Seropositivity and geographical distribution of Strongyloides stercoralis in Australia: A study of pathology laboratory data from 2012–2016

Background There are no national prevalence studies of Strongyloides stercoralis infection in Australia, although it is known to be endemic in northern Australia and is reported in high risk groups such as immigrants and returned travellers. We aimed to determine the seropositivity (number positive per 100,000 of population and percent positive of those tested) and geographical distribution of S. stercoralis by using data from pathology laboratories. Methodology We contacted all seven Australian laboratories that undertake Strongyloides serological (ELISA antibody) testing to request de-identified data from 2012–2016 inclusive. Six responded. One provided positive data only. The number of people positive, number negative and number tested per 100,000 of population (Australian Bureau of Statistics data) were calculated including for each state/territory, each Australian Bureau of Statistics Statistical Area Level 3 (region), and each suburb/town/community/locality. The data was summarized and expressed as maps of Australia and Greater Capital Cities. Principal findings We obtained data for 81,777 people who underwent serological testing for Strongyloides infection, 631 of whom were from a laboratory that provided positive data only. Overall, 32 (95% CI: 31, 33) people per 100,000 of population were seropositive, ranging between 23/100,000 (95% CI: 19, 29) (Tasmania) and 489/100,000 population (95%CI: 462, 517) (Northern Territory). Positive cases were detected across all states and territories, with the highest (260-996/100,000 and 17–40% of those tested) in regions across northern Australia, north-east New South Wales and north-west South Australia. Some regions in Greater Capital Cities also had a high seropositivity (112-188/100,000 and 17–20% of those tested). Relatively more males than females tested positive. Relatively more adults than children tested positive. Children were under-represented in the data. Conclusions/Significance The study confirms that substantial numbers of S. stercoralis infections occur in Australia and provides data to inform public health planning.

[1]  D. Bisanzio,et al.  The Global Prevalence of Strongyloides stercoralis Infection , 2020, Pathogens.

[2]  E. Dacal,et al.  Epidemiology of intestinal helminthiases in a rural community of Ethiopia: Is it time to expand control programs to include Strongyloides stercoralis and the entire community? , 2020, PLoS neglected tropical diseases.

[3]  E. Bottieau,et al.  Should We Screen HIV-Positive Migrants for Strongyloidiasis? , 2020, Pathogens.

[4]  D. MacLaren,et al.  Integrating testing for chronic strongyloidiasis within the Indigenous adult preventive health assessment system in endemic communities in the Northern Territory, Australia: An intervention study , 2020, PLoS neglected tropical diseases.

[5]  Y. Takayama,et al.  Clinical Characteristics of Disseminated Strongyloidiasis, Japan, 1975–2017 , 2020, Emerging infectious diseases.

[6]  K. Leder,et al.  Progress towards the Control of Strongyloidiasis in Tropical Australia? , 2020, The American journal of tropical medicine and hygiene.

[7]  R. Mcdermott,et al.  Rapid Progress toward Elimination of Strongyloidiasis in North Queensland, Tropical Australia, 2000-2018. , 2019, The American journal of tropical medicine and hygiene.

[8]  B. Pritt,et al.  A global genotyping survey of Strongyloides stercoralis and Strongyloides fuelleborni using deep amplicon sequencing , 2019, PLoS neglected tropical diseases.

[9]  J. Fraser.  A case report suggestive of strongyloidiasis infection occurring in temperate Australia. , 2019, Rural and remote health.

[10]  I. Molina,et al.  Strongyloides stercoralis infection: A systematic review of endemic cases in Spain , 2019, PLoS neglected tropical diseases.

[11]  J. Barratt,et al.  Detection of classic and cryptic Strongyloides genotypes by deep amplicon sequencing: A preliminary survey of dog and human specimens collected from remote Australian communities , 2019, bioRxiv.

[12]  A. W. Woodruff,et al.  Advances in Parasitology , 2019, Highlighting Operational and Implementation Research for Control of Helminthiasis.

[13]  Ingrid Arevalo-Rodriguez,et al.  Effectiveness of Screening and Treatment Approaches for Schistosomiasis and Strongyloidiasis in Newly-Arrived Migrants from Endemic Countries in the EU/EEA: A Systematic Review , 2018, International journal of environmental research and public health.

[14]  J. Judd,et al.  Cross-Cultural, Aboriginal Language, Discovery Education for Health Literacy and Informed Consent in a Remote Aboriginal Community in the Northern Territory, Australia , 2018, Tropical medicine and infectious disease.

[15]  R. Gasser,et al.  Application of PCR-Based Tools to Explore Strongyloides Infection in People in Parts of Northern Australia , 2017, Tropical medicine and infectious disease.

[16]  J. McCarthy,et al.  Soil-Transmitted Helminths in Children in a Remote Aboriginal Community in the Northern Territory: Hookworm is Rare but Strongyloides stercoralis and Trichuris trichiura Persist , 2017, Tropical medicine and infectious disease.

[17]  Sinuon Muth,et al.  Strongyloides stercoralis is associated with significant morbidity in rural Cambodia, including stunting in children , 2017, PLoS neglected tropical diseases.

[18]  A. Esterman,et al.  Control of chronic Strongyloides stercoralis infection in an endemic community may be possible by pharmacological means alone: Results of a three-year cohort study , 2017, PLoS neglected tropical diseases.

[19]  R. Baird,et al.  Trends in Strongyloides stercoralis Faecal Larvae Detections in the Northern Territory, Australia: 2002 to 2012 , 2017, Tropical medicine and infectious disease.

[20]  J. McCarthy,et al.  Strongyloides seroprevalence before and after an ivermectin mass drug administration in a remote Australian Aboriginal community , 2017, PLoS neglected tropical diseases.

[21]  S. Ambu,et al.  Epidemiological Characteristics of Strongyloidiasis in Inhabitants of Indigenous Communities in Borneo Island, Malaysia , 2016, The Korean journal of parasitology.

[22]  R. Woodman,et al.  The prevalence and clinical associations of HTLV‐1 infection in a remote Indigenous community , 2016, The Medical journal of Australia.

[23]  P. Rodari,et al.  Epidemiology of Strongyloides stercoralis in northern Italy: results of a multicentre case–control study, February 2013 to July 2014 , 2016, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[24]  K. Ross,et al.  Strongyloidiasis: A Disease of Socioeconomic Disadvantage , 2016, International journal of environmental research and public health.

[25]  L. Einsiedel,et al.  Seroprevalence of Strongyloides stercoralis in a South Australian Vietnam veteran cohort , 2015, Australian and New Zealand journal of public health.

[26]  K. Ross,et al.  Principles Relevant to Health Research among Indigenous Communities , 2015, International Journal of Environmental Research and Public Health.

[27]  J. Saugar,et al.  Usefulness of Strongyloides stercoralis serology in the management of patients with eosinophilia. , 2014, The American journal of tropical medicine and hygiene.

[28]  T. Nutman,et al.  Diagnostic Accuracy of Five Serologic Tests for Strongyloides stercoralis Infection , 2014, PLoS neglected tropical diseases.

[29]  P. Vounatsou,et al.  Strongyloides stercoralis: Global Distribution and Risk Factors , 2013, PLoS neglected tropical diseases.

[30]  B. Currie,et al.  Hookworm in the Northern Territory: down but not out , 2013, The Medical journal of Australia.

[31]  S. Hewagama,et al.  Case series of four patients with strongyloides after occupational exposure , 2012, The Medical journal of Australia.

[32]  J. Costa-Cruz,et al.  Epidemiological aspects of strongyloidiasis in Brazil , 2011, Parasitology.

[33]  E. Gotuzzo,et al.  Update on Strongyloidiasis in the Immunocompromised Host , 2011, Current infectious disease reports.

[34]  G. Gottlieb,et al.  Strongyloidiasis in transplant patients. , 2009, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[35]  A. Wilder-Smith,et al.  A global study of pathogens and host risk factors associated with infectious gastrointestinal disease in returned international travellers. , 2009, The Journal of infection.

[36]  J. Wingard,et al.  Strongyloides stercoralis hyperinfection in hematopoietic stem cell transplantation , 2009, Transplant infectious disease : an official journal of the Transplantation Society.

[37]  L. Einsiedel,et al.  Strongyloides stercoralis: a cause of morbidity and mortality for indigenous people in Central Australia , 2008, Internal medicine journal.

[38]  R. Speare,et al.  Strongyloidiasis in personnel of the Regional Assistance Mission to Solomon Islands (RAMSI) , 2008, The Medical journal of Australia.

[39]  H. Dupont,et al.  Strongyloides hyperinfection syndrome: an emerging global infectious disease. , 2008, Transactions of the Royal Society of Tropical Medicine and Hygiene.

[40]  Peter J Hotez,et al.  Helminth infections: the great neglected tropical diseases. , 2008, The Journal of clinical investigation.

[41]  Stephen Colagiuri,et al.  Grand challenges in chronic non-communicable diseases , 2007, Nature.

[42]  D. Spelman,et al.  Strongyloides stercoralis: risks posed to immigrant patients in an Australian tertiary referral centre , 2006, Internal medicine journal.

[43]  H. Kelly,et al.  Undiagnosed and potentially lethal parasite infections among immigrants and refugees in Australia. , 2006, Journal of travel medicine.

[44]  T. Nutman,et al.  Strongyloides stercoralis in the Immunocompromised Population , 2004, Clinical Microbiology Reviews.

[45]  M. Armstrong,et al.  Clinical presentation and diagnostic sensitivity of laboratory tests for Strongyloides stercoralis in travellers compared with immigrants in a non‐endemic country , 2003, Tropical medicine & international health : TM & IH.

[46]  N. Anstey,et al.  Enteric pathogens, intestinal permeability and nitric oxide production in acute gastroenteritis , 2002, The Pediatric infectious disease journal.

[47]  H. Kelly,et al.  Chronic Strongyloides stercoralis infection in Laotian immigrants and refugees 7–20 years after resettlement in Australia , 2002, Epidemiology and Infection.

[48]  M. Matsuoka,et al.  Involvement of IL-2/IL-2R system activation by parasite antigen in polyclonal expansion of CD4+25+ HTLV-1-infected T-cells in human carriers of both HTLV-1 and S. stercoralis , 2002, Oncogene.

[49]  L. Lim,et al.  Fatal disseminated strongyloidiasis in a previously treated patient , 2001 .

[50]  J. Horton.  Albendazole: a review of anthelmintic efficacy and safety in humans , 2000, Parasitology.

[51]  D. Nonaka,et al.  Paralytic ileus due to strongyloidiasis: case report and review of the literature. , 1998, The American journal of tropical medicine and hygiene.

[52]  F. Gilbert,et al.  Efficacy of albendazole against Giardia and hookworm in a remote Aboriginal community in the north of Western Australia. , 1998, Acta tropica.

[53]  M. Sinensky,et al.  Strongyloides stercoralis: identification of antigens in natural human infections from endemic areas of the United States , 1997, Parasitology Research.

[54]  S. B. Ferreira,et al.  Strongyloidiasis in patients with hematologic malignancies. , 1995, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[55]  P. Prociv,et al.  Observations on strongyloidiasis in Queensland Aboriginal communities , 1993, The Medical journal of Australia.

[56]  G. Mcgranahan.  Urban ecology and health in the third world , 1993 .

[57]  J. H. Cross.  Strongyloidiasis: A major roundworm infection of man , 1990 .

[58]  L. Pelletier.  Chronic strongyloidiasis in World War II Far East ex-prisoners of war. , 1984, The American journal of tropical medicine and hygiene.

[59]  D. Grove.  Strongyloidiasis: is it transmitted from husband to wife? , 1982, The British journal of venereal diseases.

[60]  H. Jones.  Intestinal Parasite Infections in Western Australian Aborigines , 1980, The Medical journal of Australia.

[61]  D. Grove.  Strongyloidiasis in Allied ex-prisoners of war in south-east Asia , 1980, British medical journal.

[62]  J. Walker-Smith,et al.  STRONGYLOIDIASIS CAUSING SMALL‐BOWEL OBSTRUCTION IN AN ABORIGINAL INFANT , 1969, The Medical journal of Australia.