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Poole CL, Hutson Chatham A, Kimberlin DW, Hartzes A, Brown J. Water and Sanitation Access for Children in Alabama. Pediatrics 2024; 153:e2023063981. [PMID: 38690625 DOI: 10.1542/peds.2023-063981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Safe drinking water and closed sanitation are fundamental to health and are assumed in the United States, however, gaps remain, disproportionately affecting marginalized communities. We sought to describe household sanitation access for children in rural Alabama and local health provider knowledge of sanitation related health concerns. METHODS Data were collected from self-administered surveys obtained from children enrolled in a larger cross-sectional study to determine soil transmitted helminthiasis prevalence in Alabama, from a survey of health providers from local federally qualified health centers and from a baseline knowledge check of Alabama health providers enrolled in an online sanitation health course. RESULTS Surveys completed on 771 children (approximately 10% of county pediatric population) revealed less than half lived in homes connected to centralized sewers; 12% reported "straight-pipes," a method of discharging untreated sewage to the ground outside the home, and 8% reported sewage contamination of their home property in the past year. Additionally, 15% of respondents were likely to use well water. The local health providers surveyed did not include routine screening for water and sanitation failures or associated infections. Regional healthcare providers have limited knowledge of soil transmitted helminthiasis. CONCLUSIONS A significant number of children from rural counties of Alabama with high rates of poverty reside in homes with water and sanitation challenges that predominantly affect African American families. This is an under-recognized health risk by local health providers, and its contribution to well-documented health disparities in this region is poorly understood.
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Affiliation(s)
| | | | | | | | - Joe Brown
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Hobbs CV, Rhinewalt JM, Arguello I, Malloch L, Martin L, Poston WM, Byers P, Bradbury RS. Autochthonous Ascariasis, Mississippi, USA. Emerg Infect Dis 2024; 30:821-823. [PMID: 38526329 PMCID: PMC10977833 DOI: 10.3201/eid3004.240176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
We describe a case of a 2-year-old child who expelled a single adult female Ascaris lumbricoides worm. The patient is from a rural county in Mississippi, USA, with no reported travel outside of the United States. The caregivers in the home practice good sanitation. Exposure to domestic pigs is the likely source of infection.
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Bradbury RS, Martin L, Malloch L, Martin M, Williams JM, Patterson K, Sanders C, Singh G, Arguello I, Rodriguez E, Byers P, Haynie L, Qvarnstrom Y, Hobbs CV. Surveillance for Soil-Transmitted Helminths in High-Risk County, Mississippi, USA. Emerg Infect Dis 2023; 29:2533-2537. [PMID: 37987591 PMCID: PMC10683803 DOI: 10.3201/eid2912.230709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023] Open
Abstract
Recent reports of hookworm infection in Alabama, USA, has prompted surveillance in Mississippi, given the states' similar environmental conditions. We collected stool specimens from 277 children in Rankin County, Mississippi. Kato-Katz microscopic smear, agar plate culture, and quantitative PCR indicated no soil-transmitted helminths. Nevertheless, further surveillance in other high-risk Mississippi counties is warranted.
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Poole C, Barker T, Bradbury R, Capone D, Chatham AH, Handali S, Rodriguez E, Qvarnstrom Y, Brown J. Cross-Sectional Study of Soil-Transmitted Helminthiases in Black Belt Region of Alabama, USA. Emerg Infect Dis 2023; 29:2461-2470. [PMID: 37987581 PMCID: PMC10683802 DOI: 10.3201/eid2912.230751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023] Open
Abstract
We conducted a cross-sectional study to determine the prevalence of soil-transmitted helminthiases (STH) in areas of rural Alabama, USA, that have sanitation deficits. We enrolled 777 children; 704 submitted stool specimens and 227 a dried blood spot sample. We microscopically examined stool specimens from all 704 children by using Mini-FLOTAC for helminth eggs. We tested a subset by using molecular techniques: real-time PCR analysis for 5 STH species, TaqMan Array Cards for enteric helminths, and digital PCR for Necator americanus hookworm. We analyzed dried blood spots for Strongyloides stercoralis and Toxocara spp. roundworms by using serologic testing. Despite 12% of our cohort reporting living in homes that directly discharge untreated domestic wastewater, stool testing for STH was negative; however, 5% of dried blood spots were positive for Toxocara spp. roundworms. Survey data suggests substantial numbers of children in this region may be exposed to raw sewage, which is itself a major public health concern.
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Buonfrate D, Tamarozzi F, Paradies P, Watts MR, Bradbury RS, Bisoffi Z. The diagnosis of human and companion animal Strongyloides stercoralis infection: Challenges and solutions. A scoping review. ADVANCES IN PARASITOLOGY 2022; 118:1-84. [PMID: 36088083 DOI: 10.1016/bs.apar.2022.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Strongyloidiasis is the infection caused by soil-transmitted nematodes of Strongyloides species, infecting humans and some animals. Strongyloides stercoralis is the species with most clinical and epidemiological relevance in humans and dogs, due to its high prevalence and its capacity of inducing a life-threatening hyperinfection. Diagnosis of strongyloidiasis is challenging, due to the absence of a single reference standard test with high sensitivity and specificity, which also hampers the estimation of the accuracy of other diagnostic tests. In this chapter, we review the deployment and performance of the parasitological, immunological, molecular tests for the diagnosis of strongyloidiasis in humans and in dogs. Further, we comment the available evidence from genotyping studies that have addressed the zoonotic potential of S. stercoralis. Finally, we discuss the use of different diagnostic methods in relation to the purpose (i.e., screening, individual diagnosis, inclusion in a clinical trial) and the setting (endemic/non-endemic areas) and report the accuracy figures reported by systematic reviews on either parasitological, serological or molecular techniques published in literature.
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Affiliation(s)
- Dora Buonfrate
- Department of Infectious Tropical diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy.
| | - Francesca Tamarozzi
- Department of Infectious Tropical diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Paola Paradies
- Department of Emergency and Organs Transplantation, Veterinary Section, Campus of Veterinary Medicine, University of Bari, Bari, Italy
| | - Matthew R Watts
- Centre for Infectious Diseases and Microbiology, Institute of Clinical Pathology and Medical Research - New South Wales Health Pathology and Sydney Institute for Infectious Diseases, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Richard S Bradbury
- School of Health and Life Sciences, Federation University Australia, Berwick, VC, Australia
| | - Zeno Bisoffi
- Department of Infectious Tropical diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy; Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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Seroprevalence of toxocariasis among allergic patients in Kuwait and its association with eosinophilia. Parasite Epidemiol Control 2022; 18:e00260. [PMID: 35818473 PMCID: PMC9270249 DOI: 10.1016/j.parepi.2022.e00260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/21/2022] [Accepted: 06/27/2022] [Indexed: 11/23/2022] Open
Abstract
Toxocariasis is a worldwide helminthic infection which is transmitted from infected dogs and cats and has been associated with peripheral blood eosinophilia. The Centers for Disease Control and Prevention (CDC) placed toxocariasis among the top 6 parasitic diseases in the USA which are prioritized for public health action. To our knowledge, there are no reports on human toxocariasis in Kuwait or in the other Gulf Cooperation Council (GCC) countries. This study aims at investigating the seroprevalence of toxocariasis among allergic patients in Kuwait and its association with eosinophilia, age, gender, nationality, and history of direct contact with dogs or cats. From September to December 2021, the laboratory records of allergic patients referred to Al-Rashed Allergy Hospital, Kuwait were reviewed and a total of 400 serum samples were selected: 200 samples from patients with normal eosinophil count (< 500 cells/μl) and 200 samples from patients with eosinophilia (> 500 cells/μl). The sera were screened for anti-Toxocara canis IgG antibodies via antibody enzyme-linked immunosorbent assay (Ab-ELISA). The seropositive patients were asked about their history of direct contact with dogs or cats. Statistical analyses were performed using Microsoft Excel® Analysis ToolPak software. Toxocariasis seropositivity was detected in 10 out of 400 (2.5%) allergic patients. Five patients had eosinophilia while 5 had normal eosinophil count. There was no difference in mean age or gender between Toxocara-seropositive and seronegative patients (p > 0.05). The seroprevalence rate was lower-than-expected among Kuwaiti patients (2/307, 0.7%) in comparison with non-Kuwaiti patients (8/57, 14.0%) (χ2 = 33.603, df = 1, p < 0.001) who originated from endemic South/Southeast Asian countries. Seven out of 8 (87.5%) seropositive patients had a history of direct contact with cats, dogs, or both. The seroprevalence rate of toxocariasis among allergic patients in Kuwait was 2.5%. Raising awareness and early deworming treatment/prophylaxis for juvenile dogs and cats remain crucial for toxocariasis prevention.
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Ryan U, Hill K, Deere D. Review of generic screening level assumptions for quantitative microbial risk assessment (QMRA) for estimating public health risks from Australian drinking water sources contaminated with Cryptosporidium by recreational activities. WATER RESEARCH 2022; 220:118659. [PMID: 35635918 DOI: 10.1016/j.watres.2022.118659] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 04/26/2022] [Accepted: 05/21/2022] [Indexed: 06/15/2023]
Abstract
As urban communities continue to grow, demand for recreational access (including swimming) in drinking water sources have increased, yet relatively little is understood about the public health implications this poses for drinking water consumers. Preventative risk-based approaches to catchment management, informed by quantitative microbial risk assessment (QMRA), requires accurate input data to effectively model risks. A sound understanding of the knowledge gaps is also important to comprehend levels of uncertainty and help prioritise research needs. Cryptosporidium is one of the most important causes of waterborne outbreaks of gastroenteritis globally due to its resistance to chlorine. This review was undertaken by Water Research Australia to provide the most up-to-date information on current Cryptosporidium epidemiological data and underlying assumptions for exposure assessment, dose response and risk assessment for generic components of QMRA for Cryptosporidium and highlights priorities for common research. Key interim recommendations and guidelines for numerical values for relatively simple screening level QMRA modelling are provided to help support prospective studies of risks to drinking water consumers from Cryptosporidium due to body-contact recreation in source water. The review does not cover site-specific considerations, such as the levels of activity in the source water, the influence of dilution and inactivation in reservoirs, or water treatment. Although the focus is Australia, the recommendations and numerical values developed in this review, and the highlighted research priorities, are broadly applicable across all drinking source water sources that allow recreational activities.
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Affiliation(s)
- U Ryan
- Harry Butler Institute, Murdoch University, 90 South Street, Perth, Australia.
| | - Kelly Hill
- Water Research Australia, 250 Victoria Square, Adelaide, South Australia, Australia
| | - Dan Deere
- Water Futures, Sydney, Australia and Water Research Australia, Australia
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Sanchez GV, Blackstock AJ, Davidson SL. Pediatric Medicaid Visits for Soil-Transmitted Helminth Infections in the Black Belt Region-Alabama, 2010-2018. Am J Trop Med Hyg 2022; 106:867-869. [PMID: 35073505 PMCID: PMC8922506 DOI: 10.4269/ajtmh.21-0422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/08/2021] [Indexed: 11/07/2022] Open
Abstract
Areas of rural Alabama may be at risk for re-emergence of soil-transmitted helminthiasis (STH) where environmental conditions are favorable for STH transmission, including in the agricultural Black Belt region. We describe pediatric Medicaid STH visits in Alabama and compare STH visit rates in Black Belt counties with those of non-Black Belt counties. Alabama Medicaid visit claims among children aged 0-18 years who received an STH diagnosis during January 2010-December 2018 were examined. STH-related pediatric visits were uncommon, but several counties with higher STH rates were identified. Visit rates did not differ meaningfully when comparing Black Belt with non-Black Belt region counties (rate ratio: 1.10; 95% CI: 0.73-1.64). Additional studies examining STH prevalence among children living in communities at risk for STH in Alabama can further clarify STH burden and identify communities experiencing environmental and sanitation conditions favorable to STH endemicity.
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Affiliation(s)
- Guillermo V Sanchez
- Centers for Disease Control and Prevention, Atlanta, Georgia.,Alabama Department of Public Health, Montgomery, Alabama.,Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia
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Kolak M, Li X, Lin Q, Wang R, Menghaney M, Yang S, Anguiano V. The US COVID Atlas: A dynamic cyberinfrastructure surveillance system for interactive exploration of the pandemic. TRANSACTIONS IN GIS : TG 2021; 25:1741-1765. [PMID: 34512108 PMCID: PMC8420397 DOI: 10.1111/tgis.12786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Distributed spatial infrastructures leveraging cloud computing technologies can tackle issues of disparate data sources and address the need for data-driven knowledge discovery and more sophisticated spatial analysis central to the COVID-19 pandemic. We implement a new, open source spatial middleware component (libgeoda) and system design to scale development quickly to effectively meet the need for surveilling county-level metrics in a rapidly changing pandemic landscape. We incorporate, wrangle, and analyze multiple data streams from volunteered and crowdsourced environments to leverage multiple data perspectives. We integrate explorative spatial data analysis (ESDA) and statistical hotspot standards to detect infectious disease clusters in real time, building on decades of research in GIScience and spatial statistics. We scale the computational infrastructure to provide equitable access to data and insights across the entire USA, demanding a basic but high-quality standard of ESDA techniques. Finally, we engage a research coalition and incorporate principles of user-centered design to ground the direction and design of Atlas application development.
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Affiliation(s)
- Marynia Kolak
- Division of Social SciencesCenter for Spatial Data ScienceUniversity of ChicagoChicagoILUSA
| | - Xun Li
- Division of Social SciencesCenter for Spatial Data ScienceUniversity of ChicagoChicagoILUSA
| | - Qinyun Lin
- Division of Social SciencesCenter for Spatial Data ScienceUniversity of ChicagoChicagoILUSA
| | - Ryan Wang
- Division of Social SciencesCenter for Spatial Data ScienceUniversity of ChicagoChicagoILUSA
| | - Moksha Menghaney
- Division of Social SciencesCenter for Spatial Data ScienceUniversity of ChicagoChicagoILUSA
| | - Stephanie Yang
- Division of Social SciencesCenter for Spatial Data ScienceUniversity of ChicagoChicagoILUSA
| | - Vidal Anguiano
- Division of Social SciencesCenter for Spatial Data ScienceUniversity of ChicagoChicagoILUSA
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Bradbury RS, Lane M, Arguello I, Handali S, Cooley G, Pilotte N, Williams JM, Jameson S, Montgomery SP, Hellmann K, Tharp M, Haynie L, Galloway R, Brackin B, Kirmse B, Stempak L, Byers P, Williams S, Faruque F, Hobbs CV. Parasitic Disease Surveillance, Mississippi, USA. Emerg Infect Dis 2021; 27:2201-2204. [PMID: 34287125 PMCID: PMC8314824 DOI: 10.3201/eid2708.204318] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Surveillance for soil-transmitted helminths, strongyloidiasis, cryptosporidiosis, and giardiasis was conducted in Mississippi, USA. PCR performed on 224 fecal samples for all soil-transmitted helminths and on 370 samples for only Necator americanus and Strongyloides stercoralis identified 1 S. stercoralis infection. Seroprevalences were 8.8% for Toxocara, 27.4% for Cryptosporidium, 5.7% for Giardia, and 0.2% for Strongyloides parasites.
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