Tubewell use protects against rotavirus infection during the monsoons in an urban setting

Rotavirus, a diarrheal pathogen spread via fecal-oral transmission, is typically characterized by a winter incidence peak in most countries. Unlike for cholera and other water-borne infections, the role of environmental and socioeconomic factors on the spatial variation of rotavirus seasonality remains unclear. Here, we analyze their association with rotavirus seasonality, specifically the odds of monsoon cases, across 46 locations from 2001 to 2012 in Dhaka. Drinking water from tubewells, compared to other sources, has a clear protective effect against cases during the monsoon, when flooding and water contamination are more likely. This finding supports a significant environmental component of transmission.