{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:57:05Z","timestamp":1787021825308,"version":"build-2736575974"},"update-to":[{"DOI":"10.1371\/journal.pntd.0011341","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2023,10,30]],"date-time":"2023-10-30T00:00:00Z","timestamp":1698624000000}}],"reference-count":55,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2023,10,18]],"date-time":"2023-10-18T00:00:00Z","timestamp":1697587200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-000572"],"award-info":[{"award-number":["INV-000572"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100014496","name":"Stanford University Center for Innovation in Global Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014496","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\n                      <jats:italic>Salmonella<\/jats:italic>\n                      Typhi and\n                      <jats:italic>Salmonella<\/jats:italic>\n                      Paratyphi, fecal-oral transmitted bacterium, have temporally and geographically heterogeneous pathways of transmission. Previous work in Kathmandu, Nepal implicated stone waterspouts as a dominant transmission pathway after 77% of samples tested positive for\n                      <jats:italic>Salmonella<\/jats:italic>\n                      Typhi and 70% for\n                      <jats:italic>Salmonella<\/jats:italic>\n                      Paratyphi. Due to a falling water table, these spouts no longer provide drinking water, but typhoid fever persists, and the question of the disease\u2019s dominant pathway of transmission remains unanswered.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We used environmental surveillance to detect\n                      <jats:italic>Salmonella<\/jats:italic>\n                      Typhi and\n                      <jats:italic>Salmonella<\/jats:italic>\n                      Paratyphi A DNA from potential sources of transmission. We collected 370, 1L drinking water samples from a population-based random sample of households in the Kathmandu and Kavre Districts of Nepal between February and October 2019. Between November 2019 and July 2021, we collected 380, 50mL river water samples from 19 sentinel sites on a monthly interval along the rivers leading through the Kathmandu and Kavre Districts. We processed drinking water samples using a single qPCR and processed river water samples using differential centrifugation and qPCR at 0 and after 16 hours of liquid culture enrichment. A 3-cycle threshold (Ct) decrease of\n                      <jats:italic>Salmonella<\/jats:italic>\n                      Typhi or\n                      <jats:italic>Salmonella<\/jats:italic>\n                      Paratyphi, pre- and post-enrichment, was used as evidence of growth. We also performed structured observations of human-environment interactions to understand pathways of potential exposure.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 370 drinking water samples,\n                      <jats:italic>Salmonella<\/jats:italic>\n                      Typhi was detected in 7 samples (1.8%) and\n                      <jats:italic>Salmonella<\/jats:italic>\n                      Paratyphi A was detected in 4 (1.0%) samples. Among 380 river water samples,\n                      <jats:italic>Salmonella<\/jats:italic>\n                      Typhi was detected in 171 (45%) and\n                      <jats:italic>Salmonella<\/jats:italic>\n                      Paratyphi A was detected in 152 (42%) samples. Samples located upstream of the Kathmandu city center were positive for\n                      <jats:italic>Salmonella<\/jats:italic>\n                      Typhi 12% of the time while samples from locations in and downstream were positive 58% and 67% of the time respectively. Individuals were observed bathing, washing clothes, and washing vegetables in the rivers.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Implications<\/jats:title>\n                    <jats:p>\n                      These results suggest that drinking water was not the dominant pathway of transmission of\n                      <jats:italic>Salmonella<\/jats:italic>\n                      Typhi and\n                      <jats:italic>Salmonella<\/jats:italic>\n                      Paratyphi A in the Kathmandu Valley in 2019. The high degree of river water contamination and its use for washing vegetables raises the possibility that river systems represent an important source of typhoid exposure in Kathmandu.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pntd.0011341","type":"journal-article","created":{"date-parts":[[2023,10,18]],"date-time":"2023-10-18T13:40:40Z","timestamp":1697636440000},"page":"e0011341","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":13,"title":["Environmental sampling for typhoidal Salmonellas in household and surface waters in Nepal identifies potential transmission pathways"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2128-9187","authenticated-orcid":true,"given":"Christopher","family":"LeBoa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sneha","family":"Shrestha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jivan","family":"Shakya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiva Ram","family":"Naga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sony","family":"Shrestha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mudita","family":"Shakya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander T.","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajeev","family":"Shrestha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krista","family":"Vaidya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nishan","family":"Katuwal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen","family":"Aiemjoy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaac I.","family":"Bogoch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher B.","family":"Uzzell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise O.","family":"Garrett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen P.","family":"Luby","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason R.","family":"Andrews","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dipesh","family":"Tamrakar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,10,18]]},"reference":[{"key":"pntd.0011341.ref001","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/S1473-3099(18)30685-6","article-title":"The global burden of typhoid and paratyphoid fevers: a systematic analysis for the Global Burden of Disease Study 2017","volume":"19","author":"JD Stanaway","year":"2019","journal-title":"The Lancet Infectious Diseases"},{"key":"pntd.0011341.ref002","author":"Achievements in Public Health","journal-title":"1900\u20131999: Control of Infectious Diseases."},{"key":"pntd.0011341.ref003","doi-asserted-by":"crossref","first-page":"e978","DOI":"10.1016\/S2214-109X(22)00119-X","article-title":"Incidence of typhoid and paratyphoid fever in Bangladesh, Nepal, and Pakistan: results of the Surveillance for Enteric Fever","volume":"10","author":"DO Garrett","year":"2022","journal-title":"Asia Project. 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