Public Health perspective

Human Fascioliasis an Emerging Zoonoses:

-Dr.Kedar Karki
M . V. S t . P r e v e n t i v e Ve t . M e d i c i n e
Parasitology Unit.
Central Animal disease investigation laboratory
Tr i p u r e s h w o r

I n t ro d u c t i o n

Fascioliasis is a well known parasite of herbivorous animals.it has worldwide

distribution on the animal reservoir host. A large variety of animals such as sheep, goat,
cattle, buffalo, horses and rabbits. show infection rate that varies from 70% to 90% in some
areas. Infection of the human host was very sporadic until the last two decades. When
clinical cares and outbreaks were supported. However, it has now become an important
trematode-borne infection of emerging concern until today. The estimated number of people
infected is being estimated 2.4 million in 61 countries. An estimated number of populations
at risk are considered more than 180 million throughout the world. Until today, largest
number of infected people have been reported from Bolivia, China, Ecuador. Egypt, France,
Iran, Peru and Portugal. In Nepal's context, sporadic cases had been reported from human
hospital since last decade, while screening of Human population has yet not been done. Same
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way in Iraq, Lebanon, Morocco, Tunisia, and fewer than hundred cases seems to be
documented which indicates that the problem has not yet received enough attain in these
countries.

Characteristics of Human Fascioliasis:

This disease is being reported to affects all age group, sexes of social classes and
professional particularly inhabitant of rural areas. The prevalence is lowest in children under
5 years. Females are more infected. Clinically the disease occurs acute and chronic phases
with complication, particularly in children.

Transmission of diseases:
Animal reservoir:
The species of Fasciole gigantic and Fasciola hepatica both coexist in domestic animals with
infection rate varying between 80% to 90%.
Snail host:
Lymnea cailliaudi and Lymnea snails are considered important intermediate host to harbor
the infective stage of those parasites. They prefer clear slow running water with slow salinity
and about abundant vegetation. The snail population is low in summer due to high
temperature and increase gradually to reach maximum in spring when temperature is mild
and vegetation flourishes. It is estimated that 10% to40% of snail harbors this parasite in
them to facilitate the development of infective stage and realizes it into water stream and
surrounding vegetation.
Effect of occurrence:
Dietary habits:

It is tradition consumes many species of vegetables and leafy plants as raw salads.
Many of them are although not aqua life but are grown along the bank of water, channels and
need frequent irrigation. Once collected they are washed in nearby channels during these
preparations for marketing. During this process exposes them to cercariae, which in cyst in few
hours become infective. In Nepal's context in many part of country many community they
consume the snail as their food as such, which may tend to make them more prone to this
disease condition has been reported. Iran Yeman and Egypt have reported more cases of
Fascioliasis in recent years. Same fate cannot be overlooked on our condition as it has been
reported in cause diseases i n livestock which infection rate up to 70%. Taking consideration
sanitary condition and pollution of our river stream. Use of water from these river, for
irrigation, for cultivation of many variety of green and leafy vegetables and also use of such
water for wash the vegetables suggest the most likelyhood of the infection. Getting into human
population incidence of infection.
It is estimated that highest number of cases presenting in the summer particularly in August.
This indicates infection at the end of spring or early summer. However, this should not be over
shadow the fact that transmission is continuous throughout the year. Above facts indicates that
human Fascioliasis is becoming an increasing threat to public health. However, there is still
lack of awareness of these emerging problems in much country. An urgent priority seems to be
carrying out surveillance studies to determine the risk of this infection, prevention and control.
In suspected endemic area efforts should be directed towards control of this problem.

For this regards following steps needs to be undertaken:

1. Raising awareness of medical staff particularly doctors working in health unit in rural
areas.
2. Training of technical personnel in diagnosis of Fascioliasis.

3. Man treatment of the animal reservoir.

4. Snail control.
5. Coordination with university and research centre to establish the magnitude of problem
and evaluate the drug for human treatment.
6. Cooperation with public health sector involved for control of infection in livestock and
human population.
7. Provision of safe area for the plantation of vegetables away from the all sources , of
pollution and particularly free from snails.
8. Health education and orientation forwards proper washing of salad vegetables before
consuming using either 6% vinegar or potassium permanganate for f i v e to ten minutes.
Above strategies if followed timely seems to protect human population from the new
emerging zoonoses.
9. Molluscicides may be apply, whenever practical.
10. Strategic drenching on livestock can be done in the month of August and February so as to
lower Fasciola eggs contamination in the rice field.
11. Human awareness program must be launched f r o m zoonotic section of ministry of health
in Nepal. Then only we can sky our urban per urban public health is safe from this new
likely tube emerging zooned disease, otherwise we will lost in fogy cloud as we are now
facing in regards of Japanese encephalitis and kalaazar since last 2.5 decade. Choice is
yours advise is mine

dr_kedarkarki@yahoo.com.