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SIGNIFICANCE: Water exposure during contact lens wear can transfer pathogenic microorganisms to the eye, causing ocular complications. This study determined that water exposure is prevalent among lens wearers and is independently associated with higher case contamination. Contact lens compliance education to minimize water exposure should be reenforced by contact lens organizations and practitioners. PURPOSE: Given the increasing association between water exposure and contact lens disease, this study aimed to explore the effect of water exposure and storage case contamination in soft contact lens users. METHODS: A total of 165 daily soft lens wearers completed a self-administered questionnaire on contact lens hygiene. Lens cases were collected, and microbial analysis was conducted using an adenosine triphosphate assay (for overall microbial bioburden) and limulus amebocyte lysate assay (for endotoxin levels). The lens hygiene (excellent, >35; moderate, 28 to 35; poor, <28) and water contact (≤1, good; >1, poor) scores measured the compliance and water exposure during lens wear, respectively. Multiple regression determined the association between water behaviors and case contamination. RESULTS: The average (standard deviation) age of participants was 28 (13.5) years (18 to 78 years), and 65% were female. The average overall microbial bioburden of storage cases was 3.10 (0.98) log colony-forming unit/mL (1.09 to 5.94 log colony-forming unit/mL). Forty-five percent of participants reported showering, 49.7% reported swimming while wearing lenses (65.4% of whom swam without goggles), 27.8% used wet hands to handle lenses, and 17.5% used tap water to rinse storage cases. Showering with lenses significantly increased the risk of higher storage case bioburden (P = .001), whereas using wet hands (P = .01) doubled the risk of higher case endotoxin levels (odds ratio, 2.41; confidence interval 1.19 to 4.86). CONCLUSIONS: Water contact behavior while wearing lenses is prevalent among soft lens wearers and is associated with higher case contamination. Practitioners may improve contact lens education to reduce water exposure and case contamination to reduce the risk of lens-related adverse events.

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BACKGROUND: Water exposure during contact lens wear has been associated with contact lens disease including microbial keratitis and sterile corneal infiltrates. Despite the documented risks, water exposure is common amongst lens wearers. This study aimed to determine the effect of water education in the form of "no-water" lens case stickers on water-contact behaviours and storage case contamination. METHODS: In a prospective, masked, randomised controlled trial, 200 daily lens wearers were randomised to either receive a storage case with a "no-water" sticker (test) or without a "no-water" sticker (control). Both groups received written compliance information. Participants completed a self-administered lens hygiene questionnaire at baseline and after 6 weeks. Microbial analysis of used storage cases, collected at both study visits, was conducted using ATP and limulus amebocyte lysate (LAL) assays for overall microbial contamination and endotoxin levels, respectively. A one-way ANCOVA and multiple logistic regression determined the change in water-contact behaviours and storage case contamination over time. RESULTS: A total of 188 lens wearers completed both study visits; 128 females and 60 males; average age 29 ± 13 (range 18-78 years); 95 test and 93 control participants. After 6 weeks, the overall water exposure score and endotoxin levels reduced significantly in the test group compared with the control group (p < 0.05). There were no significant changes in individual water-contact behaviours or overall storage case contamination. CONCLUSION: A no-water infographic on the contact lens case improved overall water-contact behaviours and reduced storage case endotoxin. Refining the messaging may be beneficial in future to improve other aspects of compliance.

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PURPOSE: To describe the association of water exposure with contact lens (CL)-related disease and explore the guidelines regarding water exposure to CL wearers, provided by CL manufacturing industry, global public health, and CL-related professional associations. METHODS: A review of the literature was conducted by searching PubMed, MEDLINE, and Web of Science databases up to September 2017 for articles published or translated in English using keywords: contact lens* AND tap water OR swimming OR showering OR water exposure AND microbial keratitis OR Acanthamoeba keratitis OR corneal infiltrate* OR ocular adverse event*. References in all relevant publications were also reviewed. RESULTS: Water exposure during CL wear is associated with complications ranging from sterile corneal infiltrative events to sight-threatening infections. Despite the documented risks due to water exposure, water-related habits are common among CL wearers. This suggests a lack of awareness and understanding regarding the risks among CL wearers and potentially CL practitioners. Discrepancies exist in guidelines for CL hygiene and compliance provided by the CL manufacturing industry, global public health, and CL-related professional associations. There is also widespread use of water imagery within CL marketing and packaging materials. These factors may give rise to confusion among wearers and may contribute toward risk-taking behaviors. CONCLUSIONS: Consensus among stakeholders about water and CL care is needed. Guidelines should unequivocally advocate for the avoidance of any water exposure including handling CLs with wet hands, rinsing CLs or storage cases in tap water, showering while wearing CLs and swimming with CLs without wearing goggles.

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Control and prevention of foot and mouth disease (FMD) by vaccination remains unsatisfactory in endemic countries. Indeed, consistent and new FMD epidemics in previously disease-free countries have precipitated the need for a worldwide control strategy. Outbreaks in vaccinated animals require that a new and safe vaccine be developed against foot and mouth virus (FMDV). FMDV can be eradicated worldwide based on previous scientific information about its spread using existing and modern control strategies.

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FMD clinically positive 250 tissue samples (mouth and hoof epithelium and vesicle swabs, tongue tissue) and 175 secretion samples (milk, saliva, serum, plasma) were evaluated by RT-PCR for the diagnosis of FMD with different pair of universal and serotype-specific primers from 2006 to 2007 in Punjab, Pakistan. Universal primer pair P1/P2 from VP1 gene detected FMD in 182 out of 250 (72.8%) tissues and 92 out of 175 (52.6%) secretion samples, while universal primer 1F/1R from 5'UTR region detected FMD in 218 out of 250 (87.2%) tissues and 142 out of 175 (81.1%) secretion samples. 1F/1R proved better than the P1/P2 primer pair for primary diagnosis of FMD, direct from the clinical positive samples. Direct sequencing of the universal primer pair P1/P2 revealed that O serotype of FMD was circulating in this region. O serotype of FMD was detected with O-1C(ARS4)/PNK 61, AU(O)/AU(rev), AU(O)/PNK61 primer pairs, these primer pairs also compared with each other. AU(O)/AU(rev) and AU(O)/PNK61 detected O serotype of FMD in 88.9% tissue and swab (mouth and hoof vesicle swabs) samples and 71.9% different secretion (milk, saliva, serum, plasma) samples, while O-1C(ARS4)/PNK 61 detected 48.1% tissue and swab (mouth and hoof vesicle swabs) samples and 37.5% different secretion (milk, saliva, serum, plasma) samples. AU(O)/AU(rev), AU(O)/PNK61 primer pairs detected 40.8% more tissue and swab samples, while these pairs detected 34.4% more secretion samples. Cloning of PCR product of AU(O)/AU(rev) VP1 gene and sequencing for phylogenetic studies revealed that O serotype of FMD circulating in Punjab, Pakistan was genetically very diverse from the 'O' serotype in Middle East and Europe. The dendrogram showed that Pakistan 'O' serotype was very much similar genetically to its neighbor countries (Sri Lanka, India, Iran, Iraq, and China) and PanAsia 1 lineage which caused 2001-outbreak in UK and 1994-outbreak in Saudi Arabia, etc.

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