Mass drug administration for STH with albendazole-ivermectin in an area endemic for Strongyloides stercoralis

KROLEWIECKI A, SOCIAS E, JUAREZ M, CAJAL P, VILLALPANDO C, CARLOS M, DAVILA M, CIMINO R, NUTMAN T, PEREIRO A, PALACIO K, DI PAOLO A, GIL J, JAIME C, ABRIL M, TARRAGONA S, GOLD S, LAMMIE P

Encuentro; Annual Meeting of ASTMH; 2011

The management of soil transmitted helminthiases (STH) in communities with high levels of endemicities is based on mass drug administration (MDA) programs. Desicions on the optimal tools for prevalence calculation and appropriate medications to include in the interventions are further complicated when Strongyloide stercoralis (St st) is included in the spectrum of targeted STH. We present the preliminary results of an MDA program at the community level in an area highly endemic for STH (including St st) in northwestern Argentina with the goal of assesing the performance of albendazole and ivermectin in monodosis and the utility of a new recombinant antigen based ELISA for St st as a tool for seroprevalence. Two areas were selected for this intervention, including aproximately 1200 individuals in 3 rural communities and 1200 in 3 communities in an urban-periurban area, all in Oran, Argentina. Plantations in the rural area and street blocks in the urban-periurban area were used as the unit of selection and 20% of each were randomly selected for assesment of the following parameters: single stool specimens analyzed through a comprehensive panel including agar plate and Baermann; St st NIE-ELISA serology and hemoglobin; weight was measured in the whole community and height in children up to 12yo. The overall prevalence of STH by stool examination was calculated to be 32% in the pilot area, with 12% being positive for St st; this increased to 31% when NIE-ELISA was included. The intervention with albendazole-ivermectin was carried in 2 pilot communities which include 1160, with 864 individuals treated with 1 cycle. Active and passive surveilance revealed no significant (Grade 3 or 4) adverse events nd only 3 individuals refused treatment. This initial MDA targeting comprehensively STH with the added use of St st serology for prevalence calculations is a promising approach with an appropriate safety and efficacy proven régimen. Further inclusion of the remaining communities and rounds of treatment will provide valuable information for defining an improved strategy for the management of STH in highly endemic communities.