Silvia F , Simona F , Fabrizio B , 2018. Solid organ transplant and parasitic diseases: a review of the clinical cases in the last two decades. Pathogens 7: 65.
La Hoz RM , Morris MI , AST Infectious Diseases Community of Practice , 2019. Intestinal parasites including Cryptosporidium, Cyclospora, Giardia, and Microsporidia, Entamoeba histolytica, Strongyloides, Schistosomiasis, and Echinococcus: guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 33: e13618.
Miglioli-Galvão L et al.2020. Severe Strongyloides stercoralis infection in kidney transplant recipients: a multicenter case–control study. PLoS Negl Trop Dis 14: e0007998.
Krolewiecki A , Nutman TB , 2019. Strongyloidiasis: a neglected tropical disease. Infect Dis Clin North Am 33: 135–151.
Sobh MA , el-Agroudy AE , Moustafa FE , Shokeir AA , el-Shazly A , Ghoneim MA , 1992. Impact of schistosomiasis on patient and graft outcome after kidney transplantation. Nephrol Dial Transplant 7: 858–864.
Shokeir AA , Bakr MA , el-Diasty TA , Sobh MA , Moustafa FE , el-Agroudi AE , Ghoneim MA , 1992. Urological complications following live donor kidney transplantation: effect of urinary schistosomiasis. Br J Urol 70: 247–251.
Shokeir A a , 2001. Renal transplantation: the impact of schistosomiasis. BJU Int 88: 915–920.
Beatty NL , Klotz SA , 2020. Autochthonous Chagas disease in the United States: how are people getting infected? Am J Trop Med Hyg 103: 967–969.
Pierrotti LC , Carvalho NB , Amorin JP , Pascual J , Kotton CN , López-Vélez R , 2018. Chagas disease recommendations for solid-organ transplant recipients and donors. Transplantation 102 (Suppl. 2): S1–S7.
Kransdorf EP , Zakowski PC , Kobashigawa JA , 2014. Chagas disease in solid organ and heart transplantation. Curr Opin Infect Dis 27: 418–424.
Croker C , Reporter R , Redelings M , Mascola L , 2010. Strongyloidiasis-related deaths in the United States, 1991–2006. Am J Trop Med Hyg 83: 422–426.
Al-Obaidi M et al.2019. Seroprevalence of Strongyloides stercoralis and evaluation of universal screening in kidney transplant candidates: a single-center experience in Houston (2012–2017). Open Forum Infect Dis 6: ofz172.
Castro R , Aslam S , Albers C , Gutierrez L , Gonzalez M , Alrabaa S , 2017. Strongyloides stercoralis infection incidence, risk factors and outcomes among solid organ transplant candidates and Recipients; a Florida center experience. Open Forum Infect Dis 4: S10–S11.
Rivera KR , Shah T , Garcia-Diaz J , Hand J , 2018. Strongyloides stercolaris serology in transplant patients: to test or not? Open Forum Infect Dis 5: S341.
Kottkamp A , Mehta S , 2018. Implementation of universal screening for strongyloidiasis among solid-organ and hematopoietic stem cell transplantation candidates in a non-endemic area. Open Forum Infect Dis 5: S341.
Perez-Lopez CJ , Alrabaa S , Aslam S , Teo GME , Kim T , Reljic T , 2019. Comparison of demographics and risk factors between Strongyloides stercoralis seropositive and seronegative solid-organ transplant candidates: experience from a tertiary acute care center in Florida. Open Forum Infect Dis 6: S946.
Camargo LFA , Kamar N , Gotuzzo E , Wright AJ , 2018. Schistosomiasis and strongyloidiasis recommendations for solid-organ transplant recipients and donors. Transplantation 102: S27–S34.
U.S. Census Bureau , 2021. U.S. Census Bureau QuickFacts: Hennepin County, Minnesota. Available at: https://www.census.gov/quickfacts/hennepincountyminnesota. Accessed April 4, 2022.
Migration Policy Institute , 2021. State Demographics Data—MN. Available at: https://www.migrationpolicy.org/data/state-profiles/state/demographics/MN. Accessed March 10, 2022.
Hennepin Healthcare , 2022. About Hennepin Healthcare. Available at: https://www.hennepinhealthcare.org/about-us/. Accessed March 16, 2022.
Harris PA et al.2019. The REDCap consortium: building an international community of software platform partners. J Biomed Inform 95: 103208.
Harris PA , Taylor R , Thielke R , Payne J , Gonzalez N , Conde JG , 2009. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42: 377–381.
GoodRx , 2022. Ivermectin prices and ivermectin coupons. Available at: https://www.goodrx.com/ivermectin. Accessed March 16, 2022.
GoodRx , 2022. Praziquantel prices and praziquantel coupons. Available at: https://www.goodrx.com/praziquantel. Accessed March 16, 2022.
World Bank Group , 2021. World Bank units. Available at: https://www.worldbank.org/en/about/unit. Accessed June 28, 2021.
R Core Team , 2021. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing.
Koku EF , Rajab-Gyagenda WM , Korto MD , Morrison SD , Beyene Y , Mbajah J , Ashton C , 2016. HIV/AIDS among African immigrants in the U.S.: the need for disaggregating HIV surveillance data by country of birth. J Health Care Poor Underserved 27: 1316–1329.
Le MH , Yeo YH , Cheung R , Henry L , Lok AS , Nguyen MH , 2020. Chronic hepatitis B prevalence among foreign-born and U.S.-born adults in the United States, 1999–2016. Hepatology 71: 431–443.
Olson NA , Davidow AL , Winston CA , Chen MP , Gazmararian JA , Katz DJ , 2012. A national study of socioeconomic status and tuberculosis rates by country of birth, United States, 1996–2005. BMC Public Health 12: 365.
McKenna ML et al.2017. Human intestinal parasite burden and poor sanitation in rural Alabama. Am J Trop Med Hyg 97: 1623–1628.
Nutman TB , 2017. Human infection with Strongyloides stercoralis and other related Strongyloides species. Parasitology 144: 263–273.
Schär F , Trostdorf U , Giardina F , Khieu V , Muth S , Marti H , Vounatsou P , Odermatt P , 2013. Strongyloides stercoralis: global distribution and risk factors. PLoS Negl Trop Dis 7: e2288.
Carnino L , Schwob J-M , Neofytos D , Lazo-Porras M , Chappuis F , Eperon G , 2021. Screening for parasitic infection and tuberculosis in immunosuppressed and pre-immunosuppressed patients: an observational study. Trop Med Infect Dis 6: 170.
Hyson P et al.2021. Experiences with diagnosis and treatment of Chagas disease at a United States teaching hospital—clinical features of patients with positive screening serologic testing. Trop Med Infect Dis 6: 93.
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.
Webb JA , Fabreau G , Spackman E , Vaughan S , McBrien K , 2021. The cost-effectiveness of schistosomiasis screening and treatment among recently resettled refugees to Canada: an economic evaluation. CMAJ Open 9: E125–E133.
Buonfrate D et al.2019. Multiple-dose versus single-dose ivermectin for Strongyloides stercoralis infection (Strong Treat 1 to 4): a multicentre, open-label, phase 3, randomised controlled superiority trial. Lancet Infect Dis 19: 1181–1190.
Centers for Disease Control and Prevention , 2021. Intestinal parasite: domestic guidance. Available at: https://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/intestinal-parasites-domestic.html. Accessed September 17, 2021.
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Pretransplant recommendations advise risk-based screening for strongyloidiasis, schistosomiasis, and Chagas disease. We evaluated the implementation of a chronic parasite screening protocol at a health system in a nonendemic region serving a large foreign-born population. Candidates listed for kidney transplant at Hennepin Healthcare (Minneapolis, MN) between 2010 and 2020 were included. Country of birth and serologic screening for strongyloidiasis, schistosomiasis, and Chagas disease were retrospectively obtained from electronic medical records. Parasite screening frequency and seropositivity was assessed before and after implementation of a geographic risk factor–based screening protocol in 2014. Cost-efficiency of presumptive treatment was modeled. Of 907 kidney transplant candidates, 312 (34%) were born in the United States and 232 (26%) outside the United States, with the remainder missing country of birth information. The 447 (49%) candidates evaluated after implementation of the screening protocol had fewer unidentified countries of birth (53%–27%, P < 0.001) and were more frequently screened for strongyloidiasis, schistosomiasis, and Chagas disease (14%–44%, 8%–22%, and 1–14%, respectively, all Ps < 0.001). The number of identified seropositive candidates increased after protocol implementation from two to 14 for strongyloidiasis and from one to 11 for schistosomiasis, with none seropositive for Chagas disease. The cost-efficiency model favored presumptive ivermectin when strongyloidiasis prevalence reaches 30% of those screened. Implementing a geographic risk screening protocol before kidney transplant increases attention to infectious disease risk associated with country of birth and identification of chronic parasitic infections. In populations with higher strongyloidiasis prevalence or lower ivermectin costs, presumptive treatment may be cost-efficient.
Financial support: This project was supported by a Hennepin Healthcare Department of Medicine Innovation Seed Grant Program. C. T. receives support from the National Institute of Allergy and Infectious Diseases (T32 AI055433).
Authors’ addresses: Christine Thomas, Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, E-mail: email@example.com. Jessica Butts and Jennifer Czachura, Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, E-mails: firstname.lastname@example.org and email@example.com. Altair Alonso, School of Medicine, University of Minnesota, Minneapolis, MN, E-mail: firstname.lastname@example.org. Kevin Reininger, Banner University Medical Center, Phoenix, AZ, E-mail: Kevin.Reininger@Bannerhealth.com. Megan Shaughnessy, Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, and Division of Infectious Diseases, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, E-mail: email@example.com.