{ "abstract": "Background: Improvements to water quality, sanitation, handwashing (WASH) and nutrition may prevent enteric pathogen infection during the first two years of life. Few randomised controlled trials have measured pathogen-specific effects of WASH and nutritional interventions. Methods: Within a 2x2 factorial cluster-randomized trial of WASH and nutritional interventions in Bangladesh, we tested dried blood spot specimens with multiplex assay for IgG responses to 12 enteric pathogens: Norovirus, Campylobacter, LT-producing enterotoxigenic E. coli (LT-ETEC), Shigella, non-typhoidal and typhoidal Salmonella enterica, Vibrio cholerae, Cryptosporidium, Giardia, Entamoeba histolytica, Taenia solium, and Strongyloides stercoralis. Primary analysis included children with IgG measurements at ~24 months, and secondary analysis assessed early effects in a sub-study at ~14 months. We estimated age-specific seroprevalence and marginal seroprevalence differences for WASH and nutrition effects. Trial is registered with ClinicalTrials.gov (NCT01590095). Findings: Across the four arms (450 clusters), 4817 samples were tested for IgG responses, 2453 samples at the primary endpoint. Seroprevalence increased with age, consistent with intense early-life transmission. For highest transmission pathogens, >94% of children had seroconverted to norovirus, LT-ETEC and Campylobacter by 12-18 months. WASH effects were modest and pathogen-specific but generally protective. At 24 months, children that received WASH interventions had less antibody against Shigella (-4.5%, 95% CI -7.6% to -1.5%), non-typhoidal S. enterica (-4.0%, 95% CI -6.5% to -1.5%), and Giardia (-3.4%, 95% CI -6.7% to -0.2%), although not after multiple-testing correction. Nutrition had limited effects on most enteric pathogens, but reduced non-typhoidal S. enterica at 14 months (-6.4%, 95% CI: -9.8% to -3.0%). Interpretation: Multiplex serology provided evidence that WASH may modestly reduce cumulative exposure to selected enteric pathogens, but household-level interventions were insufficient to substantially disrupt transmission in this high-exposure setting. Funding: National Institutes of Health (R01AI166671, R01AI106878, R01AI134814). The original WASH Benefits trial was funded by Gates Foundation (OPPGD759).", "abstract_shown": true, "affiliations": [], "article_type": "PUBLISHAHEADOFPRINT", "arxiv": null, "author_total": 36, "authors": [ { "name": "Mahbubur Rahman" }, { "name": "Pearl Anne Ante-Testard", "orcid": "0000-0002-3416-0817" }, { "name": "Richelle W. Kihoro" }, { "name": "Henry Kanyi", "orcid": "0000-0003-2509-8692" }, { "name": "Henry Emisiko", "orcid": "0009-0001-5507-9583" }, { "name": "Huiyu Hu", "orcid": "0009-0000-0182-6654" }, { "name": "Everlyn Kamau", "orcid": "0000-0003-4285-2255" }, { "name": "E. Brook Goodhew", "orcid": "0000-0002-2951-7607" }, { "name": "Chabier Coleman", "orcid": "0000-0002-4816-9249" }, { "name": "Shahjahan Ali", "orcid": "0000-0003-3883-1208" }, { "name": "Md Ziaur Rahman", "orcid": "0000-0002-8058-4602" }, { "name": "Abul Kasham Shoab", "orcid": "0000-0002-6497-1661" }, { "name": "Md. Rana Miah" }, { "name": "Sania Ashraf", "orcid": "0000-0001-7305-8922" }, { "name": "Sarker M Parvez", "orcid": "0000-0003-2004-5065" }, { "name": "Md. Mostofa Shakil", "orcid": "0009-0001-0893-7370" }, { "name": "Samantha J. Bents", "orcid": "0009-0003-9298-945X" }, { "name": "Julianna Colado" }, { "name": "Nikolina Walas", "orcid": "0000-0002-6137-9275" }, { "name": "Jessica A. Grembi", "orcid": "0000-0001-6142-4913" }, { "name": "Richelle C. Charles", "orcid": "0000-0002-8881-1849" }, { "name": "Edward T. Ryan", "orcid": "0009-0005-0169-394X" }, { "name": "Claire Munroe" }, { "name": "Robert L. Atmar", "orcid": "0000-0001-9989-6772" }, { "name": "Jade Benjamin-Chung", "orcid": "0000-0003-3631-3132" }, { "name": "Ayse Ercumen", "orcid": "0000-0001-6002-1514" }, { "name": "Andrew N. Mertens", "orcid": "0000-0002-1050-6721" }, { "name": "Audrie Lin", "orcid": "0000-0002-3877-3469" }, { "name": "Patrick J. Lammie", "orcid": "0000-0002-2139-6564" }, { "name": "Christine P. Stewart", "orcid": "0000-0003-4575-8571" }, { "name": "John M. Colford", "orcid": "0000-0002-3288-6956" }, { "name": "Stephen P. Luby", "orcid": "0000-0001-5385-899X" }, { "name": "Sammy M. Njenga", "orcid": "0000-0001-6309-476X" }, { "name": "Rashidul Haque", "orcid": "0000-0001-5100-136X" }, { "name": "Jeffrey W. Priest" }, { "name": "Benjamin F. Arnold", "orcid": "0000-0001-6105-7295" } ], "bibtex": "https://research.draconitic.com/paper/6615y57pshjb3.bib", "cited_by": 0, "doi": "10.64898/2026.10.30.26366885", "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.10.30.26366885v1.full", "id": "6615y57pshjb3", "issns": [], "landing_url": "https://www.medrxiv.org/content/10.64898/2026.10.30.26366885v1", "language": "en", "licence": "CC-BY", "licence_label": "CC BY", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "heading", "Article" ], [ "medrxiv", "epidemiology" ], [ "openalex", "2916|Child Nutrition and Water Access" ] ], "openalex": "W7225043678", "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.10.30.26366885v1.full.pdf", "pmcid": "PMC13734212", "pmid": "42990752", "published": "2026-10-30", "publisher": "Cold Spring Harbor Laboratory Preprints", "ris": "https://research.draconitic.com/paper/6615y57pshjb3.ris", "sources": [ { "first_seen": "2026-11-02T12:20:44Z", "native_id": "10.64898/2026.10.30.26366885", "source": "medrxiv", "url": "https://www.medrxiv.org/content/10.64898/2026.10.30.26366885v1" }, { "first_seen": "2026-11-08T12:23:50Z", "native_id": "PMC13734212", "source": "pmc", "url": "https://doi.org/10.64898/2026.10.30.26366885" } ], "subjects": [ { "field": "medicine", "origin": "medrxiv:epidemiology", "subfield": "epidemiology-public-health" } ], "title": "Effects of water quality, sanitation, handwashing and nutritional interventions on enteric pathogen seroconversion in rural Bangladesh: a cluster randomised trial", "title_text": "Effects of water quality, sanitation, handwashing and nutritional interventions on enteric pathogen seroconversion in rural Bangladesh: a cluster randomised trial", "type": "preprint", "updated_at": "2026-11-08T12:23:50Z", "url": "https://research.draconitic.com/paper/6615y57pshjb3", "venue": "medRxiv", "versions": [] }