World Health Organization · 1st edition, 2026 · 38 pages
WHO normative guidance on the process for countries to validate STH elimination as a public health problem in children through dossier submission
- Issuer
- World Health Organization
- Edition
- 1st edition, 2026
- Audience
- National NTD programme managers, public health authorities, STH control programme staff, ministries of health
- Evidence
- Expert consensus through WHO Technical Advisory Group on schistosomiasis and soil-transmitted helminthiases control and elimination (TAGSS)
- Reviewed
- 15 Oct 2026 · GMJ
What this guideline says
GMJ summary
This manual provides endemic countries with standardised procedures for validating that soil-transmitted helminthiases (STH) have been eliminated as a public health problem in children. STH elimination as a public health problem (EPHP) in children is defined as achieving <20% prevalence of any STH infection and <2% prevalence of moderate and heavy intensity (MHI) infections in children aged 10–14 years in all implementation units.
Countries must demonstrate ≥5 years of continuous preventive chemotherapy (PC) with ≥75% effective coverage before beginning a two-step pre-validation process. This involves an initial impact assessment (IA 1) followed by 3 years of surveillance, then a second impact assessment (IA 2). Only when all implementation units meet elimination criteria at both assessments can a country submit a validation dossier to WHO. The manual provides detailed templates for dossier preparation, review procedures through regional expert groups, and requirements for post-validation surveillance.
Validation does not signify programme cessation. Countries must maintain ongoing surveillance and be prepared to resume intensified PC if infections resurge above target thresholds. The document emphasises that achieving validation requires integrated approaches including deworming of women of reproductive age and improvements in water, sanitation and hygiene infrastructure.
Key points
For clinicians — doses and thresholds as stated in the guideline
- STH EPHP in children is defined as <20% prevalence of any STH infection AND <2% prevalence of moderate and heavy intensity (MHI) infections in children aged 10–14 years
- MHI infection thresholds: Ascaris lumbricoides ≥5000 eggs per gram (epg), Trichuris trichiura ≥1000 epg, hookworms ≥2000 epg
- Countries must implement ≥5 consecutive years of PC with ≥75% coverage of the target eligible population before initiating pre-validation
- Pre-validation requires two impact assessments 3 years apart (IA 1 and IA 2), both demonstrating elimination criteria are met in all implementation units
- Impact assessments must be conducted ≥6 months after the previous PC round to reflect true epidemiological status
- Post-validation surveillance requires annual monitoring at sentinel sites (1 site per 200,000–300,000 targeted children) for ≥5 years
- When STH prevalence is 2–10%, implement PC once every 2 years; 10–20% requires annual PC; ≥20% requires PC twice yearly
- Dossier review by regional expert groups aims to provide feedback within 6 months of submission
Thresholds for intensity of different species of soil-transmitted helminths
Table extracted from the guideline
| Species | Light intensity | Moderate intensity | Heavy intensity |
|---|---|---|---|
| A. lumbricoides | 1–4999 epg | 5000–49 999 epg | ≥50 000 epg |
| T. trichiura | 1–999 epg | 1000–9999 epg | ≥10 000 epg |
| Hookworms | 1–1999 epg | 2000–3999 epg | ≥4000 epg |
Source: World Health Organization, Validation of elimination of soil-transmitted helminthiases as a public health problem in children: criteria and procedure. Reproduced in summary form.
From the guideline
Verbatim
“Validation does not indicate a permanent state and the end to programmatic activities. Following STH EPHP in children, continued actions will be required to ensure that infection prevalence remains below target thresholds.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As someone who has worked with WHO on multiple health programmes, I find this validation framework particularly important for countries in our region that have implemented deworming programmes but lack systematic documentation of their impact. The requirement for two impact assessments three years apart is methodologically sound – it prevents countries from claiming elimination based on temporary reductions following recent treatment rounds. For Georgian colleagues and those in neighbouring countries, I would stress the critical importance of establishing robust surveillance infrastructure before pursuing validation; the sentinel-site approach requiring one site per 200,000–300,000 children is resource-intensive but essential for detecting recrudescence early. The main implementation challenge I foresee is data archiving – many programmes in our region lack continuous documentation going back 5–10 years, and the dossier requires district-level PC coverage data, historical information on co-implemented programmes for lymphatic filariasis or onchocerciasis, and progressive improvements in water and sanitation indicators. Countries should begin systematic data collection and archiving now, even if validation is years away, because retrospectively reconstructing programme history from fragmented sources is extremely difficult and may delay or prevent validation.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 15 Oct 2026
Applicability
Georgia and the South Caucasus
Georgia and other countries in the South Caucasus and Eastern Europe with STH-endemic areas will need to assess their current epidemiological status against these validation criteria. National programmes must ensure robust surveillance systems are established, with district-level data on PC coverage and infection prevalence among school-age children. Countries in the region implementing integrated NTD programmes (including lymphatic filariasis or onchocerciasis control) should document how these programmes interact with STH control efforts, as co-administration of anthelminthics affects elimination timelines. The emphasis on water, sanitation and hygiene improvements aligns with broader UHC and sustainable development goals, and programmes should coordinate with environmental health authorities to document progress in these indicators as part of the validation dossier. Countries should engage with WHO regional offices early to plan mapping, impact assessments and dossier preparation, recognising the 5+ year timeline required before validation can be pursued.
Questions this guideline answers
Quick answers
When can a country begin the validation process for STH elimination as a public health problem in children?
Only after implementing ≥5 consecutive years of PC with effective coverage (≥75%) in all endemic implementation units, conducting impact assessment 1 (IA 1) showing <20% prevalence of any STH and <2% prevalence of MHI infections in children aged 10–14 years in all units, completing 3 years of pre-validation surveillance, and conducting impact assessment 2 (IA 2) confirming the targets are still met.
What happens if infection levels increase again after validation?
Validation recognises a potentially reversible state. Countries must maintain post-validation surveillance at sentinel sites annually. If surveillance shows recrudescence above the <2% MHI or <20% any STH thresholds, the country must notify WHO and restart PC at higher frequency. The change in status will be noted in WHO's Global Health Observatory and Weekly Epidemiological Record.
What diagnostic methodology should be used for impact assessments?
Impact assessments require nationally representative cross-sectional surveys using Kato-Katz thick smear method (with the standard 41.7 mg template, multiply egg counts by 24 to estimate eggs per gram). Surveys must include children aged 10–14 years and be conducted at least 6 months after the previous PC round. In settings with >75% school enrolment, school-based surveys are acceptable for this age group.
What post-validation activities are required?
Countries must implement annual surveillance at sentinel sites (1 site per 200,000–300,000 targeted children per implementation unit), continue PC where prevalence remains 2–20% (frequency based on prevalence thresholds), maintain treatment access through routine health care, continue deworming of women of reproductive age, and submit annual surveillance data to WHO using the Epidemiological Data Reporting Form.
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- Issuer
- World Health Organization
- Type
- Guidance (normative)
- Edition
- 1st edition, 2026
- Status
- Current
- Published
- 2026-04-29
- Languages
- Arabic, Chinese, English, French, Russian, Spanish
- Scope
- Global
- Audience
- National NTD programme managers, public health authorities, STH control programme staff, ministries of health
- Pages
- 38
- Licence
- CC BY-NC-SA 3.0 IGO
- ISBN
- 978-92-4-012142-3
- Evidence
- Expert consensus through WHO Technical Advisory Group on schistosomiasis and soil-transmitted helminthiases control and elimination (TAGSS)
- Record history
- Created 15 Oct 2026 · updated 15 Oct 2026 · next check Apr 2027
World Health Organization. Validation of elimination of soil-transmitted helminthiases as a public health problem in children: criteria and procedure. Geneva: World Health Organization; 2026. Licence: CC BY-NC-SA 3.0 IGO.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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