Background Public health interventions based on distribution of anthelminthic drugs against lymphatic filariasis (LF), onchocerciasis, soil-transmitted helminthiasis (STH) and schistosomiasis have been implemented separately to date. A better use of available resources might be facilitated by a more coordinated approach to control such infections, including the possibility of co-administering the three recommended anthelminthic drugs through a single, large-scale intervention. Methodology/Principal Findings Ivermectin, albendazole and praziquantel were co-administered to 5,055 children and adults living in areas endemic for LF, STH and schistosomiasis in Zanzibar, United Republic of Tanzania, during a pilot intervention aimed at elucidating and quantifying possible side-effects. Subsequently, these drugs were co-administered to about 700,000 individuals during a countrywide intervention targeting a large part of the total population of Zanzibar. Passive and active surveillance measures carried out during both interventions showed that side-effects attributable to the three drugs given at the same time were mild and self-limiting events. Conclusions/Significance Our data suggest that co-administration of ivermectin, albendazole and praziquantel is safe in areas where lymphatic filariasis, soil-transmitted helminthiasis and schistosomiasis are co-endemic and where several rounds of treatment with one or two drugs have been implemented in the past. Passive surveillance measures, however, should be continued and detection, management and reporting of possible side-effects should be considered a key component of any health intervention administering drugs.
References
[1]
World Health Organization (2006) Preventive chemotherapy in human helminthiasis. Coordinated use of anthelminthic drugs in control interventions: a manual for health professionals and programme managers. Geneva: World Health Organization.
[2]
Das PK, Ramaiah KD, Augustin DJ, Kumar A (2001) Towards elimination of lymphatic filariasis in India. Trends Parasitol 10: 457–460. doi: 10.1016/S1471-4922(01)02056-6
[3]
World Health Organization (1995) World Health Organization Report 1995: Bridging the Gaps. Geneva: World Health Organization.
[4]
Fenwick A (2006) New initiatives against Africa's worms. Trans R Soc Trop Med Hyg 100: 200–207. doi: 10.1016/j.trstmh.2005.03.014
[5]
Chitsulo L, Engels D, Montresor A, Savioli L (2000) The global status of schistosomiasis and its control. Acta Trop 77: 41–51. doi: 10.1016/S0001-706X(00)00122-4
[6]
Steinmann P, Keiser J, Bos R, Tanner M, Utzinger J (2006) Schistosomiasis and water resources development: systematic review, meta-analysis, and estimates of people at risk. Lancet Infect Dis 6: 411–425. doi: 10.1016/S1473-3099(06)70521-7
[7]
Crompton DWT (1999) How much helminthiasis is there in the world? J Parasitol 85: 397–403. doi: 10.2307/3285768
[8]
Bethony J, Brooker S, Albonico M, Geiger SM, Loukas A, Diemert D, Hotez PJ (2006) Soil-transmitted helminth infections: ascariasis, trichuriasis, and hookworm. Lancet 368: 1521–1532. doi: 10.1016/S0140-6736(06)68653-4
de Silva NR, Brooker S, Hotez PJ, Montresor A, Engels D, et al. (2003) Soil-transmitted helminth infections: updating the global picture. Trends Parasitol 19: 547–551. doi: 10.1016/j.pt.2003.10.002
[11]
Raso G, Luginbuhl A, Adjoua CA, Tian-Bi NT, Silue KD, et al. (2004) Multiple parasite infections and their relationship to self-reported morbidity in a community of rural C？te d'Ivoire. Int J Epidemiol 33: 1092–1102. doi: 10.1093/ije/dyh241
[12]
Babu BV, Swain BK, Rath K (2006) Impact of chronic lymphatic filariasis on quantity and quality of productive work among weavers in an endemic village from India. Trop Med Int Health 11: 721–717.
[13]
Crompton DWT, Nesheim MC (2002) Nutritional impact of intestinal helminthiasis during the human life cycle. Annu Rev Nutr 22: 35–59. doi: 10.1146/annurev.nutr.22.120501.134539
[14]
Gryseels B, Polman K, Clerinx J, Kestens L (2006) Human schistosomiasis. Lancet 368: 1106–1118. doi: 10.1016/S0140-6736(06)69440-3
[15]
Stephenson LS, Latham MC, Ottesen EA (2000) Malnutrition and parasitic helminth infection. Parasitology 121: SupplS23–S38. doi: 10.1017/S0031182000006491
[16]
Stoltzfus R, Albonico M, Tielsch J, Chwaya HM, Savioli L (1997) Linear growth retardation in Zanzibari schoolchildren. J Nutr 127: 1099–1105.
[17]
Mohammed KA, Molyneux DH, Albonico M, Rio F (2006) Progress towards eliminating lymphatic filariasis in Zanzibar: a model programme. Trends Parasitol 22: 340–344. doi: 10.1016/j.pt.2006.05.010
[18]
Savioli L, Dixon H, Kisumku UM, Mott KE (1989) Control of morbidity due to S. haematobium on Pemba Island: selective population of school children to identify high risk localities. Trans R Soc Trop Med Hyg 83: 805–810. doi: 10.1016/0035-9203(89)90336-2
[19]
Stothard JR, Mgeni AF, Khamis S, Seto E, Ramsan M, Hubbard SJ, Kristensen TK, Rollinson D (2002) New insights into the transmission biology of urinary schistosomiasis in Zanzibar. Trans R Soc Trop Med Hyg 96: 470–475. doi: 10.1016/S0035-9203(02)90406-2
[20]
Stothard JR, Mgeni AF, Khamis S, Seto E, Ramsan M, Rollinson D (2002) Urinary schistosomiasis in schoolchildren on Zanzibar island (Unguja), Tanzania: a parasitological survey supplemented with questionnaires. Trans R Soc Trop Med Hyg 96: 507–14. doi: 10.1016/S0035-9203(02)90421-9
[21]
Renganathan E, Ercole E, Albonico M, De Gregorio G, Alawi KS, Kisumku UM, Savioli L (1995) Evolution of operational research studies and development of a national control strategy against intestinal helminths: the Pemba Island experience (1988–1992). Bull World Health Organ 73: 183–190.
[22]
World Health Organization (2005) Monitoring and epidemiological assessment of the programme to eliminate lymphatic filariasis at implementation unit level. Geneva: World Health Organization.
[23]
Horton J, Witt C, Ottesen EA, Lazdins JK, Addiss DG, et al. (2000) An analysis of the safety of single dose, two drug regimens used in programmes to eliminate lymphatic filariasis. Parasitology 121: (supplement)S147–S160. doi: 10.1017/S0031182000007423
[24]
Olds GR, King C, Hewlett J, Olveda R, Wu G, et al. (1999) Double-blind, placebo-controlled study of concurrent administration of albendazole and praziquantel in schoolchildren with schistosomiasis and geohelminths. J Infect Dis 179: 996–1003. doi: 10.1086/314686
[25]
Loukas A, Hotez PJ (2006) Chemotherapy of helminth infections. In: Brunton LL, Lazo JS, Parker KL, editors. Goodman and Gilman's The pharmacological basis of therapeutics, 11th Edition. New York: McGraw-Hill. pp. 1073–1093.
[26]
Na-bangchang K, Kietinun S, Pawa KK, Hanpitakpong W, Na-bangchang C, et al. (2006) Assessments of pharmacokinetic drug interactions and tolerability of albendazole, praziquantel and ivermectin combinations. Trans R Soc Trop Med Hyg 100: 333–345. doi: 10.1016/j.trstmh.2005.05.017
[27]
Weil GJ, Lammie PJ, Weiss N (1997) The ICT filariais test: a rapid-format antigen test for diagnosis of Bancroftian filariasis. Parasit. Today 13: 401–404. doi: 10.1016/s0169-4758(97)01130-7
[28]
Booth M, Vounatson P, N'goran EK, Tanner M, Utzinger J (2003) The influence of sampling effort and the performance of the Kato-Katz technique in diagnosing Schistosoma mansoni and hookworm co-infections in rural Cote d'Ivoire. Parasitology 103: 525–531. doi: 10.1017/S0031182003004128
[29]
Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat (2007) World Population Prospects: The 2006 Revision. New York: United Nations.
[30]
Alexander ND, Cousens SN, Yahaya H, Abiose A, Jones BR (2006) Ivermectin dose assessment without weighing scales. Bull World Health Organ 71: 361–366.
[31]
Montresor A, Engels D, Chitsulo L, Bundy DA, Brooker S, et al. (2001) Development and validation of a “tablet pole” for the administration of praziquantel in sub-Saharan Africa. Trans R Soc Trop Med Hyg 95: 542–544. doi: 10.1016/S0035-9203(01)90034-3
[32]
Montresor A, Engels , Ramsan D, Foum A, Savioli L (2002) Field test of the “dose pole” for praziquantel in Zanzibar. Trans R Soc Trop Med Hyg 96: 323–324. doi: 10.1016/S0035-9203(02)90111-2
[33]
World Health Organization (2003) Report on active surveillance for adverse events following the use of drug co-administrations in the Global Programme to Eliminate Lymphatic Filariasis. Wkly Epidemiol Rec 36: 313–320.
[34]
Dodoo A, Adjei S, Couper M, Hugman B, Edwards R (2007) When rumours derail a mass deworming exercise. The Lancet 370: 465–466. doi: 10.1016/s0140-6736(07)61211-2
[35]
Lammie PJ, Fenwick A, Utzinger J (2006) A blueprint for success: integration of neglected tropical diseases control programmes. Trends Parasitol 22: 313–321. doi: 10.1016/j.pt.2006.05.009
[36]
Brady MA, Hooper PJ, Ottesen EA (2006) Project benefits from integrating NTD programs in sub-Saharan Africa. Trends Parasitol 22: 285–291. doi: 10.1016/j.pt.2006.05.007
[37]
Hotez PJ, Molyneux DH, Fenwick A, Ottesen EA, Sachs SE, Sachs JD (2006) Incorporating a rapid-impact package for neglected tropical diseases with programs for HIV/AIDS, tuberculosis, and malaria. PLoS Med e102. doi: 10.1371/journal.pmed.0030102
[38]
Richards FO Jr, Eigege A, Miri ES, Jinadu MY, Hopkins DR (2006) Integration of mass drug administration programmes in Nigeria: the challenge of schistosomiasis. Bull World Health Organ 84: 673–6. Erratum in: Bull World Health Organ 84:760. doi: 10.2471/BLT.06.029652
