Giant Intestinal Fluke, Fasciolopsis buski outbreak Response Plan

Executive Summary (BLUF)

We are having the spread of the Giant Intestinal Fluke (Fasciolopsis buski) in the northern
part of Thailand. It can cause Fasciolopsiasis. There are 10,000 people in the area, 202 of which is
infected but we believe that there’s more. We are going to go in the area and isolate the area by
building fences around the area such as the river and other water sources in the area. We will need
to hire cops, give education about the disease and the fluke itself, and clean the infected (water
sources and also the livestock). We will separate the people who show symptoms from the one
who doesn’t. We will let people that don’t show symptoms take tests to see if they are infected or
not. If the results are positive, we will also separate them too. We will treat the patients and the
ones who are infected with medications such as Praziquantel (Biltricide) or Niclosamide.

Situation
In the Northern Thailand, there are outbreak of a Platyhelminthes parasite which disperse
in water and some animal. Now there are 202 persons who show symptom and 34 deaths. Local
medical personnel predicts that there might be much higher number of people who were infected.In
the northern part of Thailand, most of people raise farm animal and crops as their income. And
surrounding by mountain and varieties of animal include giant fluke, fish and mammal which are
carrier of the fluke. Citizen in northern Thailand usually live with livestock and wildlife which led
to outbreak of fluke. From the information that we got from local hospital, we have found that
there is not enough place for every patient.

Biology of Fasciolopsis buski

Fasciolopsis buski, or giant intestinal fluke, is a parasite living in water. Embryonated eggs
in feces start to hatch when experience warm water, which is around 25 degree celsius, and form
small Miracidias, an early stage of fluke, which are going to grow when snails are found. Aquatic
plant is where these Flukes living when they are developing in an early stage. Physical developing
starts within snails body, and when they have grown enough, these growing Flukes live in water.
It can be predicted that if dirty water was carried, these Flukes were also carried with water.
Humans need water to survive, and one of the consequences that could come from using water in
every daily life is being infected from diseases from dirty water e.g. Fasciolopsis buski. When a
man unintentionally consumes dirty water, which has new miniature Flukes living in it, Flukes are
transferred to human stomach. They later go into human intestine and start to live and develop
there. A fully developed Giant fluke living in human intestine can be 20-75 mm long and mm
wide, and their eggs are about 130-160 micrometers long and 70-90 micrometers wide.

Constraints & Restraints

There are many things shouldn’t be done when it comes to real life. Local villagers might
not feel comfortable to be watched or specially cared. The subjects may know what is happening
in their area. Killing infected subjects shouldn’t have been in considering how to solve the
spreading of Fluke disease. Eliminating all aquatic plants might destroy the ecosystem which has
been there for a long time. Completely separating contaminated livings is one of the choices in the
plan. Going in and educating what locals already know should be thought carefully. Respect is a
key factor to consider about. People need a slow and steady change not too sudden. Dangerous
chemical is not going to be used in any situation to make sure that no harm is made to people living
in the area. Injecting any chemical precaution is not going to be proceeded until it is sure that it is
not going to harm any living subject. News shouldn’t be spread to other areas to prevent any worse
situation from happening. Restricting people to stay in their accommodations should be the last
choice being made. Forcing any living to make things easier is not an effective way of solving the
spreading of Fluke disease. Importantly, cost used to spend on each person shouldn’t exceed 1000
baht, and the disease should be cured within two months period.

Response
To begin with, areas where patients live should be isolated because this will help stop the
spreading of the parasite to be inside the area. This can be done by look at the place where the
patients live and find the connections between them. For example, if the patients live nearby the
river and they intake the water from it, the river might be prohibited because it might be the place
where the parasites are living. According to the fact that the Giant Intestinal Flukes are transmitted
through humans or pigs’ feces, combining to the fact that Thai people in the undeveloped area still
use the river as their toilet. They throw all their and animal waste into the river and use the same
water to drink and clean. Next step is to cure the current patients and stop them from death. Medical
treatments such as Praziquantel and Niclosamide can be used in the treatment under the permission
of the doctors because there are side effects of using them which may be harmful to the patients
themselves and the society such as sleepiness which might cause some negative effects the society
such as car accidents. After the last treatment, we need to wait until it’s sure that there is no cases
occur anymore. If this step is not being done, then the parasite might still be in the hatching process
which can cause another outbreak in the same area and the cost of treatment will be doubled.
After we have isolated the area, we also need to build fences around the river and places
that might be infected or the parasites might be in. Since children are expected to be in the area,
we will be needing police to take care of the area and making sure that no one goes into the area
while it is being cleaned.
We will also provide education to people about the situation, the diseases they can get from
the fluke, the fluke itself, and maybe about how to preserve, cook food properly because the people
might not know about that, and also about water. We will also clean the water sources and maybe
get rid of the water plants in the potentially harmful area. We might need to replace the livestock
that are infected and replace them with new ones if needed.
 Meanwhile, like mentioned earlier, we will need cooperation from the local police to isolate
the isolated areas. We will also need some volunteers to help out on the medical side and possibly
on teaching the local people about hygiene and cooking in case they don’t know about those things.
For the people who have the symptoms, we will need to give them the medication which
is mainly Praziquantel or Niclosamide. For those who show no symptoms, we will encourage them
to go to the local hospitals and take a test to see if they have the eggs of the fluke or maybe the
fluke itself in their body. If the test comes out positive, we will need to give them the medication
also.

Prevention Steps
The first way that we can prevent the Giant Intestinal Fluke from spreading is disrupting
and stopping its life cycle. Since the eggs of the flukes are usually in water. We could clean the
water sources of the place in all places. However, we should start with the place that has worse
sanitation. People shouldn’t eat foods that are not well cooked. The use of human and pig feces as
fertilizers is not recommended because the fluke can live in the feces and they might be able to get
in to the plants which the people will be eating later. People shouldn’t interact with water sources
that might be infected such as swimming in the river in the infected area. Secondly, everyone needs
to regularly wash their hands after they had finished doing any activity. Cleanliness and hygiene
are necessary for preventing this disease from spreading, and it is the most effective way to protect
people from getting infected. Some of the ways to prevent it are freezing vegetables at -10 degree
Celsius and heat them to 60 degree Celsius in order to kill the parasite, filter or boil drinking water,
and don’t use human and pig feces in agriculture.

Conclusion
If we act now, we will be able to fix the situation and could slow the rate of the infection
cases. The number of new cases will reduce by approximately 15 per month until it reaches zero.
This will take roughly around 4 months to make this number reach zero. The number of total cases
will be around 253 people. However, we will still need to treat all the patients that are infected.
After 3-4 months, all the patients will be cured. Meanwhile, we will also destroy the life cycle of
the Fasciolopsis buski and there will be none of them left in the village. People will know how to
take care of themselves and to not get infected again. All of this will cost around 3 million baht in
total (equipment, medications, personnel, constructions included).
Graph of the Current Situations:

Projection Graph if act now:

New Cases (Decreasing by 15 Every Month)

35
32
30

25

20
17
15

10

5
2
0 0
May Jun Jul Aug

New Cases

By: Nutchanon Charnwutiwong (Nont), Achitphol Poollarp (Tarn),

Tanakom Kaweewuthisinp (Gun), Nataphorn Soontornworasate (Sea), Phuchit Bunluesak (Wan)