Don’t ignore the adults in deworming

Link in the chain “Adults tend to become reservoirs of infection and continue the transmission cycle in the community.” Picture shows a deworming programme at a school in Hyderabad.   | Photo Credit: G_RAMAKRISHNA

Since 2016, the exercise of deworming millions of children in India has become a biannual event; nearly 150 million children in the age group 1-19 are given two doses of the drug, six months apart. The programme was tweaked a year after the Health Ministry began the massive public health exercise of using a single dose of Albendazole drug to deworm children. Though the rationale behind increasing the number of doses was to improve the efficacy of deworming, studies have shown that it may not bring about significant benefits as children are prone to get reinfected.

Infection reservoirs

A 2012 paper in Cochrane Review — based on 41 trials involving more than 65,000 participants who were given a tablet once a year — did not find any significant public health benefits. A 2013 study (The Lancet) of one million children in Lucknow showed that even two doses of the drug in a year did not show significant health gain two years after treatment.

Though the government has tweaked World Health Organisation deworming guidelines by not restricting it to school-age children, the programme does not include adults. A 2013 study (Tropical Medicine and International Health) found that hookworm infection rates increased “significantly with age” — from childhood to school age or adolescent and increasing further in adults. Since prevalence of worms increases with age and as adults are excluded from the preventive chemotherapy programme, they tend to become reservoirs of infection and continue the transmission cycle in the community.

One more study (PLOS Neglected Tropical Diseases, August 2015) has also highlighted only the “limited additional impact” of increasing the frequency of treatment while restricting it to children, in the case of hookworm. This study too makes a strong case for expanding annual treatment to include adults in order to achieve community-level reduction in the intensity of hookworm infections. The paper says: “Treating children alone does not significantly impact the level of transmission. The children get reinfected after treatment because of the reservoir in adults.”

Tamil Nadu-based study

Now, researchers from Christian Medical College (CMC) in Vellore, Tamil Nadu, have shown that increasing the frequency of treatment to four times a year and including both children and adults will help achieve a significant reduction in both prevalence and intensity (number of eggs per gram of faeces) of infection.

A team led by Dr. Gagandeep Kang, Division of Gastrointestinal Sciences, CMC, studied nearly 8,700 tribal participants living in 45 villages in the Jawadhu Hills in Vellore and Tiruvannamalai districts of Tamil Nadu to understand the optimal mass deworming strategy that can produce maximum impact. The participants of all ages were divided into three groups of 15 villages each. While the first group was given the drug just once, the second group received it twice (at months 1 and 2) and the third group was given the drug four times in two cycles (at months 1 and 2, and months 8 and 9). The study is published in the journal, Contemporary Clinical Trials Communications.

Though the prevalence of worms dropped in all the three groups, the group that received the drug four times a year showed significantly lower prevalence after treatment — from 22% to 1%.

“The prevalence and intensity of infection was significantly lower in the four-dose group compared with the single-dose group 12 months after the last dose of treatment,” says Rajiv Sarkar from the Division of Gastrointestinal Sciences, CMC, and the first author of the paper.

“We should consider expanding the programme to include adults if we want to interrupt community-wide transmission and stop the exercise after a few years. Else, the chances of reinfection from adults are high in case the exercise is stopped. The national deworming programme has achieved high coverage rates which, in turn, has been effective in bringing down the infection rate, but it has to continue for a long time if restricted to children,” he says.


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Printable version | Jul 21, 2021 9:14:30 AM |

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