Primary prevention
Typically infection is transmitted from human feces to the environment back to humans via skin contact with contaminated soil. Direct human-to-human infection could occur but only with direct contact with human feces containing infectious filariform larvae. Primary prevention of infection includes wearing shoes in endemic areas; however, this may not be an option in areas where footwear is not culturally accepted.[1] Adequate sewage and sanitation systems to dispose of infected human feces will reduce transmission rates. Healthcare professionals who may come into contact with the feces of a hospitalized patient with strongyloidiasis should wear gloves and gowns and practise appropriate handwashing techniques.[1]
Water, sanitation, and hygiene (WASH) interventions may result in a slight reduction of any soil-transmitted helminth infection. However, the evidence was very uncertain for individual worm species, and there is very little data available for Strongyloides infection.[25]
Since 1999, single-dose albendazole has been given as predeparture therapy for refugees migrating to the US. The policy of giving albendazole to migrating refugees before they leave the country from which they are migrating has resulted in decreased rates of detectable strongyloides in newly arriving refugees.[26] Albendazole decreases the burden of strongyloides, making larvae more difficult to detect on stool ova and parasite exam, but single-dose albendazole will not eradicate strongyloidiasis. Since 2008, the US Centers for Disease Control and Prevention (CDC) guidance has included a recommendation for ivermectin for 2 days for migrating refugees, except those from Loa loa endemic countries in Africa, since a resultant mass killing of Loa loa microfilariae may result in fever and encephalitis.[27][28][29][30] Sub-Saharan African refugees also receive praziquantel for schistosomiasis therapy.
Secondary prevention
Screening or empiric treatment of family members with similar risk exposure is warranted. Empiric treatment of adults is likely to be preferred due to the relatively high probability of mutual exposure and chronic infection and the difficulty of detection. For children, the preference would be screening to exclude eosinophilia and stool parasites. Children have greater eosinophil levels than adults when infected with strongyloides, thus detection is easier.[54]
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