Measuring enteric pathogen force of infection through antibody responses in children
- 1Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
Abstract
Enteric pathogens account for a substantial global disease burden, yet population-based surveillance remains limited by the transient nature of pathogen shedding, which constrains the sensitivity of stool-based molecular testing to a narrow detection window. Detection of IgG responses in serological surveys could enable new insights into enteric pathogen transmission, but benchmarking serological measures relative to stool-based measures of infection remains a critical evidence gap. We compared measures of disease transmission in longitudinal birth cohort samples using multiplex IgG (1,575 dried blood spots, 369 children) and PCR assays (2,229 stool samples, 369 children) that overlapped for nine pathogens (norovirus GI/GII, Shigella/enteroinvasive Escherichia coli (EIEC), Campylobacter spp., enterotoxigenic Escherichia coli (LT-ETEC), Salmonella enterica, Giardia spp., Cryptosporidium spp., Entamoeba histolytica). Campylobacter and LT-ETEC ranked highest while E. histolytica and S. enterica ranked among the lowest by both IgG and PCR measures of infection. Measures of infection were less aligned for norovirus GI, norovirus GII, Cryptosporidium, Shigella/EIEC, and Giardia. Despite this, for most pathogens, and across both measures, force of infection was lowest in the urban city of Esmeraldas and substantially higher in more rural populations, with relative risks in assay measures (seroconversion rate and PCR detected prevalence) of approximately 2.0 for pathogens with the largest differences (Shigella/EIEC and norovirus GI). Together, our results suggest that although absolute levels of infection differed between assays, IgG and PCR captured consistent relative risk of infection across geographic strata, suggesting either method can identify high-versus low-transmission settings.
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BibTeX
@misc{walas2026measuring,
title = {{Measuring enteric pathogen force of infection through antibody responses in children}},
author = {N. Walas and L. Simbana Vivanco and S. Torres Ayala and C. Coleman and E. B. Goodhew and K. J. Jesser and N. A. Zhou and C. S. Fagnant-Sperati and J. Contreras and C. Hemlock and J. W. Priest and R. C. Charles and E. T. Ryan and C. Munroe and R. L. Atmar and J. Colado and H. Burroughs and M. Calvopina and W. Cevallos and J. Coloma and G. O. Lee and G. Trueba and J. N. S. Eisenberg and K. Levy and B. F. Arnold},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.29.26364344},
url = {https://www.medrxiv.org/content/10.64898/2026.09.29.26364344v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Measuring enteric pathogen force of infection through antibody responses in children
AU - N. Walas
AU - L. Simbana Vivanco
AU - S. Torres Ayala
AU - C. Coleman
AU - E. B. Goodhew
AU - K. J. Jesser
AU - N. A. Zhou
AU - C. S. Fagnant-Sperati
AU - J. Contreras
AU - C. Hemlock
AU - J. W. Priest
AU - R. C. Charles
AU - E. T. Ryan
AU - C. Munroe
AU - R. L. Atmar
AU - J. Colado
AU - H. Burroughs
AU - M. Calvopina
AU - W. Cevallos
AU - J. Coloma
AU - G. O. Lee
AU - G. Trueba
AU - J. N. S. Eisenberg
AU - K. Levy
AU - B. F. Arnold
PY - 2026
DA - 2026/09/29
PB - medRxiv
DO - 10.64898/2026.09.29.26364344
UR - https://www.medrxiv.org/content/10.64898/2026.09.29.26364344v1
AB - Enteric pathogens account for a substantial global disease burden, yet population-based surveillance remains limited by the transient nature of pathogen shedding, which constrains the sensitivity of stool-based molecular testing to a narrow detection window. Detection of IgG responses in serological surveys could enable new insights into enteric pathogen transmission, but benchmarking serological measures relative to stool-based measures of infection remains a critical evidence gap. We compared measures of disease transmission in longitudinal birth cohort samples using multiplex IgG (1,575 dried blood spots, 369 children) and PCR assays (2,229 stool samples, 369 children) that overlapped for nine pathogens (norovirus GI/GII, Shigella/enteroinvasive Escherichia coli (EIEC), Campylobacter spp., enterotoxigenic Escherichia coli (LT-ETEC), Salmonella enterica, Giardia spp., Cryptosporidium spp., Entamoeba histolytica). Campylobacter and LT-ETEC ranked highest while E. histolytica and S. enterica ranked among the lowest by both IgG and PCR measures of infection. Measures of infection were less aligned for norovirus GI, norovirus GII, Cryptosporidium, Shigella/EIEC, and Giardia. Despite this, for most pathogens, and across both measures, force of infection was lowest in the urban city of Esmeraldas and substantially higher in more rural populations, with relative risks in assay measures (seroconversion rate and PCR detected prevalence) of approximately 2.0 for pathogens with the largest differences (Shigella/EIEC and norovirus GI). Together, our results suggest that although absolute levels of infection differed between assays, IgG and PCR captured consistent relative risk of infection across geographic strata, suggesting either method can identify high-versus low-transmission settings.
ER -