Volume 202 - Issue 10
Strongyloidiasis: a case for notification in Australia?
Authors: Richard Speare, Adrian Miller and Wendy A Page
Med J Aust 2015; 202 (10): 523-524. || doi: 10.5694/mja15.00112
Published online: 1 June 2015
Published online: 1 June 2015
Eliminating the disease in Indigenous communities depends on accurate data
To the Editor: Australia's National Notifiable Diseases Surveillance System (NNDSS) is used to monitor trends in 58 communicable diseases or conditions. The incidence of notifiable diseases can be decreased by public health action. Some diseases require rapid local responses, such as outbreaks of vaccine-preventable or foodborne diseases. Upward trends in the incidence of other notifiable diseases — for example, tuberculosis, sexually transmitted infections and bloodborne viruses — can be managed by less-rapid responses. The NNDSS exists not for data collection per se, but for public health action.
The NNDSS is a dynamic tool of great value in specific diseases, particularly when control or elimination programs are being implemented, such as for hydatid disease, polio and measles. Diseases and conditions can be added or removed as required by the need for public health action.
Currently, Aboriginal people in rural and remote communities have a very high prevalence of strongyloidiasis, a lifelong disease caused by infection with the gastrointestinal nematode Strongyloides stercoralis.1 This parasite is very rare in mainstream Australian communities and is generally acquired overseas or from outback Indigenous communities. Prevalence in many Indigenous communities is 15% or greater, and laboratory records indicate that the infection is widespread in Indigenous communities in Queensland, the Northern Territory, Western Australia, northern South Australia and northern New South Wales.2,3 However, the epidemiological picture is patchy because data are not routinely collected.4,5 Management of individual Indigenous patients appears to be inadequate — many do not receive appropriate treatment, with potentially fatal consequences.5 A recent systematic literature review of strongyloidiasis in Indigenous Australians highlighted lack of data as one of the major barriers to controlling and eliminating the disease.5 Strongyloidiasis can be easily and cheaply cured by oral ivermectin at individual patient and community levels.1
We urge the Australian Government Department of Health to consider placing strongyloidiasis on the NNDSS, in order to establish an accurate estimate of incidence that will inform the necessary public health action at community, regional and national levels. We propose that all reported cases be laboratory confirmed, based on faecal examination or serology.6,7 These data can be collated and used to guide implementation of a national strongyloidiasis elimination program.
Competing interests
No relevant disclosures.
Acknowledgements
We thank Jenni Judd and Jennifer Shield for their contributions to the writing of this letter, and the Australian Research Council Discovery Indigenous Researchers Development program for support.
References
- Shield JM, Page W. Effective diagnostic tests and anthelmintic treatment for Strongyloides stercoralis make community control feasible. P N G Med J 2008; 51: 105-119. 1
- Mounsey K, Kearns T, Rampton M, et al. Use of dried blood spots to define antibody response to the Strongyloides stercoralis recombinant antigen NIE. Acta Tropica 2014; 138: 78-82. 2
- Shield J. Mapping Strongyloides stercoralis in Australia: fill in the gaps. Poster presented at the Ninth National Workshop on Strongyloidiasis. Proceedings of the Rural Medicine Australia 2014 Conference; Oct 30-Nov 1; Sydney, Australia. 3
- Johnston FH, Morris PS, Speare R, et al. Strongyloidiasis: a review of the evidence for Australian practitioners. Aust J Rural Health 2005; 13: 247-254. 4
- Miller A, Smith M, Judd J, et al. Strongyloides stercoralis: systematic review of barriers to controlling strongyloidiasis for Australian Indigenous communities. PLOS Negl Trop Dis 2014; 8: e3141. 5
- Speare R, Durrheim D. Strongyloides serology — useful for diagnosis and management of strongyloidiasis in rural Indigenous populations, but important gaps in knowledge remain. Rural Remote Health 2004; 4: 264. 6
- Page W. Dempsey K, McCarthy JS. Utility of serological follow-up of chronic strongyloidiasis after anthelmintic chemotherapy. Trans R Soc Trop Med Hyg 2006; 100: 1056-1064. lefthere