Deworming in children

https://www.who.int/elena/titles/guidance_summaries/deworming-children/en/

Guidance summary*

WHO recommendations

Preventive chemotherapy (deworming), using annual or biannuala single-dose albendazole (400 mg) or mebendazole (500 mg)b is recommended as a public health intervention for all young children 12–23 months of age, preschool children 1–4 years of age, and school-age children 5–12 years of age (in some settings up to 14 years of age) living in areas where the baseline prevalence of any soil-transmitted infection is 20% or more among children, in order to reduce the worm burden of soil-transmitted helminth infection.

a. Biannual administration is recommended where the baseline prevalence is over 50%.
b. A half-dose of albendazole (i.e. 200 mg) is recommended for children younger than 24 months of age.

Rationale

• Children infected with soil-transmitted helminths benefit significantly from anthelminthic treatment in terms of reduction in worm burden and weight and height gain.
• The morbidity caused by the different soil-transmitted helminth species in infected individuals is well documented and severe.
• Albendazole and mebendazole are well tolerated among children over 12 months of age at appropriate doses, with only minor and transient side-effects reported.
• Preventive chemotherapy to control soil-transmitted helminth infections in children is generally well accepted among children, parents, teachers and health workers.
• Logistical difficulties and additional costs of alternative methods to identify and treat infected individuals can be prohibitive.
• Soil-transmitted helminth-endemic areas with at least 20% soil-transmitted helminth prevalence were considered the priority for large-scale programmes due to the presence of infections of moderate and heavy intensity and, therefore, soil-transmitted helminth-related morbidity.

Remarks

• The guideline development group stressed that the recommendation for preventive chemotherapy in children is being made for the outcome of decreasing the worm burden in areas that are endemic for soil-transmitted helminths. The prevalence of soil-transmitted helminths among children is changing and this needs to be taken into account by regularly assessing the worm burden, to ensure that the intervention remains relevant.
• Provision of adequate water, sanitation and hygiene services is fundamental, to break the cycle of infection and reinfection and sustainably control soil-transmitted helminth infections. Collaboration between programmes for control of soil-transmitted helminth infection and water, sanitation and hygiene programmes is essential to ensure prioritization of water and sanitation services to areas that are endemic for soil-transmitted helminths.
• Deworming should be delivered together with promotion of health and hygiene, to reduce transmission by encouraging healthy behaviours, such as hand washing, use of footwear and proper disposal of faeces.
• Routine monitoring for effective coverage and evaluation of the impact of the intervention should be an integral part of preventive chemotherapy programmes, to help inform the decision on continuation or cessation of the programme.

* This is an extract from the relevant guideline (1). Additional guidance information can be found in this document.