SCHISTOSOMIASIS and OTHER INTESTINAL HELMINTHES 

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

SCHISTOSOMIASIS: - 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

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

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

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

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

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

MIRACIDIUM  Life 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 : Study showed that : 37.8 % = symptomatic 37.8 % = symptomatic 62.2 % = asymptomatic 62.2 % = asymptomatic

Symptoms Early Stage:  epigastric or abdominal pain  bloody-mucoid stool  dysenteric attacks  fever 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)  Caused by: ingestion of eggs from contaminated soil (Ascaris and Trichuris) or skin penetration by larvae from the soil (hookworms)  Poor environmental sanitation (open defecation) and poor personal hygiene (dirty hands) are major factors for exposure People dirtying the environment 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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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 DFS –follow-up stool exams 2-4 weeks after treatment to confirm clearance of infection. FECT Identification of larvae (rhabditiform form) through:

Treatment Ivermectin Albendazole

INTEGRATED CONTROL PROGRAM FOR SCHISTOSOMIASIS AND OTHER INTESTINAL HELMINTHES

CASE FINDING Case Finding: 1.1 clinical diagnosis * history of exposure * symptoms 1.2 Laboratory diagnosis * stool examination ( K/K method) * blood exam (COPT )

Use of sanitary toilets and safe water supply  reduction in the transmission of schisto by 75 % can be achieved. Use of Sanitary Facilities 2. ENVIRONMENTAL SANITATION Use of Foot bridges Control of Stray Animals  25 % reduction of transmission can be achieved  environmental 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.

Health Education  Objective: - change undesirable knowledge, attitudes & practices for the improvement of their personal & community health.  Health education is needed to convince people to use toilets and to participate in other control and prevention activities of the Government The impact:  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) 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 Mode of infection: SKIN PENETRATION OF CERCARIAE PERSONAL PROTECTION Intermediate host: Oncomelania snails SNAIL CONTROL Adult worms live in portal and mesenteric veins CHEMOTHERAPY Schistosoma eggs pass out with feces and hatch in fresh Water ENVIRONMENTAL SANITATION x x x x

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

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 3P’s people,parasite,poverty Summary:

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

THANK YOU..

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