Post Mass Drug Administration Research Articles

POST MASS DRUG ADMINISTRATION ASSESSMENT OF COVERAGE, COMPLIANCE, AND OBSTACLES IN A LYMPHATIC FILARIASIS ENDEMIC DISTRICT OF CENTRAL INDIA.

Introduction: Lymphatic Filariasis is still a huge problem in the endemic districts as it can cause deprivation in the economic condition of the sufferer, it is linked with stigma, and shame which leads to psychological problems in the individual. The aim was to assess the coverage, compliance, and obstacles post-Mass Drug Administration (MDA) of Filariasis in the Katni District. Methods: This community-based study was conducted in selected areas of the Katni district of Madhya Pradesh. Three rural primary health centers (PHCs) and one urban PHC were selected for the study. Afterward, 30 households were randomly selected from these 4 PHCs. The MDA drive was held in late Dec 2020 in the whole katni district. As an external evaluation, this study commenced 30 days after the drive and the data were collected. Results: A total of 128 households were surveyed, and 621 people were covered. 607 were eligible for drug administration. The overall coverage rate of MDA in the study was found to be 95.88 %. The overall effective coverage rate was 88.63 %. It was 93.93 % in urban and 86.65 % in rural areas. The overall coverage compliance gap was 7.37 %. The most common reason for the non-consumption of tablets was people busy doing work i.e., 47 %. Conclusion: It would be a challenge for the district to sustain this performance in the coming rounds of MDA. Equal Sensitization of the urban and rural populations through IEC activities and proper training for drug distributors is required.

Predisposition to soil-transmitted helminth reinfection after four rounds of mass drug administration: results from a longitudinal cohort in the Geshiyaro project, a transmission elimination feasibility study in the Wolaita zone of southern Ethiopia.

Current WHO strategies for reaching soil-transmitted helminths (STH) elimination as a public health problem excludes treating certain adult populations in endemic areas, creating infection reservoirs that drive 'bounce back' of STH infection to pretreatment levels post-mass drug administration (MDA). Predisposition is a widespread, but poorly understood phenomena among helminth infections where individuals are predisposed to reinfection after repeated treatments. This analysis uses Geshiyaro project data, an STH control programme exploring transmission interruption by community-wide MDA and enhanced water, sanitation and hygiene during 2019-2023. Parasitological survey data from longitudinal cohorts are analysed using Kendall's Tau-b rank correlation to assess the evidence for predisposition to light or heavy infection between four consecutive rounds of MDA. Correlation analyses revealed the strongest evidence for predisposition to heavy or light Ascaris lumbricoides infection was between survey 1 and 2 (Tau-b 0.29; p<0.001). Overall patterns were not observed for Trichuris trichiura or hookworm infections, however, some significant and notable correlations were recorded for some stratifications and time points. Evidence for predisposition in endemic settings in southern Ethiopia with low STH prevalence suggests that more targeted approaches to MDA in those predisposed to infection may be a sensible control strategy if cheap, point of care diagnostics are available.

Efficacy and safety of praziquantel preventive chemotherapy in Schistosoma mansoni infected school children in Southern Ethiopia: A prospective cohort study.

Background: The World Health Organization recommends efficacy and safety surveillance of anti-helminths used in mass drug administration campaigns. We evaluated the effectiveness of single-dose praziquantel against Schistosoma mansoni infection, and the safety of praziquantel plus albendazole preventive chemotherapy (PC) in Schistosoma mansoni infected school children (n = 512) in Southern Ethiopia. Method: Stool examinations were done using thick smear Kato-Katz at baseline, week-4, and week-8 of post-Mass drug administration (MDA) to assess praziquantel efficacy. Participants were followed for MDA-associated adverse events up to day 7 of post-MDA. The primary and secondary study outcomes were praziquantel efficacy (parasitological cure and egg reduction rates) and MDA-associated adverse events (AEs), respectively. Result: The overall cure rates at week-4 and week-8 were 89.1% (95%CI = 86.1-91.7) and 87.5% (95%CI = 83.6-90.8), respectively. Cure rates among moderate-to-heavily infected children were significantly lower (p = 0.001) compared to those with light infection at week-4 (84.4% vs. 91.1%, p = 0.03) and week-8 (78.6% vs. 91.9%, respectively). Older children had a higher cure rate than younger ones at week-8 (90.1% vs. 79.5%, p = 0.01). Among those who were Schistosoma egg-free (cured) at week 4, 7.8% became egg-positive at week 8. The overall egg reduction rate (ERR) at week-4 and week-8 were 93.5% and 91.3%, respectively, being lower among the 5-9 years old age groups (p = 0.01) at week-8. The proportion of children who remained schistosoma egg-positive throughout the study follow-up period was 4.6%, and their ERR at week-4 and week-8 was 50% and 51%, respectively, which is below the 90% World Health Organization threshold for efficacy. The incidence of experiencing at least one type of MDA-associated AEs were 17.0% (95%CI = 13.8%-20.5%); abdominal pain, headache, and vomiting were the most common. The proportion of mild, moderate, and severe AEs was 63.2%, 26.3%, and 10.5%, respectively. Females experienced more AEs than males (p = 0.03). Conclusion: Single-dose praziquantel is still effective for the treatment of intestinal schistosomiasis. Praziquantel and albendazole preventive chemotherapy is safe and tolerable, and associated AEs are mostly mild-to-moderate and transient. However, the reduced PZQ effectiveness in moderate-to-heavy infection and observed AEs in about one-fifth of infected children underscores the need for better treatment strategies and surveillance for early detection of parasite resistance and management of AEs.

Evaluation of Triple Drug Administration for Lymphatic Filariasis in Prayagraj District, Uttar Pradesh, India: A Cross-sectional Study

Introduction: Unplanned urbanisation and improper sanitary system in many cities in a developing country increase cases of vector borne diseases. Among these, filariasis is a major health problem in India. Campaign for triple drug therapy to eliminate the lymphatic filariasis was launched by government of India but, data assessing the Mass Drug Administration (MDA) coverage and compliance is scarce. Aim: To assess coverage and compliance of triple drug administration for Lymphatic Filariasis (LF) in Prayagraj district. Materials and Methods: This community based crosssectional study was conducted in the Department of Community Medicine at Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India. The duration of the study was 8 days, from 30th October 2021 to 6th November 2021. A total of 1739 individuals belonging to rural and urban area of district Prayagraj. Systematic selection was used for selection of subunit. Random selection of 30 subunits from the survey area was done and also Probability Proportional to Estimate Size (PPES) was used, sampling to give everyone in the survey population an equal probability of being selected. A segment of households was randomly selected (typically-10 household) from each subunit (30 subunits, e.g., village). The number and percentage of characteristics were calculated. The data has been entered in MS excel and analysis was done using Statistical Package for Social Sciences (SPSS) version 23.0. Results: The mean age of the study participants was 30.78±18.18 years for males and 30.04±17.48 years for females. A total of 1739 persons were covered in post MDA coverage evaluation survey out of which, 1361 persons belonged to rural area and 378 persons belonged to urban area. Ivermectin, albendazole and Diethylcarbamazine (DEC) were swallowed more in urban area (53.27% for each drug) as compared to rural area (18.25% for each drug). Overall, estimated 45.66% drugs were swallowed in district Prayagraj. Adverse drug effect was not found. Conclusion: The overall coverage of mass drug administration was low (45.66%) and far behind the national target of &gt;85% and it was even worse in urban area where only one-third of the population were offered mass drug administration.

Diagnostic performance of a urine-based ELISA assay for the screening of human schistosomiasis japonica: A comparative study.

The current study developed and evaluated the performance of a urine-based enzyme-linked immunosorbent assay (ELISA) for the screening of Schistosoma japonicum infection in a human cohort (n = 412) recruited from endemic areas, Northern Samar, the Philippines. The diagnostic performance of the urine ELISA assay was further compared with the Kato-Katz (KK) technique, serum-based ELISA assays, point-of-care circulating cathodic antigen (POC-CCA) urine cassette test, and droplet digital (dd)PCR assays performed on feces, serum, urine, and saliva samples, which were designated as F_ddPCR, SR_ddPCR, U_ddPCR, and SL_ddPCR, respectively. When urine samples concentrated 16× were assessed, the SjSAP4 + Sj23-LHD-ELISA (U) showed sensitivity/specificity values of 47.2/93.8% for the detection of S. japonicum infection in KK-positive individuals (n = 108). The prevalence of S. japonicum infection in the total cohort determined by the urine ELISA assay was 48.8%, which was lower than that obtained with the F_ddPCR (74.5%, p < 0.001), SR_ddPCR (67.2%, p < 0.001), and SjSAP4 + Sj23-LHD-ELISA (S) (66.0%, p < 0.001), but higher than that determined by the Sj23-LHD-ELISA (S) (24.5%, p < 0.001), POC-CCA assay (12.4%, p < 0.001), and SL_ddPCR (25.5%, p < 0.001). Using the other diagnostic tests as a reference, the urine ELISA assay showed a sensitivity between 47.2 and 56.9%, a specificity between 50.7 and 55.2%, and an accuracy between 49.3 and 53.4%. The concentrated urine SjSAP4 + Sj23-LHD-ELISA developed in the current study was more sensitive than both the KK test and POC-CCA assay, and showed a comparable level of diagnostic accuracy to that of the U_ddPCR. However, its diagnostic performance was less robust than that of the F_ddPCR, SR_ddPCR, and SjSAP4 + Sj23-LHD-ELISA (S) assays. Although they are convenient and involve a highly acceptable non-invasive procedure for clinical sample collection, the insufficient sensitivity of the three urine-based assays (the urine ELISA assay, the U_ddPCR test, and the POC-CCA assay) will limit their value for the routine screening of schistosomiasis japonica in the post mass drug administration (MDA) era, where low-intensity infections are predominant in many endemic areas.

Assessing the Quality of the Life of Lymphatic Filariasis Patients with Elephantoid Legs in a Post Mass Drug Administration (MDA) Phase Residing in Cherthala Taluk, Alappuzha

Introduction: Elephantoid legs due to past LF infection are common in Cherthala, Alappuzha, Kerala. The physical disability refers to impairment of bodily functions and difficulties in performing daily chores. The study aims to assess the quality of life of filarial patients in the post MDA phase. Objectives: To assess the quality of life of lymphatic filariasis patients in the post MDA phase. Methodology: A cross sectional study was conducted at Thaickal and Chethy Panchayats of Cherthala through health camps with the help of the Accedited social health activists (ASHAs). People with lymphoedema living in these areas were considered eligible for the study after taking their consent. 114 chronic filarial patients were recruited for the study employing a validated questionnaire; Lymphatic Filariasis Specific Quality of Life Questionnaire (LFSQQ). The domain scores were expressed as mean with standard deviation. An independent t-test was used to compare the mean scores among various groups based on demographic characters. Results: Among the 7 domains,the least score was for the mobility domain indicating that mobility was the major concern affecting in their quality of life. The highest domain score was observed in the Psychological Health domain indicating that they have mentally adjusted to this condition. Conclusion: In the present study to assess the quality of life of LF patients, the least domain score was for mobility and the highest domain score was for Psychological Health.

Mass Drug Administration (MDA) in elimination of lymphatic filariasis: Assessment in Part of Eastern India

Lymphatic filariasis, a group of parasitic infections which can lead to disfigurement, disability and chronic pain. It causes social stigma which adversely affects their social and economic life. For elimination of LF, mass drugs administration is being implemented since 2004 in Odisha. A cross-sectional study was conducted in Baragarh district in the month of April 2021. Data regarding MDA was collected from 300 (200 rural and 100 urban) households (HHs) in a pre-designed, pretested questionnaire. A total of 300 households were covered in the post MDA survey of Bargarh with 1412 individuals. Of them, 1367 (96.8%) were found to be eligible. Of those who received the drugs, compliance was 94.1%. Overall effective coverage of MDA was 82%. But the difference in compliance among the three studied clusters was not found to be significant. In all the age groups only 25% of the eligible persons had consumed the drugs in front of the DD (Effective Supervised coverage). Though the coverage and compliance were found to be better, the effective supervised coverage of MDA is still low.

Role of National Filaria Control Programme (NFCP) Units in Elimination of Lymphatic Filariasis in Uttar Pradesh, India

All 51 lymphatic filariasis (LF) endemic districts of eastern Uttar Pradesh are being targeted for elimination of lymphatic filariasis (ELF) and accordingly, mass drug administration (MDA) had to be observed for consecutive five years by administering only Di-ethyl Carbamazine Citrate (DEC) once in a year. However, the human resource deployed in the state under NFCP is not optimally involved and utilised for the purpose. Instead, one more drug albendazole (400 mg) was added along with DEC and was administered to all age groups above 2 years of age since 2008 to have an effect on the adult worm too together with mf and therefore, the parasite was destroyed preventing the infected person from developing clinical manifestation. This had to be assessed by conducting a transmission assessment survey (TAS) thrice at an interval of two years.Out of 51 filaria endemic districts of the state, 42 districts have been subjected to TAS since 2015, of which only one district, i.e. Rampur, has cleared TAS-1, TAS-2 and TAS-3 and is under post MDA surveillance. 09 districts were subjected to TAS-1 twice, but could not clear the TAS-1 level, while 09 other districts could not qualify to proceed further for TAS-1. The state is yet to achieve the elimination of LF and has to conduct more MDA rounds beyond the scheduled five rounds required for the elimination of the disease. The various reasons for not achieving the target in programme implementation have been raised in the present paper.

Mass Drug Administration (MDA) for Lymphatic Filariasis Elimination in Uttar Pradesh, India: Issues, Gaps &amp; Challenges

Uttar Pradesh is the largest state of India and is comprised of 75 revenue districts. 51 districts of eastern Uttar Pradesh are endemic for LF and are under Elimination of Lymphatic Filariasis (ELF). In order to ensure elimination of the disease from the people, the mass drug administration (MDA) is being observed in these 51 districts since 2004 by ensuring administration of drug Di-ethyl Carbamazine Citrate (DEC) alone once in a year according to the age excluding children &lt;2years, pregnant women and seriously ill persons. Thereafter, 400 mg albendazole to &gt;2 years age group was added with DEC since 2008. When both the drugs are administered together, the effect is on the adult worm too and therefore the parasite will be destroyed preventing the infected person from developing clinical manifestation. NVBDCP guidelines envisages that administration of drug to the 65% of the total population or 85% of the targeted population for five consecutive years will bring down the microfilarimia to &lt;1% among the population, ultimately leading to the elimination of the disease after conducting Transmission Assessment Survey (TAS) thrice at an interval of two years among the virgin/protected group of children i.e. 6-7 years. The Transmission Assessment Survey (TAS) is conducted after ensuring &lt;1% microfilariamia in 10 additional sites selected randomly.The state could subject only one district Rampur under post MDA surveillance, which cleared TAS-1 &amp; TAS-2. The other districts subjected for TAS during 2016, 2017, 2018 &amp; 2019 but could not qualify for conducting TAS in additional m.f. survey as microfilariamia during 2016, 2017, &amp; 2018 was found &gt;1% and during 2019, the antigenemia was found &gt;2% in 13 districts. The possible gaps, issues and challenges at various levels of the programme implementation have been discussed in the present paper, the rectification of which may lead the state for achieving the goal of elimination of the disease.

The impact of community-wide, mass drug administration on aggregation of soil-transmitted helminth infection in human host populations

BackgroundSoil-transmitted helminths (STH) are intestinal parasites estimated to infect over 1.5 billion people. Current treatment programmes are aimed at morbidity control through school-based deworming programmes (targeting school-aged children, SAC) and treating women of reproductive age (WRA), as these two groups are believed to record the highest morbidity. More recently, however, the potential for interrupting transmission by treating entire communities has been receiving greater emphasis and the feasibility of such programmes are now under investigation in randomised clinical trials through the Bill & Melinda Gates Foundation funded DeWorm3 studies. Helminth parasites are known to be highly aggregated within human populations, with a small minority of individuals harbouring most worms. Empirical evidence from the TUMIKIA project in Kenya suggests that aggregation may increase significantly after anthelminthic treatment.MethodsA stochastic, age-structured, individual-based simulation model of parasite transmission is employed to better understand the factors that might induce this pattern. A simple probabilistic model based on compounded negative binomial distributions caused by age-dependencies in both treatment coverage and exposure to infection is also employed to further this understanding.ResultsBoth approaches confirm helminth aggregation is likely to increase post-mass drug administration as measured by a decrease in the value of the negative binomial aggregation parameter, k. Simple analytical models of distribution compounding describe the observed patterns well.ConclusionsThe helminth aggregation that was observed in the field was replicated with our stochastic individual-based model. Further work is required to generalise the probabilistic model to take account of the respective sensitivities of different diagnostics on the presence or absence of infection.

A systematic review of alternative surveillance approaches for lymphatic filariasis in low prevalence settings: Implications for post-validation settings.

Due to the success of the Global Programme to Eliminate Lymphatic Filariasis (GPELF) many countries have either eliminated the disease as a public health problem or are scheduled to achieve this elimination status in the coming years. The World Health Organization (WHO) recommend that the Transmission Assessment Survey (TAS) is used routinely for post-mass drug administration (MDA) surveillance but it is considered to lack sensitivity in low prevalence settings and not be suitable for post-validation surveillance. Currently there is limited evidence to support programme managers on the design of appropriate alternative strategies to TAS that can be used for post-validation surveillance, as recommended by the WHO. We searched for human and mosquito LF surveillance studies conducted between January 2000 and December 2018 in countries which had either completed MDA or had been validated as having eliminated LF. Article screening and selection were independently conducted. 44 papers met the eligibility criteria, summarising evidence from 22 countries and comprising 83 methodologically distinct surveillance studies. No standardised approach was reported. The most common study type was community-based human testing (n = 42, 47.2%), followed by mosquito xenomonitoring (n = 23, 25.8%) and alternative (non-TAS) forms of school-based human testing (n = 19, 21.3%). Most studies were cross-sectional (n = 61, 73.5%) and used non-random sampling methods. 11 different human diagnostic tests were described. Results suggest that sensitivity of LF surveillance can be increased by incorporating newer human diagnostic tests (including antibody tests) and the use of mosquito xenomonitoring may be able to help identify and target areas of active transmission. Alternative sampling methods including the addition of adults to routine surveillance methods and consideration of community-based sampling could also increase sensitivity. The evidence base to support post-validation surveillance remains limited. Further research is needed on the diagnostic performance and cost-effectiveness of new diagnostic tests and methodologies to guide policy decisions and must be conducted in a range of countries. Evidence on how to integrate surveillance within other routine healthcare processes is also important to support the ongoing sustainability of LF surveillance.

Coverage assessment survey following trachoma mass drug administration (MDA) in six districts of Oromia, Western Ethiopia, 2017.

BackgroundTrachoma is a contagious infection of the eye by specific strains of the bacteria Chlamydia trachomatis. It is the leading cause of blindness worldwide. Mass drug administration (MDA) with azithromycin is a cornerstone of World Health Organization (WHO)’s global effort to eliminate trachoma by 2020. This coverage survey was aimed to assess trachoma post-mass drug administration (MDA) coverage among six selected districts of East Wollega, Horo Guduru Wollega, and West Shewa zones in2017.MethodsA community based cross-sectional coverage survey was conducted. The sample size was calculated automatically using Coverage Survey Builder (CSB) tool in microsoft excel. Thirty segments were selected per each selected districts of the three zones. A separate Results Entry Form for each district surveyed was completed, saved and uploaded directly into the online Coverage Survey Analysis Tool to estimate the surveycoverage and the program reach along with the corresponding 95% confidence limits and design effects. EPI-INFO 7.0 and SPSS version 20 was used for further analysis of survey data.ResultA total of 1,747 households were surveyed, out of which 10,700 individuals were interviewed. Most respondents (95.1%) stated that they heard about trachoma MDA and most of them replied that they got the information from health workers. Program reach ranged between 89.5% in Jimma Geneti district and 94.8% in Dirre Hinchini district. The most common mentioned reasons for not having taken azithromycin included not knowing about the campaign, fear of side effects and being absent during the MDA campaign.ConclusionIn this survey, four of the six districts met the target threshold (i.e. 80%) for effective coverage; Ambo rural and Jimma Geneti did not meet the target threshold.Therefore, programmatic improvements should be made for the future campaign to reach the expected thresholds while the campaign in four of the six districts should be encouraged.

Ocular immune responses, Chlamydia trachomatis infection and clinical signs of trachoma before and after azithromycin mass drug administration in a treatment naïve trachoma-endemic Tanzanian community.

BackgroundTrachoma, caused by Chlamydia trachomatis, remains the leading infectious cause of blindness worldwide. Persistence and progression of the resulting clinical disease appears to be an immunologically mediated process. Azithromycin, which is distributed at the community level for trachoma control, has immunomodulatory properties. We investigated the impact of one round of oral azithromycin on conjunctival immune responses, C. trachomatis infection and clinical signs three- and six- months post treatment relative to three pre-treatment time-points.MethodologyA cohort of children aged 6 to 10 years were recruited from a trachoma endemic region of northern Tanzania and were visited five times in a 12-month period. They were examined for clinical signs of trachoma and conjunctival swabs were collected for laboratory analysis. C. trachomatis infection was detected and the expression of 46 host genes was quantified using quantitative PCR. All community members were offered azithromycin treatment immediately after the six-month timepoint according to international guidelines.FindingsThe prevalence of C. trachomatis infection and inflammatory disease signs were significantly reduced three- and six- months post-mass drug administration (MDA). C. trachomatis infection was strongly associated with clinical signs at all five time-points. A profound anti-inflammatory effect on conjunctival gene expression was observed 3 months post-MDA, however, gene expression had largely returned to pre-treatment levels of variation by 6 months. This effect was less marked, but still observed, after adjusting for C. trachomatis infection and when the analysis was restricted to individuals who were free from both infection and clinical disease at all five time-points. Interestingly, a modest effect was also observed in individuals who did not receive treatment.ConclusionConjunctival inflammation is the major clinical risk factor for progressive scarring trachoma, therefore, the reduction in inflammation associated with azithromycin treatment may be beneficial in limiting the development of potentially blinding disease sequelae. Future work should seek to determine whether this effect is mediated directly through inhibition of pro-inflammatory intracellular signalling molecules, through reductions in concurrent, sub-clinical infections, and/or through reduction of infection exposure.

Surveillance of Wuchereria bancrofti infection by anti-filarial IgG4 in urine among schoolchildren and molecular xenomonitoring in Sri Lanka: a post mass drug administration study

BackgroundSurveillance of hidden foci or resurgence of the bancroftian filariasis has high priority to maintain the elimination status in Sri Lanka. For the surveillance, two methods were applied in Matotagama, Matara, Sri Lanka; (i) molecular xenomonitoring (MX) by PCR to detect parasite DNA in the vector, Culex (Cx) quinquefasciatus and (ii) survey of anti-filarial IgG4 in urine samples from schoolchildren.ResultsMosquitoes were collected monthly from index houses for 17 months (2013 to 2014) to confirm the existence of bancroftian parasite. Index houses in Matotagama had recorded microfilaria-positive cases in the recent past. Five schools were selected considering Matotagama as the catchment area and all students who presented on the day were tested for urine anti-filarial IgG4 in 2015. Wuchereria bancrofti DNA in Cx. quinquefasciatus pools were found in 14 of 17 months studied and ranged between 0 and 1.4%. The MX rate was greatly increased at least two times in the year following the driest months (March, August). A total of 735 schoolchildren were tested for urine anti-filarial IgG4. Three schools located closer to the MX area had higher positive rates, 3.4%, 3.6%, and 6.6%. Both highest positive rates of MX and urine were located in a nearer vicinity.ConclusionMonthly collections to study lymphatic filariasis (LF) transmission by MX was conducted for the first time in Sri Lanka. We observed that the filarial DNA-positive rate had an association with seasonal cycle of precipitation. More than 1% filarial DNA and > 5% anti-filarial antibody rates confirmed ongoing transmission in Matotagama. The combination of two non-invasive surveys, the urine anti-filarial IgG4 levels of schoolchildren and MX of vector mosquitoes, would be a convenient package to monitor the ongoing transmission (hotspots) of LF in the surveillance.

Tingginya angka kecacingan pasca pengobatan massal filariasis (DEC dan Albendazole) di SDN Juku Eja Pagatan

Helminthiasis considered as "neglected diseases" because it doesn’t induce mortality, but impact on the human resources that can lead to "lost generation. The results of the study in 2008, found the prevalence of worm infection in SDN Juku Eja &gt; 50% where the study was conducted at 3 months post-mass drug administration in it. Required periodic inspections to determine the update status of worm infection in SDN Juku Eja. Descriptive study with cross sectional design was held in SDN Juku Eja Pagatan Kusan Hilir subdistrict in February 2016 (four months after mass drug administration of filariasis in Tanah Bumbu. Population and sample were all students (grades 1-6) SDN Juku Eja Pagatan. 170 pots were distributed, 123 stool samples collected and examined using direct/native method, 102 positive samples (82.93%) consists of Ascaris lumbricoides, Trichuris trichiura, Hookworm, Hymenolepis nana, Hymenolepis diminuta and Enterobius vermicularis. The high prevalence of helminthiasis in SDN Juku Eja riddling civil disobedience in consuming filariasis mass drug or albendazole dose is not able to heal helminthiasis due to the high intensity of helminthiasis. It is estimated that the high prevalence of helminthiasis at the Juku Eja village and the process of infection in the majority of the village so that the program intervention, preventive and promotional of helminthiasis is also need to be implemented at the village level.

Self-Reported Side Effects following Mass Administration of Azithromycin to Eliminate Trachoma in Amhara, Ethiopia: Results from a Region-Wide Population-Based Survey.

.A region-wide population-based post–mass drug administration (MDA) coverage survey was conducted 3 weeks following the 2016 trachoma MDA in Amhara, Ethiopia. The prevalence of self-reported side effects was assessed among those who self-reported receiving azithromycin. A total of 16,773 individuals from 5,129 households reported taking azithromycin during the 2016 MDA in Amhara. The regional prevalence of any self-reported side effect was 9.6% (95% CI: 8.3–11.2%) and ranged from 3.9% to 12.4% among the 10 zones. The most common reported side effects were abdominal pain (53.1%), nausea (21.7%), vomiting (12.8%), and diarrhea (12.5%). Side-effect prevalence among female members was higher than in male members (11.6% versus 7.6%; P < 0.001) and increased with age. After an average of 8 years of annual MDA, the prevalence of self-reported side effects was less than 10% in this population.

Microfilaria persistent foci during post MDA and the risk assessment of resurgence in India

BackgroundPondicherry, a union territory in India, is an endemic district for bancroftian lymphatic filariasis transmitted by Culex quinquefasciatus where eight rounds of mass drug administration (MDA) were completed in 2011 (annually once from 2004 to 2011).The objectives of this study were to conduct a focal survey to assess microfilaria and antigen (Ag) prevalence among young adults and to assess vector infection and infectivity through a focal entomological survey.MethodsMosquitoes were collected using gravid traps in Sedurapet village of Pondicherry and dissected to enumerate W. bancrofti larvae stage first larval stage (L1), second larval stage (L2), and third larval stage (L3). Microfilarias (Mf) were detected using blood smears collected from inhabitants.ResultsA total of 360 individuals from 67 houses were enrolled in this study of which 290 (80.6%) were surveyed for the presence of Mf. Two Mf carriers were detected yielding an overall prevalence of 0.69% and two out of 85 (2.35%) were Mf antigen positive. Of the 2875 mosquitoes collected by gravid trap, Culex quinquefasciatus (93.9%) was the predominant species, followed by Anopheles subpictus (2.3%) and Culex vishnui (3.8%). The density of Cx. quinquefasciatus was 28.1 per trap-night. A total of 2429 Cx. quinquefasciatus were dissected and microscopically examined for abdominal conditions (gravid 85%, semi-gravid 9.4%, unfed 3.8%, and fully fed 1.9%) and filarial infection. One mosquito (infection rate equal to 0.04%) was found to harbor a second stage filarial larva, and none of the mosquitoes had infective stage larva.ConclusionOur results show no reappearance of infection of lymphatic filariasis in Sedurapet village of Pondicherry after MDA, and thus, no further intervention is required in that area for possible resurgence of lymphatic filariasis. However, monitoring should be continued as part of post MDA activities until the endpoint of complete elimination is achieved. We demonstrated that xenomonitoring can be used to monitor the post MDA situation for possible risk of transmission to initiate control measures.

Reaching endpoints for lymphatic filariasis elimination- results from mass drug administration and nocturnal blood surveys, South Gujarat, India.

BackgroundFollowing the World Health Assembly resolution on Elimination of lymphatic filariasis (ELF) as a public health problem by the year 2020, a Global Program (GPELF) was launched in 1997 to help endemic countries to initiate national programs. The current strategy to interrupt transmission of LF, is administration of once-yearly, single-dose, two-drug regimen (Albendazole with Diethylcarbamazine (DEC) to be used in endemic areas with the goal of reaching 65% epidemiological coverage for 4–6 years. We report findings of independent assessment from year 2010 to 2015 for last six rounds, after initial five rounds of Mass Drug Administration (MDA) since 2005 for ELF in endemic area of Gujarat.MethodsIndependent assessment of MDA was performed to find coverage and compliance indicators, reasons for non-coverage and non-compliance in five Implementation Units (IUs). Pre, during and post MDA evaluations were done in three phases. The impact of MDA was measured by microfilaraemia survey. A total of eight sites, four random and four fixed sentinel sites were selected to calculate microfilaria rate (MF) per IUs per year. In years 2010 to 2015, we report results from 125,936 nocturnal blood smears and 17551 population in 120 selected clusters. Four clusters were selected per year in each of the five IUs for assessment of MDA round.ResultPost MDA survey showed drug coverage between 81%-88% and epidemiological coverage 77%-89% across years. Main reasons for non-coverage were drug administrator related (the team did not visit or missed people) while non-compliance was population related (fear of side effects, sickness, people forgot or absent). During MDA findings show that the directly observed consumption is considerably improved from 58% in 2010 to 82% in 2015. The knowledge about benefits of drug provided also increased from 59% to 90% over the years. The current MF rate is less than one in all IUs with an overall 68% percent decrease from baseline year 2005 to year 2015. The average MF rate of Gujarat is 0.44 for year 2015.ConclusionsThe findings show that achieving adequate epidemiological and drug coverage is possible by actual field level operation of the program in large endemic areas. The results and feedback from independent assessment, performed regularly, could guide the policymakers and program managers for mid-term corrections and to frame strategies to enhance program. Monitoring of coverage and impact indicator together informs decisions for reaching end-point of MDA. The impact indicator- microfilaria rate in all IUs of South Gujarat Region has reached and remained less than one percent signaling end-points of MDA. Post MDA stringent monitoring in form of TAS is recommended to keep vigil on maintenance of elimination achieved.

Prevalence of Active and Latent Yaws in the Solomon Islands 18 Months after Azithromycin Mass Drug Administration for Trachoma.

IntroductionBoth yaws and trachoma are endemic in the Pacific. Mass treatment with azithromycin is the mainstay of the WHO strategy for both the eradication of yaws and the elimination of trachoma as a public health problem, but the dose recommended for trachoma is lower than that for yaws. In countries where both diseases are endemic, there is a potential for synergy between yaws and trachoma control programs if mass treatment with the lower dose of azithromycin was shown to be effective for the treatment of yaws. In an earlier study, we demonstrated a profound reduction in the clinical and serological prevalence of yaws following a single round of mass treatment with azithromycin 20 mg/kg undertaken for the purposes of trachoma elimination.MethodsThis survey was conducted 18 months following a single round of azithromycin mass treatment in the same communities in which we had conducted our previous six-month follow-up survey. We examined children aged 1–14 years and took blood and lesion samples for yaws diagnosis using the Treponema pallidum particle agglutination assay (TPPA) and the non-treponemal Rapid Plasma Reagin (RPR) test.ResultsA total of 1,284 children were enrolled in the study. Amongst children aged 5–14 years, 223 had a positive TPPA (27.5%, 95% CI 13.6–47.7%). The TPPA seroprevalence amongst this age group did not differ significantly from either our pre-mass treatment survey or our initial follow-up survey. Thirty-five children had positive TPPA and positive RPR (4.3%, 95% CI 2.1–8.7%), and this did not differ significantly from our initial post-mass drug administration (MDA) follow-up survey (4.3% versus 3.5%, p = 0.43) but remained significantly lower than our initial pre-MDA survey (4.3% vs 21.7%, p <0.0001). Village-level MDA coverage was strongly associated with dual-seropositivity (p = 0.005). Amongst children aged 1–4 years, 16 had a positive TPPA (3.5%, 95% CI 1.6–7.1%). This did not differ significantly from the seroprevalence in this age group that had been predicted based on our previous surveys (3.5% vs 5%, p = 0.11). Fourteen children (1.1%) were considered to have a skin lesion clinically consistent with yaws, but none of these individuals was seropositive for yaws. Of nine cases where a swab could be collected for PCR, all were negative for Treponema pallidum subsp. pertenue DNA.DiscussionIn this study we have shown that the benefit of a single round of mass treatment with azithromycin 20mg/kg appears to extend to 18 months without any further intervention. The lack of a significant change in seroprevalence from 6 to 18 months after mass treatment might suggest that interventions could be spaced at yearly intervals without a significant loss of impact, and that this might facilitate integration of yaws eradication with other neglected tropical disease (NTD) control programmes. MDA coverage above 90% was associated with significantly better outcomes than coverages lower than this threshold, and strategies to improve coverage at all stages of yaws eradication efforts should be investigated.

A Knowledge, Attitudes and Practices Survey Conducted Three Years after Halting Ivermectin Mass Treatment for Onchocerciasis in Guatemala.

BackgroundMass drug administration (MDA) with ivermectin for onchocerciasis was provided in Guatemala’s Central Endemic Zone (CEZ) over a 24 year period (1988–2011). Elimination of Onchocerca volvulus transmission was declared in 2015 after a three year post MDA surveillance period (2012–2014) showed no evidence of recrudescence. The purpose of the present study was to evaluate the knowledge, attitudes and practices (KAP) towards onchocerciasis and ivermectin among residents in the post endemic CEZ. A major interest in this study was to determine what community residents thought about the end of the ivermectin MDA program.Methodology/Principal FindingsA total of 148 interviews were conducted in November 2014 in four formerly hyperendemic communities using a standard questionnaire on smart phones. The majority (69%) of respondents knew that the MDA program had ended because the disease was no longer present in their communities, but a slight majority (53%) was personally unsure that onchocerciasis had really been eliminated. Sixty-three percent wanted to continue to receive ivermectin because of this uncertainty, or because ivermectin is effective against intestinal worms. Eighty-nine percent of respondents said that they would seek medical attention immediately if a family member had symptoms of onchocerciasis (especially the presence of a nodule), which is a finding very important for ongoing surveillance.Conclusions/SignificanceMany respondents wanted to continue receive ivermectin and more than half did not believe onchocerciasis had been eliminated. The ministry of health outreach services should be prepared to address ongoing concerns about onchocerciasis in the post endemic CEZ.