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Fernando DD, Mounsey KE, Bernigaud C, Surve N, Estrada Chávez GE, Hay RJ, Currie BJ, Chosidow O, Fischer K. Scabies. Nat Rev Dis Primers 2024; 10:74. [PMID: 39362885 DOI: 10.1038/s41572-024-00552-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2024] [Indexed: 10/05/2024]
Abstract
Scabies is one of the most common and highest-burden skin diseases globally. Estimates suggest that >200 million people worldwide have scabies at any one time, with an annual prevalence of 455 million people, with children in impoverished and overcrowded settings being the most affected. Scabies infection is highly contagious and leads to considerable morbidity. Secondary bacterial infections are common and can cause severe health complications, including sepsis or necrotizing soft-tissue infection, renal damage and rheumatic heart disease. There is no vaccine or preventive treatment against scabies and, for the past 30 years, only few broad-spectrum antiparasitic drugs (mainly topical permethrin and oral ivermectin) have been widely available. Treatment failure is common because drugs have short half-lives and do not kill all developmental stages of the scabies parasite. At least two consecutive treatments are needed, which is difficult to achieve in resource-poor and itinerant populations. Another key issue is the lack of a practical, rapid, cheap and accurate diagnostic tool for the timely detection of scabies, which could prevent the cycle of exacerbation and disease persistence in communities. Scabies control will require a multifaceted approach, aided by improved diagnostics and surveillance, new treatments, and increased public awareness.
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Affiliation(s)
- Deepani D Fernando
- Scabies Laboratory, Infection and Inflammation Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Kate E Mounsey
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Charlotte Bernigaud
- Research Group Dynamic, EA7380, Faculté de Santé de Créteil, USC ANSES, Université Paris-Est Créteil, Créteil, France
| | - Nuzhat Surve
- Department of Microbiology, Seth G S Medical College and KEM Hospital, Parel, Mumbai, India
| | - Guadalupe E Estrada Chávez
- State Institute of Cancer "Dr. Arturo Beltrán Ortega", Faculty of Medicine, Universidad Autónoma de Guerrero, Community Dermatology Mexico, Acapulco, Guerrero, Mexico
| | - Roderick J Hay
- St Johns Institute of Dermatology, King's College London, London, UK
| | - Bart J Currie
- Global and Tropical Health, Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Olivier Chosidow
- Hôpital Universitaire La Pitié-Salpêtrière, AP-HP, Paris, France
| | - Katja Fischer
- Scabies Laboratory, Infection and Inflammation Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
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Efon-Ekangouo A, De-Gaulle VF, Emalio Y, Orish VN, Djune-Yemeli L, Simo-Simo ML, Tsasse MA, Mbakam L, Nana-Djeunga HC, Kamgno J. Persistent transmission of soil-transmitted helminths despite 16 years of uninterrupted Mebendazole- and ivermectin-based preventive chemotherapy in the Lomie Health District (East Region, Cameroon): The emergency of complementary control strategies. PLoS Negl Trop Dis 2024; 18:e0012508. [PMID: 39321251 DOI: 10.1371/journal.pntd.0012508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 10/10/2024] [Accepted: 09/03/2024] [Indexed: 09/27/2024] Open
Abstract
BACKGROUND The control of the Soil-Transmitted Helminths (STH) infections primarily relies on the school-based Preventive Chemotherapy (PCT) with mebendazole. Given the efficacy of ivermectin on STH, the control of the latter is expected to be potentialized in areas where ivermectin is also distributed for onchocerciasis and/or lymphatic filariasis control/elimination. This study aimed to assess the prevalence and intensity of STH in the Lomie Health District where annual school-based deworming campaigns and community-directed treatments with Ivermectin have been underway for almost two decades. METHODOLOGY/PRINCIPAL FINDINGS A quantitative cross-sectional study was conducted in 10 schools of the Lomie Health District, East Region, Cameroon. Stool samples were collected from school-aged children and analysed using the Kato-Katz technique. Semi-structured questionnaires were administered to enrolees to assess compliance with water, sanitation, and hygiene (WASH). Of the 491 children (median age: 9 years; IQR: 7-10) enrolled, 83.9% (95% CI: 80.3-87.1) were infected with at least one STH species. Trichuris trichiura was the predominant species (78.5%), and no hookworm was found. The prevalence trend slightly decreased between 1987 and 2010 (~8%) and remained unchanged since 2010 (p-value = 0.05). Overall, 46.8% and 41.8% of children were heavy-to-moderately infected with Ascaris lumbricoides and T. trichiura. Poor hand hygiene (OR: 2.24, 95% IC: 1.4-3.4, p-value = 0.0002) and the use of river as a source of drinking water (OR: 14.8, 95% IC: 6.9-33.3, p-value = 0.0001) were the main risk factors associated with the STH infection in Lomie Health District. CONCLUSIONS/SIGNIFICANCE The persistent high prevalence and intensity of STH infection despite 16 years of mebendazole-based PCT and expected collateral impact of ivermectin mass distribution, points to plausible implementation gaps, poor compliance to WASH or sub-optimal efficacy of the anthelminthics used. This study highlights the need to further assess the cause of the persistent high prevalence and implement context-adapted control measures in order to curb STH transmission.
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Affiliation(s)
- Arnauld Efon-Ekangouo
- Department of Biochemistry, Faculty of Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Higher Institute of Scientific and Medical Research (ISM), Yaoundé, Cameroon
| | - Virtue F De-Gaulle
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Yannick Emalio
- Higher Institute of Scientific and Medical Research (ISM), Yaoundé, Cameroon
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Verner N Orish
- Unversity of Health and Allied Sciences, Ho Volta Region, Ghana
| | - Linda Djune-Yemeli
- Department of Biochemistry, Faculty of Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Higher Institute of Scientific and Medical Research (ISM), Yaoundé, Cameroon
| | - Michèle L Simo-Simo
- Higher Institute of Scientific and Medical Research (ISM), Yaoundé, Cameroon
- Research Centre for Epidemiology, Biostatistics and Clinical Research, Université Libre de Bruxelles, Brussels, Belgium
| | - Martine A Tsasse
- Higher Institute of Scientific and Medical Research (ISM), Yaoundé, Cameroon
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon
| | - Laetitia Mbakam
- Higher Institute of Scientific and Medical Research (ISM), Yaoundé, Cameroon
| | | | - Joseph Kamgno
- Higher Institute of Scientific and Medical Research (ISM), Yaoundé, Cameroon
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
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Chiphwanya J, Mkwanda S, Kabuluzi S, Mzilahowa T, Ngwira B, Matipula DE, Chaponda L, Ndhlova P, Katchika P, Mahebere Chirambo C, Moses P, Kumala J, Chiumia M, Barrett C, Betts H, Fahy J, Rebollo Polo M, Reimer L, Stanton MC, Thomas B, Freer S, Molyneux DH, Bockarie MJ, Mackenzie CD, Taylor MJ, Martindale S, Kelly-Hope LA. Elimination of lymphatic filariasis as a public health problem in Malawi. PLoS Negl Trop Dis 2024; 18:e0011957. [PMID: 38363794 PMCID: PMC10903958 DOI: 10.1371/journal.pntd.0011957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/29/2024] [Accepted: 02/01/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Lymphatic filariasis (LF) is a parasitic disease transmitted by mosquitoes, causing severe pain, disfiguring, and disabling clinical conditions such as lymphoedema and hydrocoele. LF is a global public health problem affecting 72 countries, primarily in Africa and Asia. Since 2000, the World Health Organization (WHO) has led the Global Programme to Eliminate Lymphatic Filariasis (GPELF) to support all endemic regions. This paper focuses on the achievements of the Malawi LF Elimination Programme between 2000 and 2020 to eliminate LF as a public health problem, making it the second sub-Saharan country to receive validation from the WHO. METHODOLOGY/PRINCIPAL FINDINGS The Malawi LF Programme addressed the widespread prevalence of LF infection and disease across the country, using the recommended WHO GPELF strategies and operational research initiatives in collaboration with key national and international partners. First, to stop the spread of infection (i.e., interrupt transmission) and reduce the circulating filarial antigen prevalence from as high as 74.4% to below the critical threshold of 1-2% prevalence, mass drug administration (MDA) using a two-drug regime was implemented at high coverage rates (>65%) of the total population, with supplementary interventions from other programmes (e.g., malaria vector control). The decline in prevalence was monitored and confirmed over time using several impact assessment and post-treatment surveillance tools including the standard sentinel site, spot check, and transmission assessment surveys and alternative integrated, hotspot, and easy-access group surveys. Second, to alleviate suffering of the affected populations (i.e., control morbidity) the morbidity management and disability prevention (MMDP) package of care was implemented. Specifically, clinical case estimates were obtained via house-to-house patient searching activities; health personnel and patients were trained in self-care protocols for lymphoedema and/or referrals to hospitals for hydrocoele surgery; and the readiness and quality of treatment and services were assessed with new survey tools. CONCLUSIONS Malawi's elimination of LF will ensure that future generations are not infected and suffer from the disfiguring and disabling disease. However, it will be critical that the Malawi LF Elimination programme remains vigilant, focussing on post-elimination surveillance and MMDP implementation and integration into routine health systems to support long-term sustainability and ongoing success. SUMMARY Lymphatic filariasis, also known as elephantiasis, is a disabling, disfiguring, and painful disease caused by a parasite that infected mosquitoes transmit to millions of people worldwide. Since 2000, the Global Programme to Eliminate Lymphatic Filariasis (GPELF) has supported endemic countries such as Malawi in south-eastern Africa, to eliminate the disease as a public health problem. The Malawi National LF Elimination Programme has worked tirelessly over the past two decades to implement the GPELF recommended strategies to interrupt the transmission with a two-drug regime, and to alleviate suffering in patients with lymphoedema and/or hydrocoele through morbidity management and disability prevention. Additionally, the LF Programme has collaborated with national and international stakeholders to implement a range of supplementary operational research projects to address outstanding knowledge gaps and programmatic barriers. In 2020, the World Health Organisation validated that Malawi had successfully eliminated LF as a public health problem, making it the second country in sub-Saharan Africa to achieve this, which is remarkable given that Malawi previously had very high infection rates. The LF Programme now remains vigilant, putting its efforts towards post-elimination surveillance and the continued implementation of care for patients with chronic conditions. Malawi's elimination of LF will ensure that future generations are not affected by this devastating disease.
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Affiliation(s)
| | | | | | - Themba Mzilahowa
- Malaria Alert Centre, Kamuzu University of Health Sciences, Blantyre, Malawi
- Centre for Health, Agriculture, Development Research, and Consulting, Blantyre, Malawi
| | - Bagrey Ngwira
- Centre for Health, Agriculture, Development Research, and Consulting, Blantyre, Malawi
| | | | | | | | | | | | - Philemon Moses
- Centre for Health, Agriculture, Development Research, and Consulting, Blantyre, Malawi
| | - Justin Kumala
- Malaria Alert Centre, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Martin Chiumia
- Malaria Alert Centre, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Carrie Barrett
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Hannah Betts
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Joan Fahy
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Maria Rebollo Polo
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- World Health Organization, Geneva, Switzerland
| | - Lisa Reimer
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Michelle C. Stanton
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Brent Thomas
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sian Freer
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - David H. Molyneux
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Moses J. Bockarie
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- School of Community Health Sciences, Njala University, Bo, Sierra Leone
| | - Charles D. Mackenzie
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Mark J. Taylor
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sarah Martindale
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Louise A. Kelly-Hope
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
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Schneider S, Wu J, Tizek L, Ziehfreund S, Zink A. Prevalence of scabies worldwide-An updated systematic literature review in 2022. J Eur Acad Dermatol Venereol 2023; 37:1749-1757. [PMID: 37147907 DOI: 10.1111/jdv.19167] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/14/2023] [Indexed: 05/07/2023]
Abstract
Scabies is a World Health Organization-defined neglected tropical disease, with continuously rising incidence worldwide in recent years. The aim of this study was to provide an update of the worldwide prevalence and new treatment approaches of scabies in population-based settings. MEDLINE (PubMed), Embase and LILACS databases were reviewed for English and German language population-based studies from October 2014 to March 2022. Two authors independently screened the records for eligibility, extracted all data and one critically appraised the quality of the studies and risk of bias. Systematic review registration: PROSPERO CRD42021247140. Overall, 1273 records were identified through database searching, of which 43 studies were included for the systematic review. Most of the studies (n = 31) examined the scabies prevalence in medium or low human development index countries. The highest prevalence of scabies reported in the general population (children and adults) was recorded in five randomly selected communities in Ghana (71.0%), whereas the highest scabies prevalence in studies, which only examined children (76.9%), was recorded in an Indonesian boarding school. The lowest prevalence was recorded in Uganda (0.18%). The systematic review highlights the prevalence of scabies worldwide, showing that scabies is still a serious, increasing disease that occurs globally and is clustered in developing countries. More transparent data on scabies prevalence are needed to identify risk factors to find new prevention measures.
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Affiliation(s)
- S Schneider
- Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany
| | - J Wu
- Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany
| | - L Tizek
- Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany
| | - S Ziehfreund
- Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany
| | - A Zink
- Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany
- Division of Dermatology and Venereology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Yotsu RR, Fuller LC, Murdoch ME, van Brakel WH, Revankar C, Barogui MYT, Postigo JAR, Dagne DA, Asiedu K, Hay RJ. A global call for action to tackle skin-related neglected tropical diseases (skin NTDs) through integration: An ambitious step change. PLoS Negl Trop Dis 2023; 17:e0011357. [PMID: 37319139 PMCID: PMC10270348 DOI: 10.1371/journal.pntd.0011357] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
On 8 June 2022, the World Health Organization (WHO) released pivotal guidance, "Ending the neglect to attain the Sustainable Development Goals: A strategic framework for integrated control and management of skin-related neglected tropical diseases." Skin-related neglected tropical diseases, or skin NTDs, comprise a group of NTDs that produce signs and symptoms on the skin and include at least 9 diseases or disease groups. Moving away from disease-specific approaches, it is anticipated that synergies will be identified and integrated building on this shared feature, where possible, to achieve a greater health impact. This paper intends to draw attention to the prospects created by this scheme. The framework is a key basis for a proposal produced by WHO dedicated to skin NTD integration and describes the practical opportunities for this evolving strategy. It underlines the wider health benefits that will follow, thus working towards Universal Health Coverage and skin health for all.
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Affiliation(s)
- Rie R. Yotsu
- Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Dermatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - L. Claire Fuller
- International Foundation for Dermatology, London, United Kingdom
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Michele E. Murdoch
- Department of Dermatology, West Herts Teaching Hospitals NHS Trust, Watford General Hospital, Watford, United Kingdom
| | | | - Chandrakant Revankar
- Elimination of NTDs (Independent), North Brunswick, New Jersey, United States of America
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One versus two doses of ivermectin-based mass drug administration for the control of scabies: A cluster randomised non-inferiority trial. PLoS Negl Trop Dis 2023; 17:e0011207. [PMID: 36930667 PMCID: PMC10058081 DOI: 10.1371/journal.pntd.0011207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/29/2023] [Accepted: 03/01/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Mass drug administration (MDA) based on two doses of ivermectin, one week apart, substantially reduces prevalence of both scabies and impetigo. The Regimens of Ivermectin for Scabies Elimination (RISE) trial assessed whether one-dose ivermectin-based MDA would be as effective. METHODS RISE was a cluster-randomised trial in Solomon Islands. We assigned 20 villages in a 1:1 ratio to one- or two-dose ivermectin-based MDA. We planned to test whether the impact of one dose on scabies prevalence at 12 and 24 months was non-inferior to two, at a 5% non-inferiority margin. RESULTS We deferred endpoint assessment to 21 months due to COVID-19. We enrolled 5239 participants in 20 villages at baseline and 3369 at 21 months from an estimated population of 5500. At baseline scabies prevalence was similar in the two arms (one-dose 17·2%; two-dose 13·2%). At 21 months, there was no reduction in scabies prevalence (one-dose 18·7%; two-dose 13·4%), and the confidence interval around the difference included values substantially greater than 5%. There was however a reduction in prevalence among those who had been present at the baseline assessment (one-dose 15·9%; two-dose 10·8%). Additionally, we found a reduction in both scabies severity and impetigo prevalence in both arms, to a similar degree. CONCLUSIONS There was no indication of an overall decline in scabies prevalence in either arm. The reduction in scabies prevalence in those present at baseline suggests that the unexpectedly high influx of people into the trial villages, likely related to the COVID-19 pandemic, may have compromised the effectiveness of the MDA. Despite the lack of effect there are important lessons to be learnt from this trial about conducting MDA for scabies in high prevalence settings. TRIAL REGISTRATION Registered with Australian New Zealand Clinical Trials Registry ACTRN12618001086257.
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Hardy M, Samuela J, Kama M, Tuicakau M, Romani L, Whitfeld MJ, King CL, Weil GJ, Schuster T, Grobler AC, Engelman D, Robinson LJ, Kaldor JM, Steer AC. Community control strategies for scabies: A cluster randomised noninferiority trial. PLoS Med 2021; 18:e1003849. [PMID: 34758017 PMCID: PMC8612541 DOI: 10.1371/journal.pmed.1003849] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 11/24/2021] [Accepted: 10/14/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Scabies is a neglected tropical disease hyperendemic to many low- and middle-income countries. Scabies can be successfully controlled using mass drug administration (MDA) using 2 doses of ivermectin-based treatment. If effective, a strategy of 1-dose ivermectin-based MDA would have substantial advantages for implementing MDA for scabies at large scale. METHODS AND FINDINGS We did a cluster randomised, noninferiority, open-label, 3-group unblinded study comparing the effectiveness of control strategies on community prevalence of scabies at 12 months. All residents from 35 villages on 2 Fijian islands were eligible to participate. Villages were randomised 1:1:1 to 2-dose ivermectin-based MDA (IVM-2), 1-dose ivermectin-based MDA (IVM-1), or screen and treat with topical permethrin 5% for individuals with scabies and their household contacts (SAT). All groups also received diethylcarbamazine and albendazole for lymphatic filariasis control. For IVM-2 and IVM-1, oral ivermectin was dosed at 200 μg/kg and when contraindicated substituted with permethrin. We designated a noninferiority margin of 5%. We enrolled 3,812 participants at baseline (July to November 2017) from the 35 villages with median village size of 108 (range 18 to 298). Age and sex of participants were representative of the population with 51.6% male and median age of 25 years (interquartile range 10 to 47). We enrolled 3,898 at 12 months (July to November 2018). At baseline, scabies prevalence was similar in all groups: IVM-2: 11.7% (95% confidence interval (CI) 8.5 to 16.0); IVM-1: 15.2% (95% CI 9.4 to 23.8); SAT: 13.6% (95% CI 7.9 to 22.4). At 12 months, scabies decreased substantially in all groups: IVM-2: 1.3% (95% CI 0.6 to 2.5); IVM-1: 2.7% (95% CI 1.1 to 6.5); SAT: 1.1% (95% CI 0.6 to 2.0). The risk difference in scabies prevalence at 12 months between the IVM-1 and IVM-2 groups was 1.2% (95% CI -0.2 to 2.7, p = 0.10). Limitations of the study included the method of scabies diagnosis by nonexperts, a lower baseline prevalence than anticipated, and the addition of diethylcarbamazine and albendazole to scabies treatment. CONCLUSIONS All 3 strategies substantially reduced prevalence. One-dose was noninferior to 2-dose ivermectin-based MDA, as was a screen and treat approach, for community control of scabies. Further trials comparing these approaches in varied settings are warranted to inform global scabies control strategies. TRIAL REGISTRATION Clinitrials.gov NCT03177993 and ANZCTR N12617000738325.
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Affiliation(s)
- Myra Hardy
- Tropical Diseases, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Josaia Samuela
- Fiji Ministry of Health and Medical Services, Suva, Fiji
| | - Mike Kama
- Fiji Ministry of Health and Medical Services, Suva, Fiji
| | | | - Lucia Romani
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Margot J. Whitfeld
- St Vincent’s Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Christopher L. King
- Center for Global Health and Diseases, Case Western Reserve University and Veterans Affairs Medical Center, Cleveland, Ohio, United States of America
| | - Gary J. Weil
- Department of Medicine, Washington University, St. Louis, Missouri, United States of America
| | - Tibor Schuster
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Anneke C. Grobler
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Daniel Engelman
- Tropical Diseases, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Leanne J. Robinson
- Vector-borne Diseases and Tropical Public Health, Burnet Institute, Melbourne, Victoria, Australia
| | - John M. Kaldor
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew C. Steer
- Tropical Diseases, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- * E-mail:
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8
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Hardy M, Samuela J, Kama M, Tuicakau M, Romani L, Whitfeld MJ, King CL, Weil GJ, Grobler AC, Robinson LJ, Kaldor JM, Steer AC. Individual Efficacy and Community Impact of Ivermectin, Diethylcarbamazine, and Albendazole Mass Drug Administration for Lymphatic Filariasis Control in Fiji: A Cluster Randomized Trial. Clin Infect Dis 2021; 73:994-1002. [PMID: 33728462 DOI: 10.1093/cid/ciab202] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Bancroftian filariasis remains endemic in Fiji despite >10 years of mass drug administration (MDA) using diethylcarbamazine and albendazole (DA). The addition of ivermectin to this combination (IDA) has improved efficacy of microfilarial clearance at 12 months in individually randomized trials in nocturnal transmission settings, but impact in a setting of diurnally subperiodic filarial transmission has not been evaluated. METHODS This cluster randomized study compared the individual efficacy and community impact of IDA vs DA as MDA for lymphatic filariasis in 35 villages on 2 islands of Fiji. Participants were tested at enrollment for circulating filarial antigen and, if positive, for microfilariae. Weight-dosed treatment was offered according to village randomization. Communities were visited at 12 months and retested for lymphatic filariasis. Infected individuals from Rotuma were retested at 24 months. RESULTS A total of 3816 participants were enrolled and 3616 were treated. At 12 months, microfilariae clearance was achieved in 72 of 111 participants detected with infection at baseline, with no difference in efficacy between treatment groups: DA, 69.2% (95% confidence interval [CI], 57.2%-79.1%) vs IDA, 62.5% (95% CI, 43.6%-78.2%); risk difference, 11.3 % (95% CI, -10% to 32.7%); P = .30. There was no difference between treatment groups in community prevalence of microfilariae at 12 months or individual clearance at 24 months. CONCLUSIONS We found no difference between IDA and DA in individual clearance or community prevalence of lymphatic filariasis at 12 months, and no improved efficacy following a second annual round of IDA. Possible explanations for the apparent lack of benefit of IDA compared to DA include drug and parasite factors affecting clearance, and higher than expected reinfection rates. Clinical Trials Registration: NCT03177993 and Australian New Zealand Clinical Trial Registry: N12617000738325.
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Affiliation(s)
- Myra Hardy
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, ,Melbourne, Victoria, Australia
| | - Josaia Samuela
- Fiji Ministry of Health and Medical Services, Suva, Fiji
| | - Mike Kama
- Fiji Ministry of Health and Medical Services, Suva, Fiji
| | | | - Lucia Romani
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Margot J Whitfeld
- St Vincent's Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Christopher L King
- Centre for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio, USA
| | - Gary J Weil
- Department of Medicine, Washington University, St Louis, Missouri, USA
| | - Anneke C Grobler
- Department of Paediatrics, University of Melbourne, ,Melbourne, Victoria, Australia.,Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Leanne J Robinson
- Vector-borne Diseases and Tropical Public Health, Burnet Institute, Melbourne, Victoria, Australia
| | - John M Kaldor
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew C Steer
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, ,Melbourne, Victoria, Australia
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9
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Rinaldi G, Porter K. Mass drug administration for endemic scabies: a systematic review. Trop Dis Travel Med Vaccines 2021; 7:21. [PMID: 34193305 PMCID: PMC8247067 DOI: 10.1186/s40794-021-00143-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/01/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Scabies is an extremely fastidious infestation caused by the Sarcoptes scabiei mite. It causes a persistent itch that can disrupt a person's mental health, sleep, and overall quality of life. In endemic areas, treatment by targeting symptomatic individuals and their contacts is often unsuccessful due to an asymptomatic period and high rates of re-infection. To overcome this, Mass Drug Administration (MDA) is often used to treat the whole community, irrespective of whether individuals presently have scabies. This review summarises the evidence for the effectiveness of MDA in treating scabies. METHODS An exhaustive literature review was conducted on MEDLINE, EMBASE, Web of Science and Scopus. All peer-reviewed articles published in English January 1990 to March 2020 were eligible and only if the studies were primary and interventional. Furthermore, the intervention had to be a pharmacological MDA method involving human subjects. RESULTS TWELVE articles that qualified for inclusion were identified. MDA for scabies significantly reduced its prevalence in communities at follow up. Some of the drivers of success were communities with low levels of migration, an uptake of MDA of > 85%, the use of oral Ivermectin therapy, the treatment of children and pregnant women within the treated population, and repeated treatment for participants diagnosed with scabies at baseline. CONCLUSIONS The average absolute reduction in prevalence of scabies was 22.0% and the relative reduction average was 73.4%. These results suggest MDA is effective in treating scabies in the endemic community. Further evidence is needed surrounding MDA use in urban areas with increased levels of migration. Importantly, MDA should not substitute the tackling of socioeconomic factors which contribute to endemic disease such as good sanitation and hygiene.
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Affiliation(s)
- Giulia Rinaldi
- Institute for Global Health, University College London, London, UK.
| | - Kholoud Porter
- Institute for Global Health, University College London, London, UK
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10
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A facility and community-based assessment of scabies in rural Malawi. PLoS Negl Trop Dis 2021; 15:e0009386. [PMID: 34061851 PMCID: PMC8195395 DOI: 10.1371/journal.pntd.0009386] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 06/11/2021] [Accepted: 04/14/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Scabies is a neglected tropical disease of the skin, causing severe itching, stigmatizing skin lesions and systemic complications. Since 2015, the DerMalawi project provide an integrated skin diseases clinics and Tele-dermatology care in Malawi. Clinic based data suggested a progressive increase in scabies cases observed. To better identify and treat individuals with scabies in the region, we shifted from a clinic-based model to a community based outreach programme. METHODOLOGY/PRINCIPAL FINDINGS From May 2015, DerMalawi project provide integrated skin diseases and Tele-dermatological care in the Nkhotakota and Salima health districts in Malawi. Demographic and clinical data of all patients personally attended are recorded. Due to a progressive increase in the number of cases of scabies the project shifted to a community-based outreach programme. For the community outreach activities, we conducted three visits between 2018 to 2019 and undertook screening in schools and villages of Alinafe Hospital catchment area. Treatment was offered for all the cases and school or household contacts. Scabies increased from 2.9% to 39.2% of all cases seen by the DerMalawi project at clinics between 2015 to 2018. During the community-based activities approximately 50% of the population was assessed in each of three visits. The prevalence of scabies was similar in the first two rounds, 15.4% (2392) at the first visit and 17.2% at the second visit. The prevalence of scabies appeared to be lower (2.4%) at the third visit. The prevalence of impetigo appeared unchanged and was 6.7% at the first visit and 5.2% at the final visit. CONCLUSIONS/SIGNIFICANCE Prevalence of scabies in our setting was very high suggesting that scabies is a major public health problem in parts of Malawi. Further work is required to more accurately assess the burden of disease and develop appropriate public health strategies for its control.
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11
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Matthews A, Le B, Amaral S, Arkell P, Monteiro M, Clarke N, Barros T, de Jesus Mendonça J, Gusmão SME, Dos Reis Seixas LM, da Piedade JHA, Engelman D, Steer AC, Fancourt NSS, Yan J, Kaldor J, Francis JR, Nery SV. Prevalence of scabies and impetigo in school-age children in Timor-Leste. Parasit Vectors 2021; 14:156. [PMID: 33722285 PMCID: PMC7962383 DOI: 10.1186/s13071-021-04645-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 02/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background Scabies and impetigo are endemic in many tropical, low- and middle-income countries. Mass drug administration (MDA) with ivermectin has emerged as a control strategy for these conditions. In 2019, Timor-Leste Ministry of Health planned to implement MDA including ivermectin for the control of lymphatic filariasis, so we undertook a baseline assessment of scabies and impetigo to better understand local epidemiology and contribute to future surveys assessing the impact of MDA. Methods A cross-sectional school survey was conducted in April–May 2019 at six primary schools in a semi-urban (Dili) and two rural (Ermera and Manufahi) settings. Children under 19 years of age present at school on survey days were eligible to participate, of whom we enrolled 1183. Trained health workers interviewed and examined 1043 participants to clinically diagnose scabies using the 2020 International Alliance for the Control of Scabies (IACS) diagnostic criteria, as well as impetigo. Prevalence was adjusted for age and sex. Mixed-effects logistic regression models were used to analyse odds of scabies and impetigo infection. All models accounted for clustering at the school level through the use of random effect terms. Population attributable risk of scabies as a cause of impetigo was also estimated. Results The overall weighted prevalence of scabies was 30.6%. Children in rural Manufahi were more likely to have scabies than those in semi-urban Dili (53.6% vs 28.2%, adjusted odds ratio [AOR] 3.5). Most cases of scabies were mild (3 to 10 lesions), and lesions were usually distributed on more than one body region. Scabies prevalence was lower among 10 to 14 year olds compared to 5 to 9 year olds. Overall weighted prevalence of impetigo was 11.3%. Relative to Dili, children in rural Ermera and Manufahi were twice as likely to have impetigo. Impetigo was twice as common in children with scabies than in those without, corresponding to an attributable risk of scabies as a cause of impetigo of 22.7%. Conclusions Scabies and impetigo prevalence in Timor-Leste is among the highest reported globally, particularly in rural areas. Scabies infestation was strongly associated with impetigo. Comprehensive control strategies are urgently needed in Timor-Leste.![]()
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Affiliation(s)
| | - Brandon Le
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Salvador Amaral
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Paul Arkell
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | | | - Naomi Clarke
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | | | | | | | | | | | - Daniel Engelman
- Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Australia
| | - Andrew C Steer
- Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Australia
| | - Nicholas S S Fancourt
- Royal Darwin Hospital, Darwin, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Jennifer Yan
- Royal Darwin Hospital, Darwin, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - John Kaldor
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Joshua R Francis
- Royal Darwin Hospital, Darwin, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Susana Vaz Nery
- The Kirby Institute, University of New South Wales, Sydney, Australia
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12
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Jones RT, Pretorius E, Ant TH, Bradley J, Last A, Logan JG. The use of islands and cluster-randomized trials to investigate vector control interventions: a case study on the Bijagós archipelago, Guinea-Bissau. Philos Trans R Soc Lond B Biol Sci 2021; 376:20190807. [PMID: 33357055 PMCID: PMC7776941 DOI: 10.1098/rstb.2019.0807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 12/30/2022] Open
Abstract
Vector-borne diseases threaten the health of populations around the world. While key interventions continue to provide protection from vectors, there remains a need to develop and test new vector control tools. Cluster-randomized trials, in which the intervention or control is randomly allocated to clusters, are commonly selected for such evaluations, but their design must carefully consider cluster size and cluster separation, as well as the movement of people and vectors, to ensure sufficient statistical power and avoid contamination of results. Island settings present an opportunity to conduct these studies. Here, we explore the benefits and challenges of conducting intervention studies on islands and introduce the Bijagós archipelago of Guinea-Bissau as a potential study site for interventions intended to control vector-borne diseases. This article is part of the theme issue 'Novel control strategies for mosquito-borne diseases'.
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Affiliation(s)
- Robert T. Jones
- Department of Disease Control, London School of Hygiene & Tropical Medicine, Keppel Street, Bloomsbury, London WC1E 7HT, UK
- ARCTEC, London School of Hygiene & Tropical Medicine, Keppel Street, Bloomsbury, London WC1E 7HT, UK
| | - Elizabeth Pretorius
- Department of Disease Control, London School of Hygiene & Tropical Medicine, Keppel Street, Bloomsbury, London WC1E 7HT, UK
| | - Thomas H. Ant
- Centre for Virus Research, Bearsden Road, Bearsden, Glasgow G61 1QH, UK
| | - John Bradley
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, Keppel Street, Bloomsbury, London WC1E 7HT, UK
| | - Anna Last
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel Street, Bloomsbury, London WC1E 7HT, UK
| | - James G. Logan
- Department of Disease Control, London School of Hygiene & Tropical Medicine, Keppel Street, Bloomsbury, London WC1E 7HT, UK
- ARCTEC, London School of Hygiene & Tropical Medicine, Keppel Street, Bloomsbury, London WC1E 7HT, UK
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13
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Mitchell E, Bell S, Thean LJ, Sahukhan A, Kama M, Koroivueti A, Kaldor J, Steer A, Romani L. Community perspectives on scabies, impetigo and mass drug administration in Fiji: A qualitative study. PLoS Negl Trop Dis 2020; 14:e0008825. [PMID: 33275592 PMCID: PMC7744044 DOI: 10.1371/journal.pntd.0008825] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 12/16/2020] [Accepted: 09/14/2020] [Indexed: 12/04/2022] Open
Abstract
Scabies is endemic in Fiji and is a significant cause of morbidity. Little is known about the sociocultural beliefs and practices that affect the occurrence of scabies and impetigo, or community attitudes towards the strategy of mass drug administration that is emerging as a public health option for scabies and impetigo control in Fiji and other countries. Data were collected during semi-structured interviews with 33 community members in four locations in Fiji’s Northern Division. Thematic analysis examined participants’ lived experiences of scabies and impetigo; community knowledge and perceptions about scabies and impetigo aetiology and transmission; community-based treatment and prevention measures; and attitudes towards mass drug administration. Many indigenous Fijian (iTaukei) participants noted extensive and ongoing experience of scabies and impetigo among children in their families and communities, but only one participant of Indian descent (Indo-Fijian) identified personal childhood experience of scabies. Scabies and impetigo were perceived as diseases affecting children, impacting on school attendance and families’ quality of sleep. Awareness of scabies and impetigo was considerable, but there were major misconceptions around disease causation and transmission. Traditional remedies were preferred for scabies treatment, followed by biomedicines provided by local health centres and hospitals. Treatment of close household contacts was not prioritised. Attitudes towards mass drug administration to control scabies were mostly positive, although some concerns were noted about adverse effects and hesitation to participate in the planned scabies elimination programme. Findings from this first study to document perspectives and experiences related to scabies and impetigo and their management in the Asia Pacific region illustrate that a community-centred approach to scabies and impetigo is needed for the success of control efforts in Fiji, and most likely in other affected countries. This includes community-based health promotion messaging on the social dynamics of scabies transmission, and a campaign of education and community engagement prior to mass drug administration. Scabies is a skin disease causing discomfort from severe itchiness. It can lead to secondary bacterial infection of the skin (impetigo) that can in turn lead to systemic complications, including septicaemia, kidney disease and rheumatic heart disease. It can also cause sleep disorders and a reduced quality of life. Recently added to the World Health Organization list of neglected tropical diseases, scabies is estimated to affect 150 million people globally each year and is endemic in many Pacific Island countries, including Fiji. We aimed to increase understanding of community beliefs and practices that affect the occurrence of scabies and impetigo, and assess community attitudes towards the use of mass drug administration for scabies and impetigo control in Fiji. The impact of scabies and impetigo on participants’ quality of life included poor sleep quality, school absenteeism and social isolation, especially among children. Participants had awareness of scabies and impetigo, however, misconceptions around the cause and the ways in which these diseases were transmitted between individuals were common. Participants often reported choosing traditional medical remedies to treat scabies; treatment at health centres was mainly sought for secondary skin infections. Attitudes towards mass drug administration were positive, although some concerns regarding adverse effects were noted. Improved strategies, including a community-centred response, are needed for the success of control efforts in Fiji.
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Affiliation(s)
- Elke Mitchell
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
- * E-mail: (EM); (LR)
| | - Stephen Bell
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Li Jun Thean
- Tropical Diseases Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Mike Kama
- Ministry of Health and Medical Services, Suva, Fiji
| | | | - John Kaldor
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Andrew Steer
- Tropical Diseases Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Melbourne Children’s Global Health, Melbourne Children’s Campus, The Royal Children’s Hospital, Melbourne, Australia
| | - Lucia Romani
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
- Tropical Diseases Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- * E-mail: (EM); (LR)
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14
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Lake SJ, Phelan SL, Engelman D, Sokana O, Nasi T, Boara D, Gorae C, Schuster T, Grobler AC, Osti MH, Andrews R, Marks M, Whitfeld MJ, Romani L, Kaldor J, Steer A. Protocol for a cluster-randomised non-inferiority trial of one versus two doses of ivermectin for the control of scabies using a mass drug administration strategy (the RISE study). BMJ Open 2020; 10:e037305. [PMID: 32868360 PMCID: PMC7462236 DOI: 10.1136/bmjopen-2020-037305] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Scabies is a significant contributor to global morbidity, affecting approximately 200 million people at any time. Scabies is endemic in many resource-limited tropical settings. Bacterial skin infection (impetigo) frequently complicates scabies infestation in these settings. Community-wide ivermectin-based mass drug administration (MDA) is an effective control strategy for scabies in island settings, with a single round of MDA reducing population prevalence by around 90%. However, current two-dose regimens present a number of barriers to programmatic MDA implementation. We designed the Regimens of Ivermectin for Scabies Elimination (RISE) trial to investigate whether one-dose MDA may be as effective as two-dose MDA in controlling scabies in high-prevalence settings. METHODS AND ANALYSIS RISE is a cluster-randomised non-inferiority trial. The study will be conducted in 20 isolated villages in Western Province of Solomon Islands where population prevalence of scabies is approximately 20%. Villages will be randomly allocated to receive either one dose or two doses of ivermectin-based MDA in a 1:1 ratio. The primary objective of the study is to determine if ivermectin-based MDA with one dose is as effective as MDA with two doses in reducing the prevalence of scabies after 12 months. Secondary objectives include the effect of ivermectin-based MDA on impetigo prevalence after 12 and 24 months, the prevalence of scabies at 24 months after the intervention, the impact on presentation to health facilities with scabies and impetigo, and the safety of one-dose and two-dose MDA. ETHICS AND DISSEMINATION This trial has been approved by the ethics review committees of the Solomon Islands and the Royal Children's Hospital, Australia. Results will be disseminated in peer-reviewed publications and in meetings with the Solomon Islands Ministry of Health and Medical Services and participating communities. TRIAL REGISTRATION DETAILS Australian New Zealand Clinical Trials Registry: ACTRN12618001086257. Date registered: 28 June 2018.
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Affiliation(s)
- Susanna J Lake
- Tropical Disease Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sophie L Phelan
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Daniel Engelman
- Tropical Disease Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Oliver Sokana
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Titus Nasi
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Dickson Boara
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Christina Gorae
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Tibor Schuster
- Clinical Epidemiology and Biostatistics Unit, McGill University, Montreal, Quebec, Canada
| | - Anneke C Grobler
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Millicent H Osti
- Tropical Disease Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Ross Andrews
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - Michael Marks
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
- Hospital for Tropical Diseases, London, UK
| | - Margot J Whitfeld
- Department of Dermatology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Lucia Romani
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - John Kaldor
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew Steer
- Tropical Disease Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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15
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Hardy M, Samuela J, Kama M, Tuicakau M, Romani L, Whitfeld MJ, King CL, Weil GJ, Grobler AC, Robinson LJ, Kaldor JM, Steer AC. The safety of combined triple drug therapy with ivermectin, diethylcarbamazine and albendazole in the neglected tropical diseases co-endemic setting of Fiji: A cluster randomised trial. PLoS Negl Trop Dis 2020; 14:e0008106. [PMID: 32176703 PMCID: PMC7098623 DOI: 10.1371/journal.pntd.0008106] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 03/26/2020] [Accepted: 01/31/2020] [Indexed: 11/02/2022] Open
Abstract
Lymphatic filariasis has remained endemic in Fiji despite repeated mass drug administration using the well-established and safe combination of diethylcarbamazine and albendazole (DA) since 2002. In certain settings the addition of ivermectin to this combination (IDA) remains a safe strategy and is more efficacious. However, the safety has yet to be described in scabies and soil-transmitted helminth endemic settings like Fiji. Villages of Rotuma and Gau islands were randomised to either DA or IDA. Residents received weight-based treatment unblinded with standard exclusions. Participants were actively found and asked by a nurse about their health daily for the first two days and then asked to seek review for the next five days if unwell. Anyone with severe symptoms were reviewed by a doctor and any serious adverse event was reported to the Medical Monitor and Data Safety Monitoring Board. Of 3612 enrolled and eligible participants, 1216 were randomised to DA and 2396 to IDA. Age and sex in both groups were representative of the population. Over 99% (3598) of participants completed 7 days follow-up. Adverse events were reported by 600 participants (16.7%), distributed equally between treatment groups, with most graded as mild (93.2%). There were three serious adverse events, all judged not attributable to treatment by an independent medical monitor. Fatigue was the most common symptom reported by 8.5%, with headache, dizziness, nausea and arthralgia being the next four most common symptoms. Adverse events were more likely in participants with microfilaremia (43.2% versus 15.7%), but adverse event frequency was not related to the presence of scabies or soil-transmitted helminth infection. IDA has comparable safety to DA with the same frequency of adverse events experienced following community mass drug administration. The presence of co-endemic infections did not increase adverse events. IDA can be used in community programs where preventative chemotherapy is needed for control of lymphatic filariasis and other neglected tropical diseases.
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Affiliation(s)
- Myra Hardy
- Tropical Diseases Research Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Josaia Samuela
- Fiji Ministry of Health and Medical Services, Suva, Fiji
| | - Mike Kama
- Fiji Ministry of Health and Medical Services, Suva, Fiji
| | | | - Lucia Romani
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Margot J. Whitfeld
- St Vincent’s Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Christopher L. King
- Centre for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Gary J. Weil
- Washington University, St. Louis, Missouri, United States of America
| | - Anneke C. Grobler
- Tropical Diseases Research Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Leanne J. Robinson
- Vector-borne Diseases and Tropical Public Health, Burnet Institute, Melbourne, Victoria, Australia
| | - John M. Kaldor
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew C. Steer
- Tropical Diseases Research Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- * E-mail:
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16
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Lopes MJ, da Silva ET, Ca J, Gonçalves A, Rodrigues A, Mandjuba C, Nakutum J, D'Alessandro U, Achan J, Logan J, Bailey R, Last A, Walker S, Marks M. Perceptions, attitudes and practices towards scabies in communities on the Bijagós Islands, Guinea-Bissau. Trans R Soc Trop Med Hyg 2020; 114:49-56. [PMID: 31722016 PMCID: PMC6974396 DOI: 10.1093/trstmh/trz102] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/29/2019] [Accepted: 08/30/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Scabies is highly endemic among impoverished populations and has been recently included in the WHO's list of neglected tropical diseases (NTDs). Community support and behavioural changes are essential for the success of control interventions. This study aimed to explore beliefs, prevention attitudes and healthcare-seeking behaviours towards scabies in the Bijagós Archipelago of Guinea-Bissau. METHODS Data were collected through two methods. Community key informants (community members, community health workers, healthcare workers and traditional healers) were interviewed using snowball sampling. A questionnaire covering perceptions, attitudes and practices was administered to community members using random cluster sampling. Thematic analysis of qualitative data was applied to identify themes. Descriptive statistics were used for quantitative data analysis. RESULTS There was a satisfactory awareness about scabies, but perceptions about disease causation and transmission were imprecise. Misconceptions about personal hygiene as the primary measure for scabies prevention were recurrent. Some participants recognised the importance of early treatment to interrupt transmission. Treatment of close contacts was not considered important. Costs were the main determining factor for treatment choice between traditional healer and the local health centre. Late presentation and delayed treatment were common and associated with poverty and stigmatisation. Scabies impaired quality of life by affecting social interactions, health, fitness to work and school attendance. CONCLUSIONS There is a need to improve education, recognition, management and affordable access to treatment. Community education, healthcare workers' training and skin NTD integrated control programmes should address the challenges highlighted in this study.
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Affiliation(s)
- Maria João Lopes
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Infectious Diseases Department, Hospital Prof. Doutor Fernando Fonseca, IC 19, 2720-276 Amadora, Portugal
| | | | - Janete Ca
- Region Sanitaria Bolama-Bijagós, Bubaque, Guinea-Bissau
| | - Adriana Gonçalves
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | | | - Cristóvão Mandjuba
- Ministry of Public Health, Avenida Unidade Africana, 26, Bissau, Guinea-Bissau
| | - Jose Nakutum
- Region Sanitaria Bolama-Bijagós, Bubaque, Guinea-Bissau
| | - Umberto D'Alessandro
- MRC Unit The Gambia at London School of Hygiene & Tropical Medicine, Atlantic Boulevard, Fajara P.O. Box 273, Banjul, The Gambia
| | - Jane Achan
- MRC Unit The Gambia at London School of Hygiene & Tropical Medicine, Atlantic Boulevard, Fajara P.O. Box 273, Banjul, The Gambia
| | - James Logan
- Disease Control Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - Robin Bailey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, UK
| | - Anna Last
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, UK
| | - Steve Walker
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, UK
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, UK
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17
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Engelman D, Cantey PT, Marks M, Solomon AW, Chang AY, Chosidow O, Enbiale W, Engels D, Hay RJ, Hendrickx D, Hotez PJ, Kaldor JM, Kama M, Mackenzie CD, McCarthy JS, Martin DL, Mengistu B, Maurer T, Negussu N, Romani L, Sokana O, Whitfeld MJ, Fuller LC, Steer AC. The public health control of scabies: priorities for research and action. Lancet 2019; 394:81-92. [PMID: 31178154 PMCID: PMC11257500 DOI: 10.1016/s0140-6736(19)31136-5] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/14/2019] [Accepted: 04/25/2019] [Indexed: 12/16/2022]
Abstract
Scabies is a parasitic disease of the skin that disproportionately affects disadvantaged populations. The disease causes considerable morbidity and leads to severe bacterial infection and immune-mediated disease. Scientific advances from the past 5 years suggest that scabies is amenable to population-level control, particularly through mass drug administration. In recognition of these issues, WHO added scabies to the list of neglected tropical diseases in 2017. To develop a global control programme, key operational research questions must now be addressed. Standardised approaches to diagnosis and methods for mapping are required to further understand the burden of disease. The safety of treatments for young children, including with ivermectin and moxidectin, should be investigated. Studies are needed to inform optimum implementation of mass treatment, including the threshold for intervention, target, dosing, and frequency. Frameworks for surveillance, monitoring, and evaluation of control strategies are also necessary.
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Affiliation(s)
- Daniel Engelman
- Tropical Diseases Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Department of General Medicine, Royal Children's Hospital, Melbourne, VIC, Australia.
| | - Paul T Cantey
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Aileen Y Chang
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Olivier Chosidow
- Department of Dermatology, Hôpital Henri-Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France; Université Paris-Est Créteil Val-de-Marne, Créteil, France
| | - Wendemagegn Enbiale
- Department of Dermatovenerology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Dirk Engels
- Uniting to Combat Neglected Tropical Diseases, Switzerland
| | - Roderick J Hay
- Department of Dermatology, King's College London, London, UK
| | - David Hendrickx
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Peter J Hotez
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | - John M Kaldor
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Mike Kama
- Ministry of Health and Medical Services, Suva, Fiji
| | | | - James S McCarthy
- QIMR Berghoefer Medical Research Institute, Brisbane, QLD, Australia
| | - Diana L Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Toby Maurer
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | | | - Lucia Romani
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Oliver Sokana
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Margot J Whitfeld
- Department of Dermatology, St Vincent's Hospital, University of New South Wales, Sydney, NSW, Australia
| | - L Claire Fuller
- Chelsea and Westminster Healthcare National Health Service Foundation Trust, London, UK; International Foundation for Dermatology, London, UK
| | - Andrew C Steer
- Tropical Diseases Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Department of General Medicine, Royal Children's Hospital, Melbourne, VIC, Australia
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18
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Romani L, Marks M, Sokana O, Nasi T, Kamoriki B, Cordell B, Wand H, Whitfeld MJ, Engelman D, Solomon AW, Kaldor JM, Steer AC. Efficacy of mass drug administration with ivermectin for control of scabies and impetigo, with coadministration of azithromycin: a single-arm community intervention trial. THE LANCET. INFECTIOUS DISEASES 2019; 19:510-518. [PMID: 30956111 PMCID: PMC6483975 DOI: 10.1016/s1473-3099(18)30790-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 11/08/2018] [Accepted: 12/10/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND In small community-based trials, mass drug administration of ivermectin has been shown to substantially decrease the prevalence of both scabies and secondary impetigo; however, their effect at large scale is untested. Additionally, combined mass administration of drugs for two or more neglected diseases has potential practical advantages, but efficacy of potential combinations should be confirmed. METHODS The azithromycin ivermectin mass drug administration (AIM) trial was a prospective, single-arm, before-and-after, community intervention study to assess the efficacy of mass drug administration of ivermectin for scabies and impetigo, with coadministration of azithromycin for trachoma. Mass drug administration was offered to the entire population of Choiseul Province, Solomon Islands, and of this population we randomly selected two sets of ten sentinel villages for monitoring, one at baseline and the other at 12 months. Participants were offered a single dose of 20 mg/kg azithromycin, using weight-based bands. Children weighing less than 12·5 kg received azithromycin oral suspension (20 mg/kg), and infants younger than 6 months received topical 1% tetracycline ointment. For ivermectin, participants were offered two doses of oral ivermectin 200 μg/kg 7-14 days apart using weight-based bands, or 5% permethrin cream 7-14 days apart if ivermectin was contraindicated. Our study had the primary outcomes of safety and feasibility of large-scale mass coadministration of oral ivermectin and azithromycin, which have been previously reported. We report here the prevalence of scabies and impetigo in residents of the ten baseline villages compared with those in the ten 12-month villages, as measured by examination of the skin, which was a secondary outcome of the trial. Further outcomes were comparison of the number of all-cause outpatient attendances at government clinics in Choiseul Province at various timepoints before and after mass drug administration. The trial was registered with the Australian and New Zealand Trials Registry (ACTRN12615001199505). FINDINGS During September, 2015, over 4 weeks, 26 188 people (99·3% of the estimated population of Choiseul [n=26 372] as determined at the 2009 census) were treated. At baseline, 1399 (84·2%) of 1662 people living in the first ten villages had their skin examined, of whom 261 (18·7%) had scabies and 347 (24·8%) had impetigo. At 12 months after mass drug administration, 1261 (77·6%) of 1625 people in the second set of ten villages had their skin examined, of whom 29 (2·3%) had scabies (relative reduction 88%, 95% CI 76·5-99·3) and 81 (6·4%) had impetigo (relative reduction 74%, 63·4-84·7). In the 3 months after mass drug administration, 10 614 attended outpatient clinics for any reason compared with 16 602 in the 3 months before administration (decrease of 36·1%, 95% CI 34·7-37·6), and during this period attendance for skin sores, boils, and abscesses decreased by 50·9% (95% CI 48·6-53·1). INTERPRETATION Ivermectin-based mass drug administration can be scaled to a population of over 25 000 with high efficacy and this level of efficacy can be achieved when mass drug administration for scabies is integrated with mass drug administration of azithromycin for trachoma. These findings will contribute to development of population-level control strategies. Further research is needed to assess durability and scalability of mass drug administration in larger, non-island populations, and to assess its effect on the severe bacterial complications of scabies. FUNDING International Trachoma Initiative, Murdoch Children's Research Institute, Scobie and Claire Mackinnon Trust, and the Wellcome Trust.
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Affiliation(s)
- Lucia Romani
- The Kirby Institute, UNSW, Sydney, NSW, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, London, UK
| | - Oliver Sokana
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Titus Nasi
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Bakaai Kamoriki
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Billie Cordell
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Handan Wand
- The Kirby Institute, UNSW, Sydney, NSW, Australia
| | | | - Daniel Engelman
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Centre for International Child Health, University of Melbourne, Melbourne, VIC, Australia
| | - Anthony W Solomon
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, London, UK
| | | | - Andrew C Steer
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Centre for International Child Health, University of Melbourne, Melbourne, VIC, Australia.
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van der Linden N, van Gool K, Gardner K, Dickinson H, Agostino J, Regan DG, Dowden M, Viney R. A systematic review of scabies transmission models and data to evaluate the cost-effectiveness of scabies interventions. PLoS Negl Trop Dis 2019; 13:e0007182. [PMID: 30849124 PMCID: PMC6426261 DOI: 10.1371/journal.pntd.0007182] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 03/20/2019] [Accepted: 01/23/2019] [Indexed: 01/12/2023] Open
Abstract
Background Scabies is a common dermatological condition, affecting more than 130 million people at any time. To evaluate and/or predict the effectiveness and cost-effectiveness of scabies interventions, disease transmission modelling can be used. Objective To review published scabies models and data to inform the design of a comprehensive scabies transmission modelling framework to evaluate the cost-effectiveness of scabies interventions. Methods Systematic literature search in PubMed, Medline, Embase, CINAHL, and the Cochrane Library identified scabies studies published since the year 2000. Selected papers included modelling studies and studies on the life cycle of scabies mites, patient quality of life and resource use. Reference lists of reviews were used to identify any papers missed through the search strategy. Strengths and limitations of identified scabies models were evaluated and used to design a modelling framework. Potential model inputs were identified and discussed. Findings Four scabies models were published: a Markov decision tree, two compartmental models, and an agent-based, network-dependent Monte Carlo model. None of the models specifically addressed crusted scabies, which is associated with high morbidity, mortality, and increased transmission. There is a lack of reliable, comprehensive information about scabies biology and the impact this disease has on patients and society. Discussion Clinicians and health economists working in the field of scabies are encouraged to use the current review to inform disease transmission modelling and economic evaluations on interventions against scabies. Scabies is a neglected tropical disease affecting more than 130 million people, with major costs on health care systems worldwide. While effective treatments exist, it is unknown which treatment strategies result in the best outcomes against the lowest costs, and to what extent this differs between communities. Health economic modelling can help answer these questions, but has rarely been used in this disease area. This review discusses all available scabies transmission models (n = 4), and uses them to create a new, comprehensive modelling framework. This framework can be used as aid for creating a scabies transmission model, the details of which will be determined by the context (population) and the question being addressed. The current paper also reviews the data that is needed to inform scabies modelling: on scabies biology, quality of life and resource use. Unfortunately, available data is limited and particularly data on crusted scabies (associated with high morbidity and mortality rates) is rare. With this review, we hope to assist researchers and policy makers to predict and/or evaluate the cost-effectiveness of interventions against scabies in their population(s) of interest. To tackle scabies, it is key to use effective treatment strategies in a cost-effective and sustainable way. The models and data described in this review, may help researchers, clinicians and funding bodies to facilitate this.
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Affiliation(s)
- Naomi van der Linden
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
- * E-mail:
| | - Kees van Gool
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Karen Gardner
- Public Service Research Group, School of Business UNSW Canberra, Canberra, Australia
| | - Helen Dickinson
- Public Service Research Group, School of Business UNSW Canberra, Canberra, Australia
| | - Jason Agostino
- Academic Unit of General Practice, Australian National University, Canberra, Australia
| | | | | | - Rosalie Viney
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
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20
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May PJ, Tong SYC, Steer AC, Currie BJ, Andrews RM, Carapetis JR, Bowen AC. Treatment, prevention and public health management of impetigo, scabies, crusted scabies and fungal skin infections in endemic populations: a systematic review. Trop Med Int Health 2019; 24:280-293. [PMID: 30582783 PMCID: PMC6850630 DOI: 10.1111/tmi.13198] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We conducted a systematic review of the treatment, prevention and public health control of skin infections including impetigo, scabies, crusted scabies and tinea in resource‐limited settings where skin infections are endemic. The aim is to inform strategies, guidelines and research to improve skin health in populations that are inequitably affected by infections of the skin and the downstream consequences of these. The systematic review is reported according to the PRISMA statement. From 1759 titles identified, 81 full text studies were reviewed and key findings outlined for impetigo, scabies, crusted scabies and tinea. Improvements in primary care and public health management of skin infections will have broad and lasting impacts on overall quality of life including reductions in morbidity and mortality from sepsis, skeletal infections, kidney and heart disease.
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Affiliation(s)
- Philippa J May
- Northern Territory Centre for Disease Control, Casuarina, Australia
| | - Steven Y C Tong
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Parkville, Australia.,Menzies School of Health Research, Charles Darwin University, Casuarina, Australia
| | - Andrew C Steer
- Royal Children's Hospital, Parkville, Australia.,Murdoch Children's Research Institute, University of Melbourne, Parkville, Australia
| | - Bart J Currie
- Menzies School of Health Research, Charles Darwin University, Casuarina, Australia.,Royal Darwin Hospital, Casuarina, Australia
| | - Ross M Andrews
- Menzies School of Health Research, Charles Darwin University, Casuarina, Australia.,National Centre for Epidemiology & Population Health, Australian National University, Canberra, Australia
| | - Jonathan R Carapetis
- Perth Children's Hospital, Nedlands, Australia.,Wesfarmers Centre for Vaccines and Infectious Diseases, University of Western Australia, Nedlands, Australia.,School of Medicine, University of Western Australia, Nedlands, Australia
| | - Asha C Bowen
- Menzies School of Health Research, Charles Darwin University, Casuarina, Australia.,Perth Children's Hospital, Nedlands, Australia.,Wesfarmers Centre for Vaccines and Infectious Diseases, University of Western Australia, Nedlands, Australia.,School of Medicine, University of Western Australia, Nedlands, Australia.,University of Notre Dame Australia, Fremantle, Australia
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21
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Chandler D, Fuller L. A Review of Scabies: An Infestation More than Skin Deep. Dermatology 2018; 235:79-90. [DOI: 10.1159/000495290] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/12/2018] [Indexed: 11/19/2022] Open
Abstract
Human scabies, a common infestation, has a worldwide distribution with a variable impact and presentation depending on the clinical situation. In developed, high-income settings, health institution and residential home outbreaks challenge health and social care services. In resource-poor settings, it is the downstream sequelae of staphylococcal and streptococcal bacteraemia, induced by scratching, which have a significant impact on the long-term health of communities. Over the past decade scabies has been recognised as a “neglected tropical disease” (NTD) by the World Health Organisation, has an accepted practical system of global diagnostic criteria and is being adopted into integrated programmes of mass drug administration for NTDs in field settings. This review seeks to summarise the recent advances in the understanding of scabies and highlight the advocacy and research headlines with their implication for diagnosis and management of outbreaks and individuals. In addition, it will indicate the priorities and questions that remain.
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22
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Martin D, Wiegand R, Goodhew B, Lammie P, Mkocha H, Kasubi M. Impact of Ivermectin Mass Drug Administration for Lymphatic Filariasis on Scabies in Eight Villages in Kongwa District, Tanzania. Am J Trop Med Hyg 2018; 99:937-939. [PMID: 30062986 PMCID: PMC6159570 DOI: 10.4269/ajtmh.18-0018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/20/2018] [Indexed: 11/29/2022] Open
Abstract
Scabies was recently added to the World Health Organization list of neglected tropical diseases. The ability to treat scabies with oral ivermectin makes a mass drug administration (MDA) campaign a feasible option for scabies control. Ivermectin MDA in communities endemic for lymphatic filariasis (LF) or onchocerciasis may already be having an impact on scabies. We examined the effect of ivermectin MDA for LF on scabies prevalence over 4 years in eight Tanzanian villages. At baseline, 4.4% (95% confidence interval [CI]: 3.7-5.4) of individuals tested positive for scabies, decreasing to 0.84% (95% CI: 0.51-1.4) after one round of ivermectin MDA but increased in Year 3 (2.5% [95% CI: 1.9-3.3]) and Year 4 (2.9% [95% CI: 2.2-3.8]). Most scabies cases were seen in children younger than 15 years. The data suggest that single-dose ivermectin MDA may not be effective in attaining long-term decreases when scabies prevalence is less than 5%.
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Affiliation(s)
- Diana Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ryan Wiegand
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brook Goodhew
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Patrick Lammie
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
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23
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Engelman D, Steer AC. Control Strategies for Scabies. Trop Med Infect Dis 2018; 3:E98. [PMID: 30274494 PMCID: PMC6160909 DOI: 10.3390/tropicalmed3030098] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 09/03/2018] [Accepted: 09/03/2018] [Indexed: 10/29/2022] Open
Abstract
Scabies is a neglected tropical disease of the skin, causing severe itching and stigmatizing skin lesions. Further, scabies leads to impetigo, severe bacterial infections, and post-infectious complications. Around 200 million people are affected, particularly among disadvantaged populations living in crowded conditions in tropical areas. After almost 50 years, research into scabies control has shown great promise, particularly in highly-endemic island settings, but these findings have not been widely adopted. Newer approaches, utilizing ivermectin-based mass drug administration, appear feasible and highly effective. Inclusion of scabies in the WHO portfolio of neglected tropical diseases in 2017 may facilitate renewed opportunities and momentum toward global control. However, further operational research is needed to develop evidence-based strategies for control in a range of settings, and monitor their impact. Several enabling factors are required for successful implementation, including availability of affordable drug supply. Integration with existing health programs may provide a cost-effective approach to control.
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Affiliation(s)
- Daniel Engelman
- Tropical Diseases, Murdoch Children's Research Institute, Parkville VIC 3052, Australia.
- Department of Paediatrics, University of Melbourne, Parkville VIC 3052, Australia.
- Department of General Medicine, Royal Children's Hospital, Parkville VIC 3052, Australia.
- International Alliance for the Control of Scabies, Parkville VIC 3052, Australia.
| | - Andrew C Steer
- Tropical Diseases, Murdoch Children's Research Institute, Parkville VIC 3052, Australia.
- Department of Paediatrics, University of Melbourne, Parkville VIC 3052, Australia.
- Department of General Medicine, Royal Children's Hospital, Parkville VIC 3052, Australia.
- International Alliance for the Control of Scabies, Parkville VIC 3052, Australia.
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24
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Hotez PJ, Fenwick A, Ray SE, Hay SI, Molyneux DH. "Rapid impact" 10 years after: The first "decade" (2006-2016) of integrated neglected tropical disease control. PLoS Negl Trop Dis 2018; 12:e0006137. [PMID: 29795551 PMCID: PMC5967703 DOI: 10.1371/journal.pntd.0006137] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Peter J. Hotez
- Texas Children’s Hospital Center for Vaccine Development, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- * E-mail: (PJH); (AF); (SIH); (DHM)
| | - Alan Fenwick
- Schistosomiasis Control Initiative, Imperial College London, London, United Kingdom
- * E-mail: (PJH); (AF); (SIH); (DHM)
| | - Sarah E. Ray
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Simon I. Hay
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
- * E-mail: (PJH); (AF); (SIH); (DHM)
| | - David H. Molyneux
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail: (PJH); (AF); (SIH); (DHM)
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25
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Forrer A, Khieu V, Schär F, Vounatsou P, Chammartin F, Marti H, Muth S, Odermatt P. Strongyloides stercoralis and hookworm co-infection: spatial distribution and determinants in Preah Vihear Province, Cambodia. Parasit Vectors 2018; 11:33. [PMID: 29329561 PMCID: PMC5767026 DOI: 10.1186/s13071-017-2604-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 12/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Strongyloides stercoralis and hookworm are two soil-transmitted helminths (STH) that are highly prevalent in Cambodia. Strongyloides stercoralis causes long-lasting infections and significant morbidity but is largely neglected, while hookworm causes the highest public health burden among STH. The two parasites have the same infection route, i.e. skin penetration. The extent of co-distribution, which could result in potential high co-morbidities, is unknown in highly endemic settings like Cambodia. The aim of this study was to predict the spatial distribution of S. stercoralis-hookworm co-infection risk and to investigate determinants of co-infection in Preah Vihear Province, North Cambodia. METHODS A cross-sectional survey was conducted in 2010 in 60 villages of Preah Vihear Province. Diagnosis was performed on two stool samples, using combined Baermann technique and Koga agar culture plate for S. stercoralis and Kato-Katz technique for hookworm. Bayesian multinomial geostatistical models were used to assess demographic, socioeconomic, and behavioural determinants of S. stercoralis-hookworm co-infection and to predict co-infection risk at non-surveyed locations. RESULTS Of the 2576 participants included in the study, 48.6% and 49.0% were infected with S. stercoralis and hookworm, respectively; 43.8% of the cases were co-infections. Females, preschool aged children, adults aged 19-49 years, and participants who reported regularly defecating in toilets, systematically boiling drinking water and having been treated with anthelmintic drugs had lower odds of co-infection. While S. stercoralis infection risk did not appear to be spatially structured, hookworm mono-infection and co-infection exhibited spatial correlation at about 20 km. Co-infection risk was positively associated with longer walking distances to a health centre and exhibited a small clustering tendency. The association was only partly explained by climatic variables, suggesting a role for underlying factors, such as living conditions and remoteness. CONCLUSIONS Both parasites were ubiquitous in the province, with co-infections accounting for almost half of all cases. The high prevalence of S. stercoralis calls for control measures. Despite several years of school-based de-worming programmes, hookworm infection levels remain high. Mebendazole efficacy, as well as coverage of and compliance to STH control programmes should be investigated.
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Affiliation(s)
- Armelle Forrer
- 0000 0004 0587 0574grid.416786.aSwiss Tropical and Public Health Institute, Basel, Switzerland
- 0000 0004 1937 0642grid.6612.3University of Basel, Basel, Switzerland
| | - Virak Khieu
- grid.415732.6National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Fabian Schär
- 0000 0004 0587 0574grid.416786.aSwiss Tropical and Public Health Institute, Basel, Switzerland
- 0000 0004 1937 0642grid.6612.3University of Basel, Basel, Switzerland
| | - Penelope Vounatsou
- 0000 0004 0587 0574grid.416786.aSwiss Tropical and Public Health Institute, Basel, Switzerland
- 0000 0004 1937 0642grid.6612.3University of Basel, Basel, Switzerland
| | - Frédérique Chammartin
- 0000 0004 0587 0574grid.416786.aSwiss Tropical and Public Health Institute, Basel, Switzerland
- 0000 0004 1937 0642grid.6612.3University of Basel, Basel, Switzerland
| | - Hanspeter Marti
- 0000 0004 0587 0574grid.416786.aSwiss Tropical and Public Health Institute, Basel, Switzerland
- 0000 0004 1937 0642grid.6612.3University of Basel, Basel, Switzerland
| | - Sinuon Muth
- grid.415732.6National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Peter Odermatt
- 0000 0004 0587 0574grid.416786.aSwiss Tropical and Public Health Institute, Basel, Switzerland
- 0000 0004 1937 0642grid.6612.3University of Basel, Basel, Switzerland
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26
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Thomas J, Christenson JK, Walker E, Baby KE, Peterson GM. Scabies-An ancient itch that is still rampant today. J Clin Pharm Ther 2017; 42:793-799. [DOI: 10.1111/jcpt.12631] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 09/04/2017] [Indexed: 12/31/2022]
Affiliation(s)
- J. Thomas
- Faculty of Health; University of Canberra; Bruce ACT Australia
| | | | - E. Walker
- Faculty of Health; University of Canberra; Bruce ACT Australia
| | - K. E. Baby
- The Canberra Hospital; Yamba Drive; Garran ACT Australia
| | - G. M. Peterson
- Faculty of Health; University of Tasmania; Hobart TAS Australia
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27
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Romani L, Whitfeld MJ, Koroivueta J, Kama M, Wand H, Tikoduadua L, Tuicakau M, Koroi A, Ritova R, Andrews R, Kaldor JM, Steer AC. The Epidemiology of Scabies and Impetigo in Relation to Demographic and Residential Characteristics: Baseline Findings from the Skin Health Intervention Fiji Trial. Am J Trop Med Hyg 2017; 97:845-850. [PMID: 28722612 DOI: 10.4269/ajtmh.16-0753] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Scabies and associated impetigo are under-recognized causes of morbidity in many developing countries. To strengthen the evidence base for scabies control we undertook a trial of mass treatment for scabies. We report on the occurrence and predictors of scabies and impetigo in participants at baseline. Participants were recruited in six island communities and were examined for the presence of scabies and impetigo. In addition to descriptive analyses, logistic regression models were fit to assess the association between demographic variables and outcome of interest. The study enrolled 2051 participants. Scabies prevalence was 36.4% (95% confidence interval [CI] 34.3-38.5), highest in children 5-9 years (55.7%). Impetigo prevalence was 23.4% (95% CI 21.5-25.2) highest in children aged 10-14 (39.0%). People with scabies were 2.8× more likely to have impetigo. The population attributable risk of scabies as a cause of impetigo was 36.3% and 71.0% in children aged less than five years. Households with four or more people sharing the same room were more likely to have scabies and impetigo (odds ratios [OR] 1.6, 95% CI 1.2-2.2 and OR 2.3, 95% CI 1.6-3.2 respectively) compared to households with rooms occupied by a single individual. This study confirms the high burden of scabies and impetigo in Fiji and the association between these two conditions, particularly in young children. Overcrowding, young age, and clinical distribution of lesion are important risk factors for scabies and impetigo. Further studies are needed to investigate whether the decline of endemic scabies would translate into a definite reduction of the burden of associated complications.
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Affiliation(s)
- Lucia Romani
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Margot J Whitfeld
- Department of Dermatology, St. Vincent's Hospital, Sydney, Australia
| | | | | | - Handan Wand
- Kirby Institute, University of New South Wales, Sydney, Australia
| | | | | | | | | | - Ross Andrews
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - John M Kaldor
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Andrew C Steer
- Murdoch Children's Research Institute, Melbourne, Australia.,Centre for International Child Health, University of Melbourne, Australia
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The Role of Nurses and Community Health Workers in Confronting Neglected Tropical Diseases in Sub-Saharan Africa: A Systematic Review. PLoS Negl Trop Dis 2016; 10:e0004914. [PMID: 27631980 PMCID: PMC5025105 DOI: 10.1371/journal.pntd.0004914] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Neglected tropical diseases produce an enormous burden on many of the poorest and most disenfranchised populations in sub-Saharan Africa. Similar to other developing areas throughout the world, this region's dearth of skilled health providers renders Western-style primary care efforts to address such diseases unrealistic. Consequently, many countries rely on their corps of nurses and community health workers to engage with underserved and hard-to-reach populations in order provide interventions against these maladies. This article attempts to cull together recent literature on the impact that nurses and community health workers have had on neglected tropical diseases. METHODS A review of the literature was conducted to assess the role nurses and community health workers play in the primary, secondary, and tertiary prevention of neglected tropical diseases in sub-Saharan Africa. Articles published between January 2005 and December 2015 were reviewed in order to capture the full scope of nurses' and community health workers' responsibilities for neglected tropical disease control within their respective countries' health systems. RESULTS A total of 59 articles were identified that fit all inclusion criteria. CONCLUSIONS Successful disease control requires deep and meaningful engagement with local communities. Expanding the role of nurses and community health workers will be required if sub-Saharan African countries are to meet neglected tropical disease treatment goals and eliminate the possibility future disease transmission. Horizontal or multidisease control programs can create complimentary interactions between their different control activities as well as reduce costs through improved program efficiencies-benefits that vertical programs are not able to attain.
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Opportunities for Integrated Control of Neglected Tropical Diseases That Affect the Skin. Trends Parasitol 2016; 32:843-854. [PMID: 27638231 DOI: 10.1016/j.pt.2016.08.005] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/04/2016] [Accepted: 08/05/2016] [Indexed: 11/23/2022]
Abstract
Many neglected tropical diseases (NTDs) affect the skin, causing considerable disability, stigma, and exacerbation of poverty. However, there has been relatively little investment into laboratory research, epidemiology, diagnostic tools or management strategies to control tropical skin disease. Integration may advance the control of skin disease across a range of domains, including mapping, diagnosis, clinical management, and community control measures such as mass drug administration. Examples of successful integration strategies include programs targeting scabies, impetigo, yaws, and diseases causing lymphoedema. Future strategies should build on these experiences and the experience of integration of other NTDs, strengthen existing health systems, and contribute toward the attainment of Universal Health Coverage. Strong partnerships and political support and will be necessary to achieve these goals.
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StrongNet: An International Network to Improve Diagnostics and Access to Treatment for Strongyloidiasis Control. PLoS Negl Trop Dis 2016; 10:e0004898. [PMID: 27607192 PMCID: PMC5015896 DOI: 10.1371/journal.pntd.0004898] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Yeoh DK, Bowen AC, Carapetis JR. Impetigo and scabies - Disease burden and modern treatment strategies. J Infect 2016; 72 Suppl:S61-7. [PMID: 27180311 DOI: 10.1016/j.jinf.2016.04.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Impetigo and scabies both present different challenges in resource-limited compared with industrialised settings. Severe complications of these skin infections are common in resource-limited settings, where the burden of disease is highest. The microbiology, risk factors for disease, diagnostic approaches and availability and suitability of therapies also vary according to setting. Taking this into account we aim to summarise recent data on the epidemiology of impetigo and scabies and describe the current evidence around approaches to individual and community based treatment.
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Affiliation(s)
- Daniel K Yeoh
- Princess Margaret Hospital for Children, Perth, Western Australia, Australia.
| | - Asha C Bowen
- Princess Margaret Hospital for Children, Perth, Western Australia, Australia; Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.
| | - Jonathan R Carapetis
- Princess Margaret Hospital for Children, Perth, Western Australia, Australia; Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.
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Romani L, Whitfeld MJ, Koroivueta J, Kama M, Wand H, Tikoduadua L, Tuicakau M, Koroi A, Andrews R, Kaldor JM, Steer AC. Mass Drug Administration for Scabies Control in a Population with Endemic Disease. N Engl J Med 2015; 373:2305-13. [PMID: 26650152 DOI: 10.1056/nejmoa1500987] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Scabies is an underrecognized cause of illness in many developing countries. It is associated with impetigo, which can lead to serious systemic complications. We conducted a trial of mass drug administration for scabies control in Fiji. METHODS We randomly assigned three island communities to one of three different interventions for scabies control: standard care involving the administration of permethrin to affected persons and their contacts (standard-care group), mass administration of permethrin (permethrin group), or mass administration of ivermectin (ivermectin group). The primary outcome was the change in the prevalence of scabies and of impetigo from baseline to 12 months. RESULTS A total of 2051 participants were enrolled; 803 were in the standard-care group, 532 in the permethrin group, and 716 in the ivermectin group. From baseline to 12 months, the prevalence of scabies declined significantly in all groups, with the greatest reduction seen in the ivermectin group. The prevalence declined from 36.6% to 18.8% in the standard-care group (relative reduction in prevalence, 49%; 95% confidence interval [CI], 37 to 60), from 41.7% to 15.8% in the permethrin group (relative reduction, 62%; 95% CI, 49 to 75), and from 32.1% to 1.9% in the ivermectin group (relative reduction, 94%; 95% CI, 83 to 100). The prevalence of impetigo also declined in all groups, with the greatest reduction seen in the ivermectin group. The prevalence declined from 21.4% to 14.6% in the standard-care group (relative reduction, 32%; 95% CI, 14 to 50), from 24.6% to 11.4% in the permethrin group (relative reduction, 54%; 95% CI, 35 to 73), and from 24.6% to 8.0% in the ivermectin group (relative reduction, 67%; 95% CI, 52 to 83). Adverse events were mild and were reported more frequently in the ivermectin group than in the permethrin group (15.6% vs. 6.8%). CONCLUSIONS Mass drug administration, particularly the administration of ivermectin, was efficacious for the control of scabies and impetigo. (Funded by the Australian National Health and Medical Research Council; Australian New Zealand Clinical Trials Registry number, ACTRN12613000474752.).
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Affiliation(s)
- Lucia Romani
- From Kirby Institute, University of New South Wales (L.R., H.W., J.M.K.), and the Department of Dermatology, St. Vincent's Hospital (M.J.W.), Sydney, Menzies School of Health Research, Charles Darwin University, Darwin, NT (R.A.), and the Centre for International Child Health, University of Melbourne (A.C.S.), Group A Streptococcal Research Group, Murdoch Children's Research Institute (A.C.S.), and Department of General Medicine, Royal Children's Hospital (A.C.S.), Melbourne, VIC - all in Australia; and the Ministry of Women, Children, and Poverty Alleviation (J.K.) and the Ministry of Health (M.K., L.T., M.T., A.K.) - both in Suva, Fiji
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Marks M, Taotao-Wini B, Satorara L, Engelman D, Nasi T, Mabey DC, Steer AC. Long Term Control of Scabies Fifteen Years after an Intensive Treatment Programme. PLoS Negl Trop Dis 2015; 9:e0004246. [PMID: 26624616 PMCID: PMC4666486 DOI: 10.1371/journal.pntd.0004246] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 10/28/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Scabies is a major public health problem in the Pacific and is associated with an increased risk of bacterial skin infections, glomerulonephritis and rheumatic fever. Mass drug administration with ivermectin is a promising strategy for the control of scabies. Mass treatment with ivermectin followed by active case finding was conducted in five communities in the Solomon Islands between 1997 and 2000 and resulted in a significant reduction in the prevalence of both scabies and bacterial skin infections. METHODS We conducted a prospective follow-up study of the communities where the original scabies control programme had been undertaken. All residents underwent a standardised examination for the detection of scabies and impetigo. RESULTS Three hundred and thirty eight residents were examined, representing 69% of the total population of the five communities. Only 1 case of scabies was found, in an adult who had recently returned from the mainland. The prevalence of active impetigo was 8.8% overall and 12.4% in children aged 12 years or less. DISCUSSION We found an extremely low prevalence of scabies 15 years after the cessation of a scabies control programme. The prevalence of impetigo had also declined further since the end of the control programme. Our results suggest that a combination of mass treatment with ivermectin and intensive active case finding may result in long term control of scabies. Larger scale studies and integration with other neglected tropical disease control programmes should be priorities for scabies control efforts.
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Affiliation(s)
- Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, United Kingdom
| | - Betty Taotao-Wini
- Department of Paediatrics, National Referral Hospital, Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Lorraine Satorara
- National Health Training Research Institute, Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Daniel Engelman
- Centre for International Child Health, University of Melbourne, Melbourne, Victoria, Australia
- Department of General Medicine, Royal Children’s Hospital, Melbourne, Victoria, Australia
- Group A Streptococcal Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Titus Nasi
- Department of Paediatrics, National Referral Hospital, Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - David C. Mabey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, United Kingdom
| | - Andrew C. Steer
- Centre for International Child Health, University of Melbourne, Melbourne, Victoria, Australia
- Department of General Medicine, Royal Children’s Hospital, Melbourne, Victoria, Australia
- Group A Streptococcal Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
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Anselmi M, Buonfrate D, Guevara Espinoza A, Prandi R, Marquez M, Gobbo M, Montresor A, Albonico M, Racines Orbe M, Martin Moreira J, Bisoffi Z. Mass Administration of Ivermectin for the Elimination of Onchocerciasis Significantly Reduced and Maintained Low the Prevalence of Strongyloides stercoralis in Esmeraldas, Ecuador. PLoS Negl Trop Dis 2015; 9:e0004150. [PMID: 26540412 PMCID: PMC4635009 DOI: 10.1371/journal.pntd.0004150] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 09/17/2015] [Indexed: 11/21/2022] Open
Abstract
Objectives To evaluate the effect of ivermectin mass drug administration on strongyloidiasis and other soil transmitted helminthiases. Methods We conducted a retrospective analysis of data collected in Esmeraldas (Ecuador) during surveys conducted in areas where ivermectin was annually administered to the entire population for the control of onchocerciasis. Data from 5 surveys, conducted between 1990 (before the start of the distribution of ivermectin) and 2013 (six years after the interruption of the intervention) were analyzed. The surveys also comprised areas where ivermectin was not distributed because onchocerciasis was not endemic. Different laboratory techniques were used in the different surveys (direct fecal smear, formol-ether concentration, IFAT and IVD ELISA for Strongyloides stercoralis). Results In the areas where ivermectin was distributed the strongyloidiasis prevalence fell from 6.8% in 1990 to zero in 1996 and 1999. In 2013 prevalence in children was zero with stool examination and 1.3% with serology, in adult 0.7% and 2.7%. In areas not covered by ivermectin distribution the prevalence was 23.5% and 16.1% in 1996 and 1999, respectively. In 2013 the prevalence was 0.6% with fecal exam and 9.3% with serology in children and 2.3% and 17.9% in adults. Regarding other soil transmitted helminthiases: in areas where ivermectin was distributed the prevalence of T. trichiura was significantly reduced, while A. lumbricoides and hookworms were seemingly unaffected. Conclusions Periodic mass distribution of ivermectin had a significant impact on the prevalence of strongyloidiasis, less on trichuriasis and apparently no effect on ascariasis and hookworm infections. Strongyloides stercoralis (Ss) is a soil-transmitted helminth (STH) that is not yet targeted by control programs, although it is highly prevalent in many areas of the world and may cause severe consequences, in particular to immunosuppressed patients, with a high fatality rate. Unfortunately, albendazole, the drug most commonly used for the control of the other STH (hookworm, Ascaris lumbricoides and Trichuris trichiura) has little effect on Ss. The drug of choice, ivermectin, has been extensively used in mass drug administration (MDA) for the filarial worms Onchocerca volvulus and Wuchereria bancrofti. In the province of Esmeraldas, in Ecuador, we studied Ss (and other STH) prevalence from 1990 (prior to MDA initiation) to 2013 (6 years after MDA cessation) in rural communities where MDA was regularly executed for onchocerciasis compared with neighboring communities where ivermectin was not distributed because onchocerciasis was not present. Ss prevalence remained high over the years in the areas with no MDA, while in those with MDA prevalence fell to zero, and remained very low 6 years after MDA cessation. A less important effect was observed for T. trichiura. Adding ivermectin to MDA programs for STH would importantly contribute to the control of Ss infection.
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Affiliation(s)
- Mariella Anselmi
- Centro de Epidemiología Comunitaria y Medicina Tropical (CECOMET), Esmeraldas, Ecuador
| | - Dora Buonfrate
- Centro per le Malattie tropicali, Negrar (Verona), Italy
| | | | - Rosanna Prandi
- Centro de Epidemiología Comunitaria y Medicina Tropical (CECOMET), Esmeraldas, Ecuador
| | - Monica Marquez
- Centro de Epidemiología Comunitaria y Medicina Tropical (CECOMET), Esmeraldas, Ecuador
| | - Maria Gobbo
- Centro per le Malattie tropicali, Negrar (Verona), Italy
| | - Antonio Montresor
- Department of Control of Neglected Tropical Diseases (NTD), World Health Organization (WHO), Geneva, Switzerland
| | | | - Marcia Racines Orbe
- Facultad de Ciencias Medicas, Universidad Central del Ecuador, Quito, Ecuador
| | - Juan Martin Moreira
- Centro de Epidemiología Comunitaria y Medicina Tropical (CECOMET), Esmeraldas, Ecuador
| | - Zeno Bisoffi
- Centro per le Malattie tropicali, Ospedale Sacro Cuore, Negrar (Verona), Italy
- * E-mail:
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Romani L, Steer AC, Whitfeld MJ, Kaldor JM. Prevalence of scabies and impetigo worldwide: a systematic review. THE LANCET. INFECTIOUS DISEASES 2015; 15:960-7. [DOI: 10.1016/s1473-3099(15)00132-2] [Citation(s) in RCA: 169] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Harris JR, Worrell CM, Davis SM, Odero K, Mogeni OD, Deming MS, Mohammed A, Montgomery JM, Njenga SM, Fox LM, Addiss DG. Unprogrammed deworming in the Kibera slum, Nairobi: implications for control of soil-transmitted helminthiases. PLoS Negl Trop Dis 2015; 9:e0003590. [PMID: 25763577 PMCID: PMC4357447 DOI: 10.1371/journal.pntd.0003590] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 02/04/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Programs for control of soil-transmitted helminth (STH) infections are increasingly evaluating national mass drug administration (MDA) interventions. However, "unprogrammed deworming" (receipt of deworming drugs outside of nationally-run STH control programs) occurs frequently. Failure to account for these activities may compromise evaluations of MDA effectiveness. METHODS We used a cross-sectional study design to evaluate STH infection and unprogrammed deworming among infants (aged 6-11 months), preschool-aged children (PSAC, aged 1-4 years), and school-aged children (SAC, aged 5-14 years) in Kibera, Kenya, an informal settlement not currently receiving nationally-run MDA for STH. STH infection was assessed by triplicate Kato-Katz. We asked heads of households with randomly-selected children about past-year receipt and source(s) of deworming drugs. Local non-governmental organizations (NGOs) and school staff participating in school-based deworming were interviewed to collect information on drug coverage. RESULTS Of 679 children (18 infants, 184 PSAC, and 477 SAC) evaluated, 377 (55%) reported receiving at least one unprogrammed deworming treatment during the past year. PSAC primarily received treatments from chemists (48.3%) or healthcare centers (37.7%); SAC most commonly received treatments at school (55.0%). Four NGOs reported past-year deworming activities at 47 of >150 schools attended by children in our study area. Past-year deworming was negatively associated with any-STH infection (34.8% vs 45.4%, p = 0.005). SAC whose most recent deworming medication was sourced from a chemist were more often infected with Trichuris (38.0%) than those who received their most recent treatment from a health center (17.3%) or school (23.1%) (p = 0.05). CONCLUSION Unprogrammed deworming was received by more than half of children in our study area, from multiple sources. Both individual-level treatment and unprogrammed preventive chemotherapy may serve an important public health function, particularly in the absence of programmed deworming; however, they may also lead to an overestimation of programmed MDA effectiveness. A standardized, validated tool is needed to assess unprogrammed deworming.
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Affiliation(s)
- Julie R. Harris
- Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Caitlin M. Worrell
- Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Stephanie M. Davis
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kennedy Odero
- Kenya Medical Research Institute, Centre for Global Health Research, Nairobi, Kenya
| | - Ondari D. Mogeni
- Kenya Medical Research Institute, Centre for Global Health Research, Nairobi, Kenya
| | - Michael S. Deming
- Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Aden Mohammed
- Public Health Department, School Health Program, Nairobi County, Nairobi, Kenya
| | - Joel M. Montgomery
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Sammy M. Njenga
- Kenya Medical Research Institute, Centre for Global Health Research, Nairobi, Kenya
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - LeAnne M. Fox
- Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - David G. Addiss
- Children Without Worms, Task Force for Global Health, Decatur, Georgia, United States of America
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Kobylinski KC, Alout H, Foy BD, Clements A, Adisakwattana P, Swierczewski BE, Richardson JH. Rationale for the coadministration of albendazole and ivermectin to humans for malaria parasite transmission control. Am J Trop Med Hyg 2014; 91:655-62. [PMID: 25070998 PMCID: PMC4183382 DOI: 10.4269/ajtmh.14-0187] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 06/04/2014] [Indexed: 10/25/2022] Open
Abstract
Recently there have been calls for the eradication of malaria and the elimination of soil-transmitted helminths (STHs). Malaria and STHs overlap in distribution, and STH infections are associated with increased risk for malaria. Indeed, there is evidence that suggests that STH infection may facilitate malaria transmission. Malaria and STH coinfection may exacerbate anemia, especially in pregnant women, leading to worsened child development and more adverse pregnancy outcomes than these diseases would cause on their own. Ivermectin mass drug administration (MDA) to humans for malaria parasite transmission suppression is being investigated as a potential malaria elimination tool. Adding albendazole to ivermectin MDAs would maximize effects against STHs. A proactive, integrated control platform that targets malaria and STHs would be extremely cost-effective and simultaneously reduce human suffering caused by multiple diseases. This paper outlines the benefits of adding albendazole to ivermectin MDAs for malaria parasite transmission suppression.
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Affiliation(s)
- Kevin C Kobylinski
- Entomology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland; Arthropod-Borne and Infectious Diseases Laboratory, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado; Research School of Population Health, The Australian National University, Canberra, Australian Capitol Territory, Australia; Department of Helminthology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland; Deployed Warfighter Protection Program, Armed Forces Pest Management Board, Silver Spring, Maryland
| | - Haoues Alout
- Entomology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland; Arthropod-Borne and Infectious Diseases Laboratory, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado; Research School of Population Health, The Australian National University, Canberra, Australian Capitol Territory, Australia; Department of Helminthology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland; Deployed Warfighter Protection Program, Armed Forces Pest Management Board, Silver Spring, Maryland
| | - Brian D Foy
- Entomology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland; Arthropod-Borne and Infectious Diseases Laboratory, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado; Research School of Population Health, The Australian National University, Canberra, Australian Capitol Territory, Australia; Department of Helminthology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland; Deployed Warfighter Protection Program, Armed Forces Pest Management Board, Silver Spring, Maryland
| | - Archie Clements
- Entomology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland; Arthropod-Borne and Infectious Diseases Laboratory, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado; Research School of Population Health, The Australian National University, Canberra, Australian Capitol Territory, Australia; Department of Helminthology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland; Deployed Warfighter Protection Program, Armed Forces Pest Management Board, Silver Spring, Maryland
| | - Poom Adisakwattana
- Entomology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland; Arthropod-Borne and Infectious Diseases Laboratory, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado; Research School of Population Health, The Australian National University, Canberra, Australian Capitol Territory, Australia; Department of Helminthology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland; Deployed Warfighter Protection Program, Armed Forces Pest Management Board, Silver Spring, Maryland
| | - Brett E Swierczewski
- Entomology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland; Arthropod-Borne and Infectious Diseases Laboratory, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado; Research School of Population Health, The Australian National University, Canberra, Australian Capitol Territory, Australia; Department of Helminthology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland; Deployed Warfighter Protection Program, Armed Forces Pest Management Board, Silver Spring, Maryland
| | - Jason H Richardson
- Entomology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland; Arthropod-Borne and Infectious Diseases Laboratory, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado; Research School of Population Health, The Australian National University, Canberra, Australian Capitol Territory, Australia; Department of Helminthology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland; Deployed Warfighter Protection Program, Armed Forces Pest Management Board, Silver Spring, Maryland
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Molyneux DH, Hopkins A, Bradley MH, Kelly-Hope LA. Multidimensional complexities of filariasis control in an era of large-scale mass drug administration programmes: a can of worms. Parasit Vectors 2014; 7:363. [PMID: 25128408 PMCID: PMC4261528 DOI: 10.1186/1756-3305-7-363] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 07/30/2014] [Indexed: 12/23/2022] Open
Abstract
The impact of control and elimination programmes by mass drug administration (MDA) targeting onchocerciasis and lymphatic filariasis (LF) in sub-Saharan Africa over the last two decades has resulted in significantly reduced prevalence and intensity of infection, with some areas interrupting transmission. However, given that these infections are often co-endemic and the drugs (either ivermectin alone or combined with albendazole) also impact on soil transmitted helminths (STH), the importance of this, in terms of reaching the global goals has not been assessed. The additional problem posed by Loa loa, where ivermectin cannot be safely administered due to the risk of serious adverse events compounds this situation and has left populations drug naïve and an alternative strategy to eliminate LF is yet to be initiated at scale. Here, we present a series of operational research questions, which must be addressed if the effectiveness of integrated control of filarial and helminth infections is to be understood for the endgame. This is particularly important in the diverse and dynamic epidemiological landscape, which has emerged as a result of the long-term large-scale mass drug administration (or not). There is a need for a more holistic approach to address these questions. Different programmes should examine this increased complexity, given that MDA has multiple impacts, drugs are given over different periods, and programmes have different individual targets.
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Affiliation(s)
- David H Molyneux
- />Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA UK
| | - Adrian Hopkins
- />Mectizan Donation Program, Task Force for Global Health, Decatur, Atlanta, GA USA
| | - Mark H Bradley
- />GlaxoSmithKline, Global Health Programme, Brentford, UK
| | - Louise A Kelly-Hope
- />Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA UK
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Okorie PN, Bockarie MJ, Molyneux DH, Kelly-Hope LA. Neglected tropical diseases: a systematic evaluation of research capacity in Nigeria. PLoS Negl Trop Dis 2014; 8:e3078. [PMID: 25121582 PMCID: PMC4133230 DOI: 10.1371/journal.pntd.0003078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 06/04/2014] [Indexed: 11/30/2022] Open
Abstract
Background Nigeria carries the highest burden and diversity of neglected tropical diseases (NTDs) in sub-Saharan Africa and is preparing to scale up its efforts to control/eliminate these diseases. To achieve this it will require a range of internal technical support and expertise for mapping, monitoring and evaluating, operational research and documenting its success. In order to begin to evaluate this potential in Nigeria, this study collated and analysed information for lymphatic filariasis (LF), onchocerciasis, schistosomiasis and soil-transmitted helminths (STH), which are currently being targeted with preventive chemotherapy through mass drug administration (MDA). Methodology/Principal Findings Information from 299 scientific articles published on the selected NTDs in 179 journals between January 2008 and September 2013 was extracted and systematically compiled into a geo-referenced database for analysis and mapping. The highest number of articles was from the southern geo-political zones of the country. The majority of articles focused on one specific disease, and schistosomiasis and STH were found to have the highest and most wide ranging research output. The main type of study was parasitological, and the least was biotechnological. Nigerian authors were mostly affiliated with universities, and there was a wide range of international co-authors from Africa and other regions, especially the USA and UK. The majority of articles were published in journals with no known impact factor. Conclusions/Significance The extensive database and series of maps on the research capacity within Nigeria produced in this study highlights the current potential that exists, and needs to be fully maximized for the control/elimination of NTDs in the country. This study provides an important model approach that can be applied to other low and middle income countries where NTDs are endemic, and NTD programmes require support from the expertise within their own country, as well as internationally, to help raise their profile and importance. Nigeria carries the highest burden and diversity of neglected tropical diseases (NTDs) in sub-Saharan Africa and is preparing to increase the control and elimination of these diseases. The aim of this study was to provide information on the disease focus and type of studies carried out by scientists working on lymphatic filariasis (LF), onchocerciasis, schistosomiasis, soil-transmitted helminths (STH)) and Loa loa filariasis in Nigeria. Information on these diseases from all published literature on the scientific articles by Nigerian authors published between January 2008 and September 2013 was collated and mapped. The results show that many institutions are working on NTDs in Nigeria and their capacity could be readily enhanced with training and resources to boost their skills and to increase their range of technical activities and research visibility, which will also help to provide essential technical and laboratory support to the national NTD programmes.
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Affiliation(s)
- Patricia N. Okorie
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- * E-mail:
| | - Moses J. Bockarie
- Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - David H. Molyneux
- Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Louise A. Kelly-Hope
- Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Can chemotherapy alone eliminate the transmission of soil transmitted helminths? Parasit Vectors 2014; 7:266. [PMID: 24916278 PMCID: PMC4079919 DOI: 10.1186/1756-3305-7-266] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 06/03/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Amongst the world's poorest populations, availability of anthelmintic treatments for the control of soil transmitted helminths (STH) by mass or targeted chemotherapy has increased dramatically in recent years. However, the design of community based treatment programmes to achieve the greatest impact on transmission is still open to debate. Questions include: who should be treated, how often should they be treated, how long should treatment be continued for? METHODS Simulation and analysis of a dynamic transmission model and novel data analyses suggest refinements of the World Health Organization guidelines for the community based treatment of STH. RESULTS This analysis shows that treatment levels and frequency must be much higher, and the breadth of coverage across age classes broader than is typically the current practice, if transmission is to be interrupted by mass chemotherapy alone. CONCLUSIONS When planning interventions to reduce transmission, rather than purely to reduce morbidity, current school-based interventions are unlikely to be enough to achieve the desired results.
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Webster JP, Molyneux DH, Hotez PJ, Fenwick A. The contribution of mass drug administration to global health: past, present and future. Philos Trans R Soc Lond B Biol Sci 2014; 369:20130434. [PMID: 24821920 DOI: 10.1098/rstb.2013.0434] [Citation(s) in RCA: 178] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Mass drug administration (MDA) is a means of delivering safe and inexpensive essential medicines based on the principles of preventive chemotherapy, where populations or sub-populations are offered treatment without individual diagnosis. High-coverage MDA in endemic areas aims to prevent and alleviate symptoms and morbidity on the one hand and can reduce transmission on the other, together improving global health. MDA is the recommended strategy of the World Health Organisation to control or eliminate several neglected tropical diseases (NTDs). More than 700 million people now receive these essential NTD medicines annually. The combined cost of integrated NTD MDA has been calculated to be in the order of $0.50 per person per year. Activities have recently been expanded due, in part, to the proposed attempt to eliminate certain NTDs in the coming two decades. More than 1.9 billion people need to receive MDA annually across several years if these targets are to be met. Such extensive coverage will require additional avenues of financial support, expanded monitoring and evaluation focusing on impact and drug efficacy, as well as new diagnostic tools and social science strategies to encourage adherence. MDA is a means to help reduce the burden of disease, and hence poverty, among the poorest sector of populations. It has already made significant improvements to global health and productivity and has the potential for further successes, particularly where incorporated into sanitation and education programmes. However logistical, financial and biological challenges remain.
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Affiliation(s)
- Joanne P Webster
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College Faculty of Medicine, , St Mary's Campus, London W2 1PG, UK
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Kwansa-Bentum B, Aboagye-Antwi F, Otchere J, Wilson MD, Boakye DA. Implications of low-density microfilariae carriers in Anopheles transmission areas: molecular forms of Anopheles gambiae and Anopheles funestus populations in perspective. Parasit Vectors 2014; 7:157. [PMID: 24690378 PMCID: PMC3974918 DOI: 10.1186/1756-3305-7-157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 03/27/2014] [Indexed: 12/04/2022] Open
Abstract
Background Previous studies have shown a general reduction in annual transmission potential (ATP) of Anopheles species after mass drug administration (MDA) in lymphatic filariasis endemic communities. Whereas results obtained from a monitoring programme after three years of MDA revealed a decrease in ATP of Anopheles funestus this was not the same for An. gambiae s.s. in Ghana. In this study, the ability of these vectors in transmitting Wuchereria bancrofti in nine lymphatic filariasis endemic communities in Gomoa District of Ghana after four rounds of MDA with ivermectin and albendazole was investigated. Methods After mass screening of inhabitants in these communities, twelve consenting volunteers with different intensities of microfilariae (mf) slept under partly opened mosquito nets as sources of mf blood meal. Hourly collection of mosquitoes and finger-pricked blood were taken from 21.00 to 06.00 hours the following day. For each hour, half of the mosquitoes collected were immediately killed and dissected for mf. The remaining half were maintained up to 13 days for parasite maturation. Parasitaemia and infection rates in the mosquitoes were determined by microscopy. The mosquitoes were identified by microscopy and molecular techniques. Results A total of 1,083 participants were screened and the overall parasite prevalence was 1.6% with mf intensities ranging from 0 to 59 per 100 μl and geometric mean intensity of 1.1 mf per ml of blood. Of the 564 mosquitoes collected, 350 (62.1%) were Anopheles spp., from which 310 (88.6%) were An. funestus and 32 (9.1%) An. gambiae. Six anopheline mosquitoes (1.7%) were found infected with L1, but no larva was observed in any of the mosquitoes maintained up to 13 days. Molecular studies showed all An. gambiae s.l. to be An. gambiae s.s., of which 21 (70%) were of the M molecular form. Conclusion At low-level parasitaemia after 4 rounds of MDA, there was no recovery of infective stage larvae of W. bancrofti in An. funestus s.l. as well as M and S forms of An. gambiae.
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Affiliation(s)
| | | | | | | | - Daniel Adjei Boakye
- Parasitology Department, Noguchi Memorial Institute for Medical Research, P,O, Box LG 581 Legon, Accra, Ghana.
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Chu BK, Gass K, Batcho W, 'Ake M, Dorkenoo AM, Adjinacou E, Mafi 'E, Addiss DG. Pilot assessment of soil-transmitted helminthiasis in the context of transmission assessment surveys for lymphatic filariasis in Benin and Tonga. PLoS Negl Trop Dis 2014; 8:e2708. [PMID: 24551267 PMCID: PMC3923741 DOI: 10.1371/journal.pntd.0002708] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 12/30/2013] [Indexed: 11/18/2022] Open
Abstract
Background Mass drug administration (MDA) for lymphatic filariasis (LF) programs has delivered more than 2 billion treatments of albendazole, in combination with either ivermectin or diethylcarbamazine, to communities co-endemic for soil-transmitted helminthiasis (STH), reducing the prevalence of both diseases. A transmission assessment survey (TAS) is recommended to determine if MDA for LF can be stopped within an evaluation unit (EU) after at least five rounds of annual treatment. The TAS also provides an opportunity to simultaneously assess the impact of these MDAs on STH and to determine the frequency of school-based MDA for STH after community-wide MDA is no longer needed for LF. Methodology/Principal Findings Pilot studies conducted in Benin and Tonga assessed the feasibility of a coordinated approach. Of the schools (clusters) selected for a TAS in each EU, a subset of 5 schools per STH ecological zone was randomly selected, according to World Health Organization (WHO) guidelines, for the coordinated survey. In Benin, 519 children were sampled in 5 schools and 22 (4.2%) had STH infection (A. lumbricoides, T. trichiura, or hookworm) detected using the Kato-Katz method. All infections were classified as light intensity under WHO criteria. In Tonga, 10 schools were chosen for the coordinated TAS and STH survey covering two ecological zones; 32 of 232 (13.8%) children were infected in Tongatapu and 82 of 320 (25.6%) in Vava'u and Ha'apai. All infections were light-intensity with the exception of one with moderate-intensity T. trichiura. Conclusions Synchronous assessment of STH with TAS is feasible and provides a well-timed evaluation of infection prevalence to guide ongoing treatment decisions at a time when MDA for LF may be stopped. The coordinated field experiences in both countries also suggest potential time and cost savings. Refinement of a coordinated TAS and STH sampling methodology should be pursued, along with further validation of alternative quantitative diagnostic tests for STH that can be used with preserved stool specimens. Since 2000, some 2 billion preventive chemotherapy treatments have been delivered for lymphatic filariasis (LF), many in areas co-endemic for soil-transmitted helminthiasis (STH). A transmission assessment survey (TAS) is recommended to determine if such ‘mass drug administration (MDA)’ for LF can be stopped in a specified evaluation unit. The TAS also provides an opportune platform to simultaneously conduct STH assessments and make informed programmatic decisions about STH control. Through piloting this coordinated TAS and STH survey approach in Benin and Tonga, we found that after 5–6 rounds of annual MDA, STH prevalence was 4.2% in Benin and 13.8–25.6% in Tonga. All infections were light intensity except one moderate A. lumbricoides case in Tonga. Our study highlights that a coordinated strategy is operationally feasible, programmatically relevant, and potentially cost-effective. A more robust sampling methodology for coordinated TAS and STH surveys should be further explored, as well as alternative diagnostic tests for STH.
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Affiliation(s)
- Brian K. Chu
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Atlanta, Georgia, United States of America
- * E-mail: ,
| | - Katherine Gass
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Atlanta, Georgia, United States of America
| | - Wilfrid Batcho
- Programme National de Lutte Contre les Maladies Transmissibles, Ministère de la Santé, Cotonou, Benin
| | - Malakai 'Ake
- Public Health Division, Ministry of Health, Nuku'alofa, Tonga
| | - Améyo M. Dorkenoo
- Programme National d'Elimination de la Filariose Lymphatique, Ministère de la Santé, Lomé, Togo
| | - Elvire Adjinacou
- Programme National de Lutte Contre les Maladies Transmissibles, Ministère de la Santé, Cotonou, Benin
| | - 'Eva Mafi
- Public Health Division, Ministry of Health, Nuku'alofa, Tonga
| | - David G. Addiss
- Children Without Worms, Task Force for Global Health, Atlanta, Georgia, United States of America
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Gunawardena S, Gunawardena NK, Kahathuduwa G, Karunaweera ND, de Silva NR, Ranasinghe UB, Samarasekara SD, Nagodavithana KC, Rao RU, Rebollo MP, Weil GJ. Integrated school-based surveillance for soil-transmitted helminth infections and lymphatic filariasis in Gampaha district, Sri Lanka. Am J Trop Med Hyg 2014; 90:661-6. [PMID: 24493672 DOI: 10.4269/ajtmh.13-0641] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We explored the practicality of integrating surveillance for soil-transmitted helminthiasis (STH, assessed by Kato-Katz) with transmission assessment surveys for lymphatic filariasis (LF) in two evaluation units (EUs) in Gampaha district, Sri Lanka (population 2.3 million). The surveys were performed 6 years after five annual rounds of mass drug administration with diethylcarbamazine and albendazole. Each transmission assessment survey tested children (N = 1,462 inland EU; 1,642 coastal EU) sampled from 30 primary schools. Low filarial antigenemia rates (0% and 0.1% for the inland and coastal EUs) suggest that LF transmission is very low in this district. The STH rates and stool sample participation rates were 0.8% and 61% (inland) and 2.8% and 58% (coastal). Most STH detected were low or moderate intensity Trichuris trichiura infections. The added cost of including STH testing was ∼$5,000 per EU. These results suggest that it is feasible to integrate school-based surveillance for STH and LF.
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Affiliation(s)
- Sharmini Gunawardena
- Department of Parasitology, Faculty of Medicine, University of Colombo, Sri Lanka; Department of Parasitology, Faculty of Medicine, University of Kelaniya, Sri Lanka; Anti Filariasis Campaign, Ministry of Health, Sri Lanka; Department of Internal Medicine, Infectious Diseases Division, Washington University School of Medicine, St. Louis, Missouri; Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, United Kingdom
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Montresor A, Gabrielli AF, Engels D, Daumerie D, Savioli L. Has the NTD community neglected evidence-based policy? PLOS NTDs 2013 expert commentary of the viewpoint by Nagpal S, Sinclair D, Garner P. PLoS Negl Trop Dis 2013; 7:e2299. [PMID: 23875037 PMCID: PMC3708845 DOI: 10.1371/journal.pntd.0002299] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Antonio Montresor
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland.
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Bockarie MJ, Kelly-Hope LA, Rebollo M, Molyneux DH. Preventive chemotherapy as a strategy for elimination of neglected tropical parasitic diseases: endgame challenges. Philos Trans R Soc Lond B Biol Sci 2013; 368:20120144. [PMID: 23798692 PMCID: PMC3720042 DOI: 10.1098/rstb.2012.0144] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Global efforts to address neglected tropical diseases (NTDs) were stimulated in January 2012 by the London declaration at which 22 partners, including the Bill & Melinda Gates Foundation, World Bank, World Health Organization (WHO) and major pharmaceutical companies committed to sustaining and expanding NTD programmes to eliminate or eradicate 11 NTDs by 2020 to achieve the goals outlined in the recently published WHO road map. Here, we present the current context of preventive chemotherapy for some NTDs, and discuss the problems faced by programmes as they consider the 'endgame', such as difficulties of access to populations in post-conflict settings, limited human and financial resources, and the need to expand access to clean water and improved sanitation for schistosomiasis and soil-transmitted helminthiasis. In the case of onchocerciasis and lymphatic filariasis, ivermectin treatment carries a significant risk owing to serious adverse effects in some patients co-infected with the tropical eye worm Loa loa filariasis. We discuss the challenges of managing complex partnerships, and maintain advocacy messages for the continued support for elimination of these preventable diseases.
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Affiliation(s)
- Moses J Bockarie
- Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK.
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Engelman D, Martin DL, Hay RJ, Chosidow O, McCarthy JS, Fuller LC, Steer AC. Opportunities to investigate the effects of ivermectin mass drug administration on scabies. Parasit Vectors 2013; 6:106. [PMID: 23594459 PMCID: PMC3639091 DOI: 10.1186/1756-3305-6-106] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 04/15/2013] [Indexed: 11/30/2022] Open
Abstract
The recent article by Mohammed et al. demonstrates an impressive effect of ivermectin mass drug administration for lymphatic filariasis on the burden of scabies. Partnering scabies research within the evaluation and monitoring of Neglected Tropical Disease programmes could potentially increase our understanding of the epidemiology and control of scabies and its important bacterial complications.
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Bisoffi Z, Buonfrate D, Montresor A, Requena-Méndez A, Muñoz J, Krolewiecki AJ, Gotuzzo E, Mena MA, Chiodini PL, Anselmi M, Moreira J, Albonico M. Strongyloides stercoralis: a plea for action. PLoS Negl Trop Dis 2013; 7:e2214. [PMID: 23675546 PMCID: PMC3649953 DOI: 10.1371/journal.pntd.0002214] [Citation(s) in RCA: 189] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Zeno Bisoffi
- Centre for Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy.
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