Epidemiological and immunological gains from solar water disinfection: Fact or wishful thinking?

Objective There is still no consensus on the impact of using solar disinfection (SODIS) to reduce the prevalence of waterborne gastrointestinal diseases. The reported reduction in diarrhoea prevalence among SODIS users has been attributed to the consumption of water free of viable pathogens. However, it has also been suggested that ingestion of SODIS-inactivated pathogens may induce protective immunological changes that may also contribute to a reduction in the frequency of diarrhoea. The present study aimed to critically review the epidemiological and immunological gains of using SODIS. Methods We critically reviewed 22 articles published in English, selected from 2118 records systematically retrieved from the databases. Results All trials (except one) reported a significant reduction in diarrhoea prevalence among children using SODIS, but some of the data from trials report contrary findings. All in vitro and in vivo assays indicate that SODIS-inactivated pathogenic bacteria have the potential to induce immunological alterations that may result in protective immunological effects. Studies with a low risk of bias are still awaited to confirm the ability to use SODIS to reduce the prevalence of diarrhoea. Conclusion Reducing the prevalence of diarrhoea depends on the success of SODIS delivery strategies in inducing behavioural changes in communities that result in the production of SODIS-compliant outcomes. The results of trials reporting a reduction in the prevalence of diarrhoea due to the use of SODIS seem to support the hypothesis of the contribution of the protective immunological effect against diarrhoea in SODIS users.