Risk of Intestinal Helminth and Protozoan Infection in a Refugee Population

Abstract

Abstract. With continuing emigration from endemic countries, screening for parasitic infections remains a priority in U.S. communities serving refugee and immigrant populations. We report the prevalence of helminths and protozoa as well as demographic risk factors associated with these infections among 533 refugees seen at the Santa Clara County, California, Refugee Clinic between October 2001 and January 2004. Stool parasites were identified from 14% of refugees, including 9% found to have one or more protozoa and 6% found to have at least one helminth. Most common protozoan infections were Giardia lamblia (6%) and Dientamoeba fragilis (3%), and for helminths, hookworm (2%). Protozoa were more frequent in refugees < 18 years of age (OR: 2.2 [1.2-4.2]), whereas helminths were more common in refugees from South Central Asia (OR: 8.0 [2.3-27.7]) and Africa (OR: 5.9 [1.6-21.6]) when compared with refugees from Eastern Europe and the Middle East. Among helminths, Ascaris lumbricoides and hookworm were concentrated among South Central Asians (6 of 7 and 10 of 11 cases, respectively), whereas Strongyloides stercoralis was predominantly found in Africans (5 of 7 cases). Although predeparture empirical treatment programs in Saharan Africa may have helped to reduce prevalence among arriving refugees from this region, parasitic infection is still common among refugees to the United States with helminth infections found in more specific populations. As refugees represent only a fraction of recent immigrants from endemic countries, current studies in nonrefugee groups are also needed.

Asymptomatic giardiasis-more prevalent in refugees than in native inhabitants of the city of Nis, Serbia

“…Our results are similar to the findings of giardiasis prevalence in the group of immigrants into the USA (6%), though those examinees were not living in collective centers [8]. Also, parasitologic investigations in Sweden [9] demonstrate that G. duodenalis is present in 17% of refugees and asylum seekers, but this protozoa was found in a small number (3/252) of refugees from the former Yugoslav republics (mainly Bosnia).…”

“…A high prevalence of giardiasis has also been recorded among immigrant refugees [8,9] and in population groups with low economic status [10][11][12].…”

Screening of Imported Infectious Diseases Among Asymptomatic Sub-Saharan African and Latin American Immigrants: A Public Health Challenge

“…42 The low prevalence and clinical significance of intestinal parasites observed in our results, questions the needs for performing stool analysis systematically. Furthermore, taking into account that the highest prevalence rates of intestinal parasites reported in the literature were in recently arrived immigrants, 4,43 we therefore propose screening stool samples for ova and intestinal parasites in sub-Saharan Africans and Latin Americans who have arrived within the last 6-12 months or if eosinophila is detected, regardless of the time since arrival.…”

Infectious Diseases in Sub-Saharan Immigrants to Spain

“…Previous studies in immigrants have described lower prevalences of helminths (6-16%), showing a trend to being higher in studies in which most cases were from sub-Saharan Africa. 7,11,33,44,45 Schistosomiasis and strongyloidiasis are potentially serious diseases and were common in this group. The prevalence of schistosomiasis (9%) by microscopic examination in this study was higher compared with other studies (0.3%).…”