Waterborne and Foodborne Illnesses of Viral Aetiology in the Republic of Guinea: A Critical Appraisal of a Sparse National Evidence Base and its Regional Proxies

Abstract

Waterborne and foodborne viruses remain a substantial contributor to diarrhoeal morbidity and to enterically transmitted hepatitis in West Africa, yet the Republic of Guinea occupies an unusual position within this literature. The country combines conditions that would be expected to sustain intense faecal-oral viral transmission, including low coverage of basic sanitation, intermittent piped supply, and an unmeasured level of drinking-water contamination, with an almost complete absence of published human virological data on the agents concerned. This critical narrative review examines what is actually known about viruses transmitted through water and food in Guinea, evaluates the strength of the inferences that are routinely drawn from regional comparators, and identifies where the evidence base fails. Literature was identified through searches of open scholarly databases and bibliographic indexes together with citation searching and institutional data sources, and was appraised for relevance, methodological adequacy and claim-source alignment rather than by citation count alone. Guinean primary evidence was found to consist of a small number of environmental, veterinary and incidental clinical reports, together with acute flaccid paralysis surveillance that captures enteroviruses for reasons unrelated to gastroenteritis. No population-based study of the aetiology of paediatric diarrhoea in Guinea was identified. Regional studies conducted in The Gambia, Mali, Senegal, Burkina Faso and Guinea-Bissau supply the substantive picture of aetiological structure, seasonality and severity, but they differ from Guinea in rotavirus vaccination status, hydrological regime and health-service configuration, and their transferability is therefore conditional rather than assured. Three conclusions are defensible. Rotavirus A almost certainly accounts for a considerable and preventable share of severe paediatric diarrhoea in Guinea, since the vaccine has not entered the national immunisation programme. Enterically transmitted hepatitis viruses circulate in Guinean pigs and in Conakry wastewater, but human burden is unquantified. The surveillance architecture built after the 2014 to 2016 Ebola virus disease epidemic is technically capable of generating the missing data and has not been directed towards enteric pathogens. Priorities are set out for closing these gaps.