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Effectiveness of Screening and Treatment Approaches for Schistosomiasis and Strongyloidiasis in Newly-Arrived Migrants from Endemic Countries in the EU/EEA: A Systematic Review

Faculty of Health Science, University of Roehampton London, London SW15 5PU, UK
Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW 2050, Australia
Centre for Tropical Diseases (CTD), IRCCS Sacro Cuore Don Calabria Negrar, Negrar, 37024 Verona, Italy
Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy
Department of Clinical Sciences, Institute of Tropical Medicine, 155 Nationalestraat, 2000 Antwerp, Belgium
Division of Infectious Diseases and Clinical Epidemiology, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC H3A 0G4, Canada
Department of Medicine at the Doherty Institute, University of Melbourne, Parkville, VIC 3010, Australia
Victorian Infectious Diseases Service, The Royal Melbourne Hospital RMH, Parkville VIC 3050, Australia
Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad Tecnológica Equinoccial, Quito 170509, Ecuador
Clinical Biostatistics Unit, Hospital Universitario Ramon y Cajal (IRYCIS); CIBER Epidemiology and Public Health (CIBERESP), 28034 Madrid, Spain
Bruyere Research Institute, University of Ottawa, Ottawa, ON K1N 6N5, Canada
European Centre for Disease Prevention and Control, Gustav III: s Boulevard 40, 169 73 Solna, Sweden
Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau-CIBERESP), 08025 Barcelona, Spain
Centre for Global Health Institute of Population Health, University of Ottawa, Ottawa, ON K1N 6N5, Canada
ISGlobal, Barcelona Institute for Global Health (ISGlobal-CRESIB, Hospital Clínic-University of Barcelona), E-08036 Barcelona, Spain
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(1), 11;
Received: 15 September 2018 / Revised: 12 December 2018 / Accepted: 17 December 2018 / Published: 20 December 2018
(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)
PDF [5010 KB, uploaded 24 December 2018]


We aimed to evaluate the evidence on screening and treatment for two parasitic infections—schistosomiasis and strongyloidiasis—among migrants from endemic countries arriving in the European Union and European Economic Area (EU/EEA). We conducted a systematic search of multiple databases to identify systematic reviews and meta-analyses published between 1 January 1993 and 30 May 2016 presenting evidence on diagnostic and treatment efficacy and cost-effectiveness. We conducted additional systematic search for individual studies published between 2010 and 2017. We assessed the methodological quality of reviews and studies using the AMSTAR, Newcastle–Ottawa Scale and QUADAS-II tools. Study synthesis and assessment of the certainty of the evidence was performed using GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. We included 28 systematic reviews and individual studies in this review. The GRADE certainty of evidence was low for the effectiveness of screening techniques and moderate to high for treatment efficacy. Antibody-detecting serological tests are the most effective screening tests for detection of both schistosomiasis and strongyloidiasis in low-endemicity settings, because they have higher sensitivity than conventional parasitological methods. Short courses of praziquantel and ivermectin were safe and highly effective and cost-effective in treating schistosomiasis and strongyloidiasis, respectively. Economic modelling suggests presumptive single-dose treatment of strongyloidiasis with ivermectin for all migrants is likely cost-effective, but feasibility of this strategy has yet to be demonstrated in clinical studies. The evidence supports screening and treatment for schistosomiasis and strongyloidiasis in migrants from endemic countries, to reduce morbidity and mortality. View Full-Text
Keywords: migrant populations; schistosomiasis/schistosoma; strongyloidiasis/strongyloides; screening/diagnosis; treatment; public health; GRADE migrant populations; schistosomiasis/schistosoma; strongyloidiasis/strongyloides; screening/diagnosis; treatment; public health; GRADE

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Agbata, E.N.; Morton, R.L.; Bisoffi, Z.; Bottieau, E.; Greenaway, C.; Biggs, B.-A.; Montero, N.; Tran, A.; Rowbotham, N.; Arevalo-Rodriguez, I.; Myran, D.T.; Noori, T.; Alonso-Coello, P.; Pottie, K.; Requena-Méndez, A. Effectiveness of Screening and Treatment Approaches for Schistosomiasis and Strongyloidiasis in Newly-Arrived Migrants from Endemic Countries in the EU/EEA: A Systematic Review. Int. J. Environ. Res. Public Health 2019, 16, 11.

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