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Background: We examined fidelity and feasibility of implementation of COVID-19 preventive measures in schools, and explored associations between adherence to these measures and staff well-being, to inform policy on sustainable implementation and staff wellbeing. Methods: Surveys were conducted across 128 schools in England with 107 headteachers and 2698 staff-members with reference to autumn term 2020, examining school-level implementation of preventive measures, adherence, and teacher burnout (response rates for headteacher and staff surveys were 84% and 59%, respectively). Results: The median number of measures implemented in primary and secondary schools was 33 (range 23-41), and 32 (range 22-40), respectively; most measures presented challenges. No differences were found regarding number of measures implemented by school-level socio-economic disadvantage. High adherence was reported for staff wearing face-coverings, staff regularly washing their hands, (secondary only) desks facing forwards, and (primary only) increased cleaning of surfaces and student hand-washing. Adherence to most measures was reported as higher in primary than secondary schools. Over half of school leaders and 42% (517/1234) of other teaching staff suffered from high emotional exhaustion. Higher teacher-reported school-wide adherence with measures was consistently associated with lower burnout for leaders and other teaching staff. Conclusions: Findings indicate a tremendous effort in implementing preventive measures and an urgent need to support investments in improving teacher wellbeing.

The transmission soil transmitted helminths (STH) occurs via ingestion of or contact with infective stages present in soil contaminated with human faeces. It follows therefore that efforts to reduce faecal contamination of the environment should help to reduce risk of parasite exposure and improvements in water, sanitation and hygiene (WASH) are seen as essential for the long-term, sustainable control of STH. However, the link between WASH and STH is not always supported by the available evidence from randomised controlled trials, which report mixed effects of WASH intervention on infection risk. This review critically summarises the available trial evidence and offers an interpretation of the observed heterogeneity in findings. The review also discusses the implications of findings for control programmes and highlights three main issues which merit further consideration: intervention design, exposure assessment, and intervention fidelity assessment.

Background: One-fifth of the global population is infected with soil-transmitted helminths (STH). Mass drug administration (MDA) with deworming medication is widely implemented to control morbidity associated with STH infections. However, surveillance of human infection prevalence by collecting individual stool samples is time-consuming, costly, often stigmatized, and logistically challenging. Current methods of STH detection are poorly sensitive, particularly in low-intensity and low-prevalence populations. Methodology/Principal findings: We aimed to develop a sensitive and specific molecular method for detecting STH DNA in large volumes of soil (20 g) by conducting laboratory and proof of concept studies across field sites in Kenya, Benin, and India. We collected human stool (n = 669) and soil (n = 478) from 322 households across the three study sites. We developed protocols for DNA extraction from 20 g of soil and qPCR to detect Ascaris lumbricoides, Trichuris trichiura, Necator americanus, and Ancylostoma duodenale. Agreement between detection of STH via qPCR, digital droplet PCR (ddPCR), and microscopy-based methods was assessed using the Cohen's Kappa statistic. Finally, we estimated associations between soil characteristics and detection of STH in soil by qPCR, as well as between STH detected in soil and STH detected in stool from matched households, adjusting for soil characteristics. The overall prevalence of STH in soil by qPCR was 31% for A. lumbricoides, 3% for T. trichiura, and 13% for any hookworm species. ddPCR and qPCR performed similarly. However, there was poor agreement between STH detected in soil by qPCR versus light microscopy. Microscopy underestimated the prevalence of A. lumbricoides and N. americanus and overestimated T. trichiura. Detection of an STH species in household soil was strongly associated with increased odds of a household member being infected with that same species. Conclusions/Significance: Soil surveillance for STH has several benefits over stool-based surveillance, including lower cost and higher success rates for sample collection. Considering that delivery of MDA occurs at the community level, environmental surveillance using molecular methods could be a cost-effective alternate strategy for monitoring STH in these populations. Author summary: Soil surveillance to determine soil-transmitted helminth (STH) prevalence in communities with MDA programs could be cost-effective. Though microscopic methods for the detection of STH in soil exist, they are laborious. With recent increased availability of DNA extraction kits and polymerase chain reaction (PCR) reagents, using molecular assays are promising and provide the ability to discriminate between closely related helminth species. In this study, we developed a sensitive and specific molecular method for the detection of STH in large quantities of soil and field-tested it in three countries. [ABSTRACT FROM AUTHOR]

Objective To investigate, in Amhara, Ethiopia, the association between prevalence of active trachoma among children aged 1-9 years and community sanitation usage. Methods Between 2011 and 2014, prevalence of trachoma and household pit latrine usage were measured in five population-based cross-sectional surveys. Data on observed indicators of latrine use were aggregated into a measure of community sanitation usage calculated as the proportion of households with a latrine in use. All household members were examined for clinical signs, i.e. trachomatous inflammation, follicular and/or intense, indicative of active trachoma. Multilevel logistic regression was used to estimate prevalence odds ratios (OR) and 95% confidence intervals (CI), adjusting for community, household and individual factors, and to evaluate modification by household latrine use and water access. Findings In surveyed areas, prevalence of active trachoma among children was estimated to be 29% (95% CI: 28-30) and mean community sanitation usage was 47% (95% CI: 45-48). Despite significant modification (p < 0.0001), no pattern in stratified ORs was detected. Summarizing across strata, community sanitation usage values of 60 to < 80% and [greater than or equal to] 80% were associated with lower prevalence odds of active trachoma, compared with community sanitation usage of < 20% (OR: 0.76; 95% CI: 0.57-1.03 and OR: 0.67; 95% CI: 0.48-0.95, respectively). Conclusion In Amhara, Ethiopia, a negative correlation was observed between community sanitation usage and prevalence of active trachoma among children, highlighting the need for continued efforts to encourage higher levels of sanitation usage and to support sustained use throughout the community, not simply at the household level. Objectif Etudier dans la region Amhara, en Ethiopie, l'association entre la prevalence du trachome actif chez les enfants ages de 1 a 9 ans et l'utilisation d'installations d'assainissement collectif. Methodes Entre 2011 et 2014, la prevalencedu trachome et l'utilisation de latrines a fosse domestiques ont ete mesurees dans le cadre de cinq enquetes transversales menees aupres de la population. Les donnees sur les indicateurs observes concernant l'utilisation de latrines ont ete regroupees dans une mesure de l'utilisation des installations d'assainissement collectif exprimee comme la proportion de menages utilisant des latrines. Tous les membres des menages ont fait l'objet d'un examen destine a detecter les signes cliniques, c'est-a-dire une inflammation trachomateuse folliculaire et/ou intense, revelateurs d'un trachome actif. Une regression logistique a plusieurs niveaux a ete utilisee pour estimer le rapport de cote (RC) de prevalence ainsi que les intervalles de confiance (IC) a 95%, en tenant compte de facteurs lies a la communaute, aux menages et aux individus, et pour evaluer les variations induites par l'utilisation de latrines domestiques et un acces a l'eau. Resultats Dans les zones etudiees, la prevalence du trachome actif chez les enfants a ete estimee a 29% (IC a 95%: 28-30) et l'utilisation moyenne des installations d'assainissement collectif a 47% (IC a 95%: 45-48). Malgre des variations considerables (p < 0,0001), aucune tendance liee aux RC stratifies ne s'est degagee. Pour resumer en tenant compte des differentes strates, lorsque les valeurs relatives a l'utilisation des installations d'assainissement collectif etaient comprises entre 60 et 80% ou [greater than or equal to] 80%, le rapport de cote de prevalence du trachome actif etait plus faible que lorsque les valeurs relatives a l'utilisation des installations d'assainissement collectif etaient Conclusion Dans la region Amhara de l'Ethiopie, une correlation negative a ete observee entre l'utilisation dlnstallations d'assainissement collectif et la prevalence du trachome actif chez les enfants, soulignant la necessite de poursuivre les efforts pour encourager l'utilisation dlnstallations d'assainissement et promouvoir une utilisation durable dans l'ensemble de la population, et non seulement au niveau des menages. Objetivo Investigar, en Amhara, Etiopia, la relacion entre la prevalencia del tracoma activo en ninos de entre 1 y 9 anos y el uso comunitario del saneamiento. Metodos Entre 2011 y 2014, se midieron la prevalencia del tracoma y el uso domestico de las letrinas de pozo en cinco encuestas transversales basadas en la poblacion. Los datos sobre los indicadores observados del uso de letrinas se agregaron en una medida del uso del saneamiento comunitario calculado como el porcentaje de hogares con una letrina en uso. Se examino a todos los miembros del hogar en busca de sintomas clinicos, es decir, inflamacion tracomatosa, folicular y/o intensa, indicio de tracoma activo. Se utilizo una regresion logistica de varios niveles para estimar la prevalencia de los cocientes de posibilidades (CP) y los intervalos de confianza (IC) del 95%, ajustandose a factores comunitarios, domesticos e individuales, y para evaluar la modificacion por uso de letrinas y acceso al agua en los hogares. Resultados En las zonas encuestadas, se estimo que la prevalencia del tracoma activo en ninos era del 29% (IC del 95%: 28-30) y que el uso comunitario del saneamiento era del 47% (IC del 95%: 45-48). A pesar de una importante modificacion (p < 0,0001), no se detecto ningun patron en los CP estratificados. Como resumen de los estratos, los valores de uso comunitario del saneamiento del 60 al < 80% y [greater than or equal to] 80% se relacionaron con una menor prevalencia de tracoma activo, en comparacion con un uso comunitario del saneamiento de, Introduction It has been estimated that, as a result of trachoma, approximately 1.2 million people are blind and a further 1.7 million have low vision. (1) Globally, trachoma remains the [...]

Background: One of the most debated questions in the COVID-19 pandemic has been the role of schools in SARS-CoV-2 transmission. The COVID-19 Schools Infection Survey (SIS) aims to provide much-needed evidence addressing this issue. Objective: We present the study protocol and participation profile for the SIS study, aimed at assessing the role of schools in SARS-CoV-2 infection and transmission within school settings, and investigating how transmission within and from schools could be mitigated through the implementation of school COVID-19 control measures. Methods: SIS was a multisite, prospective, observational cohort study conducted in a stratified random sample of primary and secondary schools in selected local authorities in England. A total of 6 biobehavioral surveys were planned among participating students and staff during the 2020-2021 academic year, between November 2020 and July 2021. Key measurements were SARS-CoV-2 virus prevalence, assessed by nasal swab polymerase chain reaction; anti-SARS-CoV-2 (nucleocapsid protein) antibody prevalence and conversion, assessed in finger-prick blood for staff and oral fluid for students; student and staff school attendance rates; feasibility and acceptability of school-level implementation of SARS-CoV-2 control measures; and investigation of selected school outbreaks. The study was approved by the United Kingdom Health Security Agency Research Support and Governance Office (NR0237) and London School of Hygiene & Tropical Medicine Ethics Review Committee (reference 22657). Results: Data collection and laboratory analyses were completed by September 2021. A total of 22,585 individuals--1891 staff and 4654 students from 59 primary schools and 5852 staff and 10,188 students from 97 secondary schools--participated in at least one survey. Across all survey rounds, staff and student participation rates were 45.2% and 16.4%, respectively, in primary schools and 30% and 15.2%, respectively, in secondary schools. Although primary student participation increased over time, and secondary student participation remained reasonably consistent, staff participation declined across rounds, especially for secondary school staff (3165/7583, 41.7% in round 1 and 2290/10,374, 22.1% in round 6). Although staff participation overall was generally reflective of the eligible staff population, student participation was higher in schools with low absenteeism, a lower proportion of students eligible for free school meals, and from schools in the least deprived locations (in primary schools, 446/4654, 9.6% of participating students were from schools in the least deprived quintile compared with 1262/22,225, 5.7% of eligible students). Conclusions: We outline the study design, methods, and participation, and reflect on the strengths of the SIS study as well as the practical challenges encountered and the strategies implemented to address these challenges. The SIS study, by measuring current and incident infection over time, alongside the implementation of control measures in schools across a range of settings in England, aims to inform national guidance and public health policy for educational settings. [ABSTRACT FROM AUTHOR]

Background: There remains uncertainty about the epidemiology of SARS-CoV-2 among school students and staff and the extent to which non-pharmaceutical-interventions reduce the risk of school settings., Methods: We conducted an open cohort study in a sample of 59 primary and 97 secondary schools in 15 English local authority areas that were implementing government guidance to schools open during the pandemic. We estimated SARS-CoV-2 infection prevalence among those attending school, antibody prevalence, and antibody negative to positive conversion rates in staff and students over the school year (November 2020-July 2021)., Findings: 22,585 staff and students participated. SARS-CoV-2 infection prevalence among those attending school was highest during the first two rounds of testing in the autumn term, ranging from 0.7% (95% CI 0.2, 1.2) among primary staff in November 2020 to 1.6% (95% CI 0.9, 2.3) among secondary staff in December 2020. Antibody conversion rates were highest in the autumn term. Infection patterns were similar between staff and students, and between primary and secondary schools. The prevalence of nucleoprotein antibodies increased over the year and was lower among students than staff. SARS-CoV-2 infection prevalence in the North-West region was lower among secondary students attending school on normal school days than the regional estimate for secondary school-age children., Interpretation: SARS-CoV-2 infection prevalence in staff and students attending school varied with local community infection rates. Non-pharmaceutical interventions intended to prevent infected individuals attending school may have partially reduced the prevalence of infection among those on the school site., Funding: UK Department of Health and Social Care., Competing Interests: None declared., (Crown Copyright © 2022 Published by Elsevier Ltd.)

Anopheles darlingi is the most important malaria vector in the Amazon basin of South America, and is capable of transmitting both Plasmodium falciparum and P. vivax. To understand the genetic structure of this vector in the Amazonian region of Peru, a simple polymerase chain reaction (PCR)-based test to identify this species of mosquito was used. A random amplified polymorphic DNA-PCR was used to study genetic variation at the micro-geographic level in nine geographically separate populations of An. darlingi collected in areas with different degrees of deforestation surrounding the city of Iquitos. Within-population genetic diversity in nine populations, as quantified by the expected heterozygosity (H(E)), ranged from 0.27 to 0.32. Average genetic distance (F(ST)) among these populations was 0.017. These results show that the nine studied populations are highly homogeneous, suggesting that strategies can be developed to combat this malaria vector as a single epidemiologic unit.