Incident Action Plan - Gastrodiscoides Hominis 2019-2020 Outbreak

Made By:

Name Class Section Student ID

Ms. Chanakarn Kiattaweemunkong 1101 6161077

Ms. Phannamon Prathomthong 1104 6161126

Ms. Nakulkarn Pollom 1102 6161132

Ms. Poonyanuch Jirapongtanavech 1102 6161196

Ms. Nolaphan Roongrojpanawan 1104 6161210

Executive Summary

The purpose of this medical response plan is to provide recommendations about how to stop
the outbreak of the Gastrodiscoides hominis. There is an outbreak of the disease in the north of
Thailand in 2019. According to our response plan, people in the area will be following rules that are
created by the community leaders, which are permitted by the government, and will be watched
regularly when they are outside. This can help to stop the disease from spreading outside the area. The
monitoring of those areas includes the prohibition of using natural water sources that are not
decontaminated, eating seafood, snails, and pork, banned night soil and water vegetation, examining
the seafood and pork which are to be exported, locking down the area, medical checkups, and lastly
separating infected pigs from the area. Also, we can prevent this from happening in the future by
educating the community about the fluke’s life cycle, cleaning the food properly, tagging the food
which is free from parasites, and lastly restrain pigs from having access to ponds and canals.

Situation

There has been a widespread outbreak in northern Thailand of a parasite called

“Gastrodiscoides hominis,” building up 202 known cases and 34 deaths. The exact number isn’t
known, but the number of people infected could be higher.

Area:
The countryside seems to be the place where the most infections occur; it also appears that
towns nearby each other have a total of 10,000 accumulative people. Though there is not much
transfer of diseases between these areas, people would still go about the time every day, possibly
unaware that they are infected. To make matters worse, there is no deep sanitation of the place, lack of
law implementation, and the small local hospitals can barely fit enough people inside.
Around the towns are forests filled to the brim with many mammals, reptiles, and mollusk
species that are sheltered near or in many freshwater rivers and streams. Locals are dependent on that
water, making meals from the animals that live there. Not only do people there get foods from the
water, but people there also live off of agriculture. We know that because about ⅓ of people there
have farm animals and use them to make their earnings. Meat from them is distributed to all major
cities.

The graphs below show the prediction of the number of cases that may be in the next 3
months:
Graph - New Cases, Project 3 Months:

Graph - Total Cases, Project 3 Months:

Organism Identified:

The Gastrodiscoides Hominis is the parasite of humans which is usually found in Assam,
India, the Philippines, and Southeast Asia. The Gastrodiscoides are identified as Digenea Fluke which
is in a phylum Platyhelminthes, class of Trematoda, Amphistomidae Family, Gastrodiscoides
Hominis genus. The gastrodiscoides are mostly found in pig, but when it affects humans, it could
cause dangerous health problems. However, it doesn’t cause a strong infection.

Habitat:

Gastrodiscoides hominis can be found in Vietnam, Philippines, Bangladesh, and most

commonly in the Assam state of India. It is prevalent in areas that use "night soil" like in Southeast
and Central Asia. Its natural habitat is the colon of pigs and has also been found in monkeys, rats,
fish, and other fish-eating animals. It can also be found on humans’ caecum wall.

Characteristics:

➢ Appearance

The gastrodiscoides hominis is a red fluke with ventral suckers which helps it hang onto their
host. In front of the fluke, it appears shrunken with an altered tip. At the back, it has reproductive
organs, oval-shaped ovaries, and the two-lobed testicles, which are located below the cecum
surrounded by the glands. Also, the features of eggs are the green-gray rhombus which is around 4-6 x
5-10 mm in size.

➢ Life Cycle

● The eggs of Gastrodiscoides hominis usually goes into a water source where they are
ingested by the snail host.
○ The eggs hatch and release miracidium, developing into the sporocyst stage
followed by redia.
○ The redia transforms into the cercarial stage under 20 days.
● The cercaria will find the second host.
 ○ They become metacercaria which will either attach to plants or remain within
there.
● The final host will take in the metacercaria, approximately 30-150 days after being
within the snail, either getting infected by eating infected fish or vegetation.
○ The parasite will go through the hole into the duodenum then go down to the
intestine where it self-fertilizes.
○ It then moves to the cecum and colon where it attaches and lays eggs. By the
time feces has left its body, the eggs have already hatched.

Symptoms

You could get infected by the Gastrodiscoides Hominis by ingesting contaminated vegetables.
Affecting the small intestines. The symptoms you would experience from Gastrodiscoides are:

- Heavy infections, usually asymptomatic (showing no symptoms)

Asymptomatic but still causes intestinal problems;
- Diarrhea
- Fever
- Abdominal Pain
- Vomiting
- Colic (severe, fluctuating pain in the stomach)
- Malabsorption (lack of ability to absorb nutrients from their diets)
- Intestinal flu
- An increase in mucous production
*In severe cases, tissue reactions can occur in the heart/mesenteric lymphatics
(Lymph nodes along the lymphatic vessels)

Prognosis:
- Most of the medicine used to eliminate the Gastrodiscoides hominis should not be used with
pregnant women. They must use other types of medicine with fewer doses instead, which
could fail in some cases.
- Light infections may resolve spontaneously within one year, even without treatment. The
prognosis may be grave in patients with heavy infection.
- Immunocompromised hosts may be at an increased risk of complications. For example,
intestinal worms were found to penetrate into colonic lymphoid tissue in a patient with colon
cancer.
Constrains
- We cannot kill and harm animals.

Restrains
- We will not experiment on humans.
- We will not experiment on conserved animals.
- We will not harm the environment.
- We will not kill any living things.
- We will not experiment with anything on ourselves.
- We will not contaminate any water sources with any type of chemicals.

Response

In order to reduce the number of infected people and stop this disease from spreading to other
regions, proper management and responses should be followed to lower the number of cases caused
by Gastrodiscoides hominis.

As a part of a Medical Disaster Assistance Response Team (Med - DART), possible ways to
stop this outbreak and reduce the number of infected people are:
1. The government should allow community leaders to watch over people’s activities in
the community for at least a month until the situation is subsided. The government
should also provide financial support and allow the leaders to have the power to
create their own community rules such as prohibiting people in the community from
using natural water sources without boiling or decontaminating it first, selling
uncooked meat and seafood, eating snails and vegetables that were grown in water in
the area where the epidemic occurred. To still be able to control this epidemic as well
as interrupting people’s diet as less as possible, the community leaders should assign
cops and food inspectors to monitor the market. Food in the market must be cooked
properly and snails should be banned from the market. Food inspectors should also
provide the proper way of cooking food for the people as well as inspecting how well
the food is cooked before selling. People are not allowed to sell or buy uncooked
food. The cops must charge people who are involved in selling and buying raw food
as well as confiscating the products.
2. The government should send teams to give out clean water for drinking to the people
and banned water vegetation and the ones that use “night soil”. Also, locking those
infected areas away from tourists and other people who are not permitted by the
government or are not a part of the medical team.
3. Cops that are carefully selected by the government will stand by in the entrance,
checkpoint, or immigration areas of each infected region, filtering people from
traveling to other places as well as entering the area. Under any circumstances, the
cops must ask for the purpose of traveling in or out of the area, if it is an emergency
or good reason (such as picking up relatives to go to a better hospital, to take care of
sick relatives outside the area), they are allowed to go but after they get medical
checkups. This will reduce the chances of people defecating in water sources outside
the area. Foods, especially seafood and pork, that are to be exported from the area
will be deeply examined for the flukes before sending out to other places. Foods with
 flukes will go through the food irradiation process to reduce and eliminate
microorganisms in the food before cooking and sell to consumers.

Treatment:

Next, the government should force everyone in the area to get checkups. These are some ways
sick and other people will be taken care:
1. People who show signs and symptoms of the disease will be sent to the hospital for
check-ups,
2. Patients who have the disease will be treated immediately. They will be given drugs
such as Praziquantel.
a. Praziquantel is in the drug class of Anthelmintics (antiparasitic drugs) and is
a prescription drug used as anti-worm medication. It prevents newly hatched
worms from growing or multiplying in your body.
b. Praziquantel is administered at 25mg/kg given orally three times a day for
two days. The dose is the same for children.
c. For patients who are unable to take Praziquantel, alternative medicine is
Bithional, this medicine can also cure tapeworms and flukes. But it is not as
effective as Praziquantel.
d. Bithionol is given orally at a dose of 30 to 50 mg per kg of bodyweight on
alternate days for 10 - 15 doses.
3. Patients must visit the hospital for checkup and stool examination after they took all
the prescribed drugs to make sure that they got rid of all the flukes and are healthy.

Meanwhile, healthcare organizations must send a medical research team to examine the water
sources and snails, pigs, and fish. Especially the pigs since they’re part of the definite host of the
fluke. Pigs that have flukes will be separated from the rest and away from water sources to prevent
them from defecating in the water. Their feces will not be used as soil until the situation is resolved.

Medical Concerns:

❖ Praziquantel:
- You should not take it if you are allergic to praziquantel, or if you have taken
rifampin (Rifadin, Rifater, Rifamate) in the last 4 weeks.
- You shouldn't ingest any grapefruit or grapefruit juice with praziquantel since it could
lead to potentially dangerous effects.
- You should also mention to your doctor if you have had kidney disease, heart disease,
liver disease, or a history of seizures or epilepsy in the past before taking this
medicine.
- Shouldn’t be given to a child younger than 4 years old.
- It could also impair your thinking and reactions.
- Do not chew or crush the medicine, taken with about 8 ounces of water.
- Should not be taken if you are pregnant or you plan to become pregnant because it
could cause harm to the baby through breastfeeding.

❖ Bithionol
- Used for patients who are unable to use praziquantel.
 - Should be taken with meals to lower the intensity of gastrointestinal symptoms.
- Should be given in 2-3 divided doses.
- It should not be used in early pregnancy unless there is a strong indication for use.

Projections:

The graphs below show the number of new cases and total cases at the current time
by months, with the first case reported in September. The graph ranges from September to
April.

In the event that we intervene presently, we can moderate the rate of diseases by a normal of
15 cases per month until modern cases. If we wait for 3 months, we expect that we simply can
moderate the rate of infections by 10 cases per month. It will cost us 1,000 baht per individual to
remedy their contamination and return them to wellbeing.

By intervening now, the number of new cases will drop to 0 by August, as shown in
the graphs below.
 If we intervene 3 months later the number of new cases will drop to 0 by March of the
next year as shown in the graph below. It will take a longer time to drop the new cases to 0
because, during the 3 months that we wait, the number of new cases will keep rising.

Cost:

● Total cost (Now):

○ Number of patients: 253 patients, Total cost: 253,000 baht (1,000 baht
per person).
● Total cost (Delay):
○ Number of patients: 655 patients, Total cost: 655,000 baht (1,000 baht
per person).
Future Prevention

Theoretically, the control of gastrodiscoides by blocking or interruption of the parasite’s life-

cycle can be achieved in very simple ways. Control methods should include the following main axes:
● prevention of human contamination
● actions at the human level to cut disease spread by humans
● control the disease at animal reservoir level
● actions at the level of the intermediate molluscan host.

Education:

Include the lessons on the life cycle of different parasites, the method of cleaning the food for
consuming, and making sure that they get rid of the parasites, the symptoms, and prevention of the
diseases into the curriculum. By understanding all this information, it would hinder these animals
from our people. Moreover, educate the people to be aware of parasites and harmful microorganisms
in food, so they see the importance of cooking thoroughly and avoid eating raw meat which comes
from unreliable or unknown resources. As well as, we should educate local people who have not
known about how to prevent the parasites before. In order to make it inefficient, we have to change
their habit and tradition of eating if not everything will be the same.

1. Local people
a. Many people still enjoy eating raw food products in many areas. However, we
already know that significant results in the control of intestinal helminthiasis may be
achieved by the implementation of control programs in school-aged children with
good therapy planning. So that the ministry of education has to publish a document
indicating the health education priorities that should be addressed in schools’ books
or having a seminar every month with local people in order to make them understand
an idea about the parasites.

2. Changing in traditional
a. However, the time has passed and everything in century-old traditions has to be
changed. In some countries, eating raw plants is customary, and treated water is not
available, the prevention of reinfection relies on consistent educational programs
stressing the importance of thoroughly cooking all aquatic plants and boiling all
water. Unfortunately, the belief that cooking food destroys the flavor and nutritional
value still persist. Basically, we have to change their habit of eating little by little and
educated local people as mentioned in 1(a).
Biology and Chemistry:

Changing the natural habitat of the parasites so they are unable to live in that environment,
and animals are unable to stay alive in that area. If people are infected with these parasites. They
should be cured with synthetic anthelmintic drugs, paralyzed or staved by the adult worms until they
die and are excreted from the body, which would help many more. Further researches should be done
on various parasites and diseases to gain in-depth and reliable information and to be applied to future
occurrences.

Economy and Engineering:

Engineering a method of checking and killing the parasites in the marine and freshwater
animals. If the foods are approved from these parasites, then we tag them with a special tag that
allows customers to consume it safely. Having the government approved the methods and tags
throughout society would help economically. Firstly, pigs and livestock that are imported from the
farm have to be separated in each of the safe containers. Then, the animals have to be vaccinated and
check-ups for the fluke and parasites before tagging them. After that, we send them to the food
business to be ensured by collecting samples of their blood or having a diagnosis test by a vet. The
vets have to be analyzed that the animals are infected or not, if not, we will send those to food storage
and. To be able to sell, food storage has to be clean and approved by the Department of Livestock
Development, meaning that it has to be hygiene and pass their qualifications before putting the last
special tag to the product. Such that customers can be trusted on the products.

Moreover, there should be more healthcare centers and hospitals in the area. Since the local
hospital does not have enough space to contain all patients and will not be able to renovate or to
construct another building on time, we suggest that temporarily turning a non-healthcare building into
a patient care space until the renovation or construction is complete. Another alternative way, which is
cost-effective, is to build small tents for medical care in each area. Also, each hospital or healthcare
center must-have equipment and ambulances ready all the time in case there are emergency cases.
They have to be supplied with different kinds of medicines in case some patients are allergic to
particular chemicals in medicine.

Politics:

To control the disease at the animal reservoir level, measures should be adopted to restrain
pigs from having access to ponds and canals. Pigs may easily acquire this disease because they are
often fed with infected raw vegetables. Thus, the plants must always be checked for the presence of
metacercariae. The use of aquatic green fodder for pigs shall be prohibited. Moreover, the
pharmacological treatment of pigs should be carried out after proper parasitological diagnosis of pig
feces. Thus, instituting modern pig farming in endemic areas should be the best initiative to control
infection of this animal reservoir host.

Conclusion
 In conclusion, Gastrodiscoides hominis is a parasitic flatworm that affects the small
intestines. Some symptoms that can be observed from this fluke are diarrhea, abdominal pain, fever,
and etc,. In order to stop and prevent diseases from spreading elsewhere, the government should take
action as fast as possible. This can be done by giving community leaders the power to watch over
people in the areas with a high percentage of infected, sending out teams to thoroughly clean the
waters, also trying to lock down the infected areas, building medical tents, and prohibiting people in
the area from traveling. In addition, changing eating habits by avoiding raw food products are some
ways that can prevent the infection of the disease. On the other hand, if people somehow get infected,
there will be different types of medicine used for the treatment. By doing all these things, we could
help prevent the disease from further spreading.

References

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