Safety and Tolerability of Mass Diethylcarbamazine and Albendazole Administration for the Elimination of Lymphatic Filariasis in Kenya: An Active Surveillance Study

Christabel Khaemba,Sultani Matendechero,Sammy M Njenga,Pamela Nambwa,Kefa Bota,Fred Siyoi,Eleni Aklillu,Abbie Barry,Elvis Kirui,Cecilia Wandera,Wyckliff P Omondi,Parthasarathi Gurumurthy,Margaret Oluka,Anastacia Guantai

doi:10.3390/ph14030264

Abstract

Preventive chemotherapy with diethylcarbamazine citrate (DEC) and albendazole (ALB) is the core intervention strategy to eliminate lymphatic filariasis (LF). We conducted a large-scale prospective active safety surveillance study to identify the incidence, type, severity, and risk factors for adverse events (AEs) following mass drug administration (MDA) of single-dose DEC and ALB in 10,010 participants from Kilifi County, Kenya. AEs were actively monitored and graded at 24 h, 48 h, and on day 7 Post-MDA. Out of 10,010 enrolled study participants, 1621 participants reported a total of 3102 AEs during a seven-day follow-up. The cumulative incidence of AEs was 16.2% (95% CI, 15.5–16.9%). The proportion of participants who experienced one, two, or ≥three types of AEs was 9.2%, 4.6%, 2.4%, respectively. AEs were mild (87.3%), moderate (12.4%), and severe (0.3%) and resolved within 72 h. The five most common AEs were dizziness (5.9%), headache (5.6%), loss of appetite (3.3%), fever (2.9%), and drowsiness (2.6%). Older age, taking concurrent medications, ≥three tablets of DEC, and type of meal taken before MDA were significant predictors of AEs. One in six participants experienced systemic mild-to-moderate severity grading and transient AEs. DEC and ALB co-administration for the elimination of LF is generally safe and well-tolerated.

Highlights

Lymphatic filariasis (LF), commonly known as elephantiasis, is a painful and disfiguring neglected tropical disease (NTD) caused by mosquito-borne thread-like filarial worms; namely Wuchereria bancrofti, Brugia malayi and Brugia timori (Brugia spp.) [1]Wuchereria bancrofti accounts for over 90% of the lymphatic filariasis (LF) infections
Population drug combinations used in mass drug administration (MDA) to control LF in the community
Our result indicates that post-MDA adverse events (AEs) were more likely to occur in participants who had taken fatty or high protein meal than carbohydrates

Summary

Introduction

Lymphatic filariasis (LF), commonly known as elephantiasis, is a painful and disfiguring neglected tropical disease (NTD) caused by mosquito-borne thread-like filarial worms (nematodes); namely Wuchereria bancrofti, Brugia malayi and Brugia timori (Brugia spp.) [1]. Wuchereria bancrofti accounts for over 90% of the LF infections. The infection is commonly acquired during childhood causing obscure. Pharmaceuticals 2021, 14, 264 damage to the lymphatic system. The painful and disfiguring visible manifestations of the disease, including lymphoedema, elephantiasis, and scrotal swelling, occur later in life, often leading to stigmatization and poverty [2,3,4]. Health Organization (WHO), LF is a leading cause of permanent and long-term disability, with more than 120 million people infected globally.

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Conclusion