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.Key words | Campylobacter, Cryptosporidium, ELISA, endemic infection, E. coli 0157, Giardia, molecular studies, noroviruses, outbreaks, sero-epidemiology, seroprevalence, waterborne pathogens, western blot
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DEFINITIONS AND GENERAL ASPECTS OF IMMUNOLOGYEpidemiology, at its simplest, is the study of the occurrence (number and frequency) and distribution of cases by person This paper is in the public domain: verbatim copying and redistribution of this paper are permitted in all media for any purpose, provided this notice is preserved along with the paper's original DOI. Anyone using the paper is requested to properly cite and acknowledge the source as J. The outcome of the contamination of water supply and transmission to consumers depends on complex dynamics with various, usually ill characterised, factors-the organism, the exposed persons (and their levels of immunity) and the environment (Casemore 1994(Casemore , 1995Meinhardt et al. 1996).In order to better understand the natural history of waterborne infections and the complexities of the dynamics of transmission (see Figure 1), epidemiological investigations can be enhanced by serologic studies . The purpose of this paper concerns the national estimate of risk of endemic infection from water. However, reports on immunological studies and on the investigation of outbreaks are fundamental to the understanding of endemic infection and illness. In general terms, prevalence in outbreaks likely represents the upper boundary for endemic infection estimates.Sero-epidemiology is a form of study in which the demonstration of antibodies to the organism of interest is used as a surrogate or marker for the d...