Only 2.1% (= 8) of respondents used an outdoor toilet. potential.5C7 infection can remain ETO latent for decades; life-threatening systemic hyperinfection can occur when an infected person becomes immunocompromised by medications or other conditions.8 Strongyloidiasis deaths in the United States during 1991C2006 occurred in people with a median age of 66 years and mainly among white men Oxethazaine born in the Southeast who had Oxethazaine immunosuppressive conditions.8 infection occurs through exposure to stool-contaminated ground by either ingesting or skin contact with ground made up of larvae. Risk for transmission increases if infected persons use outdoor toilets, which may have inadequate sewage disposal and fecal management, thus transmitting contamination to others through exposure to contaminated ground during work or play. Prevalence of these infections in the United States might have decreased through time as a result of improvements in sanitation9; however, this assumption has not been tested. Rural populations in the United States, where infections are most likely to continue, are difficult to reach and less likely than others to access medical care.10 Remote Area Medical (RAM; Knoxville, TN) clinics provide free medical, dental, and vision services to underserved populations; residents of these communities have a high historical prevalence of parasitic infections.4 Kentucky RAM mobile clinics were held in two rural Appalachian communities over one weekend each in 2013. We conducted a cross-sectional study of antibody positivity among RAM clinic patients to identify risk factors for contamination and determine whether additional more comprehensive studies are warranted. We Oxethazaine previously published results of the first weekend clinic, obtaining antibodies in 5 of 102 participants tested (5% prevalence).11 Below, we present the results from both Kentucky clinics. The study was approved by the Institutional Review Boards of the Kentucky Cabinet for Health and Family Services and the Centers for Disease Control and Oxethazaine Prevention. All RAM clinic attendees were approached on entry to the clinic and invited to participate in the study. Participants aged 18 years old provided written consent, and parents or guardians provided written consent for participants aged 18 years old. We administered a risk factor questionnaire through person-to-person interview that requested the following demographic information: age, sex, travel history (including military support), and type of toilet at their residence. The survey data and test results were entered into a Microsoft Access (Microsoft Corp., Redmond, WA) database and imported into SAS 9.3 (SAS Institute, Inc., Cary, NC). Fisher’s exact test and Student’s test were used to compare dichotomous and continuous outcomes, respectively. Approximately 100 L blood for serum isolation was collected at the time of survey administration by finger stick. Samples were stored in a cooler for 48 hours and then brought to the laboratory of the Centers for Disease Control and Prevention (CDC) for antibody testing. Two tests were used: the crude antigen enzyme-linked immunosorbent assay (CrAg ELISA) and the NIE immunoassay (using the MagPlex technology; Luminex Corp., Austin, TX) recently developed at the CDC. In the validation testing by the CDC, the CrAg ELISA had a slightly higher sensitivity (96% versus 93%, respectively) and a similarly high specificity (98% versus 97%, respectively). Positive results are consistent with current or previous contamination but do not differentiate between the two infections. All samples from the first weekend clinic were tested on both assays, whereas samples from the second clinic were only tested around the MagPlex immunoassay. Serum samples with discrepant results between tests were rerun on both assays, and if a positive result was repeated on either test, the result was reported as positive. The CDC notified all study participants of their test results and.