Towards a US national estimate of the risk of endemic waterborne disease – sero-epidemiologic studies

Worldwide literature on serological methods and sero-surveys on waterborne pathogens has been reviewed. Outbreak investigation and research reports have also been examined to aid understanding of the serological response and transmission dynamics. The aim was to seek an estimate of seroprevalence and to determine if this could inform the US national estimate of risk for endemic waterborne infection associated with public water supplies. Antibody responses indicate infection, both symptomatic and asymptomatic, so probably give a truer indication of prevalence. Outbreak data can probably be regarded as the upper bound for seroprevalence estimations. Antibody is not necessarily protective per se but is a good indicator for at least partial resistance to symptomatic infection; absence of antibody will normally imply susceptibility. Pathogens transmitted by water are commonly transmitted by other routes. However, the fact that other transmission routes are more common does not detract from the potential protective effect of immunity when waterborne transmission occurs. Data indicate that seroprevalence varies widely, reflecting geographic, social and hygiene factors, but is generally greater where surface water sources are used rather than groundwater. Areas of low seroprevalence may expect a high attack rate in the event of contamination of their water supply.