Rapid responses are electronic letters to the editor. They enable our users to debate issues raised in articles published on thebmj.com. Although a selection of rapid responses will be included online and in print as readers' letters, their first appearance online means that they are published articles. If you need the url (web address) of an individual response, perhaps for citation purposes, simply click on the response headline and copy the url from the browser window. Letters are indexed in PubMed.
Durrheim (2013)1 “Simply wearing footwear could interrupt the transmission of Strongyloides stercoralis” (BMJ 2013; 347: f5219) is to be applauded for suggesting that an environmental rather than clinical intervention might be the key to controlling Strongyloides stercoralis. For too long we have taken a purely clinical approach – ie pills – to treating Strongyloides infection in humans, and ignored both the reinfection rates and the potential for development of antihelminthic resistance. However cultural acceptability of footwear, particularly in hot climates, is low, suggesting other environmental control methods should also be assessed.
Grove’s thirty year old suggestion that the most effective control measures against human helminthes has been the installation and usage of safe waste disposal systems still holds. In light of growing concern about overuse of antimicrobials and (in Australia) a desire to ‘close the gap’ between health outcomes of indigenous and non-indigenous people, ‘simple’ solutions to health problems such as functioning house hardware should not be overlooked in favour of complex clinical interventions.