Placebo-controlled community trial of four cycles of single-dose diethylcarbamazine or ivermectin against Wuchereria bancrofti infection and transmission in India.
Identifieur interne : 012A79 ( Main/Exploration ); précédent : 012A78; suivant : 012A80Placebo-controlled community trial of four cycles of single-dose diethylcarbamazine or ivermectin against Wuchereria bancrofti infection and transmission in India.
Auteurs : P K Das [Inde] ; K D Ramaiah ; P. Vanamail ; S P Pani ; J. Yuvaraj ; K. Balarajan ; D A BundySource :
- Transactions of the Royal Society of Tropical Medicine and Hygiene [ 0035-9203 ]
Descripteurs français
- KwdFr :
- Diéthylcarbamazine (administration et posologie), Filaricides (administration et posologie), Filariose lymphatique (traitement médicamenteux), Filariose lymphatique (transmission), Humains, Ivermectine (administration et posologie), Méthode en double aveugle, Observance thérapeutique, Services de santé communautaires.
- MESH :
- administration et posologie : Diéthylcarbamazine, Filaricides, Ivermectine.
- traitement médicamenteux : Filariose lymphatique.
- transmission : Filariose lymphatique, Humains, Méthode en double aveugle, Observance thérapeutique, Services de santé communautaires.
English descriptors
- KwdEn :
- MESH :
- chemical , administration & dosage : Diethylcarbamazine, Filaricides, Ivermectin.
- drug therapy : Elephantiasis, Filarial.
- transmission : Elephantiasis, Filarial.
- Community Health Services, Double-Blind Method, Humans, Patient Compliance.
Abstract
A double-blind placebo-controlled trial was carried out in 1994-98 to compare the effects of 4 cycles of single-dose diethylcarbamazine (DEC) or ivermectin on prevalence and geometric mean intensity (GMI) of microfilaraemia in the human population, infection rates in the vector population, and transmission intensity of Culex-transmitted Wuchereria bancrofti in rural areas in Tamil Nadu state, south India. Fifteen villages (population approximately 26,800) were included in the study: 5 villages each were randomly assigned to community-wide treatment with DEC or ivermectin or placebo. People over 14 kg bodyweight received DEC 6 mg/kg, ivermectin 400 micrograms/kg or a placebo, all identically packaged. After 2 cycles of treatment at a 6-month interval, the code was broken and the study continued as an open trial, with third and fourth cycles of treatment at a 12-month interval; 54-77% of eligible people (20,872) received treatment during the 4 cycles. Microfilaraemia prevalence and GMI fell by 48% and 65% with DEC and 60% and 80% with ivermectin respectively after 4 cycles of treatment. There was no change in the incidence of acute adenolymphangitis. Infection in resting mosquitoes fell significantly in all arms: 82%, 78% and 42% in the ivermectin, DEC and placebo arm, respectively. Landing mosquitoes also showed the same trend. The decline in infectivity was significant for resting (P < 0.05) and landing mosquitoes (P < 0.05) with ivermectin and DEC (P < 0.05), and for neither in the placebo group (P > 0.05). Transmission intensity was reduced by 68% with ivermectin and 63% with DEC. Transmission was apparently interrupted in 1 village with ivermectin, but infected resting mosquitoes were consistently found in this village. Single-dose community-level treatment with DEC or ivermectin is effective in reducing W. bancrofti infection in humans and mosquitoes, and may result in total interruption of transmission after several years of control. There is an immediate need to define the role of vector, parasite and community factors that influence the elimination of lymphatic filariasis, particularly the duration of treatment vis-à-vis efficacy of drugs, treatment compliance and efficiency of vectors.
PubMed: 11491011
Affiliations:
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Le document en format XML
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<sourceDesc><biblStruct><analytic><title xml:lang="en">Placebo-controlled community trial of four cycles of single-dose diethylcarbamazine or ivermectin against Wuchereria bancrofti infection and transmission in India.</title>
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<affiliation wicri:level="1"><nlm:affiliation>Vector Control Research Centre, Medical Complex, Indira Nagar, Pondicherry-605 006, India. mosquito@sancharnet.in</nlm:affiliation>
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<author><name sortKey="Ramaiah, K D" sort="Ramaiah, K D" uniqKey="Ramaiah K" first="K D" last="Ramaiah">K D Ramaiah</name>
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<author><name sortKey="Vanamail, P" sort="Vanamail, P" uniqKey="Vanamail P" first="P" last="Vanamail">P. Vanamail</name>
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<author><name sortKey="Pani, S P" sort="Pani, S P" uniqKey="Pani S" first="S P" last="Pani">S P Pani</name>
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<author><name sortKey="Yuvaraj, J" sort="Yuvaraj, J" uniqKey="Yuvaraj J" first="J" last="Yuvaraj">J. Yuvaraj</name>
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<author><name sortKey="Balarajan, K" sort="Balarajan, K" uniqKey="Balarajan K" first="K" last="Balarajan">K. Balarajan</name>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Community Health Services</term>
<term>Diethylcarbamazine (administration & dosage)</term>
<term>Double-Blind Method</term>
<term>Elephantiasis, Filarial (drug therapy)</term>
<term>Elephantiasis, Filarial (transmission)</term>
<term>Filaricides (administration & dosage)</term>
<term>Humans</term>
<term>Ivermectin (administration & dosage)</term>
<term>Patient Compliance</term>
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<keywords scheme="KwdFr" xml:lang="fr"><term>Diéthylcarbamazine (administration et posologie)</term>
<term>Filaricides (administration et posologie)</term>
<term>Filariose lymphatique (traitement médicamenteux)</term>
<term>Filariose lymphatique (transmission)</term>
<term>Humains</term>
<term>Ivermectine (administration et posologie)</term>
<term>Méthode en double aveugle</term>
<term>Observance thérapeutique</term>
<term>Services de santé communautaires</term>
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<term>Filaricides</term>
<term>Ivermectin</term>
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<keywords scheme="MESH" qualifier="administration et posologie" xml:lang="fr"><term>Diéthylcarbamazine</term>
<term>Filaricides</term>
<term>Ivermectine</term>
</keywords>
<keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Elephantiasis, Filarial</term>
</keywords>
<keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr"><term>Filariose lymphatique</term>
</keywords>
<keywords scheme="MESH" qualifier="transmission" xml:lang="en"><term>Elephantiasis, Filarial</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Community Health Services</term>
<term>Double-Blind Method</term>
<term>Humans</term>
<term>Patient Compliance</term>
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<keywords scheme="MESH" qualifier="transmission" xml:lang="fr"><term>Filariose lymphatique</term>
<term>Humains</term>
<term>Méthode en double aveugle</term>
<term>Observance thérapeutique</term>
<term>Services de santé communautaires</term>
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<front><div type="abstract" xml:lang="en">A double-blind placebo-controlled trial was carried out in 1994-98 to compare the effects of 4 cycles of single-dose diethylcarbamazine (DEC) or ivermectin on prevalence and geometric mean intensity (GMI) of microfilaraemia in the human population, infection rates in the vector population, and transmission intensity of Culex-transmitted Wuchereria bancrofti in rural areas in Tamil Nadu state, south India. Fifteen villages (population approximately 26,800) were included in the study: 5 villages each were randomly assigned to community-wide treatment with DEC or ivermectin or placebo. People over 14 kg bodyweight received DEC 6 mg/kg, ivermectin 400 micrograms/kg or a placebo, all identically packaged. After 2 cycles of treatment at a 6-month interval, the code was broken and the study continued as an open trial, with third and fourth cycles of treatment at a 12-month interval; 54-77% of eligible people (20,872) received treatment during the 4 cycles. Microfilaraemia prevalence and GMI fell by 48% and 65% with DEC and 60% and 80% with ivermectin respectively after 4 cycles of treatment. There was no change in the incidence of acute adenolymphangitis. Infection in resting mosquitoes fell significantly in all arms: 82%, 78% and 42% in the ivermectin, DEC and placebo arm, respectively. Landing mosquitoes also showed the same trend. The decline in infectivity was significant for resting (P < 0.05) and landing mosquitoes (P < 0.05) with ivermectin and DEC (P < 0.05), and for neither in the placebo group (P > 0.05). Transmission intensity was reduced by 68% with ivermectin and 63% with DEC. Transmission was apparently interrupted in 1 village with ivermectin, but infected resting mosquitoes were consistently found in this village. Single-dose community-level treatment with DEC or ivermectin is effective in reducing W. bancrofti infection in humans and mosquitoes, and may result in total interruption of transmission after several years of control. There is an immediate need to define the role of vector, parasite and community factors that influence the elimination of lymphatic filariasis, particularly the duration of treatment vis-à-vis efficacy of drugs, treatment compliance and efficiency of vectors.</div>
</front>
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<affiliations><list><country><li>Inde</li>
</country>
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<tree><noCountry><name sortKey="Balarajan, K" sort="Balarajan, K" uniqKey="Balarajan K" first="K" last="Balarajan">K. Balarajan</name>
<name sortKey="Bundy, D A" sort="Bundy, D A" uniqKey="Bundy D" first="D A" last="Bundy">D A Bundy</name>
<name sortKey="Pani, S P" sort="Pani, S P" uniqKey="Pani S" first="S P" last="Pani">S P Pani</name>
<name sortKey="Ramaiah, K D" sort="Ramaiah, K D" uniqKey="Ramaiah K" first="K D" last="Ramaiah">K D Ramaiah</name>
<name sortKey="Vanamail, P" sort="Vanamail, P" uniqKey="Vanamail P" first="P" last="Vanamail">P. Vanamail</name>
<name sortKey="Yuvaraj, J" sort="Yuvaraj, J" uniqKey="Yuvaraj J" first="J" last="Yuvaraj">J. Yuvaraj</name>
</noCountry>
<country name="Inde"><noRegion><name sortKey="Das, P K" sort="Das, P K" uniqKey="Das P" first="P K" last="Das">P K Das</name>
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