Selective mass treatment with ivermectin to control intestinal helminthiases and parasitic skin diseases in a severely affected population.
OBJECTIVE
To assess the short-term and long-term impact of selective mass treatment with ivermectin on the prevalence of intestinal helminthiases and parasitic skin diseases in an economically depressed community in north-east Brazil.


METHODS
An intervention was carried out in a traditional fishing village in north-east Brazil where the population of 605 is heavily affected by ectoparasites and enteroparasites. The prevalence of intestinal helminths was determined by serial stool examination and the prevalence of parasitic skin diseases by clinical inspection. A total of 525 people out of a target population of 576 were treated at baseline. The majority of these were treated with ivermectin (200 microg/kg with a second dose given after 10 days). If ivermectin was contraindicated, participants were treated with albendazole or mebendazole for intestinal helminths or with topical deltamethrin for ectoparasites. Follow-up examinations were performed at 1 month and 9 months after treatment.


RESULTS
Prevalence rates of intestinal helminthiases before treatment and at 1 month and 9 months after mass treatment were: hookworm disease 28.5%, 16.4% and 7.7%; ascariasis 17.1%, 0.4% and 7.2%; trichuriasis 16.5%, 3.4% and 9.4%; strongyloidiasis 11.0%, 0.6% and 0.7%; and hymenolepiasis 0.6%; 0.4% and 0.5%, respectively. Prevalence rates of parasitic skin diseases before treatment and 1 month and 9 months after mass treatment were: active pediculosis 16.1%, 1.0% and 10.3%; scabies 3.8%, 1.0% and 1.5%; cutaneous larva migrans 0.7%, 0% and 0%; tungiasis 51.3%, 52.1% and 31.2%, respectively. Adverse events occurred in 9.4% of treatments. They were all of mild to moderate severity and were transient.


CONCLUSIONS
Mass treatment with ivermectin was an effective and safe means of reducing the prevalence of most of the parasitic diseases prevalent in a poor community in north-east Brazil. The effects of treatment lasted for a prolonged period of time.
Heukelbach
Jörg
J
Department of Community Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil.
Winter
Benedikt
B
Wilcke
Thomas
T
Muehlen
Marion
M
Albrecht
Stephan
S
de Oliveira
Fabíola Araújo Sales
FA
Kerr-Pontes
Lígia Regina Sansigolo
LR
Liesenfeld
Oliver
O
Feldmeier
Hermann
H
D000328:Adult; D000977:Antiparasitic Agents; D001938:Brazil / Q000453:epidemiology; D005260:Female; D006373:Helminthiasis / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007411:Intestinal Diseases, Parasitic / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D007559:Ivermectin / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D015995:Prevalence; D015980:Public Health Practice; D012532:Scabies / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D012876:Skin Diseases, Parasitic / Q000453:epidemiology / Q000517:prevention & control; D017206:Strongylida Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D016896:Treatment Outcome
D000977:Antiparasitic Agents; D007559:Ivermectin