RESUMEN
In areas endemic for lymphatic filariasis, progression of lymphoedema is associated with recurrent bacterial acute dermatolymphangioadenitis (ADLA). The role of antibacterial soap in preventing ADLA is unknown. In a randomized double-blinded clinical trial in Leogane, Haiti, lymphoedema patients washed affected legs with antibacterial (n = 97) or plain soap (n = 100). Reported ADLA incidence (by recall) before the study was 1.1 episodes per person-year, compared to 0.40 assessed during the 12-month study. ADLA incidence was significantly associated with age, illiteracy and lymphoedema stage, but not with soap type. Washing with soap, regardless of its antibacterial content, can help decrease ADLA incidence. (ClinicalTrials.gov identifier number NCT00139100.).
Asunto(s)
Antibacterianos/uso terapéutico , Filariasis Linfática/prevención & control , Linfedema/prevención & control , Jabones/uso terapéutico , Adulto , Filariasis Linfática/complicaciones , Filariasis Linfática/epidemiología , Femenino , Haití/epidemiología , Humanos , Linfedema/epidemiología , Linfedema/etiología , MasculinoRESUMEN
In 2000, annual mass administration of diethlycarbamazine and albendazole began in Leogane Commune, Haiti, to interrupt transmission of lymphatic filariasis (LF). After 5 years of treatment, microfilaremia, antigenemia, and mosquito infection rates were significantly reduced, but LF transmission was not interrupted. These finding have implications for other LF elimination programs.
Asunto(s)
Albendazol/administración & dosificación , Dietilcarbamazina/administración & dosificación , Filariasis Linfática/epidemiología , Filariasis Linfática/prevención & control , Filaricidas/administración & dosificación , Programas de Gobierno/normas , Albendazol/efectos adversos , Albendazol/uso terapéutico , Animales , Dietilcarbamazina/efectos adversos , Dietilcarbamazina/uso terapéutico , Quimioterapia Combinada , Filariasis Linfática/tratamiento farmacológico , Filariasis Linfática/parasitología , Filaricidas/efectos adversos , Filaricidas/uso terapéutico , Haití/epidemiología , Humanos , Microfilarias/efectos de los fármacos , Prevalencia , Evaluación de Programas y Proyectos de Salud , Wuchereria bancrofti/efectos de los fármacosRESUMEN
To support the global program to eliminate lymphatic filariasis (LF), well-monitored demonstration projects are important for defining the relationship between coverage and reductions in microfilaremia. We are using mass treatment with diethylcarbamazine (DEC) and albendazole in an effort to eliminate LF from Leogane, Haiti. Wuchereria bancrofti microfilaremia prevalence at baseline ranged from 0.8% to 15.9% in four sentinel sites. After three rounds of DEC-albendazole mass drug administration (MDA), both microfilaremia prevalence and intensity decreased dramatically. Mild and moderate adverse reactions after treatment were common, especially after the first MDA, but decreased after subsequent MDAs. Drug coverage for the first year was estimated to be 72%, but concerns about adverse reactions appeared to decrease drug coverage in the second MDA. As a result of community education efforts that focused on providing a greater understanding of adverse reactions, coverage increased dramatically for the third round. Program efficiency increased substantially; the costs per person treated for three rounds of MDA were 2.23 US dollars, 1.96 US dollars, and 1.30 US dollars per person, respectively. The Leogane experience highlights the importance of adapting community education and mobilization campaigns to achieve and maintain good coverage.
Asunto(s)
Albendazol/administración & dosificación , Dietilcarbamazina/administración & dosificación , Filaricidas/administración & dosificación , Evaluación de Programas y Proyectos de Salud , Albendazol/economía , Albendazol/uso terapéutico , Animales , Dietilcarbamazina/economía , Dietilcarbamazina/uso terapéutico , Quimioterapia Combinada , Filariasis Linfática/tratamiento farmacológico , Filariasis Linfática/economía , Filariasis Linfática/epidemiología , Filariasis Linfática/prevención & control , Filaricidas/economía , Filaricidas/uso terapéutico , Programas de Gobierno/economía , Haití , Educación en Salud , Humanos , Microfilarias/efectos de los fármacos , Microfilarias/crecimiento & desarrollo , Vigilancia de Guardia , Wuchereria bancrofti/efectos de los fármacosRESUMEN
Annual mass treatment with antifilarial drugs is the cornerstone of the global program to eliminate lymphatic filariasis (LF). Although the primary goal of the program is to interrupt transmission of LF, additional public health benefits also are expected because of the known anthelminthic properties of these drugs. Since rapid re-infection with intestinal helminths occurs following treatment, annual de-worming may not be sufficient to produce a lasting reduction in the prevalence and intensity of these infections. We conducted stool examinations in four sentinel communities before and approximately nine months after each of two rounds of mass drug administration (MDA) with diethylcarbamazine and albendazole in the context of an LF elimination program in Leogane, Haiti. At baseline, overall Ascaris, Trichuris, and hookworm infection prevalences were 20.9%, 34.0%, and 11.2%, respectively (n = 2,716 stools). Nine months after the second MDA, Ascaris, Trichuris and hookworm prevalences had decreased significantly, to 14.1%, 14.6%, and 2.0%, respectively (n = 814 stools). Infection intensity decreased significantly for all three parasites as well. These results demonstrate that substantial reductions in intestinal helminth infections are associated with mass treatment of filariasis in Haiti and are consistent with the conclusion that high levels of coverage for the LF program can decrease transmission of geohelminths.
Asunto(s)
Albendazol/uso terapéutico , Antihelmínticos/uso terapéutico , Dietilcarbamazina/uso terapéutico , Filariasis Linfática/tratamiento farmacológico , Parasitosis Intestinales/tratamiento farmacológico , Nematodos/efectos de los fármacos , Adolescente , Adulto , Distribución por Edad , Albendazol/administración & dosificación , Animales , Antihelmínticos/administración & dosificación , Niño , Preescolar , Dietilcarbamazina/administración & dosificación , Filariasis Linfática/epidemiología , Filariasis Linfática/prevención & control , Heces/parasitología , Femenino , Humanos , Lactante , Recién Nacido , Parasitosis Intestinales/epidemiología , Parasitosis Intestinales/parasitología , Parasitosis Intestinales/prevención & control , Masculino , Persona de Mediana Edad , Prevalencia , Vigilancia de GuardiaRESUMEN
BACKGROUND: In the global program for the elimination of lymphatic filariasis (LF) longitudinal assessment of the prevalence of microfilaremia and antigenemia is recommended to monitor the effect of mass treatment on transmission. Additional monitoring tools such as entomologic and antibody methods may be useful in identifying residual foci of infection. In this study, we characterized serologic markers of infection and exposure spatially both before and after mass treatment, in an area of initial low Wuchereria bancrofti infection prevalence. METHODS: Consenting persons in the sentinel community were tested for circulating microfilaria and antigen (by immunochromatographic test) before and after the 1st annual mass drug administration of diethylcarbamazine and albendazole. A cohort of 161 persons provided serum specimens both years that were tested for antifilarial IgG (1 and 4) antibody. Every house was mapped using a differential Global Positioning System; this information was linked to the serologic data. W. bancrofti infection in the mosquito vector was assessed with year-round collection. Multiple linear regression was used to investigate the influence of antigen-positive persons on the antifilarial antibody responses of antigen-negative neighbors. RESULTS: After mass treatment, decreases were observed in the sentinel site in the overall prevalence of antigen (10.4% to 6.3%) and microfilaremia (0.9 to 0.4%). Of the persons in the cohort that provided serum specimens both years, 79% received treatment. Antigen prevalence decreased from 15.0% to 8.7%. Among 126 persons who received treatment, antigen and antifilarial IgG1 prevalence decreased significantly (p = 0.002 and 0.001, respectively). Among 34 persons who did not receive treatment, antifilarial IgG1 prevalence increased significantly (p = 0.003). Average antifilarial IgG1 levels decreased in households with high treatment coverage and increased in households that refused treatment. Each 10-meter increase in distance from the residence of a person who was antigen-positive in 2000 was associated a 4.68 unit decrease in antifilarial IgG1 level in 2001, controlling for other factors (p = 0.04). DISCUSSION: Antifilarial antibody assays can be used as a measure of filarial exposure. Our results suggest that micro-scale spatial heterogeneity exists in LF exposure and infection. Treatment appeared to be associated with reduced exposure at the sub-community level, suggesting the need to achieve high and homogeneous coverage. Public health messages should note the benefits of having one's neighbors receive treatment with antifilarial drugs.
RESUMEN
In October 2000, 71,187 persons were treated for lymphatic filariasis using albendazole and diethylcarbamazine (DEC) or DEC alone in Leogane, Haiti. We documented the frequency of adverse reactions, severity and cost of treatment. Adverse reactions were classified as minor, moderate, or severe. Overall, 24% (17,421) of the treated persons reported one or more adverse reactions. There were 15,916 (91%) minor and 1502 (9%) moderate adverse reaction reports. Men outnumbered women 2:1 in reporting moderate problems. Three patients, representing roughly one in 25,000 persons treated, were hospitalized with severe adverse reactions judged to be treatment-associated by physician review. The cost per person treated for adverse reactions was more than twice the cost per person treated for lymphatic filariasis (dollar 1.60 versus dollar 0.71). Severe adverse reactions to lymphatic filariasis treatment using DEC with or without albendazole are uncommon. Minor and moderate reactions are more commonly reported and their management represents a challenge to lymphatic filariasis elimination programs.