INTEGRATED HELMINTH

CONTROL PROGRAM
 SOIL-TRANSMITTED
SO S HELMINTHS
S

• intestinal parasitic worms which cause

soil
soil--transmitted helminthiasis (STH)
• develop
d l ini the
th soilil

• man is the onlyy host

• enter the body through the mouth and
soles
l off the
h feet
f
3 MOST COMMON HELMINTHS

Ascaris lumbricoides

Hookworm

Trichuris trichiura
 MAGNITUDE OF STH

 2.7 billion people are affected with intestinal

helminths worldwide the majority in
developing countries (WHO)

 In the Philippines:
 PR among
g children 6
6–
–14 y/
y/o is 44.7% (UNICEF/DOH/UP
(UNICEF/DOH/UP--NIH 2010)

 PR among children 1–
1–5 y/o is 43.7%, (DOH 2010)

 Associated factors:
 Poverty
 Poor nutrition
 Inadequate sanitary facilities
 Poor personal and environmental hygiene
 EFFECTS OF STH
Decreased physical activity Decreased mental activity

Poor physical development

 SIGNS & SYMPTOMS OF STH

 Abdominal pain and enlargement

 Weight loss
 Anemia
 Malnutrition
 Loss of appetite
 LIFE STAGES OF WORMS

1.
1 Egg
E stage
t 2.
2 Larval
L l stage
t

3. Adult stage
 ASCARIS LUMBRICOIDES

Most common intestinal helminth in man

L
Largest
t intestinal
i t ti l roundworm
d

Transmitted thru fecal

fecal-oral
oral route

White creamy or pinkish in color

White,

Lives in the small intestine

Life span is 12-18 months

 ASCARIS LUMBRICOIDES

• Lays about 240,000 eggs/day

• 1 female worm produces approximately

65,000,000 eggs in 9 months

• Infective stage is embryonated egg

• Dx – DFS or Kato Katz Technique

Life cycle of Ascaris lumbricoides

Unfertilizedegg
 ASCARIS LUMBRICOIDES
Pathology
A. Larvae
1. Trauma or petechial hemorrhages in the
lungs

2. Massive damage to lung tissues

3. Granulomatous reactions if lodged in

brain, kidney, eyeball, or spinal cord
C
Complications
li ti off Ascariasis
A i i

Photo courtesy of Dr. BD Cabrera

I t ti l perforation
Intestinal f ti
C
Complications
li ti off Ascariasis
A i i

Photo courtesy of Dr. BD Cabrera

A
Ascaris
i in
i the
th liliver
Complications of Ascariasis

Photo courtesy of Dr. BD Cabrera

Ascaris in the brain

 TRICHURIS TRICHIURA
q y with ascaris
• Occurs most frequently
• Lives in the large intestines
• Transmitted thru fecal
fecal-oral
oral route
• Light infection is asymptomatic
• Life span is 5 years
• Anterior 2/3 of the bodyy is slender &
attached to the mucosa of cecum
 TRICHURIS TRICHIURA

• Lays 2,000 to 7,000 eggs/day

• Infective stage is embryonated egg
• No migration phase in the lungs, liver or heart
• Posterior end is thick giving a “whiplike” shape
• Modified Kato Katz technique
Life cycle
y of Trichuris trichiura
Complications of Trichiuriasis
li i f i hi i i

Photo courtesy of Dr. BD Cabrera

Rectal prolapse  
p p
 HOOKWORM

A. duodenale N. americanus
 HOOKWORM

Ancylostoma
A l t duodenale
d d l
Necator americanus

• Blood-sucking nematodes
• Prevalence rate is 5-45%
5 45%
• 96% infection caused by N. americanus
• 2% infection caused by A. duodenale
• 2% mixed
i d iinfection
f ti
 HOOKWORM

• Adult worms are identified based on the

presence of cutting plates or teeth
• Infective stage is 3rd stage larva
• Lives in the large intestine
• Modified
M difi d K
Kato
t KKatz
t ttechnique
h i
 Ancylostoma duodenale

• Mouth located on dorsal side of anterior end

• Buccal capsules with 2 pairs of ventral teeth
and 1 pair of accessory teeth
• Body contour follows the general
curvature
t off body
b d – letter
l tt “C”
• Lays
y 20,000 to 30,000 eggs/day
gg y
• Life span is up to 8 yrs
 Necator americanus
e a e y sstout
• Relatively ou with ce ca cu
cervical aue
curvature
that appears like a hook
• Well developed buccal capsules
• 2 pairs of semi
semi-lunar
lunar cutting plates

• Lays 5,000 to 10,000 eggs/day

Life cycle of Hookworm
 HOOKWORM

Pathology

Larva

• Ground itch or Coolie itch

• Creeping eruption or cutaneous
lar a migrans
larva
• Pulmonary
y lesions
 HOOKWORM
Pathology
Adult worm
• Anemia
N. americanus
– 0.03-0.05 ml/
day/worm

A. duodenale
– 0.16-0.34 ml/day/worm
 HOOKWORM
Pathology is related to intensity of infection

25 worms - no symptoms
25 – 100 worms – mild symptoms, anemia
100 – 500 worms – considerable
id bl d damage,
considerable symptoms
500 – 1,000 worms – severe symptoms,
severe pathology,
often fatal consequences
 HOOKWORM
Pathology is related to intensity of infection

25 worms - no symptoms
25 – 100 worms – mild symptoms, anemia
100 – 500 worms – considerable
id bl d damage,
considerable symptoms
500 – 1,000 worms – severe symptoms,
severe pathology,
often fatal consequences
VISION

Healthy and Productive Filipinos in

the 21st century

GOAL
To reduce morbidity
and mortality due to
soil--transmitted
soil
helminthiasis
 General Objectives

To reduce the prevalence of STH to below

30% among 1-12 y/o by 2016 and lower
STH infection among the adolescent
females, pregnant women and special
population groups of food
handlers/operators, farmers, soldiers and
indigenous peoples
 Indicators

1. S TH prevalence of 1-5 y/o children

reduced to less than 30% from 43.7%
43 7%
(2010)
2. S TH prevalence
l off 6
6-12
12 y/o
/ children
hild
reduced to less than 30% (2010) from
44.7% (2010)
3. Risk to STH infection among special
population groups reduced to less than
10% from 36.9%
36 9% (2010)
 Specific objectives

1. To increase the coverage of deworming

of target population groups at risk to
STH infection
2. To expand coverage of water, sanitation
and hygiene
yg
3. To increase proportion of households
aware of proper STH prevention and
control
 Why deworm?
 short
h term goall – treatment is
i iintended
d d
to p
prevent and control morbidityy by:
y
 reducing worm burden

 longg term goal

g – treatment is to prevent
healthy people from becoming infected
by:
 Reducing the source of infection
TREATMENT GUIDELINES

a. Target population
• children 1-5
1 5 y/o
– suffer the greatest morbidity
– deworming is intended for curative care
• children 6-12 y/o
– harbor the greatest load of infection
– significant sources of infection
TREATMENT GUIDELINES

b. Schedule of mass deworming

• children 1-5 y/o (preschoolers)
– GP – April and October

– RHU, BHS, day care workers

• children 6-12 y/o (schoolchildren)
– July and January
– school nurses and teachers
 TREATMENT GUIDELINES

Filariasis endemic areas (2 y/o & above)

1st dose will be given on:
1-5 yrs old - April by GP
6 2 yrs old
6-12 ld – July
l by
b DepEd
d

2nd dose will be given in Oct-Nov

Oct Nov by
FEP

The filariasis team will be in charge of all

activities in their areas including the
recording and reporting of accomplishment
 TREATMENT GUIDELINES

c. Approach to deworming
• Facility – based or fixed post
- deworming children in RHUs, BHS, day
care centers, schools, etc

• Door – to – door
- deworming children house to house
especially
p y in under-served, remote areas
or poorest segment of the community
 TREATMENT GUIDELINES

DURATION OF DEWORMING

• Mass treatment should be

done every 6 months or 2X a
year for 3 consecutive years
then once a year thereafter
DIAGRAMMATIC REPRESENTATION OF HOW
STH TRANSMISSION CAN BE INTERRUPTED

Reduce worm
burden and
decrease
t
transmission
i i
 TREATMENT GUIDELINES

DOH recommended drugs for mass

t t
treatment
t
Albendazole 400 mg, single dose in
flavored and chewable tablet form

Mebendazole 500 mg, single dose in

flavored and chewable tablet form
 TREATMENT GUIDELINES
Drug Dosage by Target Groups

Target Groups Drug Dosage

12-24 months children albendazole 200 mg,
ssingle
g e dose
or
mebendazole 500 mg
mebendazole, mg,
single dose
more than
h 2 - 12 years albendazole,
lb d l 400 mg,
old children single dose
or
mebendazole 500 mg,
single dose
 TREATMENT GUIDELINES

Side-effects of anthelminthic drugs

 Rare and generally a reaction to the 
degeneration of worms that have been killed
 Only S/E that needs intervention is allergic skin 
reaction which can be treated with histamine 
antagonist
 Mild abdominal pain is most frequently reported 
S/E – does not need treatment
 Erratic worm migration
TREATMENT GUIDELINES

Disposal of the worms

• worms expelled as a result of
deworming should be flushed thru
the toilet
• if no toilets are available, it should be
burned
• worms should not be buried in the
soil
TREATMENT GUIDELINES

Precautions

• severe malnutrition
• diarrhea
• high grade fever
• abdominal pain
 TREATMENT GUIDELINES

Effects of deworming

 Improved
p iron stores and hemoglobin
g levels
 Improved growth
 I
Improved
d ffoodd iintake
k
 Improved
p cognitive
g performance
p
 Reduced incidence of clinical complications
Good Day!