Division of Infectious Diseases, Boston Medical Center, Boston, USA.
Department of Internal Medicine, McGill University, Montreal, QC, Canada.
Lancet Glob Health. 2019 Feb;7(2):e236-e248. doi: 10.1016/S2214-109X(18)30490-X.
Global migration from regions where strongyloidiasis and schistosomiasis are endemic to non-endemic countries has increased the potential individual and public health effect of these parasitic diseases. We aimed to estimate the prevalence of these infections among migrants to establish which groups are at highest risk and who could benefit from screening.
We did a systematic review and meta-analysis of strongyloidiasis and schistosomiasis prevalence among migrants born in endemic countries. Original studies that included data for the prevalence of Strongyloides or Schistosoma antibodies in serum or the prevalence of larvae or eggs in stool or urine samples among migrants originating from countries endemic for these parasites and arriving or living in host countries with low endemicity-specifically the USA, Canada, Australia, New Zealand, Israel, and 23 western European countries-were eligible for inclusion. Pooled estimates of the prevalence of strongyloidiasis and schistosomiasis by stool or urine microscopy for larvae or eggs or serum antibodies were calculated with a random-effects model. Heterogeneity was explored by stratification by age, region of origin, migrant class, period of study, and type of serological antigen used.
88 studies were included. Pooled strongyloidiasis seroprevalence was 12·2% (95% CI 9·0-15·9%; I 96%) and stool-based prevalence was 1·8% (1·2-2·6%; 98%). Migrants from east Asia and the Pacific (17·3% [95% CI 4·1-37·0]), sub-Saharan Africa (14·6% [7·1-24·2]), and Latin America and the Caribbean (11·4% [7·8-15·7]) had the highest seroprevalence. Pooled schistosomiasis seroprevalence was 18·4% (95% CI 13·1-24·5; I 97%) and stool-based prevalence was 0·9% (0·2-1·9; 99%). Sub-Saharan African migrants had the highest seroprevalence (24·1·% [95% CI 16·4-32·7]).
Strongyloidiasis affects migrants from all global regions, whereas schistosomiasis is focused in specific regions and most common among sub-Saharan African migrants. Serological prevalence estimates were several times higher than stool estimates for both parasites. These data can be used to inform screening decisions for migrants and support the use of serological screening, which is more sensitive and easier than stool testing.
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从流行地区向非流行地区移民的全球流动增加了这些寄生虫病对个人和公共卫生的潜在影响。我们旨在评估移民中的这些感染率，以确定哪些人群面临最大风险，以及哪些人群可以受益于筛查。
我们对源于流行地区的移民中的旋毛虫病和血吸虫病的患病率进行了系统综述和荟萃分析。原始研究包括血清中旋毛虫或血吸虫抗体的流行率，或源自这些寄生虫流行国家的移民的粪便或尿液样本中幼虫或卵的流行率，以及这些移民在低流行率的宿主国家（即美国、加拿大、澳大利亚、新西兰、以色列和 23 个西欧国家）的到达或居住情况。采用随机效应模型计算粪便或尿液显微镜检查幼虫或卵或血清抗体的旋毛虫病和血吸虫病的患病率的汇总估计值。通过分层分析年龄、原籍地区、移民类别、研究期间和使用的血清学抗原类型来探索异质性。
共纳入 88 项研究。旋毛虫病血清流行率为 12.2%（95%CI 9.0-15.9%；I 96%），粪便流行率为 1.8%（1.2-2.6%；98%）。来自东亚和太平洋地区（17.3%[95%CI 4.1-37.0%]）、撒哈拉以南非洲（14.6%[7.1-24.2%]）和拉丁美洲和加勒比地区（11.4%[7.8-15.7%]）的移民血清流行率最高。血吸虫病血清流行率为 18.4%（95%CI 13.1-24.5；I 97%），粪便流行率为 0.9%（0.2-1.9%；99%）。撒哈拉以南非洲的移民血清流行率最高（24.1%[95%CI 16.4-32.7]）。
旋毛虫病影响来自全球所有地区的移民，而血吸虫病则集中在特定地区，且在撒哈拉以南非洲的移民中最为常见。两种寄生虫的血清流行率估计值均比粪便估计值高几倍。这些数据可用于为移民提供筛查决策依据，并支持使用更敏感和更容易的血清学筛查。
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