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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Public Health | doi: 10.3389/fpubh.2019.00231

Visitors to a Tropical Marine Beach Show Evidence of Immunoconversions to Multiple Waterborne Pathogens

 Kaneatra J. Simmons1,  Tarsha N. Eason2, Clarissa L. Curioso3,  Shannon M. Griffin4, Malini K. Ramudit3,  Kevin H. Oshima4, Elizabeth A. Sams5,  Timothy J. Wade5,  Ann Grimm4, Alfred Dufour4 and  Swinburne A. Augustine4*
  • 1Fort Valley State University, United States
  • 2National Risk Management Research Laboratory, United States Environmental Protection Agency, United States
  • 3Oak Ridge Institute for Science and Education (ORISE), United States
  • 4National Exposure Research Laboratory, United States Environmental Protection Agency, United States
  • 5National Health and Environmental Effects Research Laboratory, United States Environmental Protection Agency, United States

Determining infections from environmental exposures, particularly from waterborne pathogens is a challenging proposition. The study design must be rigorous and account for numerous factors including study population selection, sample collection, storage and processing, as well as data processing and analysis. These challenges are magnified when it is suspected that individuals may potentially be infected by multiple pathogens at the same time. Previous work demonstrated the effectiveness of a salivary antibody multiplex immunoassay in detecting the prevalence of immunoglobulin G (IgG) antibodies to multiple waterborne pathogens and helped identify asymptomatic norovirus infections in visitors to Boquerón Beach, Puerto Rico. In this study, we applied the immunoassay to three serially collected samples from study participants within the same population to assess immunoconversions (incident infections) to six waterborne pathogens: Helicobacter pylori, Campylobacter jejuni, Toxoplasma gondii, hepatitis A virus and noroviruses GI. I and GII.4. Further, we examined the impact of sampling on the detection of immunoconversions by comparing the traditional immunoconversion definition based on two samples to criteria developed to capture trends in three sequential samples collected from study participants. The expansion to three samples makes it possible to capture the IgG antibody responses within the survey population to more accurately assess the frequency of immunoconversions to target pathogens. Based on the criteria developed, results showed that when only two samples from each participant were used in the analysis, 25.9% of the beachgoers immunoconverted to at least one pathogen; however, the addition of the third sample reduced immunoconversions to 6.5%. Of these incident infections, the highest levels were to noroviruses followed by T. gondii. Moreover, many individuals displayed evidence of immunoconversions to multiple pathogens. This study suggests that detection of simultaneous infections is possible, with far reaching consequences for the population. The results may lead to further studies to understand the complex interactions that occur within the body as the immune system attempts to ward off these infections. Such an approach is critical to our understanding of medically important synergistic or antagonistic interactions and may provide valuable and critical information to public health officials, water treatment personnel and environmental managers.

Keywords: Immunoconversions, Incident infections, Exposure, Multiplex immunoassay, salivary antibodies, antibody response, Luminex, immunology, Puerto Rico, Boqueron Beach

Received: 10 Jun 2019; Accepted: 02 Aug 2019.

Edited by:

ETHEL ELJARRAT, Department of Environmental Chemistry, Institute of Environmental Assessment and Water Research (CSIC), Spain

Reviewed by:

M. J. Alam, University of Houston, United States
Jill Stewart, University of North Carolina at Chapel Hill, United States  

Copyright: © 2019 Simmons, Eason, Curioso, Griffin, Ramudit, Oshima, Sams, Wade, Grimm, Dufour and Augustine. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Swinburne A. Augustine, National Exposure Research Laboratory, United States Environmental Protection Agency, Cincinnati, Ohio, United States,