Report on Baylisascariasis Cases and Implications for Sustainable Development Goals

1.0 Introduction

A recent report from the Centers for Disease Control and Prevention (CDC) detailed two 2024 cases of raccoon roundworm (Baylisascaris procyonis) infection in children in Los Angeles County. These incidents underscore significant public health challenges and highlight the interconnectedness of human health, urban environments, and ecosystem stability, directly relating to several United Nations Sustainable Development Goals (SDGs). One case resulted in severe, persistent cognitive, motor, and visual deficits due to a delayed diagnosis, emphasizing the critical need for improved health responses in line with SDG 3 (Good Health and Well-being).

2.0 Case Analysis and Clinical Presentation

The two unrelated pediatric patients presented with symptoms consistent with baylisascariasis, a rare but serious zoonotic disease caused by the ingestion of B. procyonis eggs from raccoon feces or contaminated soil.

• Patient A: A 14-year-old with autism and a history of pica. This patient recovered neurologically following treatment.
• Patient B: A 15-month-old, previously healthy child who suffered severe, persistent neurologic complications following a substantial delay in diagnosis and treatment.

2.1 Symptomatology

Clinical findings in the patients included:

• Encephalopathy
• Presence of roundworm larva in the eye
• Peripheral and cerebrospinal fluid eosinophilia
• Behavioral changes
• Unsteady gait
• Brain abnormalities identified on imaging

The disparate outcomes directly reflect challenges to achieving SDG 3, particularly Target 3.8 concerning universal health coverage and access to quality essential healthcare services, and SDG 10 (Reduced Inequalities), as the disease disproportionately affects vulnerable populations such as young children and persons with developmental disabilities.

3.0 Environmental Factors and Alignment with SDG 11 and SDG 15

The investigation identified raccoon feces as the probable source of infection, with one exposure linked to a rooftop raccoon latrine. This points to critical issues in urban wildlife management and environmental health.

• SDG 11 (Sustainable Cities and Communities): The presence of raccoon latrines in human-occupied properties highlights a failure in creating safe and resilient urban environments. Managing human-wildlife interactions is essential for public health and achieving Target 11.6, which aims to reduce the adverse environmental impact of cities.
• SDG 15 (Life on Land): B. procyonis is an intestinal parasite with high prevalence in North American raccoon populations, with up to 80% of raccoons affected in some regions. This zoonotic spillover event illustrates the direct link between ecosystem health and human well-being, reinforcing the importance of sustainably managing terrestrial ecosystems as outlined in SDG 15.

4.0 Recommendations for Achieving Sustainable Development Goals

The report’s conclusions provide a clear framework for actions that support multiple SDGs. The following recommendations are critical for preventing future cases and advancing global development targets.

1. Enhance Healthcare Provider Capacity (SDG 3): Healthcare providers must maintain a high index of suspicion for B. procyonis infection in patients presenting with eosinophilic meningoencephalitis, especially in vulnerable groups. The consideration of empiric treatment with albendazole can prevent severe disability, directly contributing to ensuring healthy lives and well-being for all.
2. Promote Public Health Education (SDG 4: Quality Education): Public awareness campaigns are essential. Educating communities on exposure prevention strategies, including securing property against raccoon activity, avoiding contact with raccoon feces, and safely removing latrines, constitutes a vital form of public health education that empowers individuals to protect themselves.
3. Improve Urban Environmental Management (SDG 11): Municipal authorities and property owners must implement strategies to manage urban wildlife and mitigate risks. This includes proper waste management and securing buildings to prevent the establishment of raccoon latrines, thereby creating safer and more sustainable living spaces.

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article discusses issues related to human health, environmental risks in communities, and the interaction between humans and wildlife, which connect to the following Sustainable Development Goals (SDGs):

• SDG 3: Good Health and Well-being

  This is the most prominent SDG, as the article’s central theme is a rare but serious human disease, baylisascariasis, caused by raccoon roundworm. It details the health impacts on two children, including “severe cognitive, motor, and visual deficits,” and discusses diagnosis, treatment, and the importance of the healthcare response.

• SDG 11: Sustainable Cities and Communities

  The infections occurred in Los Angeles County, an urban environment. The article highlights environmental health risks within a community, specifically the presence of “raccoon feces that had fallen from a rooftop latrine.” It calls for public awareness and “preventing raccoon activity around properties,” which relates to managing waste and wildlife in human settlements to ensure they are safe and healthy.

• SDG 10: Reduced Inequalities

  The article implicitly touches upon this goal by identifying particularly vulnerable groups. It notes that healthcare providers should be especially vigilant with “young children or persons with developmental disabilities or pica.” One of the patients had autism and pica, highlighting how pre-existing conditions and disabilities can increase vulnerability to certain health risks.

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the issues discussed, the following specific SDG targets are relevant:

1. Target 3.3: End epidemics and combat communicable diseases

   The article focuses on baylisascariasis, a communicable (zoonotic) disease. The investigation by the CDC and local health officials into the two cases is a direct effort to understand and control the spread of such a disease. The article states that the parasite causes “widespread, typically asymptomatic infection in raccoons,” indicating a persistent reservoir for a disease that needs to be combatted to protect human health.

2. Target 3.d: Strengthen capacity for early warning and management of health risks

   The article functions as a public health alert. The conclusion explicitly calls for action to improve the management of this health risk: “Health care providers should suspect B. procyonis infection in patients with eosinophilic meningoencephalitis… and consider empiric treatment with albendazole.” This is a direct call to strengthen the capacity of healthcare providers for early warning (suspicion and diagnosis) and risk management (prompt treatment), especially since a “substantial delay” in diagnosis led to severe complications for one patient.

3. Target 11.6: Reduce the adverse environmental impact of cities

   This target includes paying attention to “municipal and other waste management.” The article identifies raccoon feces and “rooftop latrine” sites as the source of the infectious agent. The recommendation for the public to engage in “safely removing raccoon latrines” is a form of managing hazardous biological waste within a community to reduce its adverse environmental and health impacts.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the article mentions or implies several qualitative and quantitative indicators:

• Incidence of specific communicable diseases

  The report of “2024 raccoon roundworm infections in two children” is a direct measure of the incidence of baylisascariasis. Tracking the number of human cases over time would be a key indicator for progress under Target 3.3.

• Prevalence of parasites in animal reservoirs

  The article provides a crucial environmental risk indicator by stating that “up to 80% of raccoons in the Northeast, Midwest, and West Coast regions are affected” by the parasite. Monitoring this prevalence in local raccoon populations can help measure the underlying risk to humans and inform public health interventions related to Target 3.3 and Target 11.6.

• Timeliness and accuracy of diagnosis

  A key theme is the negative outcome associated with delayed diagnosis. The article notes one patient “developed severe persistent neurologic complications after a substantial delay in receiving an accurate diagnosis.” The time between onset of symptoms and correct diagnosis/treatment is a critical, albeit implied, indicator of healthcare system capacity under Target 3.d. A reduction in this delay would signify progress.

• Public awareness and preventive actions

  The article concludes by emphasizing the need for the public to be aware of “exposure prevention strategies.” An implied indicator of progress for Target 11.6 would be the adoption of these behaviors, such as the rate of properties implementing measures for “preventing raccoon activity” and “safely removing raccoon latrines.”

4. Create a table with three columns titled ‘SDGs, Targets and Indicators” to present the findings from analyzing the article. In this table, list the Sustainable Development Goals (SDGs), their corresponding targets, and the specific indicators identified in the article.

Source: cidrap.umn.edu