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Humanitarian Entrant Health Service Management of Infections Reference: HEHS 3.1 Issued: July 2011 Review date: July 2016 As a general principle, for treatment of all infectious diseases in humanitarian entrants, Humanitarian Entrant Health Service (HEHS) the Medical officers should adhere to the following evidence-based guidelines for treatment; 1. Diagnosis, management and prevention of infections in recently arrived refugees, Australasian Society for Infectious Disease, 2009. Accessed at http://www.asid.net.au/downloads/RefugeeGuidelines.pdf 2. Therapeutic Guidelines: Antibiotic (Therapeutic Guidelines Ltd: North Melbourne, available at Department of Health WA library http://www.library.health.wa.gov.au/corporate/resources/resource.cfm 3. Australian Medicines Handbook, available Department of Health WA library; http://www.library.health.wa.gov.au/corporate/resources/resource.cfm Specific Considerations Empirical Treatment for Helminths • Albendazole 400mg oral stat (200mg oral stat for patients <=10kg) should be offered to all patients over 2 years of age, excluding those who are in the first trimester of pregnancy or who are breastfeeding as it is safe and effective against Ascaris lumbricoides, Trichuris trichiuria, Ancylostoma duodenale, Necator americanus, Giardia intestinalis, Opisthorchis viverrini, Taenia solium and Hymenolepis nana. • Albendazole is a category D drug. Women who are within the first trimester of pregnancy, likely to become pregnant within one month, or breastfeeding can be offered Pyrantel 20mg/kg oral stat max 750mg or stool examination. Pyrantel is a category B2 drug, and the product information recommends that it should be avoided during pregnancy where possible. Therefore, the benefits of treating helminthic infection in pregnancy with pyrantel, should be weighed up against the risks of untreated helminthic infection to the mother and/or the unborn child. Alternatively, a stool sample may be collected for microscopy prior to treatment. • Children two years of age or under can also be offered Pyrantel 20mg/kg oral stat, up to a max of 750mg. Page 1 of 3 North Metropolitan Area Health Service: Public Health and Ambulatory Care July 2011 Malaria • Malarial infection in children, especially those under the age of 5 years should be considered a medical emergency; • All children with malaria must be referred to the Paediatric Infectious Diseases Physician or Fellow at Princess Margaret Hospital for Children for urgent assessment and treatment; • After hours, children with malaria may be referred to PMH Emergency Department; • Asymptomatic adults with low parasite load and normal indices on full blood count should be referred to the nearest Infectious Diseases Clinic for early outpatient appointment. Discuss with Infectious Diseases registrar and fax/email referral letter; • Symptomatic adults, pregnant women or adults with high parasite load, anaemia or thrombocytopenia, require urgent assessment and should be discussed with the Infectious Disease registrar/physician at the appropriate hospital; and • If the HEHS medical officer is unavailable, the HEHS nursing staff should initiate the client referral to hospital on receipt of a positive malaria result from the laboratory. Notifications • The HEHS medical officers are responsible for notifying Communicable Disease Control of patients they find to have a notifiable infectious disease. Sexually Transmitted Infections • Patients with uncomplicated sexually transmitted infections should be treated in accordance with the Department of Health’s Guidelines for Managing Sexually Transmitted Infections. Available here for download; http://www.public.health.wa.gov.au/3/634/3/guidelines_for_.pm Schistosomiasis • See Appendix 1 for management of Schistosomiasis References 1. 2. 3. Muennig P et al. The cost effectiveness of strategies for the treatment of intestinal parasites in immigrants. NEJM, Vol 340. No 10 March 1999 Australasian Society for Infectious Diseases; Diagnosis, Management and Prevention of Infections in recently arrived refugees 2008 Therapeutic Guidelines: Antibiotic, Therapeutic Guidelines Ltd: North Melbourne Page 2 of 3 North Metropolitan Area Health Service: Public Health and Ambulatory Care July 2011 Appendix 1: Management of Schistosomiasis Algorithm Patient with positive or borderline positive schistosomiasis serology Collect stool and urine specimen and treat with Praziquantel x 2 doses 4 hours apart (African 20mg/kg/dose, Asian 30mg/kg/dose) Ova detected Complicated infection • Patient symptomatic • Signs of chronic liver disease • Co-infection with Hepatitis B or C • Abnormal LFTs (ALT > 100) Refer to Infectious Diseases Physician Uncomplicated infection • Patient asymptomatic • Clinical examination normal • LFTs normal Ova not detected No follow up required Letter for GP; follow up in 3 months to ensure cure (if still positive, refer to Infectious Diseases Clinic) Page 3 of 3 North Metropolitan Area Health Service: Public Health and Ambulatory Care July 2011