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Evaluation of the Impact of Overseas Pre-departure Treatment for Infection with Intestinal Parasites among Montagnard Refugees Migrating from Cambodia to North Carolina

We evaluated the effectiveness of an overseas pre-departure regimen of five days of albendazole for presumptive treatment of intestinal parasites by examining stool specimens in treated and untreated Montagnard refugees after arrival in the United States. Among 815 refugees evaluated, fully treated refugees had a significantly lower prevalence of helminths (11 [1.4%] of 777), specifically hookworm and Ascaris lumbricoides, than untreated pregnant women (3 [20%] of 15) (P < 0.001). Multivariate analysis showed that treatment was associated with significantly lower rates of infection with helminths but not protozoa. Post-arrival gastrointestinal symptoms were not associated with findings on stool examination. Our evaluation suggests that although additional studies are needed to determine optimal treatment regimens for intestinal parasites, especially among young children and pregnant women, a five-day course of pre-departure albendazole was effective in reducing helminthic infection in treated refugees.

Received August 15, 2007. Accepted for publication February 11, 2008.

Acknowledgments: We thank Suzanne Wahlquist, John MacArthur, David Addiss, and Henry Bishop (Division of Parasitic Diseases, CDC, Atlanta, GA) for their work in the laboratory and support of clinical management of infected refugees in North Carolina; George Robertson for laboratory support and Rehan Mohammad for information technology assistance at NCSLPH; the Los Angeles Quarantine Station staff and Annelise Casano for data management assistance in the Division of Global Migration and Quarantine, CDC (Atlanta, GA); Jean-Marie Maillard for support in the Communicable Disease Control Branch, North Carolina Division of Public Health; Phyllis Stevens, Debbie Turner, Lou Cook, Bernie Ihland, and the staffs of Guilford, Mecklenberg, Wake, Forsyth, and Craven counties for their implementation of the enhanced refugee health program in North Carolina; Maria Cano, Ulana Bodnar, David Kim, and Kevin Yeskey for their clinical support; Heather Wachtel, Anthony Albert, Rey Fernandez, and Joyce Elmore for assisting with medical record abstraction in North Carolina; and Linda Ekwenugo, Steve Goard, Shirley Gibson, and Recordo Gibson for data entry at CDC in Atlanta.

Disclaimer: The findings and conclusions in this report are those of the author(s) and do not necessarily represent the views of the funding agency.

Disclosure: J. Jina Shah is currently working for Novartis Vaccines. Work for this paper was done prior to employment with Novartis, and there is no conflict of interest.

^* Address correspondence to J. Jina Shah, Novartis Vaccines, 4560 Horton Street, MS X-600A, Emeryville, CA 94608. E-mail: jina.shah{at}gmail.com

Authors’ addresses: J. Jina Shah, Novartis Vaccines, 4560 Horton Street, MS X-600A, Emeryville, CA 94608, Tel: 510-923-5509, Fax: 510-923-3450, E-mail: jina.shah{at}gmail.com. Susan A. Maloney, International Emerging Infections Program, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop D59, Atlanta, GA 30329-4018, Tel: 404-639-4448, Fax: 404-639-4441. Yecai Liu and Martin S. Cetron, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329-4018, Tel: 404-498-1600, Fax: 404-639-4441. Elaine W. Flagg, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E46 Atlanta, GA 30329-4018. Stephanie P. Johnston and Patricia P. Wilkins, Division of Parasitic Diseases, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop F36, Atlanta, GA 30341-3717, Tel: 770-488-7044, Fax: 770-488-3115. Suzanna A. Young, Refugee Health Program, North Carolina Division of Public Health, Department of Health and Human Services, 5505 Six Forks Road, 1915 MSC, Raleigh, NC 27699-1915, Tel: 919-707-5204, Fax: 919-870-4800. Robert Weston, Omak Clinic, 916 Koala Drive, Omak, WA 98841, Tel: 509-826-1800, Fax: 509-826-7916. Samuel Merritt, North Carolina State Laboratory of Public Health, 306 North Wilmington Street, PO Box 28047, Mail Service Center 1918, Raleigh, NC 27611-8047. Vincent Keane, 84 Napier Street, Cottesloe, Western Australia, 6011, Australia, Tel: 61-8-9385-2450. Jaime Calderon, International Organization for Migration, Surya Building Floor 12A, JI. M. H. Thamrin Kav. 9, Jakarta 10350, Indonesia, Tel: 62-21-3983-8528, Fax: 62-21-3983-8528. Donald J. Sharp, Centers for Disease Control and Prevention, Mailstop G24, 1600 Clifton Road, NE, Atlanta, GA 30333. Louise Causer, National Centre in HIV Epidemiology and Clinical Research, Sydney, New South Wales 2052 Australia, Tel: 61-2-9385-0900, Fax: 61-2-9385-1874. James H. Maguire, University of Maryland School of Medicine, 660 West Redwood Street, Howard Hall, Suite 100, Room 102B, Baltimore, MD 21201, Tel: 410-706-0206, Fax: 410-706-8013.