Ascariasis Follow-up

Updated: Apr 15, 2016
  • Author: David R Haburchak, MD, FACP; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Follow-up

Transfer

Patients with ascariasis who have partial or complete obstruction should be treated at facilities with surgical support.

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Deterrence/Prevention

Community control of ascariasis has been difficult to achieve. The most successful control programs, such as those in Japan, have consisted of combined approaches, including improved sanitation, night soil disposal, and mass community treatment. Concern has increased for the emergence of drug resistance among heavily retreated populations.

The prevalence of ascariasis in Japan in 1949 was 63%; the disease was essentially eliminated by 1973. Hand washing may be a neglected means of prevention, even in endemic areas, as shown by a recent study from Sri Lanka.

A program of latrine construction, health education, and twice-annual anthelmintics decreased the prevalence of ascariasis in Korea from 80% in 1949 to 55% by 1971. After a 4-year educational campaign and latrine construction program in northern Bangladesh, 36% of children aged 5-13 remained infected. Rates of infection were lower among children who used latrines and who had been educated concerning the risks of ascariasis. [27] As rates of ascariasis lessen, specific infected families should be targeted. A recent systematic review and meta-analysis of preventive water and sanitation measures concluded that the risk of ascariasis was lowered 60% by piped water, 38% by access to sanitarian latrines, and 62% by handwashing before eating and 55% after defecating. [28] Each, in combination with the use of soap, has the potential for significant control, especially if applied in schools together with thrice yearly deworming. [29]

Current ascariasis treatment strategies recommend repeated mass treatment of communities to reduce intensity of worm burden until socioeconomic progress allows improved sanitation. Although such targeted therapy programs may control the morbidity of ascariasis by decreasing the number of worms per patient, they do not seem to decrease transmission rates. The ascariasis reinfection rate after a single community campaign in South Africa was 40% at 29 weeks. Children have been targeted in school campaigns, but continued worm burden and shedding by adults have blunted impact, especially if campaigns are less than thrice yearly. A 6-month educational program directed at behavioral remediation of school children and their parents in Java has shown promise when combined with a deworming campaign.

A 2012 Cochrane review [30] was rather discouraging in its assessment of the benefit of community deworming programs, suggesting only the possibility of slight benefit in weight gain and hemoglobin, but not cognitive improvement as measured by school attendance and performance.

Avoiding pigs and pig manure prevents A suum infection in developed countries.

Work continues on a vaccine. A recombinant, nasally administered 16-kd secretory protein, As16, was shown to result in a 56% decrease in worm burden in mice challenged with A suum larvae. [31] The Sabin Vaccine Institute is developing a "Pan-anthelmintic" vaccine against hookworm, trichuriasis, and ascariasis using at least 2 of 6 candidate A suum antigens. It appears that at least 5 years will be required to field such a candidate vaccine. [32]

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Prognosis

Immediate cure rates after single-dose albendazole in South Africa were 95%, with egg reduction rates of more than 99%. [33]

Most treated patients become reinfected within months unless they are relocated to an area of significantly improved sanitation.

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