SCHISTOSOMIASIS and OTHER INTESTINAL HELMINTHES SCHISTOSOMIASIS chronic tropical

SCHISTOSOMIASIS and OTHER INTESTINAL HELMINTHES

SCHISTOSOMIASIS Ø chronic tropical disease Ø Bloodfluke called Schistosoma Japonicum Ø Transmitted through the intermediary host of a tiny snail known as Oncomelania Quadrazi. asi.

SCHISTOSOMIASIS: - is one of the most widespread parasitic infection afflicting mankind for a long time (118 years in the Philippines) - second to malaria in Prevalence - rank first in prevalence among water-borne diseases

-thrives where environmental sanitation is poor. - eggs hatch into miracidia that penetrate snail intermediate hosts that inhabit these fresh water bodies -total population of 12 million exposed to the disease

Life Cycle of Schistosomiasis Adult worms live in portal and mesenteric veins Mode of infection: SKIN PENETRATION OF CERCARIAE Schistosoma eggs pass out with feces and hatch in fresh Water into miracidia. Intermediate host: Oncomelania snails

An area is endemic: 1. Presence of Positive cases 2. Presence of Infected Snails ( Oncomelania quadrasi )

Transmission WASHING OF CLOTHES DEFECATING ON SCHISTO INFESTED AREA. LAUNDERING IN SCHISTO ENDEMIC AREAS

Adult Worm of Schistosoma Japonicum in the Portal Vein S LIVE IN THE BLOOD VESSEL CONNECTING THE LIVER AVERAGE LIFE SPAN IS 3 -5 YEARS BUT CAN SURVIVE UP TO 30 YEARS OR MORE

SCHISTOSOMA EGG PRODUCED/ EGGLAYING 500 – 2000 EGGS / DAY /FEMALE WORM

MIRACIDIUM ØLife span is 48 hrs Infective up to 24 Hrs.

CERCARIAE Will survive for a maximum of 3 days, & infective for 36 hrs.

Symptomatology : Study showed that : 37. 8 % = symptomatic 62. 2 % = asymptomatic

Symptoms Ø Ø Early Stage: epigastric or abdominal pain bloody-mucoid stool dysenteric attacks fever Ø Ø Advance Stage: enlargement of the abdomen enlargement of the liver and spleen epileptic seizures of the Jacsonian type Cor-pulmonale

Soil-transmitted Helminth Infections (ascariasis, trichuriasis, hookworm infection) q. Caused by: ingestion of eggs from contaminated soil (Ascaris and Trichuris) or skin penetration by larvae from the soil (hookworms) q. Poor environmental sanitation (open defecation) and poor personal hygiene (dirty hands) are major factors People dirtying the environment for exposure infect other people… Open defecation!

-helminth parasites of man include the nematodes (roundworms), trematodes (flukes) and cestodes (tapeworms) -major cause of poor cognitive development and physical retardation and anemia in children

-Persevere in areas where poverty or poor economic condition breed poor personal hygiene and inadequate sanitation. - Highly agricultural communities found to be high prevalence of STH. - Erratic migration of ascaris worms can lead to a very serious conditions and even death.

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3 MOST COMMON HELMINTHS

EFFECTS OF STH

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Enterobius Vermicularis - Human ‘pinworm”

Eggs of E. Vermicularis in Scotch Tape or Cellulose Tape Preparation

Life Cycle E. Vermicularis

Signs and Symptoms • Frequently asymptomatic • Perianal pruritis • Anorexia • Irritability • Abdominal pain

Treatment Mebendazole, Abendazole

Strongyloides Stercoralis

Signs and Symptoms • Frequently asymptomatic • Abdominal pain • Diarrhea • Pulmonary symptoms

Laboratory Diagnosis Identification of larvae (rhabditiform) through: • DFS –follow-up stool exams 2 -4 weeks after treatment to confirm clearance of infection. • FECT

Treatment • Ivermectin • Albendazole

INTEGRATED CONTROL PROGRAM FOR SCHISTOSOMIASIS AND OTHER INTESTINAL HELMINTHES

Case Finding: 1. 1 clinical diagnosis * history of exposure * symptoms 1. 2 Laboratory diagnosis * stool examination ( K/K method) * blood exam (COPT ) CASE FINDING

Use of sanitary toilets and safe water supply Ø reduction in the transmission of schisto by 75 % can be achieved. Use of Sanitary Facilities Use of Foot bridges Control of Stray Animals Ø 25 % reduction of transmission can be achieved Øenvironmental sanitation through the use of latrines can prevent contamination of the environment with eggs of STH, schistosomes and food-borne helminthes thus arresting the life cycle. 2. ENVIRONMENTAL SANITATION

Health Education Ø Objective: - change undesirable knowledge, attitudes & practices for the improvement of their personal & community health. ØHealth education is needed to convince people to use toilets and to participate in other control and prevention activities of the Government The impact: Ø is measured in terms of health enhancing behaviors; the outcome is reduction in morbidity & mortality

Preventive chemotherapy can prevent development of serious morbidity as well as transmission. 85% coverage should be achieved in this intervention.

2. Water , Sanitation And Hygiene ( WASH) > serves as the cornerstone in the reduction of diseases specially those related to intestinal parasitism. > is formulated in line with the UNICEF’s water, sanitation, and hygiene strategies for 2006 – 2015.

Control of Schistosomiasis x Adult worms live in portal and mesenteric veins CHEMOTHERAPY x Mode of infection: SKIN PENETRATION OF CERCARIAE PERSONAL PROTECTION x Schistosoma eggs pass out with feces and hatch in fresh Water ENVIRONMENTAL SANITATION x Intermediate host: Oncomelania snails SNAIL CONTROL

DESIRED BEHAVIOUR CHANGE SUBMIT FOR EXAMINATION & TREATMENT USE OF SANITARY FACILITIES USE OF FOOTBRIDGES, CONTROL OF STRAY ANIMA PARTICIPATE IN SNAIL CONTROL MEASURES

Summary: s § Schistosomiasis is still a public health problem. § Helminthiasis affect people of all ages and cause profound effects esp. on children §Kato-Katz is use to diagnose Schistosomiasis and STH §An integrated control program can be used for Schisto and STH §The DISEASE is influenced by the 3 P’s people, parasite, poverty

. Disposal of excreta containing Schistosome eggs into fresh water v. SCHISTOSOMIASIS IS SPREAD BY PEOPLE AND NOT BY SNAILS v HUMAN PARASITES ARE A REASONABLE INDICATION OF LACK OF PERSONAL CLEANLINESS AND HYGIENE

N A TH . . U O Y K

GOOD DAY!!! SONIA G. MARGALLO, RMT Schisto/STH/ FWBD Assistant Program Manager