I remember being given a deworming formulation when I was a child.” This was shared by one of the most respected pediatric infectious disease experts in the country upon learning of the incident in Cavite. She is now in her 70s, so this should give you an idea of how long the importance of deworming has been championed. In that conversation, we both expressed our concern that this piece of news, which has gripped the headlines in the past week, might cause direct and collateral damage not only to the deworming program but also to other public health initiatives. In situations such as these, we both agreed that we should be resolute in taking quick action by sharing the necessary information to counter assumptions and provide the needed sobriety.
You may wonder, how grave is the problem? Soil-transmitted helminthiasis is classified as a neglected tropical disease. In the Philippines, the more prevalent agents are Ascaris lumbricoides (giant roundworm of man), Trichuris trichiura (whipworm), and the hookworms Ancylostoma duodenale and Necator americanus. In a review by Mationg et al. in 2021, across the country, despite the launch of the Integrated Helminth Control Program by the Department of Health in 2006, prevalence remained high, ranging from 24.9 percent to 97.4 percent.
Data from the World Health Organization (WHO) Neglected Tropical Diseases Portal as of 2024, state that for the Philippines, the number of preschool-aged children and school-aged children, who are the most vulnerable to these infections, requiring preventive chemotherapy for soil-transmitted helminthiasis was at 37,310,807. National coverage of preschool children then was at 48.61 percent, while that of school-aged children was at 44.91 percent. Hopefully, our statistics have improved in the last year.
Who are the most affected? Are other populations at risk? Pre and school-aged children are the most vulnerable because of several factors. Children are more likely to play and get exposed to contaminated soil, frequently place their hands in their mouths, or handle food with unwashed hands, enabling the transfer of viable worm eggs. Walking barefoot across contaminated soil can also place them at risk for hookworm infection via larval penetration of the skin.
WHO recommends that preventive chemotherapy be given to pregnant women after the first trimester living in areas where both the “baseline prevalence of hookworm and Trichuris infection is 20 percent or more in pregnant women, and where anemia is a severe public health problem, with a prevalence of 40 percent or higher among pregnant women.”
What are the signs and symptoms and the complications? For the above-mentioned helminths, if infections are light, affected individuals may be asymptomatic. Symptoms become more severe as infection progresses. These include abdominal pain, diarrhea, loss of appetite, and weight loss. For Ascaris, during the acute stage of the infection, migrating larvae passing through the liver and the lungs can cause fever, coughing, and wheezing. Heavier infections can result in intestinal obstruction. In Trichuris, or whipworm infection, some affected individuals may have blood in their stools. Rectal prolapse is a dreaded complication. For hookworm infestation, penetrating larvae may result in an itchy red rash, commonly called “ground itch.” Chronic infection with these parasites can lead to iron deficiency anemia.
It is important to note that combined infections are possible and have been documented. As a whole, if left untreated, infection leads to impaired nutrition, which substantially impacts physical growth, cognitive, and intellectual development.
What is the treatment? Albendazole and mebendazole are safe and cost-effective deworming medicines. From the 2017 guidelines on preventive chemotherapy for soil-transmitted infections for at risk population groups, from a review of drug safety trials, which involved more than 6,500 administrations of albendazole and mebendazole, “the most frequent adverse events reported were epigastric pain or discomfort, headache, nausea, dizziness, edema, myalgia, and vomiting.”
What can we all do to help? First and foremost, let us share information correctly. If unsure, please stop and do not contribute to a potentially tense situation by passing the wrong message. Consult those who can provide you with the necessary expertise if you have questions. Control does not only involve mass deworming or periodic preventive chemotherapy amongst targeted and vulnerable groups, but must include efforts to improve sanitation, such as avoiding open defecation in areas without proper infrastructure, improving health behaviors through sustained educational campaigns on the importance of handwashing and the use of footwear.
We have a national program and policies in place. Though there may be perceived or real gaps, let us just give support where it is most needed. This is just one of the many urgent public health concerns that we are confronted with. Keep in mind that we are all invested stakeholders.
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