Investigation of Four Cases of Stevens–Johnson Syndrome among Participants in a Mass Drug Administration Campaign with Sulfadoxine-Pyrimethamine and Primaquine in Haiti, 2020

Abstract

In 2018, a mass drug administration (MDA) campaign for malaria elimination was piloted in Haiti. The pilot treated 36,338 people with sulfadoxine-pyrimethamine (SP) and primaquine; no severe adverse events were detected. In 2020, another MDA campaign using the same medications was implemented to mitigate an upsurge in malaria cases during the COVID-19 pandemic. Four cases of Stevens–Johnson syndrome (SJS) were identified among the 42,249 people who took the medications. Three of these individuals required hospitalization; all survived. In addition to SP ingestion, an investigation of potential causes for increased SJS cases identified that all four cases had human leukocyte antigens A*29 and/or B*44:03, another known risk factor for SJS. Additionally, three of the four case individuals had antibodies to SARS-CoV-2, and the fourth may have been exposed around the same time. These findings raise the possibility that recent SARS-CoV-2 infection may have contributed to the increased risk for SJS associated with SP exposure during the 2020 campaign.

Acceptability, Feasibility, Drug Safety, and Effectiveness of a Pilot Mass Drug Administration with a Single Round of Sulfadoxine–Pyrimethamine Plus Primaquine and Indoor Residual Spraying in Communities with Malaria Transmission in Haiti, 2018

“…However, a similar MDA campaign in 2020 identified four cases of SCARs, which raises concerns about using SP for MDA during the current pandemic. 44 Last, there was no change in parasite prevalence or seroprevalence at 10 weeks after the campaign compared with baseline; however, this finding could be consistent with a temporary blunting of the peak transmission that was not captured between these survey time points. The other possibilities for the lack of a significant difference in parasite prevalence from baseline to 10 weeks could have been the suboptimal IRS and LLIN coverage or the limitations of a pre- and postintervention comparison.…”

“…The cause of this startling number of SCARs is not definitive; however, the main differences between our pilot experience in 2018 and the MDA in 2020 were related to the contextual factors of the COVID-19 pandemic. 44 …”