Intestinal parasites among African refugees resettled in Massachusetts and the impact of an overseas pre-departure treatment program

This study analyzed the prevalence of intestinal parasitoses diagnosed shortly after arrival in the United States among African refugees before and after implementation of an overseas program of empirical treatment with albendazole. Variables included results of microscopy of a single stool specimen, age, sex, ethnicity, departure origin, and receipt of albendazole. Of 1,254 refugees, 56% had intestinal parasites. Fourteen percent had helminths, and 2% had multiple helminths. In addition, 52% had protozoans with 25% having multiple protozoans. The most common pathogens were Giardia lamblia (14%) and Trichuris trichiura (91%). Overall, refugees who arrived in Massachusetts after implementation of the treatment program were less likely to have any parasites (odds ratio [OR] = 0.61, 95% confidence interval [CI] = 0.47-0.78) and helminths (OR = 0.15, 95% Cl = 0.09-0.24) than refugees who arrived previously. These more recently arrived refugees were also less likely to have hookworm (OR = 0.03, 95% Cl = 0.00-0.29), Trichuris (OR = 0.05, 95% Cl = 0.02-0.13), Ascaris (OR = 0.07,95% Cl = 0.01-0.58), and Entamoeba histolytica (OR = 0.47, 95% CI = 0.26-0.86). Empirically treating refugees prior to departure for the United States appears to have resulted in decreases in intestinal helminths and possibly some protozoans among African refugees tested shortly after arrival in this country.