Notification of strongyloidiasis in Australia

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Tuesday, 2 June, 2015

Infection with the parasitic worm, Strongyloides stercoralis is lifelong, unless treated. This cunning parasite lives in the small intestine of humans and produces infective larvae inside the body. These autoinfective larvae reinfect the unfortunate host from the inside. The original infection is due to infective larvae that have developed in faeces deposited on the ground (just like hookworm). But unlike hookworm, when the old worms die, for Strongyloides, the effete mother worms have been replaced by generations of young and vigorous daughters. Once infected, always infected!

The good news is that strongyloidiasis is easily cured - ivermectin is highly effective.

In the Medical Journal of Australia this week, myself, and colleagues, Adrian Miller and Wendy Page put forward a case to make infection with S. stercoralis a notifiable disease and ask for it to be included in Australia's National Notifiable Diseases Surveillance Scheme (NNDSS). Listing strongyloidiasis on the NNDSS would provide the information needed to control and eliminate this parasite from Australia.

Strongyloidiasis occurs largely in marginalised groups: members of rural and remote Aboriginal communities, refugees, and in soldiers and peace-keepers who have served in endemic areas. The occasional tourist also is infected. In Aboriginal communities prevalence seems to be about 20% (Maunsey et al 2014; Shield et al 2015) while a recent study showed about 11% of Vietnam veterans carried the parasite (Rahmanian et al 2015).

Strongyloidiasis can cause acute disease, chronic disease with low level morbidity or rarely severe disease with death. The latter typically occurs when people with chronic strongyloidiasis are started on corticosteroids (Buonfrate et al 2013).

Accurate data on the incidence and location of strongyloidiasis in Australia can inform a national control and eradication program and may also improve management of individual patients, particularly if a strongyloides register is implemented.

References

Buonfrate D, Requena-Mendez A, Angheben A, Muñoz J, Gobbi F, Van Den Ende J, Bisoffi Z. Severe strongyloidiasis: a systematic review of case reports. BMC Infectious Diseases 2013;13:78.
Mounsey K, Kearns T, Rampton M, Llewellyn S, King M, Holt D, Currie BJ, Andrews R, Nutman T, McCarthy J. Use of dried blood spots to define antibody response to the Strongyloides stercoralis recombinant antigen NIE. Acta Tropica 2014;138:78-82.
Rahmanian H, MacFarlane AC, Rowland KE, Einsiedel LJ, Neuhaus SJ. Seroprevalence of Strongyloides stercoralis in a South Australian Vietnam veteran cohort. Australian and New Zealand Journal of Public Health 2015; doi: 10.1111/1753-6405.12360. [Epub ahead of print]
Shield J, Aland K, Kearns T, Gongdjalk G, Holt D, Currie B, Prociv P. Intestinal parasites of children and adults in a remote Aboriginal community of the Northern Territory, Australia, 1994-1996. Western Pacific Surveillence and Response Journal 2015;6(1):44-51.
Speare R, Miller A, Page W. Strongyloidiasis: a case for notification in Australia? Medical Journal of Australia 2015;202(10):i-ii.:

Posted Rick Speare