Strongyloidiasis is a helminth infection that remains under-researched despite its ability to cause significant illness. Women and children may be at particular risk of health consequences from this parasite. This systematic literature review aims to examine research on the long-term health effects that strongyloidiasis has in pregnant women and children. We conducted a structured search using multiple databases to collect all primary studies discussing health effects of strongyloidiasis in the aforementioned groups. The review included 20 results: 16 primary studies and four case reports. The methodological quality of studies was substandard, and there was substantial heterogeneity to the statistical analysis and outcomes assessed in the literature. Statistically significant associations were found between strongyloidiasis and low birth weight, as well as wasting. No links were found between strongyloidiasis and anaemia. Due to testing methods used in the studies, the prevalence of Strongyloides stercoralis in these studies was probably under-estimated. Current research is suggestive that strongyloidiasis has long-term adverse health effects on the offspring of infected mothers and in chronically-infected children. Data analysis was hindered by both methodological and statistical flaws, and as such, reliable conclusions regarding the health impacts could not be formed.

Infection with Strongyloides stercoralis can cause life-threatening disease in immunocompromised patients. Strongyloidiasis is thought to be hyper-endemic in tropical Australia, but there are limited contemporary seroprevalence data to inform local elimination strategies. To define the temporospatial epidemiology of strongyloidiasis in Far North Queensland, tropical Australia, the serology results of 2,429 individuals tested for the infection between 2000 and 2018 were examined. The proportion of positive tests fell from 36/69 (52.2%) in 2000 to 18/222 (8.1%) in 2018 (P < 0.001). Indigenous patients were more likely to have a positive result (Odds Ratio [OR]: 3.9, 95% CI: 3.0-5.0); however, by the end of the study period, residence in a rural or remote location (OR 3.9 (95% CI: 1.2-13.0), P = 0.03) was a more important risk factor for seropositivity than Indigenous status (OR 1.1 (95% CI: 0.4-3.1) P = 0.91). Ivermectin prescription data were available for the period 2004-2018, with annual prescriptions increasing from 100 to 185 boxes (P = 0.01). The volume of ivermectin dispensed correlated negatively with seropositivity (Spearman's rho = −0.62, P = 0.02). An expanded environmental health program was implemented during the study period and likely contributed to the declining seroprevalence; however, the relative contributions of the individual components of this program are difficult to quantify. The seroprevalence of strongyloidiasis has declined markedly in this region of tropical Australia despite there being no targeted campaign to address the disease. Expanded prescription of ivermectin and public health interventions targeting the few remaining high-prevalence communities would be expected to expedite disease elimination.

INTRODUCTIONStrongyloidiasis is a neglected tropical disease caused by the parasite Strongyloides stercoralis that remains consistently under-researched despite an estimated worldwide prevalence of 370 million people. 1 Strongyloidiasis is of particular concern to immunosuppressed patients, in which the parasite can proliferate rapidly (hyperinfection syndrome), with a mortality of 70%-100%. 1 Pregnant women are potentially at risk of hyperinfection syndrome, due to the combined effects of immunosuppression during pregnancy and the prescription of corticosteroids, which are routinely administered if a preterm birth is suspected. 2 In a 2015 reported case from New York, a Haitian woman died and her foetus was stillborn. 2 Moreover, the offspring of chronically infected mothers are at risk of low birthweight.Cairns is the largest city in tropical Far North Queensland (FNQ), in a region in which strongyloidiasis is suspected to be hyper-endemic. Little is known about the current burden of strongyloidiasis, as studies typically show inconsistent prevalence data from single towns, which due to their unique socioeconomic circumstances cannot be generalized to the whole region. Two studies in rural Queensland found prevalences of 4% and 12%, respectively, 3,4 while a study in the Kimberley found 36%. 5 Without reliable, up-to-date prevalence studies clinicians are unable to appropriately screen and treat at-risk patients.We performed a prospective cohort study examining the prevalence and clinical burden of strongyloidiasis in pregnant women in FNQ. From January to July 2018, all women able to provide informed consent were invited to participate at antenatal clinics at Cairns Hospital, irrespective of age, ethnicity or medical co-morbidities. Consented women had S. stercoralis serology added to their routine prenatal blood tests and were then followed until the end of their pregnancy. Cairns Hospital is the main health service performing deliveries for FNQ including the Torres Strait, making this site a suitable location to collect an accurate sample and accurately describe Strongyloides' prevalence. The study received ethical approval from the FNQ Human Research Ethics Committee (Reference Number HREC/17/QCH/25-1125).Eighty-seven women were approached for involvement with one woman declining, leaving 86 women who consented for involvement in this study (Table 1). Compliance with the testing protocol was challenging: amongst the 86 consented participants, only 60 then went on to complete testing for S. stercoralis. In contrast to our hypothesis, a very low prevalence rate of 3.3% (two patients, 95% CI, 0.8%-12.5%) was recorded amongst the cohort. Both were Aboriginal or Torres Strait Island Australians and one had type two diabetes mellitus, one from the greater Cairns region and one from a remote community. No child complications were observed, and the seropositive participants were treated. | 439 PALTRIDGE ET AL.Neither of the two participants who were positive for S. stercoralis had eosinophilia. This corroborates th...