Presumptive Treatment and Medical Screening for Parasites in Refugees Resettling to the United States
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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.
KeywordsIntestinal parasites Schistosomiasis Refugees Presumptive therapy Screening Strongyloidiasis
- 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.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.
- 7.Mody RK. Intestinal parasites. In: Walker PF, Barnett ED, editors. Immigrant medicine, vol. 1. 1st ed. Philadelphia: Elsevier; 2007.Google Scholar
- 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
- 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
- 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.