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EFFECTS OF IVERMECTIN AND DIETHYLCARBAMAZINE ON MICROFILARIAE AND OVERALL MICROFILARIA PRODUCTION IN BANCROFTIAN FILARIASIS

Ivermectin and diethylcarbamazine (DEC) are used in mass treatment programs for the elimination of lymphatic filariasis because of their strong effects on microfilaremia. However, the effects of treatment on adult worms and the degree of individual variation in efficacy are unclear. We analyzed series of microfilaria (Mf) counts from individuals treated with a single dose of 400 µg/kg ivermectin or 6 mg/kg DEC (N = 23 in each group; 1 year follow-up). For each individual, we estimated the microfilaricidal effect and the reduction in overall Mf production (e.g., caused by death or sterilization of worms, or inhibited Mf release from the female worm uterus). Ivermectin on average killed 96% of Mf and reduced Mf production by 82%. DEC killed 57% of Mf and reduced Mf production by 67%, with some individuals responding very poorly. The strong reduction in overall Mf production is good news for control of lymphatic filariasis, but the prospects of elimination will be diminished if part of the population systematically responds poorly to treatment.

Received March 17, 2005. Accepted for publication May 31, 2005.

Acknowledgments: The authors thank Paul Simonsen (DBL), Dan Meyrowitsch (DBL), and Anton Plaisier for their contribution to this work in earlier stages of the project. The authors thank Theo Stijnen for his statistical advice.

Financial support: This investigation received financial support from the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases.

^* Address correspondence to Wilma A. Stolk, Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands. E-mail: w.stolk{at}erasmusmc.nl

Authors’ addresses: Wilma A. Stolk, Gerrit J. van Oortmarssen, Sake J. de Vlas, and J. Dik F. Habbema, Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands, Telephone: +31 10 4087714, Fax: +31 10 4089449. S. P. Pani, S. Subramanian, and P. K. Das, Vector Control Research Centre, Indian Council of Medical Research, Indira Nagar, Medical Complex, Pondicherry 605 006, India, Telephone: +91 413 2272396/2272397, Fax: +91 413 2272041.

Reprint requests: Wilma A. Stolk, Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands, Telephone: +31 10 4087714, Fax: +31 10 4089449, E-mail: w.stolk{at}erasmusmc.nl.