2.1. Ivermectin in Mass drug administration (MDA): A miracle drug, or a double sword in the elimination programs
Ivermectin has been used in several hundreds of millions of individuals within the onchocerciasis and lymphatic filariasis MDA control programs and is considered well tolerated[59]. The drug has shown good efficacy against several other parasitic infections, such as soil-transmitted helminth infections, pediculosis, and cutaneous larva migrans [87]. A reduction of the transmission of soil-transmitted helminth infections and scabies in affected communities has also been perceived as an additional benefit within the ivermectin-based filariasis and onchocerciasis control programs [80]. During mass treatments in Brazil aiming at the …show more content…
2015, the results of the Skin Health Intervention Fiji Trial (SHIFT) were published in 2015 [59]. In this comparative trial, in an island community with hyperendemic scabies, they found significant reductions in scabies prevalence as well in impetigo rate from baseline to 1 year in all groups (standard care, topical permethrin, and ivermectin), particularly in the ivermectin group. Adverse events were more common in the group of ivermectin, but all events were mild and resolved quickly. Three island communities were randomly assigned to one of three different interventions for scabies control: standard care involving the administration of permethrin to affected persons (who had scabies) and their contacts (standard-care group), mass administration of permethrin (permethrin group), or mass administration of oral ivermectin 200 μg/ kg single dose (ivermectin group). The prevalence declined from 36.6% to 18.8% in the standard-care group, from 41.7% to 15.8% in the permethrin group, and the greatest reduction was in the ivermectin group (from 32.1% to 1.9%). All groups have also shown reduction in the prevalence of impetigo, with the greatest reduction seen in the ivermectin group. Adverse events (itching or headache) were mild and were reported more frequently in the ivermectin than permethrin group (15.6% vs. 6.8%) …show more content…
As a pragmatic approach , it may be important to provide both doses to everyone in the community, not only to patients with clinical scabies, to prevent resistance development. The importance of this second dose in the mass administration of ivermectin as a scabies control mean still need to be evaluated, as do the diagnostic and epidemiologic algorithms that determine when to initiate a program of MDA, the time interval between interventions, and when to cease providing the interventions [98]
Ivermectin has been used in several hundreds of millions of individuals within the onchocerciasis and lymphatic filariasis MDA control programs and is considered well tolerated[59]. The drug has shown good efficacy against several other parasitic infections, such as soil-transmitted helminth infections, pediculosis, and cutaneous larva migrans [87]. A reduction of the transmission of soil-transmitted helminth infections and scabies in affected communities has also been perceived as an additional benefit within the ivermectin-based filariasis and onchocerciasis control programs [80]. During mass treatments in Brazil aiming at the …show more content…
2015, the results of the Skin Health Intervention Fiji Trial (SHIFT) were published in 2015 [59]. In this comparative trial, in an island community with hyperendemic scabies, they found significant reductions in scabies prevalence as well in impetigo rate from baseline to 1 year in all groups (standard care, topical permethrin, and ivermectin), particularly in the ivermectin group. Adverse events were more common in the group of ivermectin, but all events were mild and resolved quickly. Three island communities were randomly assigned to one of three different interventions for scabies control: standard care involving the administration of permethrin to affected persons (who had scabies) and their contacts (standard-care group), mass administration of permethrin (permethrin group), or mass administration of oral ivermectin 200 μg/ kg single dose (ivermectin group). The prevalence declined from 36.6% to 18.8% in the standard-care group, from 41.7% to 15.8% in the permethrin group, and the greatest reduction was in the ivermectin group (from 32.1% to 1.9%). All groups have also shown reduction in the prevalence of impetigo, with the greatest reduction seen in the ivermectin group. Adverse events (itching or headache) were mild and were reported more frequently in the ivermectin than permethrin group (15.6% vs. 6.8%) …show more content…
As a pragmatic approach , it may be important to provide both doses to everyone in the community, not only to patients with clinical scabies, to prevent resistance development. The importance of this second dose in the mass administration of ivermectin as a scabies control mean still need to be evaluated, as do the diagnostic and epidemiologic algorithms that determine when to initiate a program of MDA, the time interval between interventions, and when to cease providing the interventions [98]