The aim of the study was to evaluate the knowledge of mothers and grandmothers regarding breastfeeding and health-seeking behavior for neonatal sickness in a rural community. A cross-sectional survey, using a triangulation of qualitative (focus group discussion) and quantitative (structured questionnaire) methods was carried out. Although most of the grandmothers and mothers believed in early feeding within 2 h of delivery, they often administered prelacteal feeds such as ghutti and honey. Colostrum was considered beneficial. Most respondents believed that ghutti, water, or both should be given along with breastmilk. Diluted buffalo milk was the preferred choice if supplementation was required. It was thought that weaning should be introduced after 6 months of life. Mothers preferred to give dalia and khichri as the initial weaning food compared to roti and dal water by grandmothers. Both grandmothers and mothers felt that a baby who was playful and not crying excessively was usually healthy. Most of the respondents described the normal pattern of breathing, feeding, urination, and defecation adequately. Most of the grandmothers and mother's felt that by touching forehead and limbs of baby could reliably assess temperature. Refusal to feed was considered as a marker of a sickness by most grandmothers and mothers. However, they also believed that health-seeking for poor feeding could be delayed for 1 day. Respiratory distress was described by the presence of fast respiration, chest retractions, or noisy breathing. Most respondents did not know how to assess cyanosis or seizures. Jaundice was descried as yellowish discoloration of skin, eyes, and urine. Failure to pass urine for 4-6 h bothered most of the respondents. The first response to illness was home remedies. The choice of healthcare was unqualified village practitioners followed by government hospital. Knowledge regarding desirable breastfeeding practices was inadequate and quite a few inappropriate beliefs were widely prevalent. Although knowledge regarding sickness was present, health-seeking from qualified providers was considerably delayed with most respondents preferring village practitioners to government hospitals.

BackgroundThe polio environmental surveillance (ES) system has been an incredible tool for advancing polio eradication efforts because of its ability to highlight the spatial and temporal extent of poliovirus circulation. While ES often outperforms, or is more sensitive than AFP surveillance, the sensitivity of the ES system has not been well characterized. Fundamental uncertainty of ES site sensitivity makes it difficult to interpret results from ES, particularly negative results.Methods and findingsTo study ES sensitivity, we used data from Afghanistan and Pakistan to examine the probability that each ES site detected the Sabin 1, 2, or 3 components of the oral polio vaccine (OPV) as a function of virus prevalence within the same district (estimated from AFP data). Accounting for virus prevalence is essential for estimating site sensitivity because Sabin detection rates should vary with prevalence—high immediately after supplemental immunization activities (SIAs), but low in subsequent months. We found that most ES sites in Pakistan and Afghanistan are highly sensitive for detecting poliovirus relative to AFP surveillance in the same districts. For example, even when Sabin poliovirus is at low prevalence of ~0.5–3% in AFP surveillance, most ES sites have ~34–50% probability of detecting Sabin. However, there was considerable variation in ES site sensitivity and we flagged several sites for re-evaluation based on low sensitivity rankings and low wild polio virus detection rates. In these areas, adding new sites or modifying collection methods in current sites could improve sensitivity of environmental surveillance.ConclusionsRelating ES detections to virus prevalence significantly improved our ability to evaluate site sensitivity compared to evaluations based solely on ES detection rates. To extend our approach to new sites and regions, we provide a preliminary framework for relating ES and AFP detection rates, and descriptions of how detection rates might relate to SIAs and natural seasonality.

Wild poliovirus type 1 (WPV1) transmission is ongoing only in Afghanistan and Pakistan (1). Following a decline in case numbers during 2013-2016, the number of cases in Afghanistan has increased each year during 2017-2020. This report describes polio eradication activities and progress toward polio eradication in Afghanistan during January 2019-July 2020 and updates previous reports (2,3). Since April 2018, insurgent groups have imposed bans on house-to-house vaccination. In September 2019, vaccination campaigns in areas under insurgency control were restarted only at health facilities. In addition, during March-June 2020, all campaigns were paused because of the coronavirus disease 2019 (COVID-19) pandemic. The number of WPV1 cases reported in Afghanistan increased from 21

Healthcare-associated hepatitis B virus (HBV) outbreaks have been reported in the USA and from several countries in Europe. Patient-to-patient transmission of HBV in these settings has been linked to several different types of exposure but one of the most common exposures implicated is the use of 'finger-stick' lancet devices for blood glucose testing. This article is an account of the investigations into a series of HBV outbreaks linked to the use of lancing devices in community healthcare settings in the UK. Between February 2004 and December 2006, nine individuals with acute HBV infection were reported to five local units of the Health Protection Agency. Investigations identified a further 12 individuals with HBV infection in residents in these settings. The epidemiological and environmental evidence suggests that HBV transmission occurred mostly from a significant breakdown in infection control measures in blood glucose testing. The occurrence of these outbreaks has highlighted the confusion that exists and the need for clear recommendations regarding the use of such devices in the UK.

cVDPV can emerge when attenuated OPV virus reverts to neurovirulence as a result of transmission in areas with low immunization coverage.