Current Infectious Disease Reports

, Volume 15, Issue 3, pp 222–231

Presumptive Treatment and Medical Screening for Parasites in Refugees Resettling to the United States

  • William M. Stauffer
  • Paul T. Cantey
  • Susan Montgomery
  • LeAnne Fox
  • Monica E. Parise
  • Olga Gorbacheva
  • Michelle Weinberg
  • Annelise Doney
  • Lisa Rotz
  • Martin S. Cetron
Tropical, Travel and Emerging Infections (L Chen, Section Editor)

Abstract

More than 50,000 refugees are resettled to the United States annually, many from areas highly endemic for parasites. Some of these infections present little clinical consequence after migration, but others are responsible for morbidity and mortality. The Centers for Disease Control and Prevention has issued predeparture presumptive treatment and postarrival medical guidelines for the management of parasites. Although these guidelines are evidence based, there remain significant challenges to presumptive treatment programs in refugees. Gaps in the evidence continue; resettling populations are continually changing, thus altering the epidemiology; and there are logistical and cost barriers to fully implementing recommendations. This article will review the evolution and status of current guidelines, as well as identify gaps and challenges to full implementation. It is imperative for clinicians serving this population to be familiar with interventions received by refugees, since previous treatment will impact screening, diagnostic evaluation, and treatment decisions.

Keywords

Intestinal parasites Schistosomiasis Refugees Presumptive therapy Screening Strongyloidiasis 

References

  1. 1.
    United Nations High Commissioner for Refugees. Global Trends in 2012. 60 years and still counting. [Accessed May 21, 2012]. Available from http://www.unhcr.org/4dfa11499.html.
  2. 2.
    United States Department of State, 2012. Proposed refugee admission guidelines for fiscal year 2012; report to Congress. [Accessed May 21, 2012] Available from http://www.state.gov/documents/organization/181378.pdf.
  3. 3.
    de Silva NR, Booker S, Hotez PJ, et al. Soil-transmitted helminth infections: updating the global picture. Trends Parasitol. 2003;19:547–51.PubMedCrossRefGoogle Scholar
  4. 4.
    Bethony J, Brooker S, Albonico M, et al. Soil-transmitted helminth infections: Ascaris, trichuriasis, and hookworm. Lancet. 2006;367:1521–32.PubMedCrossRefGoogle Scholar
  5. 5.
    Hotez PJ, Molyneux DH, Fenwick A, et al. Control of neglected tropical diseases. N Engl J Med. 2007;357:1018–27.PubMedCrossRefGoogle Scholar
  6. 6.
    Peterson MH, Konczyk MR, Ambrosino K, et al. Parasitic screening of a refugee population in Illinois. Diagn Microbiol Infect Dis. 2001;40(1):75–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Mody RK. Intestinal parasites. In: Walker PF, Barnett ED, editors. Immigrant medicine, vol. 1. 1st ed. Philadelphia: Elsevier; 2007.Google Scholar
  8. 8.
    Lurio J, Verson H, Karp S. Intestinal Parasites in Cambodians: comparison of diagnostic methods used in screening refugees with implications for treatment of populations with high rates of infestation. J Am Board Fam Pract. 1991;4:71–8.PubMedGoogle Scholar
  9. 9.
    Miller JM, Boyd HA, Ostrowski SR, et al. Malaria, intestinal parasites, and schistosomiasis among Barawan Somali refugees resettling to the U.S.: A strategy to reduce morbidity and decrease the risk of imported infections. Am J Trop Med Hyg. 2000;62:115–21.PubMedGoogle Scholar
  10. 10.
    Muennig P, Pallin D, Sell RL, Chan MS. The cost effectiveness of strategies for the treatment of intestinal parasites in immigrants. N Engl J Med. 1999;340:773–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Swanson SJ, Phares CR, Mamo B, et al. Albendazole therapy and enteric parasites in United States-bound refugees. N Engl J Med. 2012;366:1498–507.PubMedCrossRefGoogle Scholar
  12. 12.
    Geltman PL, Cochran J, Hedgecock C. Intestinal parasites among African refugees resettled in Massachusetts and the impact of an overseas predeparture treatment program. Am J Trop Med Hyg. 2003;69:657–62.PubMedGoogle Scholar
  13. 13.
    Posey DL, Blackburn BG, Weinberg M, et al. High prevalence and presumptive treatment of schistosomiasis and strongyloides among African refugees. Clin Infect Dis. 2007;45(10):1210–5.CrossRefGoogle Scholar
  14. 14.
    Caruana SR, Kelly HA, Ngeow JY, et al. Undiagnosed and potentially lethal parasite infections among immigrants and refugees in Australia. J Trav Med. 2006;13:233–9.CrossRefGoogle Scholar
  15. 15.
    Boulware DR, Stauffer WM, Hendel-Paterson BR, Rocha J, et al. Maltreatment of Strongyloides infection: case series and worldwide physician–in-training survey. Am J Med. 2007;120(60):545;e1-8.Google Scholar
  16. 16.
    de Silva S, Saykao P, Kelly H, et al. Chronic Strongyloides stercoralis infection in Laotian immigrants and refugees 7–20 years after resettlement in Australia. Epidemiol Infect. 2002;128(3):439–44.PubMedCrossRefGoogle Scholar
  17. 17.
    Lim S, Katz K, Krajden S, et al. Complicated and fatal Strongyloides infection in Canadians: risk factors, diagnosis and management. CMAJ. 2004;171:479–84.PubMedGoogle Scholar
  18. 18.
    Newberry AM, Williams DN, Stauffer WM, et al. Strongyloides hyperinfection presenting as acute respiratory failure and gram-negative sepsis. Chest. 2005;128(5):3681–4.PubMedCrossRefGoogle Scholar
  19. 19.
    Gill GV, Beeching NJ, Khoo S, et al. A British Second World War veteran with disseminated strongyloides. Trans Roy Soc Trop Med Hyg. 2004;98:382–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Orem J, Mayanja B, Okongo M, Morgan D. Strongyloides stercoralis hyperinfection in a patient with AIDS in Uganda successfully treated with ivermectin. Clin Infect Dis. 2003;37(1):152–3.PubMedCrossRefGoogle Scholar
  21. 21.
    Ross AGP, Bartley PB, Sleigh AC, et al. Schistosomiasis. N Engl J Med. 2002;346(16):1212–20.PubMedCrossRefGoogle Scholar
  22. 22.
    Aryeetey ME, Wagnatsuma Y, Yegoah G, et al. Urinary schistosomiasis in southern Ghana: 1. prevalence and morbidity assessment in three (defined) rural areas drained by the Densu River. Parasitol Int. 2000;49(2):155–63.PubMedCrossRefGoogle Scholar
  23. 23.
    Seybolt LM, Christiansen D, Barnett ED. Diagnostic evaluation of newly arrived asymptomatic refugees with eosinophilia. Clin Infect Dis. 2006;42(3):363–7.PubMedCrossRefGoogle Scholar
  24. 24.
    Summer AP, Stauffer W, Maroushek SR, Nevins TE. Hematuria in children due to schistosomiasis in a non-endemic setting. Clin Pediatr. 2006;45(2):177–81.CrossRefGoogle Scholar
  25. 25.
    Rotger M, Serra T, de Cardenas MG, et al. Increasing incidence of imported schistosomiasis in Mallorca, Spain. Eur J Clin Microbiol Infect Dis. 2004;13(11):855–6.CrossRefGoogle Scholar
  26. 26.
    Kameh D, Smith A, Brock MS, et al. Female genital schistosomiasis: case report and review of the literature. South Med J. 2004;97(5):525–7.PubMedCrossRefGoogle Scholar
  27. 27.
    O’Brien DP, Leder K, Matchett E, et al. Illness in returned travelers and immigrants/refugees: the 6-year experience of two Australian infectious disease units. J Trav Med. 2006;13:145–52.CrossRefGoogle Scholar
  28. 28.
    Spicher VM, Genin B, Jordan AR, et al. Peritoneal schistosomiasis: an unusual laparoscopic finding. J Pediatr Surg. 2004;39(4):631–3.PubMedCrossRefGoogle Scholar
  29. 29.
    Ranque S, Chippaux J, Garcia A, Boussinesq M. Follow-up of Ascaris lumbricoides and Trichuris trichiura infections in children living in a community treated with ivermectin at 3-monthly intervals. Ann Trop Med Parasitol. 2001;95(4):389–93.PubMedCrossRefGoogle Scholar
  30. 30.
    Marti H, Haji HJ, Savioli L, et al. A comparative trial of a single-dose ivermectin versus three days of albendazole for treatment of Strongyloides stercoralis and other soil-transmitted helminth infections in children. Am J Trop Med Hyg. 1996;55(5):477–81.PubMedGoogle Scholar
  31. 31.
    Muennig P, Pallin D, Challah C, Khan K. The cost-effectiveness of ivermectin vs. albendazole in the presumptive treatment of strongyloides in immigrants to the United States. Epidemiol Infect. 2004;132(6):1055–63.PubMedCrossRefGoogle Scholar
  32. 32.
    Stauffer WM, Sellman JS, Walker PF. Biliary liver flukes (Opisthorciasis and Clonorhiasis) in immigrants in the United States: often subtle and diagnosed years after arrival. J Trav Med. 2004;11(3):157–60.Google Scholar
  33. 33.
    O’Neal SE, Townes JM, Wilkins PP, et al. Seroprevalence of antibodies against Taenia solium cysticerci among refugees resettled in United States. Emerg Infect Dis. 2012;18(3):431–8.PubMedCrossRefGoogle Scholar
  34. 34.
    World Health Organization. Preventive chemotherapy in human helminthiasis. Coordinated use of antihelminthic drugs in control interventions: a manual for health professionals and programme managers. WHO Press, World Health Organization, Geneva, Switzerland. Available at: http://whqlibdoc.who.int/publications/2006/9241547103_eng.pdf . Last accessed, July 10, 2012.

Copyright information

© Springer Science+Business Media New York (outside the USA) 2013

Authors and Affiliations

  • William M. Stauffer
    • 1
    • 5
  • Paul T. Cantey
    • 2
  • Susan Montgomery
    • 2
  • LeAnne Fox
    • 2
  • Monica E. Parise
    • 2
  • Olga Gorbacheva
    • 3
    • 4
  • Michelle Weinberg
    • 5
  • Annelise Doney
    • 5
  • Lisa Rotz
    • 5
  • Martin S. Cetron
    • 5
  1. 1.Department of Medicine, Division of Infectious Diseases and International MedicineUniversity of MinnesotaMinneapolisUSA
  2. 2.Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and PreventionAtlantaUSA
  3. 3.International Organization for MigrationGenevaSwitzerland
  4. 4.International Organization for MigrationKathmanduNepal
  5. 5.Division of Global Migration and QuarantineCenters for Disease Control and PreventionAtlantaUSA

Personalised recommendations