Abstract
We aimed to evaluate the evidence on screening and treatment for two parasitic infections—schistosomiasis and strongyloidiasis—among migrants from endemic countries arriving in the European Union and European Economic Area (EU/EEA). We conducted a systematic search of multiple databases to identify systematic reviews and meta-analyses published between 1 January 1993 and 30 May 2016 presenting evidence on diagnostic and treatment efficacy and cost-effectiveness. We conducted additional systematic search for individual studies published between 2010 and 2017. We assessed the methodological quality of reviews and studies using the AMSTAR, Newcastle–Ottawa Scale and QUADAS-II tools. Study synthesis and assessment of the certainty of the evidence was performed using GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. We included 28 systematic reviews and individual studies in this review. The GRADE certainty of evidence was low for the effectiveness of screening techniques and moderate to high for treatment efficacy. Antibody-detecting serological tests are the most effective screening tests for detection of both schistosomiasis and strongyloidiasis in low-endemicity settings, because they have higher sensitivity than conventional parasitological methods. Short courses of praziquantel and ivermectin were safe and highly effective and cost-effective in treating schistosomiasis and strongyloidiasis, respectively. Economic modelling suggests presumptive single-dose treatment of strongyloidiasis with ivermectin for all migrants is likely cost-effective, but feasibility of this strategy has yet to be demonstrated in clinical studies. The evidence supports screening and treatment for schistosomiasis and strongyloidiasis in migrants from endemic countries, to reduce morbidity and mortality.
Highlights
The public health importance of schistosomiasis and strongyloidiasis has increased in non-endemic regions as a result of growing global migration [1,2]
Quality data on the prevalence of schistosomiasis and strongyloidiasis among migrant populations in the EU/EEA is limited, available data from endemic regions shows that prevalence of schistosomiasis is between 20% and 40% and prevalence of strongyloidiasis is between 10% and
We found no studies evaluating the cost-effectiveness of schistosomiasis screening and treatment interventions in migrant populations
Summary
The public health importance of schistosomiasis and strongyloidiasis has increased in non-endemic regions as a result of growing global migration [1,2]. Sc. mansoni is the most prevalent in Africa, the Americas, the Middle East and the West Indies, followed by Sc. haematobium in Africa and the Middle East and Sc. japonicum in east and south-east Asia [3]. Prevalence rates of 10–50% for Sc. haematobium infections have been reported in some countries in sub-Saharan Africa and the Middle East [4], and prevalence rates of 1–40% have been reported for Sc. mansoni in sub-Saharan Africa and South America and for Sc. japonicum in Indonesia, parts of China and south-east Asia [5]. Strongyloidiasis is caused by the nematode Strongyloides stercoralis and, it generally occurs in sub-tropical and tropical countries, it can be present in temperate countries where conditions are favourable [6]. The global burden of both diseases has been underestimated because of the poor sensitivity of diagnostic methods used in low-resource settings [6], but recent estimates indicate that around 370 million people are infected with St. stercoralis [7] and more than 200 million are infected with schistosomiasis causing a loss of more than 1.53 million disability-adjusted life years (DALYs) [4,5,8,9]
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