Improvement in severe onchocercal skin disease after a single dose of ivermectin

SummaryThe Onchocerciasis Control Program (OCP), one of the most successful vertical disease control programs in the history of public health, came to an end in 2003 with devolvement of responsibilities for control program activities passed to the countries affected. Fortunately, 15 years ago the Mectizan Ò Distribution Program (MDP) was founded to provide a complementary approach to controlling the disabling consequences of this parasitic infection. With over 250 million doses of ivermectin distributed over the past 15 years, the MDP is well on its way to both solidifying the progress made by the OCP and extending program reach well beyond the boundaries of the OCP. Through the extensive clinical testing protocols implemented in a variety of countries in Aftica, ivermectin has been proven to be a safe and highly effective treatment for onchocerciasis. Regular distribution to populations living in endemic areas has demonstrated significant reductions in blinding ocular complications, transmission, and disability caused by onchocercal skin disease. As yet undocumented, are the likely significant impact regular population dosing with ivermectin has on intestinal helminth infections, lymphatic filariasis, and human scabies infection. While there are significant barriers to continued program success, focussed attention on expanding and improving community-directed ivermectin distribution is likely to lead to further progress against this resilient infection.

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“…however, is not affected by ivermectin treatment (Pacqué et al 1991b;Burnham 1995;Kennedy et al 2002).…”

Section: A49mentioning

confidence: 85%

“…1998b; Ogbuagu & Eneanya 1998). Depigmentation however, is not affected by ivermectin treatment (Pacqué et al. 1991b; Burnham 1995; Kennedy et al.…”

Section: Onchocercal Skin Diseasementioning

confidence: 99%

Impact of ivermectin on illness and disability associated with onchocerciasis

Tielsch

Beeche

2004

Tropical Med Int Health

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“…Current evidence on the short-term effect of ivermectin on onchocercal skin disease (OSD) and related itching is conflicting and inconclusive. Although ivermectin reduces microfilarial loads in the skin, previous studies did not find a consistent and clear effect on OSD (Pacque et al 1991;Whitworth et al 1992b;Sumo et al 1993;Burnham 1995) and itching (Sumo et al 1993;Whitworth et al 1992aWhitworth et al , 1996Burnham 1995).…”

Section: Introductionmentioning

confidence: 94%

The effects of ivermectin on onchocercal skin disease and severe itching: results of a multicentre trial

Brieger

Awedoba

Eneanya

et al. 1998

Tropical Med Int Health

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Summaryobjective To determine the effects of ivermectin in annual, 3-monthly and 6-monthly doses on onchocercal skin disease (OSD) and severe itching.method A multicentre, double-blind placebo controlled trial was conducted among 4072 residents of rural communities in Ghana, Nigeria and Uganda. Baseline clinical examination categorized reactive skin lesions as acute papular onchodermatitis, chronic papular onchodermatitis and lichenified onchodermatitis. Presence and severity of itching was determined by open-ended and probing questions. Clinical examination and interview took place at baseline and each of 5 subsequent 3-monthly follow-up visits.results While prevalence and severity of reactive lesions decreased for all 4 arms, those receiving ivermectin maintained a greater decrease in prevalence and severity over time. The difference between ivermectin and placebo groups was significant for prevalence at 9 months and for severity at 3 months. Differences between placebo and ivermectin groups were much more pronounced for itching. From 6 months onward, the prevalence of severe itching was reduced by 40-50% among those receiving ivermectin compared to the trend in the placebo group.conclusion This is an important effect on disease burden as severe itching is for the affected people the most troubling complication of onchocerciasis. The difference among regimens was not significant, and the recommended regimen of annual treatment for the control of ocular onchocerciasis appears also the most appropriate for onchocerciasis control in areas where the skin manifestations predominate. The final determination of the effect on skin lesions requires a longer period of study. keywords onchocerciasis, ivermectin, onchodermatitis, itching correspondence W. R. Brieger,

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“…Due to lack of suitable model host for laboratory study, the high cost and ethical consideration for subjecting humans to placebo trial for up to ten years have precluded determination of the outcome of a single treatment. It has been documented by Pacque et al (32) that up to 33% of patients in non-endemic areas were cured with only 1 dose of ivermectin. Thus, the study of treatment compliance rate after a decade of intervention and the observed impact of single dose treatment on skin mf load and nodule rates clearly support the efficacy of single-dose treatment.…”

Section: Discussionmentioning

confidence: 97%

Field-based evidence of single and few doses of annual ivermectin treatment efficacy in eliminating skin microfilaria load after a decade of intervention

Osue

2017

Ethiop J Health Sci

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BACKGROUND: Impact assessment of community-based ivermectin treatment control of onchocerciasis is required to determine its effectiveness. This study was conducted to evaluate geographic coverage and demographic ivermectin treatment compliance. METHODS: The number of village dosage were obtained from the community based distributors. Bioclinical data of participants comprising gender, age, number of treatment received from inception and dosage were obtained. Each participant was subjected to physical examination for palpable nodule and other skin clinical signs and symptoms of onchocerciasis. Visual acuity test was done using the Snellen illiterate E-chart. Eye examination was performed using touch loop and handheld ophthalmoscope. Skin snips from both iliac crests were incubated overnight at 28-32ºC and emerged micrifilaria enumerated under an inverted microscope. The changes in epidemiological indices at post-decade of mass drug administration were compared with baseline data. RESULTS: Village annual ivermectin treatment doses averaged 62%, ranging between 10-100%. Individual treatment compliance rate was generally low with an average of 4 treatments and a range between 0-10. Despite variations in treatment compliance, there were significant improvements in some onchocercal morbidities. These include reduced number and severity of itching, visual impairment, papular onchodermatitis, onchocercomata (palpable nodules) and leopard skin. Ivermectin treatment halted development of new blind cases, except the case of a man who had optic nerve disease and became blind 2 years after ivermectin treatment had commenced. There was a significant overall reduction in parasite burden with very low mean skin microfilaria load of 1.7mf per skin snip and 3.7% skin mf prevalence, compared to baseline data of 17.7mf and 37.9% respectively. The palpable nodule was also drastically reduced from 14.5% to 6.4%. Outcome of this study has practically demonstrated that even a single dose ivermectin treatment is capable of clearing skin mf load on a longterm basis. This assertion is exemplified by the result obtained from Bomjock village that had taken treatment only at inception, and the prevalence rate was reduced from 70% to about 9.0% at postdecade of intervention.

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Improvement in severe onchocercal skin disease after a single dose of ivermectin

Abstract: Single-dose ivermectin shows promise as the first acceptable treatment for severe onchocercal dermatitis.

Cited by 10 publications

References 23 publications

Impact of ivermectin on illness and disability associated with onchocerciasis

Impact of ivermectin on illness and disability associated with onchocerciasis

The effects of ivermectin on onchocercal skin disease and severe itching: results of a multicentre trial

Field-based evidence of single and few doses of annual ivermectin treatment efficacy in eliminating skin microfilaria load after a decade of intervention

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