Recommendations from First National Workshop on Strongyloidiasis

The first National Workshop on Strongyloidiasis was held at Nhulunbuy, East Arnhem Land, Northern Territory from 6-8 September 2001. Sponsors were Miwatj Health, East Arnhem Land and the School of Public Health and Tropical Medicine, James Cook University, Townsville. This initial workshop was attended by a mixed group of about 30 parasitologists, doctors, nurses, environmental officers and Indigenous health personnel. Recommendations from the meeting were developed by Wendy Page and Rick Speare. Downland these recommendations as an Acrobat file.

Recommendation 1: That medical and nurse clinicians are educated on the high prevalence of strongyloidiasis in rural and remote Aboriginal communities in tropical Australia and the need to be alert for its occurrence, and how to avoid mortality and morbidity from disseminated strongyloidiasis.

Actions for Recommendation 1:

• Through workshops and continuing professional education inform clinicians and nurses in rural areas about strongyloidiasis in Aboriginal and Torres Strait Islander communities and best practice management (Rick Speare, Wendy Page).
• A case series of 225 cases of strongyloidiasis at Miwatj Health will be evaluated and compared with 198 serology negative cases to highlight what symptoms and signs Aboriginal people with strongyloidiasis have (Wendy Page, Karen Dempsey, Rick Speare, James McCarthy).
• Publish a paper for laboratory technicians on the laboratory diagnosis of strongyloidiasis (Wayne Melrose, Rick Speare)
• Educate remote area nurses in strongyloidiasis through Rural Health Centres in Northern Territory and Queensland (Article published in CRANA Newsletter, education sessions - Rick Speare, Sarina White).
• Train Miwatj Aboriginal Health workers in diagnosis and management of strongyloidiasis (Miwatj Health, Rick Speare, Wayne Melrose, Richard Trudgeon)
• Video on strongyloidiasis in top end communities (Brett Shorthouse - Digital Dimensions, Rick Speare)
• Further develop flip chart on strongyloidiasis for Indigenous communities (Miwatj Health, Wendy Page, Jeffrey Baxter, Sue Smith)
• A WWW page on strongyloidiasis will be established to host these guidelines as well as accurate data on strongyloidiasis. (Rick Speare)
• A clinical GP audit on management of eosinophilia is currently being done by 14 GPs from the Top End GP Division. This has made these GPs much more aware of strongyloidiasis in their Aboriginal patients and more cases are being diagnosed, treated and monitored. (Wendy Page)
• Opportunities for longitudinal studies to evaluate the value of the Strongyloides ELISA in monitoring cases exist with Miwatj Health, Garden Point, and Westmead. These opportunities will be evaluated for suitability, ethical approval and funding sought.

Recommendation 2: That best practice guidelines for diagnosis, treatment and long term elimination of strongyloidiasis in individual Aboriginal patients be established. These are modifications of Central Qld GP Division guidelines. Actions for Recommendation 2:

• Rewrite guidelines incorporating modifications. Faeces in children, serology in adults. Emperical treatment - 1 / mth x 3. Repeat 6th monthly until negative, and then follow-up at 2 years (Wendy Page, Rick Speare).
• Distribute guidelines in hard copy and on WWW site on Strongyloides.
• Assist CARPA in rewriting the Strongyloides section of the CARPA Manual (Wendy Page, Rick Speare)

Recommendation 3: That a Strongyloides register be established to enable patients to be adequately monitored.

Actions for Recommendation 3:

• Feasibility study be carried out to look at stakeholders, legalities, practicalities.
• Secure funds for feasibility study.

Recommendation 4: That surveys be done to determine which rural and remote Indigenous communities have Strongyloides.

Actions for Recommendation 4:

• GP information
• Hospital data
• Lab data
• Analysis of Rogan Lee's data base - gross pattern for Australia
• Feasibility of community based surveys

Actions for Recommendation 5:

• This could initially be done through ARDS using Richard Trudgeon and Rick Speare to inform decision makers, making a video with Yolgnu dubbing, and spreading message to 2/3 community using Miwatj Health, ARDS, AHW, nurses and the video.

Recommendation 6: That each Aboriginal community in East Arnhem Land be allowed to decide what options, if any, they would choose to use to eliminate Strongyloides from their community.

Actions for Recommendation 6:

• Key decision makers be informed first then rest of community members
• When 2/3 of community understands, communities asked to comment.

Recommendation 7: That the environmental and housing factors leading to transmission of Strongyloides in Aboriginal communities, and devise strategies to stop transmission.

Actions for Recommendation 7:

• Research to be done on factors favouring development and survival of Strongyloides in soil (Rick Speare, Deon Canyon, Wayne Melrose: JCU Merit Research Grant obtained by Rick Speare - Dec 2001).
• Community survey be done in an endemic community to detect Strongyloides larvae (Rick Speare, Deon Canyon, Mick Kinnaird)
• Environmental health personnel work out strategies to decrease development and survival of larvae to decrease transmission.

Recommendation 8: Research on serology to determine the true significance of borderline/equivocal results.

Actions for Recommendation 8:

• Obtain funding to do research (James McCarthy, Rogan Lee)
• Serological tests (? Rogan)
• Faecal testing - improve sensitivity (James McCarthy)

Recommendation 9: Untreated strongyloidiasis is a contraindication for immunosuppressive drugs. Recommend any person prescribed immunosuppressive drugs be checked for strongyloidiasis.

Actions for Recommendation 9:

• Contract ADRAC re implementation
• Contact National Prescribing Service
• MSD educational
• Publish medicolegal paper on indefensibility of failure to test prior to use of immunosuppressives.