177119 Community Based Parasitic Screening and Treatment of Sudanese Refugees: Lack of Loa loa Co-Infection and Implications for Treatment

Monday, October 27, 2008: 1:30 PM

Judith Harbertson, PhD, MPH , Department of Epidemiology & Threat Assessment, U.S. Military HIV Research Program (MHRP), San Diego, CA
Anne G. Thomas, PhD , Graduate School of Public Health, San Diego State University, Coronado, CA
Sharon Reed, MD , UCSD Medical Center, San Diego, CA
John A.D. Leake, MD, MPH , Children's Hospital and Health Center, San Diego, CA
Kathleen Moser, MD, MPH , San Diego County Health and Human Services Agency, San Diego, CA
Thomas B. Nutman, MD , Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD
Jamie L. Wolf, BS , Graduate School of Public Health, San Diego State University, San Diego, CA
Stephanie K. Brodine, MD , Graduate School of Public Health, San Diego State University, San Diego, CA
Objectives: A 2004 CDC study of the Lost Boys and Girls of Sudan resettled refugees (ages 21-30) reported a 69% prevalence of schistosomiasis and strongyloidiasis, prompting guidelines for empiric therapy on arrival to the U.S. Despite the fact that these chronic parasitic infections are associated with significant morbidity and mortality, these recommendations have not been widely implemented. Additionally, data is limited on the prevalence of these infections in more diverse Sudanese refugee groups, particularly children and females, and the frequency of co-infection with Loa loa, which precludes use of ivermectin. Seroprevalence of schistosomiasis, strongyloidiasis and Loa loa were assessed in a community based sample of resettled Sudanese refugees.

Methods: Sudanese refugee families were recruited via community organizations for a questionnaire, including geographic exposures, history of chronic abdominal pain, physical exam, serologic parasitic screening, and treatment.

Results: Nearly half of the 173 Sudanese (86/173; 49%), were infected with either schistosomiasis (45/170; 26%), strongyloidiasis (57/173; 33%), or both (16/170; 9%). There were no associations between age and likelihood of infection, aside from no schistosomiasis infections in children under 3. There were no Loa loa infections and ivermectin was provided to all participants. There was a strong community response to participation in the study and desire for screening and treatment.

Conclusions: High infection rates of schistosomiasis and strongyloidiasis in a community based sample of Sudanese confirm the urgency for compliance with CDC guidelines for empiric therapy. Co-infection with Loa loa may be lower than estimated, allowing more effective therapy for strongyloidiasis.

Learning Objectives:
1.Describe the prevalence of schistosomiasis, strongyloidiasis and Loa loa in a community based sample of Sudanese resettled refugees. 2.Discuss the implementation of current treatment guidelines for schistosomiasis, strongyloidiasis and Loa loa in Sudanese refugees. 3.Develop a community outreach approach and determine appropriate treatment for resettled Sudanese in the local community.

Keywords: Refugees, Disease Management

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was directly involved with collection, data entry and analysis of this data.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.