A bid to stamp out parasitic disease strongyloidiasis in remote Australian communities

Strongyloidiasis—a poorly understood parasitic worm disease common in remote Australian communities and some returned travelers, refugees or asylum seekers—is finally gaining attention in the national research arena.

Australian First Nations communities have one of the highest rates of strongyloidiasis in the world, says Flinders University environmental health expert Professor Kirstin Ross. The article, "Locally acquired strongyloidiasis in remote Australia: why are there still cases?" (2023) by Ross has been published in Philosophical Transactions of the Royal Society B: Biological Sciences.

The gastrointestinal infection caused by a parasitic worm or nematode, Strongyloides stercoralis, causes a range of symptoms including "wasting, nutritional deficiencies and failure to thrive in kids, and can be fatal if infected people become immunocompromised or undergo steroid treatment," she says.

"The disease is not seen in mainstream Australia, but is very common in Indigenous communities," says Professor Ross, who is part of a new $5 million Australian Government National Health and Medical Research Council (NHMRC) Synergy Grant project to tackle the problem.

"This disease is transmitted when plumbing or other environmental health hardware components are failing.

"Non-overseas acquired cases are seen almost exclusively in Australian remote communities, where poorly constructed and/or poorly maintained toilets, laundries, wastewater systems or inadequate rubbish collection creates poor sanitation and possible contact with contaminated soil or feces."

Professor Ross says adequate funding is vital to address strongyloidiasis transmission and prevalence—including giving remote communities control over housing design, construction and maintenance, as well as funding allocation, governance and training opportunities.

"Additionally, making strongyloidiasis a notifiable disease, together with using cases as a prompt for action, will help to eliminate this disease."

The article says that although considered strongyloidiasis a tropical disease, we have argued "elsewhere it is better described as a disease of disadvantage."

"It is an indictment on successive governments that we still see cases of strongyloidiasis in Australia."

More than a billion people worldwide carry parasitic nematode worms in their intestines, with Strongyloides stercoralis estimated to be present in more than 600 million people. Although infections with these worms are fairly well tolerated most of the time, they can take a deadly turn in people with a weakened immune system.