Redefining diarrheal disease surveillance: long term nucleic acids stability with simple, low-cost stool preservation

similarly to cold-or frozen-stored samples.Shigella DSS showed no significant difference from column-extracted NA Mean CT after 18 months of storage: 28.33 RT vs. 28.64GS, 95% CI: (-0.44, 0.84).Rotavirus DSS showed lower CTs than column-extracted samples; mean CT after 18 months: 19.40 RT vs. 26.92GS, 95% CI: (6.57, 8.66), indicating increased nucleic acid yield from DSS. Norovirus DSS showed higher CTs from DSS, with consistent CT from DSS from time zero through 18 months: 30.63 RT vs. 25.79GS, 95% CI: (-5.98, -4.06).This suggests initial NA loss upon spotting, but CTs remained stable thereafter for the duration of the study. InterpretationDSS samples remained stable for NA extraction at RT for at least 18 months for Shigella and rotavirus.Norovirus detection from DSS showed slight initial degradation but remained detectable with stable CTs over time.DSS thus provides a practical, low-cost tool to enhance stool-based pathogen detection in global diarrheal surveillance.