Effectiveness of Residential Acaricides to Prevent Lyme and Other Tick-borne Diseases in Humans.

BACKGROUND: In the northeastern United States, tick-borne diseases are a major public health concern. In controlled studies, a single springtime application of acaricide has been shown to kill 68%-100% of ticks. Although public health authorities recommend use of acaricides to control tick populations in yards, the effectiveness of these pesticides to prevent tick bites or human tick-borne diseases is unknown. METHODS: We conducted a 2-year, randomized, double-blinded, placebo-controlled trial among 2727 households in 3 northeastern states. Households received a single springtime barrier application of bifenthrin or water according to recommended practices. Tick drags were conducted 3-4 weeks after treatment on 10% of properties. Information on human-tick encounters and tick-borne diseases was collected through monthly surveys; reports of illness were validated by medical record review. RESULTS: Although the abundance of questing ticks was significantly lower (63%) on acaricide-treated properties, there was no difference between treatment groups in human-tick encounters, self-reported tick-borne diseases, or medical-record-validated tick-borne diseases. CONCLUSIONS: Used as recommended, acaricide barrier sprays do not significantly reduce the household risk of tick exposure or incidence of tick-borne disease. Measures for preventing tick-borne diseases should be evaluated against human outcomes to confirm effectiveness.

Vibrio infections and surveillance in Maryland, 2002-2008.

OBJECTIVE: Vibrio is a naturally occurring waterborne pathogen with potential occupational, recreational, and commercial impacts. During the last 15 years in the U.S. and in Maryland, the incidence of vibriosis has increased. Due to the increase in cases in Maryland, warming water temperatures, and public concern about human health effects resulting from exposure to the Chesapeake Bay, we reviewed cases of vibriosis and evaluated the Vibrio surveillance system in Maryland for timeliness and data quality, attributes necessary for successful outbreak investigation and illness prevention. METHODS: The evaluation included (1) informal qualitative surveys of state and local personnel who report and manage Vibrio cases and (2) a review of Vibrio surveillance data from 2002 through 2008 for data quality and timeliness of the system. RESULTS: From 2002 to 2008, 188 laboratory-confirmed cases of vibriosis were reported in Maryland with an annual average of 27 cases. The species of Vibrio that were most frequently responsible for infection, regardless of clinical presentation, were V. parahaemolyticus (43.6%), V. vulnificus (23.9%), V. alginolyticus (9.6%), and non-toxigenic V. cholerae (9.0%). The case fatality rate fluctuated during the study period, but the number of cases increased. CONCLUSIONS: The surveillance system in Maryland is flexible and captures cases of vibriosis where specimens were collected for testing; however, the system may not adequately capture mild, self-limiting infections. Better integration of data collection for clinical, laboratory, and environmental information and improved completion of variables for shellfish harvest or water exposure locations could improve the system. Quarterly meetings comprising surveillance, public health laboratory, and food-control personnel could direct and ensure the success of improvement efforts.

Screening for Chlamydia trachomatis and Neisseria gonorrhoeae among adolescents in Family Court, Philadelphia, Pennsylvania.

OBJECTIVES: To evaluate the use of the Family Court System as a venue for screening adolescents, especially males for sexually transmitted diseases (STD). GOAL: To identify, treat, and describe the prevalence of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) infections among adolescents on probation under the jurisdiction of the Family Court System of Philadelphia from April 2004 through December 2006. STUDY DESIGN: We analyzed data from the first several years of this program, which offered education and voluntary noninvasive screening for CT and GC to adolescents adjudicated delinquent and placed on probation through the Family Court of Philadelphia. RESULTS: Between April 1, 2004 and December 31, 2006, 2270 adolescents were counseled about STDs, of whom 1605 voluntarily submitted a urine specimen for STD testing. Among the 1594 unique individuals with a valid test result, 13.9% (44 of 317) of females, 7.0% (90 of 1277) of males, and 8.4% overall (134 of 1594) were found to be positive for either or both STD. In total, treatment was confirmed for 93.3% (84/90) of males and 100% (44/44) of females testing positive. CONCLUSIONS: Noninvasive STD testing was well accepted by adolescents in the Family Court System. Over several years of study, infection rates were found to be persistently high in both males and females. The Family Court is an effective venue to identify and treat adolescent males and females with chlamydia and/or gonorrhea infection.