Impact on prevalence of intestinal helminth infection in school children administered with seven annual rounds of diethyl carbamazine (DEC) with albendazole.

Background & objectives: One third of the world’s population is infected with one or more of the most common soil-transmitted helminths (STH). Albendazole (ALB) is being administered with diethyl carbamazine (DEC) in filariasis endemic areas to eliminate lymphatic filariasis (LF) and helminth infections. In this study, the cumulative impact of seven annual rounds of mass drug administrations (MDA) of DEC and ALB on STH infection in school children in selected villages in southern India was determined. Methods: During 2001-2010, seven MDAs were implemented by the Tamil Nadu state health department, India. LF and STH infections were monitored in school children from 18 villages of the two treatment arms (viz, DEC alone and DEC+ALB). Kato-Katz cellophane quantitative thick smear technique was employed to estimate STH infections at three weeks, six months and one year post MDA. Results: Prior to treatment, an overall STH prevalence was 60 per cent. After each MDA, infection markedly reduced at three weeks post-treatment in both the arms. The prevalence increased at six months period, which was maintained up to one year. After seven rounds of MDA, the infection reduced from 60.44 to 12.48 per cent in DEC+ALB arm; while the reduction was negligible in DEC alone arm (58.77 to 52.70%). Interpretation & conclusions: Seven rounds of MDA with DEC+ALB reduced the infection load significantly, and further sustained low level of infection for 10 years. However, complete parasite elimination could not be achieved. To curtail STH infection in the community, MDA should be regularized and environmental sanitation measures need to be improved by effective community-based campaigns.

Adverse reactions following mass drug administration with diethylcarbamazine in lymphatic filariasis endemic areas in the Northeast of Brazil / Reações adversas após tratamento em massa com dietilcarbamazina em áreas endêmicas de filariose linfática no nordeste do Brasil

INTRODUCTION: The Global Programme to Eliminate Lymphatic Filariasis was launched with the goal of eliminating this disease via the annual mass drug administration (MDA) of a single dose of antifilarial drugs. Adverse drug reactions following MDA are a major factor of poor treatment adherence in several countries. This study assessed the occurrence of adverse drug reactions (ADRs) following the first round of mass treatment in two communities treated with different dosages of diethylcarbamazine (DEC) in the City of Recife, Brazil. METHODS: Population-based cross-sectional surveys were conducted in a random sample of the population living in both communities (Areas I and II). The dose of DEC recommended by the WHO (6mg/kg) was calculated based on the individual's weight-for-age. In Area II, weight differences between the genders were also considered when determining dosage. Data were obtained through interviews conducted in the first 12 to 48h and on the 5th day after MDA during household visits. RESULTS: A total of 487 and 365 individuals were interviewed in Areas I and II, respectively. The prevalence of ADRs in Area I (23.6; 95%CI: 19.1-29.5) was higher than in Area II (16.2; 95%CI:11.9-21.5)(p=0.0078). The prevalence of ADRs among females was higher than in males in Area I (p=0.0021). In Area II, no significant difference between the genders was observed (p=0.1840). Age was not associated with ADRs in either area. CONCLUSIONS: Adjusting MDA dosage schedules according to weight-for-age and sex may be may contribute to reduce the occurrence of adverse drug reactions in the population.

INTRODUÇÃO: O Programa Global de Eliminação da Filariose Linfática foi lançado visando à eliminação da doença pela administração de medicamentos em massa (MDA). As reações adversas seguidas ao MDA são um importante fator de baixa adesão ao tratamento em vários países. Este estudo avaliou a ocorrência de reações adversas medicamentosas (ADRs) após a primeira dose de tratamento em massa em duas comunidades tratadas com diferentes doses de dietilcarbamazina (DEC), na Cidade de Recife, Brasil. MÉTODOS: Estudos transversais foram realizados em uma amostra aleatória da população de duas áreas (Áreas I e II). A dose de DEC recomendada pela OMS (6mg/kg) foi calculada com base em parâmetros populacionais de peso para a idade. Na Área II, diferenças de peso entre os sexos também foram consideradas no cálculo. Dados foram obtidos através de entrevistas nas primeiras 12 às 48h e 5º dia após o tratamento durante visitas domiciliares. RESULTADOS: Um total de 487 e 365 pessoas foi entrevistado nas Áreas I e II, respectivamente. A prevalência de ADRs na Área I (23,6; IC95%: 19,1-29,5) foi maior do que na Área II (16,2; IC 95%:11,9-21,5)(p=0,0078). Na Área I, a prevalência de ADRs foi maior nas mulheres do que nos homens (p=0,0021), não se observando diferença na Área II (p=0,1840). Idade não esteve associada à ADRs. CONCLUSÕES: Doses de tratamento em massa (MDA) ajustadas por peso para a idade e sexo parecem contribuir para redução da ocorrência de ADRs na população.

Effect of a single dose of diethylcarbamazine, albendazole or both on the clearance of Wuchereria bancrofti microfilariae and antigenaemia among microfilaria carriers: A randomized trial.

Background. Lymphatic filariasis is a major vector-borne parasitic disease. The global programme to eliminate lymphatic filariasis was launched in 1997 and currently over 570 million people are covered under it in 48 countries. Mass annual single-dose drug administration of diethylcarbamazine (DEC), co-administrated with albendazole for 5–6 years and mass distribution of diethylcarbamazine-fortified salt are the two strategies for elimination of filariasis. Methods. Asymptomatic volunteers residing in Puducherry, India were screened for microfilaria (mf) by examining nocturnal thick blood smears. Those testing positive were randomly assigned to receive a single dose of DEC (6 mg/kg body weight) or albendazole 400 mg or both. Participants were hospitalized for 5 days. Membrane filtration count was used to assess microfilaraemia and ELISA (Og4C3) assay to measure circulating filarial antigens (CFA). Measurements were done before treatment and at 1, 2 and 3 years post-treatment. Viability of the adult worms was assessed by looking for the filarial dance sign (FDS) using ultrasound examination of the scrotum in men with hydrocele. Results. Fifty-four microfilaraemic individuals were studied. The mf prevalence started decreasing only by day 180 posttreatment in the DEC group but much earlier in the other two groups (day 30 in the albendazole and day 90 in the DEC with albendazole group). The decrease in mf was marginal (17.6%, 26.3% and 27.8%, respectively) by the end of year 1 posttreatment, but significant (96.7%, 78.6% and 93.3%, respectively) by the end of year 2 post-treatment (p<0.05). By the end of year 3, the level decreased to 80% in the DEC, 90% in the albendazole and to 100% in the DEC and albendazole groups. However, the mf intensity decreased © The National Medical Journal of India 2010 Vector Control Research Centre, Department of Health Research (ICMR), Indira Nagar, Puducherry 605006, India S. L. HOTI, S. P. PANI, P. VANAMAIL, K. ATHISAYA MARY, L. K. DAS, P. K. DAS Correspondence to S. L. HOTI; slhoti@yahoo.com significantly (by 39%; p<0.05) by day 7 post-treatment in both the DEC and DEC with albendazole groups, but only by day 30 in the albendazole group. In all the drug groups, the prevalence as well as intensity of CFA returned to pretreatment levels by the end of year 3 post-treatment. Conclusion. Annual single-dose administration of all the 3 drug regimens significantly reduced antigenaemia levels. There were no significant differences in the efficacy and overall pattern of CFA clearance between the 3 drug regimens.

Strengthening of mass drug administration implementation is required to eliminate lymphatic filariasis from India: an evaluation study.

BACKGROUND & OBJECTIVES: The mass drug administration (MDA) is one of the strategies to eliminate lymphatic filariasis in India. Eleven districts are endemic for the disease in Madhya Pradesh state of India, which conduct MDA activities annually. A mid-term evaluation was conducted with the objectives to review the progress of the single dose of di-ethyl-carbamazine (DEC) administration, and to understand the functioning of the programme to recommend mid-term amendments. METHODS: A qualitative cross-sectional study was conducted in three endemic districts of Madhya Pradesh between July and October 2007. The teams of faculty members from medical college visited the study districts and collected data by desk review, indepth interviews, on site observations, and from the community. RESULTS: The filaria units in these districts were understaffed. There were no night clinics in two out of the three districts. The sufficient number of trainings for MDA were conducted without any mechanism for quality assurance. There was erratic and inadequate supply of DEC tablets, leading to the postponement of MDA activity, twice. The evaluated coverage with DEC tablets was much lower than that reported by the district officials. The tablet intake was not ensured by the distributors and the compliance rate was in the range of 60-70%. The IEC activities were conducted in limited areas, and there were prevailing myths and misconceptions, contributing to low compliance rate. There was no proper recording of the data on filariasis with gross mismatch at district headquarters and peripheral health facilities. A proportion of community members developed side effects following DEC tablet intake and had to visit private health facilities for treatment. INTERPRETATION & CONCLUSION: This evaluation study noted that MDA is restricted to tablet distribution only and the major issues of implementation in compliance, health education, side effect and morbidity management, and the logistics were not being given due attention. The implementation should be strengthened immediately in the MDA programme in India to achieve the goal of LF elimination by 2015.

Effect of repeated mass chemotherapy for filariasis control on soil-transmitted helminth infections in Sri Lanka.

BACKGROUND: In July 2006 Sri Lanka completed 5 rounds of annual mass drug administration (MDA) with diethylcarbamazine citrate (DEC) and albendazole as part of its national programme for elimination of lymphatic filariasis (LF). Albendazole is highly effective against soil-transmitted helminths (STH). This study was carried out to assess the effect of repeated annual MDA on STH infections in the Western Province of Sri Lanka, an area co-endemic for LF and STH. METHODS: Faecal samples were obtained (during August-September 2006), from grade 5 students in 17 schools in the Western Province that were included in a national survey of schoolchildren's health in 2003, and examined using the modified Kato-Katz technique. The prevalence and intensity of roundworm, whipworm and hookworm infections in 2003 and 2006 were compared. RRESULTS:Faecal samples from 255 children were examined in 2003; 448 were examined in 2006. Roundworm prevalence was marginally lower in 2006 (4.0%) than in 2003 (4.7%), as was hookworm (0.2% vs 0.4%), whereas whipworm prevalence was higher (13.8% vs 9.4%). These differences as well as that between the geometric mean egg counts were not statistically significant. Compliance with MDA in 2006, as reported by the schoolchildren examined, was only 59%. CCONCLUSIONS:Four annual rounds of MDA with DEC and albendazole had virtually no effect on STH infections in the study area.

Study on the factors affecting the MDA programme in Kerala state.

The Mass Annual Single dose DEC administration (MDA) was initiated in India from 1997. In Kerala MDA was studied as a pilot project in Alappuzha and Kozhikode District from 2000-04 and the first round of MDA was launched in Kerala covering eleven endemic districts, in March 2005. On evaluation, the drug distribution coverage, compliance, etc. were found to be not satisfactory and a need to elicit the factors for poor performance of MDA is felt essential. The main reasons for poor performance of MDA in Kerala state were the lack of adequate prior information to the target population regarding the importance LF elimination programme and inadequate awareness. The fear of side reactions, antipropagonda, poor IEC activities repeated postponement of programme, insufficient time for mobilisation etc. were the other reasons for poor compliance. The purpose of the present study was to bring the observations to the notice of the authorities so that appropriate remedial measures are incorporated.

Adverse reactions of 300 MG diethylcarbamazine, and in a combination of 400 MG albendazole, for a mass annual single dose treatment, in migrant workers in Phang Nga province.

BACKGROUND: Foreign migrant workers with work permits in Thailand are given once a year 300 mg diethyl-carbamazine (DEC) for bancroftian filariasis, and 400 mg albendazole (ABZ) for helminthiasis. Treatment effectiveness, tolerability, and safety of two treatment arms, DEC + ABZ and DEC alone, had never been fully documented. OBJECTIVE: Evaluate the tolerability of the two treatment arms and analyze the effects of adverse reaction, prevalence, and intensity of both common and uncommon adverse drug reactions (ADR) in relation to the reaction time (2 hours = acute, > 2 to 24 hours = subacute, and > 24 to 72 hours = latent). MATERIAL AND METHOD: A hospital-based clinical study of on-hour-2 treatment with both treatment arms in 280 Myanmar male migrant volunteers (DEC + ABZ = 150, DEC = 130) was conducted in Phang Nga province, southern Thailand Of these, ADR evaluation at three reaction times was performed using antigenemic (WbAg+) and non-antigenemic (WbAg-) volunteer groups (DEC + ABZ/WbAg+ = 14, DEC/WbAg+ = 12, DEC + ABZ/ WbAg- = 8, andDEC/WbAg- = 16). RESULTS: Both drug groups had similarly overall ADR prevalence [5.2%for DEC + ABZ and 5. 1% for DEC (p > 0. 05)], as well as mean ADRacute scores (p > 0. 05) on hour 2 post-treatment. The four groups had maximum overall prevalence (10% to 40%for ADRsubacute). It was more likely to show no relationship between treatment arms and WbAg (neither WbAg+ nor WbAg-) with adverse reaction intensity for ADRacute, ADRsubacute, Or ADRlatent Three major specific ADR were fatigue, dizziness, and headache. CONCLUSION: Adverse reaction prevalence and intensity were independent for WbAg and treatment arm. The DEC + ABZ have no greater effects on ADR development as the DEC does. The common ADR after treatment are not required for symptomatic treatment. The study confirms DEC + ABZ regime can be safe and not toxic for use in mass treatment of those migrants in Thailand and, its value, in a mass annual single dose treatment, is beneficial for the Global Alliance to Eliminate of Lymphatic Filariasis (GAELF).

Mass drug administration against lymphatic filariasis: experiences from Kozhikode district of Kerala State.

The mass DEC drug administration to eliminate lymphatic filariasis in Kozhikode district was monitored from 2001 to 2003 to assess the drug distribution coverage, compliance, reasons for non-compliance, side reactions, mf prevalence and intensity, infection and infectivity rates in the vector. The drug distribution coverage and compliance were much below the required level. "No disease so not necessary" (42.5%) and "fear of side reactions" (25.2%) were the two major reasons for non-compliance. The adverse reactions were minimal. No appreciable changes were found in the mf prevalence and intensity. For the successful implementation of the MDA programme, proper planning, intense and timely efforts to motivate the community and innovative drug delivery strategies are required.

Efficacy of a single-dose treatment with 300 mg diethylcarbamazine and a combination of 400 mg albendazole in reduction of Wuchereria bancrofti antigenemia and concomitant geohelminths in Myanmar migrants in Southern Thailand.

BACKGROUND: There seems to be a large magnitude of parasitic worm loads caused by nocturnally periodic Wuchereria bancrofti and geohelminths, in cross-border Myanmar migrant workers in Thailand. We are therefore considering an effective Mass Drug Administration (MDA) with Diethylcarbamazine (DEC) and Albendazole (ABZ). Due to short periods of their residency and current situation of W. bancrofti antigenemics and concomitant geohelminths, treatment effects on the containment of the infections need to be analyzed. OBJECTIVES: Analyze short-term effects on reduction of W. bancrofti antigen (WbAg) and geohelminths' egg (GhE) loads. The efficacy of a single-dose combined treatment with 300 mg DEC (for filariasis) and 400 mg ABZ (for helminthiasis) was evaluated and compared with a single-dose treatment arm with 300 mg DEC alone. MATERIAL AND METHOD: A randomized clinical trial of two treatment choices in 28 Myanmar male workers (DEC/ABZ or group I = 15, DEC or group II = 13) was conducted in Phang Nga province, Southern Thailand. Because of the withdrawal of three subjects of the DEC group, all the 10 DEC subjects were follow-up monitored at post treatment 2, 4, 8 and 12 weeks. Their mean age was 26.4 years; worm loads (mean +/- SD x 10(3)) of W. bancrofti, Ascaris and Trichuris was 103.9 +/- 44.1 antigen units (AU)/ml, 47.3 +/- 38.7 eggs per gram (EPG) and 16.6 +/- 22.2 EPG respectively. The data on the 15 DEC/ABZ subjects showed a mean age of 25.7 years; corresponding worm loads = 96.1 +/- 54.6 AU/ml, 397.0 +/- 117.3 EPG and 54.5 +/- 42.8 EPG respectively. The Antigen Reduction Rates (ARR) and Egg Reduction Rates (ERR) were presented. RESULTS: At the 12-week post treatment, WbAg loads (mean +/- SD x 10(3) AU/ml) were 61.5 +/- 58.4 for group I and 76.8 +/- 40.7 for group II. A significant WbAg reduction was noted for both groups at weeks 8 and 12 (p < 0.05). Also, the significant reduction of GhE loads was more pronounced for both groups after week 2 (p < 0.05). When comparing efficacy of the treatment choices by the treatment retention time, it was more likely to show both groups had similar adulticidal effects on either WbAg, denoted as the ARR (F = 0. 064, p = 0.806) or GhE, denoted as the ERR (F = 0.196, p = 0.669). CONCLUSION: The single-dose 300 mg DEC plus 400 mg ABZ, or 300 mg DEC alone, can be effectively used for treating infections with W. bancrofti and concomitant geohelminths commonly observed in the area. But treatment rounds are required to clear the infections. The reduction of the parasitic worm loads in the legal Myanmar migrants provide values in monitoring and evaluating an effective MDA program with the DEC/ABZ at the provincial level.

Independent assessment of Mass Drug Administration in filariasis affected Surat city.

The Mass Drug Administration (MDA) done in Surat city (Gujarat) during 2005, revealed good impact on infection and infectivity in mosquitoes and also on microfilaria rate & mean infection density. The overall impact seen was 23% on mf rate, 28% on mean mf density, 65% on infection rate and 50% on infectivity rate in vectors. Indigenous population contribution to microfilaria cases was 9.7%, whereas migratory population contributed 72.2%; predominant 51.9% from Orissa and 20.3% from U.P. Of the total 3640 persons interviewed for MDA compliance in seven zones of the Surat city revealed that actual drug consumption was 76.7% (2792/3640). Another 11.9% although took the drug but did not consume and 11.4% refused. Important reasons for consuming was fear to get the disease (40.7%) and for not consuming; 'will consume after meal' (6.9%), too many tablets (1.7%), seek consent from doctor (1.5%), lack of awareness (1.4%) etc. Refusal was mainly due to the reason as respondents felt apparently healthy. Assessment of IEC activities suggested that main awareness was created by media (local or national TV, banners or handbills, local news papers or mike announcement) alongwith some impact made through NGO's. These observations clearly indicated the utility of effective health education for optimum community participation and shown that it was crucial for successful community based elimination campaign. However some gray areas also suggest the scope for further improvements.

The efficacy of a single-oral-dose administration of ivermectin and diethylcarbamazine on the treatment of feline Brugia malayi.

The combination of ivermectin and diethylcarbamazine (DEC) have been shown to be superior to either drug alone for the suppression of Brugia malayi in humans, but their efficacy against infection with B. malayi in cats has never been investigated. Fourteen asymptomatic microfilaremic (1-200 microfilariae/20 microl blood) cats received oral doses of ivermectin (400 microg/kg body weight) and DEC (6 mg/kg body weight) as a single treatment. A two-month post-treatment examination revealed that 87-100% of the microfilariae in each subject had been cleared, with two of the subjects being amicrofilaremic. A further reduction in microfilarial levels was observed until the final follow-up, at 8 months post-treatment, when the mean clearance rate was 99% and 12 out of the 14 subjects (86%) were amicrofilaremic. The combination of ivermectin and DEC demonstrated a microfilaricidal effect superior to that of either drug used alone, both in the initial rapid clearance of microfilariae, and in sustaining the effect for 8 months. This finding has important implications for the control of brugian lymphatic filariasis in the cat reservoir.

Short-term effects of treatment with 300 mg oral-dose diethylcarbamazine on nocturnally periodic Wuchereria bancrofti microfilaremia and antigenemia.

Seven microfilaremic Myanmar patients were treated with a single 300 mg dose of diethylcarbamazine (DEC) orally, as part of a case-finding survey in Ranong Province, Southern Thailand. This was conducted in order to evaluate the short-term effects of single-dose DEC on Wuchereria bancrofti microfilaremia and antigenemia during a 12-week course of treatment. Analysis of microfilarial periodicity on initial treatment revealed the microfilarial peak density (k) was at 52 minutes after midnight (0052). The periodicity index was then 103.26%. Single-dose DEC treatment did not affect the k values. A linear model of W. bancrofti microfilarial density reduction predicts a sharp decrease in the mean microfilarial density 2 weeks after DEC intake (Z = -2.197, p = 0.028). Over a longer period, a non-linear model predicts an increase in the mean microfilarial density to pre-treatment levels, having little or no macrofilaricidal effects. We reconfirmed the existence of nocturnally periodic W. bancrofti infection in Myanmar migrants in Ranong Province, and the short-term microfilaricidal activity of 300 mg single-dose DEC treatment used for biannual mass treatment and the DEC provocative test. Without an adequate DEC treatment dose, recrudescence can occur. A rational approach to the management of introduced nocturnally periodic W. bancrofti in Myanmar migrants, who came for short periods of stay in transmission-prone areas, is needed.

Surveillance of imported bancroftian filariasis after two-year multiple-dose diethylcarbamazine treatment.

Myanmar migrants are at increased risk for nocturnally periodic Wuchereria bancrofti causing imported bancroftian filariasis. They have a significant influence on the effectiveness of diethylcarbamazine (DEC) mass treatment at the provincial level in the National Program to Eliminate Lymphatic Filariasis (PELF) during the fiscal years (FY) 2002-2006, in Thailand. Two oral doses of DEC 6 mg/kg are given twice a year to the eligible Myanmar migrants (> or = 2 years old). A 300 mg DEC provocation test is given once a year to all Myanmar migrants with work permits. Effectiveness evaluation parameters, such as cumulative index (CI) and the effectiveness ratio (ER), were obtained after 2 years of the multiple-dose DEC treatment program in Ranong Province, Southern Thailand. By cross-sectional night blood surveys at the end of FY 2003 in two districts of Ranong Province, the microfilarial positive rates (MPR) were 0.8% and 1.2% for Mueang Ranong and Kra Buri, respectively. The MPR in the agricultural (1.5%) and industrial (0.4%) occupations were not significantly different from each other. Our findings suggest that most untreated microfilaremics working in agriculture, with short-term residency in Thailand, may have delayed multiple-dose DEC treatment.

Tolerability and efficacy of a three-age class dosage schedule of Diethylcarbamazine citrate (DEC) in the treatment of microfilaria carriers of Wuchereria bancrofti and its implications in mass drug administration (MDA) strategy for elimination of lymphatic filariasis (LF).

A six-age class dosage schedule of Diethylcarbamazine (DEC) of 50mg (1-2 years), 100mg (3-4 years), 150mg (5-8 years), 200mg (9-11 years), 250mg (12-14 years) and 300mg for above 14 years is being adopted for annual single dose MDA for LF elimination treat Wuchereria bancrofti microfilaria carriers. In order to increase the community compliance as well as to make the distribution easier during MDA, a revised 3 age class dosage schedule of 100mg (2-4 years), 200mg (5-14 years) and 300mg for above 14 years was evaluated for its tolerability and efficacy. By this change, it was observed that the 4-8 years age class is receiving 50 mg higher and 11-14 years age class is receiving 50mg lesser dose compared to the earlier class schedule. Therefore, the safety aspect in the age class of 4-8 years and efficacy component in the age class of 11-14 years were assessed. Apparently "healthy" asymptomatic microfilaraemic volunteers between the age class of 4-8 and 11-14 years were recruited for the study. The incidence of side reaction in the 4-8 years age class was 50.0% with 150mg dose and 66.7% with 200mg (P>0.05). No life threatening adverse reactions was observed in any dosage schedule. Fever, headache and myalgia, the predominant adverse reactions were mild and similar in both schedules. The mean intensity of the three major specific adverse reactions (fever, headache and myalgia) also did not differ significantly (P>0.05). For the purpose of LF elimination, efficacy in terms of reduction in mean microfilaria load is important. In the 11-14 year age class considerable reduction in the geometric mean density (GMD) was observed by day 90 and 180 post-therapy in both groups (250mg group and 200mg group) compared to pre-therapy level. By day 360 post-therapy, the difference was statistically not significant (P>0.05) (reduction of 72.2% in 250mg and 69.6% reduction in 200mg). The reductions in GMD were statistically significant when compared to pre-therapy levels in both the old (250mg) and new (200mg) doses. Thus, three- age class dosage schedule is as safe and efficacious as the six- age class schedule.

Border and imported bancroftian filariases: baseline seroprevalence in sentinel populations exposed to infections with Wuchereria bancrofti and concomitant HIV at the start of diethylcarbamazine mass treatment in Thailand.

Border bancroftian filariasis caused by Wuchereria bancrofti nocturnally subperiodic mainly exists in Karens residing alongside the Thailand-Myanmar border. Imported bancroftian filariasis caused by W. bancrofti nocturnally periodic mainly exists in cross-border Myanmar migrants. We analyzed seroprevalence data based on W. bancrofti adult worm antigen (Ag) loads and human immunodeficiency virus (HIV) immunoglobulins in the sentinel population samples which were studied prior to the start of the diethylcarbamazine (DEC) mass treatment phase in the PELF during fiscal years 2002-2006. In the Karens, the cumulative infection prevalence (36.8% serological antigen positivity or SAP) was specific for age (p < 0.001) but universal for gender (p = 0.77). The infection intensity (median Ag load = 60,827 antigen units or AU/ml) was specific for age (p = 0.031) and for males (p = 0.016). In the Myanmars, infection prevalence (24.0% SAP) was universal for age (p = 0.961) and for gender (p = 0.676). The infection intensity (median Ag load = 19,068 AU/ml) was universal for age (p = 0.433) but specific for females (p = 0.027). Overall, the Ag loads between the groups were significantly different (p = 0.014). In analysis of concomitant HIV and W. bancrofti infections, 7 (3.2%) Myanmars infected with HIV 1 and 3 (5.7%) with concomitant infections, subjected to biannual DEC treatment with 300 mg oral-dose FILADEC, were prevalent. The antigenemia clearance in the concomitant infections (r = -0.732, p = 0.039) as well as in the single W. bancrofti infection (r = -0.781, p = 0.022) was correlated with time required to clear antigenemias. We reemphasize that W. bancrofti adult worm Ag loads in the sentinel population samples would be beneficial for the PELF's implementers at the provincial level to probe the disease burdens in target areas and to evaluate and monitor the DEC treatment efficacy and effectiveness in those sentinel populations, including those with concomitant HIV eligible for the DEC mass treatment phase in the PELF.

A rapid method to assess the coverage of the mass drug administration of diethylcarbamazine in the program to eliminate lymphatic filariasis in India.

A rapid method to assess the coverage of mass drug administration (MDA) in the program to eliminate lymphatic filariasis needs to be developed for monitoring and evaluation of the program. This study attempted to develop and test a method of rapid assessment of coverage by using the existing resources of the program. This is based on the data obtained from the randomly selected health workers and drug distributors involved in the drug distribution process and the data of a household coverage survey of the program. The MDA coverage rate obtained through the evaluation survey was highly correlated with the rates obtained from health workers and drug distributors as a rapid assessment. Thus, MDA coverages assessed through health workers and drug distributors can give a good coverage estimate. The involvement of the existing human resources of the program in this rapid method of assessing MDA coverage was cost-effective.

Tolerability and efficacy of single dose diethylcarbamazine (DEC) alone or co-administration with Ivermectin in the clearance of Wuchereria bancrofti microfilaraemia in Pondicherry, South India.

The tolerability and efficacy of single dose DEC (12mg/kg body weight) or co-administration of DEC (6mg/kg body weight) with Ivermectin (200 or 400 mcg/kg of body weight) was studied in 60 asymptomatic W. bancrofti microfilariae (Mf) carriers following a double blind randomized design. The drugs were tolerated well. The incidence of adverse reactions of DEC (85.0%), DEC + Ivermectin 200mcg (95.0%) and DEC + Ivermectin 400mcg (100%) did not vary significantly (P>0.05). The mean score of adverse reaction intensity due to DEC + Ivermectin 200mcg (1.41) was significantly higher compared to DEC (0.61) (P<0.05). However, there was no significant difference between and DEC +Ivermectin 400mcg (0.89) and DEC + Ivermectin 200mcg (1.41) and DEC + Ivermectin 400mcg and DEC. The major adverse reactions were fever, headache and myalgia in all groups. The incidence and intensity of the adverse reactions were maximum between 24 to 48 hours of post therapy. The haematological and biochemical parameters did not vary significantly between pre and 7-day post therapy values in any of the study groups (P>0.05). Efficacy was measured in terms of proportion of cases clearing microfilaraemia completely and reduction in geometric mean parasite density in comparison to pre therapy levels. At the end of one year, DEC with Ivermectin 400mcg group showed significantly higher efficacy in complete clearance of Mf (94.4%) than that of DEC with Ivermectin 200mcg (60.0%) or DEC alone (52.6%) (P<0.05). However, no significant difference was observed in reduction of geometric mean Mf density (99.9%, 99.7%, 99.5% respectively). In all the groups, the tolerability and efficacy of the drugs were independent of host age and gender.