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2017 HCHB_digital

Worms Pinworms

Worms Pinworms (Enterobius vermicularis) are small worms that live in the lower digestive tract. Pinworms may also be called threadworms, enterobiasis or oxyuriasis. They are white and thin and look like a small piece of white cotton about the size of a staple (5–10mm). Occasionally they can be spotted in the stool (poo) or around the anus, but are usually difficult to see. A "sticky tape" test involves sticking and then quickly removing a piece of sticky tape to the anus in an attempt to catch any pinworm eggs. This is best done late at night or early morning as the female pinworm deposits her eggs outside the anus during the night. The tape is then viewed under a microscope for the presence of eggs. Generally, it is not considered necessary to confirm the diagnosis by actually observing either pinworms or their eggs; the suspicion of an infection is usually enough for treatment. Humans are considered the only hosts of pinworms, so this type of worm cannot be caught from pets. Pets carry other sorts of worms, such as roundworm, tapeworm and hookworm which can be transmitted very occasionally to people. Children and individuals who are immunocompromised are more vulnerable to infection with animal worms than adults. Pinworm is the most common worm infection occurring in New Zealand and it is estimated that every child is infected with this parasite at least once before reaching secondary school. Symptoms of worms Many people infested with worms have no symptoms at all. Some people, particularly children, are more likely to complain of: • itching around the bottom, typically at night – this is caused by a reaction to the glue used by the pinworm to attach its eggs to the skin • sleep disturbance from scratching, which may result in daytime tiredness or irritability • teeth grinding or bed-wetting • broken, infected skin around the bottom from persistent scratching (refer to pharmacist) • abdominal pain, nausea or vomiting with severe infestations. Sometimes in females, the adult worms migrate to the vagina instead of returning to the bowel. Itchiness in the vaginal region along with a mucous or blood-stained discharge may be reported. Symptoms of either hookworm or tapeworm infections are usually nonspecific. Infection may cause inflammation in the intestines which may then cause abdominal discomfort and loss of appetite leading to weight loss and malnutrition. Roundworms tend to migrate around the body to the lungs, liver and eyes and, while most mild infections are asymptomatic, some people may have a swollen liver, rash, or complain of lung or eye problems. Transmission of worms Pinworm eggs are able to survive outside of their human host for up to two weeks and the eggs are easily picked up through contact with infected surfaces (such as bed sheets, toys, taps) and then swallowed if hands are not washed properly before eating. Airborne eggs carried in dust or released into the air after making the bed may also be inhaled. Larvae hatch out of the pinworm eggs and live in the lower bowel, migrating out of the infected person’s bottom (usually at night) to lay their eggs. If children scratch their bottom, the eggs can get under their fingernails. The eggs can then be transferred to objects or other people and be swallowed, starting the cycle again. Children are more likely to become infected because they sometimes forget to wash their hands after playing, going to the toilet, or before eating food and are often putting their hands in their mouth. People get roundworm and hookworm infections through direct contact with infected pet faeces. Tapeworms are transmitted by fleas and also through undercooked meat from infected animals. Pets should be wormed and deflead monthly, and dog faeces should be bagged and disposed off promptly. Eggs and larvae of roundworm and hookworm are very resilient and can survive for a long time in areas such as parks, playgrounds, backyards, and even inside homes. Initial assessment In a quiet area of the pharmacy, talk with the caregiver or person with suspected worms about their symptoms (it is not necessary to actually visualise a worm). TREATMENT OPTIONS Category Examples Comments Mebendazole Pyrantel Sanitising products [PHARMACY ONLY MEDICINE] eg, Combantrin-1, de-Worm, Vermox [PHARMACY ONLY MEDICINE] eg, Combantrin [GENERAL SALE] eg, Dermasoft Alcohol Free Foaming Hand Sanitiser, Germ-X range The dose is the same for everybody aged over two years. Repeat dose in two to four weeks. Chewable tablets, squares or suspension are available. The tablet can also be crushed and given to children mixed with honey, food or fruit juice. The dose is 10mg/kg (consult guide on back of packet). Recommended for children aged one year or older. Treatment of children aged less than one year should be under medical advice. Repeat the dose in two to four weeks. Chewable squares, suspension and tablets are available. Take as a single dose, after food. Encourage children and adults to wash their hands or use sanitising gels or wipes before eating and after going to the toilet. This can help stop the spread of worms. @PharmacyToday. A part of your everyday. New Zealand’s only e-newsletter designed specifically to provide a news snack for pharmacy. With links to you’re only a click away from the full story. Page 170 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION Reassure the customer that pinworms occur across the social strata and do not imply a lack of hygiene. Many people also periodically treat their children for worms every six months or so, regardless of whether or not they have symptoms, and this is acceptable practice. Run through the Refer to Pharmacist questions and refer any people with "yes" answers to a Pharmacist. For all other customers, show them the treatment products available, discuss the dosage, and ways to prevent reinfection. Treatment Anti-worm products (anthelmintics) sold through New Zealand pharmacies contain either mebendazole or pyrantel (see Treatment Options). Both are effective at treating pinworm, roundworm and hookworm infections. People with suspected tapeworm infection or with persisting symptoms despite treatment with either mebendazole or pyrantel should be referred to a doctor. Advice for customers • Treat the whole family, even if some family members have no symptoms. • To prevent reinfection: » » wash hands thoroughly before eating food and after toileting (encourage use of gel hand-sanitisers and personal hand towels at school or work) » » scrub underneath fingernails and keep them short, as eggs may lodge under nails » » while undergoing treatment for worms, shower at night and again the next morning to remove eggs » » undress children in the shower so eggs are washed away » » change underwear daily » » disinfect the toilet seat daily for one week after treatment » » wash bed linen and towels in hot water, separate from other washing, daily until worms have been eradicated. Do not shake before washing » » vacuum carpet and furniture to remove eggs. • If children scratch themselves in their sleep it may be necessary for them to wear cotton mitts and tight-fitting underpants at night. This prevents anusto-mouth transfer. • Worm and de-flea dogs and cats monthly. » » Dogs and cats of any age may get roundworms and hookworms but they are most vulnerable when they are very young. Most pets show no sign of infection, although heavy infestations may be fatal. » » Puppies are often born with a significant number of worms which are often passed to them from their mother before or shortly after birth. » » Teach children to always wash their hands after coming into contact with animals. Keep play areas, lawns and gardens free of animal waste. Cover sandpits when not in use. Refer to PHARMACIST The following questions aim to identify customers who would benefit from further input from a pharmacist. Your initial assessment may have already provided some answers. Decide if any further questions still need to be asked and refer any “yes” answers to a pharmacist. • Does the person have any other health conditions (eg, immunosuppression, cancer, is pregnant or breastfeeding)? • Is the person concerned about a child aged less than two years? • Has the person been overseas to a developing or remote country within the past year? • Is there blood in the faeces? • Is there any accompanying diarrhoea? • Has there been a marked weight loss? • Is the skin around the anal area broken due to scratching? • Has treatment been tried before without success? • Do the worms keep coming back? • Does the person have any allergies to medicines? Page 171

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