TREATMENT,PREVENTION AND

CONTROL OF INTESTINAL
PARASITIC INFECTION

N.ONILA CHANU
PhD SCHOLAR
Sikkim Manipal University
 INTODUCTION

 Distributed throughout the world with high prevalence

rates.
 Constitute important health & social problem.
 General health care strategies have created.
 Control may be a sensitive both socially & politically.
 To collect accurate epidemiological, parasitological &
pathological data are important.
 THE COST OF NOT HAVING A CONTROL
PROGRAMME

Causes significant losses in:

 Nutrition, growth &development.
 Work & productivity
Medical care cost
 For government:
 Direct cost:
-Hospitalization,
-Outpatient services &
-Drug supply
 Indirect cost:
- Provision of medical facilities
-Training of qualified medical personnel
-Administration of health services & research
Medical cost for individuals

-Retail purchase of drugs

- Laboratory examination & transportation
- Medical fees
- Hospital treatment &
- Health insurance
 PREVENTION & CONTROL STRATEGIES

 Accurate surveys of the distribution & extent of

parasitic diseases is essential.
 Epidemiological research led to
I. How parasites are transmitted
II. How their numbers are regulated within the host
III. How the population dynamics may be distributed for
the purpose of control.
Incidence rate fall as the transmission co-efficient
declines with improvement.
Collect existing information about nature ,extend
to other infection & other diseases in the area under
study.
Supplemented by field study on
- Human behavior
- Local practices in food hygiene
- Methods of faeces disposal
- Quality & accessibility of water supply
 Approaches for control & prevention differs for each
infection & for each area, depending on:

 Local public health importance

 Local health priorities
 Political will
 Man power & economic resources
 Potential for achieving co ordination between
control programme & other major health programme
 SOME PATTERNS OF INFECTIONS OF
INTESTINAL PARASITES
Defects in sanitation, Most likely infection pattern
water supply & food
hygiene.
Faeces disposal High endemicity of
Indiscriminate defecation
-around the houses -Ascariasis in children under 6 yrs
-around the village - Hookworm infection & Ascariasis in all
age group
Water supply High endemicity or epidemics of
-Inadequate quantity -All intestinal parasitic
infection,giardiasis,amoebiasis &
hymenlopiasis.
-Contaminated - Epidemics of giardiasis & amoebiasis.
Food Moderate endemicity of

Contaminated with soil All soil-transmitted

helminthiasis in all age
group.
-Contaminated with faecal -Amoebiasis in adults &
materials( though giadiasis in children.
flies,dirty hands etc).
- Infected meat -Taeniasis in adults
 Recent advances in the epidemiology of major
helminthic & protozoan infection

Ascariasis
 High prevalence rate in all the age groups.
 Reinfection always occur, when the drugs regimen is
discontinued.
 Prevalence pattern shows striking stability
 Feedback mechanism & complex regulatory factors
operate in the host-parasite relationship helps in parasite
population control.
Hookworm infection
Stable & the frequency distribution of the worm
in the host is over dispersed.
Treatment will reduce the intensity & prevalence.
Taeniasis/ cysticercosis

High reproductive potential & efficient eggs

dispersal mechanism of adult tapeworm makes a high
infection pressure.
Immunological regulatory mechanism protect
against reinfection or development of cyticercosis of
low intensity.
different pattern of infection
• the hyperendemic pastoral type
• the endemic urban-rural type
• the epidemic type
Amoebiasis

Epidemic outbreaks are rare, associated with

sewage seepage into water supply.
Direct assessment of transmission is hindered by
difficulties in
-Evaluating the numerous variable involved
- Analyzing the interacting role.
- evaluating the changes in specific environmental
factors.
killed by dessiccation & boiling but not by chlorine.
Giardiasis

Occur more in young children, infants can

infected as early as 3months of age.
 Cysts are more resistant to chemical
disinfectants, survive longer.
IgA Ab present in breast milk, protect infants
against infection.
 Spontaneous disappearance is the result of
immunological process.
 Cryptosporidium

Number of oocysts in the stool has no relationship with

the severity of the illness.
Contact with animals does not account for all cases.
Common during warm, rainy & humid months of the year.
More severe in the urban areas.
 Objectives and general approaches

Specific objectives is essential for

-Proper planning of the programme
- Selection of strategies
- Methods for implanting strategies
- Setting of targets
- Monitoring & evaluation
Long term: to reduce prevalence, intensity & severity
Short term: to bringing the diseases under control
quickly.
 Objective & strategies for prevention
short term long term
objective strategy objective strategy
Ascaries Reduce Individual Reduce Improve
mortality medical care, prevalence sanitation,
& community- & intensityhealth
morbidity oriented , education,
selective community-
chemotherapy oriented
chemotherapy.
Stongyloidiasis Prevent Examination Reduce Improve
morbidity & treatment prevalence personnel
& hygiene
mortality
 Short term Long term

objective strategy objective strategy

Hookworm Reduce Standard care Reduce Improve
infection morbidity management, prevalence & sanitation,
& community intensity health education
mortality orientated
therapy

T. solium Prevent Diagnosis & Reduce Chemotherapy,

taeniasis neuocystic treatment in prevalence of meat
ercosis individuals & taeniasis inspection,impo
communities ve sanitation
 Short term Long term
objective strategy objective strategy

Amoebiasis Reduce Individual medical Reduce Non

mortality care, improve prevalence specific
& personal of hygienic
morbidity hygeine,food safety, pathogenic measures
health education strains

Giardiasis Reduce Individuals medical Reduce same

morbidity, care, improve prevalence
prevents & personal hygiene &
control water quality, health
epidemics education
 Evaluation of priorities, cost and benefits

Include analytical approaches

-To estimate the comparative cost
- Benefits of different health programme
- Changes in knowledge, attitudes & behavior of the people
-Measuring the potential gain in healthy life days through
programme.
- Comparison of impact & benefits.
 Decided whether the benefits from control are justify the
cost of the measured required
 Implementation strategies

Control of epidemics
-Require immediate action
- Waterborne (amoebiasis): determine source of infection
& sanitary measures.
- Plantation workers(hookworm): sanitary facilities, health
education & treatment.
- Taenisis/ cysticercosis: check for infected pork or pork
product.
- Hymenolepiasis: chemotherapy, hygeine improvement
- Ascariasis: chemotherapy, improvement
 Case management
Concern with medical case of individuals
Required suitable laboratory facilities, effective drugs &
health education.
Community oriented projects:
Aim:- to control prevalent infection themselves.
- to promote community co operation in health
matter.
Should not limited to one activity.
 Implementation within other programmes

Implemented with
 Water supply & sanitation
 Diarrheal diseases control
 Maternal & child health, feeding programmes
 Food safety, health education & occupational health
Well-design anthelminthic programmes
 Costs & financing
• Minimal when the programme is so designated
Methodologies and tools
• Depend on accurate & reliable initial surveys
• Proper monitoring of the progress of intervention
programme.
• Diagnostic tools
• Drugs delivery & use
• Choice of sanitary technology
• Health for individuals & the community.
 Survey methodologies

Provides information necessary for problem

identification.
 Form the basis for decision about appropriate actions.
Enables health officials to monitor the progress of
control programme & to modify them when necessary.
 Serves as a system for long term monitoring parasitic
prevalence.
Surveillance

Occurrence & distribution must be scrutinized

Collect & analyze data on prevalence & intensity
Mortality registration
 Morbidity reporting
Demographic data
Data management

Quantitative information programme should be

analyzed by statistical method
Calculation should be made of reinfection and
parasites reproduction rates.
Basic demographic data is need to know the
transmission pattern of different infection
Data on mortality must be analyzed & compared
annually.
 Diagnostic tools
 able to detect mixed infection
3 levels of diagnosis
-Quantitative diagnostic work: intensity measurement
- Community surveys: quick & accurate diagnosis to
process large number of samples
- Individuals patients: clinical judgment & specific
laboratory investigation
Diagnostic tests, methods of recording & interpreting
results need to be standardized
Chemotherapy: drug delivery, use & selection

 Community-oriented give immediate results

Drug selecion-Dosage regimen, ease of
administration & absence of side-effect
Availability & cost- depends on national drug
policy
 Single oral dose useful in population based
programmes
 Coverage, frequency & timing
On the basis of
- prevalence data
- reinfection rates
- the level of community cooperation
- Coverage of the available laboratory facilities
Populations for selective treatment may be stratified by
- Age
-Profession
- Place of residence
- Level of prevalence
 Monitoring & evaluation

Required the measurement of

- Effective coverage
- Drugs efficacy
- Drugs tolerance
Evaluation should done at regular intervals
Include calculation of actual transmission rate.
 Drugs failure
Lack of compliance
 Drugs resistance
Operational failure
Evaluation process requires an experienced
statistician & parasitologist.
 Sanitation technology

Provision of clean water supplies & better

sanitation is the major contribution.
However ideal sanitation is seldom achieved due to
- Lack of strict hygienic practice
- Use of contaminated water
- Indiscriminate defecation
- Lack of personnel hygienic
Choice of technology

 Technically & environmentally sound

 Financially affordable
 Socially & culturally acceptable
 Simple to install, operate & maintain
 Beneficial to public health
Various sources of water

Shallow wells- cheapest & easiest but unsafe

 Spring water- no treatment required
Deep groundwater, rain water, spring water, lake
water, irrigation water & run off water- required
simple treatment
River water- required extensive treatment
All surface water must be filtered
Treatment & rescue of excreta

 Primary sedimentation & biological treatment are

insufficient
Best method- composting night-soil & sludge, at
60 degree Celsius, for 5 days
 Untreated sewage or faeces favors the spread of
nematodes infections
Slurry from biogas plants contains Ascaries egg
 Discharge of effluents: enables helminthes eggs &
protozoan cysts survive for longer time in fresh or sea
water.
 Untreated raw sewage for irrigation- increase IPI in
population consuming irrigated agricultural produce.
 Followed international guidelines.
 Health education & community involvement

 Preparatory phase
-Development of community cooperation
- orientation of health staff
- securing the collaboration of education authorities &
other influential local organization
- obtaining the support of the mass media
- collection or preparation of appropriate educational
materials
 Implementation phase

• Training school teachers in the programme &

control of IPI
• Inclusion of similar instruction in school curricula
• keeping the community informed about the
progress of the programme.
 Drugs commonly used in the treatment of parasitic
infection
Drugs Types of Mode of action Comments
agent
Amphotericin B Polyene Increase cell membrane Acanthamoeba
macrolide permeability.

Choroquine 4 amino Binds to P.falciparum,

quinine ferriprotoporphtrin IX & but not for
is lytic for parasite P.vivex

Emetine Alkaloid Interruption of cell Amebiasis

devision
Drugs Types of agent Mode of action Comments
Hetrazan Piperazine Alter surface Filarial infection
derivative properties &
mobilization

Ivermectin 22,23 dihydro Acts on gamma- larval

derivative of aminobutyric acid migrants,nemato
avermectin B receptor on the des infection
parasite
Mebendazole Benzimidazole- Inhibition glucose Trichuriasis,
benzine+ 5 ring uptake in ascariasis,
structure+ nematodes & hookworm &
3Carbon+ cestodes strongyloides
infections
Drugs Types of agent Mode of action Comments

Metronidazole 5-nitroimidazole Interfere with Amoebiasis,

DNA T.vaginalis &
metabolism in G.lambia
paasites
Niclosamide Heterocyclic Increasing the Cysticecosis,tape
pyrazinoiso membrane wom infection &
quinoline permeability to intestinal flukes
derivative calcium

Pyrantel Naphthylamine Acts as a Hookworm,

pamoate sulfonic acid cholinergic Ascaris, pinwom.
antagonist
Thiabendazole Benzimidazole Unknown Strongyloides