Soil-Transmitted

Helminth
Control
Program
Al Patrick C. Alajas, RN, MD
 OBJECTIVES
• Discuss the different types of helminths
and their clinical characteristics
• Discuss the link between helminth
infections and environmental sanitation
• Discuss the treatment and program of the
DOH in partnership with DepEd
 SOIL-TRANSMITTED
HELMINTHS
1. Ascaris
2. Enterobius
3. Necator*
4. Ancylostoma*

*hookworms
 1. ASCARIS
• Largest
• 40 cm in length
• Fecal-oral
• 240,000 eggs per day
• Survive up to 1-2
years
ASCARIS
 ASCARIS
• Abdominal pain
• Cough
• Bowel obstruction
• Appendicitis
 2. ENTEROBIUS
• “pinworm”
• “seatworm”
• Fecal-oral
• Nocturnal
migration
• 10,000 eggs per
worm
• Autoinfection
ENTEROBIUS
 ENTEROBIUS
• Perianal pruritus
(worse at night)
• Anorexia
• Insomnia
• Irritability
• Abdominal pain
 3. HOOKWORMS
• Ancylostoma spp.
• Necator spp.
• Directly penetrate
the skin
• Thousands of eggs
per day
HOOKWORMS
 HOOKWORMS
• Iron-deficiency
anemia
• 0.2 ml per day per
worm
• “Ground-itch”
HOOKWORMS
GENERAL CYCLE
GENERAL EFFECTS
 DIAGNOSIS OF HELMINTH
INFECTION
• Microscopy
• Direct visualization
• “Scotch tape method”
SCOTCH TAPE METHOD
DIRECT VISUALIZATION
 COMMON THEMES
• Lack sanitary facilities (esp. sanitary
toilets) and continuing practice of open
defecation in prevalent areas
• Use of human feces as fertilizer and
subsequent contamination of vegetables
• Children most affected
Environmental sanitation is
an essential component in
the control of STH in the
community.
ENVIRONMENTAL
SANITATION
 HELMINTH CONTROL
PROGRAM
AIM: reduce deaths and disease prevalence

TARGET:
-children
-women
-at risk occupations (soldiers, farmers,
food handlers, indigenous groups)
 STRATEGIES
• Mass chemotherapy
– Mass Drug Administration (MDA)
– School-aged children (1-18 years old)
– Albendazole/Mebendazole
– Every 6 months (January and July)
• Integration with WASH
• Involvement of the community
 Treatment

• WHO recommended drugs

o Albendazole (400 mg)
o Mebendazole (500 mg)

• Safe, effective, inexpensive,

and easy to administer even
by non-medical personnel
(e.g. teachers)
• Used in millions of people with
mostly mild and transient adverse
events
• Donated by major pharmaceuticals
(GSK and J&J)
 Albendazole

• Poorly absorbed from

gastrointestinal tract
• Rapidly metabolized in
the liver
• Half-life of 8 hours
• Largely eliminated in
urine
(WHO, 2004 and 2006)
 Mebendazole
• Absorbed by the
gastrointestinal tract in very
small amounts
• Metabolized in liver
• Half-life of 2-9 hours,
lengthened by impaired
hepatic function
• Excreted in feces
(WHO, 2006)
 Albendazole and Mebendazole

• Contraindications:
o Known hypersensitivity
o Pregnancy in first trimester
• Adverse events:
o Mostly mild and transient
o Include gastrointestinal discomfort and
headache
• No evidence of added benefit of
antihistamine with deworming
 DOH Integrated Helminth
Control Program
• Launched in 2006
• MDA target of 85% in
1-18 years old
• Bi-annual school-
based
deworming
o Every January and
July (National School
Deworming Month)
Launch of the WOW Western Visayas in
Pandan, Antique, 2007 (Philippine Star)
 Safety and Adverse Events (AEs)
• Mostly mild and
transient, and serious
AEs extremely
infrequent

• Temporary minor
reactions occur mainly School-age children in Calatrava, Negros
Occidental after deworming in 2012
(UP Manila - NTD Study Group)
in infected people
• Heavily infected more likely to
experience such reactions as a
result of body’s response to dying
worms

• Excluded from treatment:

o Seriously ill individuals
o With previous serious reaction to
treatment
(WHO, 2006)
 Management of Adverse Events
Adverse event Management

Hypersensitivity or allergic Antihistamine

reaction

Moderate to severe Antispasmodic

abdominal pain

Diarrhea Oral rehydrating solution

(DOH, 2010)
MASS DEWORMING