Tungiasis is a neglected parasitic skin disease caused by penetration of female sand fleas into the epidermis. The ectoparasitosis is widespread in resource-poor communities in South America, the Caribbean and sub-Saharan Africa. To identify risk factors for the presence of sand fleas and severe infestation in an endemic community, we examined the entire population of a traditional fishing village for the presence of embedded sand fleas and determined the number and type of lesions. Demographic, behavioural and environmental characteristics of the population were assessed using a structured questionnaire. Multivariable analysis showed that both occurrence of tungiasis and heavy infestation were significantly related to poor housing conditions (odds ratio [OR]=4.7, 95% CI 1.4-15.8), lack of health education (OR=4.1, 95% CI 2.0-8.6) and presence of animals on the compound (OR=1.9, 95% CI 1.1-3.4). Contrary to common belief, a protective effect of frequent use of closed footwear could not be demonstrated. Based on the population attributable fractions calculated for the major risk factors identified, we conclude that several low-cost interventions would have a considerable impact on the occurrence of tungiasis and heavy infestation.

Gripenet has been monitoring the activity of influenza-like-illness (ILI) with the aid of volunteers via the internet in the Netherlands and Belgium since 2003 and in Portugal since 2005. In contrast with the traditional system of sentinel networks of mainly primary care physicians coordinated by the European Influenza Surveillance Scheme (EISS), Gripenet obtains its data directly from the population. Any resident of the three countries can participate in Gripenet by completing an application form on the appropriate websites (http://www.gripenet.pt), which contains various medical, geographic and behavioural questions. Participants report weekly on the website any symptoms they have experienced since their last visit. ILI incidence is determined on the basis of a uniform case definition.In the 2006/2007 season, 19,623 persons participated in Gripenet in the Netherlands, 7,025 in Belgium and 3,118 in Portugal. The rise, peak and decline of ILI activity occurred at similar times according to Gripenet and EISS. However, ILI attack rates in the Netherlands (6.6%), Belgium (6.1%) and Portugal (5.6%) were remarkably more similar in Gripenet than in EISS (0.8%, 3.9%, and 0.6% respectively).Monitoring ILI activity with the direct participation of volunteers provides similar incidence curves compared to the traditional system coordinated by EISS. Whereas EISS provides an established system whose data is validated by virology tests, Gripenet is a fast and flexible monitoring system whose uniformity allows for direct comparison of ILI rates between countries. A current objective of Gripenet is to engage more European countries.

Tungiasis is hyperendemic in many poor communities in Brazil and is associated with considerable morbidity. In order to understand the factors that determine the distribution of this ectoparasitosis in a rural community, an epidemiological study was carried out in a traditional fishing village in Ceará State, north-eastern Brazil. Based on active case detection and voluntary participation, 91% of the population (belonging to 95% of all families) was examined. Embedded fleas were looked for over all parts of the body, counted, and the lesions were staged. The overall prevalence of infestation was 51.3% (95% CI: 47.0-55.5). More males than females were infested (54.8% vs 48.3%); however, this difference was not statistically significant. Age-specific prevalence rates followed an S-shaped curve with peaks in children aged 5-9 years and people elder than 60 years. The parasite burden was high (range 1-145 lesions; arithmetic mean: 8.9) and particularly elevated in males, children <15 years and the elderly. The distribution of the parasite burden was uneven within the population with the majority of the lesions in a few individuals: the 23 subjects (8% of all infested) with severe infestation (>30 lesions) accounted for 1,366 of the 2,493 lesions (54.8%) documented. The study shows that tungiasis is a highly prevalent ectoparasitosis in this deprived community with a peculiar distribution of prevalence and parasite burden.

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