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Joo H, Maskery BA, Alpern JD, Weinberg M, Stauffer WM. Cost-effectiveness of treatment strategies for populations from strongyloidiasis high-risk areas globally who will initiate corticosteroid treatment in the USA. J Travel Med 2024; 31:taad054. [PMID: 37074145 PMCID: PMC10986739 DOI: 10.1093/jtm/taad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND The risk of developing strongyloidiasis hyperinfection syndrome appears to be elevated among individuals who initiate corticosteroid treatment. Presumptive treatment or treatment after screening for populations from Strongyloides stercoralis-endemic areas has been suggested before initiating corticosteroids. However, potential clinical and economic impacts of preventative strategies have not been evaluated. METHODS Using a decision tree model for a hypothetical cohort of 1000 individuals from S. stercoralis-endemic areas globally initiating corticosteroid treatment, we evaluated the clinical and economic impacts of two interventions, 'Screen and Treat' (i.e. screening and ivermectin treatment after a positive test), and 'Presumptively Treat', compared to current practice (i.e. 'No Intervention'). We evaluated the cost-effectiveness (net cost per death averted) of each strategy using broad ranges of pre-intervention prevalence and hospitalization rates for chronic strongyloidiasis patients initiating corticosteroid treatment. RESULTS For the baseline parameter estimates, 'Presumptively Treat' was cost-effective (i.e. clinically superior with cost per death averted less than a threshold of $10.6 million per life) compared to 'No Intervention' ($532 000 per death averted) or 'Screen and Treat' ($39 000 per death averted). The two parameters contributing the most uncertainty to the analysis were the hospitalization rate for individuals with chronic strongyloidiasis who initiate corticosteroids (baseline 0.166%) and prevalence of chronic strongyloidiasis (baseline 17.3%) according to a series of one-way sensitivity analyses. For hospitalization rates ≥0.022%, 'Presumptively Treat' would remain cost-effective. Similarly, 'Presumptively Treat' remained preferred at prevalence rates of ≥4%; 'Screen and Treat' was preferred for prevalence between 2 and 4% and 'No Intervention' was preferred for prevalence <2%. CONCLUSIONS The findings support decision-making for interventions for populations from S. stercoralis-endemic areas before initiating corticosteroid treatment. Although some input parameters are highly uncertain and prevalence varies across endemic countries, 'Presumptively Treat' would likely be preferred across a range for many populations, given plausible parameters.
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Affiliation(s)
- Heesoo Joo
- Division of Global Migration and Quarantine, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brian A. Maskery
- Division of Global Migration and Quarantine, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jonathan D. Alpern
- Infectious Disease Section, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- Department of Medicine, Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Michelle Weinberg
- Division of Global Migration and Quarantine, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - William M. Stauffer
- Division of Global Migration and Quarantine, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
- Department of Medicine, Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, USA
- Center for Global Health and Social Responsibility, University of Minnesota, Minneapolis, MN, USA
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2
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Gordon CA, Utzinger J, Muhi S, Becker SL, Keiser J, Khieu V, Gray DJ. Strongyloidiasis. Nat Rev Dis Primers 2024; 10:6. [PMID: 38272922 DOI: 10.1038/s41572-023-00490-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/27/2024]
Abstract
Strongyloidiasis is a neglected tropical disease caused primarily by the roundworm Strongyloides stercoralis. Strongyloidiasis is most prevalent in Southeast Asia and the Western Pacific. Although cases have been documented worldwide, global prevalence is largely unknown due to limited surveillance. Infection of the definitive human host occurs via direct skin penetration of the infective filariform larvae. Parasitic females reside in the small intestine and reproduce via parthenogenesis, where eggs hatch inside the host before rhabditiform larvae are excreted in faeces to begin the single generation free-living life cycle. Rhabditiform larvae can also develop directly into infectious filariform larvae in the gut and cause autoinfection. Although many are asymptomatic, infected individuals may report a range of non-specific gastrointestinal, respiratory or skin symptoms. Autoinfection may cause hyperinfection and disseminated strongyloidiasis in immunocompromised individuals, which is often fatal. Diagnosis requires direct examination of larvae in clinical specimens, positive serology or nucleic acid detection. However, there is a lack of standardization of techniques for all diagnostic types. Ivermectin is the treatment of choice. Control and elimination of strongyloidiasis will require a multifaceted, integrated approach, including highly sensitive and standardized diagnostics, active surveillance, health information, education and communication strategies, improved water, sanitation and hygiene, access to efficacious treatment, vaccine development and better integration and acknowledgement in current helminth control programmes.
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Affiliation(s)
- Catherine A Gordon
- Infection and Inflammation Program, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia.
- Faculty of Medicine, University of Queensland, St Lucia, Brisbane, Queensland, Australia.
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Stephen Muhi
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- The University of Melbourne, Department of Microbiology and Immunology, Parkville, Victoria, Australia
| | - Sören L Becker
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany
| | - Jennifer Keiser
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Virak Khieu
- National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Darren J Gray
- Population Health Program, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia
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3
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Bustamante J, Sainz T, Montojo FA, Almirón MD, Subirats M, Vega DM, Mellado MJ, López-Hortelano MG. Screening for parasites in migrant children. Travel Med Infect Dis 2022; 47:102287. [PMID: 35304329 DOI: 10.1016/j.tmaid.2022.102287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 01/26/2022] [Accepted: 02/23/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Globalization has pushed population movements in the last decades, turning imported diseases into the focus. Due to behavioral habits, children are at higher risk of acquiring iparasitosis. This study aims to investigate the prevalence of parasites in migrant children and factors associated with parasitic diseases. METHOD Retrospective cross-sectional study (2014-2018) including children diagnosed with parasitosis. The diagnosis was based on serology and/or microscopic stool-sample evaluation. Epidemiological and clinical data were recorded. RESULTS Out of 813 migrant children screened, 241 (29.6%) presented at least one parasite, and 89 (10.9%) more than one. The median age was 6.6 years (IQR: 3.1-11.9) and 58.9% were males. Most cases were referred for a health exam; only 52.3% of children were symptomatic, but 43.6% had eosinophilia. The most common diagnosis were giardiasis (35.3%), schistosomiasis (19.1%), toxocariasis (15.4%), and strongyloidiasis (9.1%). After the multivariate analysis, African origin and presenting with eosinophilia were the main risk factors for parasitism. CONCLUSIONS parasitosis are frequent among migrant children. Children are often asymptomatic, and thus active screening for parasitosis should be considered among high-risk populations. Eosinophilia can be useful to guide complimentary tests, as well as geographical origin, but normal eosinophil count does not exclude parasitosis.
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Affiliation(s)
- Jorge Bustamante
- Department of Pediatrics, Hospital General de Valdepeñas, Ciudad Real, Spain; La Paz Research Institute (IdiPAZ) Madrid, Spain; Universidad Autónoma de Madrid (UAM), Spain
| | - Talía Sainz
- La Paz Research Institute (IdiPAZ) Madrid, Spain; Universidad Autónoma de Madrid (UAM), Spain; General Pediatrics and Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain; Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Spain.
| | - Fátima Ara Montojo
- La Paz Research Institute (IdiPAZ) Madrid, Spain; General Pediatrics Department, Hospital de Quiron, Pozuelo, Spain
| | - Mariana Díaz Almirón
- La Paz Research Institute (IdiPAZ) Madrid, Spain; Biostatistics Department, La Paz University Hospital, Spain
| | - Mercedes Subirats
- La Paz Research Institute (IdiPAZ) Madrid, Spain; Department of Microbiology and Parasitology, Hospital La Paz Madrid, Spain
| | - Dolores Montero Vega
- La Paz Research Institute (IdiPAZ) Madrid, Spain; Department of Microbiology and Parasitology, Hospital La Paz Madrid, Spain
| | - María José Mellado
- La Paz Research Institute (IdiPAZ) Madrid, Spain; Universidad Autónoma de Madrid (UAM), Spain; General Pediatrics and Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain; Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Spain
| | - Milagros García López-Hortelano
- La Paz Research Institute (IdiPAZ) Madrid, Spain; General Pediatrics and Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain; Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Spain
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4
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Phares CR, Liu Y, Wang Z, Posey DL, Lee D, Jentes ES, Weinberg M, Mitchell T, Stauffer W, Self JL, Marano N. Disease Surveillance Among U.S.-Bound Immigrants and Refugees — Electronic Disease Notification System, United States, 2014–2019. MMWR. SURVEILLANCE SUMMARIES 2022; 71:1-21. [PMID: 35051136 PMCID: PMC8791661 DOI: 10.15585/mmwr.ss7102a1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Problem/Condition Period Covered Description of System Results Interpretation Public Health Action
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Wikman-Jorgensen PE, Llenas-Garcia J, Shedrawy J, Gascon J, Muñoz J, Bisoffi Z, Requena-Mendez A. Cost-effectiveness of different strategies for screening and treatment of Strongyloides stercoralis in migrants from endemic countries to the European Union. BMJ Glob Health 2021; 5:bmjgh-2020-002321. [PMID: 32461226 PMCID: PMC7254101 DOI: 10.1136/bmjgh-2020-002321] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The best strategy for controlling morbidity due to imported strongyloidiasis in migrants is unclear. We evaluate the cost-effectiveness of six possible interventions. METHODS We developed a stochastic Markov chain model. The target population was adult migrants from endemic countries to the European Union; the time horizon, a lifetime and the perspective, that of the health system. Average and incremental cost-effectiveness ratios (ACER and ICER) were calculated as 2016 EUR/life-year gained (LYG). Health interventions compared were: base case (no programme), primary care-based presumptive treatment (PCPresTr), primary care-based serological screening and treatment (PCSerTr), hospital-based presumptive treatment (HospPresTr), hospital-based serological screening and treatment (HospSerTr), hospital-based presumptive treatment of immunosuppressed (HospPresTrim) and hospital-based serological screening and treatment of the immunosuppressed (HospSerTrim). The willingness to pay threshold (WTP) was €32 126.95/LYG. RESULTS The base case model yielded a loss of 2 486 708.24 life-years and cost EUR 3 238 393. Other interventions showed the following: PCPresTr: 2 488 095.47 life-years (Δ1 387.23LYG), cost: EUR 8 194 563; ACER: EUR 3573/LYG; PCSerTr: 2 488 085.8 life-years (Δ1377.57LYG), cost: EUR 207 679 077, ACER: EUR 148 407/LYG; HospPresTr: 2 488 046.17 life-years (Δ1337.92LYG), cost: EUR 14 559 575; ACER: EUR 8462/LYG; HospSerTr: 2 488 024.33 life-years (Δ1316.08LYG); cost: EUR 207 734 073; ACER: EUR 155 382/LYG; HospPresTrim: 2 488 093.93 life-years, cost: EUR 1 105 483; ACER: EUR -1539/LYG (cost savings); HospSerTrim: 2 488 073.8 life-years (Δ1365.55LYG), cost: EUR 4 274 239; ACER: EUR 759/LYG. One-way and probabilistic sensitivity analyses were undertaken; HospPresTrim remained below WTP for all parameters' ranges and iterations. CONCLUSION Presumptively treating all immunosuppressed migrants from areas with endemic Strongyloides would generate cost savings to the health system.
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Affiliation(s)
- Philip Erick Wikman-Jorgensen
- Medicina Interna, Hospital Universitari San Juan de Alicante, San Juan de Alicante, Alicante, Spain .,Foundation for the Promotion of the Research in Healthcare and Biomedicine, Valencia, Spain
| | - Jara Llenas-Garcia
- Medicina Interna/Enfermedades Infecciosas, Hospital Vega Baja-FISABIO, San Bartolome-Orihuela, Alicante, Spain.,Clinical Medicine, Universidad Miguel Hernandez de Elche Facultad de Medicina, Sant Joan D'Alacant, Spain
| | - Jad Shedrawy
- Public Health, Karolinska Institutet, Stockholm, Stockholm County, Sweden
| | | | | | - Zeno Bisoffi
- Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Veneto, Italy.,Diagnostics and Public Health, University of Verona, Verona, Veneto, Italy
| | - Ana Requena-Mendez
- Instituto de Salud Global Barcelona, Barcelona, Spain.,Division of Infectious Diseases, Department of Medicine-Solna, Karolinska Institutet, Stockholm, Sweden
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6
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Fleit M, Volkman H, Alpern JD, Lindrose AR, Stauffer W, Mitre E. Impact of Anthelmintic Price Increases on Practice Patterns of Healthcare Providers Caring for Immigrant and Refugee Populations in the United States. Am J Trop Med Hyg 2020; 104:718-723. [PMID: 33372650 DOI: 10.4269/ajtmh.20-0362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 07/11/2020] [Indexed: 11/07/2022] Open
Abstract
In the United States, prices of long-established, generic anthelmintic medications have markedly risen. In the past decade, albendazole and mebendazole have increased in price by > 8,000%, whereas praziquantel has increased by > 500%. To determine the effect of these price increases on the practice patterns of healthcare providers, we conducted a cross-sectional electronic survey of clinics in the United States that primarily care for immigrant and refugee patient populations. Among 32 clinics, 53.1% reported that price increases impacted how providers diagnosed and treated helminth infections. A third (34.4%) of clinics reported that price increases have left them unable to treat known helminth infections. Other ways in which price increases impacted practice patterns included prescribing anthelmintics other than albendazole, mebendazole, or praziquantel when possible (34.4%); avoiding screening asymptomatic patients for helminth infections (15.6%); advising patients to acquire medications from another country (15.6%) or the patient's home country (9.4%); reducing anthelmintic dosing regimens to fewer pills (9.4%); and advising patients to purchase medications on the Internet (6.3%). These findings suggest price increases have negatively impacted the diagnosis and treatment of helminth infections in this population, and have resulted in the inability to treat known helminth infections. These findings have significant implications for the morbidity and mortality of infected individuals, as well as for public health in the United States.
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Affiliation(s)
- Madeline Fleit
- Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Hannah Volkman
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Jonathan D Alpern
- HealthPartners Institute, HealthPartners Travel and Tropical Medicine Center, Minneapolis, Minnesota
| | - Alyssa R Lindrose
- Department of Microbiology and Immunology, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - William Stauffer
- Center for Global Health and Social Responsibility, School of Public Health, University of Minnesota, Minneapolis, Minnesota.,Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.,Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Edward Mitre
- Department of Microbiology and Immunology, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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7
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World Gastroenterology Organisation Global Guidelines: Management of Strongyloidiasis February 2018-Compact Version>. J Clin Gastroenterol 2020; 54:747-757. [PMID: 32890112 DOI: 10.1097/mcg.0000000000001369] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Strongyloides stercoralis is a soil-transmitted helminth, but it has a unique life cycle that can be completed in the human host, in a process known as autoinfection. Worldwide, the burden of disease is substantial (300 to 400 million infections). Strongyloidiasis is mainly prevalent in the tropics and subtropics, but there is as yet no global public health strategy for controlling the parasite.
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8
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Zammarchi L, Tilli M, Botta A, Buonfrate D, Bartoloni A, Boccalini S. Strategies for management of strongyloidiasis in migrants from Sub-Saharan Africa recently arrived in Italy: A cost-effectiveness analysis. Travel Med Infect Dis 2020; 36:101561. [PMID: 31982632 DOI: 10.1016/j.tmaid.2020.101561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 01/18/2020] [Accepted: 01/20/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Italian and the European Centre for Disease Control and Prevention guidelines both recommend a systematic serological screening for strongyloidiasis in sub-Saharan migrants (SSA), however, studies on clinical and economic impact of this strategy in the Italian and European settings are lacking. METHODS A population of 100,000 migrants from SSA to Italy was considered and a Markov decision tree model was developed to assess the clinical and economic impact of two interventions for strongyloidiasis compared with the current practice (passive diagnosis of symptomatic cases): a) universal serological screening and treatment with ivermectin in case of positive test b) universal presumptive treatment with ivermectin. One and 10-year time horizon in the health-care perspective were considered. RESULTS In the one and 10-year time horizon respectively the costs for passive diagnosis was €1,164,169 and €9,735,908, those for screening option was € 2,856,011 and € 4,959,638 and those for presumptive treatment was €3,538,474 and € 4,883,272. Considering the cost per cured subject in the one-year time horizon, screening appears more favorable (€209.53), than the other two options (€232.55 per presumptive treatment and €10,197.29 per current strategy). Incremental cost-effectiveness ratio (ICERs) of screening strategy and presumptive treatment were respectively 265.27 and 333.19. The sensitivity analysis identified strongyloidiasis' prevalence as the main driver of ICER. CONCLUSIONS Compared to the current practice (passive diagnosis) both screening and presumptive treatment strategies are more favorable from a cost-effectiveness point of view, with a slight advantage of the screening strategy in a one-year time horizon.
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Affiliation(s)
- Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Referral Center for Tropical Diseases of Tuscany, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy.
| | - Marta Tilli
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Annarita Botta
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Dora Buonfrate
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Referral Center for Tropical Diseases of Tuscany, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Sara Boccalini
- Department of Health Sciences, University of Florence, Italy
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9
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Singer R, Xu TH, Herrera LNS, Villar MJ, Faust KM, Hotez PJ, Aiken ARA, Mejia R. Prevalence of Intestinal Parasites in a Low-Income Texas Community. Am J Trop Med Hyg 2020; 102:1386-1395. [PMID: 32207401 PMCID: PMC7253135 DOI: 10.4269/ajtmh.19-0915] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/09/2020] [Indexed: 01/14/2023] Open
Abstract
Strongyloidiasis affects an estimated hundreds of millions of people worldwide, with infection possibly persisting for life without appropriate therapy because of the helminth's unique autoinfection cycle. Like other soil-transmitted helminths, because of the environmental conditions required for the life cycle of Strongyloides stercoralis, this parasite is endemic to tropical, subtropical, and temperate countries and areas with inadequate sanitation infrastructure. Given continued poverty and that nearly one in five American homes are lacking proper sanitation systems, many U.S. regions are at risk for intestinal parasites. A central Texas community was chosen as the study site, given previous reports of widespread sanitation failure, degree of poverty, and community willingness to participate. A total of 92 households were surveyed and residents tested for nine intestinal parasites using a multi-parallel quantitative real-time polymerase chain reaction and ELISA serology. From 43 stool samples, 27 (62.8%) tested positive for Blastocystis spp. and one (2.3%) for Giardia lamblia. From 97 serum samples, Strongyloides serology detected 16 (16.5%) positive individuals. These high rates of heterokont and helminthic laboratory findings in a peri-urban central Texas community suggest several key policy implications, including that strongyloidiasis should be added to the Texas notifiable conditions list, that clinical suspicion for this infection should be heightened in the region, and that residents without access to functioning and sustainable sanitation infrastructure should be provided that access as a basic human right and to promote public health.
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Affiliation(s)
- Rachael Singer
- Lyndon B. Johnson School of Public Affairs, The University of Texas at Austin, Austin, Texas
| | - Teena Huan Xu
- Department of Pediatrics: Tropical Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Lauren Nicholas S. Herrera
- Department of Pediatrics: Tropical Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Maria Jose Villar
- Department of Pediatrics: Tropical Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Kasey M. Faust
- Department of Civil, Architectural and Environmental Engineering, The University of Texas at Austin, Austin, Texas
| | - Peter J. Hotez
- Department of Pediatrics: Tropical Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Abigail R. A. Aiken
- Lyndon B. Johnson School of Public Affairs, The University of Texas at Austin, Austin, Texas
| | - Rojelio Mejia
- Department of Pediatrics: Tropical Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
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10
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Baker EC, Ming DK, Choudhury Y, Rahman S, Smith PJ, Muñoz J, Chiodini PL, Griffiths CJ, Whitty CJM, Brown M. High Prevalence of Strongyloides among South Asian Migrants in Primary Care-Associations with Eosinophilia and Gastrointestinal Symptoms. Pathogens 2020; 9:E103. [PMID: 32041352 PMCID: PMC7168230 DOI: 10.3390/pathogens9020103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/29/2020] [Accepted: 02/04/2020] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal (GI) symptoms are a frequent reason for primary care consultation, and common amongst patients with strongyloidiasis. We conducted a prospective cohort and nested case control study in East London to examine the predictive value of a raised eosinophil count or of GI symptoms, for Strongyloides infection in South Asian migrants. We included 503 patients in the final analyses and all underwent a standardised GI symptom questionnaire, eosinophil count and Strongyloides serology testing. Positive Strongyloides serology was found in 33.6% in the eosinophilia cohort against 12.5% in the phlebotomy controls, with adjusted odds ratio of 3.54 (95% CI 1.88-6.67). In the GI symptoms cohort, 16.4% were seropositive but this was not significantly different compared with controls, nor were there associations between particular symptoms and Strongyloidiasis. Almost a third (35/115) of patients with a positive Strongyloides serology did not have eosinophilia at time of testing. Median eosinophil count declined post-treatment from 0.5 cells × 109/L (IQR 0.3-0.7) to 0.3 (0.1-0.5), p < 0.001. We conclude Strongyloides infection is common in this setting, and the true symptom burden remains unclear. Availability of ivermectin in primary care would improve access to treatment. Further work should clarify cost-effectiveness of screening strategies for Strongyloides infection in UK migrant populations.
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Affiliation(s)
| | - Damien K. Ming
- Hospital for Tropical Diseases, University College London Hospitals, London WC1E 6JB, UK; (P.L.C.); (C.J.M.W.); (M.B.)
| | - Yasmin Choudhury
- William Harvey Heart Centre, Bart’s and the London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK;
| | | | | | - Jose Muñoz
- Barcelona Centre for International Health Research, 08014 Barcelona, Spain;
| | - Peter L. Chiodini
- Hospital for Tropical Diseases, University College London Hospitals, London WC1E 6JB, UK; (P.L.C.); (C.J.M.W.); (M.B.)
| | - Chris J. Griffiths
- Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK;
| | - Christopher J. M. Whitty
- Hospital for Tropical Diseases, University College London Hospitals, London WC1E 6JB, UK; (P.L.C.); (C.J.M.W.); (M.B.)
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Michael Brown
- Hospital for Tropical Diseases, University College London Hospitals, London WC1E 6JB, UK; (P.L.C.); (C.J.M.W.); (M.B.)
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
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11
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Shetty AK. Infectious Diseases among Refugee Children. CHILDREN (BASEL, SWITZERLAND) 2019; 6:E129. [PMID: 31783605 PMCID: PMC6955676 DOI: 10.3390/children6120129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 11/23/2019] [Indexed: 12/24/2022]
Abstract
In recent years, there has been a substantial increase in refugee and asylum-seeking adults, adolescents and children to high-income countries. Infectious diseases remain the most frequently identified medical diagnosis among U.S.-bound refugee children. Medical screening and immunization are key strategies to reduce the risk of infectious diseases in refugee, internationally adopted, and immigrant children. Notable infectious diseases affecting refugee and other newly arriving migrants include latent or active tuberculosis, human immunodeficiency virus type 1 (HIV), hepatitis B, hepatitis C, vaccine-preventable diseases, malaria, and other parasitic infections. The U.S. Centers for Disease Control and Prevention and the American Academy of Pediatrics have published guidelines for health assessment of newly arriving immigrant, refugee, and internationally adopted children. Although, data on the health risks and needs of refugee exists in some high-income countries, there is an urgent need to develop robust evidence-informed guidance on screening for infectious diseases and vaccination strategies on a broader scale to inform national policies. Innovative approaches to reach migrant communities in the host nations, address health and other complex barriers to improve access to high-quality integrated health services, and strong advocacy to mobilize resources to improve health, safety, and wellbeing for refugee children and their families are urgent priorities.
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Affiliation(s)
- Avinash K Shetty
- Department of Pediatrics and Office of Global Health, Wake Forest School of Medicine and Brenner Children's Hospital, Medical Center Blvd, Winston-Salem, NC 27157, USA
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12
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Immigrant and Refugee Health: A Centers for Disease Control and Prevention Perspective on Protecting the Health and Health Security of Individuals and Communities During Planned Migrations. Pediatr Clin North Am 2019; 66:549-560. [PMID: 31036234 PMCID: PMC6625646 DOI: 10.1016/j.pcl.2019.02.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Migration and forced displacement are at record levels in today's geopolitical environment; ensuring the health of migrating populations and the health security of asylum and receiving countries is critically important. Overseas screening, treatment, and vaccination during planned migration to the United States represents one successful model. These strategies have improved tuberculosis detection and treatment, reducing rates in the United States; decreased transmission and importation of vaccine-preventable diseases; prevented morbidity and mortality from parasitic diseases among refugees; and saved health costs. We describe the work of CDC's Division of Global Migration and Quarantine and partners in developing and implementing these strategies.
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13
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Greenaway C, Castelli F. Infectious diseases at different stages of migration: an expert review. J Travel Med 2019; 26:5307656. [PMID: 30726941 DOI: 10.1093/jtm/taz007] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 01/29/2019] [Accepted: 02/01/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Human migration is increasing in magnitude and scope. The majority of migrants arriving in high-income countries originate from countries with a high prevalence of infectious diseases. The risk and burden of infectious diseases are not equally distributed among migrant groups and vary with migration stage. METHODS A broad literature review was conducted on the drivers for infectious diseases and associated health outcomes among migrants across different stages of migration. The aim was to provide practitioners with an overview of the key infectious disease risks at each stage to guide health promotion strategies. RESULTS A complex interaction of factors leads to infectious diseases and associated poor health outcomes among migrants. The most important drivers are the epidemiology of infectious diseases in their countries of origin, the circumstances and conditions of the migration journey and barriers accessing healthcare post-arrival. During the recent large waves of forced migration into Europe, the primary health concerns on arrival were psychological, traumatic and chronic non-communicable diseases. In the early settlement period, crowded and unhygienic living conditions in reception camps facilitated outbreaks of respiratory, gastrointestinal, skin infections and vaccine preventable diseases. After re-settlement, undetected and untreated latent infections due to tuberculosis, viral hepatitis, HIV, chronic helminthiasis and Chagas' disease led to poor health outcomes. Migrants are disproportionally affected by preventable travel-related diseases such as malaria, typhoid and hepatitis due to poor uptake of pre-travel prophylaxis and vaccination. Infectious diseases among migrants can be decreased at all migration stages with health promotion strategies adapted to their specific needs and delivered in a linguistically and culturally sensitive manner. CONCLUSIONS Tailored health promotion and screening approaches and accessible and responsive health systems, regardless of legal status, will be needed at all migration stages to limit the burden and transmission of infectious diseases in the migrant population.
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Affiliation(s)
- Christina Greenaway
- Division of Infectious Diseases, Jewish General Hospital, McGill University, Montreal, Canada.,Centre for Clinical Epidemiology of the Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Canada.,JD MacLean Centre for Tropical Diseases at McGill, McGill University Health Centre, McGill University, Montreal, Canada
| | - Francesco Castelli
- JD MacLean Centre for Tropical Diseases at McGill, McGill University Health Centre, McGill University, Montreal, Canada.,University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy.,UNESCO Chair 'Training and Empowering Human Resources for Health Development in Resource-Limited Countries', University of Brescia, Brescia, Italy
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14
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Heenan RC, Volkman T, Stokes S, Tosif S, Graham H, Smith A, Tran D, Paxton G. 'I think we've had a health screen': New offshore screening, new refugee health guidelines, new Syrian and Iraqi cohorts: Recommendations, reality, results and review. J Paediatr Child Health 2019; 55:95-103. [PMID: 30094942 DOI: 10.1111/jpc.14142] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/24/2018] [Accepted: 06/28/2018] [Indexed: 11/30/2022]
Abstract
AIM To examine refugee health assessments in Syrian and Iraqi children in the context of changes to offshore immigration screening, updated Australian refugee health guidelines and the primary care refugee health model in Victoria. METHODS This is a retrospective audit of Syrian and Iraqi children aged 0-17 years attending a specialist immigrant health service from January 2015 to September 2017. RESULTS We saw 128 children (7 months-16 years, 64.8% male). Prior to arrival, 58.9% of children had experienced trauma, and 67.9% had missed at least 1 year of school. Almost all children (93.3%) were linked with a regular general practitioner in Australia, and 23.6% children were linked with a refugee health nurse; offshore health records were infrequently available. Of school-aged children, 25% were not enrolled in school 3 months after arrival. Only 2 of 113 (1.8%) children had completed a recommended refugee health assessment, and 55.1% had commenced appropriate catch-up vaccination in primary care. After screening completion, the most prevalent conditions were low vitamin D (63.6%); growth/nutrition (24.2%), neurological/metabolic (16.4%), learning/behaviour (15.6%) and mental health (12.5%) concerns; latent tuberculosis infection (11.8%); and developmental delay (10.2%). Sixteen children required surgery after arrival, and six children had life-threatening medical conditions on arrival - only one had an offshore critical alert; care for the other five children resulted in 133 unanticipated hospital admission days. CONCLUSIONS There are substantial challenges with the current primary care screening model in Victoria. Disability, developmental and mental health concerns were prominent in this cohort, and many children had delays in education access, compounding prior disadvantage.
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Affiliation(s)
- Rachel C Heenan
- Immigrant Health Service, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Thomas Volkman
- Immigrant Health Service, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Simon Stokes
- Immigrant Health Service, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Shidan Tosif
- Immigrant Health Service, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Hamish Graham
- Immigrant Health Service, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Andrea Smith
- Immigrant Health Service, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - David Tran
- Immigrant Health Service, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, Northern Hospital, Melbourne, Victoria, Australia
| | - Georgia Paxton
- Immigrant Health Service, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
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15
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Schroeder JC, Jones D, Maranich A. Peripheral Eosinophilia Found in Pediatric Enterobius vermicularis Infections. Clin Pediatr (Phila) 2019; 58:13-16. [PMID: 30280584 DOI: 10.1177/0009922818805193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Enterobius vermicularis, the common pinworm, is well known in North America as a parasitic infection, mainly affecting children. It is a very contagious organism, and it is responsible for a high number of infections in the United States each year. A rise in eosinophilia is linked to most parasitic infections. However, the correlation between eosinophilia and enterobiasis infections is not well documented in the literature. In this article, we present 3 cases involving patients seen for pediatric gastroenterology consultation with concern for inflammatory bowel disease. As part of their evaluation, each patient was found to have eosinophilia of unknown significance with an ultimate diagnosis of pinworm infections made by endoscopy. Their illness presentation did not include classic enterobiasis symptoms such as rectal pruritus or nighttime irritability. These cases support a link between eosinophilia and enterobiasis that may be instructive for pediatric providers seeing patients with eosinophilia for which there is no readily apparent underlying cause.
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Affiliation(s)
| | - David Jones
- 2 San Antonio Military Medical Center, San Antonio, TX, USA
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16
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Agbata EN, Morton RL, Bisoffi Z, Bottieau E, Greenaway C, Biggs BA, Montero N, Tran A, Rowbotham N, Arevalo-Rodriguez I, Myran DT, Noori T, Alonso-Coello P, Pottie K, Requena-Méndez A. Effectiveness of Screening and Treatment Approaches for Schistosomiasis and Strongyloidiasis in Newly-Arrived Migrants from Endemic Countries in the EU/EEA: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 16:ijerph16010011. [PMID: 30577567 PMCID: PMC6339107 DOI: 10.3390/ijerph16010011] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 12/12/2018] [Accepted: 12/17/2018] [Indexed: 01/08/2023]
Abstract
We aimed to evaluate the evidence on screening and treatment for two parasitic infections-schistosomiasis and strongyloidiasis-among migrants from endemic countries arriving in the European Union and European Economic Area (EU/EEA). We conducted a systematic search of multiple databases to identify systematic reviews and meta-analyses published between 1 January 1993 and 30 May 2016 presenting evidence on diagnostic and treatment efficacy and cost-effectiveness. We conducted additional systematic search for individual studies published between 2010 and 2017. We assessed the methodological quality of reviews and studies using the AMSTAR, Newcastle⁻Ottawa Scale and QUADAS-II tools. Study synthesis and assessment of the certainty of the evidence was performed using GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. We included 28 systematic reviews and individual studies in this review. The GRADE certainty of evidence was low for the effectiveness of screening techniques and moderate to high for treatment efficacy. Antibody-detecting serological tests are the most effective screening tests for detection of both schistosomiasis and strongyloidiasis in low-endemicity settings, because they have higher sensitivity than conventional parasitological methods. Short courses of praziquantel and ivermectin were safe and highly effective and cost-effective in treating schistosomiasis and strongyloidiasis, respectively. Economic modelling suggests presumptive single-dose treatment of strongyloidiasis with ivermectin for all migrants is likely cost-effective, but feasibility of this strategy has yet to be demonstrated in clinical studies. The evidence supports screening and treatment for schistosomiasis and strongyloidiasis in migrants from endemic countries, to reduce morbidity and mortality.
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Affiliation(s)
- Eric N. Agbata
- Faculty of Health Science, University of Roehampton London, London SW15 5PU, UK
- Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
- Correspondence:
| | - Rachael L. Morton
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW 2050, Australia; (R.L.M.); (A.T.); (N.R.)
| | - Zeno Bisoffi
- Centre for Tropical Diseases (CTD), IRCCS Sacro Cuore Don Calabria Negrar, Negrar, 37024 Verona, Italy;
- Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, 155 Nationalestraat, 2000 Antwerp, Belgium;
| | - Christina Greenaway
- Division of Infectious Diseases and Clinical Epidemiology, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC H3A 0G4, Canada;
| | - Beverley-A. Biggs
- Department of Medicine at the Doherty Institute, University of Melbourne, Parkville, VIC 3010, Australia;
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital RMH, Parkville VIC 3050, Australia
| | - Nadia Montero
- Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad Tecnológica Equinoccial, Quito 170509, Ecuador; (N.M.); (I.A.-R.)
| | - Anh Tran
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW 2050, Australia; (R.L.M.); (A.T.); (N.R.)
| | - Nick Rowbotham
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW 2050, Australia; (R.L.M.); (A.T.); (N.R.)
| | - Ingrid Arevalo-Rodriguez
- Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad Tecnológica Equinoccial, Quito 170509, Ecuador; (N.M.); (I.A.-R.)
- Clinical Biostatistics Unit, Hospital Universitario Ramon y Cajal (IRYCIS); CIBER Epidemiology and Public Health (CIBERESP), 28034 Madrid, Spain
| | - Daniel T. Myran
- Bruyere Research Institute, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Teymur Noori
- European Centre for Disease Prevention and Control, Gustav III: s Boulevard 40, 169 73 Solna, Sweden;
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau-CIBERESP), 08025 Barcelona, Spain;
| | - Kevin Pottie
- Centre for Global Health Institute of Population Health, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Ana Requena-Méndez
- ISGlobal, Barcelona Institute for Global Health (ISGlobal-CRESIB, Hospital Clínic-University of Barcelona), E-08036 Barcelona, Spain;
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17
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Mitchell T, Lee D, Weinberg M, Phares C, James N, Amornpaisarnloet K, Aumpipat L, Cooley G, Davies A, Tin Shwe VD, Gajdadziev V, Gorbacheva O, Khwan-Niam C, Klosovsky A, Madilokkowit W, Martin D, Htun Myint NZ, Yen Nguyen TN, Nutman TB, O'Connell EM, Ortega L, Prayadsab S, Srimanee C, Supakunatom W, Vesessmith V, Stauffer WM. Impact of Enhanced Health Interventions for United States-Bound Refugees: Evaluating Best Practices in Migration Health. Am J Trop Med Hyg 2017; 98:920-928. [PMID: 29260657 PMCID: PMC5930906 DOI: 10.4269/ajtmh.17-0725] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
With an unprecedented number of displaced persons worldwide, strategies for improving the health of migrating populations are critical. United States-bound refugees undergo a required overseas medical examination to identify inadmissible conditions (e.g., tuberculosis) 2-6 months before resettlement, but it is limited in scope and may miss important, preventable infectious, chronic, or nutritional causes of morbidity. We sought to evaluate the feasibility and health impact of diagnosis and management of such conditions before travel. We offered voluntary testing for intestinal parasites, anemia, and hepatitis B virus infection, to U.S.-bound refugees from three Thailand-Burma border camps. Treatment and preventive measures (e.g., anemia and parasite treatment, vaccination) were initiated before resettlement. United States refugee health partners received overseas results and provided post-arrival medical examination findings. During July 9, 2012 to November 29, 2013, 2,004 refugees aged 0.5-89 years enrolled. Among 463 participants screened for seven intestinal parasites overseas and after arrival, helminthic infections decreased from 67% to 12%. Among 118 with positive Strongyloides-specific antibody responses, the median fluorescent intensity decreased by an average of 81% after treatment. The prevalence of moderate-to-severe anemia (hemoglobin < 10 g/dL) was halved from 14% at baseline to 7% at departure (McNemar P = 0.001). All 191 (10%) hepatitis B-infected participants received counseling and evaluation; uninfected participants were offered vaccination. This evaluation demonstrates that targeted screening, treatment, and prevention services can be conducted during the migration process to improve the health of refugees before resettlement. With more than 250 million migrants globally, this model may offer insights into healthier migration strategies.
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Affiliation(s)
- Tarissa Mitchell
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Deborah Lee
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michelle Weinberg
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christina Phares
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nicola James
- International Organization for Migration, Bangkok, Thailand
| | | | | | - Gretchen Cooley
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anita Davies
- International Organization for Migration, Bangkok, Thailand
| | | | | | | | | | | | | | - Diana Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Thomas B Nutman
- Laboratory of Parasitic Diseases, National Institutes of Health, Bethesda, Maryland
| | - Elise M O'Connell
- Laboratory of Parasitic Diseases, National Institutes of Health, Bethesda, Maryland
| | - Luis Ortega
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | - William M Stauffer
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.,Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
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18
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Guerrero-Wooley R, Aranda-Aguirre E, Li W, Wilkin A, Palavecino E. Case Report: Strongyloides stercoralis Hyperinfection in a Patient with Chronic Lymphocytic Leukemia. Am J Trop Med Hyg 2017; 97:1629-1631. [PMID: 29140240 DOI: 10.4269/ajtmh.17-0492] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Strongyloides stercoralis is an intestinal nematode that can cause disseminated infection in an immunocompromised host. It is most commonly acquired in developing countries. It was previously a common infection in many parts of the United States, particularly in the Appalachian region, but is rarely identified currently. Here, we describe a patient born and raised in Appalachia, with no history of travel outside the United States, who presented with chronic lymphocytic leukemia and S. stercoralis hyperinfection characterized by acute respiratory failure, altered mental status, and extended-spectrum-beta-lactamase Klebsiella pneumoniae bacteremia. Despite prompt identification of the parasite on sputum microscopy and initiation of therapy with oral ivermectin and meropenem, the patient subsequently died. This case highlights the continued possibility of S. stercoralis infection in patients from Appalachia.
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Affiliation(s)
- Richelle Guerrero-Wooley
- Section on Infectious Diseases, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - Ernesto Aranda-Aguirre
- Section on Infectious Diseases, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - Wencheng Li
- Department of Pathology, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - Aimee Wilkin
- Section on Infectious Diseases, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - Elizabeth Palavecino
- Department of Pathology, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
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19
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ALARCON-VALDES P, ORTIZ-REYNOSO M, SANTILLAN-BENITEZ J. Perspective on the Genetic Response to Antiparasitics: A Review Article. IRANIAN JOURNAL OF PARASITOLOGY 2017; 12:470-481. [PMID: 29317871 PMCID: PMC5756296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Drugs' pharmacokinetics and pharmacodynamics can be affected by diverse genetic variations, within which simple nucleotide polymorphisms (SNPs) are the most common. Genetic variability is one of the factors that could explain questions like why a given drug does not have the desired effect or why do adverse drug reactions arise. METHODS In this retrospective observational study, literature search limits were set within PubMed database as well as the epidemiological bulletins published by the Mexican Ministry of Health, from Jan 1st 2001 to Mar 31st 2017 (16 years). RESULTS Metabolism of antiparasitic drugs and their interindividual responses are mainly modified by variations in cytochrome P450 enzymes. These enzymes show high frequencies of polymorphic variability thus affecting the expression of CYP2C, CYP2A, CYP2A6, CYP2D6, CYP2E6 and CYP2A6 isoforms. Research in this field opens the door to new personalized treatment approaches in medicine. CONCLUSION Clinical and pharmacological utility yield by applying pharmacogenetics to antiparasitic treatments is not intended as a mean to improve the prescription process, but to select or exclude patients that could present adverse drug reactions as well as to evaluate genetic alterations which result in a diversity of responses, ultimately seeking to provide a more effective and safe treatment; therefore choosing a proper dose for the appropriate patient and the optimal treatment duration. Furthermore, pharmacogenetics assists in the development of vaccines. In other words, the aim of this discipline is to find therapeutic targets allowing personalized treatments.
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