Control of chronic <i>Strongyloides stercoralis</i> infection in an endemic community may be possible by pharmacological means alone: Results of a three-year cohort study

Abstract

<div><p>Objectives</p><p>To assess the effect of treatment with ivermectin on the prevalence of <i>S</i>. <i>stercoralis</i> infection in an Australian Aboriginal population over a three year period, and to assess the validity of using a lower ELISA cut-off in diagnosis.</p><p>Methods</p><p>A three-year cohort study of 259 adult Australian Aboriginals living in a remote community in northern Australia. <i>S stercoralis</i> infection was diagnosed using commercial ELISA testing, and employed a lower threshold for treatment than that recommended. Follow up was conducted at 6 months and 3 years following ivermectin treatment.</p><p>Findings</p><p>Treatment with ivermectin was highly effective and resulted in a sustained fall in the prevalence of infection in the study group (Initial prevalence 35.3%, 3 year prevalence 5.8%, McNemar’s chi<sup>2</sup> = 56.5, p<0.001). Results of treatment suggested use of a lower ELISA threshold for treatment was valid in this setting. Follow up identified a small group of subjects with persistently positive ELISA serology despite repeated treatment.</p><p>Interpretation</p><p>Control of <i>S</i>. <i>stercoralis</i> infection in this cohort appears to be feasible using pharmacological treatment alone.</p></div

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