RESUMO
In October 2000, to interrupt transmission of Wuchereria bancrofti, an intense health-education campaign followed by a mass drug administration (MDA) with diethylcarbamazine and albendazole was undertaken in Leogane, Haiti. Three months after the MDA, which was the first in the study area, a knowledge-attitude-practice (KAP) survey, with a cluster-sample design and probability sampling, was undertaken, to determine the existing knowledge of the local residents, their attitudes toward the MDA, and the possible reasons for non-compliance. Questionnaire-based interviews were used to explore the KAP of 304 subjects (one randomly chosen resident aged > 14 years from each selected household) in 33 communities. Most (93%) of the interviewees were aware of filariasis and 72% knew at least one clinical sign of the disease. Awareness of the MDA was high (91%). The most frequently mentioned sources of information were other people (56%) and radio announcements (33%). More than 80% of the respondents encouraged other people to take the drugs distributed in the MDA and 63% had been treated. The primary reasons given for failing to take the drugs were absenteeism during the distribution (17%), use of contraceptive drugs (12%) and pregnancy (11%). In a multivariate analysis, being male [odds ratio (OR) = 3.3; 95% confidence interval (CI) = 1.5-7.4], knowing that a mosquito transmits the disease (OR = 2.6; CI = 1.2-5.4), and having learned about the MDA through posters and banners (OR = 2.9; CI = 1.2-7.5) were found to be positively associated with taking the drugs. Information from such post-treatment surveys should be useful in developing better health communication for subsequent MDA.
Assuntos
Filariose Linfática/prevenção & controle , Filaricidas/administração & dosagem , Conhecimentos, Atitudes e Prática em Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adolescente , Adulto , Idoso , Filariose Linfática/psicologia , Filariose Linfática/transmissão , Feminino , Haiti , Educação em Saúde/métodos , Promoção da Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Recusa do Paciente ao TratamentoRESUMO
In this study we documented unexpected moderate-to-severe iodine deficiency in Haitian schoolchildren although they live in a coastal community where presumably they have access to iodine-containing seafood. This fact combined with the lack of an iodized salt supply and endemic lymphatic filariasis makes community distribution of diethylcarbamazine-fortified, iodized salt an attractive strategy for elimination of lymphatic filariasis and iodine deficiency disorders in this area of Haiti. Combining lymphatic filariasis elimination with other public health interventions is one strategy to increase its public health benefit and maximize the impact of limited public health resources.
Assuntos
Dietilcarbamazina/uso terapêutico , Filariose Linfática/prevenção & controle , Filaricidas/uso terapêutico , Iodo/deficiência , Iodo/uso terapêutico , Cloreto de Sódio na Dieta/uso terapêutico , Tireotropina/sangue , Criança , Pré-Escolar , Feminino , Haiti/epidemiologia , Humanos , Iodo/urina , MasculinoRESUMO
A major gastroenteritis outbreak among >400,000 residents of Milwaukee, Wisconsin, in April 1993 was attributed to Cryptosporidium parvum oocysts in drinking water. Plasma specimens obtained from children (6 months to 12 years old) for routine blood lead level surveillance March-May 1993 were assayed by ELISA for levels of IgG antibody against the immunodominant Triton-17 and 27-kDa C. parvum antigens. Over a 5-week period, the seroprevalence for antibodies to the 2 antigens increased from 15% to 82% and from 17% to 87%, respectively, in samples from children living in southern ZIP code areas (n=218), whereas smaller increases (20% to 43% and 22% to 46%, respectively) were noted among samples from children living in northern ZIP code areas (n=335; P<.0001). The results demonstrate that C. parvum infection was much more widespread than previously appreciated and confirm that infection was associated with residence in the area served by the southern water treatment plant.
Assuntos
Anticorpos Antiprotozoários/sangue , Criptosporidiose/epidemiologia , Surtos de Doenças , Gastroenterite/epidemiologia , Animais , Criança , Pré-Escolar , Criptosporidiose/parasitologia , Cryptosporidium parvum/crescimento & desenvolvimento , Ensaio de Imunoadsorção Enzimática , Feminino , Gastroenterite/parasitologia , Humanos , Imunoglobulina G/análise , Lactente , Masculino , Estudos Retrospectivos , Fatores de Risco , Estudos Soroepidemiológicos , Água/parasitologia , Wisconsin/epidemiologiaRESUMO
To evaluate the effectiveness of salt fortified with diethylcarbamazine (DEC) and iodine for elimination of Bancroftian filariasis and iodine deficiency, all consenting residents of Miton, Haiti (n = 1,932) were given salt fortified with 0.25% diethylcarbamazine and 25 ppm of iodine for one year. Wuchereria bancrofti microfilaria prevalence and intensity, antigenemia, and urinary iodine were measured before and one year after salt distribution began. To measure the effect of DEC-fortified salt on adult worm motility, 15 microfilaria-positive men were examined by ultrasound of the scrotal area. Entomologic surveys were conducted to determine the proportion of W. bancrofti-infected Culex quinquefasciatus. After one year of treatment, the prevalence and intensity of microfilaremia were both reduced by more than 95%, while antigenemia levels were reduced by 60%. The motility of adult worms, as detected by ultrasound, was decreased, but not significantly, by DEC-fortified salt. The proportion of vector mosquitoes carrying infective stage larvae decreased significantly from 2.3% in the nine months before the intervention to 0.2% in the last three-month follow-up period. Iodine deficiency, which had been moderate to severe, was eliminated after one year of iodized salt consumption. The DEC-fortified salt was well accepted by the community and reduced microfilaremia and transmission to low levels in the absence of reported side effects. Based on these results, salt cofortified with DEC and iodine should be considered as a concurrent intervention for lymphatic filariasis and iodine deficiency elimination programs.
Assuntos
Antígenos de Helmintos/sangue , Dietilcarbamazina/administração & dosagem , Filariose/prevenção & controle , Filaricidas/administração & dosagem , Iodo/administração & dosagem , Iodo/deficiência , Cloreto de Sódio na Dieta/administração & dosagem , Wuchereria bancrofti/imunologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Criança , Pré-Escolar , Serviços de Saúde Comunitária , Culex/parasitologia , Ensaio de Imunoadsorção Enzimática , Feminino , Filariose/epidemiologia , Haiti/epidemiologia , Humanos , Lactente , Recém-Nascido , Insetos Vetores/parasitologia , Iodo/urina , Masculino , Pessoa de Meia-Idade , Prevalência , Escroto/diagnóstico por imagem , Resultado do Tratamento , UltrassonografiaRESUMO
In 1997, enhanced health assessments were performed for 390 (10%) of approximately 4,000 Barawan refugees resettling to the United States. Of the refugees who received enhanced assessments, 26 (7%) had malaria parasitemia and 128 (38%) had intestinal parasites, while only 2 (2%) had Schistosoma haematobium eggs in the urine. Mass therapy for malaria (a single oral dose of 25 mg/kg of sulfadoxine-pyrimethamine) was given to all Barawan refugees 1-2 days before resettlement. Refugees >2 years of age and nonpregnant women received a single oral dose of 600 mg albendazole for intestinal parasite therapy. If mass therapy had not been provided, upon arrival in the United States an estimated 280 (7%) refugees would have had malaria infections and 1,500 (38%) would have had intestinal parasites. We conclude that enhanced health assessments provided rapid on-site assessment of parasite prevalence and helped decrease morbidity among Barawan refugees, as well as, the risk of imported infections.
Assuntos
Enteropatias Parasitárias/epidemiologia , Malária Falciparum/epidemiologia , Programas de Rastreamento/métodos , Refugiados , Esquistossomose Urinária/epidemiologia , Esquistossomose mansoni/epidemiologia , Adolescente , Adulto , Idoso , Animais , Antimaláricos/uso terapêutico , Criança , Pré-Escolar , Coccidiose/diagnóstico , Coccidiose/tratamento farmacológico , Coccidiose/epidemiologia , Criptosporidiose/diagnóstico , Criptosporidiose/tratamento farmacológico , Criptosporidiose/epidemiologia , Cryptosporidium parvum/isolamento & purificação , Combinação de Medicamentos , Eucoccidiida/isolamento & purificação , Feminino , Humanos , Lactente , Enteropatias Parasitárias/diagnóstico , Enteropatias Parasitárias/tratamento farmacológico , Malária Falciparum/diagnóstico , Malária Falciparum/tratamento farmacológico , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Plasmodium falciparum/isolamento & purificação , Pirimetamina/uso terapêutico , Esquistossomose Urinária/diagnóstico , Esquistossomose Urinária/urina , Esquistossomose mansoni/diagnóstico , Somália/epidemiologia , Sulfadoxina/uso terapêutico , Estados UnidosRESUMO
This review of the safety of the co-administration regimens to be used in programmes to eliminate lymphatic filariasis (albendazole + ivermectin or albendazole + diethylcarbamazine [DEC]) is based on 17 studies conducted in Sri Lanka, India, Haiti, Ghana, Tanzania, Kenya, Ecuador, the Philippines, Gabon, Papua New Guinea, and Bangladesh. The total data set comprises 90,635 subject exposures and includes individuals of all ages and both genders. Results are presented for hospital-based studies, laboratory studies, active surveillance of microfilaria-positive and microfilaria-negative individuals, and passive monitoring in both community-based studies and mass treatment programmes of individuals treated with albendazole (n = 1538), ivermectin (9822), DEC (576), albendazole + ivermectin (7470), albendazole + DEC (69,020), or placebo (1144). The most rigorous monitoring, which includes haematological and biochemical laboratory parameters pre- and post-treatment, provides no evidence that consistent changes are induced by any treatment; the majority of abnormalities appear to be sporadic, and the addition of albendazole to either ivermectin or DEC does not increase the frequency of abnormalities. Both DEC and ivermectin show, as expected, an adverse event profile compatible with the destruction of microfilariae. The addition of albendazole to either single-drug treatment regimen does not appear to increase the frequency or intensity of events seen with these microfilaricidal drugs when used alone. Direct observations indicated that the level of adverse events, both frequency and intensity, was correlated with the level of microfilaraemia. In non microfilaraemic individuals, who form 80-90% of the 'at risk' populations to be treated in most national public health programmes to eliminate lymphatic filariasis (LF), the event profile with the compounds alone or in combination does not differ significantly from that of placebo. Data on the use of ivermectin + albendazole in areas either of double infection (onchocerciasis and LF), or of loiais (with or without concurrent LF) are still inadequate and further studies are needed. Additional data are also recommended for populations infected with Brugia malayi, since most data thus far derive from populations infected with Wuchereria bancrofti.
Assuntos
Albendazol/uso terapêutico , Dietilcarbamazina/uso terapêutico , Filariose Linfática/tratamento farmacológico , Filaricidas/uso terapêutico , Ivermectina/uso terapêutico , Ensaios Clínicos como Assunto , Sinergismo Farmacológico , Quimioterapia Combinada , Filariose Linfática/prevenção & controle , Humanos , Programas Nacionais de Saúde , Organização Mundial da SaúdeRESUMO
The immunochromatographic (ICT) filariasis test is a rapid screening tool that will be useful for defining the prevalence and distribution of Wuchereria bancrofti as part of the global program to eliminate lymphatic filariasis. To address questions about its usefulness for monitoring control programs, we used the ICT filariasis test to assess residual antigen levels following antifilarial treatment. Our results demonstrate that antigen levels persist in microfilaria-negative persons for up to three years after treatment. Different strategies for monitoring control programs may have to be considered.
Assuntos
Antígenos de Helmintos/sangue , Filariose/tratamento farmacológico , Filaricidas/uso terapêutico , Wuchereria bancrofti/imunologia , Animais , Cromatografia/métodos , Dietilcarbamazina/uso terapêutico , Filariose/diagnóstico , Humanos , Ivermectina/uso terapêutico , Wuchereria bancrofti/isolamento & purificaçãoRESUMO
This randomized, placebo-controlled trial investigated the efficacy and nutritional benefit of combining chemotherapeutic treatment for intestinal helminths (albendazole) and lymphatic filariasis (ivermectin). Children were infected with Ascaris (29.2%), Trichuris (42.2%), and hookworm (6.9%), with 54.7% of children having one or more of these parasites. Wuchereria bancrofti microfilaria were found in 13.3% of the children. Children were randomly assigned to treatment with placebo, albendazole, ivermectin, or combined therapy. Combination treatment reduced the prevalence of Trichuris infections significantly more than either drug alone. Combination therapy also significantly reduced the prevalence and density of W. bancrofti microfilaremia compared with placebo or ivermectin alone. Only combination therapy resulted in significantly greater gains in height (hookworm-infected children) or weight (Trichuris-infected children) compared with the placebo group. Combined albendazole and ivermectin was a more efficacious treatment for intestinal helminth and W. bancrofti infections in children and resulted in nutritional benefits not found with either drug alone.
Assuntos
Albendazol/uso terapêutico , Anti-Helmínticos/uso terapêutico , Helmintíase/prevenção & controle , Enteropatias Parasitárias/prevenção & controle , Ivermectina/uso terapêutico , Animais , Ascaríase/tratamento farmacológico , Ascaríase/epidemiologia , Ascaríase/prevenção & controle , Estatura , Criança , Pré-Escolar , Método Duplo-Cego , Quimioterapia Combinada , Filariose Linfática/tratamento farmacológico , Filariose Linfática/epidemiologia , Filariose Linfática/prevenção & controle , Feminino , Haiti/epidemiologia , Helmintíase/tratamento farmacológico , Helmintíase/epidemiologia , Infecções por Uncinaria/tratamento farmacológico , Infecções por Uncinaria/epidemiologia , Infecções por Uncinaria/prevenção & controle , Humanos , Enteropatias Parasitárias/tratamento farmacológico , Enteropatias Parasitárias/epidemiologia , Masculino , Avaliação Nutricional , Prevalência , Tricuríase/tratamento farmacológico , Tricuríase/epidemiologia , Tricuríase/prevenção & controle , Wuchereria bancrofti/efeitos dos fármacosRESUMO
Using DNA sequencing and phylogenetic analysis, we identified four distinct Cryptosporidium genotypes in HIV-infected patients: genotype 1 (human), genotype 2 (bovine) Cryptosporidium parvum, a genotype identical to C. felis, and one identical to a Cryptosporidium sp. isolate from a dog. This is the first identification of human infection with the latter two genotypes.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/parasitologia , Criptosporidiose/parasitologia , Cryptosporidium/classificação , Cryptosporidium/genética , Animais , Sequência de Bases , Doenças do Gato/parasitologia , Gatos , Bovinos , Criptosporidiose/veterinária , Cryptosporidium/isolamento & purificação , Cryptosporidium parvum/genética , Cryptosporidium parvum/isolamento & purificação , DNA de Protozoário/análise , Doenças do Cão/parasitologia , Cães , Fezes/parasitologia , Genótipo , Humanos , Dados de Sequência Molecular , Filogenia , Reação em Cadeia da Polimerase/métodos , RNA de Protozoário/análise , Análise de Sequência de DNARESUMO
From January 1991 through September 1994, we observed people who were infected with HIV to assess the impact of enteric parasite-associated diarrhea. Respondents answered comprehensive questionnaires covering clinical and epidemiologic information and provided stool specimens monthly, which were examined unstained as well as stained with trichrome, chromotrope 2R, and with Kinyoun carbol-fuchsin, and with indirect immunofluorescence for Cryptosporidium. In all, 602 participants, who were interviewed, provided stool specimens at 3254 monthly visits. Parasites were associated with 50 of 354 (14.1%) acute diarrheal episodes (lasting < or = 28 days) and with 97 of 279 (34.8%) chronic episodes (lasting > 28 days). A parasite was associated with 31 of 222 (14.0%) episodes that occurred when CD4+ counts were > or = 200 cells/microl and with 150 of 566 (26.5%) episodes that occurred when CD4+ counts were < 200 cells/microl. The most commonly identified parasite was C. parvum, which was associated with 18 of 354 (5.1%) acute episodes and 36 (12.9%) of the 279 chronic episodes of diarrhea. In this patient population, enteric protozoan parasites were commonly associated with illness, particularly as immunosuppression worsened, and were more likely to be associated with chronic rather than acute diarrhea.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/etiologia , Contagem de Linfócito CD4 , Diarreia/etiologia , Infecções por HIV/complicações , Infecções por HIV/imunologia , Enteropatias Parasitárias/etiologia , Infecções Oportunistas Relacionadas com a AIDS/complicações , Adulto , Animais , Doença Crônica , Criptosporidiose/complicações , Criptosporidiose/etiologia , Cryptosporidium parvum/isolamento & purificação , Diarreia/complicações , Fezes/parasitologia , Feminino , Humanos , Enteropatias Parasitárias/complicações , Estudos Longitudinais , Masculino , Microsporida/isolamento & purificação , Microsporidiose/complicações , Microsporidiose/etiologia , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
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.
Assuntos
Anticorpos Anti-Helmínticos/sangue , Imunoglobulina M/sangue , Schistosoma mansoni/imunologia , Esquistossomose mansoni/diagnóstico , Esquistossomose mansoni/imunologia , Adolescente , Animais , Brasil , Criança , Pré-Escolar , Fezes/parasitologia , Seguimentos , Humanos , Incidência , Contagem de Ovos de Parasitas , Prevalência , Estudos Prospectivos , População Rural , Esquistossomose mansoni/epidemiologia , Esquistossomose mansoni/transmissão , Estações do Ano , Sensibilidade e EspecificidadeRESUMO
The present study was undertaken to assess the relationship between microfilarial clearance and clearance of circulating filarial antigen from the blood of Wuchereria bancrofti-infected persons following chemotherapy with either diethylcarbamazine or ivermectin. Patients received either 12 weekly doses of 6 mg/kg of diethylcarbamazine (DEC), a single dose of 6 mg/kg of DEC, a single dose of 420 microg/kg of ivermectin, or 20 microg/kg of ivermectin, followed by 6 mg/kg of DEC five days later. Microfilarial clearance was marked in all groups, but was significantly less in the single-dose DEC. In contrast, as monitored by the Og4C3 monoclonal anitbody assay, clearance of circulating filarial antigen was highly variable, not only between groups but within each group. As a result, there were few statistically significant differences in antigen clearance between groups. In no instance did the antigen level fall to zero, even in individuals that remained microfilaria negative during two or three years of follow-up. These results suggest that living adult worms persist in almost all persons treated with DEC and/or ivermectin.
Assuntos
Antígenos de Helmintos/sangue , Dietilcarbamazina/uso terapêutico , Filariose/tratamento farmacológico , Filariose/imunologia , Filaricidas/uso terapêutico , Ivermectina/uso terapêutico , Wuchereria bancrofti/imunologia , Adolescente , Adulto , Idoso , Animais , Criança , Feminino , Filariose/sangue , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Lymphatic filariasis and intestinal helminth infections are important disorders in tropical areas. Periodic treatment with albendazole is now used in many school-based intestinal helminth-control programmes. However, few such programmes exist for lymphatic filariasis, despite evidence that single-dose treatment with ivermectin can greatly reduce the concentration of Wuchereria bancrofti microfilariae in the blood for months to years. We aimed to assess the potential for school-based control of lymphatic filariasis by investigating the efficacy and tolerability or combined ivermectin and albendazole in Haitian schoolchildren. METHODS: In January, 1996, we collected 832 20 microL capillary blood samples for inclusion in a randomised controlled study from children aged 5-11 years, and examined them by microscopy for W bancrofti microfilariae. Infected children were randomly assigned treatment with placebo (n = 29), a single 200-400 micrograms/kg dose of ivermectin (mean, 273 micrograms/kg, n = 28), 400 mg albendazole (n = 29), or a combination of 200-400 micrograms/kg ivermectin and 400 mg albendazole (n = 24). Children with high concentrations of microfilariae in the blood were admitted to hospital and adverse reactions were monitored for 3-5 days, otherwise children were examined at school or during a visit to their home. 4 months after treatment, we examined blood samples again for microfilariae. FINDINGS: 113 microfilaraemic children were enrolled (mean age 7.8 years). 4 months after treatment, the proportion of children who remained positive for microfilariae was significantly lower in the ivermectin plus albendazole group (four [17%]), but there were no significant changes in the other three groups (20 [69%] placebo, 22 [76%] albendazole alone, 17 [61%] ivermectin alone remained positive; p = 0.004). Geometric mean microfilarial concentration decreased from 9.3 to 5.3 per 20 microL blood among children who received placebo; from 15.5 to 1.5 per 20 microL blood among those who received ivermectin only (p = 0.032); from 14.1 to 5.1 per 20 microL blood among those who received albendazole alone; and from 13.7 to 0.3 per 20 microL blood among those who received both ivermectin and albendazole (p = 0.0001). Systemic adverse reactions did not differ significantly between children who received ivermectin alone and those who were treated with ivermectin and albendazole [corrected]. INTERPRETATION: For children with W bancrofti microfilaraemia, combined treatment with ivermectin and albendazole was more effective than treatment with ivermectin only, with no measurable increase in severity of adverse reactions.
Assuntos
Albendazol/uso terapêutico , Filariose/tratamento farmacológico , Filaricidas/uso terapêutico , Ivermectina/uso terapêutico , Parasitemia/tratamento farmacológico , Wuchereria bancrofti , Animais , Criança , Pré-Escolar , Quimioterapia Combinada , Feminino , Filariose/sangue , Filariose/parasitologia , Haiti , Humanos , Masculino , Parasitemia/sangue , Parasitemia/parasitologia , Resultado do TratamentoRESUMO
During the spring of 1993 an estimated 403000 residents of the greater Milwaukee, Wisconsin area experienced gastrointestinal illness due to infection with the parasite Cryptosporidium parvum following contamination of the city's water supply. To define the clinical, laboratory and epidemiologic features of outbreak-associated cryptosporidiosis in children, medical and laboratory records for all children submitting stool samples to the microbiology laboratory of the Children's Hospital of Wisconsin between 7 April and 13 May 1993 were reviewed retrospectively. Interviews with parents were also conducted to obtain additional clinical history. Cryptosporidium, as the sole pathogen, was identified in stools from 49 (23%) of the 209 children enrolled in the study. Children with laboratory-confirmed cryptosporidiosis were more likely to live in areas of Milwaukee supplied with contaminated water (RR = 1.92, CI = 1.19-3.09), to be tested later in their illness (P < 0.05), to have submitted more than one stool specimen (P = 0.01), to have an underlying disease that altered their immune status (RR = 2.78, CI = 1.60-4.84), and to be older than 1 year of age (RR = 2.02, CI = 1.13-3.60). Clinical illness in these patients was more prolonged and associated with weight loss and abdominal cramps compared with Cryptosporidium-negative children. In the context of this massive waterborne outbreak relatively few children had documented infection with Cryptosporidium. If many children who tested negative for the parasite were truly infected, as the epidemiologic data suggest, existing laboratory tests for Cryptosporidium were insensitive, particularly early in the course of illness.
Assuntos
Criptosporidiose/epidemiologia , Adolescente , Adulto , Fatores Etários , Animais , Criança , Pré-Escolar , Criptosporidiose/diagnóstico , Cryptosporidium parvum/isolamento & purificação , Surtos de Doenças , Fezes/parasitologia , Feminino , Humanos , Hospedeiro Imunocomprometido , Incidência , Lactente , Recém-Nascido , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Abastecimento de Água/análise , Redução de Peso , Wisconsin/epidemiologiaRESUMO
OBJECTIVE: We describe the impact of the 1993 waterborne cryptosporidiosis outbreak on metropolitan Milwaukee child care homes and centers. METHODS: Information on outbreak-related illness and changes in policies and practices was collected from directors of 117 facilities. Stool specimens from 129 diapered children from 11 centers were screened for Cryptosporidium. RESULTS: Most (74%) facility directors reported children or staff with diarrhea during the outbreak; however, only 4 (3.4%) facilities closed because of illness among staff or children. During the outbreak child care homes were less likely to exclude children with diarrhea than were child care centers. Among diapered children attending centers the Cryptosporidium prevalence was 30%; 29% of infected children had no history of diarrhea associated with the Milwaukee outbreak. CONCLUSIONS: Facilities continued to operate during the outbreak despite considerable illness among children and staff. The news media were effective means for providing public health information to child care facilities. Although secondary transmission undoubtedly took place in child care facilities, the presence of children with asymptomatic Cryptosporidium infections did not result in an increased risk of diarrhea in infant and toddler rooms.
Assuntos
Criptosporidiose/epidemiologia , Surtos de Doenças , Água/parasitologia , Adulto , Animais , Criança , Creches , Pré-Escolar , Fezes/parasitologia , Feminino , Humanos , Lactente , Masculino , Wisconsin/epidemiologiaRESUMO
BACKGROUND: Cryptosporidiosis, an intestinal parasitic infection, has gained considerable media attention since a 1993 waterborne outbreak in Milwaukee, Wis, in which more than 400,000 persons became ill. However, the incidence of and risk factors for human cryptosporidiosis in the general US population are unknown. It has been suggested, but not documented, that physicians are generally unaware of the need to specifically request testing for this organism. OBJECTIVE: To assess physician awareness of cryptosporidiosis and knowledge of laboratory testing for Cryptosporidium oocysts. METHODS: A self-administered questionnaire was mailed to a stratified random sample of Connecticut physicians. Specialties were limited to physicians in internal medicine, gastroenterology, infectious disease, pediatrics, and family or general practice. Responses were compared among specialties. RESULTS: While most physicians were aware that cryptosporidiosis causes watery diarrhea (range, 67%-98%), particularly in patients with acquired immunodeficiency syndrome (> 85% of all specialties), many did not know the symptoms or failed to identify other groups at increased risk. More than 75% of gastroenterologists, general or family practitioners, internists, and pediatricians never or rarely order diagnostic testing for Cryptosporidium even when their patients have symptoms consistent with cryptosporidiosis. More than 30% of physicians assumed Cryptosporidium testing was included in a standard ova and parasite examination. CONCLUSIONS: Cryptosporidiosis is likely to be unrecognized and underdiagnosed in Connecticut. This may occur because many physicians are unaware of cryptosporidiosis, unsure of the symptoms, do not test for it, or do not order the appropriate test. Unless there is more widespread use of specific tests, it will be difficult to evaluate specific preventive initiatives to limit the overall health impact of cryptosporidiosis.