The National Strongyloides Working Group in Australia 10 workshops on: commendations and recommendations

The National Strongyloides Working Group in Australia 10 workshops on: commendations and recommendations Journal Article

Australian and New Zealand Journal of Public Health

• Author(s): Ross, Kirstin E., Bradbury, Richard S., Garrard, Tara A., O’Donahoo, Francis J., Shield, Jennifer M., Page, Wendy, Miller, Adrian, Robertson, Gemma, Judd, Jenni A., Speare, Rick
• Published: 2017
• Publisher: John Wiley & Sons, Ltd
• Volume: 41
• ISBN: 1326-0200

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Abstract: Strongyloidiasis, caused by the intestinal helminth Strongyloides stercoralis, is commonly found in developing nations in tropical and subtropical regions. Strongyloidiasis was omitted by the World Health Organization (WHO) as one of the Soil Transmitted Helminths in their Neglected Tropical Diseases Roadmap and can therefore be considered one of the most neglected tropical diseases. Despite its reputation as a disease of developing countries, strongyloidiasis remains an important disease in Australia, particularly for Aboriginal and Torres Strait Islanders, and those living in remote communities. The majority of people infected with S. stercoralis present with a chronic form of strongyloidiasis. Infected people may be asymptomatic, or they may suffer primarily with gastrointestinal, respiratory and/or dermatological symptoms, ranging in severity from mild and intermittent to severe and unrelenting. Due to the autoinfective life-cycle, almost unique among human intestinal helminth infections, infection may be life-long. Secondary infection may cause pneumonia, meningitis or septicaemia, and is more likely to occur in immunosuppressed individuals, particularly those treated with corticosteroids. Returned service personnel and those who have migrated from, lived in, or travelled through endemic areas, may develop severe disease many decades after initial infection. Control and prevention measures must incorporate education, environmental health, effective diagnostics, and appropriate treatment of infected persons. Commonly used anthelminthics such as albendazole, mebendazole, and pyrantel are not effective against S. stercoralis, leaving patients with residual worms that subsequently multiply and re-establish infection. Ivermectin is currently recommended as the most effective treatment option. The pioneering work on strongyloidiasis in Australia was performed by Professor David Grove and his colleagues for World War II ex-prisoners of war who were still infected 40 years after returning home. Grove developed an enzyme-linked immunosorbent assay (ELISA) based on the detection of antibodies to Strongyloides in serum, which became a routine pathology test for diagnosing strongyloidiasis from 1987. National Strongyloides workshops: The first National Workshop on Strongyloidiasis was held in Nhulunbuy in 2001. A community elder asked “We’ve had Strongyloides for so long, why hasn’t something been done?” In response to this, the National Strongyloides Working Group (NSWG) was formed as a special interest group of the Australasian College of Tropical Medicine. The chairperson, Emeritus Professor Rick Speare from James Cook University, is an internationally recognised expert on strongyloidiasis. The group has expanded to consist of several multidisciplinary experts including parasitologists, veterinary and molecular scientists, pathologists, environmental health officers, medical practitioners, health promotion and prevention professionals, and other interested parties. The stated aims of the group are to: raise awareness of strongyloidiasis; inform health professionals and community members about the disease and its prevention, diagnosis, treatment, and control; advocate on behalf of affected people for appropriate changes to government policy in relation to prevention, diagnosis, and treatment, based upon current research. The ultimate goal is eliminating the disease from Australia. Much has been achieved in Australia since the first meeting of this interest group of concerned experts. These achievements deserve recognition. Here we describe the achievements and make a series of recommendations for consideration for research and clinical practice in the future.

• Urls: https://doi.org/10.1111/1753-6405.12611