Synergising tools for capacity assessment and One Health operationalisation.

Multisectoral, One Health collaboration is essential for addressing national and international health threats that arise at the human-animal-environment interface. Thanks to the efforts of multiple organisations, countries now have an array of One Health tools available to assess capacities within and between sectors, plan and prioritise activities, and strengthen multisectoral, One Health coordination, communication, and collaboration. By doing so, they are able to address health threats at the human-animal-environment interface, including emerging zoonotic and infectious diseases, more efficiently. However, to ensure optimal outcomes for the countries using these One Health tools, the partners responsible for implementation should regularly collaborate and share information such as implementation timelines, results and lessons learned, so that one process can inform the next. This paper presents a consensus framework on how commonly implemented One Health tools might align to best support countries in strengthening One Health systems. Twelve One Health tools were selected based on their high implementation rates, authors' experience with these tools and their focus on multisectoral, One Health coordination. Through a four-step process, the authors: a) jointly carried out a landscape analysis of One Health tools, using a Cloudbased spreadsheet to share the unique characteristics and applications of each tool; b) performed an implementation analysis to identify and share implementation dynamics and identify respective outcomes and synergies; c) jointly created a consensus conceptual model of how the authors suggest the tools might logically work together; and d) extrapolated from steps 1-3 an agreed-upon overarching conceptual framework for how current and future One Health tools could be categorised to best support One Health system strengthening at the national level. Highlighted One Health tools include the States Parties Annual Reporting Tool under the International Health Regulations (IHR), the World Organisation for Animal Health Performance of Veterinary Services (PVS) Pathway, the Joint External Evaluation process, IHR/PVS National Bridging Workshops, the Centers for Disease Control and Prevention One Health Zoonotic Disease Prioritization Tool, the Food and Agriculture Organization (FAO) Laboratory Mapping Tool, the FAO Assessment Tool for Laboratories and Antimicrobial Resistance Surveillance Systems, the FAO Surveillance Evaluation Tool, the One Health Systems Mapping and Analysis Resource Toolkit, the National Action Plan for Health Security, and IHR Monitoring and Evaluation Framework tools for After Action Reviews and Simulation Exercises. A new guidance document entitled, Taking a Multisectoral, One Health Approach: A Tripartite Guide to Addressing Zoonotic Diseases in Countries was also included as a framework that provides guidance to support the implementation of the outputs of the tools described.

La collaboration multisectorielle suivant l'approche Une seule santé est essentielle pour répondre aux menaces sanitaires survenant à l'interface homme­animal­ environnement à l'échelle nationale et internationale. Grâce aux efforts conjugués de nombreuses organisations, les pays disposent désormais d'une gamme d'outils Une seule santé permettant à la fois d'évaluer les capacités intra et intersectorielles, de planifier et prioriser les activités, et de renforcer la coordination, la communication et la collaboration multisectorielles suivant cette approche. Grâce à ces outils, les pays sont mieux armés pour faire face avec efficacité aux menaces sanitaires à l'interface homme­animal­environnement, en particulier celles liées aux maladies zoonotiques et infectieuses émergentes. Néanmoins, pour optimiser les retombées pour les pays du recours aux outils Une seule santé, les partenaires chargés de leur mise en oeuvre devraient régulièrement collaborer et partager leurs informations, notamment le calendrier de mise en oeuvre, les résultats obtenus et les enseignements tirés, afin que chaque processus contribue à l'amélioration des suivants. Les auteurs présentent un cadre consensuel sur la manière dont les outils Une seule santé les plus courants peuvent converger afin d'aider le mieux possible les pays à renforcer leurs systèmes basés sur cette approche. Douze outils ont été choisis en fonction de leur fréquence d'utilisation, de l'expérience acquise par les auteurs et de l'accent mis sur la coordination multisectorielle Une seule santé. Les auteurs ont ensuite procédé à un examen en quatre étapes, comme suit : a) analyse générale des outils sélectionnés, au moyen d'un tableur sur serveur dématérialisé permettant de saisir et de partager les caractéristiques et les applications spécifiques de chaque outil ; b) analyse de la mise en oeuvre des outils, visant à déterminer et à partager la dynamique et les caractéristiques de mise en oeuvre, ainsi que les résultats respectifs et les synergies qui en ressortent ; c) création d'un modèle conceptuel consensuel contenant les propositions des auteurs en vue d'une convergence raisonnée des fonctionnalités de ces outils ; d) à partir des trois étapes précédentes, conception d'un cadre conceptuel transversal destiné à catégoriser les outils Une seule santé actuels et futurs afin d'apporter un soutien optimal au renforcement des systèmes Une seule santé à l'échelle des pays. Parmi les outils examinés figurent l'Outil d'autoévaluation pour l'établissement de rapports annuels par les États Parties de l'Organisation mondiale de la santé (OMS), qui concerne l'application du Règlement sanitaire international (RSI) ; le Processus sur les Performances des Services vétérinaires (PVS) de l'Organisation mondiale de la santé animale (OIE) ; le processus d'Évaluation extérieure conjointe ; les ateliers nationaux de liaison RSI/PVS ; l'outil Une seule santé de priorisation des maladies zoonotiques des Centres pour le contrôle et la prévention des maladies (CDC) ; l'Outil de cartographie des laboratoires de l'Organisation des Nations Unies pour l'alimentation et l'agriculture (FAO) ; l'Outil d'évaluation de la FAO pour les laboratoires et les systèmes de surveillance de l'antibiorésistance ; l'Outil d'évaluation de la FAO sur la surveillance ; la Boîte à outils cartographiques et analytiques sur les systèmes Une seule santé ; les Plans d'action nationaux de sécurité sanitaire ; et enfin les outils d'examen après action et protocoles de simulation du Cadre de suivi et d'évaluation du RSI. Le document d'orientation récemment publié sous le titre Taking a multisectoral One Health approach: a Tripartite guide to addressing zoonotic diseases in countries [Adopter une approche multisectorielle Une seule santé : Guide tripartite pour lutter contre les maladies zoonotiques] est également présenté, en tant qu'il fournit un cadre directeur en appui de la mise en oeuvre des résultats des outils d'évaluation ci-dessus.

La colaboración multisectorial en clave de Una sola salud es esencial para responder a las amenazas sanitarias de dimensión nacional e internacional que surgen en la confluencia de personas, animales y medio ambiente. Gracias al trabajo de numerosas organizaciones, los países disponen ahora de un repertorio de herramientas concebidas desde la óptica de Una sola salud para evaluar las capacidades existentes dentro de los sectores y entre ellos, planificar y jerarquizar actividades y potenciar las labores de coordinación, comunicación y colaboración multisectoriales en clave de Una sola salud. Gracias a todo ello, los países están en condiciones de luchar más eficazmente contra las amenazas sanitarias en la interfaz de personas, animales y medio ambiente, en particular las enfermedades infecciosas y zoonóticas emergentes. No obstante, para que los países obtengan resultados óptimos del uso de estas herramientas de Una sola salud es preciso que los distintos colaboradores encargados de aplicarlas colaboren e intercambien información periódicamente, por ejemplo sobre plazos de ejecución, resultados obtenidos y enseñanzas extraídas, de tal manera que un proceso pueda alimentar el siguiente. Los autores presentan un conjunto de principios consensuados sobre el modo en que cabría armonizar entre sí las herramientas de Una sola salud utilizadas con frecuencia para que los países cuenten con un apoyo idóneo a la hora de fortalecer los sistemas de Una sola salud. Ante todo, los autores seleccionaron doce de esas herramientas atendiendo a su (elevado) nivel de utilización, la experiencia de los propios autores con ellas y la medida en que privilegian la coordinación multisectorial en clave de Una sola salud. Después, siguiendo un proceso en cuatro etapas: a) efectuaron colectivamente un análisis general de las herramientas existentes, empleando una hoja de cálculo situada en la «nube¼ para poner en común las características y aplicaciones únicas de cada herramienta; b) analizaron la utilización práctica de esas herramientas de Una sola salud para dilucidar y poner en común la dinámica de aplicación de cada una y determinar sus respectivos resultados y sinergias; c) elaboraron de forma concertada un modelo teórico del modo en que, a su juicio, sería lógico que las herramientas funcionaran conjuntamente; y d) a partir de los pasos 1 a 3, extrapolaron consensuadamente un marco teórico global con el que se podrían clasificar las herramientas de Una sola salud, actuales y futuras, para prestar un apoyo idóneo al fortalecimiento del sistema de Una sola salud en cada país. Las herramientas de Una sola salud seleccionadas son: el instrumento de evaluación para la presentación anual de informes de los Estados Partes que forma parte del Reglamento Sanitario Internacional (RSI); el proceso PVS (Prestaciones de los Servicios Veterinarios) de la Organización Mundial de Sanidad Animal (OIE); la herramienta de evaluación externa conjunta del RSI; los talleres nacionales de coordinación RSI-PVS; la herramienta de jerarquización de enfermedades zoonóticas en clave de Una sola salud de los Centros para el Control y la Prevención de Enfermedades (CDC); la herramienta de inventario de laboratorios de la Organización de las Naciones Unidas para la Alimentación y la Agricultura (FAO); la herramienta de evaluación de laboratorios y sistemas de vigilancia de las resistencias a los antimicrobianos de la FAO; la herramienta de evaluación de la vigilancia de la FAO; el juego de herramientas y material de análisis y cartografía de los sistemas de Una sola salud; los planes de acción nacional de seguridad sanitaria de la OMS; las herramientas del marco de seguimiento y evaluación del RSI para la realización de exámenes posteriores a la acción y ejercicios de simulación. También se incluyó una nueva guía de la Tripartita para combatir las enfermedades zoonóticas en los países desde la lógica multisectorial de Una sola salud (Taking a multisectoral One Health approach: a Tripartite guide to addressing zoonotic diseases in countries), en el cual se ofrecen pautas para secundar la aplicación en la práctica de los resultados obtenidos con las citadas herramientas.

Introduction. One Health: over a decade of progress on the road to sustainability.

One Health has gained momentum in every region across the world over the past decade. The human, animal and environmental health sectors of countries worldwide have increasingly requested support for the implementation of a multisectoral, One Health approach to best address health threats at the human-animal-environment interface. Such threats include zoonotic diseases, emerging infectious diseases, antimicrobial resistance (AMR), food safety, wildlife diseases and other issues that affect health, such as poverty. A variety of successes covering One Health topics at the sub-national, national, regional and global levels ranging from AMR to zoonoses are highlighted in this issue of the World Organisation for Animal Health (OIE) Scientific and Technical Review. Authors contributing to this Review were asked to highlight One Health success stories and discuss remaining challenges that might help in achieving a better understanding of the most efficient way to implement a One Health approach. The series of articles in this issue is not meant to form an exhaustive reference of every known health issue that might benefit from a One Health approach, but rather is a collection of ideas for further reflection that contributes to a better understanding of how to successfully advance the approach. This publication also highlights the challenges remaining in One Health, and its numerous authors share success stories and point out gaps so as to help others to implement One Health effectively. At the same time, these authors advocate the value of using a One Health approach to improve the health of humans and animals living in a shared environment. Readers will notice that a number of key themes are raised time and again, most notably, the value of taking a One Health approach to coordination, collaboration and communication, and the steps required to make One Health sustainable. These steps include formalising multisectoral, One Health coordination mechanisms and using One Health tools developed by national and global partners to support the approach and its implementation. The One Health approach brings together all relevant sectors and disciplines across the human-animal-environment interface in a collaboration that is more effective, efficient and sustainable than might be achieved without the shared goal of improving health for all, both humans and animals.

Nous assistons depuis une dizaine d'années à la montée en puissance de l'approche Une seule santé dans toutes les régions du monde. Les secteurs nationaux en charge de la santé publique, animale et environnementale sont désormais nombreux à demander d'être soutenus dans la mise en place d'une approche Une seule santé multisectorielle pour mieux faire face aux menaces sanitaires à l'interface homme­ animal­environnement. Parmi ces menaces figurent les maladies zoonotiques, les maladies infectieuses émergentes, l'antibiorésistance, la sécurité sanitaire des aliments, les maladies de la faune sauvages et d'autres problématiques affectant la santé, en particulier la pauvreté. Ce numéro de la Revue scientifique et technique de l'Organisation mondiale de la santé animale (OIE) met en avant un certain nombre d'exemples réussis d'applications à l'échelle infranationale, nationale, régionale et mondiale du concept Une seule santé dans différents domaines allant de l'antibiorésistance aux zoonoses. Il a été demandé aux auteurs qui ont contribué à ce numéro de décrire les exemples d'applications réussies, mais aussi d'examiner les défis à relever afin de réunir les connaissances qui nous permettront de mettre en oeuvre cette approche de la manière la plus efficace possible. Les articles réunis dans ce numéro ne prétendent pas constituer l'inventaire exhaustif de tous les problèmes sanitaires connus ayant pu bénéficier de l'approche Une seule santé mais proposent plutôt un recueil d'idées destinées à mener une réflexion approfondie pour une meilleure compréhension des progrès qui pourraient être envisagés avec succès. Cette publication souligne également les défis qui restent à relever dans ce domaine, les nombreux auteurs faisant ressortir aussi bien les récits de réussites que les lacunes à combler afin d'aider d'autres acteurs à mettre en oeuvre efficacement l'approche Une seule santé. En même temps, les auteurs préconisent d'appliquer l'approche Une seule santé afin d'améliorer la santé des hommes et des animaux vivant dans un même environnement. Les lecteurs ne manqueront pas de constater que certaines thématiques clés apparaissent maintes et maintes fois, par exemple l'importance de l'approche Une seule santé pour renforcer la coordination, la collaboration et la communication ainsi que les différentes mesures à prendre pour en garantir la durabilité. Ces mesures concernent notamment la mise en place de mécanismes officiels et multisectoriels de coordination et le recours aux outils Une seule santé élaborés par les partenaires nationaux et mondiaux afin de soutenir l'approche et sa mise en oeuvre. Cette approche réunit toutes les disciplines et les secteurs pertinents à l'interface homme­animal­ environnement en vue d'une collaboration plus efficace, plus efficiente et plus durable, ce qui n'aurait pas été le cas sans cet objectif commun d'améliorer la santé pour tous, hommes et animaux.

En el curso del último decenio, los planteamientos de Una sola salud han ido ganando impulso en todas las regiones del planeta. Los sectores de la salud humana, animal y ambiental de países del mundo entero piden cada vez más apoyo para poner en práctica la lógica multisectorial de Una sola salud como expediente idóneo para afrontar las amenazas sanitarias que surgen en los ámbitos de confluencia (la interfaz) de personas, animales y medio ambiente, amenazas como enfermedades zoonóticas, enfermedades infecciosas emergentes, resistencias a los antimicrobianos, factores de insalubridad de los alimentos o enfermedades de la fauna silvestre, sin olvidar otros problemas que también inciden en la salud, como la pobreza. En este número de la Revista científica y técnica de la Organización Mundial de Sanidad Animal (OIE) se destacan diversos logros obtenidos a escala infranacional, nacional, regional o mundial en relación con uno u otro tema ligado a la noción de Una sola salud, desde la resistencia a los antimicrobianos hasta las zoonosis. A los autores que firman los artículos de este número se les pidió que dieran cuenta de ejemplos en que se hubieran aplicado con éxito los principios de Una sola salud y examinaran aquellos problemas aún por resolver que pudieran ser de ayuda para aprehender más eficazmente la mejor manera de poner en práctica los postulados de Una sola salud. El conjunto de artículos aquí reunidos no aspira a constituir una referencia exhaustiva de todos los problemas sanitarios conocidos que podrían beneficiarse de los principios de Una sola salud, sino más bien una suma de ideas que alimenten la reflexión y ayuden a entender mejor la manera de promover con éxito esta metodología. También se destacan aquí las dificultades que subsisten en relación con Una sola salud: los numerosos autores que firman esta publicación dan cuenta de ejemplos fructíferos y también de eventuales deficiencias para ayudar a otros a aplicar eficazmente los principios de Una sola salud, al tiempo que defienden el interés de trabajar desde este planteamiento para mejorar el estado de salud de personas y animales que habitan un medio común. Observará el lector que hay una serie de temas cardinales que surgen una y otra vez, en especial la utilidad de inscribir las labores de coordinación, colaboración y comunicación en la lógica de Una sola salud y los pasos necesarios para que esta metodología arraigue duraderamente, entre ellos el hecho de oficializar mecanismos de coordinación multisectorial en clave de Una sola salud y de emplear las herramientas de Una sola salud elaboradas por asociados de dimensión nacional o mundial para enriquecer este concepto o respaldar su aplicación práctica. La lógica de Una sola salud federa a cuantos sectores y disciplinas intervienen en la interfaz de personas, animales y medio ambiente en un proceso de colaboración que resulta más eficaz, eficiente y sostenible de lo que podría conseguirse en ausencia del objetivo común de mejorar el estado de salud tanto de las personas como de los animales.

Multistate Outbreak of Human Salmonella Typhimurium Infections Linked to Pet Hedgehogs - United States, 2011-2013.

Zoonotic Salmonella infections cause approximately 130 000 illnesses annually in the United States. Of 72.9 million US households owning at least one pet, five million own small mammals; 3000 hedgehogs were documented by USDA in USDA-licensed breeding facilities and pet stores in 2012. State health department collaborators and PulseNet, the national bacterial subtyping network, identified human infections of a Salmonella Typhimurium outbreak strain, which were investigated by CDC, USDA-APHIS and state public and animal health officials. A case was defined as an illness in a person infected with the outbreak strain identified between 1 December 2011 and 3 June 2013. Investigators collected information on patient exposures, cultured animal and environmental specimens for Salmonella, and conducted traceback investigations of USDA-licensed hedgehog facilities. There were 26 cases in 12 states. Illness onset dates ranged from 26 December 2011 to 8 April 2013. The median patient age was 15 years (range = <1-91 years); 58% were female. Among 23 persons with available information, 8 (35%) were hospitalized and one outbreak strain-associated death was reported. Of 25 patients with available information, 20 (80%) reported pet hedgehog contact in the week before illness onset. The outbreak strain was isolated from animal and environmental samples collected from three ill persons' homes in three states. Hedgehogs were purchased in geographically distant states from USDA-licensed breeders (10/17, 59%); a USDA-licensed pet store (1/17, 6%); unlicensed or unknown status breeders (3/17, 18%); and private individuals (3/17, 18%). Traceback investigations of USDA-licensed facilities did not reveal a single source of infection. Public and animal health collaboration linked pet hedgehog contact to human infections of Salmonella Typhimurium, highlighting the importance of a One Health investigative approach to zoonotic salmonellosis outbreaks. More efforts are needed to increase awareness among multiple stakeholders on the risk of illness associated with pet hedgehogs.

A Multistate Investigation of Antibiotic-Resistant Salmonella enterica Serotype I 4,[5],12:i:- Infections as Part of an International Outbreak Associated with Frozen Feeder Rodents.

While most human Salmonella infections result from exposure to contaminated foods, an estimated 11% of all Salmonella infections are attributed to animal exposures, including both direct animal handling and indirect exposures such as cleaning cages and handling contaminated pet food. This report describes the epidemiologic, environmental and laboratory investigations conducted in the United States as part of the response to an international outbreak of tetracycline-resistant Salmonella enterica serotype I 4,[5],12:i:- infections with over 500 illnesses occurring from 2008 to 2010. This investigation found that illness due to the outbreak strain was significantly associated with exposure to pet reptiles and frozen feeder rodents used as food for pet reptiles. Salmonella isolates indistinguishable from the outbreak strain were isolated from a frozen feeder mice-fed reptile owned by a case patient, as well as from frozen feeder mice and environmental samples collected from a rodent producing facility (Company A). An international voluntary recall of all Company A produced frozen feeder animals sold between May 2009 and July 2010 occurred. Only 13% of cases in our investigation were aware of the association between Salmonella infection and mice or rats. Consumers, the pet industry, healthcare providers and veterinarians need to be aware of the potential health risk posed by feeder rodents, whether live or frozen. Frozen feeder rodent producers, suppliers and distributors should follow the animal food labelling requirements as described in 21 CFR §501.5, and all packages of frozen feeder rodents should include safe handling instructions. Persons should wash their hands thoroughly with soap and water after handling live or frozen feeder rodents, as well as reptiles or anything in the area where the animals live. Continued opportunities exist for public health officials, the pet industry, veterinarians and consumers to work together to prevent salmonellosis associated with pet food, pets and other animals.

Nationwide outbreak of multidrug-resistant Salmonella Heidelberg infections associated with ground turkey: United States, 2011.

On 23 May 2011, CDC identified a multistate cluster of Salmonella Heidelberg infections and two multidrug-resistant (MDR) isolates from ground turkey retail samples with indistinguishable pulsed-field gel electrophoresis patterns. We defined cases as isolation of outbreak strains in persons with illness onset between 27 February 2011 and 10 November 2011. Investigators collected hypothesis-generating questionnaires and shopper-card information. Food samples from homes and retail outlets were collected and cultured. We identified 136 cases of S. Heidelberg infection in 34 states. Shopper-card information, leftover ground turkey from a patient's home containing the outbreak strain and identical antimicrobial resistance profiles of clinical and retail samples pointed to plant A as the source. On 3 August, plant A recalled 36 million pounds of ground turkey. This outbreak increased consumer interest in MDR Salmonella infections acquired through United States-produced poultry and played a vital role in strengthening food safety policies related to Salmonella and raw ground poultry.

Distribution and Diversity of Salmonella Strains in Shipments of Hatchling Poultry, United States, 2013.

Multistate outbreaks of salmonellosis associated with live poultry contact have been occurring with increasing frequency. In 2013, multistate outbreaks of salmonellosis were traced back to exposure to live poultry, some of which were purchased at a national chain of farm stores (Farm store chain Y). This study was conducted at 36 stores of Farm store chain Y and was concurrent with the timing of exposure for the human outbreaks of salmonellosis in 2013. We used environmental swabs of arriving shipment boxes of hatchling poultry and shipment tracking information to examine the distribution, diversity and anti-microbial resistance of non-typhoidal Salmonella (NTS) across farm stores and hatcheries. Isolates recovered from shipment boxes underwent serotyping, anti-microbial resistance (AMR) testing and pulsed-field gel electrophoresis (PFGE). Postal service tracking codes from the shipment boxes were used to determine the hatchery of origin. The PFGE patterns were compared with the PFGE patterns of NTS causing outbreaks of salmonellosis in 2013. A total of 219 hatchling boxes from 36 stores in 13 states were swabbed between 15 March 2013 and 18 April 2013. NTS were recovered from 59 (27%) of 219 hatchling boxes. Recovery was not significantly associated with species of hatchlings, number of birds in the shipment box, or the presence of dead, injured or sick birds. Four of the 23 PFGE patterns and 23 of 50 isolates were indistinguishable from strains causing human outbreaks in 2013. For serotypes associated with human illnesses, PFGE patterns most frequently recovered from shipment boxes were also more frequent causes of human illness. Boxes positive for the same PFGE pattern most frequently originated from the same mail-order hatchery. Only one of 59 isolates was resistant to anti-microbials used to treat Salmonella infections in people. This study provides critical information to address recurrent human outbreaks of salmonellosis associated with mail-order hatchling poultry.

Nationwide outbreak of Salmonella Montevideo infections associated with contaminated imported black and red pepper: warehouse membership cards provide critical clues to identify the source.

In November 2009, we initiated a multistate investigation of Salmonella Montevideo infections with pulsed-field gel electrophoresis pattern JIXX01.0011. We identified 272 cases in 44 states with illness onset dates ranging from 1 July 2009 to 14 April 2010. To help generate hypotheses, warehouse store membership card information was collected to identify products consumed by cases. These records identified 19 ill persons who purchased company A salami products before onset of illness. A case-control study was conducted. Ready-to-eat salami consumption was significantly associated with illness (matched odds ratio 8·5, 95% confidence interval 2·1-75·9). The outbreak strain was isolated from company A salami products from an environmental sample from one manufacturing plant, and sealed containers of black and red pepper at the facility. This outbreak illustrates the importance of using membership card information to assist in identifying suspect vehicles, the potential for spices to contaminate ready-to-eat products, and preventing raw ingredient contamination of these products.

Population-based survey of taeniasis along the United States-Mexico border.

Taenia solium and T. saginata are zoonotic tapeworms of substantial medical and economic importance. Although human taeniasis is widely recognised as an endemic problem in Mexico, its presence in the United States is poorly understood. The first population-based study to estimate the prevalence of human infection with Taenia tapeworms along the Texas-Mexico border has recently been conducted. Households were interviewed in the Texan city of El Paso and in the neighbouring Ciudad Juárez, in Mexico. Faecal samples from household members were then checked for Taenia eggs by flotation and/or for Taenia copro-antigens in an ELISA. The overall prevalence of taeniasis in this border region was found to be 3% but, compared with the residents of Juárez, El Paso residents were 8.6-fold more likely to be tapeworm carriers. The interviews revealed some important differences between the two study sites, particularly the more frequent use of anthelminthic drugs on the Mexican side of the border. These findings have implications in terms of the planning of effective health-education campaigns to decrease the prevalence of taeniasis in the human populations along the Texas-Mexico border.