{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T19:01:41Z","timestamp":1790017301713,"version":"4.0.1"},"update-to":[{"DOI":"10.1371\/journal.pntd.0014724","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000}}],"reference-count":52,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"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":["049001"],"award-info":[{"award-number":["049001"]}],"id":[{"id":"10.13039\/100000865","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>Background<\/jats:title>\n                    <jats:p>Surveys to monitor large-scale deworming programs against soil-transmitted helminthiases (STH) involve collection and examination of stool samples from schoolchildren. These surveys are resource demanding and interrupt school activities. A potentially cost-saving alternative that does not involve children is to process fecal sludge samples from school pit latrines. As a first step towards a proof-of-principle of latrine-based monitoring of STH programs, we optimized tools to collect fecal sludge and to quantify STH eggs in the samples.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>First, we developed and field-tested three locally made fecal sludge sampling prototypes. Second, we developed a modified egg counting method and conducted spiking experiments to explore its analytical performance. Third, we estimated the variation in egg counts in fecal sludge samples that were collected from six primary schools in Ethiopia at different pit latrine depths used by boys and girls and that were repeatedly examined. Finally, field data was used to inform an egg count simulation model to quantify the variation in egg counts and to determine the sampling and analysis strategies that resulted in surveys as precise as stool-based surveys.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The modified fecal sludge sampling prototypes were generally successful, except for a few pit latrines with dried\/solid fecal sludge and insufficient sludge volume. The egg counting method had moderately high analytical sensitivity that varied across the consistency of the samples and examination effort. The variation in egg counts was mainly explained by differences between squat holes followed by repeated fecal sludge sample processing. Latrine-based surveys were as precise as stool-based surveys only for\n                      <jats:italic>Ascaris<\/jats:italic>\n                      and when the intensity of infections was low.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We developed a sampling and diagnostic strategy that we will use in a follow-up study which will be conducted in Jimma Zone across 25 schools (52 children per school) and will compare the mean fecal sludge egg counts at school level with the STH prevalence in children.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pntd.0014724","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T18:02:41Z","timestamp":1789495361000},"page":"e0014724","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development, field-testing and optimization of tools to quantify soil-transmitted helminths in fecal sludge from school pit latrines in Ethiopia"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9807-917X","authenticated-orcid":true,"given":"Abebaw","family":"Tiruneh","sequence":"first","affiliation":[{"name":"Jimma University","place":["Jimma, Ethiopia"],"department":["School of Medical Laboratory Sciences, Institute of Health"]},{"name":"Ghent University","place":["Merelbeke-Melle, Belgium"],"department":["Department of Translational Physiology, Infectiology and Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeleke","family":"Mekonnen","sequence":"additional","affiliation":[{"name":"Jimma University","place":["Jimma, Ethiopia"],"department":["School of Medical Laboratory Sciences, Institute of Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Roose","sequence":"additional","affiliation":[{"name":"Ghent University","place":["Merelbeke-Melle, Belgium"],"department":["Department of Translational Physiology, Infectiology and Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mio","family":"Ayana","sequence":"additional","affiliation":[{"name":"Jimma University","place":["Jimma, Ethiopia"],"department":["School of Medical Laboratory Sciences, Institute of Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiona","family":"Vande Velde","sequence":"additional","affiliation":[{"name":"Ghent University","place":["Merelbeke-Melle, Belgium"],"department":["Department of Translational Physiology, Infectiology and Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel C.","family":"Mrimi","sequence":"additional","affiliation":[{"name":"Ghent University","place":["Merelbeke-Melle, Belgium"],"department":["Department of Translational Physiology, Infectiology and Public Health"]},{"name":"Ifakara Health Institute","place":["Dar es Salaam, Tanzania"],"department":["Environmental Health and Ecological Science Department"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John S.","family":"Gilleard","sequence":"additional","affiliation":[{"name":"University of Calgary","place":["Alberta, Canada"],"department":["Faculty of Veterinary Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R.","family":"Templeton","sequence":"additional","affiliation":[{"name":"Imperial College London","place":["London, United Kingdom"],"department":["Department of Civil and Environmental Engineering"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zewdie","family":"Birhanu","sequence":"additional","affiliation":[{"name":"Jimma University","place":["Jimma, Ethiopia"],"department":["Department of Health, Behavior, and Society, Institute of Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaco J.","family":"Verweij","sequence":"additional","affiliation":[{"name":"Elisabeth Tweesteden Hospital","place":["Tilburg, The Netherlands"],"department":["Microvida Laboratory for Medical Microbiology and Immunology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luc E.","family":"Coffeng","sequence":"additional","affiliation":[{"name":"Erasmus MC, University Medical Center Rotterdam","place":["Rotterdam, The Netherlands"],"department":["Department of Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Levecke","sequence":"additional","affiliation":[{"name":"Ghent University","place":["Merelbeke-Melle, Belgium"],"department":["Department of Translational Physiology, Infectiology and Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"pntd.0014724.ref001","first-page":"3","volume-title":"Common intestinal helminths of man: life cycle charts","author":"DM Melvin","year":"1965"},{"key":"pntd.0014724.ref002","author":"World Health Organization","year":"2012"},{"issue":"5","key":"pntd.0014724.ref003","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1016\/j.ijheh.2019.05.004","article-title":"Burden of disease from inadequate water, sanitation and hygiene for selected adverse health outcomes: an updated analysis with a focus on low- and middle-income countries","volume":"222","author":"A Pr\u00fcss-Ust\u00fcn","year":"2019","journal-title":"Int J Hyg Environ Health"},{"issue":"7","key":"pntd.0014724.ref004","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0006688","article-title":"A longitudinal cohort study of soil-transmitted helminth infections during the second year of life and associations with reduced long-term cognitive and verbal abilities","volume":"12","author":"B Blouin","year":"2018","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0014724.ref005","article-title":"Helminth infections: soil-transmitted helminth infections and schistosomiasis.","volume-title":"Disease control priorities in developing countries","author":"PJ Hotez","year":"2006","edition":"2"},{"issue":"3","key":"pntd.0014724.ref006","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.ijgo.2014.12.002","article-title":"Prevalence of helminth infestation during pregnancy and its association with maternal anemia and low birth weight","volume":"129","author":"AK Aderoba","year":"2015","journal-title":"Int J Gynaecol Obstet"},{"key":"pntd.0014724.ref007","volume-title":"Guideline: preventive chemotherapy to control soil-transmitted helminth infections in at-risk population groups","author":"World Health Organization","year":"2017"},{"issue":"1645","key":"pntd.0014724.ref008","doi-asserted-by":"crossref","first-page":"20130435","DOI":"10.1098\/rstb.2013.0435","article-title":"The coverage and frequency of mass drug administration required to eliminate persistent transmission of soil-transmitted helminths","volume":"369","author":"R Anderson","year":"2014","journal-title":"Philos Trans R Soc Lond B Biol Sci"},{"issue":"7","key":"pntd.0014724.ref009","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0010575","article-title":"Reduction in DALYs lost due to soil-transmitted helminthiases and schistosomiasis from 2000 to 2019 is parallel to the increase in coverage of the global control programmes","volume":"16","author":"A Montresor","year":"2022","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0014724.ref010","volume-title":"2030 targets for soil-transmitted helminthiases control programmes","author":"World Health Organization","year":"2019"},{"key":"pntd.0014724.ref011","volume-title":"Guidelines for School-based Deworming Programs: Information for policy-makers and planners on conducting deworming as part of an integrated school health program","author":"School Health Integrated Programming","year":"2016"},{"issue":"6","key":"pntd.0014724.ref012","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0007514","article-title":"Sampling strategies for monitoring and evaluation of morbidity targets for soil-transmitted helminths","volume":"13","author":"F Giardina","year":"2019","journal-title":"PLoS Negl Trop Dis"},{"issue":"3","key":"pntd.0014724.ref013","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.inhe.2011.06.002","article-title":"Planning schistosomiasis control: investigation of alternative sampling strategies for Schistosoma mansoni to target mass drug administration of praziquantel in East Africa","volume":"3","author":"HJW Sturrock","year":"2011","journal-title":"Int Health"},{"issue":"12","key":"pntd.0014724.ref014","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1093\/trstmh\/trac033","article-title":"The observed relationship between the degree of parasite aggregation and the prevalence of infection within human host populations for soil-transmitted helminth and schistosome infections","volume":"116","author":"K Kura","year":"2022","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"pntd.0014724.ref015","doi-asserted-by":"crossref","DOI":"10.1093\/infdis\/jiz535","article-title":"Impact of different sampling schemes for decision making in soil-transmitted helminthiasis control programs","volume":"221","author":"LE Coffeng","year":"2020","journal-title":"J Infect Dis"},{"key":"pntd.0014724.ref016","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1186\/1756-3305-3-71","article-title":"Comparative cost assessment of the Kato-Katz and FLOTAC techniques for soil-transmitted helminth diagnosis in epidemiological surveys","volume":"3","author":"B Speich","year":"2010","journal-title":"Parasit Vectors"},{"issue":"9","key":"pntd.0014724.ref017","article-title":"Comparison of individual and pooled diagnostic examination strategies during the national mapping of soil-transmitted helminths and Schistosoma mansoni in Ethiopia","volume":"12","author":"GT Leta","year":"2018","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0014724.ref018","volume-title":"Assessing schistosomiasis and soil-transmitted helminthiases control programmes: monitoring and evaluation framework","author":"World Health Organization","year":"2024"},{"issue":"12","key":"pntd.0014724.ref019","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0011583","article-title":"Cost-effectiveness of comparative survey designs for helminth control programs: post-hoc cost analysis and modelling of the Kenyan national school-based deworming program","volume":"18","author":"M Minnery","year":"2024","journal-title":"PLoS Negl Trop Dis"},{"issue":"5","key":"pntd.0014724.ref020","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0002189","article-title":"Comparison of individual and pooled stool samples for the assessment of soil-transmitted helminth infection intensity and drug efficacy","volume":"7","author":"Z Mekonnen","year":"2013","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0014724.ref021","volume-title":"Diagnostic target product profiles for monitoring and evaluation of soil-transmitted helminth control programs","author":"World Health Organization","year":"2021"},{"issue":"6","key":"pntd.0014724.ref022","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1080\/10962247.2023.2197825","article-title":"Environmental sampling for disease surveillance: recent advances and recommendations for best practice","volume":"73","author":"JL Santarpia","year":"2023","journal-title":"J Air Waste Manag Assoc"},{"issue":"16","key":"pntd.0014724.ref023","doi-asserted-by":"crossref","DOI":"10.1128\/AEM.00686-18","article-title":"Environmental sampling as a low-technology method for surveillance of foot-and-mouth disease virus in an area of endemicity","volume":"84","author":"C Colenutt","year":"2018","journal-title":"Appl Environ Microbiol"},{"key":"pntd.0014724.ref024","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.actatropica.2017.02.014","article-title":"Detection and quantification of soil-transmitted helminths in environmental samples: a review of current state-of-the-art and future perspectives","volume":"169","author":"ID Amoah","year":"2017","journal-title":"Acta Trop"},{"issue":"4","key":"pntd.0014724.ref025","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0010307","article-title":"Assessment of environmental contamination with soil-transmitted helminths life stages at school compounds, households and open markets in Jimma Town, Ethiopia","volume":"16","author":"B Tadege","year":"2022","journal-title":"PLoS Negl Trop Dis"},{"issue":"9","key":"pntd.0014724.ref026","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0012416","article-title":"Soil surveillance for monitoring soil-transmitted helminths: method development and field testing in three countries","volume":"18","author":"M Manuel","year":"2024","journal-title":"PLoS Negl Trop Dis"},{"issue":"1","key":"pntd.0014724.ref027","article-title":"Environmental surveillance of soil-transmitted helminths and other enteric pathogens in settings without networked wastewater infrastructure","volume":"4","author":"JEE Siko","year":"2025","journal-title":"PLOS Water"},{"key":"pntd.0014724.ref028","author":"Provinos","year":"2026"},{"key":"pntd.0014724.ref029","author":"Retsch","year":"2026"},{"key":"pntd.0014724.ref030","doi-asserted-by":"crossref","DOI":"10.2166\/9781780409122","volume-title":"Methods for faecal sludge analysis","author":"K Velkushanova","year":"2021"},{"issue":"10","key":"pntd.0014724.ref031","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0006655","article-title":"Modification and optimization of the FECPAKG2 protocol for the detection and quantification of soil-transmitted helminth eggs in human stool","volume":"12","author":"M Ayana","year":"2018","journal-title":"PLoS Negl Trop Dis"},{"issue":"4","key":"pntd.0014724.ref032","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0008037","article-title":"Evaluation of copromicroscopy and serology to measure the exposure to Ascaris infections across age groups and to assess the impact of 3 years of biannual mass drug administration in Jimma Town, Ethiopia","volume":"14","author":"D Dana","year":"2020","journal-title":"PLoS Negl Trop Dis"},{"issue":"2","key":"pntd.0014724.ref033","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/j.ecohyd.2017.10.003","article-title":"Fecal contamination of soil and water in sub-Saharan Africa cities: the case of Addis Ababa, Ethiopia","volume":"18","author":"TH Debela","year":"2018","journal-title":"Ecohydrol Hydrobiol"},{"key":"pntd.0014724.ref034","volume-title":"Environmental regulations and technology: control of pathogens and vector attraction in sewage sludge, (including domestic septage) under 40 CFR part 503","author":"U.S. Environmental Protection Agency (EPA)","year":"2003"},{"key":"pntd.0014724.ref035","doi-asserted-by":"crossref","DOI":"10.1093\/cid\/ciae020","article-title":"Improving the cost-efficiency of preventive chemotherapy: impact of new diagnostics on stopping decisions for control of schistosomiasis","volume":"78","author":"LE Coffeng","year":"2024","journal-title":"Clin Infect Dis"},{"issue":"6","key":"pntd.0014724.ref036","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0011160","article-title":"A general framework to support cost-efficient survey design choices for the control of soil-transmitted helminths when deploying Kato-Katz thick smear","volume":"17","author":"A Kazienga","year":"2023","journal-title":"PLoS Negl Trop Dis"},{"issue":"4","key":"pntd.0014724.ref037","doi-asserted-by":"crossref","first-page":"638","DOI":"10.4314\/wsa.v43i4.11","article-title":"Occurrence and survival of pathogens at different sludge depths in unlined pit latrines in Kampala slums","volume":"43","author":"S Nabateesa","year":"2017","journal-title":"Water SA"},{"issue":"3","key":"pntd.0014724.ref038","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0009176","article-title":"Impact of sampling depth on pathogen detection in pit latrines","volume":"15","author":"D Capone","year":"2021","journal-title":"PLoS Negl Trop Dis"},{"issue":"12","key":"pntd.0014724.ref039","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1021\/acs.estlett.0c00610","article-title":"Analysis of fecal sludges reveals common enteric pathogens in urban Maputo, Mozambique","volume":"7","author":"D Capone","year":"2020","journal-title":"Environ Sci Technol Lett"},{"issue":"4","key":"pntd.0014724.ref040","doi-asserted-by":"crossref","first-page":"622","DOI":"10.2166\/washdev.2016.074","article-title":"Prevalence and diversity of intestinal helminth eggs in pit latrine sludge of a tropical urban area","volume":"6","author":"WA Letah Nzouebet","year":"2016","journal-title":"J Water Sanit Hyg Dev"},{"key":"pntd.0014724.ref041","first-page":"55","article-title":"Faecal sludge sample collection and handling.","volume-title":"Methods for faecal sludge analysis","author":"T Koottatep","year":"2021"},{"key":"pntd.0014724.ref042","article-title":"Sampling for faecal sludge and other liquid wastes in emergency settings [version 1; not peer reviewed]","volume":"5","author":"Gates Foundation","year":"2021","journal-title":"Gates Open Res"},{"issue":"6","key":"pntd.0014724.ref043","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0010495","article-title":"Higher helminth ova counts and incomplete decomposition in sand-enveloped latrine pits in a coastal sub-district of Bangladesh","volume":"16","author":"M Rahman","year":"2022","journal-title":"PLoS Negl Trop Dis"},{"issue":"1","key":"pntd.0014724.ref044","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1186\/s13104-017-2519-7","article-title":"Is there a difference in prevalence of helminths between households using ecological sanitation and those using traditional pit latrines? A latrine based cross sectional comparative study in Malawi","volume":"10","author":"S Kumwenda","year":"2017","journal-title":"BMC Res Notes"},{"key":"pntd.0014724.ref045","volume-title":"Standard methods for the recovery and enumeration of helminth ova in wastewater, sludge, compost and urine-diversion waste in South Africa","author":"P Moodley","year":"2008"},{"issue":"9","key":"pntd.0014724.ref046","doi-asserted-by":"crossref","first-page":"2063","DOI":"10.1016\/S0043-1354(02)00597-3","article-title":"Precision and accuracy of an assay for detecting Ascaris eggs in various biosolid matrices","volume":"37","author":"DD Bowman","year":"2003","journal-title":"Water Res"},{"issue":"5","key":"pntd.0014724.ref047","doi-asserted-by":"crossref","first-page":"43","DOI":"10.2166\/wst.2007.555","article-title":"Helminth ova control in wastewater and sludge for advanced and conventional sanitation","volume":"56","author":"B Jim\u00e9nez","year":"2007","journal-title":"Water Sci Technol"},{"issue":"4","key":"pntd.0014724.ref048","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1645\/22-57","article-title":"Ascaris suum egg recovery from sludge samples after phase extraction","volume":"110","author":"D Naidoo","year":"2024","journal-title":"J Parasitol"},{"key":"pntd.0014724.ref049","volume-title":"DPDx - Laboratory Identification of Parasites of Public Health Concern: Parasites A\u2013Z index","author":"Centers for Disease Control and Prevention (CDC)"},{"key":"pntd.0014724.ref050","doi-asserted-by":"crossref","DOI":"10.1596\/32640","volume-title":"Health, safety and dignity of sanitation workers: an initial assessment","author":"World Bank, ILO, WaterAid, and WHO","year":"2019"},{"issue":"6","key":"pntd.0014724.ref051","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0009422","article-title":"The role of diagnostic technologies to measure progress toward WHO 2030 targets for soil-transmitted helminth control programs","volume":"15","author":"LJ Stuyver","year":"2021","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0014724.ref052","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1038\/nature05448","article-title":"Requirements for high impact diagnostics in the developing world","volume":"444","author":"M Urdea","year":"2006","journal-title":"Nature"}],"updated-by":[{"DOI":"10.1371\/journal.pntd.0014724","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000}}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0014724","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T18:08:57Z","timestamp":1790014137000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0014724"}},"subtitle":[],"editor":[{"given":"Tao","family":"Wang","sequence":"first","affiliation":[{"name":"University of Melbourne","place":["AUSTRALIA"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,9,15]]},"references-count":52,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,15]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0014724","relation":{},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,15]]}}}