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Treatment Schedules for Presumptive Parasitic Infections

PDF version of these guidelines for printing [PDF - 2 pages]

This table describes presumptive anti-parasitic treatment currently provided to the largest groups of U.S.-bound refugees. The first three columns list the region, departure country, and ethnicity/national origin of the refugees. The fourth column lists recommended presumptive treatment for parasites (including malaria).

Treatment Schedules for Presumptive Parasitic Infections for U.S.-Bound Refugees, Administered by IOMa—February 2017
Region Country of Processing Principal Refugee Groups Presumptive Parasite Treatment for Eligible Refugeesb Special Notes
Africa Chad Central African Republic; Sudanese Darfuri Albendazol Praziquantel Artemether-lumefantrine Ivermectin is not administered to refugees who have resided or traveled in Loa loa-endemic countries due to risk of encephalopathy associated with ivermectin treatment in a person with Loa loa infection. See list of Loa loa-endemic countries.c
Burundi, Djibouti, Ethiopia, Kenya, Rwanda, South Africa, Tanzania, Uganda, others Somali; Congolese; Ethiopian; Eritrean; Sudanese (other than Sudanese Darfuri); South Sudanese Albendazole
Praziquantel
Ivermectin
Artemether-lumefantrine
Of note, refugees of Congolese or South Sudanese origin who resided or traveled in Democratic Republic of Congo (DRC) or South Sudan do NOT receive ivermectin. However, children of Congolese or South Sudanese origin who were born in the camps in non Loa loa-endemic countries and have not resided or traveled in DRC or South Sudan are (usually) treated with ivermectin.

Only refugees from sub-Saharan Africa receive artemether-lumefantrine.

Asia Malaysia, Nepal, Pakistan, Thailand Burma/Myanmar origin
(Karen, Karenni, Kachin, Rohingya); 

Bhutanese; other
Albendazole
Ivermectin
 
Indonesia, Sri Lanka Multiple Albendazole  
Mideast Egypt Iraqi; Syrian Albendazole
Ivermectin
 
Iraq, Jordan
Lebanon, Turkey Multiple None  
Europe Austria, Malta, Moldova, Russia, Ukraine Multiple None  
Americas Cuba, Ecuador,
El Salvador, Guatemala, Honduras
Cuban; Colombian; Salvadoran; Guatemalan; Honduran None  

a Information provided by the International Organization for Migration (IOM) during required overseas refugee medical exam.

b Presumptive parasite treatments: albendazole (for soil-transmitted helminths), 400 mg for refugees > 2 years old, 200 mg for children 12-23 months of age; ivermectin (for Strongyloides), 200 μg/kg once a day for 2 days for adults and children weighing > 15kg; and praziquantel (for schistosomiasis), 40 mg/kg divided in 2 doses for adults and children > 4 yo. 
See http://www.cdc.gov/immigrantrefugeehealth/guidelines/overseas/intestinal-parasites-overseas.html
Arthemether-lumifantrine (AL, for malaria) 6-dose treatment for adults and children weighing > 5kg.
See http://www.cdc.gov/immigrantrefugeehealth/guidelines/overseas/malaria-guidelines-overseas.html

c Ivermectin is not administered to refugees who resided or traveled in countries where Loa loa is endemic due to the risk of encephalopathy associated with ivermectin treatment in persons who are also infected with Loa loa. Countries that are currently considered endemic for Loa loa are Angola, Cameroon, Central African Republic, Chad, Democratic Republic of the Congo, Equatorial Guinea, Gabon, Nigeria, Republic of the Congo, and South Sudan.

 
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