246793 Helminth infections in Northern California refugees are declining

Monday, October 31, 2011: 3:24 PM

Alicia Chang, MD , Division of Infectious Diseases, Stanford University School of Medicine, Stanford, CA
Jenny NT Du, MPH , Division of Infectious Diseases, Stanford University School of Medicine, Stanford, CA
Abdulkareem Agunbiade, BS , Division of Infectious Diseases, Stanford University School of Medicine, Stanford, CA
Sharon Perry, PhD , Division of Infectious Diseases, Stanford University School of Medicine, Stanford, CA
Maria de Luz Sanchez, BA , Division of Infectious Diseases, Stanford University School of Medicine, Stanford, CA
Shufang Yang, BS , Division of Infectious Diseases, Stanford University School of Medicine, Stanford, CA
Gulshan Bhatia, MRCP , Tuberculosis Clinic and Refugee Health Assessment Program, Santa Clara Valley Health and Hospital System, San Jose, CA
Julie Parsonnet, MD , Division of Infectious Diseases, Stanford University School of Medicine, Stanford, CA
Background: Each year, the United States (U.S.) welcomes between 50-70,000 refugees, many from countries with a high prevalence of intestinal parasites. Consequently, the CDC promulgated recommendations for presumptive pre-departure treatment of refugees. Objective: To compare the prevalence of intestinal helminths and protozoa among refugees at the Santa Clara County, California, Refugee and Tuberculosis Clinic from 2008-2010 with the prevalence reported in a prior survey from 2001-2004. Methods: Refugees living in the U.S. for less than two years and between the ages of 18 and 55 provided three stool specimens on different days. Parasite infection was determined by presence of ova or parasites in at least 1/3 stools. Results: In the 2008-2010 cohort, of 231 participants, 97.5% had been U.S. residents for less than one year. We found stool parasites in 12.6%, similar to the prior survey (16.4%, p=0.2). The most common infections were Entamoeba histolytica (3.9%), Giardia lamblia (3.9%), and Strongyloides stercolaris (0.9%). Protozoa were more common among refugees from South Asia (OR: 3.1 [1.4-6.6]) and Africa (OR: 2.6 [1.03-6.5]) than among those from the Middle East. Helminths were mainly identified in immigrants from South Asia (6/7 cases). Although the rates of protozoa infection were similar in the two cohorts(10.8%, 2008-2010 vs. 8.6%, 2001-2004, p=0.2), the rate of helminth infection was significantly lower in recent years (1.7% vs 7.9%, p<0.001). Conclusion: Helminth infections are uncommon in recent immigrants. Pre-departure treatment programs may have contributed to this finding, but further studies are needed to specifically address program penetrance and efficacy.

Learning Areas:
Epidemiology

Learning Objectives:
To compare the prevalence of intestinal helminths and protozoa among refugees at the Santa Clara County, California, Refugee and Tuberculosis Clinic from 2008-2010 with the prevalence reported in a prior survey from 2001-2004.

Keywords: Refugees, Infectious Diseases

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I assisted in the analysis of the data and writing of the abstract.
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.