Ivermectin at single doses of 0.2-1.0 mg/kg body weight reduced the microfilarial counts of subperiodic Brugia malayi in Presbytis cristata by 59.9%-89.6% of initial counts, 4 weeks after treatment. Adult filaricidal activity was poor, live adult worms being recovered from all animals at autopsy. There was no serious side effect at these doses.
The nuisance bites of blackflies and transmission of Onchocerca volvulus, which causes onchocerciasis, constitutes a threat to public health and an impediment to food production in rural and riverine communities in Nigeria. The entomological profile of onchocerciasis at Adani, Nigeria, was investigated from August 2010 to January 2011 to determine the transmission of O. volvulus after 15 years of ivermectin distribution in the area. A total of 548 adult female blackflies of the Simulium damnosum complex were caught using human baits and dissected. Of this number, 248 flies were caught in the wet season (August to October), while 300 flies were caught in the dry season (November to January). The relative abundance of flies at Adani varied from 21 in December to 243 in January. The monthly catches between September and October and between December and January were significantly different. The monthly population density of the flies ranged from 0.5Flies/Man/Hour (FMH) in December to 5.5FMH in January. The diurnal biting pattern of the S. damnosum complex at the site showed a bimodal peak of activity with the evening peak being higher than the morning peak except in October when the morning peak was higher than the evening peak. The morning peaks were observed between 7.00 am and 10.00 am, whereas the evening peaks occurred between 4.00 pm and 6.00 pm. The morning and evening biting peaks in all the months were not significantly different. Nulliparous flies accounted for 75.7% of the total catch, whereas 24.3% of the flies caught were parous. The infection, infective bites and transmission of O. volvulus during the study period were zero. This study suggests that transmission of O. volvulus has been halted and the flies are presently more nuisance biters than disease vectors since no stage of O. volvulus was found in the flies dissected.
Recent evidence suggests that, in some foci, elimination of onchocerciasis from Africa may be feasible with mass drug administration (MDA) of ivermectin. To achieve continental elimination of transmission, mapping surveys will need to be conducted across all implementation units (IUs) for which endemicity status is currently unknown. Using boosted regression tree models with optimised hyperparameter selection, we estimated environmental suitability for onchocerciasis at the 5 × 5-km resolution across Africa. In order to classify IUs that include locations that are environmentally suitable, we used receiver operating characteristic (ROC) analysis to identify an optimal threshold for suitability concordant with locations where onchocerciasis has been previously detected. This threshold value was then used to classify IUs (more suitable or less suitable) based on the location within the IU with the largest mean prediction. Mean estimates of environmental suitability suggest large areas across West and Central Africa, as well as focal areas of East Africa, are suitable for onchocerciasis transmission, consistent with the presence of current control and elimination of transmission efforts. The ROC analysis identified a mean environmental suitability index of 0·71 as a threshold to classify based on the location with the largest mean prediction within the IU. Of the IUs considered for mapping surveys, 50·2% exceed this threshold for suitability in at least one 5 × 5-km location. The formidable scale of data collection required to map onchocerciasis endemicity across the African continent presents an opportunity to use spatial data to identify areas likely to be suitable for onchocerciasis transmission. National onchocerciasis elimination programmes may wish to consider prioritising these IUs for mapping surveys as human resources, laboratory capacity, and programmatic schedules may constrain survey implementation, and possibly delaying MDA initiation in areas that would ultimately qualify.
A clinical trial on the efficacy of a single oral dose of ivermectin at 20, 50, 100, and 200 micrograms/kg was carried out in 40 subjects with subperiodic Brugia malayi microfilaremia. There was no significant difference in the clearance of microfilaremia in the four treatment groups, and the lowest geometric mean microfilarial count (GMC) achieved in the 40 subjects was 8.8/ml or 8.3% of the initial count (106.1/ml), at two weeks post-treatment. The GMC started to increase at one month post-treatment and by six months was 22.2% of the initial GMC. Only 27.5%, 23.1%, 15.0%, and 18.9% of subjects were amicrofilaremic at two, four, 12, and 24 weeks post-treatment, respectively. Mild fever in 35% of the subjects was the primary side reaction and was more common in those with microfilarial counts > or = 500/ml (85.7%) than in those with counts < 500/ml (32%). The clearance of B. malayi microfilaremia by ivermectin was less rapid than that reported for Wuchereria bancrofti. The smaller number of side reactions encountered in the present study compared with those reported for bancroftian filariasis is probably related to the lower microfilarial density in the present subjects. Since ivermectin at a single oral dose of 20-200 micrograms/kg can reduce the GMC to less than 10% at two weeks and maintain it below 25% of the initial level even at six months post-treatment, it is recommended that the drug be seriously evaluated for use in the control of brugian filariasis.
Some insecticides to control and prevent screw-worm fly strike by Chrysomya bezziana in calves and adult cattle were tested in field trials on cattle in Sabah, East Malaysia. Ivermectin injected subcutaneously in newborn calves at 200 mu/kg provided 10 days protection from screw-worm fly strike, which allowed navels to dry. Ivermectin, 1% dichlofenthion plus gentian violet and 3% lindane plus pine oil smear were all effective in preventing re-strike of treated wounds in adult cattle. A single subcutaneous injection of ivermectin at 200 mu/kg was effective, whereas it was necessary to re-apply the dichlofenthion and lindane smear preparations every 48h.
Ivermectin has demonstrated many successes in the treatment of a range of nematode infections. Considering the increase in malaria resistance, attention has turned toward ivermectin as a candidate for repurposing for malaria. This study developed and validated an ivermectin physiology-based pharmacokinetic model in healthy adults (20-50 years), pediatric (3-5 years/15-25 kg) subjects, and a representative adult malaria population group (Thailand). Dosing optimization demonstrating a twice-daily dose for 3- or 5-day regimens would provide a time above the LC50 of more than 7 days for adult and pediatric subjects. Furthermore, to address the occurrence of CYP450 induction that is often encountered with antiretroviral agents, simulated drug-drug interaction studies with efavirenz highlighted that a 1-mg/kg once-daily dose for 5 days would counteract the increased ivermectin hepatic clearance and enable a time above LC50 of 138.8 h in adults and 141.2 h in pediatric subjects. It was also demonstrated that dosage regimen design would require consideration of the age-weight geographical relationship of the subjects, with a dosage regimen for a representative Thailand population group requiring at least a single daily dose for 5 days to maintain ivermectin plasma concentrations and a time above LC50 similar to that in healthy adults.