the presence of onsite wastewater systems and private wells might be associated with an increased risk of Cryptosporidium infection.

Enteric illness risks before and after water treatment improvements.

This study evaluated whether occurrence of acute gastrointestinal illnesses declined after filtration and ozonation were added to a previously unfiltered, chlorinated high-quality surface water source in a northwest United States city. Enteric and other illnesses were recorded for two 6-month periods for control and intervention sites in the same city. During phase 1, chlorinated, unfiltered drinking water for both sites was obtained from protected watersheds. During phase 2, the intervention site received chlorinated, filtered and ozonated drinking water. The water was not altered in the control site. No overall differences were found in the risk of any of the illnesses after the new water treatment plant was completed. There was a significantly increased risk of diarrhoea and highly credible gastrointestinal illness in participants with three or more episodes of the same type of illness during phase 1.

Protective immunity associated with a strong serological response to a Cryptosporidium-specific antigen group, in HIV-infected individuals.

This study assessed whether serological responses to Cryptosporidium antigens are associated with a reduced risk of diarrheal illness in cases of infection with human immunodeficiency virus (HIV). The association between serological responses to the Cryptosporidium 15/17-kDa and 27-kDa antigen groups and reported diarrheal illness was examined by use of data from a previously published study of cases of HIV infection. In immunosuppressed individuals, a strong serological response to the 27-kDa antigen group was associated with a reduced risk of diarrhea without weight loss. This finding suggests that acquired protective immunity to cryptosporidiosis may be important in controlling the burden of cryptosporidiosis in immunosuppressed individuals.

How clean must our drinking water be: the importance of protective immunity.

BACKGROUND: Cryptosporidium parvum is an important cause of epidemic diarrhea. Few studies have assessed whether serological evidence of prior infection in adults is related to a reduced occurrence of enteric illness. METHODS: Serum samples and enteric illness event data were obtained in 2000 and 2001 from 326 people served by 1 of 2 unfiltered surface sources or 1 groundwater source. In 2001, filtration was initiated at 1 of the surface sources. Poisson regression related illness episodes with serological responses to the 15/17- and 27-kDa Cryptosporidium antigen groups. RESULTS: Subjects with moderately strong responses to the 15/17-kDa antigen had <65% of the risk of all 1-3-day episodes of diarrheal or gastrointestinal illness and <40% of the risk of all >/=4-day episodes, compared with subjects without a moderately strong response. Water source, change in water treatment, and very weak responses were unrelated to illness events. CONCLUSIONS: Endemic Cryptosporidium infections are a common cause of diarrheal and gastrointestinal illness in persons without a moderately strong response to the 15/17-kDa antigen group. Users of surface-derived drinking water are more likely to have strong serological responses to this antigen group and may be at a lower risk of endemic gastrointestinal illness caused by Cryptosporidium infection.

Is contaminated groundwater an important cause of viral gastroenteritis in the United States?

The large volume of human sewage discharged into the ground has raised concerns about contamination of underground water supplies and possible human health risks. Few groundwater outbreaks reported in the United States, however, have been linked to enteric viruses. Studies on the occurrence of groundwater enteric viruses have detected viruses in groundwater, but many of these studies selected high-risk wells for testing. The results likely overestimated the occurrence of virus contamination in groundwater as well as the resulting public-health risks. This study found only limited evidence for viral contamination of groundwater in the absence of bacterial indicators of sewage contamination. From current studies of virus contamination in groundwater, the authors could not identify a sufficient population with evidence of exposure convincing enough to make an epidemiological investigation feasible and thus were unable to epidemiologically evaluate health risks that may be associated with viral contamination of groundwater. To better estimate the potential health risks, surveys should look at the occurrence of groundwater virus contamination in water that does not have bacterial indicators of sewage contamination and in water that has not been adequately disinfected. These surveys should include groundwater from a wide range of geological conditions.