Risk assessment and risk regionalization, based on the surveillance system for foot and mouth disease in South America.

Within the framework of the International Animal Health Code of the Office International des Epizooties (OIE), important contributions have been made by the Animal and Plant Health Inspection Service/United States Department of Agriculture (APHIS/USDA), the Ministry of Agriculture of Canada, the Ministry of Agriculture and Fisheries of New Zealand and other organisations, by the development of risk assessment methods and regionalization criteria for risk assessment. The authors attempt to contribute to these efforts by proposing a regional risk evaluation of foot and mouth disease (FMD) in South America. Two examples of risk assessments for international trade, i.e., in bovine embryos and in meat, are used to demonstrate the importance of an effective disease surveillance system as the basis for risk regionalization for international trade in animals and animal products. As a result of progress in the control and eradication of FMD in South America, it is expected that major livestock production regions will soon be in low- to very low-risk categories.

Knowledge, attitudes and practices during a community-level ivermectin distribution campaign in Guatemala.

Community acceptance and participation are essential for the success of mass ivermectin chemotherapy programmes for onchocerciasis (river blindness). To explore the local understanding of the purpose of ivermectin and willingness to continue taking the drug, we performed questionnaire surveys in four communities with hyperendemic onchocerciasis after each of three ivermectin treatment rounds. More than 100 respondents participated in each KAP survey, representing the heads of 30% of the households in each community. The respondents rarely stated that the goal of the ivermectin treatment programme was to prevent visual loss. Instead, they said they were taking the drug for their general well-being, to cure the onchocercal nodule (filaria), or to cure the microfilaria, a term newly introduced by agents of the treatment programme. The principal reason identified for refusal to take ivermectin was anxiety about drug-related adverse reactions, and there were marked differences between communities in acceptance of treatment. In one community over 50% of residents initially refused to take ivermectin, although participation rates improved somewhat after programmatic adjustments. We recommend that ivermectin distribution programmes establish surveillance activities to detect where acceptance is poor, so that timely and community-specific adjustments may be devised to improve participation.