A low-cost intervention for cleaner drinking water in Karachi, Pakistan.

Objective: To pilot test an inexpensive, home-based water decontamination and storage system in a low-income neighborhood of Karachi.

Methods: Fifty households received a 20-L plastic water storage vessel with a high-quality spout and a regular supply of diluted hypochlorite solution. Twenty-five control households were recruited.

Microbiologic effectiveness of hand washing with soap in an urban squatter settlement, Karachi, Pakistan.

We conducted a study in a squatter settlement in Karachi, Pakistan where residents report commonly washing their hands to determine if providing soap, encouraging hand washing, and improving wash-water quality would improve hand cleanliness. We allocated interventions to 75 mothers and collected hand-rinse samples on unannounced visits. In the final model compared with mothers who received no hand-washing intervention, mothers who received soap would be expected to have 65% fewer thermotolerant coliform bacteria on their hands (95% CI 40%, 79%) and mothers who received soap, a safe water storage vessel, hypochlorite for water treatment, and instructions to wash their hands with soap and chlorinated water would be expected to have 74% fewer (95% CI 57%, 84%).

Processes for obtaining nonmedical exemptions to state immunization laws.

Objectives: This study sought to determine the specific processes required for obtaining religious and philosophical exemptions to school immunization laws.

Methods: State health department immunization program managers in the 48 states that offer nonmedical exemptions were surveyed. Categories were assigned to reflect the complexity of the procedure within a state for obtaining an exemption.

Health consequences of religious and philosophical exemptions from immunization laws: individual and societal risk of measles.

Context: All US states require proof of immunization for school entry. Exemptions are generally offered for medical, religious, or philosophical reasons, but the health consequences of claiming such exemptions are poorly documented.

Objectives: To quantify the risk of contracting measles among individuals claiming religious and/or philosophical exemptions from immunization (exemptors) compared with vaccinated persons, and to examine the risk that exemptors pose to the nonexempt population.