Research

Impact of two rounds of mass drug administration using diethylcarbamazine combined with albendazole on the prevalence of Brugia timori and of intestinal helminths on Alor Island, Indonesia

Tim Oqueka¹, Taniawati Supali², Is Suhariah Ismid², Purnomo³, Paul Rückert⁴, Mark Bradley⁵ and Peter Fischer^1,6

¹Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Strasse 74, D-20359 Hamburg, Germany

²Department of Parasitology, Faculty of Medicine, University of Indonesia, Salemba 6, Jakarta 10430, Indonesia

³U.S. Naval Medical Research Unit No. 2, Jakarta, Indonesia

⁴German Technical Co-operation (GTZ), P.O. box 1217, Kupang 85000, Indonesia

⁵Global Community Partnerships, GlaxoSmithKline, 980 Great West Road, Brentfort Middlesex TW8 9GS, U.K

⁶Department of Internal Medicine, Infectious Diseases Division, Washington University School of Medicine, 660 S. Euclid, Campus box 8051, St. Louis, MO 63110, USA

Filaria Journal 2005, 4:5doi:10.1186/1475-2883-4-5

Published:	13 July 2005

Abstract

Background

Annual mass drug administration (MDA) using diethylcarbamizine (DEC, 6 mg/kg) combined with albendazole (alb, 400 mg) is recommended by the Global Programme to Eliminate Lymphatic Filariasis (GPELF). This strategy has been shown to be efficient in the of control bancroftian filariasis, but data on brugian filariasis as well as on the positive side effects on intestinal helminths are lacking.

Methods

The effect of one selective treatment and two rounds of MDA using DEC and alb on the prevalence and intensity of Brugia timori infection were studied on Alor island using a cross-sectional and a cohort approach. Before the campaign and ten months after each treatment cycle microfilariae (mf) were assessed by filtration of night blood. Before and ten months after MDA, stool samples were collected and the prevalence of intestinal helminths were determined.

Results

In all, the mf-rate dropped from 26.8% before any treatment to 3.8% following the second MDA. Almost all mf-positive, treated individuals showed very low mf densities. The crude prevalence of hookworm dropped from 25.3% to 5.9%. The reduction of prevalence of Ascaris lumbricoides (32.3% to 27.6%) and Trichuris trichiura (9.4% to 8.9%) was less pronounced. Within a cohort of 226 individuals, which was examined annually, the prevalence of A. lumbricoides dropped from 43.8% to 26.5% and of T. trichiura from 12.8% to 6.6%. The results indicate that this MDA approach reduces not only the mf prevalence of B. timori but also the prevalence of hookworm and to a lesser extent also of A. lumbricoides and T. trichiura.

Conclusion

The MDA using DEC and alb as recommended by GPELF is extremely effective for areas with brugian filariasis. The beneficial effect of MDA on intestinal helminths may strengthen the national programme to eliminate lymphatic filariasis in Indonesia and may set resources free which are otherwise used for deworming campaigns of schoolchildren.