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)