Title
Guidelines on Deworming Drug Use and AEFD Management
Law
Doh Administrative Order No. 2010-0023
Decision Date
Jul 13, 2010
The Revised Guidelines on Mass Drug Administration and Management of Adverse Events Following Deworming and Serious Adverse Events provides guidelines for the administration of deworming drugs and the management of adverse events in the Philippines, aiming to control soil-transmitted helminthiasis and improve the health of children and special populations.
revised guidelines
mass drug administration
adverse events

Policy intent and objectives

  • The Order is designed to guide health workers in administering deworming drugs to different age groups.
  • The Order requires health workers to manage adverse events following deworming and address AEFD involving the drug of choice.
  • The Order mandates AEFD reporting and recording to ensure proper documentation and follow-up.

Core definitions for AEFD

  • Adverse drug reaction (ADR) is defined as a noxious and unintended reaction occurring at doses normally used in humans for prophylaxis, diagnosis, or treatment, or for modification of physiological function.
  • Adverse event following deworming (AEFD) is defined as a medical event after ingestion of deworming drugs, where adverse reactions may be mild and transient and typically occur within 8–12 hours after ingestion (half-life of albendazole).
  • Eligible population is defined as a group of individuals qualified or entitled to receive anthelminthic treatment in preventive chemotherapy interventions.
  • Mass deworming is defined as giving an antihelminthic/deworming drug to an entire group without prior diagnosis of infection to eliminate intestinal parasites, including hookworm, ascaris, and trichuris.
  • Preschool children are all children between 1 to 5 years old who are not yet attending school but may be in daycare centers.
  • Preventive chemotherapy is defined as the use of anthelminthic drugs, alone or in combination, as a public health tool against helminth infections.
  • School children are all children between 6 to 12 years old or those enrolled in Grade 1 to Grade 6.
  • Serious adverse experience (SAE) is defined as an adverse experience following treatment with a drug that results in: death, life-threatening condition, in-patient hospitalization or prolonging of an existing hospitalization, persistent or significant disability/incapacity, congenital anomaly, cancer, or overdose.
  • Soil-transmitted helminthiasis (STH) is an infection caused by nematodes including Ascaris lumbricoides, Trichuris trichiura, or hookworm.

Recommended drugs and general rules

  • The Order recommends albendazole 400 mg chewable, flavored tablet and mebendazole 500 mg chewable, flavored tablet for mass treatment of intestinal infections.
  • The Order requires that albendazole and mebendazole be administered because they are benzimidazole derivatives effective against single or mixed infections of intestinal worms.
  • The Order provides that persons 1 year old and above may take deworming drugs regardless of whether they have intestinal worms (including roundworm, whipworm, hookworm, pinworm, and other intestinal parasites) and regardless of when the last deworming was given.
  • The Order requires that both drugs shall be taken ON FULL STOMACH.
  • The Order explains that albendazole and mebendazole act by interfering with the energy-producing processes of worms, causing worm immobility and death.

Dosage, frequency, and target groups

  • The Order prescribes dosing and frequency of deworming by target groups using albendazole or mebendazole.
  • For the target group of 12 a 24 months:
    • The Order sets Albendazole: 200 mg or 1/2 tablet and Mebendazole: 500 mg tablet.
    • The Order requires dosing every 6 months.
  • For the target group of 2 years old and above (including preschoolers, school children, pregnant, lactating adults, women of childbearing age, special population, and special groups):
    • The Order sets Albendazole: 400 mg or 1 tablet and Mebendazole: 500 mg tablet.
    • The Order requires dosing every 6 months.
  • The Order requires specific delivery settings:
    • Preschool children and out-of-school youths are given deworming drugs at the Rural Health Unit or Municipal Health Center.
    • School children are dewormed in schools.
    • Pregnant, lactating adults and other special groups are given deworming drugs at the Rural Health Unit or Municipal Health Center.

AEFD adverse reactions and management

  • The Order describes AEFD reactions as generally expected to manifest within the first 10 hours after drug intake and as mild and transient, such that treatment is not necessary in most cases.
  • The Order authorizes supportive drugs in few cases when adverse reactions occur.
  • For local sensitivity or allergy, the Order requires management by giving an antihistamine.
  • For mild abdominal pain, the Order requires management by giving an antispasmodic.
  • For diarrhea, the Order requires management by giving an oral rehydrating solution.
  • For erratic worm migration, the Order requires management by pulling out the worms from mouth/nose.
  • The Order allows parents/caregivers to manage adverse reactions.
  • The Order requires a doctor consultation if reactions persist, and requires informing any AEFD team in accordance with Section 5B1.

Precautionary measures during implementation

  • The Order requires that the target clients or their caregivers be adequately informed of possible adverse reactions and how to manage them if they occur.
  • The Order requires accurate recording of adverse reactions and requires informing the AEFD team.
  • The Order requires community-level health personnel be informed of ongoing deworming activity.
  • The Order requires that support drugs be available at the nearest health facility.
  • The Order directs that the following individuals are advised not to take deworming drugs:
    • Seriously ill child/individual
    • Child/individual with abdominal pain
    • Child/individual with diarrhea
    • Child/individual who previously suffered hypersensitivity to the drug
    • Severely malnourished (underweight) child/individual

Reporting procedures and AEFD teams

  • The Order requires immediate reporting of any serious adverse event experienced by a client within 8–10 hours after drug ingestion to the appropriate authority.

  • The Order requires that adverse reactions be reported to the AEFD Team.

  • The Order requires the AEFD Team composition at each level:

    • Municipal Level:
      • Municipal Health Officer
      • Municipal Epidemiology Surveillance Office (if available)
      • STH Coordinator
      • DOH representative
    • Provincial Level:
      • Provincial Health Officer
      • Provincial Epidemiology Surveillance Officer (if available)
      • STH Coordinator
      • DOH representative
    • Regional Level:
      • Regional STH Coordinator
      • Regional Epidemiology Surveillance Officer
      • DOH representative

  • The Order requires AEFD Teams to investigate at their level and assess whether the event is truly AEFD.

  • The Order requires completion of an investigation form during AEFD assessment by AEFD Teams (Annex 2).

  • The Order requires AEFD Teams to recommend appropriate action if the event is considered secondary to the deworming drug.

  • The Order requires that if further investigation is required, the team shall refer the case to the next higher level.

  • If hospitalization is needed, the Order requires the AEFD Team to facilitate admission to a government hospital.

  • The Order provides that an AEFD reporting form (Annex 2) must be filled up by a health worker, parent, or teacher with pertinent information on onset of adverse events.

  • The Order requires forwarding the AEFD reporting form to the relevant offices involved in the investigation of the AEFD.

  • The Order directs that a flow chart (Annex 3) serves as a guide for reporting AEFD cases.

Funds for CHDs in AEFD occurrences

  • The Order requires the Integrated Helminth Control Program to sub-allot PHP 50,000 to each CHD annually to help defray expenses related to AEFD during deworming activities.
  • The Order provides that if no AEFD incident occurs, the allocated funds can be used for other STH activities.

Roles and responsibilities by agency

  • The National Center for Disease Prevention and Control (NCDPC):
    • Establishes a pool of experts or designates collaborating centers to provide experts at the national level for technical assistance in managing severe adverse drug reactions.
    • Develops and updates policies and guidelines on AEFD management for Rural Health Units, hospitals, and other government agencies involved in mass deworming.
    • Allocates funds for AEFD management.
  • The National Epidemiology Center (NEC):
    • Conducts an in-depth investigation of serious adverse experiences that may be life-threatening or require hospitalization.
    • Establishes and maintains a database in coordination with NCDPC.
    • Analyzes data provided by RESU.
    • Recommends appropriate action when necessary.
    • Provides feedback to concerned offices/LGUs as necessary.
  • The Centers for Health Development (CHD)/Regional Epidemiology Surveillance Unit (RESU):
    • Confirms reported AEFD occurrence.
    • Conducts investigation in collaboration with LGUs.
    • Analyzes data and recommends appropriate action.
    • Allocates fund to augment national funds in AEFD conduct.
  • The Municipal/Provincial/City Health Offices (MHO/CHO/PHO):
    • Oversee implementation of the program.
    • Conduct initial investigation on reported AEFD through PESU/MESU.
    • Recommend appropriate action when necessary.
    • Augment funds for AEFD conduct.
    • Report to CHD or refer to the next higher level when further investigation is required.
  • Government Hospitals:
    • Ensure treatment of referrals related to AEFD.
    • Report cases of EFD to MESU/PESU/RESU.
  • Parents/Health workers/Teachers:
    • Report AEFD cases to proper authority, including PESU/MESU.
    • Report AEFD cases to nearest health facility or proper authority, including MHO/PHN PESU/MESU.

Repeal and immediate effect

  • The Order repeals or rescinds provisions of AO 2006-0028, AO 176 s. 04, and other issuances that are inconsistent with DOH Administrative Order No. 2010-0023.
  • The Order takes effect immediately upon issuance by the Secretary of Health, Enrique T. Ona, MD, FPCS, FACS.

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