Strategy STH elimination

More than 1.5 billion people, or 24% of the

world’s population, are infected with soil-
transmitted helminth infections worldwide.
Infections are widely distributed in tropical and
subtropical areas, with the greatest numbers
occurring in sub-Saharan Africa, the Americas,
China and East Asia.
Over 267 million preschool-age children and
over 568 million school-age children live in areas
where these parasites are intensively
transmitted, and are in need of treatment and
preventive interventions.
Nearly 900 000 people, including teachers,
school principals and health workers,
participated in today’s National
Deworming Day. During a similar campaign
in 2015, 89 million children were treated.
Children who could not be reached due to
absenteeism or sickness will be given the
albendazole tablet on Monday 15 February
2016. The tablets are provided free of
charge by the Government of India and
WHO
 WHO’s strategy
The strategy for control of soil-transmitted
helminth infections is to prevent and control
morbidity through the periodic treatment of at-
risk population living in endemic areas.

People at risk are:

preschool-aged children;
school-aged children;
women of childbearing age (including pregnant
women in the second and third trimesters and
breastfeeding women).
 WHO recommends periodic treatment with
anthelminthic (deworming) medicines, without
previous individual diagnosis to all at-risk people
living in endemic areas.

Treatment should be given once a year when the

prevalence of soil-transmitted helminth
infections in the community is over 20%, and
twice a year when the prevalence of soil-
transmitted helminth infections in the
community exceeds 50%.
 This intervention reduces morbidity by reducing the
worm burden.

In addition:
education on health and hygiene reduces transmission
and reinfection by encouraging healthy behaviours;
provision of adequate sanitation is also important but
not always possible in resource-constrained settings.
Periodic deworming can be easily integrated with child
health days or vitamin A supplementation programmes
for preschool-aged children, or integrated with school-
based health programmes
 Schools provide an important entry point for
deworming activities, as they provide easy
access to health and hygiene education
components, such as the promotion of hand
washing and improved sanitation.
In 2011, over 300 million preschool-aged and
school-aged children were treated with
anthelminthic medicines in endemic countries,
corresponding to 30% of the children at risk.
 Aim
The aim of periodic administration
of anthelminthics is to control
morbidity from soil-transmitted
helminthiases by reducing and
maintaining low the intensity of
infection
 Global target
The global target is to eliminate
morbidity due to from soil-
transmitted helminthiases in
children by 2020. This will be
obtained by regularly treating at
least 75% of the children in endemic
areas (estimated total number 873
million).
 WHO’s control interventions are based on the
periodic administration of anthelminthics to
groups of people at risk, supported by the need
for improvement in sanitation and health
education.

WHO recommends annual treatment in areas

where prevalence rate of soil-transmitted
helminthiases is between 20% and 50%, and, a
bi-annual treatment in areas with prevalence
rates of over 50%.
 Soil-transmitted helminth infections are
widely distributed in all WHO Regions.
For the control of these infections, WHO
recommends the periodic administration
of anthelminthic medicines (albendazole or
mebendazole) as a public health
intervention, for children (from 1 to 15
years of age) living in areas where the
prevalence of STH is estimated to be over
20%. %.
 goal
Goal Priority Indicator
Original (and current) At least 75% of children in
strategy: need of treatment are
Deworm high-risk groups regularly treated
Implications
• Endpoint: measurable
endpoint but no indicator
of morbidity, no stopping
strategy
• Parasitologic
monitoring: limited
monitoring required
• Platform: school or child
health day platforms may
be adequate
• Water, sanitation, and
hygiene: integration
advocated
• Cost: least expensive
• Research: little
operational research
required
Revised Less than 1% • Endpoint: measurabl
strategy: Elimination moderate or heavy e endpoint, indirect
of soil-transmitted infection intensity indicator of morbidity
helminthiasis as a prevalence in all risk • Parasitologic
public health problem groups monitoring: intense
monitoring required
• Platform: integrated
or community-based
platform may be
required
• Water, sanitation,
and hygiene: intense
integration required
• Cost: more
expensive
• Research: operation
al research required
Ambitious Less than 1% overall • Endpoint: measura
strategy: Interruption soil-transmitted ble endpoint, indirect
of soil-transmitted helminth infection indicator of
helminth prevalence in all risk morbidity
transmission groups • Parasitologic
monitoring: intense
monitoring and
evaluation required
• Platform: integrate
d or community-
based platform
required
• Water, sanitation,
and hygiene: more
intense integration
required
• Cost: most
expensive
• Research: operation
al research required
 WHO recommended medicines
The WHO recommended medicines –
albendazole (400 mg) and mebendazole
(500 mg) – are effective, inexpensive and easy to
administer by non-medical personnel (e.g.
teachers).

They have been through extensive safety testing

and have been used in millions of people with
few and minor side-effects.
Both albendazole and mebendazole are donated
to national ministries of health through WHO in
all endemic countries for the treatment of all
children of school age.
This publication reports the global
target that was defined in the
Strategic plan for the control of
STH 2012–2020
According to WHO estimates about 836 million
children worldwide require preventive
chemotherapy for soil-transmitted
helminthiases.

In 2016 more than 517 million children in need

of treatment received preventive chemotherapy
for STH, corresponding to 63% global coverage.
In 2016, 38 countries have reached the World
Health Assembly's target of treating at least 75%
of school-aged children for the disease.
 Table 4. Key characteristics of 3 different strategies pertaining to future soil-transmitted
helminthiasis control efforts.

Becker SL, Liwanag HJ, Snyder JS, Akogun O, Belizario. V Jr, et al. (2018) Toward the 2020 goal of soil-transmitted helminthiasis
control and elimination. PLOS Neglected Tropical Diseases 12(8): e0006606. https://doi.org/10.1371/journal.pntd.0006606
https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0006606
 WHO’s global target is to control
morbidity due to soil-transmitted
helminthiases in children by 2020.
 Intestinal worms
Soil-transmitted helminth infections are among the
most common infections worldwide and affect the
poorest and most deprived communities. They are
transmitted by eggs present in human faeces which in
turn contaminate soil in areas where sanitation is poor.
The main species that infect people are the roundworm
(Ascaris lumbricoides), the whipworm (Trichuris
trichiura) and the hookworms (Necator
americanusand Ancylostoma duodenale).
 WHO recommends periodic treatment with
anthelminthic (deworming) medicines, without
previous individual diagnosis, to all people at
risk living in endemic areas.
Soil-transmitted helminthiases adversely affect
nutritional status: A. lumbricoides competes for
micronutrients; T. trichiura causes intestinal
malabsorption and hookworm infections cause
blood loss and anaemia.
Periodical large-scale distribution of
anthelminthics is the most cost-effective
intervention against these parasites.
• SOURCE

WHO. 2019. Soil-transmitted helminth infections

https://
www.who.int/news-room/fact-sheets/detail/soil-transmitted-helminth-infections

Beccker, Sple R, et al. 2018. Toward the 2020 goal of soil-transmitted helminthiasis control
and elimination. Journal List PLoS Negl Trop Dis v.12(8); 2018 Aug PMC6091919
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6091919/