Presumptive Treatment and Medical Screening for Parasites in Refugees Resettling to the United States

Abstract

More than 50,000 refugees are resettled to the United States annually, many from areas highly endemic for parasites. Some of these infections present little clinical consequence after migration, but others are responsible for morbidity and mortality. The Centers for Disease Control and Prevention has issued predeparture presumptive treatment and postarrival medical guidelines for the management of parasites. Although these guidelines are evidence based, there remain significant challenges to presumptive treatment programs in refugees. Gaps in the evidence continue; resettling populations are continually changing, thus altering the epidemiology; and there are logistical and cost barriers to fully implementing recommendations. This article will review the evolution and status of current guidelines, as well as identify gaps and challenges to full implementation. It is imperative for clinicians serving this population to be familiar with interventions received by refugees, since previous treatment will impact screening, diagnostic evaluation, and treatment decisions.

Positive clinical outcome using a modified dosing regimen of benznidazole in dogs at high risk for infection or acutely infected with Trypanosoma cruzi

“…20,21 The use of chemoprophylaxis generally is based on the high risk of acquiring infection, high clinical impact of infection, low ecological impact, high cost-effectiveness, and low frequency of adverse drug effects. 21 Administration of benznidazole can cause adverse effects in humans including hypersensitivity dermatitis, gastrointestinal upset, polyneuritis, and rarely bone marrow suppression and hepatopathy. 22 In dogs, dose-dependent neurologic signs have been reported at dosages >20 mg/kg/day.…”

“…Similarly in veterinary medicine, routine administration of macrocyclic lactones is recommended for eliminating Dirofilaria immitis infection. In human medicine, preexposure or postexposure chemoprophylaxis is a feasible strategy for the presumptive treatment of some endemic parasites in immigrants and travelers 20,21 . The use of chemoprophylaxis generally is based on the high risk of acquiring infection, high clinical impact of infection, low ecological impact, high cost‐effectiveness, and low frequency of adverse drug effects 21 .…”

Strongyloides Hyperinfection in a Renal Transplant Patient: Always Be on the Lookout

“…For this reason and for the potentially deadly complications of untreated disease, refugees from South East Asia should receive preemptive treatment before arrival to the US. The Division of Global Migration and Quarantine of the Center for Disease Control and Prevention (since 2005) recommends prearrival ivermectin at a dose of 200  μ g/kg/day orally once a day for 2 days for those without contraindications [10]. Our patient arrived to the US before this recommendation was enacted.…”

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“…Historically, the United States has resettled more than 50,000 refugees per year, half of whom are under 18 [1][2][3]. Although this number has decreased significantly over the past two years, refugees continue to arrive from either their country of origin or a refugee camp in another country, typically in the same region of the world as their country of origin.…”

“…The Centers for Disease Control and Prevention (CDC) oversees mandated health screenings in accordance with the Refugee Act of 1980 [4]. At least 1/3 of the world's population is infected with parasites, making this a common condition in refugees resettled in the United States (US) [1,3,5,6].…”