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Helminth (Worms) Infection - screening and presumptive treatment

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Pre-Cardiac Surgery / Pre-Cardiac Intervention

  • Guideline outlines presumptive worm treatment for children and infants > 1 year of age coming from the Melanesian Islands (i.e. Vanuatu and Solomon Islands, Papua New Guinea, Kiribati). 
  • Routine presumptive worm treatment is not indicated for children coming from Samoa, Tonga, Fiji, Niue, Rarotonga, or the Cook Islands. Children from these areas should be assessed as for any other child, and treatment prescribed only where infection exists or is suspected
  • Routine presumptive treatment is not recommended for children under the age of 1 year, due to the lack of safety data for anti-helminth medications in this population. Where infection is suspected or confirmed in children under the age of 1, treatment should be prescribed on an individual patient basis.

Treatment

  • Start worm treatment when child presents for their first booked appointment in the cardiac clinic at Starship Hospital following arrival in New Zealand. 
  • Ensure the guardian has prescription and knows how to give the medication.
  • Confirm worm treatment completed when child returns for their second booked appointment when coming in for full work up for surgery / intervention. Document in history that worm treatment complete.
  • On admission to hospital on day before surgery in 23b or Level 2 day stay confirm date and time of worm treatment in admission history. 
  • NB: if child has an associated anaemia on the first FBC consider giving iron supplementation after completion of anti-helminth treatment and repeating FBC in 3-4 weeks.

Dosing

The following dose recommendations are for presumptive treatment only. For guidance regarding management of children with suspected or confirmed helminth infections (based on clinical features, eosinophilia, stool ova, cysts and parasites (OCP) exam) please contact the paediatric infectious disease team.

Mebendazole

Mebendazole is suggested as first choice due to cost and availability
Dose: 1-12 year olds: 100mg PO twice daily for 3 days. Take after food.

References

  1. Woods, DJ (editor), New Zealand Formulary [Internet]. 2013 [updated 2014 Jan 1; cited 2014 Jan 31]. Available from: www.nzformulary.org

  2. World Health Organization Strategy Development and Monitoring for Parasitic Diseases and Vector Control (PVC) Control, Prevention and Eradication (CPE) Programme on Communicable Diseases (CDS)
  3. Guidelines for Overseas Presumptive Treatment of Strongyloidiasis, Schistosomiasis, and Soil-Transmitted Helminth Infections. Centre for Disease Control and prevention (CDC). http://www.cdc.gov/immigrantrefugeehealth/guidelines/overseas/intestinal-parasites-overseas.html#children

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Document Control

  • Date last published: 29 July 2016
  • Document type: Clinical Guideline
  • Services responsible: Paediatric Cardiology
  • Author(s): Marion Hamer, John Stirling, Elizabeth Oliphant
  • Editor: Marion Hamer
  • Review frequency: 2 years