The war vs worms

It looked like a scene straight out of a sci-fi movie about alien invasion. One slide showed ugly blobs with tiny, hair-like extensions while another had wicked hook-like protrusions. Yet another looked deceivingly like a plateful of spaghetti noodles ... from hell.

If you’re not careful, you could very well be the unwilling host of these monsters who can easily make themselves comfortable in your stomach and intestines, or worse, spread and burrow into the different organs in your body.

Knowing the gravity of worm infection among Filipinos, Janssen Pharmaceutica, UP Manila National Institutes of Health, select local government units in Metro Manila and Biñan, Laguna, as well as various health institutions have declared war against these parasites and have come up with guidelines on the prevention of worm infection.

In the second phase of this project, referred to as the War on Worms, the concerned agencies zero in on adult food handlers working in various restaurants in the metropolis, including fine-dining establishments and five-star hotels.

It’s a scary thought that people would be unknowing victims of helminth (or common worms) infection just because they thought that the plush restaurant with a great ambiance where they ate was a stickler for food hygiene. Let this be a wake-up call, guys and gals: Just because the restaurant has great-tasting, quite expensive food, served by impeccably-dressed waiters, doesn’t mean it’s a worm- and parasite-free place. If the restaurant’s food handlers have not been screened and rid of parasites – or dewormed, to put it bluntly – you can never be sure that your food is not contaminated. While we don’t want to make paranoids out of food lovers, it’s still best to be careful, and check whether the establishment has an updated permit from the the appropriate agencies and LGUs. The food handlers also have to undergo regular screenings so they don’t become carriers of these parasites.

At the launch of the second phase of the War on Worms, UP-NIH deputy director Dr. Jun Belizario emphasized the importance of a concerted effort by different agencies to prevent the spread of intestinal parasites. "We’re not only referring to public establishments, but also to food handling at home. Intestinal parasitism is included in the top 10 causes of morbidity and often affects the poor and the impoverished," says Belizario, who is also known as the "Worm Buster."According to the World Health Organization, about two-thirds of food handlers do not practice proper hygiene. This results in highly contaminated food, which is "perhaps the most widespread health problem in the contemporary world." Try to observe a typical carinderia, a school canteen, or even a fastfood outlet.

Oftentimes, the person manning the cash box can also be seen handling food stuff, or serving the food, and is also the one cleaning table tops and counters. What makes matters worse is the presence of open trash cans nearby and the use of dirty rags. More often than not, the habit of washing hands is not a priority.

According to health experts, such sites are the perfect breeding grounds of parasites, which are divided into two categories: helminths or common worms and protozoans. Helminths include hookworms, roundworms, flukes, and whipworms, which thrive in the intestines of cooks, waiters, and food handlers. Protozoans, meanwhile, are minute, single-celled organisms that are easily passed from person to person. Protozoans include amoebae, flagellates, and coccidians.

According to doctors, the whipworm is the most common helminth that affects Filipinos, and the most difficult to get rid of. The hookworm, meanwhile, hooks up with people who have the habit of walking barefoot, and often causes chronic blood loss. And as its name suggests, the roundworm is smooth and chubby, and can grow as thick as a pencil.

The protozoans are small but terrible organisms that can cause severe symptoms. For instance, amoebic colitis causes the ulceration of the large intestines. E. histolytica is responsible for amoebiasis, or amoebic dysentery, and lodges in the large intestines, also causing ulceration and diarrhea. The infection takes a deadly turn when these organisms, carried by the bloodstream, find their way to the liver, lungs, appendix, and even the brain.

A 2002 study shows that six out of 10 food handlers in food establishments in Manila and Cebu may be infected, despite being screened and cleared by local health units. It was found out that school canteens show a 61.8 percent infection rate. Tertiary hospitals in Metro Manila have a high infection rate at 42.4 percent, while mall employees in Cebu log in a 38.3 percent figure. About 24 percent of mall employees in Cebu were found to be infected with worms, while 17.9 percent were suffering from protozoan infection. To make matters worse, it was found out that the most commonly used method of screening, referred to as Direct Fecal Smear, doesn’t give satisfactory results as far as determining the extent of the infestation is concerned. It is suggested that screening be done using the Formalin Ether/Ethyl Acetate Concentration Technique, a stool concentration technique that allows microscopic examination fecal samples. For normal worm infestations, such as hookworms and whipworms, experts advise the use of over-the-counter antihelmintic medicines like Antiox Choco. Says Belizario, "De-worming is not a one-shot deal. It needs to be sustained."

One such program that the Department of Health signed recently is Administrative Order 2006-0001. For six months, a team of health experts from various private and government agencies worked to come up with operational guidelines for parasitologic screening of food handlers. Simply put, there are now clear rules on how to go about having food handlers screened and de-wormed properly and effectively.

Of course, the new administrative order wouldn’t be effective without its proper and serious implementation. For the order to have enough teeth, local government units need to cooperate fully and private citizens have to be vigilant enough. If the problem is not contained, this country might just turn into a breeding ground of an alien nation of horrible parasites.