{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T03:34:53Z","timestamp":1791689693458,"version":"4.3.4"},"reference-count":104,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,4]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    Strongyloidiasis remains endemic in Okinawa, Japan; however, epidemiological data over the past 30 years are limited. This study aimed to assess the current seroprevalence of strongyloidiasis in Okinawa. We conducted a cross-sectional study at Okinawa Chubu Hospital in 2022. Serum samples from 1,485 participants were screened using an ELISA-based antibody test with the recombinant\n                    <jats:italic>Strongyloides stercoralis<\/jats:italic>\n                    antigen NIE. Seropositive participants underwent three stool examinations: the formalin\u2013ether concentration method, agar plate culture, and real-time polymerase chain reaction. The crude seroprevalence was 3.2% (\n                    <jats:italic>n<\/jats:italic>\n                    = 47\/1,485, 95% CI: 2.3\u20134.2%), and the age-adjusted seroprevalence was 2.4% (95% CI: 1.3\u20134.2%). Age 80 years old or older was a significant risk factor (odds ratio: 7.84, 95% CI: 3.59\u201317.2;\n                    <jats:italic>P<\/jats:italic>\n                    &lt;0.001). This age group had 8.5% seropositivity (95% CI: 5.5\u201312.4%) and comprised 51.1% of all positive participants. However, five seropositive participants were ages younger than 40 years old. Of the seropositive individuals who underwent stool testing, 30.8% (\n                    <jats:italic>n<\/jats:italic>\n                    = 8\/26) had positive results, and all were 70 years old or older. Despite the absence of a strongyloidiasis control program over the past 30 years, the seroprevalence has markedly declined. The shift toward older age among seropositive participants suggests that environmental transmission is now rare in Okinawa, with most infections likely acquired decades ago. Nonetheless, the persistent high endemicity among the elderly calls for continued clinical awareness of strongyloidiasis.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.25-0500","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T16:05:56Z","timestamp":1769097956000},"page":"519-525","source":"Crossref","is-referenced-by-count":1,"title":["Declining Seroprevalence of Strongyloidiasis in Okinawa, Japan: A Cross-Sectional Study"],"prefix":"10.4269","volume":"114","author":[{"given":"Akihiro","family":"Kosuge","sequence":"first","affiliation":[{"name":"Department of Tropical Medicine and Parasitology, Juntendo University Graduate School of Medicine, Tokyo, Japan;"},{"name":"Department of Emergency Medicine, Okinawa Chubu Hospital, Okinawa, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoyuki","family":"Fukuda","sequence":"additional","affiliation":[{"name":"Department of Tropical Medicine and Parasitology, Juntendo University Graduate School of Medicine, Tokyo, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asano","family":"Funakoshi","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Okinawa Chubu Hospital, Okinawa, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoko","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Department of Tropical Medicine and Parasitology, Juntendo University Graduate School of Medicine, Tokyo, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eiji","family":"Nagayasu","sequence":"additional","affiliation":[{"name":"Division of Parasitology, Department of Infectious Diseases, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Miida","sequence":"additional","affiliation":[{"name":"Department of Clinical Medical Technology, Faculty of Medical Science, Juntendo University, Chiba, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teruyuki","family":"Hachiman","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Okinawa Chubu Hospital, Okinawa, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haruhiko","family":"Maruyama","sequence":"additional","affiliation":[{"name":"Division of Parasitology, Department of Infectious Diseases, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haruo","family":"Obara","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Okinawa Chubu Hospital, Okinawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshihiro","family":"Mita","sequence":"additional","affiliation":[{"name":"Department of Tropical Medicine and Parasitology, Juntendo University Graduate School of Medicine, Tokyo, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Pathogens","first-page":"468","article-title":"The global prevalence of Strongyloides stercoralis infection","volume":"9","author":"Buonfrate","year":"2020"},{"key":"b2","series-title":"Am J Trop Med Hyg","first-page":"727","article-title":"Status of strongyloidiasis in Japan, 2000\u20132017","volume":"103","author":"Ikuno","year":"2020"},{"key":"b3","series-title":"BMC Infect Dis","first-page":"78","article-title":"Severe strongyloidiasis: A systematic review of case reports","volume":"13","author":"Buonfrate","year":"2013"},{"key":"b4","series-title":"Nat Rev Dis Primers","first-page":"6","article-title":"Strongyloidiasis","volume":"10","author":"Gordon","year":"2024"},{"key":"b5","series-title":"Lancet","first-page":"252","article-title":"Soil-transmitted helminth infections","volume":"391","author":"Jourdan","year":"2018"},{"key":"b6","series-title":"Iran J Parasitol","first-page":"440","article-title":"Prevalence of soil-transmitted helminth infections and associated risk factors among schoolchildren in Nakhon Si Thammarat, Thailand","volume":"15","author":"Laoraksawong","year":"2020"},{"key":"b7","series-title":"Acta Trop","first-page":"90","article-title":"Estimating occurrence of Strongyloides stercoralis in the Caribbean island countries: Implications for monitoring and control","volume":"171","author":"Ketzis","year":"2017"},{"key":"b8","series-title":"Rev Esp Salud Publica","first-page":"581","article-title":"Diagnosis of Strongyloides stercoralis infection: Meta-analysis on evaluation of conventional parasitological methods (1980\u20132013)","volume":"88","author":"Campo Polanco","year":"2014"},{"key":"b9","series-title":"Am J Trop Med Hyg","first-page":"248","article-title":"Efficacy of stool examination for detection of Strongyloides infection","volume":"53","author":"Sato","year":"1995"},{"key":"b10","series-title":"PLoS Negl Trop Dis","first-page":"e0006229","article-title":"Accuracy of molecular biology techniques for the diagnosis of Strongyloides stercoralis infection\u2014A systematic review and meta-analysis","volume":"12","author":"Buonfrate","year":"2018"},{"key":"b11","series-title":"Lab Invest","first-page":"87","article-title":"Antibodies to Strongyloides stercoralis larval surface antigens in chronic strongyloidiasis","volume":"47","author":"Genta","year":"1982"},{"key":"b12","series-title":"PLoS Negl Trop Dis","first-page":"e0003491","article-title":"Accuracy of five serologic tests for the follow up of Strongyloides stercoralis infection","volume":"9","author":"Buonfrate","year":"2015"},{"key":"b13","series-title":"Mol Biochem Parasitol","first-page":"73","article-title":"Characterization of a recombinant immunodiagnostic antigen (NIE) from Strongyloides stercoralis L3-stage larvae","volume":"125","author":"Ravi","year":"2002"},{"key":"b14","series-title":"J Infect Dis","first-page":"444","article-title":"A luciferase immunoprecipitation systems assay enhances the sensitivity and specificity of diagnosis of Strongyloides stercoralis infection","volume":"198","author":"Ramanathan","year":"2008"},{"key":"b15","series-title":"PLoS Negl Trop Dis","first-page":"e0003694","article-title":"Development of Ss-NIE-1 recombinant antigen based assays for immunodiagnosis of strongyloidiasis","volume":"9","author":"Rascoe","year":"2015"},{"key":"b16","article-title":"Diagnostic Methods for the Control of Strongyloidiasis, Virtual Meeting, 29 September 2020.","year":"2020"},{"key":"b17","article-title":"WHO Guideline on Preventive Chemotherapy for Public Health Control of Strongyloidiasis.","year":"2024"},{"key":"b18","series-title":"Clin Parasitol","first-page":"90","article-title":"Comparative evaluations of 17 cases of strongyloidiasis at Okinawa Chubu Hospital","volume":"34","author":"Kosuge","year":"2023"},{"key":"b19","series-title":"Emerg Infect 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Age.","year":"2025"},{"key":"b26","series-title":"Trans R Soc Trop Med Hyg","first-page":"342","article-title":"Molecular diagnosis of Strongyloides stercoralis in faecal samples using real-time PCR","volume":"103","author":"Verweij","year":"2009"},{"key":"b27","series-title":"J Jpn Med Assoc","first-page":"601","article-title":"Status of parasitic infection in villages in Okinawa","volume":"39","author":"Sasa","year":"1958"},{"key":"b28","article-title":"Creating a Healthy Society\u201415th Anniversary Commemorative Magazine of the Okinawa Prefectural Preventive Medicine Association.","year":"1978"},{"key":"b29","series-title":"Annu Rep Okinawa Prefectural Inst Health Environ","first-page":"51","article-title":"Transition of prevalence of intenstinal parasites in Itoman District, Okinawa, Japan","volume":"18","author":"Asato","year":"1984"},{"key":"b30","series-title":"Jap J Trop Med Hyg","first-page":"169","article-title":"Current status of Strongyloides infection in Okinawa, Japan","volume":"20","author":"Asato","year":"1992"},{"key":"b31","series-title":"Jap J Trop Med Hyg","first-page":"9","article-title":"Epidemiological features of Strongyloides infection in Okinawa, Japan: Comparative study with other endemic areas","volume":"28","author":"Kobayashi","year":"2000"},{"key":"b32","series-title":"Annu Rep Okinawa Prefectural Inst Health Environ","first-page":"58","article-title":"Epidemiological study of strongyloidiasis in Okinawa","volume":"17","author":"Asato","year":"1983"},{"key":"b33","series-title":"J Parasitol","first-page":"425","article-title":"Efficacy of agar-plate culture in detection of Strongyloides stercoralis infection","volume":"76","author":"Arakaki","year":"1990"},{"key":"b34","series-title":"Clin Microbiol Infect","first-page":"543","article-title":"Novel approaches to the diagnosis of Strongyloides stercoralis infection","volume":"21","author":"Buonfrate","year":"2015"},{"key":"b35","series-title":"Parasitol Res","first-page":"1717","article-title":"Prevalence of Blastocystis hominis and Strongyloides stercoralis infection in Okinawa, Japan","volume":"101","author":"Hirata","year":"2007"},{"key":"b36","series-title":"PLoS Negl Trop Dis","first-page":"e0005253","article-title":"Genome-wide analyses of individual Strongyloides stercoralis (Nematoda: Rhabditoidea) provide insights into population structure and reproductive life cycles","volume":"10","author":"Kikuchi","year":"2016"},{"key":"b37","series-title":"PLoS Negl Trop Dis","first-page":"e3285","article-title":"Association between footwear use and neglected tropical diseases: A systematic review and meta-analysis","volume":"8","author":"Tomczyk","year":"2014"},{"key":"b38","series-title":"Am J Trop Med Hyg","first-page":"97","article-title":"Seroepidemiology of strongyloidiasis in the Peruvian Amazon","volume":"74","author":"Yori","year":"2006"},{"key":"b39","article-title":"The Government of Japan, Prefecture Economic Accounts Fiscal Years 1955\u20131975 (Showa 30\u201349).","year":"2025"},{"key":"b40","article-title":"Prefectural Economic Accounts Fiscal Years 1990\u20132003 (Heisei 2\u201315).","year":"2025"},{"key":"b41","article-title":"World Bank Country Classifications by Income Level for 2024\u20132025.","author":"Eric","year":"2024"},{"key":"b42","article-title":"Statistical Data on Agriculture in Okinawa.","year":"2023"},{"key":"b43","article-title":"Housing and Land Survey of Japan.","year":"2008"},{"key":"b44","series-title":"Strongyloides and Strongyloidiasis in Japan.","author":"Shiroma","year":"1997"},{"key":"b45","series-title":"Am J Trop Med Hyg","first-page":"339","article-title":"Rapid progress toward elimination of strongyloidiasis in North Queensland, tropical Australia, 2000\u20132018","volume":"102","author":"Paltridge","year":"2020"},{"key":"b46","series-title":"Infect Dis (Lond)","first-page":"360","article-title":"Comparison of ELISA and PCR of the 18S rRNA gene for detection of human strongyloidiasis using serum sample","volume":"51","author":"Javanian","year":"2019"},{"key":"b47","series-title":"J Travel Med","first-page":"211","article-title":"Transmission of Strongyloides steracolis person to person","volume":"7","author":"Czachor","year":"2000"},{"issue":"Part 1","key":"b48","series-title":"Parasitology","first-page":"97","article-title":"Age-prevalence and household clustering of Strongyloides stercoralis infection in Jamaica","volume":"110","author":"Lindo","year":"1995"},{"key":"b49","article-title":"About Strongyloides.","year":"2024"},{"key":"b50","series-title":"PLoS Negl Trop Dis","first-page":"e0005752","article-title":"Different but overlapping populations of Strongyloides stercoralis in dogs and humans\u2014Dogs as a possible source for zoonotic strongyloidiasis","volume":"11","author":"Jaleta","year":"2017"},{"key":"b51","series-title":"Annu Rep Okinawa Prefectural Inst Health Environ","first-page":"41","article-title":"Survey Strongyloides in domestic dogs in Okinawa Prefecture","volume":"27","author":"Asato","year":"1993"},{"key":"b52","series-title":"Pathog Glob Health","first-page":"7","article-title":"Prevalence of strongyloidiasis in the general population of the world: A systematic review and meta-analysis","volume":"115","author":"Eslahi","year":"2021"},{"key":"b1","series-title":"Pathogens","first-page":"468","article-title":"The global prevalence of Strongyloides stercoralis infection","volume":"9","author":"Buonfrate","year":"2020"},{"key":"b2","series-title":"Am J Trop Med Hyg","first-page":"727","article-title":"Status of strongyloidiasis in Japan, 2000\u20132017","volume":"103","author":"Ikuno","year":"2020"},{"key":"b3","series-title":"BMC Infect Dis","first-page":"78","article-title":"Severe strongyloidiasis: A systematic review of case reports","volume":"13","author":"Buonfrate","year":"2013"},{"key":"b4","series-title":"Nat Rev Dis Primers","first-page":"6","article-title":"Strongyloidiasis","volume":"10","author":"Gordon","year":"2024"},{"key":"b5","series-title":"Lancet","first-page":"252","article-title":"Soil-transmitted helminth infections","volume":"391","author":"Jourdan","year":"2018"},{"key":"b6","series-title":"Iran J Parasitol","first-page":"440","article-title":"Prevalence of soil-transmitted helminth infections and associated risk factors among schoolchildren in Nakhon Si Thammarat, Thailand","volume":"15","author":"Laoraksawong","year":"2020"},{"key":"b7","series-title":"Acta Trop","first-page":"90","article-title":"Estimating occurrence of Strongyloides stercoralis in the Caribbean island countries: Implications for monitoring and control","volume":"171","author":"Ketzis","year":"2017"},{"key":"b8","series-title":"Rev Esp Salud Publica","first-page":"581","article-title":"Diagnosis of Strongyloides stercoralis infection: Meta-analysis on evaluation of conventional parasitological methods (1980\u20132013)","volume":"88","author":"Campo Polanco","year":"2014"},{"key":"b9","series-title":"Am J Trop Med Hyg","first-page":"248","article-title":"Efficacy of stool examination for detection of Strongyloides infection","volume":"53","author":"Sato","year":"1995"},{"key":"b10","series-title":"PLoS Negl Trop Dis","first-page":"e0006229","article-title":"Accuracy of molecular biology techniques for the diagnosis of Strongyloides stercoralis infection\u2014A systematic review and meta-analysis","volume":"12","author":"Buonfrate","year":"2018"},{"key":"b11","series-title":"Lab Invest","first-page":"87","article-title":"Antibodies to Strongyloides stercoralis larval surface antigens in chronic strongyloidiasis","volume":"47","author":"Genta","year":"1982"},{"key":"b12","series-title":"PLoS Negl Trop Dis","first-page":"e0003491","article-title":"Accuracy of five serologic tests for the follow up of Strongyloides stercoralis infection","volume":"9","author":"Buonfrate","year":"2015"},{"key":"b13","series-title":"Mol Biochem Parasitol","first-page":"73","article-title":"Characterization of a recombinant immunodiagnostic antigen (NIE) from Strongyloides stercoralis L3-stage larvae","volume":"125","author":"Ravi","year":"2002"},{"key":"b14","series-title":"J Infect Dis","first-page":"444","article-title":"A luciferase immunoprecipitation systems assay enhances the sensitivity and specificity of diagnosis of Strongyloides stercoralis infection","volume":"198","author":"Ramanathan","year":"2008"},{"key":"b15","series-title":"PLoS Negl Trop Dis","first-page":"e0003694","article-title":"Development of Ss-NIE-1 recombinant antigen based assays for immunodiagnosis of strongyloidiasis","volume":"9","author":"Rascoe","year":"2015"},{"key":"b16","article-title":"Diagnostic Methods for the Control of Strongyloidiasis, Virtual Meeting, 29 September 2020.","year":"2020"},{"key":"b17","article-title":"WHO Guideline on Preventive Chemotherapy for Public Health Control of Strongyloidiasis.","year":"2024"},{"key":"b18","series-title":"Clin Parasitol","first-page":"90","article-title":"Comparative evaluations of 17 cases of strongyloidiasis at Okinawa Chubu Hospital","volume":"34","author":"Kosuge","year":"2023"},{"key":"b19","series-title":"Emerg Infect Dis","first-page":"401","article-title":"Clinical characteristics of disseminated strongyloidiasis, Japan, 1975\u20132017","volume":"26","author":"Mukaigawara","year":"2020"},{"key":"b20","series-title":"Int J Parasitol","first-page":"1025","article-title":"Application of enzyme-linked immunosorbent assay for mass examination of strongyloidiasis in Okinawa, Japan","volume":"20","author":"Sato","year":"1990"},{"key":"b21","article-title":"Applying the Degree of Urbanisation\u2014A Methodological Manual to Define Cities, Towns and Rural Areas for International Comparisons\u20142021 Edition.","year":"2021"},{"key":"b22","article-title":"Previous Meteorological Data.","year":"2025"},{"key":"b23","article-title":"Prefectural Economic Accounts.","year":"2025"},{"key":"b24","article-title":"Basic Data on Agriculture, Forestry and Fisheries, Okinawa Prefecture.","year":"2025"},{"key":"b25","article-title":"Reiwa 04 Year Basic Resident Register Population by Age.","year":"2025"},{"key":"b26","series-title":"Trans R Soc Trop Med Hyg","first-page":"342","article-title":"Molecular diagnosis of Strongyloides stercoralis in faecal samples using real-time PCR","volume":"103","author":"Verweij","year":"2009"},{"key":"b27","series-title":"J Jpn Med Assoc","first-page":"601","article-title":"Status of parasitic infection in villages in Okinawa","volume":"39","author":"Sasa","year":"1958"},{"key":"b28","article-title":"Creating a Healthy Society\u201415th Anniversary Commemorative Magazine of the Okinawa Prefectural Preventive Medicine Association.","year":"1978"},{"key":"b29","series-title":"Annu Rep Okinawa Prefectural Inst Health Environ","first-page":"51","article-title":"Transition of prevalence of intenstinal parasites in Itoman District, Okinawa, Japan","volume":"18","author":"Asato","year":"1984"},{"key":"b30","series-title":"Jap J Trop Med Hyg","first-page":"169","article-title":"Current status of Strongyloides infection in Okinawa, Japan","volume":"20","author":"Asato","year":"1992"},{"key":"b31","series-title":"Jap J Trop Med Hyg","first-page":"9","article-title":"Epidemiological features of Strongyloides infection in Okinawa, Japan: Comparative study with other endemic areas","volume":"28","author":"Kobayashi","year":"2000"},{"key":"b32","series-title":"Annu Rep Okinawa Prefectural Inst Health Environ","first-page":"58","article-title":"Epidemiological study of strongyloidiasis in Okinawa","volume":"17","author":"Asato","year":"1983"},{"key":"b33","series-title":"J Parasitol","first-page":"425","article-title":"Efficacy of agar-plate culture in detection of Strongyloides stercoralis infection","volume":"76","author":"Arakaki","year":"1990"},{"key":"b34","series-title":"Clin Microbiol Infect","first-page":"543","article-title":"Novel approaches to the diagnosis of Strongyloides stercoralis infection","volume":"21","author":"Buonfrate","year":"2015"},{"key":"b35","series-title":"Parasitol Res","first-page":"1717","article-title":"Prevalence of Blastocystis hominis and Strongyloides stercoralis infection in Okinawa, Japan","volume":"101","author":"Hirata","year":"2007"},{"key":"b36","series-title":"PLoS Negl Trop Dis","first-page":"e0005253","article-title":"Genome-wide analyses of individual Strongyloides stercoralis (Nematoda: Rhabditoidea) provide insights into population structure and reproductive life cycles","volume":"10","author":"Kikuchi","year":"2016"},{"key":"b37","series-title":"PLoS Negl Trop Dis","first-page":"e3285","article-title":"Association between footwear use and neglected tropical diseases: A systematic review and meta-analysis","volume":"8","author":"Tomczyk","year":"2014"},{"key":"b38","series-title":"Am J Trop Med Hyg","first-page":"97","article-title":"Seroepidemiology of strongyloidiasis in the Peruvian Amazon","volume":"74","author":"Yori","year":"2006"},{"key":"b39","article-title":"The Government of Japan, Prefecture Economic Accounts Fiscal Years 1955\u20131975 (Showa 30\u201349).","year":"2025"},{"key":"b40","article-title":"Prefectural Economic Accounts Fiscal Years 1990\u20132003 (Heisei 2\u201315).","year":"2025"},{"key":"b41","article-title":"World Bank Country Classifications by Income Level for 2024\u20132025.","author":"Eric","year":"2024"},{"key":"b42","article-title":"Statistical Data on Agriculture in Okinawa.","year":"2023"},{"key":"b43","article-title":"Housing and Land Survey of Japan.","year":"2008"},{"key":"b44","series-title":"Strongyloides and Strongyloidiasis in Japan.","author":"Shiroma","year":"1997"},{"key":"b45","series-title":"Am J Trop Med Hyg","first-page":"339","article-title":"Rapid progress toward elimination of strongyloidiasis in North Queensland, tropical Australia, 2000\u20132018","volume":"102","author":"Paltridge","year":"2020"},{"key":"b46","series-title":"Infect Dis (Lond)","first-page":"360","article-title":"Comparison of ELISA and PCR of the 18S rRNA gene for detection of human strongyloidiasis using serum sample","volume":"51","author":"Javanian","year":"2019"},{"key":"b47","series-title":"J Travel Med","first-page":"211","article-title":"Transmission of Strongyloides steracolis person to person","volume":"7","author":"Czachor","year":"2000"},{"issue":"Part 1","key":"b48","series-title":"Parasitology","first-page":"97","article-title":"Age-prevalence and household clustering of Strongyloides stercoralis infection in Jamaica","volume":"110","author":"Lindo","year":"1995"},{"key":"b49","article-title":"About Strongyloides.","year":"2024"},{"key":"b50","series-title":"PLoS Negl Trop 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