Estimating occurrence of Strongyloides stercoralis in the Caribbean island countries: Implications for monitoring and control

Background: Few data are available for the prevalence of Strongyloides stercoralis in the Caribbean region. This frequently under diagnosed soil-transmitted helminth (STH) can result in long-term low intensity chronic infections that are asymptomatic or can cause varied intestinal disturbances. With autoinfections, infections lasting over 60 years can Occur and hyperinfections lead to high morbidity and mortality. Methodology/principal findings: Historical literature was searched to determine the prevalence of S. stercoralis in the Caribbean island countries with some additional countries and islands included for comparative data. A previously published model was used to calculate prevalence taking in to account the sensitivity of the diagnostic methods used. Data for 17 islands/Caribbean countries were found and sufficient data were located to calculate prevalence for 14 locations. Prevalence ranges from < 1% to 20.3% and while it has decreased in many islands it has not decreased at the same rate as other STHs in the last 40 years within the Caribbean region. Conclusions/significance: S. stercoralis continues to be an important STH within the Caribbean. Potential reasons for the current prevalence include: long lasting infections, populations not targeted with mass drug administration (MDA) programs being infected, low efficacy of commonly used drugs in MDA programs, and under diagnosis resulting in infections not being treated.