Volume 80, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


Centers for Disease Control guidelines for schistosomiasis and strongyloidiasis in Sudanese and Somali refugees are not widely implemented. Given limited prevalence data, we conducted a seroprevalence study of schistosomiasis, strongyloidiasis, and loiasis in Sudanese refugees across diverse ages. Sudanese refugees, ages 4–78, were recruited via community organizations. Half of the patients (86/172), were seropositive for schistosomiasis (46/171; 26.9%), strongyloidiasis (56/172; 33%), or both (16/171; 9.4%). No infections were detected. Infection rates were similar in adults and children except that no schistosomiasis was detected in children < 4 years of age at the time of immigration to the United States. The high prevalence of schistosomiasis and strongyloidiasis in a community-based sample of Sudanese confirms the urgency for compliance with CDC refugee health guidelines. We detected no co-infection with using the most sensitive serologic techniques, allowing use of ivermectin, the most effective treatment of strongyloidiasis.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. United States Department of Homeland Security, 2007. Yearbook of Immigration Statistics: 2006. Washington, D.C: Office of Immigration Statistics.
  2. Centers for Disease Control and Prevention, 2005. Recommendations for Presumptive Treatment of schistosomiasis and strongyloidiasis among the Lost Boys and Girls of Sudan. January 21. Available at: http://www.cdc.gov/ncidod/dq/pdf/LostBoysandGirlsPresumptiveTreatmentRecommendations.pdf. Accessed April 9, 2008.
  3. Centers for Disease Control and Prevention, 2005. Updated: Recommendations for Presumptive Treatment of schistosomiasis and strongyloidiasis among the Lost Boys and Girls of Sudan. June 14. Available at: http://www.cdc.gov/ncidod/dq/pdf/Overseas_Domestic_Pres_Tx_Rec_Sudanese_6-13-05.pdf. Accessed April 9, 2008.
  4. Centers for Disease Control and Prevention, 2008. Refugee Health Guidelines: Intestinal Parasites Overseas Recommendations. August 28. Available at: http://www.cdc.gov/ncidod/dq/refugee/rh_guide/. Accessed November 3, 2008.
  5. Posey DL, Blackburn BG, Weinberg M, Flagg EW, Ortega L, Wilson M, Secor WE, Sanders-Lewis K, Won K, Maguire JH, 2007. High prevalence and presumptive treatment of schistosomiasis and strongyloidiasis among African refugees. Clin Infect Dis 45: 1310–1315. [Google Scholar]
  6. Keystone JS, 2007. Can one afford not to screen for parasites in high-risk immigrant populations? Clin Infect Dis 45: 1316–1318. [Google Scholar]
  7. Marti H, Haji HJ, Savioli L, Chwaya HM, Mgeni AF, Ameir JS, Hatz C, 1996. A comparative trial of a single-dose ivermectin versus three days of albendazole for treatment of Strongyloides stercoralis and other soil-transmitted helminth infections in children. Am J Trop Med Hyg 55: 477–481. [Google Scholar]
  8. Twum-Danso NA, 2003. Loa loa encephalopathy temporally related to ivermectin administration reported from onchocerciasis mass treatment programs from 1989 to 2001: implications for the future. Filaria J 2: 7S. [Google Scholar]
  9. Muennig P, Pallin D, Sell RL, Chan MS, 1999. The cost effectiveness of strategies for the treatment of intestinal parasites in immigrants. N Engl J Med 340: 773–779. [Google Scholar]
  10. Burbelo PD, Ramanathan R, Klion AD, Iadarola MJ, Nutman TB, 2008. Rapid, novel, specific, high-throughput assay for diagnosis for Loa loa infection. J Clin Microbiol 46: 2298–2304. [Google Scholar]
  11. Ramanathan R, Burbelo PD, Groot S, Iadarola MJ, Neva FA, Nutman TB, 2008. A luciferase immunoprecipitation systems assay enhances the sensitivity and specificity of diagnosis of Strongyloides stercoralis infection. J Infect Dis 198: 444–451. [Google Scholar]
  12. Tsang VC, Wilkins PP, 1997. Immunodiagnosis of schistosomiasis. Immunol Invest 26: 175–188. [Google Scholar]
  13. Segarra-Newnham M, 2007. Manifestations, diagnosis, and treatment of Strongyloides stercoralis infection. Ann Pharmacother 41: 1992–2001. [Google Scholar]
  14. Marcos LA, Terashima A, DuPont HL, Gotuzzo E, 2008. Strongyloides hyperinfection syndrome: an emerging global infectious disease. Trans R Soc Trop Med Hyg 102: 314–318. [Google Scholar]
  15. Lam CS, Tong MK, Chan KM, Siu YP, 2006. Disseminated strongyloidiasis: a retrospective study of clinical course and outcome. Eur J Clin Microbiol Infect Dis 25: 14–18. [Google Scholar]
  16. Muennig P, Pallin D, Challah C, Khan K, 2004. The cost-effectiveness of ivermectin vs. albendazole in the presumptive treatment of strongyloidiasis in immigrants to the United States. Epidemiol Infect 132: 1055–1063. [Google Scholar]
  17. Ross AG, Bartley PB, Sleigh AC, Olds GR, Li Y, Williams GM, McManus DP, 2002. Schistosomiasis. N Engl J Med 346: 1212–1220. [Google Scholar]
  18. Gryseels B, Polman K, Clerinx J, Kestens L, 2006. Human schistosomiasis. Lancet 368: 1106–1118. [Google Scholar]
  19. Berhe N, Myrvang B, Gundersen SG, 2008. Reversibility of schistosomal periportal thickening/fibrosis after praziquantel therapy: a twenty-six month follow-up study in Ethiopia. Am J Trop Med Hyg 78: 228–234. [Google Scholar]
  20. Siddiqui AA, Berk SL, 2001. Diagnosis of Strongyloides stercoralis infection. Clin Infect Dis 33: 1040–1047. [Google Scholar]
  21. de Vlas SJ, Gryseels B, 1992. Underestimation of Schistosoma mansoni prevalences. Parasitol Today 8: 274–277. [Google Scholar]
  22. Nutman TB, Miller KD, Mulligan M, Ottesen EA, 1986. Loa loa infection in temporary residents of endemic regions: recognition of a hyperresponsive syndrome with characteristic clinical manifestations. J Infect Dis 154: 10–18. [Google Scholar]
  23. Dupont A, Zue-N’dong J, Pinder M, 1988. Common occurrence of amicrofilaraemic Loa loa filariasis within the endemic region. Trans R Soc Trop Med Hyg 82: 730. [Google Scholar]
  24. Ravi V, Ramachandran S, Thompson RW, Andersen JF, Neva FA, 2002. Characterization of a recombinant immunodiagnostic antigen (NIE) from Strongyloides stercoralis L3-stage larvae. Mol Biochem Parasitol 125: 73–81. [Google Scholar]
  25. Loutfy MR, Wilson M, Keystone JS, Kain KC, 2002. Serology and eosinophil count in the diagnosis and management of strongyloidiasis in a non-endemic area. Am J Trop Med Hyg 66: 749–752. [Google Scholar]
  26. Yori PP, Kosek M, Gilman RH, Cordova J, Bern C, Chavez CB, Olotegui MP, Montalvan C, Sanchez GM, Worthen B, Worthen J, Leung F, Ore CV, 2006. Seroepidemiology of strongyloidiasis in the Peruvian Amazon. Am J Trop Med Hyg 74: 97–102. [Google Scholar]
  27. Franco-Paredes C, Dismukes R, Nicolls D, Hidron A, Workowski K, Rodriguez-Morales A, Wilson M, Jones D, Manyang P, Kozarsky P, 2007. Persistent and untreated tropical infectious diseases among Sudanese refugees in the United States. Am J Trop Med Hyg 77: 633–635. [Google Scholar]
  28. Gardon J, Gardon-Wendel N, Demanga N, Kamgno J, Chippaux JP, Boussinesq M, 1997. Serious reactions after mass treatment of onchocerciasis with ivermectin in an area endemic for Loa loa infection. Lancet 350: 18–22. [Google Scholar]
  29. Nutman TB, 2006. Asymptomatic peripheral blood eosinophilia redux: common parasitic infections presenting frequently in refugees and immigrants. Clin Infect Dis 42: 368–369. [Google Scholar]
  30. Libman MD, MacLean JD, Gyorkos TW, 1993. Screening for schistosomiasis, filariasis, and strongyloidiasis among expatriates returning from the tropics. Clin Infect Dis 17: 353–359. [Google Scholar]
  31. Seybolt LM, Christiansen D, Barnett ED, 2006. Diagnostic evaluation of newly arrived asymptomatic refugees with eosinophilia. Clin Infect Dis 42: 363–367. [Google Scholar]
  32. Geltman PL, Cochran J, Hedgecock C, 2003. Intestinal parasites among African refugees resettled in Massachusetts and the impact of an overseas pre-departure treatment program. Am J Trop Med Hyg 69: 657–662. [Google Scholar]

Data & Media loading...

  • Received : 17 Sep 2008
  • Accepted : 26 Nov 2008

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error