Ivermectin for malaria control in mass drug administration programmes

Abstract

We read with interest the Article by Edgard Dabira and colleagues1Dabira ED Soumare HM Conteh B et al.Mass drug administration of ivermectin and dihydroartemisinin–piperaquine against malaria in settings with high coverage of standard control interventions: a cluster-randomised controlled trial in The Gambia.Lancet Infect Dis. 2022; (published online Nov 25.)https://doi.org/10.1016/S1473-3099(21)00680-0Summary Full Text Full Text PDF Scopus (3) Google Scholar about mass drug administration of ivermectin and dihydroartemisinin–piperaquine against malaria in The Gambia (the MASSIV trial).1Dabira ED Soumare HM Conteh B et al.Mass drug administration of ivermectin and dihydroartemisinin–piperaquine against malaria in settings with high coverage of standard control interventions: a cluster-randomised controlled trial in The Gambia.Lancet Infect Dis. 2022; (published online Nov 25.)https://doi.org/10.1016/S1473-3099(21)00680-0Summary Full Text Full Text PDF Scopus (3) Google Scholar Although using ivermectin as an endectocide to kill Anopheles spp mosquitoes is an interesting new opportunity for malaria control, to implement such a strategy via national malaria and neglected tropical disease control programmes could be a major challenge. While ivermectin has an excellent safety profile, little is known of its potential teratogenicity.2Nicolas P Maia MF Bassat Q et al.Safety of oral ivermectin during pregnancy: a systematic review and meta-analysis.Lancet Glob Health. 2020; 8: e92-100Summary Full Text Full Text PDF PubMed Scopus (40) Google Scholar The dose of ivermectin administered orally during the trial, 300–400 μg/kg per day for 3 consecutive days, is above the 150–200 μg/kg typically given as a single dose during mass drug administration programmes against onchocerciasis.3WHOCommunity-directed treatment with ivermectin (CDTI). World Health Organization.https://www.who.int/apoc/publications/cdti_practical_guide_for_trainers_of_cdds.pdf?ua=1Date accessed: December 26, 2021Google Scholar During the MASSIV trial, pregnancy tests were done among women of childbearing age to avoid inadvertent intake of ivermectin; however, many women were reluctant to be tested because of a lack of privacy.4Fehr A Nieto-Sanchez C Muela J et al.From informed consent to adherence: factors influencing involvement in mass drug administration with ivermectin for malaria elimination in The Gambia.Malar J. 2021; 20: 198Crossref PubMed Scopus (3) Google Scholar The long experience with ivermectin mass drug administration has shown that pregnant women are often exposed to the drug. In a study in Ghana, 14·6% of pregnant women surveyed after a mass drug administration effort (1·7% of women of childbearing age) were inadvertently treated with ivermectin.5Gyapong JO Chinbuah MA Gyapong M Inadvertent exposure of pregnant women to ivermectin and albendazole during mass drug administration for lymphatic filariasis.Trop Med Int Health. 2003; 8: 1093-1101Crossref PubMed Scopus (70) Google Scholar Routine pregnancy testing during mass drug administration by community distributors might not be feasible. Most women will probably be reluctant to reveal their pregnancy status to the ivermectin distributors3WHOCommunity-directed treatment with ivermectin (CDTI). World Health Organization.https://www.who.int/apoc/publications/cdti_practical_guide_for_trainers_of_cdds.pdf?ua=1Date accessed: December 26, 2021Google Scholar because of uncertainty in the pregnancy status, social risk, and privacy considerations, in particular in the case of unplanned or unwanted pregnancies and during the early stages of pregnancy. Use of ivermectin to kill Anopheles spp mosquitoes is only indirectly beneficial for the treated individual. Therefore, before conducting additional mass drug administration studies with ivermectin for malaria control, the safety of ivermectin treatment during pregnancy, including its potential teratogenic risk, should be further investigated. Moreover, qualitative research is needed to assess the willingness of populations to participate in such mass drug administration programmes and to determine how such programmes should be carried out. We declare no competing interests. Ivermectin for malaria control in mass drug administration programmes – Authors' replyWe thank Astrid Christine Erber and Robert Colebunders for their comments on our Article on mass drug administration of ivermectin and dihydroartemisinin–piperaquine for malaria control.1 Full-Text PDF Mass drug administration of ivermectin and dihydroartemisinin–piperaquine against malaria in settings with high coverage of standard control interventions: a cluster-randomised controlled trial in The GambiaThe intervention was safe and well tolerated. In an area with high coverage of standard control interventions, mass drug administration of ivermectin and dihydroartemisinin–piperaquine significantly reduced malaria prevalence; however, no effect of ivermectin on vector parous rate was observed. Full-Text PDF