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BMJ 2012; 344 doi: (Published 25 April 2012) Cite this as: BMJ 2012;344:e2888

Sharp decline in intestinal parasites follows mass treatment of refugees


In May 1999, the US Centers for Disease Control and Prevention (CDC) launched a programme of presumptive treatment with albendazole for overseas refugees destined for the US. The prevalence of intestinal nematodes dropped sharply over the next eight years, from 20.8% (of 4370) to 4.7% (of 22 586), in refugees resettled in Minnesota.

Stool samples collected from arriving refugees before and after the change show significant reductions in Ascaris lumbricoides (prevalence ratio 0.06, 95% CI 0.04 to 0.09), hookworm (0.07, 0.05 to 0.09), Trichuris trichiuria (0.27, 0.23 to 0.32), and Strongyloides stercoralis (0.26, 0.18 to 0.37). The authors think that the CDC’s policy is the most likely explanation for this drop. Prevalence of Giardia intestinalis remained high (8.5%), and the prevalence of Entamoeba species increased between 1999 and 2007. All analyses were adjusted for age, sex, and region of origin. The authors couldn’t take account of any policy changes that might have occurred in source countries, however—most commonly Somalia, Laos, Ethiopia, Liberia, Vietnam, and Burma.

A dose of albendazole, originally 600 mg then reduced to 400 mg, was given to refugees in South East Asia and Africa no more than three days before departure to the US. Most refugees were young, and a third were children under 15 years. The US authorities monitoring the programme reported no serious adverse events related to treatment. In response to these findings, the CDC has already expanded its presumptive treatment programme to include praziquantel and ivermectin for some refugee populations.

Chemoradiotherapy improves control of invasive bladder cancer

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Radiotherapy is one alternative to cystectomy for adults with invasive bladder cancer, and a recent trial from the UK reports that adding chemotherapy improves disease-free survival compared with radiotherapy alone. Participants …

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