Effectiveness of two annual, single‐dose mass drug administrations of diethylcarbamazine alone or in combination with albendazole on soil‐transmitted helminthiasis in filariasis elimination programme

Mani, T. R.; Rajendran, R.; Sunish, I. P.; Munirathinam, A.; Arunachalam, N.; Satyanarayana, K; Dash, A. P.

doi:10.1111/j.1365-3156.2004.01298.x

Cited by 31 publications

(16 citation statements)

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“…For areas endemic for W. bancrofti there are an increasing number of studies which show the positive effect of filariasis control using MDA with DEC combined with alb on the reduction of intestinal helminths [8-11,38]. The results of the present study can extend this observation to areas endemic for Brugia infections.…”

Section: Discussionsupporting

confidence: 70%

“…This approach has been shown to reduce microfilaraemia of W. bancrofti and B. malayi efficiently [5-7]. Studies in areas endemic for W. bancrofti also indicate that the treatment with DEC combined with alb has the additional long-term beneficial effect of reducing prevalence and intensity of infection with intestinal helminths such as Ascaris lumbricoides , hookworms and Trichuris trichiura [8-11]. …”

Section: Introductionmentioning

confidence: 99%

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et al. 2005

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BackgroundAnnual mass drug administration (MDA) using diethylcarbamizine (DEC, 6 mg/kg) combined with albendazole (alb, 400 mg) is recommended by the Global Programme to Eliminate Lymphatic Filariasis (GPELF). This strategy has been shown to be efficient in the of control bancroftian filariasis, but data on brugian filariasis as well as on the positive side effects on intestinal helminths are lacking.MethodsThe effect of one selective treatment and two rounds of MDA using DEC and alb on the prevalence and intensity of Brugia timori infection were studied on Alor island using a cross-sectional and a cohort approach. Before the campaign and ten months after each treatment cycle microfilariae (mf) were assessed by filtration of night blood. Before and ten months after MDA, stool samples were collected and the prevalence of intestinal helminths were determined.ResultsIn all, the mf-rate dropped from 26.8% before any treatment to 3.8% following the second MDA. Almost all mf-positive, treated individuals showed very low mf densities. The crude prevalence of hookworm dropped from 25.3% to 5.9%. The reduction of prevalence of Ascaris lumbricoides (32.3% to 27.6%) and Trichuris trichiura (9.4% to 8.9%) was less pronounced. Within a cohort of 226 individuals, which was examined annually, the prevalence of A. lumbricoides dropped from 43.8% to 26.5% and of T. trichiura from 12.8% to 6.6%. The results indicate that this MDA approach reduces not only the mf prevalence of B. timori but also the prevalence of hookworm and to a lesser extent also of A. lumbricoides and T. trichiura.ConclusionThe MDA using DEC and alb as recommended by GPELF is extremely effective for areas with brugian filariasis. The beneficial effect of MDA on intestinal helminths may strengthen the national programme to eliminate lymphatic filariasis in Indonesia and may set resources free which are otherwise used for deworming campaigns of schoolchildren.

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Section: Discussionsupporting

confidence: 70%

Section: Introductionmentioning

confidence: 99%

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et al. 2005

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“…A bounce back in STH infection levels was seen following treatment, but the difference in prevalence between albendazole and DEC- treated SAC compared to DEC-treated SAC remained significant (34.56% prevalence of STH in the intervention arm and 59.60% in control arm 11 months post-MDA) ( P <0.005)56. A subsequent study demonstrated that biannual MDA had greater benefit in keeping the prevalence of STH low following treatment (14.15% in intervention arm and 50.25% in control arm, 11 months post-two rounds of MDA, P< 0.001)57. After seven annual rounds of LF MDA from March 2001 to February 2010, STH prevalence was 12.48 per cent in the intervention arm, with hookworm showing the largest reduction with a final prevalence of 1.17 per cent, Ascaris 10.92 per cent and Trichuris 1.17 per cent ( P <0.05)58.…”

Section: Mass Drug Administration (Mda) Interventionsmentioning

confidence: 90%

“…Since the introduction of government-run MDA for lymphatic filariasis (LF) in endemic areas in 1998 in Tamil Nadu, several observational studies have documented the impact of mass interventions for STH in the community55565758. In Villupuram district, Tamil Nadu, community-wide MDA with albendazole and diethylcarbamazine (DEC) resulted in a decrease of STH (measured in a subgroup of children aged 9-10 yr) from 60.40 to 15.60 per cent [percentage reduction of Ascaris - 74.30% in intervention arm (albendazole with DEC) and 30.80% in control (DEC alone), hookworm reduction of 89.50% in intervention arm and 25.99% in the control arm, Trichuris reduction of 81.58% in intervention arm and 77.25% in the control arm]55.…”

Section: Mass Drug Administration (Mda) Interventionsmentioning

confidence: 99%

Intervention strategies to reduce the burden of soil-transmitted helminths in India

et al. 2018

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Soil-transmitted helminth (STH) infections continue to be a major global cause of morbidity, with a large proportion of the burden of STH infections occurring in India. In addition to direct health impacts of these infections, including anaemia and nutritional deficiencies in children, these infections also significantly impact economic development, as a result of delays in early childhood cognitive development and future income earning potential. The current World Health Organization strategy for STH is focused on morbidity control through the application of mass drug administration to all pre-school-aged and school-aged children. In India, the control of STH-related morbidity requires mobilization of significant human and financial resources, placing additional burdens on limited public resources. Infected adults and untreated children in the community act as a reservoir of infection by which treated children get rapidly reinfected. As a result, deworming programmes will need to be sustained indefinitely in the absence of other strategies to reduce reinfection, including water, hygiene and sanitation interventions (WASH). However, WASH interventions require sustained effort by the government or other agencies to build infrastructure and to promote healthy behavioural modifications, and their effectiveness is often limited by deeply entrenched cultural norms and behaviours. Novel strategies must be explored to provide a lasting solution to the problem of STH infections in India other than the indefinite provision of deworming for morbidity control.

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“…In Haiti, 2 annual single-dose MDAs with DEC (6 mg/kg) and albendazole (400 mg) reduced Ascaris , Trichuris and hookworm prevalences from 20.9% to 14.1%, 34.0% to 14.6%, and 11.2% to 2.0%, respectively, 9 months after the second MDA [68]. In India, the same treatment reduced the prevalence of Ascaris by 83%, Trichuris by 63% and hookworm by 69%, 11 months after the second MDA [69]. These “beyond-filariasis” benefits will not only give the anti-filariasis campaign a broader public health significance but also help to improve compliance among people and sustain the elimination program.…”

Section: Re-evaluation Of Low-dose Dec Treatment Introduction Of Newmentioning

confidence: 99%

The Global Programme to Eliminate Lymphatic Filariasis: History and achievements with special reference to annual single-dose treatment with diethylcarbamazine in Samoa and Fiji

Kimura¹

2011

Trop.Med.Health

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Diethylcarbamazine (DEC), first introduced in 1947, was shown to have strong efficacy and safety for treatment of human lymphatic filariasis, which is caused mostly by a species Wuchereria bancrofti. Many studies to optimize the dosage and treatment schedule of DEC followed, and, based on the results, control programs with various regimens were implemented in different endemic areas/countries. By the mid 1970s, with endorsement by the WHO Expert Committee on Filariasis (3rd report, 1974), the standard DEC regimen for W. bancrofti infection in mass treatment had been established in principle: a total dose of 72 mg/kg of body weight given in 12 divided doses, once weekly or monthly, at 6 mg/kg each. Not long after the committee report, the efficacy of annual single-dose treatment at 6 mg/kg, which is only one twelfth of the WHO-recommended dose in a year, was reported effective in French Polynesia (study period: 1973-78), and later in Samoa (study period: 1979-81). These results were published between 1978 and 1985 in the Bulletin of WHO but received little attention. In the mid 1980s, the efficacy of ivermectin, the first-choice drug for onchocerciasis, against lymphatic filariae came to light. Since the effect at a single dose was remarkable, and often better than DEC, it was predicted that the newly introduced drug would replace DEC. Treatment experiments with ivermectin increased quickly in number. Meanwhile, annual single-dose mass drug administration (MDA) with DEC at 6 mg/kg was under scrutiny in Samoa and Fiji. In the early 1990s, the Samoan study, which covered the entire population of 160,000 with 3 annual MDAs, reported a significant reduction in microfilaria (mf) prevalence and mean mf density, while in Fiji, the efficacy of 5 rounds of annual MDA (total dose, 30 mg/kg) was shown to be as effective as 28 multi-dose MDA spread over 2 years (6 weekly plus 22 monthly treatments at 5 mg/kg; total dose, 140 mg/kg). Several additional studies carried out in Samoa in relation to the annual single-dose MDAs revealed that low density mf carriers, who have a very low mf count of 1-20/ml of venous blood, could not play a significant role in filariasis transmission.From around 1990, studies on spaced low-dose DEC treatments and various types of combination chemotherapy with DEC and ivermectin increased. Albendazole, a well-known anti-intestinal helminths agent, was later added to the combination. The main findings of these studies with W. bancrofti are: (i) a single dose of DEC at 6 mg/kg reduced mean mf density by ca. 90% 1 year after treatment; (ii) the same dose could damage/kill adult worms; (iii) a single dose of ivermectin at ca. 400 µg/kg was more effective than DEC in reducing mf density during the first year and was similarly or less effective in the second year; (iv) ivermectin probably could not kill adult worms; (v) a single combined dose of albendazole (400 mg) and DEC (6 mg/kg) was effective to reduce mf density by 85 to nearly 100% 12-24 months after treatment; and (vi) ivermectin or albendazole incl...

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Effectiveness of two annual, single‐dose mass drug administrations of diethylcarbamazine alone or in combination with albendazole on soil‐transmitted helminthiasis in filariasis elimination programme

Cited by 31 publications

References 18 publications

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Intervention strategies to reduce the burden of soil-transmitted helminths in India

The Global Programme to Eliminate Lymphatic Filariasis: History and achievements with special reference to annual single-dose treatment with diethylcarbamazine in Samoa and Fiji

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