Strengthening preventive strategies to reduce the burden of ocular parasitic infections among vulnerable populations: A public health perspective
Year: 2025
Type: article
Abstract: Dear Editor, Ocular parasitic infections have emerged as a public health concern, as they can result in irreversible impairment of vision, predominantly influencing children in rural settings with poor health conditions.[1] Most of these infections are zoonotic in origin and are often neglected, even though they can result in serious conditions such as uveitis, chorioretinitis, and blindness.[1,2] It is worth noting that due to the rising travel and migration of people, these infections have shown their global presence.[2] The findings of a systematic review and meta-analysis reported 1%–2% of ocular toxocariasis cases, especially in low- and middle-income nations, among children and young adults.[3] Another study reported that 9% of uveitis cases were due to toxoplasmosis infections among the general population.[4] The objectives of the article are to identify the role of the environment in the causation of ocular parasitic infections, to enlist the diagnostic and therapeutic challenges in ocular parasitic infections, and to propose prevention and control strategies for the effective containment of these infections. A wide range of environment-related factors together contribute to the rising incidence of ocular parasitic infections.[1,3–5] To begin with, poor health literacy, coupled with open defecation and the absence of a sewerage system, allows parasite eggs (viz., Toxocara, etc.) to contaminate soil and water, augmenting the chance of transmission to humans.[5] People living in rural areas often cohabitate with domestic or stray animals, which serve as reservoirs for parasites like Onchocerca.[5] In addition, the lack of handwashing and general hygiene enhances the risk of ingesting or transferring parasitic organisms to the eyes when individuals rub their eyes with contaminated fingers.[1] Moreover, the use of contaminated water sources for bathing can expose individuals to Acanthamoeba or Toxoplasma, especially when water gets into the eyes.[4,5] Substandard housing conditions increase the chances of exposure to different vectors for parasites like Onchocerca volvulus, thereby increasing the overall risk.[3,4] In addition, people working in animal husbandry, slaughterhouses, or agriculture are at high risk of frequent contact with animals and parasite larvae or eggs.[3,5] Further, due to malnutrition and weakened immunity among people from low socioeconomic groups, they become more vulnerable to ocular manifestations of different parasitic infections.[5] Ocular parasitic infections are linked with multiple diagnostic challenges, including nonspecific clinical presentations, limited access to specialized diagnostic tests (like ultrasound B-scan), and low sensitivity of conventional methods (routine microscopy or serology) to detect parasitic infections.[6,7] In addition, a lack of awareness among clinicians results in underreporting of ocular parasitic diseases, as they are often not counted as one of the differential diagnoses.[1,5] Further, for the confirmatory diagnosis, it might require invasive procedures like vitreous tap or biopsy, which require expertise and are not often feasible in underserved areas.[6,7] On a similar note, concerns have been highlighted even for the treatment, like limited availability of anti-parasitic medications in endemic regions, or the necessity to administer these drugs with other medications/surgical intervention, which is not practical in rural and remote settings.[5–7] Further, the possibilities of drug resistance, recurrence of infections, and provocation of a strong inflammatory response in response to the treatment cannot be ruled out.[1] Finally, for many ocular parasitic infections, there are no standardized treatment protocols, leading to variability in care.[1,5] Acknowledging the rising incidence of ocular parasitic infections and the resulting complications, high propensity to affect vulnerable populations, the presence of multiple predisposing environmental factors, and the involved diagnostic and therapeutic challenges, there is an immense need to strengthen prevention and control measures [Figure 1].[1–8] The first set of interventions targets promoting the practice of regular hand hygiene (viz., washing hands with soap after touching animals or before eating), avoiding rubbing eyes with contaminated hands, and safe food handling and cooking practices (like thoroughly washing vegetables and properly cooking meat).[8] In addition, protective goggles must be used in occupations involving animal contact to avoid parasitic larvae from entering the eye.[5] In addition, contact lens hygiene must be maintained by avoiding tap water to clean lenses to prevent Acanthamoeba keratitis.[5] There is an urgent need to take steps to improve awareness of the general population about the potential risks of owning or handling pets, the need to maintain personal hygiene, and healthy animal-handling practices, using different modes of mass media.[2,5]Figure 1: Prevention and control measuresThe next set of interventions deals with the domain of veterinary and environment, wherein the practice of regular deworming of pets, stray dogs, and livestock should be strongly advocated.[3,4] Further, we must encourage safe disposal of animal faeces and strengthen vector control programs to limit vectors that can transmit parasitic ocular infections.[3,4,8] Moreover, animal husbandry practices (like providing clean water, separating livestock from household areas, etc.) need to be improved to interrupt the chain of transmission.[4,5] These measures must be supplemented with the strengthening of health system services, including training of eye care and primary health providers, and promoting community-based surveillance to detect cases at the earliest.[1,4,6,7] There is a definite need to promote collaboration between concerned sectors (viz., health, animal husbandry, environmental agencies, etc.) to strengthen integrated parasite control.[1–5] Finally, we must ensure that ocular parasitic infections receive funding and global attention from policymakers and leaders, and this will require surveillance activities to gather collected data.[1,2,4] In conclusion, ocular parasitic diseases are a serious public health concern that affects vulnerable population groups. An integrated, multi-sectoral approach involving public health, veterinary services, and environmental management is essential to reduce the burden of ocular parasitic infections, especially among vulnerable groups. Data availability statement Data will be made available on reasonable request to the corresponding author. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Authors: Saurabh RamBihariLal Shrivastava, Prateek Sudhakar Bobhate, Deepika Singh
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7103149297