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Limiting the environmental transmission of soil-transmitted helminths (STHs), which infect 1.5 billion people worldwide, will require sensitive, reliable, and cost-effective methods to detect and quantify STHs in the environment. We review the state-of-the-art of STH quantification in soil, biosolids, water, produce, and vegetation with regard to four major methodological issues: environmental sampling; recovery of STHs from environmental matrices; quantification of recovered STHs; and viability assessment of STH ova. We conclude that methods for sampling and recovering STHs require substantial advances to provide reliable measurements for STH control. Recent innovations in the use of automated image identification and developments in molecular genetic assays offer considerable promise for improving quantification and viability assessment.

The combination of deworming and improved sanitation or hygiene may result in greater reductions in soil-transmitted helminth (STH) infection than any single intervention on its own. We measured STH prevalence in rural Bangladesh and assessed potential interactions among deworming, hygienic latrines, and household finished floors.

Improvements of water, sanitation, and hygiene (WASH) infrastructure and appropriate health-seeking behavior are necessary for achieving sustained control, elimination, or eradication of many neglected tropical diseases (NTDs). Indeed, the global strategies to fight NTDs include provision of WASH, but few programs have specific WASH targets and approaches. Collaboration between disease control programs and stakeholders in WASH is a critical next step. A group of stakeholders from the NTD control, child health, and WASH sectors convened in late 2012 to discuss opportunities for, and barriers to, collaboration. The group agreed on a common vision, namely "Disease-free communities that have adequate and equitable access to water and sanitation, and that practice good hygiene." Four key areas of collaboration were identified, including (i) advocacy, policy, and communication; (ii) capacity building and training; (iii) mapping, data collection, and monitoring; and (iv) research. We discuss strategic opportunities and ways forward for enhanced collaboration between the WASH and the NTD sectors.

For a period of 2 years, five follow-up measures of prevalence and incidence rates were estimated in a prospective study of S. mansoni infection in a group of schoolchildren who were living in a rural area of the Municipality of Itariri (São Paulo, Brazil), where schistosomiasis is transmitted by Biomphalaria tenagophila. Infection was determined by the examination of three Kato-Katz stool slides, and the parasitological findings were analyzed in comparison to serological data. In the five surveys, carried out at 6-month intervals (March-April and September-October), the prevalences were, respectively, 8.6, 6.8, 9.9, 5.8 and 17.2% by the Kato-Katz, and 56.5, 52.6, 60.8, 53.5 and 70.1% by the immunofluorescence test (IFT). Geometric mean egg counts were low: 57.8, 33.0, 35.6, 47.3 and 40.9 eggs per gram of feces, respectively. Of the total of 299 schoolchildren, who submitted five blood samples at 6-month intervals, one for each survey, 40% were IFT-positive throughout the study, and 22% were IFT-negative in all five surveys. Seroconversion from IFT negative to positive, indicating newly acquired S. mansoni infection, was observed more frequently in surveys carried out during March-April (after Summer holidays), than during September-October. Seasonal trends were not statistically significant for detection of S. mansoni eggs in stool. The results indicate that the use of IgM-IFT is superior to parasitological methods for detection of incidence of S. mansoni infection in areas with low worm burden.

Background The International Trachoma Initiative (ITI) provides azithromycin for mass drug administration (MDA) to eliminate trachoma as a public health problem. Azithromycin is given as tablets for adults and powder for oral suspension (POS) is recommended for children aged <7 y, children <120 cm in height (regardless of age) or anyone who reports difficulty in swallowing tablets. An observational assessment of MDA for trachoma was conducted to determine the frequency with which children aged 6 mo through 14 y received the recommended dose and form of azithromycin according to current dosing guidelines and to assess risk factors for choking and adverse swallowing events (ASEs). Methods MDA was observed in three regions of Ethiopia and data were collected on azithromycin administration and ASEs. Results A total of 6477 azithromycin administrations were observed; 97.9% of children received the exact recommended dose. Of children aged 6 mo to <7 y or <120 cm in height, 99.6% received POS. One child experienced choking and 132 (2%) experienced ≥1 ASEs. Factors significantly associated with ASEs included age 6–11 mo or 1–6 y, non-calm demeanor and requiring coaxing prior to drug administration. Conclusions There is a high level of adherence to the revised azithromycin dosing guidelines and low incidence of choking and ASEs. [ABSTRACT FROM AUTHOR]

In countries where bancroftian filariasis is endemic, lymphedema of the leg is a public health problem, particularly for women, who are disproportionately affected. We investigated the effect of basic lymphedema [...]

To assess the total medical costs and productivity losses associated with the 1993 waterborne outbreak of cryptosporidiosis in Milwaukee, Wisconsin, including the average cost per person with mild, moderate, and [...]

In Campos dos Goytacazes, northern Rio de Janeiro state, Brazil, reports of uveitis consistent with toxoplasmosis led to a survey of the prevalence and risk factors for Toxoplasma gondii infection [...]

An outbreak of cryptosporidiosis caused by fecally-contaminated apple cider illustrates that this disease may be transmitted by food products. Cryptosporidiosis is a parasitic infection that causes diarrhea, abdominal cramps, or vomiting. In October of 1993, some elementary and high school students in central Maine developed cryptosporidiosis after attending an agricultural fair. Researchers interviewed 611 students and teachers who had attended the fair. A total of 160 interviewees had cryptosporidiosis, 154 of whom had drunk apple cider during the afternoon of the fair. Sixty-six percent of cryptosporidiosis patients had vomiting and diarrhea, 12% had diarrhea only, and 16% had vomiting only. The average period from infection to illness was six days with the illness lasting an average of six days. The apples used in the implicated cider came from a tree on a farm. Students shook the tree to free the fruit. The apples that fell on the ground were contaminated by calf feces. cryptosporidiosis oocysts were identified in the cider, the cider press, and in a stool sample from a calf on the farm., Background. - Recent waterborne outbreaks have established Cryptosporidium as an emerging enteric pathogen, but foodborne transmission has rarely been reported. In October 1993, an outbreak of cryptosporidiosis occurred among students and staff attending a 1-day school agricultural fair in central Maine. Design. - Environmental/laboratory investigation and cohort study. Participants. - Attendees of the fair and their household members. Main Outcome Measures. - Clinical or laboratory-confirmed cryptosporidiosis. Clinical cryptosporidiosis was defined as 3 days of either diarrhea (three loose stools in a 24-hour period) or vomiting. Results. - Surveys were completed for 611 (81%) of the estimated 759 fair attendees. Among attendees who completed the survey, there were 160 (26%) primary cases. Cryptosporidium oocysts were detected in the stools of 50 (89%) of 56 primary and secondary case patients tested. The median incubation period was 6 days (range, 10 hours to 13 days); the median duration of illness was 6 days (range,1 to 16 days). Eighty-four percent of primary case patients had diarrhea and 82% had vomiting. Persons drinking apple cider that was hand pressed in the afternoon were at increased risk for cryptosporidiosis (154 [54%] of 284 exposed vs six [2%] of 292 unexposed; relative risk, 26; 95% confidence interval, 12 to 59). Cryptosporidium oocysts were detected in the apple cider, on the cider press, and in the stool specimen of a calf on the farm that supplied the apples. The secondary household transmission rate was 15% (53/353). Conclusions. - This is the first large cryptosporidiosis outbreak in which foodborne transmission has been documented. It underscores the need for agricultural producers to take measures to avoid contamination of foodstuffs with infectious agents common to the farm environment. (JAMA. 1994;272:1592-1596

The outbreak of cryptosporidium infection that occurred in Milwaukee, WI, in 1993 was most likely the result of cryptosporidium occysts in the water coming from one of the city's two water-treatment plants. Cryptosporidium is a protozoan that causes a gastrointestinal illness associated with diarrhea, fever, nausea and vomiting. As many as 400,000 people were infected during the Milwaukee outbreak. Tests were conducted on water from the city's two treatment plants and on the feces of people infected. The turbidity of the water at one of the water treatment plants was unusually high during the outbreak, and analysis of water that left the plant during the outbreak revealed a 100-fold increase in cryptosporidium. A survey of Milwaukee residents showed that only people drinking water that was treated at this plant were infected.

The American Public Health Association and the American Academy of Pediatrics recently published health and safety guidelines for child care Centers. A survey was conducted t6 determine the extent to which practices in US child care centers are reflective of these guidelines. Compliance with 16 guidelines ranged from 19.5% to 98.6%, varied considerably by state, and was not consistently associated with selected center characteristics. Prevention efforts should focus on practices for which compliance is low and on those that have the greatest disease- and injury-reducing potential. (Am J Public Health. 1994;84:1161-1164), Injury prevention and communicable disease prevention strategies appear to vary greatly between licensed child care centers. A total of 2,003 child care-center directors were interviewed 1 1/2 years before the American Public Health Association and the American Academy of Pediatrics published guidelines for the control and prevention of communicable diseases and injuries in child care centers. Overall, centers were more likely to already be in compliance with communicable disease-control guidelines than injury-control guidelines. Directors reported that staff washed their hands after every diaper change in 74% of the centers. However, only 40% of the directors reported that four-year-olds in their centers always washed their hands after using the toilet. Thirty-eight percent of the surfaces under the highest piece of playground equipment were considered adequate to prevent serious injuries. It appears that substantial changes will be necessary to bring child care centers in line with the new guidelines.

Children in day care centers appear to be at risk for injuries requiring medical attention while attending the centers. Researchers interviewed the directors of 1,797 day care centers. Of these centers, 443 (25%) reported a total of 556 injuries that required medical attention. The most common injuries were cuts or ragged wounds, making up about 31% of all injuries. About 15% of the injuries were bumps or bruises, 10% were fractures and 8% were dental injuries. Burns and poisonings accounted for less than 1% of all reported injuries. Fifty-one percent of the injuries occurred on the playground, while 28% occurred in the classroom. Less than 1% of injuries occurred in a parking lot, street or vehicle and none occurred in a swimming pool. Ninety-eight (18%) injuries were caused by falls from playground climbing equipment. More than half of the fractures and concussions (53%) were caused by falls from playground equipment., Objective. Because an increasing proportion of US children spends time in day care center environments, a national estimate of injury risks in day care centers is needed. Methods. We interviewed directors of 1797 day care centers from every state and the District of Columbia from October to December 1990 and analyzed medically attended injuries and center characteristics reported by the directors. Results. The centers were attended by 138 404 children. In the 2 months before the center directors were interviewed, 556 children sustained injuries requiring medical attention while attending the centers. The injury rate was 1.5 injuries per 100 000 child hours in day care. The most common injuries were cuts or lacerations (31%), bumps or bruises (15%), fractures (10%), and dental injuries (8%). Most injuries (51%) occurred on the playground. Many injuries (18%), and more than half of fractures and concussions (53%) were due to falls from climbing equipment. Conclusions. Day care center injury rates estimated by this study were relatively low. Many injuries that occur in this setting are probably minor. However, lowering the height of playground equipment and providing more resilient playground surfaces could further reduce injury risks in day care centers. Pediatrics 1994;93:364-368; child care, children, day care centers, epidemiology, injury, pediatric, playground, prevention

Most licensed child day-care centers may have regulations prohibiting tobacco smoke. Environmental tobacco smoke can be hazardous to the health of young children. Among 2,003 licensed child day-care centers, more than 99% had policies regarding employee smoking that agreed with state or local regulations. Most of the day-care centers would hire smokers. Fifty-percent of the day-care centers had policies prohibiting smoking indoors and outdoors, and 26% had policies prohibiting smoking indoors only. Day-care centers in western or southern states were more likely to have stricter policies regarding employee smoking than those in northeast or midwest states. Centers in states with regulations or laws restricting smoking in day-care facilities were also more likely to have stricter employee smoking policies than other centers., The authors analyzed data from a national survey of 2003 directors of licensed child day-care centers to determine employee smoking policies, measure compliance with state and local employee smoking regulations for child day-care centers and state clean indoor air laws, and to estimate the extent of exposure to environmental tobacco smoke in these settings. Forty states regulated employee smoking in child day-care centers, but only three states required day-care centers to be smoke-free indoors. More than 99% of licensed child day-care centers had employee smoking policies that complied with the appropriate state or local smoking regulations. Nearly 55% of centers were smoke-free indoors and outdoors, and 26% were smoke-free indoors only. The best predictors of more stringent employee smoking policies were location in the West or South, smaller size, independent ownership, or having written smoking policies. Despite the presence of strong smoking policies at the majority of licensed child day-care centers, more than 752000 children in the United States are at risk for environmental tobacco smoke exposure in these settings. Health care professionals and parents should insist that child day-care centers be smoke-free indoors and, preferably, smoke-free indoors and outdoors. Pediatrics 1993; 91:460-463; child day-care centers, cigarette smoking, smoking policies, environmental tobacco smoke.