Title: Survey on Parasitic Helminths in Philippines

Introduction

Helminths are multicellular eukaryotic creatures that fall into three primary groups:
nematodes (roundworms like Enterobius and Ascaris), trematodes (flukes like Schistosoma and
Fasciola), and cestodes (tapeworms like Taenia and Echinococcus) (Sepúlveda & Kinsella,
2013).Trematodes, also known as flukes, are flat-bodied parasites with a distinct shape, equipped with oral
and ventral suckers that help them attach to their hosts. Unlike nematodes, trematodes possess a digestive
system and are generally smaller than cestodes (Orlofske et al., 2015; Thompson & Geary, 2003). Their
life cycle typically involves three hosts: a mollusk as the first intermediate host, followed by a second
intermediate host such as fish or vegetation, and finally a definitive host, which can be humans or animals
(Orlofske et al., 2015; Thomas et al., 1997). Trematodes can infect various tissues in the host, including the
liver (Schistosoma spp.), lungs (Paragonimus spp.), and blood vessels. The pathology they cause is often a
result of tissue damage and immune responses to the eggs they deposit in host tissues (Orlofske et al., 2015
; Hailemeskel et al., 2020).

Furthermore, nematodes, or roundworms, are cylindrical, unsegmented worms that

periodically shed their cuticle. These worms have a well-developed digestive system and are
among the most diverse helminths, capable of infecting both plants and animals (Khan et al.,
2021; Thompson & Geary, 2003). Nematodes have a simpler life cycle compared to trematodes,
often requiring just one host. Some species, like Strongyloides stercoralis, can even undergo
autoinfection, where larvae re-infect the same host without needing an intermediate one (Wu et
al., 2022; Midha et al., 2017). Depending on their habitat, nematodes can either be intestinal or
tissue-dwelling. Intestinal nematodes, such as Ascaris lumbricoides, can cause obstruction and
malnutrition, whereas tissue-dwelling nematodes like Trichuris trichiura lead to colonic
inflammation (Olopade et al., 2022; Wu et al., 2022; Hotez et al., 2005).

These parasitic worms pose a significant public health threat, particularly in the
Philippines, where they contribute substantially to the disease burden, especially among
marginalized communities (Belizario et al., 2011). According to Onichandran et al. (2014),
helminth infections affect millions of people worldwide, with the Philippines being one of the
most severely impacted countries. When these parasites infect humans and other hosts, they can
lead to the development of various diseases (Weinstock & Leung, 2022). Furthermore, helminth
infections are particularly prevalent in rural and impoverished areas of the Philippines, where
limited access to clean water, sanitation, and healthcare exacerbates the situation (Magalhães et
al., 2015).

In addition to these environmental challenges, schistosomiasis and other trematode

infections are among the most prevalent helminth infections in the country, alongside soil-
transmitted helminthiasis (STH) diseases caused by Ascaris lumbricoides (roundworm), Trichuris
trichiura (whipworm), and hookworms (Srinivasamurthy & Bairy, 2021; Hotez et al., 2005).

Soil-transmitted helminth (STH) infections are prevalent in the Philippines due to poor
sanitation and hygiene practices, disproportionately affecting children. These infections often
result in heavy worm burdens, which in turn lead to malnutrition, stunted growth, and cognitive
impairments (Hotez et al., 2005; Roach, 2020). Ascaris lumbricoides and Trichuris trichiura are
widespread and highly endemic in the country, with notable spatial variation in their prevalence
across different regions. For instance, Luzon and the Visayas experience higher infection rates
compared to Mindanao (Soares Magalhães, 2015). A study by Lee et al. (2000) in Legazpi City
revealed that 78.1% of children and adolescents were infected with intestinal parasites, with T.
trichiura (51%) and A. lumbricoides (40%) being the most prevalent, while hookworm infections
were more localized, with smaller foci in the Visayas and Mindanao (Magalhães, 2015). Poor
hygiene practices, such as failing to wash hands with soap, are significant risk factors for STH
infections (Flores, 2018). Additionally, rural areas tend to have higher infection rates than urban
areas. For example, in Legazpi City, the infection rate in rural areas was 92.3%, compared to 56%
in urban areas (Lee et al., 2000).

Schistosomiasis

In addition to soil-transmitted helminths, waterborne diseases, such as schistosomiasis,

continue to be a major public health concern in the Philippines. Schistosomiasis, a neglected
tropical disease often linked to water sources, affects more than 200 million people globally (King
et al., 2005; Walz, 2015; WHO, 2021). This disease is caused by Schistosoma blood flukes, with
the infection occurring when cercariae, the larval stage of the parasite, penetrate the skin of
individuals exposed to contaminated water, typically harboring freshwater snails that act as
intermediate hosts (McManus, 2020; Colley et al., 1998). In the Philippines, schistosomiasis
remains a pressing public health issue, especially in rural and agricultural settings where
environmental conditions and human activities facilitate its transmission (Olveda & Gray, 2019).

Among the different species of Schistosoma, S. japonicum is the most dominant and
problematic in the Philippines due to its zoonotic lifecycle. This species not only infects humans
but also other mammals, such as water buffaloes, pigs, dogs, and wild animals like monkeys and
field rats, which serve as potential reservoirs for the parasite (Riley et al., 2008; Chen et al., 2010;
McGarvey et al., 2006). This zoonotic nature makes controlling the disease particularly
challenging, as both human and animal populations contribute to its transmission (Kuo, 2024;
Rion et al., 2022). Transmission in the Philippines is closely linked to environmental factors, such
as the presence of water bodies and favorable snail habitats. In areas like Agusan del Sur in
Mindanao, the prevalence of schistosomiasis is high, with rainfall and flooding providing ideal
conditions for snail populations and increasing human-water contact (Leonardo et al., 2008;
Araujo, 2019). Moreover, climate change is expected to exacerbate these conditions, potentially
intensifying transmission cycles by promoting snail growth during the rainy season (Recopuerto-
Medina et al., 2023).

Human activities also contribute significantly to the risk of exposure, particularly through
rice farming, fishing, and recreational use of water. These activities increase direct contact with
contaminated waters, which explains the higher infection rates observed in rice paddies and
fishing areas (Araujo et al., 2018; Falcone et al., 2022). As agriculture plays a major role in the
proliferation of the disease, with a significant portion of the population being involved in rice
farming, it is crucial to address these activities to mitigate the spread of schistosomiasis. The
Philippine government is already taking steps to address these challenges, with ongoing initiatives
aimed at mechanizing farming to reduce human-wildlife contact and the risk of infection.
However, the country’s current mechanization level is still low, with plans to improve it in the
coming years to match the average among other ASEAN countries (Cariño, 2023; Tacio, 2022).

Schistosomiasis continues to be especially endemic in poor rural populations with limited

access to clean water, sanitation, and health care. This disease causes malady to the community of
regions with rough access to these simple services, not to mention the impact of polyparasitism,
occurring when several parasitic infections coexist in a community. In the case of places like
Northern Samar, people typically suffer from many diseases at once and this complicates the
public health burden (Blas et al., 2004; Weerakoon et al., 2018). While a need exists to control
schistosomiasis, the complexities in transmission dynamics and the social and environmental
factors fostering its spread imply significant barriers to effective intervention (Olveda & Gray,
2019).

Foodborne trematodiasis, iSn addition to the soil-transmitted helminths and

schistosomiasis, foodborne trematodiasis, caused by liver and lung flukes such as Fasciola and
Paragonimus, is also a significant concern in the Philippines. These infections are primarily
linked to the consumption of undercooked or raw aquatic products, including freshwater crabs,
crayfish, and wild boar meat (Srinivasamurthy & Bairy, 2021; Seryodkin et al., 2023).
Paragonimiasis, a zoonotic foodborne lung disease, is caused by lung flukes of the genus
Paragonimus and is acquired through the ingestion of raw or undercooked freshwater crabs or
crayfish, or wild boar meat (Nawa et al., 2014). Moreover, a study conducted in Lake Mainit
found a high prevalence of Fasciola sp. in bovine feces, indicating a potential zoonotic
transmission route through livestock (Jumawan, 2020).

Risk factors for helminths

Poverty and education are key socioeconomic factors that contribute to the prevalence of
helminth infections. Low-income communities are particularly vulnerable due to limited access to
clean water, sanitation, and healthcare, which exacerbate the risk of infection (Recopuerto-Medina
et al., 2023; Cross, 1986). Moreover, a lack of awareness about helminth transmission and
prevention further complicates control efforts. In rural areas, misconceptions about mass drug
administration (MDA) and open defecation practices are widespread, which hinders effective
intervention (Parikh et al., 2013).

Climate and land use are critical environmental factors influencing helminth transmission.
High rainfall and warm temperatures create ideal conditions for the survival and spread of
helminth larvae, with precipitation, particularly during the driest quarter, identified as a key factor
in the distribution of schistosomiasis (Recopuerto-Medina et al., 2023). In addition, agricultural
areas, such as rice fields and irrigation canals, present high-risk environments for helminth
transmission, as these areas often harbor snails that act as intermediate hosts for trematodes (Paller
et al., 2019).

Poor hygiene practices, such as not using soap when washing hands, are a major risk factor
for STH infections (Flores et al., 2018). Additionally, cultural practices like consuming raw or
undercooked foods, such as crabs and pork, contribute to the transmission of diseases like
paragonimiasis and taeniasis/cysticercosis (Cabrera, 1984; Mohamed-Nor, 2013).

Control strategies for helminth infections in the Philippines include Mass Drug
Administration (MDA), health education and sanitation, geographical targeting, and zoonotic
control. MDA, which distributes drugs like albendazole and praziquantel, is effective but relies on
community acceptance, as seen in Guimaras where misconceptions hindered participation (Hotez
et al., 2005; Parikh et al., 2013). Health education promotes preventative behaviors such as
handwashing and proper sanitation, and improving infrastructure like clean water and toilets is
vital for reducing transmission (Parikh et al., 2013). Geographical targeting using tools like GIS
identifies high-prevalence areas for better resource allocation (Magalhães et al., 2015;
Recopuerto-Medina et al., 2023; Brooker et al., 2003). Zoonotic control, involving a One Health
approach, focuses on controlling animal reservoirs like crabs and snails and includes veterinary
interventions like livestock deworming (Cabrera, 1984; Nawa et al., 2014; Jumawan et al., 2020).
Methods
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