High prevalence and presumptive treatment of schistosomiasis and strongyloidiasis among African refugees.
BACKGROUND
Schistosomiasis and strongyloidiasis cause substantial morbidity and mortality among hundreds of millions of infected persons worldwide. In the United States, these infections are most commonly found among international travelers, immigrants, and refugees from areas of endemicity. Refugees resettled to the United States since 2000 include >3800 "Lost Boys and Girls" of Sudan and 8000 Somali Bantu. Many Lost Boys and Girls of Sudan reported chronic abdominal pain only since arrival, and some received diagnoses of schistosomiasis or strongyloidiasis. We assessed seroprevalence of these infections among these refugees and hypothesized an association between infection and abdominal pain.


METHODS
We offered a survey assessing chronic abdominal pain and serologic testing for schistosomiasis and strongyloidiasis to all 800 attendees of a Lost Boys and Girls of Sudan reunion in the United States. Serologic testing was performed on preimmigration specimens obtained from 100 United States-bound Somali Bantu refugees.


RESULTS
Of the 462 Sudanese refugees (58%) tested, 44% and 46% were seropositive for schistosomiasis (primarily due to Schistosoma mansoni) and strongyloidiasis, respectively; 24% of those who tested positive for schistosomiasis had S. mansoni antigenemia. Forty-six percent reported chronic abdominal pain, which was not associated with either infection. Among 100 Somali Bantu, 73% and 23% tested seropositive for schistosomiasis (primarily due to Schistosoma haematobium) and strongyloidiasis, respectively.


CONCLUSIONS
The high seroprevalence of schistosomiasis and strongyloidiasis among Sudanese Lost Boys and Girls and Somali Bantu refugees supports presumptive treatment for these refugees. Current refugee resettlement policies inadequately address these diseases; our data support consideration of predeparture presumptive therapy for all refugees from areas of endemicity.
Posey
Drew L
DL
Division of Global Migration and Quarantine, National Center for Preparedness, Detection, and Control of Infectious Diseases, Atlanta, GA 30333, USA. dposey@cdc.gov
Blackburn
Brian G
BG
Weinberg
Michelle
M
Flagg
Elaine W
EW
Ortega
Luis
L
Wilson
Marianna
M
Secor
W Evan
WE
Sanders-Lewis
Kolby
K
Won
Kimberly
K
Maguire
James H
JH
D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000947:Antigens, Helminth / Q000097:blood; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012036:Refugees; D012548:Schistosoma haematobium / Q000276:immunology; D012550:Schistosoma mansoni / Q000276:immunology; D012552:Schistosomiasis / Q000188:drug therapy* / Q000453:epidemiology*; D016036:Seroepidemiologic Studies; D012998:Somalia / Q000208:ethnology; D013322:Strongyloidiasis / Q000188:drug therapy* / Q000453:epidemiology*; D013397:Sudan / Q000208:ethnology; D014481:United States / Q000453:epidemiology
D000947:Antigens, Helminth