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On August 21, 2020, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). On June 1, 2020, with declines in coronavirus disease 2019 (COVID-19) cases and hospitalizations in Rhode Island,* child care programs in the state reopened after a nearly 3-month closure implemented as part of mitigation efforts. To reopen safely, the Rhode Island Department of Human Services (RIDHS) required licensed center-and home-based child care programs to reduce enrollment, initially to a maximum of 12 persons, including staff members, in stable groups (i.e., staff members and students not switching between groups) in physically separated spaces, increasing to a maximum of 20 persons on June 29. Additional requirements included universal use of masks for adults, daily symptom screening of adults and children, and enhanced cleaning and disinfection according to CDC guidelines. † As of July 31, 666 of 891 (75%) programs were approved to reopen, with capacity for 18,945 children, representing 74% of the state's January 2020 child care program population (25,749 children). High compliance with RIDHS requirements was observed during 127 unannounced program monitoring visits (C Molina, RIDHS, personal communication, 2020). Program administrators reported that maintaining stable staffing was the most difficult requirement to implement because of the need to rotate staff members to cover teacher breaks, vacation, and sick leave and that continued adherence to small, stable classes might not be feasible without additional funding. During June 1-July 31, the Rhode Island Department of Health (RIDOH) conducted investigations of any reported COVID-19 case in a child or adult, including staff members, parents, or guardians, present at a child care program. Reported cases were classified as confirmed if a person received a positive reverse transcription-polymerase chain reaction (RT-PCR) test result for SARS-CoV-2, the virus that causes COVID-19, or probable if a person met clinical and epidemiologic criteria with no laboratory testing. § Child care classes with a symptomatic person identified were required to close for 14 days or until * h t t p s : / / w w w. b o s t o n g l o b e .

In-person learning benefits children and communities (1). Understanding the context in which transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), occurs in schools is critical to improving the safety of inperson learning.

Malaria transmission in northern Zambia has increased in the past decade, despite malaria control activities. Evidence-based intervention strategies are needed to effectively reduce malaria transmission. Zambia’s National Malaria Control Centre conducted targeted indoor residual spraying (IRS) in Nchelenge District, Luapula Province, from 2014 to 2016 using the organophosphate insecticide pirimiphos-methyl. An evaluation of the IRS campaign was conducted by the Southern Africa International Centers of Excellence for Malaria Research using actively detected malaria cases in bimonthly household surveys carried out from April 2012 to July 2017. Changes in malaria parasite prevalence after IRS were assessed by season using Poisson regression models with robust standard errors, controlling for clustering of participants in households and demographic, geographical, and climatological covariates. In targeted areas, parasite prevalence declined approximately 25% during the rainy season following IRS with pirimiphos-methyl but did not decline during the dry season or in the overall study area. Within targeted areas, parasite prevalence declined in unsprayed households, suggesting both direct and indirect effects of IRS. The moderate decrease in parasite prevalence within sprayed areas indicates that IRS with pirimiphos-methyl is an effective malaria control measure, but a more comprehensive package of interventions is needed to effectively reduce the malaria burden in this setting.

Background There have been estimates that over 150,000 Haitian children are living in servitude. Child domestic servants who perform unpaid labor are referred to as “restavèks.” Restavèks are often stigmatized, prohibited from attending school, and isolated from family placing them at higher risk for experiencing violence. In the absence of national data on the experiences of restavèks in Haiti, the study objective was to describe the sociodemographic characteristics of restavèks in Haiti and to assess their experiences of violence in childhood. Methods The Violence Against Children Survey was a nationally representative, cross-sectional household survey of 13–24 year olds (n = 2916) conducted May–June 2012 in Haiti. A stratified three-stage cluster design was used to sample households and camps containing persons displaced by the 2010 earthquake. Respondents were interviewed to assess lifetime prevalence of physical, emotional, and sexual violence occurring before age 18. Chi-squared tests were used to assess the association between having been a restavèk and experiencing violence in childhood. Findings In this study 17.4% of females and 12.2% of males reported having been restavèks before age 18. Restavèks were more likely to have worked in childhood, have never attended school, and to have come from a household that did not have enough money for food in childhood. Females who had been restavèks in childhood had higher odds of reporting childhood physical (OR 2.04 [1.40–2.97]); emotional (OR 2.41 [1.80–3.23]); and sexual violence (OR 1.86 [95% CI 1.34–2.58]) compared to females who had never been restavèks. Similarly, males who had ever been restavèks in childhood had significantly increased odds of emotional violence (OR 3.06 [1.99–4.70]) and sexual violence (OR 1.85 [1.12–3.07]) compared to males who had never been restavèks, but there was no difference in childhood physical violence. Interpretation This study demonstrates that child domestic servants in Haiti experience higher rates of childhood violence and have less access to education and financial resources than other Haitian children. These findings highlight the importance of addressing both the lack of human rights law enforcement and the poor economic circumstances that allow the practice of restavèk to continue in Haiti.

Tree cavities are a critical resource for many animals, especially as nesting sites for birds. Patterns of cavity distribution in temperate forests are well studied, yet little is known of cavities in tropical forests, despite a hypothesized decrease in cavity availability with decreasing latitude. We studied cavity density and distribution in a wet lowland tropical forest in Costa Rica and compared our results with estimates from forests around the world. Cavities at our site were common, occurred frequently in living trees, and were often formed by damage or decay rather than by woodpeckers. Most cavities had small openings, and woodpecker‐created cavities were nonrandomly oriented. Contrary to prediction, cavity density appears to increase from the poles to the tropics. We suggest potential mechanisms to explain these patterns.

An outbreak of cholera began in Haiti in October of 2010. To understand the progression of epidemic cholera in Haiti, in April of 2012, we initiated laboratory-enhanced surveillance for diarrheal disease in four Haitian hospitals in three departments. At each site, we sampled up to 10 hospitalized patients each week with acute watery diarrhea. We tested 1,616 specimens collected from April 2, 2012 to March 28, 2013; 1,030 (63.7%) specimens yielded Vibrio cholerae, 13 (0.8%) specimens yielded Shigella, 6 (0.4%) specimens yielded Salmonella, and 63 (3.9%) specimens tested positive for rotavirus. Additionally, 13.5% of children < 5 years old tested positive for rotavirus. Of 1,030 V. cholerae isolates, 1,020 (99.0%) isolates were serotype Ogawa, 9 (0.9%) isolates were serotype Inaba, and 1 isolate was non-toxigenic V. cholerae O139. During 1 year of surveillance, toxigenic cholera continued to be the main cause of acute diarrhea in hospitalized patients, and rotavirus was an important cause of diarrhea-related hospitalizations in children.

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