New liver fluke test under review
Thai health authorities will retain stool examinations as the standard test for liver fluke infection after follow-up tests confirmed only four infections among 292 university students who had initially tested positive using a new urine screening kit, raising questions about the test’s performance in a real-world setting.
Thai health authorities will retain stool examinations as the standard test for liver fluke infection after follow-up tests confirmed only four infections among 292 university students who had initially tested positive using a new urine screening kit, raising questions about the test’s performance in a real-world setting.
The Department of Disease Control (DDC) said on Tuesday that the World Health Organization recommends stool examination as the definitive diagnostic method, so Thailand will continue to use it while experts develop guidelines on the appropriate use of the urine-based screening kit.
Dr Niti Haetanurak, the department’s deputy director-general, said 380 Mahasarakham University students who initially tested positive on a urine test were selected for follow-up.
So far, 292 have completed stool examinations, with only four confirmed to have liver fluke infections. Another 11 were found to be infected with other parasites, including tapeworms.
Health inspections were subsequently ordered for all somtam shops near the Mahasarakham and Rajabhat Maha Sarakham universities, and also restaurants that use pla ra, or Isan fermented fish, in their dishes
The findings were discussed at a meeting of the National Communicable Diseases Committee after more than 4,000 students at the school tested positive with a urine screening kit developed by Khon Kaen University.
Designed to offer a faster, more convenient alternative to stool testing, the kit is available through the National Health Security Office (NHSO) benefit scheme.
Dr Somrerk Jungsaman, permanent secretary of the Ministry of Public Health, said officials would review whether people who test positive through urine screening alone should receive anti-parasitic treatment.
Current DDC guidelines recommend treatment only after stool examination confirms infection.
He said the kit had performed well in laboratory studies conducted in populations with a much higher prevalence of infection than is currently seen in the Northeast, where DDC surveillance data indicate a prevalence of about 5%. Its effectiveness in community screening therefore requires further evaluation.
“This research was conducted with good intentions because stool examinations are difficult and often receive limited cooperation,” Dr Somrerk said. “The challenge is determining whether laboratory results can be replicated in real-world settings.”
Dr Yongjua Laosirithaworn, director of the Division of General Communicable Diseases, said positive urine test results should be treated as preliminary and confirmed by stool examination.
Officials said preventing cholangiocarcinoma, or bile duct cancer, remains the ministry’s priority through early detection, public education, improved sanitation and discouraging the consumption of raw or undercooked freshwater fish.
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