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Mass Drug Administration of Triclabendazole for Fasciola Hepatica in Bolivia
Human infection with Fasciola hepatica leads to obstruction of the common bile duct by adult worms and disease characterized by biliary colic, epigastric pain, and nausea. Recommended treatment is a single dose of triclabendazole (TCBZ) (10 mg/kg). Because in the 1990s the Bolivian Altiplano bordering Lake Titicaca was thought to have the highest prevalence of human fascioliasis worldwide, the Bolivian Ministry of Health instituted TCBZ mass drug administration (MDA). From 2008 to 2016 (excepting 2015), one dose of 250 mg was administered, usually in September/October, to each resident of highly endemic regions willing to participate. This is apparently the first reported use of MDA for Fasciola. The proportion of persons in key regions receiving TCBZ MDA was 87% in 2016. In 2017, we resurveyed key regions, and found that the MDA program had been dramatically successful. Whereas Fasciola prevalence was reported as 26.9% in Huacullani/Tiahuanaco and 12.6% in Batallas in 1999, there was 0.7% prevalence in Huacullani/Tiahuanaco and 1% in Batallas in 2017. However, lessons from schistosomiasis control efforts suggest that for sustained control of Fasciola infection, Fasciola MDA needs to be maintained and coupled with measures to control infection in the intermediary snail and in the animal hosts of F. hepatica.
Author Notes
Disclosure: J. B. is an officer of the AB Foundation.
Financial support: Funded by a grant to J. S. from the AB Foundation.
Authors’ addresses: Sergio Mollinedo and Cleye F. Villarroel, Instituto de Salud y Medio Ambiente (ISMA), La Paz, Bolivia, E-mails: jsergiomollinedo@gmail.com and labomollinedo@msn.com. Patricia Gutierrez, Jaime Soto, and Paula Soto, FUNDERMA (Fundación Nacional de Dermatología), Santa Cruz, Bolivia, E-mails: pgutierrezduenas@gmail.com, dra.paula.dermalaser@gmail.com, and jaime.soto@infoleis.com. Rosa Azurduy, Freddy Valle, and Alejandra Salas, Servicio Departamental de Salud (SEDES), La Paz, Bolivia, E-mails: rosazurduy@hotmail.com, freddyvallelpz@gmail.com, and asalcla@yahoo.es. Zoraida Mollinedo, Universidad Amazónica de Pando, Pando, Bolivia, E-mail: zoridex@gmail.com. Janet Ransom, Fast-Track Drugs and Biologics, North Potomac, MD, E-mail: jransom@fasttrackresearch.com. Robb Lawrence, Chesapeake Therapeutics, Reistertown, MD, E-mail: rlawrence@chesapeaketherapeutics.com. Jonathan Berman, AB Foundation, North Bethesda, MD, E-mail: jbe9320457@aol.com.