Mass Drug Administration of Triclabendazole for Fasciola Hepatica in Bolivia

Abstract

Human infection with Fasciola hepatica leads to obstruction of the common bile duct by adult worms and disease characterized by biliary colic, epigastric pain, and nausea. Recommended treatment is a single dose of triclabendazole (TCBZ) (10 mg/kg). Because in the 1990s the Bolivian Altiplano bordering Lake Titicaca was thought to have the highest prevalence of human fascioliasis worldwide, the Bolivian Ministry of Health instituted TCBZ mass drug administration (MDA). From 2008 to 2016 (excepting 2015), one dose of 250 mg was administered, usually in September/ October, to each resident of highly endemic regions willing to participate. This is apparently the first reported use of MDA for Fasciola. The proportion of persons in key regions receiving TCBZ MDA was 87% in 2016. In 2017, we resurveyed key regions, and found that the MDA program had been dramatically successful. Whereas Fasciola prevalence was reported as 26.9% in Huacullani/Tiahuanaco and 12.6% in Batallas in 1999, there was 0.7% prevalence in Huacullani/Tiahuanaco and 1% in Batallas in 2017. However, lessons from schistosomiasis control efforts suggest that for sustained control of Fasciola infection, Fasciola MDA needs to be maintained and coupled with measures to control infection in the intermediary snail and in the animal hosts of F. hepatica.

<p>Human Fascioliasis: Current Epidemiological Status and Strategies for Diagnosis, Treatment, and Control</p>

“…This program treated all the population for more than 10 years with a fixed 250 mg dose independently of age or weight. 89 A recent study by Mollinedo et al documented a reduction in Fasciola prevalence to <1% compared with 12–27% from historical data in the area where the program was implemented. 89 This experience has not been replicated in other areas and further evaluation of its effectiveness and sustainability are probably warranted.…”

New perspectives for fascioliasis in Upper Egypt’s new endemic region: Sociodemographic characteristics and phylogenetic analysis of Fasciola in humans, animals, and lymnaeid vectors

“…Previous studies conducted in Egypt and other hyperendemic regions reported this observation [ 29 , 36 , 59 – 62 ]. They might become infected by eating uncooked contaminated plants while helping their parents in farming or by drinking contaminated water while playing in drainage canals [ 63 , 64 ]. This observation has been reported in other studies conducted in several South American and Middle Eastern countries [ 32 , 65 ].…”

¿Tumor hepático o Fasciola hepática gigante?: reporte de caso

“…En Latinoamérica se ha reportado resistencia al Triclabendazol en Chile (14) , y en zonas del norte de Perú (13) ; sin embargo, en Bolivia se ha usado en forma masiva desde el 2008 al 2016 tendiendo éxito dramático (15) . En conclusión, el estudio de un paciente con masa hepática, procedente de la sierra debe llevar a plantear en sus diagnósticos diferenciales Fasciola hepática; y se debe tener criterios clínicos, laboratoriales y/o de imágenes para pensar en esta enfermedad.…”