David G. Addiss

Highly endemic, waterborne toxoplasmosis in north Rio de Janeiro state, Brazil.

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 in 1997–1999. The survey population was selected randomly from schools, randomly chosen communities, and an army battalion. Serum samples from 1,436 persons were tested. With results adjusted for age, 84% of the population in the lower socioeconomic group was seropositive, compared with 62% and 23% of the middle and upper socioeconomic groups, respectively (p<0.001). When multivariate analysis was performed, drinking unfiltered water was found to increase the risk of seropositivity for the lower socioeconomic (odds ratio [OR]: 3.0, 95% confidence interval [CI] 1.3 to 6.9) and middle socioeconomic (OR: 1.7, 95% CI 1.2 to 2.3) populations. We also found a high T. gondii seroprevalence in this Brazilian community. Drinking unfiltered water increased the risk of T. gondii seropositivity, indicating the potential importance of oocyst transmission in water in this region.

Cost of Illness in the 1993 Waterborne Cryptosporidium Outbreak, Milwaukee, Wisconsin

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 severe illness, we conducted a retrospective cost-of-illness analysis using data from 11 hospitals in the greater Milwaukee area and epidemiologic data collected during the outbreak. The total cost of outbreak-associated illness was

Morbidity management in the Global Programme to Eliminate Lymphatic Filariasis: a review of the scientific literature

96.2 million:

Decreased Prevalence of Chlamydia trachomatis Infection Associated With a Selective Screening Program in Family Planning Clinics in Wisconsin

31.7 million in medical costs and

Risk factors for recurrent Chlamydia trachomatis infections in women

64.6 million in productivity losses. The average total costs for persons with mild, moderate, and severe illness were

Schistosomiasis in Lake Malawi

116,

Randomised placebo-controlled comparison of ivermectin and albendazole alone and in combination for Wuchereria bancrofti microfilaraemia in Haitian children.

475, and

Integration of Water, Sanitation, and Hygiene for the Prevention and Control of Neglected Tropical Diseases: A Rationale for Inter-Sectoral Collaboration

7,808, respectively. The potentially high cost of waterborne disease outbreaks should be considered in economic decisions regarding the safety of public drinking water supplies.

Occurrence of living adult Wuchereria bancrofti in the scrotal area of men with microfilaraemia

The Global Programme to Eliminate Lymphatic Filariasis (GPELF) has two major goals: to interrupt transmission of the parasite and to provide care for those who suffer the devastating clinical manifestations of the disease (morbidity control). This latter goal addresses three filariasis-related conditions: acute inflammatory episodes; lymphoedema; and hydrocele. Research during the last decade has confirmed the importance of bacteria as a cause of acute inflammatory episodes in filariasis-endemic areas, known as acute dermatolymphangioadenitis (ADLA). Current lymphoedema management strategies are based on the central role of ADLA as a trigger for lymphoedema progression. Simple intervention packages are in use that have resulted in dramatic reductions in ADLA rates, a lower prevalence of chronic inflammatory cells in the dermis and subdermis, and improvement in quality of life. During the past decade, the socioeconomic impact of ADLA and lymphoedema in filariasis-endemic areas has received increasing attention. Numerous operational research questions remain to be answered regarding how best to optimize, scale up, monitor, and evaluate lymphoedema management programmes. Of the clinical manifestations targeted by the GPELF, hydrocele has been the focus of the least attention. Basic information is lacking on the effectiveness and complications of hydrocele surgery and risk of post-operative hydrocele recurrence in filariasis-endemic areas. Data on the impact of mass administration of antifilarial drugs on filarial morbidity are inconsistent. Several studies report reductions in acute inflammatory episodes, lymphoedema, and/or hydrocele following mass drug administration, but other studies report no such association. Assessing the public health impact of mass treatment with antifilarial drugs is important for programme advocacy and morbidity control strategies. Thus, although our knowledge of filariasis-related morbidity and its treatment has expanded in recent years, much work remains to be done to address the needs of more than 40 million persons who suffer worldwide from these conditions.

Ultrasonigraphic Evidence of Abnormal Lymphatic Vessels in Young Men with Adult Wuchereria Bancrofti Infection in the Scrotal Area

The effectiveness of selective screening for control of Chlamydia trachomatis is unknown. In 1986, a statewide screening program began in family planning clinics in Wisconsin after the prevalence of infection among women was found to be 10.7% in four nonurban clinics and 13.7% in an urban Milwaukee clinic. In 1990, endocervical specimens were obtained from 1,757 women attending these same clinics; 5.2% of women in the non-urban clinics and 6.9% in the Milwaukee clinic tested positive for C. trachomatis. Prevalence of infection had decreased similarly (by 53% overall) in both high- and low-risk groups in all five clinics. Although reported condom use increased from 16% to 31%, most other demographic and behavioral risk factors for infection did not significantly change; in contrast, the prevalence of clinical signs of infection decreased. The percentage of infections identified by selective screening criteria decreased from 77% to 55%. Selective screening and attendant activities, as well as an increase in condom use, were associated with a decrease in prevalence of C. trachomatis infection in this population.