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Global Refugees Checklist
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Overview of Intestinal Parasites

Practitioners have traditionally ordered intensive and expensive stool testing and parasitic treatments for newly arriving refugees; however, most parasitic infections have a self-limited nature outside the endemic region. Strongyloides and Schistosoma are notable exceptions:

Key Recommendations:

Quality of Evidence: MODERATE

Balance of benefits and harms Values and preferences
  • Strongyloides is estimated to infect 100 million people worldwide. Among immigrant populations, refugees from Southeast Asia and Africa appear to have the highest risk of infection.
  • Subclinical infections or low-grade disease can persist for decades after immigration and in the presence of immunosuppression may transform into life-threatening disseminated disease.
  • Treatment with ivermectin is of short duration, is highly effective (NNT 2, CI ~1 to 3) and has a favourable adverse-effect profile.

The committee attributed more value to:

  • The availability of a highly sensitive and specific serologic test
  • effective treatment options to prevent potentially life-threatening disseminated disease

Attributed less value to:

  • Potential limitations of serologic testing in distinguishing current from remote infection in high-risk newly arriving refugees
  • Schistosoma is estimated to infect 200 million people worldwide, of whom approximately 85% live in Africa.
  • Among immigrant populations, refugees from Africa have the highest risk of infection.
  • Subclinical infections or low-grade disease can persist for decades after immigration and may cause future morbidity or death.
  • Serologic testing is the most sensitive diagnostic modality currently available.
  • Treatment with praziquantel is of short duration, is highly effective (NNT 4, 95% CI ~1 to 124) and has a favourable adverse-effect profile.

The committee attributed more value to:

  • Availability of a highly sensitive and specific serologic test
  • Effective treatment to prevent future morbidity or death

Attributed less value to:

  • Limitations of serologic testing in distinguishing current from remote infection in high-risk newly arriving refugees

Links to Other Learning Resources

Pottie K, Greenaway C, Feightner J, Welch V, Swinkels H, Rashid M, Narasiah L, Kirmayer L, Ueffing E, MacDonald N, Hassan G, McNally M, Kahn K, Buhrmann R, Dunn S, Dominic A, McCarthy AE, Gagnon AJ, Rousseau C, Tugwell P and co-authors of the Canadian Collaboration for Immigrant and Refugee Health. Overview: Evidence-based clinical guidelines for immigrants and refugees. CMAJ 2011; 183(12):E824-E925.

Design and Production: Centre for e-Learning, Teaching and Learning Support Service (TLSS), University of Ottawa