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Article History

Received: 5 December 2024

Accepted: 13 May 2025

First Online: 4 August 2025

Declarations

:

: Ethical approval is not required for this study because the data analyzed cannot be linked to any specific person or a group of people. Historic wastewater samples were collected through environmental monitoring and not from human patients, while clinical data were deidentified and/or aggregated. Accordingly, there is no possibility of linking a given environmental sample to identifiable human data.

: AK, AA, IR, ALD, DR, ZR, AJS, RH, MR [icddr, b], FJ, MR [IEDCR], and AR received grantsfor research to institutions from The Rockefeller Foundation. MDB is employed by The Rockefeller Foundation. AK, DR, AA, IR, and ALD are employee-owners of Mathematica, own stock options at Mathematica, and shares in mutual funds that include health care firms. AK has received grants or contracts for research (through institution) from The World Bank, The RockefellerFoundation, North Carolina Department of Health and Human Services, Dogwood Health Trust(through the Jackson County Department of Public Health and Haywood County Health and Human Services Agency), and the Massachusetts Department of Public Health; has received honoraria for educational events for Genome Canada; has participated on the World Bank’s Advisory Board of the Heatwave Data Collaborative (unpaid service); and has served as an unpaid board member to the town of Waynesville’s Environmental Sustainability Board. ALD has received grants or contracts for research to institution from the US Department of Health and Human Services, National Science Foundation, and the University of Chicago; and has been financially supported by the Bill and Melinda Gates Foundation for conference attendance (GeoField). DR has received grants or contracts for research to institution from the US Department of Health and Human Services, The Rockefeller Foundation, The Global Center on Adaptation, and the Massachusetts Department of Public Health; has received consulting fees from Imperial College London for research activities; has received payment for lecturing activities at Imperial College London; and has been financially supported by Mathematica to attend health- and economics-related conferences. IR has received grants or contracts for research (through institution) from The Rockefeller Foundation, the World Bank, North CarolinaDepartment of Health and Human Service, the US Centers for Medicare and Medicaid Services, the US Center for Medicare and Medicaid Innovation, and Rural Health RedesignCenter Organization, Inc. AA has received grants or contracts for research (through institution) from United States Agency for International Development, the Bill and Melinda GatesFoundation, AGRA, Agency Fund, and the World Bank Strategic Impact Evaluation Fund; and has received consultancy fees from the World Bank, United Nations Development Programme, and Food and Agriculture Organization. RH has received grants or contracts for research (through institution) from Emory University, The Ministry of Health and Family Welfare (Bangladesh), and UNICEF Bangladesh; and has received payments to institution for conference attendances from The Rockefeller Foundation. AJS has received grants or contracts for research (through institution) from Emory University. FJ has received grants or contracts for research (through institution) from Emory University, National Institutes of Health, ELRHA, and the Islamic Development Bank.MR [icddr, b] has received grants or contracts for research (through institution) from Emory University and UNICEF Bangladesh. ZR has received grants or contracts for research (through institution) from Emory University and UNICEF Bangladesh; and has received payments to institution forconference attendance from The Rockefeller Foundation. AR and MR [IEDCR] have received an honorarium from The Rockefeller Foundation to serve in a technical workshop; and have received financial support from The Rockefeller Foundation for field travelling and workshops.