Annual meeting of the Partners for Measles Advocacy Washington DC, 23-24 September 2008

8th Annual Meeting of the Partners for Measles AdvocacyWashington, September 23-24, 2008

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Annual meeting of the Partners for Measles AdvocacyWashington DC, 23-24 September 2008

Annual meeting of the Partners for Measles AdvocacyWashington DC, 23-24 September 2008

Expanding the benefit through integration

Deworming updateExpanding the benefit through integration

Deworming update

Albis Francesco GABRIELLIMedical Officer

Preventive Chemotherapy and Transmission ControlDepartment of Control of Neglected Tropical Diseases

Headquarters, Geneva

Albis Francesco GABRIELLIMedical Officer

Preventive Chemotherapy and Transmission ControlDepartment of Control of Neglected Tropical Diseases

Headquarters, Geneva


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1. Introductions to helminths and their control

2. Reasons for including deworming in immunization interventions

3. Precautions when deworming very young children

4. Overview of what is happening worldwide

Overview of the presentationOverview of the presentation


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Introduction to helminth controlIntroduction to helminth control

Preventive chemotherapy (PC) is the mainstay of the WHO-recommended strategy to control (and eliminate) helminth infections

PC is the large-scale distribution of anthelminthic drugs, at regular intervals, to population groups at-risk

Target diseases: lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminthiasis

Goal: prevention of morbidity (+ reduction of transmission)


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IntegrationIntegration

Since 2006 WHO stresses the need for "integration" in helminth control, with the aim of rationalising interventions and reducing costs

Integration among helminthic diseases: one drug is effective against more than a single disease, one disease can be treated with more than a single drug

Integration with other ongoing health interventions: seize all opportunities offered by existing "delivery channels"


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IntegrationIntegration

Since 2006 WHO stresses the need for "integration" in helminth control, with the aim of rationalising interventions and reducing costs

Integration among helminthic diseases: one drug is effective against more than a single disease, one disease can be treated with more than a single drug

Integration with other ongoing health interventions: seize all opportunities offered by existing "delivery channels"


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Delivery channelsDelivery channels

School-based interventions

Community-based interventions

Routine health services (IMCI, etc.)

MCH interventions

Immunization campaigns (measles, polio)

Micronutrient supplementation activities

Insecticide treated nets (ITNs) distribution

Child Health Days/Weeks

Any combination of the above


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Soil-transmitted helminthiasis (STH)Soil-transmitted helminthiasis (STH)

The most widespread disease worldwide (>2 billion people are infected): roundworm, whipworm, hookworm infections

Prevalence and intensity of infection peak in childhoodSevere impact on nutritional status (anaemia, micronutrient

deficiencies), and on physical and intellectual development of children

1 tablet of ALB or MBD given once or twice a year (deworming) "protects" children from risks associated with infection

ALB and MBD can be administered from the 1st birthday onwards


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Including STH deworming in immunization interventions

Including STH deworming in immunization interventions

Logistics reason: – Overlapping of target populations – ALB/MBD are very cheap drugs (0.02 USD/tablet)– Popular and well-received drugs (flavoured, impact is visible) – Ease of administration

Scientific reasons (what immunization interventions can gain):– Deworming contributes to an effective immune response– Deworming increases vitamin A absorption

RESULT: where deworming is co-delivered, an increase in vaccination coverage has been observed >> OR needed


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Precautions when deworming young children (under 5s)

Precautions when deworming young children (under 5s)

The drugs are extremely safe: their administration must be equally safe, in order to avoid risk of choking on tablets

Use chewable tablets (better if flavoured)

Provide training on how to treat, how to handle children, what to do in case of choking

Administer drugs under supervision

Set the health post correctly: triage+registration>>vitamin A>>deworming tablet>>measles/injectable>>ITN

Crush tablets b/w two spoons, then add water (for children <3 years)

NEVER force a child !!!


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STH deworming worldwide (2006)STH deworming worldwide (2006)

130 countries/territories endemic

PSAC: >82M treated / 386M at-risk (21.4%) in 51 countries

SAC: >77 M treated / 878M at-risk (8.8%) in 64 countries

In PSAC the high coverage, especially in the African Region, is …" a consequence a consequence of the inclusion of deworming activities in ongoing, well-organized, large-scale of the inclusion of deworming activities in ongoing, well-organized, large-scale interventions with a strong monitoring system, such as immunization campaigns, interventions with a strong monitoring system, such as immunization campaigns, micronutrient distribution interventions or mother and child health daysmicronutrient distribution interventions or mother and child health days "…

Weekly Epidemiological Record 27/28, 2008, 83, 237-252


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27 countries including deworming into interventions delivering vaccines or vaccine-related products

Different combinations:– Vitamin A, deworming– Measles, deworming– OPV, deworming– OPV, vitamin A, deworming– ITN, measles, deworming– Vitamin A, iron, deworming– Measles, vitamin A, deworming– ITN, measles, vitamin A, deworming

>51M PSAC dewormed via the above interventions / 82M dewormed in total (62%)

>12M PSAC dewormed in interventions co-delivering measles vaccine (14.8% of those dewormed in total; 23.8% of those dewormed via any of the above interventions)

STH deworming worldwide (2006)STH deworming worldwide (2006)


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Documents & publications (I)Documents & publications (I)

Helminth control strategy

Inclusion of deworming into existing delivery channels


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Documents & publications (II)Documents & publications (II)

Deworming very young children

Yearly progress report on numbers treated


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Please visit our websitesPlease visit our websites

The WHO Department of Control of Neglected Tropical Diseases:

http://www.who.int/neglected_diseases/en/

For documents and publications:

http://www.who.int/wormcontrol/documents/en/

For the newsletter "Action against Worms": http://www.who.int/neglected_diseases/preventive_chemotherapy/pctnewsletter/en/index.html


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Thank you