The severely under-recognized public health risk of strongyloidiasis in North American cities-A One Health approach.

Strongyloides and other soil-transmitted helminths represent a severely under-recognized zoonotic public health risk, especially in North American cities. They are present throughout North America, including in urban areas, causing morbidity and mortality in human and non-human animals. Epidemiological "masking" of strongyloidiasis due to overlapping symptoms with other systemic diseases, including allergies, and diagnostic limitations complicate our understanding of the epidemiological extent of this disease, and auto-infection allows long-term persistence of individual infections. Zoonotic transmission and environmental transmission are critical components in the epidemiology of strongyloidiasis, and other diseases caused by soil-transmitted helminths. In this review, we bring together medical, veterinary and environmental expertise in a "One Health" context, to document and analyse this under-recognized risk. We also present implementable opportunities for action with respect to diagnostics, treatment, community engagement and land management to mitigate the impact and transmission of strongyloidiasis and other diseases caused by soil-transmitted helminths.