| Immunology |
In vitro and in vivo studies to understand how Strongyloides modulates immune response to SARS-CoV-2 and whether outcomes and severity of COVID-19 are different in co-infected individuals. In vitro and in vivo studies to understand how COVID-19 modulates immune responses in chronic Strongyloides infection and whether this predisposes or protects individuals from SHS. Prospective studies examining the impact of chronic Strongyloides infection on B- and T-cell-mediated immune responses to COVID-19 vaccination in higher endemicity settings.
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| Epidemiology and public health |
Strongyloides seroprevalence surveys in low endemicity settings to better define geographic distribution of strongyloidiasis and inform screening programs. Epidemiologic studies and mathematical modeling to assess the combined impact of Strongyloides and COVID-19 within communities and to assist governments and public health bodies in identification of successful mitigation strategies. Seroprevalence surveys for Strongyloides IgG among persons who have been diagnosed with COVID-19, ideally in combination with demographic and social data such as travel and occupation to identify subgroups of patients with COVID-19 at highest risk for subclinical Strongyloides infection.
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| Screening at risk populations |
Development of evidence-based educational interventions for healthcare providers in low endemicity settings to increase knowledge, awareness, and reduce missed Strongyloides screening opportunities. Multi-site validation of proposed screening algorithms for both low, moderate, and high endemicity settings. For high endemicity settings with limited resources, comparison of the health and economic outcomes of Strongyloides screening algorithms versus empiric treatment with 1–2 doses of ivermectin prior to initiation of corticosteroids.
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| Diagnostic testing |
Sensitivity/specificity estimates from studies examining the performance in persons with COVID-19 of different serologic testing assays used for Strongyloides screening prior to corticosteroid initiation. Development of an inexpensive diagnostic test (such as a rapid antigen test) that is highly sensitive, requires little technical ability/training, and can be used to very rapidly effectively rule out chronic Strongyloides infection for screening prior to corticosteroid use. Increased availability and implementation of Strongyloides PCR assays that can be used in LMIC settings, preferably using the same testing platforms as PCR assays currently being used for SARS-CoV-2 diagnosis in these settings. Prospective evaluation to optimize alternative diagnostic methods that have a short turnaround time (such as Baermann method) for use in resource-limited settings where PCR is unavailable, e.g., for screening for asymptomatic Strongyloides infection in high endemicity settings prior to corticosteroid administration.
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| Treatment |
Pharmacokinetic studies to establish to optimal dosing and safety outcomes of subcutaneous formulations of ivermectin. Prospective clinical trials of subcutaneous ivermectin use for chronic strongyloidiasis and SHS to establish its safety and efficacy for use in critically ill patients with COVID-19 when the oral route cannot be used.
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| Research settings |
Development and implementation of screening protocols for subclinical Strongyloides infection in both low and higher endemicity settings for participants in clinical trials of COVID-19 therapeutics. Seroprevalence surveys, testing for Strongyloides IgG by ELISA, for example, could be performed on stored serum specimens that may have been previously collected for COVID-19 research studies. Reporting of strongyloidiasis (including SHS and disseminated Strongyloides) and other parasitic infections, as an adverse event in studies of COVID-19 therapeutics, and as an adverse event of special interest where the investigational drug is expected to have immune modulatory or antiparasitic effects.
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| Special populations |
Prospective studies are needed to confirm the safety and appropriate dosing for ivermectin in special populations such as infants, and those who are breastfeeding or pregnant. Health policy interventions are needed to ensure that underserved populations such as refugees, migrants, or incarcerated persons can access screening for Strongyloides if they are diagnosed with COVID-19 and require corticosteroids.
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