1.

7
National Schistosomiasis Control and
Elimination Program

Group 4 22 July 2015

OUTLINE INTERMEDIATE SNAIL HOSTS

I. Schistosomiasis  Snails (Oncomelania hupensis quadrasi) serve as
A. Etiology
the intermediary agent between mammalian hosts
B. Mode of Transmission
C. Symptoms  Found in freshwater aquatic environments such as
D. Pathogenesis tropical lotic (lakes and reservoirs) and lentic
E. Clinical Manifestations environments (rivers)
F. Diagnosis  They are most common in waters where water plants
G. Treatment are abundant and in water moderately polluted
II. Epidemiology
withorganic matter, such as feces and urine, as is often
III. History of NSCEP
IV. The NSCEP the case near human habitations
V. NSCEP Targets and Accomplishments
VI. Challenges/Issues Encountered by NSCEP SYMPTOMS
VII. Where do we want to be?  Not by worms but by reactions to eggs
VIII. Plans for the year 2015  Eggs produced by adult worms that do not pass
IX. The Medical Teleparasitology Project out of the body can lodge in the intestine or the
X. Updates bladder
XI. Criteria for Elimination of Schistosomiasis in the
 Years of infection may cause damage to the
Philippines
XII. The Four Pronged Approach liver, intestine, spleen, lungs, and bladder.
XIII. Appendix  Most people are asymptomatic when first
infected
Source: 3A 2017 (normal text), 3B 2017 (italicized text), 3A o Days after infection, a rash or pruritus
2016 (dark yellow text) may develop
o Within 1 to 2 months of infection,
SCHISTOSOMIASIS symptoms such as fever, chills, cough
ETIOLOGY and muscle aches may develop.
 Schistosomiasis is an acute and chronic, parasitic  Untreated schistosomiasis may persist for years
disease caused by digenetic blood flukes (trematode o Abdominal pain, enlarged liver, blood in
worms) of the genus Schistosoma stool or urine, problems in passing urine.
 Three main species infecting humans are Schistosoma o May also increase risk for bladder cancer
japonicum, Schistosoma haematobium, and  Rarely, eggs may be found in the brain or spinal
Schistosoma mansoni. cord
o Cause seizures, paralysis, or spinal cord
Table 1. Parasite species and geographical distribution of inflammation
Schistosomiasis (WHO, 2013)
Species Geographic PATHOGENESIS
Distribution
Schistosoma Africa, Middle East,
mansoni Caribbean, Brazil,
(mesenteric Venezuela,
venules of colon) Suriname
Schistosoma China, Indonesia,
japonicum Philippines
(mesenteric
venules of SI)
Intestinal Schistosoma Several districts of
Schistosomiasis mekongi Cambodia and Lao
(mesenteric People’s Democratic
venules of SI) Republic
Schistosoma Rain forest areas of
guineensis and central Africa
related S.
intercalatum
(mesenteric
venules of colon)
Schistosoma Africa, Middle East
Urogenital haematobium
Schistosomiasis (vesical venous
plexus)
Life Cycle of S. japonicum
(Centers for Disease Control and Prevention, 2012)
MODE OF TRANSMISSION
 Transmission to humans is through skin penetration of
From CDC
the cercaria released by the Oncomelania hupensis
 Eggs are eliminated with feces or urine
quadrasi snail species into the water typically when
 Under optimal conditions the eggs hatch and release
wading, swimming, bathing, or washing.
miracidia, which swim and penetrate specific snail
 Typical transmission sites intermediate hosts.
o Drainage canal
 The stages in the snail include 2 generations of
o Riverbank
sporocysts and the production of cercariae.
o Irrigated rice fields and surrounding drainage canals  Upon release from the snail, the infective cercariae
o The banks of natural and artificial lakes
swim, penetrate the skin of the human host, and shed
their forked tail, becoming schistosomulae.
 The schistosomulae migrate through several tissues and
stages to their residence in the veins.

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 NATIONAL SCHISTOSOMIASIS CONTROL AND ELIMINATION PROGRAM
 Adult worms in humans reside in the mesenteric venules
in various locations, which at times seem to be specific
for each species.
 For instance, S. japonicum is more frequently found in
the superior mesenteric veins draining the small
intestine, and S. mansoni occurs more often in the
superior mesenteric veins draining the large intestine.
 However, both species can occupy either location, and
they are capable of moving between sites, so it is not
possible to state unequivocally that one species only
occurs in one location.
 S. haematobium most often occurs in the venous plexus
of bladder, but it can also be found in the rectal venules.
 The females (size 7 to 20 mm; males slightly smaller)
deposit eggs in the small venules of the portal and
perivesical systems.
 The eggs are moved progressively toward the lumen of
the intestine (S. mansoni and S. japonicum) and of the
bladder and ureters (S. haematobium), and are
eliminated with feces or urine, respectively.
 Human contact with water is thus necessary for infection
by schistosomes.
 Various animals, such as dogs, cats, rodents, pigs,
hourse and goats, serve as reservoirs for S. japonicum,
and dogs for S. mekongi.
 The strains of Schistosoma japonicum require
Oncomelania snails as intermediate hosts.
 Oncomelania H. quadrasi
o An operculated fresh water amphibious
snail with separate male and female sexes.
o They are sexually mature by the time they
measure 3.5 mm.
o A single copulation will allow the fertilized
female to lay eggs every five days for one
month.
o Their usual habitats are small clear
water streams, water-logged rice
fields, swamps, and water seepage
areas along mountains or foothills.
 In a stream or small swamp, they
are found both in the water and in
the banks.
o They are numerous in areas where the soil
is moist.
o Those in the water are found more in the
shallower portions, in protruding rocks,
or on floating leaves and branches.
 Three phases of infection
 Cercariae penetrate and migrate
through the skin
 Often asymptomatic
Migratory phase
 May cause transient dermatitis
(swimmer’s itch), pulmonary lesions,
& pneumonitis
 “Katayama fever
 First egg release
 Allergic responses (serum sickness
due to overwhelming immune
Acute phase
complex formation)
 Pyrexia, fatigue, aches,
lymphadenopathy, GI discomfort,
eosinophilia
 Cumulative deposition of eggs in
tissues
Chronic phase  Egg-induced immune response,
granuloma formation, and
associated fibrotic changes
 The main pathology: due to host granulomatous
reaction to eggs deposited in the liver and other
organs.
 Pathology and clinical manifestations of cercarial
penetration and of schistosomular migration are
considered minor and are not invariable.
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1.7
 The quantum of cercariae that infect the host and
mature to lay eggs, determine severity of
infection.
STAGE MANIFESTATION
Cercarial Dermatitis
penetration
Superficial lung petechiae (parenchyma
Schistosomular to vasculature)
migration Pneumonitis (pulmonary
microvasculature)
Granulomatous hypersensitivity reaction
 Initial deposition: accelerated
formatrion of larger and
Eggs
destructive granulomas
 Chronic: small or modulated
granulomas
 Most serious consequence of granuloma formation
in the liver: obstruction of the intrahepatic portal
branches
o Leads to portal hypertension with
accompanying splenomegaly
o Collateral circulation
 Eggs are shunted into the
systemic circulation and filtered in
the pulmonary vasculature,
eventually causing pulmonary
hypertension.
o Ascites
CHRONIC SCHISTOSOMIASIS
 Due to eggs retained in host tissues- highly
immunogenic and induce vigorous circulating and local
immune responses and cause granulomatous reactions
 Granuloma formation in organs reach a size many times
that of parasite eggs, thus inducing organomegaly and
obstruction (eg. Hepatomegaly)
 Subsequent to the granulomatous response, fibrosis
sets in, resulting in more permanent disease sequelae.
 The accumulation of antigen-antibody complexes
results in deposits in renal glomeruli and may cause
significant kidney disease.
LIVER DISEASE IN SCHISTOSOMIASIS
 Is initiated after the ova that are carried by portal
blood embolize to the liver
o Because of their size they lodge at presinusoidal
sites, where granulomas are formed
o These granulomas contribute to the hepatomegaly
observed in infected individuals
 Schistosomal liver enlargement is also associated
with certain class I and class II human leukocyte
antigen (HLA) haplotypes and markers
 Presinusoidal portal blockage causes several
hemodynamic changes, including portal
hypertension and assoc. development of
portosystemic collaterals at the esophagogastric
junction and other sites
 Esophageal varices are most likely to break and
cause repeated episodes of hematemesis
 Because changes in hepatic portal blood flow occur
slowly, compensatory arterialization of the blood flow
through the liver is established
o While this compensatory mechanism may be assoc.
with certain metabolic side effects, retention of
hepatocyte perfusion permits maintenance of
normal liver function for several years
 FIBROSIS – relates to the second most significant
pathologic change in the liver
o It is characteristically periportal (Symmers' clay
pipe–stem fibrosis) but may be diffuse
o Fibrosis, when diffuse, may be seen in areas of egg
deposition and granuloma formation but is also seen
in distant locations such as portal tracts
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o Schistosomiasis results in pure fibrotic lesions in the  portal hypertension with

liver hematemesis and
o Cirrhosis occurs when other nutritional factors or splenomegaly (S. mansoni,
infectious agents (e.g. hepB or C virus) are involved S. japonicum)
 cystitis and ureteritis (S.
S.HAEMATOBIUM SCHISTOSOMIASIS haematobium) with
 While S. mansoni and S. japonicum schistosomiasis hematuria, which can
focuses on granuloma formation and fibrosis of the progress to bladder cancer,
liver, similar processes occur in urinary  pulmonary hypertension (S.
schistosomiasis mansoni, S. japonicum, more
 Granuloma formation at the lower end of the ureters rarely S. haematobium)
obstructs urinary flow, with subsequent development of  glomerulonephritis, and CNS
hydroureter and hydronephrosis lesions
 Similar lesions in the urinary bladder cause the Table 2. Symptoms with acute and chronic
protrusion of papillomatous structures into its cavity; schistosomiasis
these may ulcerate and/or bleed Condition Symptoms
 The chronic stage of infection is associated with  Fever
scarring and deposition of calcium in the bladder  Abdominal pain (liver/spleen
wall area)
Symptoms  Bloody diarrhea or blood in the
CLINICAL MANIFESTATIONS associated with stools
acute  Cough
 Also known as Katayama’s schistosomiasis  Malaise
fever  Headache
 Occurs weeks after the initial  Rash
infection and is seen as  Body aches
ACUTE
symptoms of fever, cough,  Abdominal pain
SCHISTOSOMIASIS
abdominal pain, diarrhea,  Abdominal swelling (ascites)
hepatosplenomegaly,  Bloody diarrhea or blood in the
eosinophilia stools
 Occasionally central nervous  Blood in the urine and painful
system lesions occur urination
Symptoms
 Presents as ulceration  Shortness of breath and
associated with
caused by eggs result in coughing
chronic
dysentery or diarrhea  Weakness
COLONIC schistosomiasis
 Chronic stage of colonic  Chest pain and palpitations
SCHISTOSO-
schistosmiasis is usually  Seizures
MIASIAS
asymptomatic but occasional  Paralysis
bouts of diarrhea may occur  Mental status changes
and are associated with  Lesions on the vulva or the
malignancies perianal area
 Most serious consequence
of chronic schistosomiasis DIAGNOSIS
HEPATOSPLENIC
 Presents as  S. japonicum is primarily a parasite of the portal vein
DISEASE
hepatosplenomegaly, and its branches
ascites, and symptoms of o in view of this, eggs are not demostrable in the feces
collateral circulation unless they are deposited in the terminal vein or
 Commonly manifests as cor capillaries of the intestinal mucosa or submucosa,
PULMORY pulmonale from obstruction and subsequently escape to the intenstinal lumen
SCHISTOSOMIASIS of lung vasculature due to  Consequently, infections where there is scarring or
granuloma formation and fibrosis of sites of ulcerations prevent passage of eggs
fibrosis to the intestinal lumen
 Motor or sensory disturbance  Stool examination therefore frequently give negative
depending on site of egg results even in active infection
deposition and granuloma  Schistosome eggs can also be recovered by rectal or
formation liver biopsy
 Route: portal vein via  These procedures require skills not within the
mesenteric and pelvic veins capabilities of ordinary medical laboratory technologists
to spinal veins and are not practical for mass screening or field surveys
CEREBRAL
 Acutely manifest as
SCHISTOSOMIASIS
fulminating MICROSCOPIC EXAMINATION
meningoencephalitis, fever,  The gold standard for diagnosis of schistosomiasis in
headache, confusion, suspected patients via identification of ova in stool or
lethargy, and coma urine
 Chronic cases give a clinical  Most suitable for enumeration of eggs, evaluation
picture of tumor with of epidemiology, effectiveness of control
localizing signs and increased measures and drug trials
intracranial pressure  Done 2 months after contact with freshwater
 May result in manifestations  Limited sensitivity in patients with low infectious burden
CONTINUING/
that include, colonic o May be increased bu collection of specimen on
CHRONIC
polyposis with bloody three different days
INFECTION
diarrhea (Schistosoma  Diagnosis may be done by observation of even a
mansoni mostly), single ovum in thick smears (Kato-Katz technique)

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 NATIONAL SCHISTOSOMIASIS CONTROL AND ELIMINATION PROGRAM
 Formalin concentration techniques may be done to
increase yield in low infectious burdens
 Recommended by WHO for use in field studies
 Preparations may be stored for around 2 weeks, thus
making it ideal for identification of egg density.
 Urine examination for S. haematobium may be
concentrated via sedimentation, centrifugation or
filtration.
 Maximum egg excretion for S. haematobium: between
10am and 2pm.
CIRCUMOVAL PRECIPITIN TEST (COPT)
 Demonstrates the formation of bleb or septate
precipitates attached to one or more points on the egg
surface after incubation of schistosome eggs in a
patient’s serum
 It is currently the method of choice for definitive
diagnosis of infection in the Philippines
 Used if microscopic examination yields a negative result
and there is a high index of suspicion for infection with
schistosomiasis
ANTIBODY DETECTION
 Employed if a patient has a history of travelling
to endemic areas in the past and have not
received prior appropriate treatment
 Serum must be collected at least 6 to 8 weeks
after likely infection to ensure full development
of parasite to adult stage.
 ELISA, indirect hemagglutination,
immunofluorescence.
 Not recommended for patients with active
infection and treated previous infection.
ANTIGEN TESTS
 Circulating Anodic Antigen (CAA)
 Circulating Cathodic Antigen (CCA)
 Commercially available kits containing
monoclonal antibodies for schistosomule
antigens
PCR ASSAYS
 Highly specific and sensitive for detection of
schistosome DNA
 Can establish diagnosis regardless of clinical
stage of disease
 Stool, urine, blood serum
TISSUE BIOPSIES
 May also be done for diagnosis when urine or
stool examination is negative (CDC)
 Bladder biopsy: S. hematobium
 Rectal biopsy: all other species
TREATMENT
PRAZIQUANTEL
 Can be used for infections with
major Schistosoma species
 Most effective against the adult worm and requires
the presence of a mature antibody response to the
parasite
 Drug of choice for treatment of schistosomiasis
 Recommended dosage: 60mg/kg/day PO, in 3
divided doses in a day
 Mechanism of action:
o Increases permeability of schistosome
membranes, leading to efflux of calcium ions thus
paralyzing the worms
 Treatment for travellers should be at least 6-8 weeks
after last exposure to potentially contaminated
freshwater
 Although a single course of treatment is usually curative,
the immune response in lightly infected patients may be
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1.7
less robust, and repeat treatment may be needed after
2 to 4 weeks to increase effectiveness
 If the pre-treatment stool or urine examination was
positive for schistosome eggs, follow up examination at
1 to 2 months post-treatment is suggested to help
confirm successful cure
Table 3. Praziquantel Dose and Duration for Different
Schistosoma Species
Schistosoma species Praziquantel dose and
infection Duration
Schistosoma mansoni,
40 mg/kg per day orally in 2
S. haematobium, S.
divided doses for one day
Intercalatum
S. japonicum, S. 60 mg/kg per day orally in 3
Mekongi divided doses for one day
EPIDEMIOLOGY AND PREVALENCE IN THE
PHILIPPINES
 Prevalent especially in poor communities without
access to safe drinking water and adequate sanitation.
 Mostly affects poor and rural communities,
particularly agricultural and fishing populations.
 Inadequate hygiene and contact with infected water
make children especially vulnerable to infection.
 The general distribution:
o Africa, the Middle East, South America
and South East Asia
o It is estimated that at least 90% of those requiring
treatment for schistosomiasis live in Africa
o Worldwide, more than 200 million are known to be
infected and up to 800 million daily are at risk to
become infected
o The number of deaths due to schistosomiasis is
difficult to estimate because of hidden pathologies
such as liver and kidney failure and bladder cancer.
o Estimates therefore vary widely between 20,000 and
200,000 deaths per year (WHO, 2015).
 From the data of WHO, we are still considered to have a
low to moderate prevalence (10 to 49%) of
schistosomiasis with a greater prevalence occurring in
Visayas and Mindanao regions.
 According to IAMAT, schistosomiasis in the Philippines is
mainly caused by Oncomelania quadrasi snails infected
with S. japonicum.
 Still endemic in 12 regions with approximately 12
million at risk and almost 2.5 million directly exposed to
the parasite.
 Specifically 28 provinces, 190 municipalities and 2,230
barangays are affected.
 According to DOH, the national mean prevalence based
on the active surveillance by field health schistosomiasis
teams is 2.5%. having the highest prevalence and
intensity of infection among 5-15 years old
 The intensity of infection varies widely between villages
all as a function of geography, age, sex, and ecology with
a difference in prevalence for the same region ranging
from 0% to 45%.
 In all of the endemic provinces, the prevalence rate of
the disease was higher among males than females;with
the usually affected age groups to be are 55-59 years or
25- 29 years of age.
 This is due to occupational hazards such as farming
and fishing that are key factors for infection.
 This suggests that occupational exposure is a significant
predictor of infection (DOH Philippines 2008).
 Although adults have a higher infection prevalence, the
highest intensity of infection was found to be among the
5- 15-year age group.
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Morbidity of Schistosomiasis per Region, 2010

 Top endemic provinces being Mindoro Oriental,

Agusan del Sur and Sorsogon.
 Kato-Katz thick smear examination was used in
diagnosing Schistosoma japonicum
 Prevalence for each province was computed by dividing
the number of positives by the total number of
individuals whose stools were examined from the five
barangays per province.
 CARAGA is the region with the most # of cases
(morbidity) in the Philippines

Field data collected by the schistosomiasis research

team, CPH, UPM 2005-2008

Table. Prevalence of Schistosomiasis by province (2005

to 2007)
PROVINCES PREVALENCE (%)
Agusan del Sur 3.95
Northern Samar 2.45
Eastern Samar 1.79
Bukidnon 1.66
Surigao del Sur 1.3 Morbidity rate per 100,000 population in the Philippines
Leyte 0.91 from 1998 to 2012
Lanao del Norte 0.81
Davao del Norte 0.78 7
Western Samar 0.77 5.9
Compostela Valley 0.68 6
Mindoro Oriental 0.63 4.3
Catabato- Kidapawan 0.54
5
Marawi City 0.12 4
Sorsogon 0.36 2.7 2.4
Surigao del Norte 0.29 3 2
South Cotabato 0.28 2 1.4
Sultan Kudarat 0.24
Iloilo City 0.2 1
Davao del Sur- Digos 0.09
0
Agusan del Norte 0.08
Cagayan 0.04 2009 2010 2011 2012 2013 2014
Prevalence Rate of Schistosomiasis in the Phlippines by
Year 2009-2014
 From the figure above, morbidity rate is decreasing
over the years but the decline is not constant
 There is still a huge discrepancy between number of
cases identified in 1998 and 2012
o May signify effectiveness of control
programs implemented by the DOH and
WHO

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 NATIONAL SCHISTOSOMIASIS CONTROL AND ELIMINATION PROGRAM
Schistosomiasis mortality rate per 100,000 popuation in
the Philippines from 1989 to 2009
 Observed decline in mortality rate from 1989 to
2009.
 More stable and consistent compared to the
morbidity rate
HISTORY OF NSCEP
SCHISTOSOMIASIS CONTROL PROJECT
 Formulated: 1961
 Integrated into the total health program of the
rural health units at the local level
 Managerial positions: provincial health officer and
regional health director
 Approach before introduction of praziquantel:
o Decrease transmission by breaking the
parasite life cycle through reduction of the
number of snail intermediate hosts
o Limiting human exposure to the infective
form of the parasite, and
o Health education
 Methods of control
o Agro-engineering methods of snail control
o Environmental sanitation measure
o Health education
o Treatment of cases with Stibophen
 MAIN PROBLEM: financial constraints
NATIONAL SCHISTOSOMIASIS CONTROL
COMMISSION
 RA 4359
 Liaison agency between Philippine government
and WHO/UNICEF
 Also serves as a coordinating body to ensure
concerted effort of agencies concerned in planning
and implementing a comprehensive program for
schistosomiasis control in endemic and potentially
endemic areas in the country.
 Multisectorial and involves:
o The Secretary of Health as chairman, the
Secretary of Education, the Secretary of
Agriculture and Natural Resources, the
Secretary of Public Works
Communications, the Chairman, National
Economic Council, the Social Welfare
Administrator, the Commissioner of
Agricultural Productivity, the Director
General of Program Implementation
Agency, the National Irrigation
Administrator, the Presidential Assistant
on Community Development, the General
Manager, National Waterworks
Sewerage Authority, the Budget
Commissioner, and the President,
Philippine Medical Association.
 Duties:
o To formulate and carry out
comprehensive national schistosomiasis
control program
o Foster effective exchange of information
and coordination of projects, programs,
and activities of various agencies
connected with schistosomiasis control
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1.7
o Establish effective liaison with
participating agencies
o Submit recommendations to the President
on administrative or legislative measures
that will effectively carry out national
control program for the disease
SCHISTOSOMIASIS CONTROL COUNCIL
 Formed under PD 893 by President Marcos in 1976.
 Reconstitution of NSCC into NCC
 Functions and objectives:
o Formulate an integrated national program for the
control of schistosomiasis in the Philippines
o Coordinate and integrate the implementation of
schistosomiasis control programs, projects, and
activities of all agencies and instrumentalities of
the government as well as those of the private
sector involved in controlling the disease
o Formulate an effective information and education
campaign scheme and other such complimentary
schemes necessary for the control of the disease
o Promot special studies and researchers on related
aspects of schistosomiasis control and treatment
o Represent the government in its dealings with the
World Health Organization or with the United
Nations International Children’s Emergency Fund
or any other international health agencies or
entities or with foreign governments or their
agencies in matters involving schistosomiasis
control, subject to existing laws, rules, and
regulations
o Undertake such other activity as may be deemed
necessary for the attainment of the objectives of
the Council
THE NATIONAL SCHISTOSOMIASIS CONTROL AND
ELIMINATION PROGRAM
 The Kalusugan Pangkalahatan of the Department
of Health aims to provide every Filipino the
highest possible quality of health care that is
accessible, efficient, equitably distributed,
adequately funded, fairly financed, and
appropriately used by an informed and
empowered public.
o Under this program are technical clusters,
in which, The Support to Service Delivery
Technical Cluster (SSDTC) belongs to.
o Among the units in the SSDTC is the
National Center for Disease Prevention
and Control (NCDPC).
o One of the diseases that the NCDPC
addresses is the elimination of the
schistosomiasis as a public health
problem in all endemic areas, hence, the
and
formerly called Schistosomiasis Control
Commission (SCC), is now the National
Schistosomiasis Control and Elimination
Program (NSCEP).
 One of it is particularly address the elimination of
Schistosomiasis as a public health problem in all
endemic areas
VISION
&
 Schistosomiasis-Free Philippines by 2016
MISSION
 synchronize and harmonize public and private
stakeholders’ efforts in the elimination of
a
Schistosomiasis in the Philippines
OVER-ALL GOAL
 Schistosomiasis is eliminated as a public health
problem in all endemic areas.
 Basis for elimination of schistosomiasis:
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o Prevalence rate is reduced to less than 1% o Living in a highly endemic barangay (PR > 10%),
for at least five (5) consecutive years. without the benefit of a stool exam
 Current target o School children from provinces that have reached
o Eliminate 5 areas (Bohol, Zamboanga del the elimination level of <1/100,000 prevalence for
Norte, Zamboanga Sibugay, Davao del 5 consecutive years.
sure, Davao city) by 2016  According to Belizario et al (2004), the
o Elimination of the disease as a public rationale behind selecting school children
health problem in 23 endemic provinces as a target population is that
by 2020 chemotherapy in the age group has been
shown to reduce significant short term
morbidity, and prevent long term
OBJECTIVES complications in adulthood associated
Objective Indicator/s with chronic infection.
1.Reduce the Percent prevalence rate  To further promote these objectives, July was
prevalence rate of of Schistomiasis and the declared as the mass treatment and awareness
Schistosomiasis in number of provinces month for schistosomiasis, in 2009.
endemic provinces that have reached  The drug of choice for mass treatment is
below 1% by 2016 elimination level praziquantel, single dose, 40 mg per kg body
2.Increase the coverage Percent coverage in weight, given with a full stomach.
of mass treatment to mass treatment of  Observe for ADRs
85% per year in all exposed population (5- o Headache, dizziness, abdominal
endemic areas 65 years old) discomfort, and less commonly, nausea,
vomiting, diarrhea, fever, and urticarial
STRATEGIES rashes
1. Preventive chemotherapy and infection control
2. Transmission control
3. Public-private partnership ACTIVITY 2: SELECTIVE TREATMENT OF CASES
4. Advocacy and social mobilization  Selective treatment of cases, covering positive cases
5. Monitoring and evaluation – those found to be infected upon stool examination –
from areas of moderate prevalence rates (2.1 – 9.9%),
ENABLING ACTIVITIES and low prevalence rates (< 2%).
 Linkaging and networking  Drug of choice is praziquantel, 600 mg/tab, 60
 Policy guidelines and CPGs mg per kg body weight, taken one day in two
 Institutional capacity building divided doses, with 4-6 hours interval and given
 Competency enhancement of frontline service provider with a full stomach.
 Monitoring and supervision  Praziquantel is not contraindicated at any stage of
pregnancy, with the benefits of treatment far
outweighing the risks associated with schistosomiasis,
POLICIES AND GUIDELINES
such as maternal anemia and poor birth and survival
rates of infants.
A.O. 2007-0015 and A.O 2007-0015 A  Current Efforts:
 Revised Guidelines in the Management and Prevention o Constant revision of the manual of
of Schistosomiasis operation procedures, guidelines and
sentinel surveillance by the Department of
A.O. 2009-0013 Health
 Declaring the month of JULY every year as Mass o mass treatment planning and workshop
Treatment and Awareness Month for Schistosomiasis in o Further research on the improvement of
the established endemic areas schistosomiasis control
o Clinical practice guidelines training in
STRATEGY 1: PREVENTIVE CHEMOTHERAPY AND public hospitals and Centers for Health
INFECTION CONTROL Development
 Objective: to scale up access to preventive o Case management training for municipal
chemotherapy with a treatment coverage of 85%, and health officers and selected hospitals
intensifying case management interventions.
 Activities STRATEGY 2: TRANSMISSION CONTROL
o Mass treatment of population age 5-65 years  Objective: to promote the use of safe water and
(DOH-AO 2009-0013). proper sanitation facilities using the WASHED
o Selective treatment of cases, covering positive (Water, Sanitation, Hygiene Education,
cases Deworming) framework
 WHO has categorized communities based on the  Activities:
prevalence of schistosomiasis to determine the o Snail mapping and control
strategy of protective therapy to be given (Please o Environmental sanitation
see appendix)
ACTIVITY 1: SNAIL MAPPING AND CONTROL
 Targeted towards the intermediate host of
ACTIVITY 1: MASS TREATMENT OF POPULATION
Schistosoma japonicum.
AGE 5-65 YEARS
A. SNAIL MAPPING
 Goal: at least 85% coverage in high-prevalence  Existing and potential disease transmission sites
barangays for 3 consecutive years, followed by its are first identified in endemic areas
evaluation using the parasitologic and process  Breeding sites for the snails are also mapped out.
indicators.  Common breeding sites: rice paddies, creeks,
 Coverage: springs, dams, and others (Belizario et al, 2004).
o Citizens in the specified age group (5 to 65 years)  Mapping is done using survey tools such as GPS
units given to endemic provinces, in order to plot

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 NATIONAL SCHISTOSOMIASIS CONTROL AND ELIMINATION PROGRAM 1.7

sites wherein snails which may or may not be  Practice of scientific

positive for schistosomiasis, breed. farming that promotes
improved rice culture
B. SNAIL CONTROL o Constant plowing
 This is achieved through focal and area-wide o Periodic weeding of the
approaches. fields
 FOCAL APPROACH  Chemical control
o Involves water contact studies to identify o The use of chemicals to control snails is
the most common transmission sites, in only recommended in areas with low
areas where these are limited. prevalence (<1%) as a final phase of
 AREA-WIDE APPROACH elimination
o Areas where transmission is spread over o use of molluscicides for snail control is
greater areas, such as a watershed or restriced due to acute inhalation toxicity,
irrigation system. aquatic organism toxicity and ground
 After identification of sites, control measures are water contamination
undertaken to reduce the number of snails
infected. ACTIVITY 2: ENVIRONMENTAL SANITATION
 These measures include:  Promotes elimination of infection among people in
endemic areas, and the general health of the
INFRASTRU  Lining of canals with concrete population
CTURE- to ensure that the canals are  Improper waste disposal allows the parasite to
DIRECTED properly emptied spread via water, survive in intermediate hosts, and
MEASURES  Weeds are kept to a minimum, eventually infect people, perpetuating schistosomiasis,
thereby giving the snails less as well as a myriad of other preventable infections.
venues to reproduce.  In line with this, sanitary toilets must be used, and
ENVIRONM  Management of irrigation defecation must be avoided in rice paddies, rivers, and
ENTAL  Clearing of swamps other bodies of water.
MODIFICAT  Covering of snail habitats  The safety of water sources must also be ascertained
ION with landfills before the water is used for bathing, washing, and
 Farming methods: drinking. Boiling water, treatment with iodine or
o Constant plowing chlorine, and filtering all reduce the chances of
o Periodic weeding. parasite survival
 Proper protective gear such as rubber boots to
 All these measures are aimed at lowering the snail prevent contact with water that may be carrying the
populations to minimize vectors available for the parasite.
parasite. o These measures also apply to farm, stray, and
 However, in the event that these methods fail, domesticated animals, which are potential
and only as a terminal measure, chemical means agents of transmission of the parasite.
of reducing snail populations may be done using  Current efforts: Integrated forum on Neglected
molluscicides. Tropical Disease (NTD) for sanitary inspectors (DOH)
o This method is applicable only to areas  Specific campaigns
with low prevalence (< 1%), due to o Latrine construction and utilization
the risks of: o Safe water supply
 Acute inhalation toxicity o Control of stray and domesticated animals
 Aquatic organism toxicity o Foot bridges
 Ground water contamination
o Current efforts: STRATEGY 3: PUBLIC-PRIVATE PARTNERSHIP
o Training on snail site mapping and  Multisectorial approach
surveillance  Linkages has been made and establish to the
o Further research on animal and snail infection various sectors and organizations that share the
o Analysis of the parasite and vector same goal as to the elimination of the disease
o Operational research on animal and snail burden caused by the infection of Schistosoma
infection (DOH-CPH) spp.
o Species diversity analysis of S. japonicum and
Oncomelania quadrasi (UP-CPH) 1. DEPARTMENT OF HEALTH
o Animal infection survey and diagnostic  Development of a new Clinical Practice Guideline
technique development for bovine for management of schistosomiasis
infection(UP-CPH) o Includes new trends specific for
neurological and other ectopic organ
ENVIRONMENTAL involvement
PHYSICAL SNAIL
MODIFICATION o Aimed to be provided on various medical
CONTROL
METHODS and academic institutions with the aim of
 Engineering of hydraulic  Proper management of improving the practice of clinicians in
infrastructures irrigation systems detecting and intervening against the
 Concrete lining of canals  Clearing of vegetation in disease.
to ensure: swampy areas to expose
o High water velocity the vector snails to 2. DEPARTMENT OF EDUCATION
o Weed control sunlight  Plays a key role in management of cases on
o Periodic flushing  Construction of fish ponds endemic areas with the help of their Public School
o Emptying of canals when water cannot be Surveillance System.
drained  It was reported that the members of the faculty
 Covering of snail habitats are the ones assisting the medical officials in
with land fills distributing the medications for children of school
age during the yearly mass treatment programs.

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 NATIONAL SCHISTOSOMIASIS CONTROL AND ELIMINATION PROGRAM
3. LOCAL GOVERNMENT UNITS
 Responsible in the local management of their
cases through their rural health units.
 This entails that the management of new and
chronic cases are being spearheaded by the local
communities in their endemic areas.
 Furthermore, there are yearly mass treatment
programs being conducted with the supervision of
the regional officials of the DOH.
 The following enumerated sectors are the partners of
Department of Health in the delivery of technical
assistance, planning and research on feasibility and
safety of treatments, delivery of treatments as well as
surveillance and monitoring.
o Department of Agriculture (BAI, NIA,
BFAR)
o Department of Science and Technology
o Department of Local Government/ Local
Government Units
o Philippine Information Agency, Kapisanan
ng mga Broadcaster ng Pilipinas
o Department of Public Works And
Highways
 Cement lining of canals
o Department of Natural Resources
 Snail mapping
o Department of Tourism
o Department of Social Welfare and
Development
 Current Efforts:
o Technical assistance and capability building to
LGUs and other stakeholder (DOH)
o Development of schistosomiasis strategic plan and
framework (DOH-CPH)
o Feasibility and safety of school-based combined
treatment for soil-transmitted helminth infectios
and schistosomiais (DOH-NIH-DepEd)
o Validating the WHO dose pole in the Philippines for
school-based mass drug administration of
praziquantel for morbidity control of
schistosomiasis (DOH-NIH-DepEd)
o Efficacy and safety of 40 mg/kg and 60 mg/kg
single doses of praziquantel in the treatment of
schistosomiasis
o Resurgence of shistosomiasis japonicum in school
children in Agusan del Norrte Philippines:
Opportunities for control in the school setting
(DOH-NIH-DepEd)
Partners and Satkeholders in the SCEP
STRATEGY 4: ADVOCACY AND SOCIAL
MOBILIZATION
 Health Promotion
 Information being disseminated in health promotion
includes facts about the disease process, disease
infection, transmission, prevention and control of
endemic parasitic diseases.
 The knowledge of the people on schistosomiasis is
very vital particularly among the primary health care
workers as they are the health educators in the
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1.7
community that will encourage community
participation in control programs of the DOH
 The program in this strategy is being partnered with
the Department of Education.
o The school curriculum is encouraged to
integrate health education among children on
disease infection, transmission, prevention and
control of endemic parasitic diseases.
o This practice is highly advised in schools
coming from the endemic provinces
 Influencing change in the attitudes and practices of
the people is dependent upon the efforts of the
community organizations and the willingness of the
residents to accept and participate to the projects.
 The use of tri-media is recommended as an effective
tool to create awareness, to advocate, promote and
educate the people on disease transmission,
diagnosis, treatment, prevention and control of
schistosomiaisis.
o Educational programs are aired through radio
and television.
o All of these are necessary in order to obtain the
cooperation of the people for the control and
prevention of the disease.
o Promotion of the most important interventions
in the control of schistosomiasis, which is the
mass treatment, may be done through media.
o The National Center for Disease Prevention and
Control of the DOH is the main agency involved
in this management.
 Together with the National Center for
Health Promotion, they conceptualize and
develop prototype advocacy materials
(radio plugs, advisory flyers and other
promotional materials) that will hopefully
catch the attention of the targeted
exposed population and convince them for
schistosomiasis mass treatment.
 Community assemblies and other gatherings are
avenues to disseminate information in endemic
provinces.
 To further promote awareness on schistosomiases,
the DOH has made partnership with the World Health
Organization (WHO), Asian Institute of Journalism and
Communication (AIJC) and FHI 360.
o The WHO allows researches regarding the
current status of schistosomiasis in the
country to be made and published.
o They also provide health promotional
materials regarding the disease.
o AIJC on the other hand developed and
produced advocacy kits and other advocacy
materials for Local Chief Executives to gain
the support of local leaders to prioritize the
health improvements in their localities for the
NTDs including schistosomiasis.
o They also help in the capacity building in
communication planning and Information-
Education-Communication (IEC) materials
development.
 FHI 360 has launched a 5-year program in 2011, End
Neglected Tropical Diseases in Asia (END in Asia), to
reduce the incidence and mortality related to
neglected tropical diseases including schistosomiasis.
As part of this program, FHI 360 train service
providers, improve logistics for supplies, enhance
monitoring and evaluation systems and provide health
promotion materials.
 Current Efforts:
o Technical and logistic support for the conduct
of Multi-stakeholders forum and kick-off
launching of Mass Treatment and awareness
month to various partners
o Development of Communication plan and
o materials (DOH-AIJ)
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 NATIONAL SCHISTOSOMIASIS CONTROL AND ELIMINATION PROGRAM
o Development of NTD IEC Materials “Urbani
Kits” for schools (DOH-FHI/USAID)
o Development of NTD Maps for three diseases
(DOH-FHI)
o Development of NTD Provincial maps for
Malaria, STH, Filaria and SCH (DOH-WHO)
 Future projects:
o Coalition building in the endemic provinces
and revival of Schistosomiasis task force
STRATEGY 5: MONITORING AND EVALUATION
 Goal: strengthening monitoring of infections as well
as evaluation and enhancement of the current
surveillance system.
 Activities:
o Sentinel surveillance and monitoring
o Health impact assessment
o Quality assurance
1. SENTINEL SURVEILLANCE AND MONITORING
 Done first by the establishment of sentinel sites,
areas in the community where in-depth data are
gathered and analyzed.
 In areas with a large population (>120,000
population per province) barangay schools may be
selected as sentinel sites for surveillance as health
centers alone may not be enough.
 Selection of snail sentinel sites may be conducted
as well.
o Using these schools as sentinel sites,
school children especially those belonging
to grades 1-3 can be monitored
specifically in.
o Kato-Katz technique is done to this
population annually to determine the
trends in human infection.
 In areas that are not endemic with new or
suspected case of Schistosomiasis, rapid
epidemiological surveys are warranted to prevent
further transmissions.
 In endemic areas, households are monitored in
terms of their existing sanitary toilet facilities,
safe water supply facilities and the utilization of
these facilities.
 In order to assess the status of prevalence per
area, prevalence surveys are done every five
years in endemic areas using random selection
(multi-stage sampling) of endemic barangays.
 Surveillance of known cases is made through the
Rural Health Unit Database System:
Schistosomiasis Information System and hospital
registry for cases of neuroschistosomiasis.
o Using these gathered data, the
Department of Health can generate
prevalence maps to determine and predict
prevalence patterns nationwide.
o The development of the Neglected
Tropical Diseases (NTD) Map has also
been helpful in the surveillance of
schistosomiasis cases.
2. HEALTH IMPACT ASSESSMENT
 Health impact assessments help the communities
make informed choices about improving public
health through community’s collective effort.
 Because schistosomiasis is a multifactorial
problem, the approach to eradicate the disease
must also be multisectorial.
 Health impact assessment should be carried out
in close association with environmental
assessment, because health impact assessment
considers changes in both environmental and
social determinants of health.
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1.7
 The involvement of other departments of the
government, along with different NGOs and the
citizens themselves is of great importance.
 The program requires input from each stakeholder
for recommendations to further improve the
control programs implemented, as stated by
Department of Health former secretary Francisco
Duque III.
3. QUALITY ASSURANCE
 To ensure the quality of the diagnostic methods,
10% of the total slides are subjected to a blind
validation by a Certified Validator for
Schistosomiasis from other provinces.
 In addition, slides examined by the RHUs and
other health facilities are validated by a certified
provincial validator and 15% of the total slides
validated are sent to be validated by UPM-CPH or
RITM.
 Process indicators: consumption of drugs,
treatment coverage
 Parasitologic Indicators: prevalence of infection,
intensity of infection, incidence
 VECTOR Indicators: snail density, snail infection
rate, estimated snail population
 Current efforts:
o Rural health unit (RHU) database system:
Schistosomiasis information (SIS) expanded to
zero surveillance web-based information using
geographic information systems (GIS) Maps
(DOH-NIH) is now being utilized.
o Hospital registry for neuroschistosomiasis and
other complicated cases are available for such
cases.
o Assessment of disease-free provinces is being
done using sensitive diagnostic test (DOH-NIH).
As of 2010, only 533758 out of the 1382447
(38.61%) patients diagnosed were treated and
cured accordingly.
o Prevalence survey on schistosomiasis and soil
transmitted helminthiasis (STH-RITHM)
o Development of prevalence maps (DOH-CPH-FHI)
o Schistosomiasis School Sentinel Surveillance
NSCEP TARGETS AND ACCOMPLISHMENTS
 Please see appendix.
 IMPORTANT!
CHALLENGES AND ISSUES ENCOUNTERED BY
NSCEP
 Wavering political commitment of LGUs in the
implementation and sustenance of public health
interventions for addressing schistosomiasis
 Sustenance of program integration and environmental
sanitation activities at various levels
 Increasing treatment coverage of MDA in regions VIII,
X and CARAGA.
 Use of more sensitive diagnostic tools in areas with
low to elimination levels of prevalence to prevent
underestimation of the actual value.
 Problems are encountered in addressing the zoonotic
component of the disease
WHERE DO WE WANT TO BE?
 Currently, 18 provinces remain endemic for
schistosomiasis but the prevalence rates in those
areas remain low (<10%)
 11 provinces have achieved a prevalence of 0 to
<1% and is categorized in the elimination level.
 Sustain these gains via:
o Strengthened active surveillance of human and
snail vectors
o Infection control
o Transmission control
Page 10 of 15
 NATIONAL SCHISTOSOMIASIS CONTROL AND ELIMINATION PROGRAM
o Safe water supply
o Water sealed toilets
o Ordinances to control animal host
o Mass treatment of school children
o Quality control of laboratory and laboratory staff
NSCEP PLANS FOR THE YEAR 2015
*Please see appendix
MEDICAL TELEPARASITOLOGY PROECT
 A type of telehealth services
 A network of health care professionals in diagnostic
parasitology that remotely share information in order
to deliver healthcare services to far flung areas using
information and communication technologies for the
exchange of information regarding the diagnosis,
treatment, and prevention of disease.
 This system aims to develop a database of cases
referred to the system and thus subsequently map the
distribution of parasitic infections in the country—
which will provide quality data and evidence for
advocacy and formulation of policies regarding the
control and prevention of parasitic infections.
 Spearheaded by Dr. Vicente Y. Belizario
 Aims to develop and demonstrate a feasible referral
system which links laboratories over select regional
diagnostic referral centers without requiring the
physical presence of the experts in their localities. It
aims for a timely and accurate diagnosis of parasitic
infections by providing training, reference, diagnostic
assistance, and continuing education for medical
technologists.
 Significance:
o Correct and timely diagnosis of parasitic
infections, preventing misdiagnosis and allowing
for appropriate and correct management of
patients especially in far-flung and underserved
areas;
o A feedback mechanism for referring parties who
are part of the network to share their microscopic
and laboratory findings, express their opinions
and to communicate with experts in the field and
vice versa;
o Capacity building of laboratory personnel as
referring parties;
o Support for Neglected Tropical Disease
Information System (NTDIS) currently being
developed by the DOH through a database of all
referred cases that will be utilized in mapping
parasitic infections in the Philippines and
o An updated data and generation of new
information that will be used to improve current
guidelines and policies on NTD control and
contribute to global discussions on the diagnosis
of parasitic infections.
 Collaborating agencies:
o Department of Science and Technology-Philippine
Council for Health and Development
o Department of Health
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1.7
o Academic Institutions (Davao Medical School
Foundation Inc and Saint Louis University, Baguio)
o Local PAMET Chapter
UPDATES
 Leonardo et al. in 2015
o Described schistosomiasis as endemic in 28
provinces in 12 regions, 14 cities, 189
municipalities, and 2221 barangays
o Most of these areas, characterized by the
absence of dry season, found in CARAGA and
Region VIII.
o More than 12 million people are at risk and
about 2.5 million are directly exposed from
3012 snail-infested bodies of water nationwide
which are largely found in Mindanao (80%).
o The same article assessed the prevalence as
well as the age and sex distribution of
schistosomiasis in two new endemic foci in
the country namely Gonzaga, Cagayan
and Calatrava, Negros Occidental which
showed Calatrava of having lower prevalence.
CRITERIA FOR ELIMINATION OF
SCHISTOSOMIASIS IN THE PHILIPPINES
 FOUR PARAMETERS
1. Criteria for Morbidity Control
 The prevalence rate of cases and heavy intensity
infection is less than 5% in endemic population
(residents);
 The prevalence rate in domestic animals is less
than 5%;
 Data and files reflecting the changes in human
and snail infections at the barangay and
municipal level are available (including validation
of snail sites)
 Preventive chemotherapy treatment coverage is
85% or more and 100% geographic coverage for
5 to 65 years of the population
2. Criteria for Elimination as a Public Health
Problem
 The prevalence rate of cases and heavy intensity
infection is less than 1% in endemic population
(residents) for at least three (3) years.
 The prevalence rate in domestic animals is less t
han 1%.
 No infected Oncomelania snails are found for two
successive years
 Data and files reflecting the changes in human a
nd snail infections at the municipal and
barangay level are available.
3. Criteria for Areas Eligible for Elimination of the
Disease
 No new human schistosomiasis case (incidence) is
found for five (5) successive years.
 No schistosomiasis case in domestic animals
with local infection is found for five successive
years.
 No infected Oncomelania snails are found after
careful surveys for two successive years.
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 NATIONAL SCHISTOSOMIASIS CONTROL AND ELIMINATION PROGRAM 1.7

 Data and files reflecting the changes in human  Stop water contamination by infected
and snail infections at the municipal and barangay individuals or animals
level are available. 4. Safe water supplies, IEC and PPEs
 Available elimination plan  Prevent contact of human and bovine reservoirs
 Existing and functional surveillance system (zero with snai- or cercaria-contaminated water
surveillance)
CURRENT RESEARCHES AND PROGRAMS ON
4. Criteria for Areas who have Achieved Disease SCHISTOSOMIASIS
Elimination 1. Neuroschistosomiasis Registry
 No new infection in man (autochthonous cases) or  Department of Clinical Epidemiology-UPCM
domestic animals is detected for five years after  In partnership with the Philippine Neurologic
reaching the criteria for transmission interruption. Association,PGH
 To monitor the target provinces in Mindanao
THE FOUR PRONGED APPROACH  Research areas include zero surveillance, area
*Please see appendix evaluation and focal surveys
1. Preventive chemotherapy or selective treatment  Currently under Phase II
 Similar to strategy 1 of NSCEP  Please see appendix.
 Kill worms in man and reservoir hosts (esp.
carabaos) via praziquantel-based therapy. 2. RITM-Schistosomiasis Study Program
 Cattle and carabaos  Objectives:
o Have a high prevalence of S. japonicum o development of cost-effective schistosomiasis
infection in Northern Samar control measures based on existing
o Average daily egg output: 195,000 technology that can be applied by the DOH in
o Warrants an integrated approach for schistosomiasis endemic areas in the
hampering bovine transmission of Philippines
schistosomiasis via bovine chemotherapy or o development of alternative diagnostic tests
vaccination for determining prevalence and intensity of
2. Snail control infection in field settings
 Killing of intermediate host (Oncomelania o conduct of studies that will provide new
snails) via biological, chemical and insights in the pathogenesis of disease and
environmental control. resistance to Schistosoma japonicum infection
 Biological control that can include the development of a safe
o Competitor snails like the Thiarid snail and effective vaccine against establishment of
family infection.
o Snail-eating fish
 Chemical control 3. Neglected Tropical Diseases-USAID
o Molluscicides  DOH in partnership with USAIC
 Environmental control  NTDs Elimination and Control Program
o Concrete lining of canals  create large-scale activities to eliminate
o Weeding lymphatic filariasis (LF) and control the
o Irrigation management transmission of schistosomiasis (SCH) and soil-
o Swamp clearing transmitted helminthes (STH)
3. Environmental sanitation, IEC and behavior  “WASHED” — water, sanitation, hygiene,
change education and deworming
 Prevents infection of Oncomelania snails by
schistosome miracidia

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 1.7
National Schistosomiasis Control and
Elimination Program

Group 4 22 July 2015

STEPS TOWARD THE ELIMINATION OF SCHISTOSOMIASIS

1. Countries 2. Countries eligible 3. Countries eligible
4. Countries that
eligible for for elimination as a for elimination
GROUP have achieved
control of public health (interruption of
elimination
morbidity problem transmission)
Elimination
Elimination as a public Post-elimination
Goal Control of morbidity (interruption of
health problem surveillance
transmission)
Intensified preventive V Surveillance to detect
Preventive Adjusted preventive
chemotherapy in E and respond to
chemotherapy chemotherapy
residual areas of R resurgence of
Recommende
transmission I transmission and to
d Complementary Complementary public
F prevent reintroduction
Intervention public health health interventions
Complementary public I (schistosomiasis
interventions, strongly
health interventions C should be made
where possible recommended
essential A notifiable)
100% geographical T
coverage and at I
least 75% national O
Prevalence of heavy-
coverage N
intensity infection Reduction of incidence Incidence of infection
Target
<1% in all sentinel of infection to zero remains zero
Prevalence of
sites
heavy-intensity
infection <5%
across sentinel sites
Group Up to 5-10 years Until all countries have
Up to 3-6 years from Up to 5 years from
progression from joining the interrupted
joining the group joining the group
(1 to 4) group transmission

ROLES AND RESPONSIBILITIES OF STAKEHOLDERS IN SUPPORT OF DISEASE PREVENTION AND

HELMINTH CONTROL PROGRAMS IN THE PHILIPPINES
STAKEHOLDER ROLES AND RESPONSIBILITIES
 Formulate policies and control programs
DOH
 Provide opportunity for capacity building (LGU and school health staff
 Capacity building (BHWs, local health unit and hospital staff, local officials) for
implementation, surveillance, and monitoring of policies and control programs at the local
LGU level
 Forge partnerships and spearhead advocacy, social mobilization, program marketing at the
local level
 Capacity building (direct involvement of trained teachers in drug distribution and
administration) for implementation of control programs in the school setting
DEPED
 Advocacy (advocacy meetings through parent-teacher assemblies, health education, and
information dissemination)
 Capacity building (assistance of day care workers in drug distribution and administration)
DSWD
 Advocacy (health education and information dissemination to parents)
 Technical assistance
INTERNATIONAL  Logistical support
AGENCIES  Academic institutions
AND  Research for policy generation
ACADEMIC  Monitoring and evaluation of control programs and initiatives
INSTITUTIONS  Capacity building
 Advocacy
 Technical assistance
PRIVATE SECTOR
 Logistical support
(MEDIA, SOCIO-
 Advocacy (program marketing)
CIVIC GROUPS,
 Social mobilization
NGOS)
 Research (NGOs)

APPENDIX
Distribution of Schistosoma Infection by Age Group, Sex and Year

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 NATIONAL SCHISTOSOMIASIS CONTROL AND ELIMINATION PROGRAM 1.7

NOTE: SCHISTOSOMIASIS IS MOST PREVALENT IN THE 15 to 49 AGE GROUP AND IN MALES.

WHO CLASSIFICATION OF THE DIFFERENT COMMUNITIES BASED ON THEIR RISKS

CATEGORY PREVALENCE OF ANY
ACTIONS TO BE TAKEN
SCHISTOSOMIASIS
INFECTION AMONG SCHOOL-
SCHOOL AGE CHILDREN ADULTS
AGED CHILDREN
High-risk > 50% by parasitological methods Treat all school age children Treat adults considered to
community (intestinal and urinary (enrolled and not enrolled) once be at risk (from special
schistosomiasis) a year groups to entire
communities living in
endemic areas)
Moderate- > 10 and < 50% by pathological Treat all school age children Treat adults considered to
risk methods (intestinal and urinary (enrolled and not enrolled) twice be at risk (from special
community schistosomiasis) a year groups to entire
communities living in
endemic areas)
Low-risk < 10% by parasitological methods Treat all school age children Praziquantel should be
community (intestinal and urinary (enrolled and not enrolled) twice available in dispensaries and
schistosomiasis) during their primary schooling clinics for treatment of
age (e.g. once on entry & once suspected cases
on exit)

NSCP TARGETS AND PROGRAM ACCOMPLISHMENTS (!!!!)

STRATEGIC BASELINE ACCOMPLISHMENT
INDICATOR TARGETS
OBJECTIVES (2009) 2013 2014 2015 2016
Prevalence Rate (%) of
4.3 % <1% 2% 1.4% <1%
Schistosmiasis
Schistosomiasis Number of Provinces
in endemic areas with Enhanced Control
is eliminated for Elimination of 0 5 0 0 5
Schistosomiasis as a
public health problem.
Coverage in MDA Coverage of 85% in
is increased in MDA among exposed 85%
30% 44% 57% 85%
endemic population (5-65 years (Annual)
provinces old)

THE FOUR PRONGED APPROACH

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 NATIONAL SCHISTOSOMIASIS CONTROL AND ELIMINATION PROGRAM 1.7

CATEGORY OF AREAS BASED ON LEVEL OF PREVALENCE

LOW TO MODERATE (>1% ELIMINATION LEVEL (<1%
PREVALENCE) PREVALENCE)
Surigao Norte (8.1%-2012) Davao del Sur (0 %-2013)
Agusan Sur (3.7%-2012) Bohol (0 %)
Agusan Norte (14.2%-2011) Zamboaga del Norte (0%)
North Cotabato (1.6%-2013) Davao Oriental (0.6%)
Compostela Valley (1%) Davao City (0 %-2013)
North Leyte (1.8%-2013) South Cotabato (0.8%-2013)
North Samar (5.4%) Mindoro Oriental (0 .3%-2013)
Eastern Samar (4%- 2013) Davao del Norte (0.7%)
TARGET West Samar (5.5%) Sultan Kudarat (0%-2013)
AREAS Bukidnon (5.8%) Maguindanao (0.1%)
Lanao del Norte (3.3%) Zamboanga de Sibugay (0%-2013)
Zamboanga del Sur (1%)
Lanao Sur (1%)
Cagayan (2.7%)
Sorsogon (3.3%)
Negros Occidental (4.8%)
Misamis Occidental (1.3%)
Surigao del Sur (2%)
Elimination Level: <1%;
Low: >1% but <10%;
Moderate: >10% but <50%;
High: >50%
PROGRAM THRUSTS MAJOR ACTIVITIES
Preventive Chemotherapy and Clinical Practice Guidelines (CPG) Dissemination to Public and Private sectors
Infection Control MDA in all endemic areas
Capability building of LGU and other partners in Malacological surveillance and
Transmission Control
control and environmental sanitation
Advocacy and Social Integrated forum on Schistosomiaisis, STH, FWBD and Environmental
Mobilization Sanitation for LGU and other partners (Luzon/Visayas and Mindanao Cluster)
Focal Prevalence Survey in some Provinces and Assessment of 5 Areas who
Monitoring and Evaluation have reached elimination
Pre-Post MDA program review
Public-Private/P2P Partnership Engagement of Technical partners in various projects

Different Areas of Research and Investigation in a study entitled, Development of a Registry for
Neuroschistosomiasis, Philippines, June 2013-2014

ACTIVITIES PARTNER TARGET REMARKS

a. Neuroschistosomiasis Registry Academe 2 Provinces Ongoing
b. Zero surveillance Academe 12 Provinces Ongoing
c. Evaluation of areas under the DZFI Academe 5 Provinces 2-Ongoing
3-To start 2nd quarter
(2014)
d. Evaluation of endemic areas after a minimum of 5 years of Academe 22 Provinces To start 2nd quarter
PC (Focal surveys) (2014)

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