Guidelines on Deworming Drug Use and AEFD Management

Provide guidance to health workers and service providers on:
1. Proper administration of deworming drugs to specific age groups.
2. Management of adverse events following deworming (AEFD).
3. Accurate reporting and recording of AEFD cases.

This Order applies to all national, regional, and local DOH offices and stakeholders involved in the deworming program.

Adverse Drug Reaction (ADR): Unintended harmful reaction at normal drug doses.
Adverse Event Following Deworming (AEFD): Medical event after ingesting deworming drugs, usually mild and transient within 8-12 hours.
Eligible Population: Individuals qualified to receive preventive deworming treatment.
Mass Deworming: Administering deworming drugs to entire groups without prior diagnosis to eliminate intestinal parasites.
Preschool Children: Ages 1-5 years, not yet in school.
Preventive Chemotherapy: Use of anthelminthic drugs as a public health measure.
School Children: Ages 6-12 or Grade 1 to 6 enrollees.
Serious Adverse Experience (SAE): AE causing death, life-threatening conditions, hospitalization, disability, congenital anomalies, cancer, or overdose.
Soil-Transmitted Helminthiasis (STH): Infection caused by nematode worms - roundworm, whipworm, hookworm.

Recommended drugs: Albendazole 400 mg and Mebendazole 500 mg chewable tablets, included in the Philippine National Drug Formulary and WHO essential medicines.
Both drugs are benzimidazole derivatives effective against single or mixed worm infections.
Drugs disrupt worm energy metabolism leading to worm death.
Drugs are taken regardless of prior deworming history and must be taken on a full stomach.

Target populations include preschoolers (1-5 years), school children (6-12 years), women of childbearing age (including 2nd and 3rd trimester pregnant and lactating women), and high-risk adults (e.g., food handlers, farmers, indigenous peoples).
Dosages:
- For children 12-24 months: Albendazole 200 mg (1/2 tablet), Mebendazole 500 mg (1 tablet) every six months.
- For 2 years and older: Albendazole 400 mg (1 tablet), Mebendazole 500 mg (1 tablet) every six months.
Preschoolers and special groups receive drugs at Rural Health Units or Municipal Health Centers.
Schoolchildren receive drugs in schools.

Albendazole and Mebendazole have excellent safety profiles with only mild, transient adverse effects typically within 10 hours of ingestion.
Common adverse reactions include local sensitivity/allergy, mild abdominal pain, diarrhea, and erratic worm migration.
Management includes:
- Antihistamines for allergic reactions.
- Antispasmodics for abdominal pain.
- Oral rehydrating solutions for diarrhea.
- Physical removal of worms expelled via mouth or nose.
Parents/caregivers may manage minor reactions; persistent or severe reactions require doctor consultation and notification of AEFD teams.

Inform target recipients and caregivers of possible adverse reactions and their management.
Ensure accurate recording and informing of authorities for any adverse reactions.
Health personnel must be aware of ongoing deworming activities.
Supply health facilities with supportive drugs.
Persons advised not to take deworming drugs include severely ill individuals, those with abdominal pain or diarrhea, history of hypersensitivity to the drugs, and severely malnourished persons.

Serious adverse events within 8-10 hours after drug ingestion must be reported immediately.
AEFD teams established at municipal, provincial, and regional levels are responsible for investigation and assessment.
AEFD team composition includes health officers, epidemiology surveillance officers, STH coordinators, and DOH representatives.
AEFD investigations involve case evaluation, form completion, recommendation of appropriate actions, with referrals to higher levels if needed.
Hospital admission for severe cases shall be facilitated by the AEFD teams.
Reporting uses the standardized AEFD reporting form completed by health workers, parents, or teachers.
Funds (PhP 50,000 annually) are allocated to local health offices for management of AEFD-related expenses.

National Center for Disease Prevention and Control (NCDPC): Develops policies, manages technical assistance, allocates funds.
National Epidemiology Center (NEC): Conducts in-depth investigations, maintains database, provides feedback.
Centers for Health Development (CHD)/Regional Epidemiology Surveillance Unit (RESU): Confirms AEFD occurrence, conducts investigations, analyzes data, allocates supplemental funds.
Local Health Offices (MHO/CHO/PHO): Oversee program implementation, carry out initial investigations, recommend action, report or refer cases.
Government Hospitals: Provide treatment for referrals, report AEFD cases.
Parents, health workers, and teachers: Report AEFD cases to proper authorities.

Provisions of inconsistent prior Administrative Orders (AO 2006-0028, AO 176 s. 04) and other issuances are repealed or rescinded.
The Order takes effect immediately upon release.