Open Defecation Sites, Unmet Sanitation Needs, and Potential Sanitary Risks in Atlanta, Georgia, 2017-2018

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ObjectivesTo survey the spatial distribution and enteric pathogen profile of discarded human feces in the city of Atlanta, Georgia.MethodsAfter defining priority search areas in central Atlanta, we conducted 5 searches of open defecation sites totaling 15 hours during the period from October 2017 to January 2018. We collected fresh stools for analysis via multiplex reverse-transcription polymerase chain reaction to identify presence of 15 common parasitic, bacterial, and viral enteric pathogens.ResultsWe identified and mapped 39 open defecation sites containing 118 presumptive human stools; 23% of the 26 collected fresh stools tested positive for 1 or more pathogens. An estimated 12% of stools were positive for enterotoxigenic Escherichia coli, 7.7% for Giardia spp., 3.8% for norovirus, and 3.8% for Salmonella spp. The majority (92%) of identified open defecation sites were within 400 meters of a shelter or soup kitchen.ConclusionsThough this study was constrained by a small sample size, results suggest that open defecation in Atlanta is common and may pose risks to public health.Public Health ImplicationsOpen defecation may pose health risks to people experiencing homelessness and the general public.

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