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Autores comunican

Fortaleza, Brasil (especial para SIIC):
O tratamento em massa é considerado a estratégia-chave para o controle de verminoses intestinais em comunidades de baixo poder aquisitivo. Assim como as verminoses intestinais, as doenças ectoparasitárias afetam principalmente comunidades carentes. Porém, essas doenças raramente são reconhecidas como problema de Saúde Pública.
A ivermectina é uma droga anti-helmíntica segura que também apresenta efeito comprovado contra diferentes ectoparasitoses. Entretanto, essa droga é recomendada pela OMS somente para o tratamento de filarioses.
Esse estudo foi realizado na comunidade de Balbino (Município de Cascavel), cerca de 60 km ao sul de Fortaleza, capital do Estado do Ceará (Brasil). No período do estudo, a população de Balbino era 605 habitantes, distribuídos em 141 famílias.
Todas as famílias foram visitadas, e exame clínico pela presença de ectoparasitoses prevalentes (pediculose capitis, escabiose, tungíase e larva migrans cutânea) e exame de fezes seriado (três vezes) foram realizados. Exames de seguimento foram realizados quatro semanas e nove meses após o baseline.
Foram tratados todos os membros das famílias onde pelo menos um dos membros havia sido diagnosticado como portador de verminose intestinal ou ectoparasitose. A ivermectina foi administrada oralmente (200 μg/kg) e a mesma dose foi repetida após 10 dias. Em caso de contra-indicação para o uso da droga (idade < 5 anos, peso < 15 kg, gravidez, amamentação ou doença renal ou hepática), foram administrados mebendazol ou albendazol. Crianças < 6 meses de idade somente foram tratadas (mebendazol) caso detectado uma verminose intestinal. Gestantes e nutrizes no baseline foram tratadas somente no seguimento. Em caso de escabiose ou pediculose, foi aplicada deltametrina tópica por três dias consecutivos em caso de contra-indicação para ivermectina.
De 576 indivíduos da população-alvo, 478 (83%) receberam ivermectina, 24 (4.2%) albendazol, 15 (2.6%) mebendazol, e 88 (15.3%) não receberam nenhum tratamento. A prevalência das verminoses intestinais mais comuns (ancilostomíase, ascaridíase, tricuríase e estrongiloidíase) diminuiu significantemente após um mês (p < 0.001) e permaneceu significantemente reduzida quando comparada com o baseline (p < 0.001). As prevalências de verminoses intestinais antes, um mês e nove meses após a intervenção foram respectivamente: ancilostomíase 28.5% (IC 95%: 24.7-32.6), 16.4% (13.3-20.1) e 7.7% (5.4-10.9); ascaridíase 17.1% (14.0-20.6), 0.4% (0.1-1.7) e 7.2% (5.0-10.3); tricuríase 16.5% (13.4-20.0), 3.4% (2.0-5.5) e 9.4% (6.8-12.8); estrongiloidíase 11.0% (8.5-14.2), 0.6% (0.2-2.0) e 0.7% (0.2-2.3); himenolepíase 0.6% (0.2-1.8), 0.4% (0.1-1.7) e 0.5% (0.1-2.0).
As prevalências de ectoparasitoses nos mesmos períodos foram respectivamente: pediculose capitis ativa 16.1% (13.1-19.5), 1.0% (0.4-2.4) e 10.3% (7.9-13.2); escabiose 3.8% (2.4-5.9), 1.0% (0.4-2.4) e 1.5% (0.7-3.0); larva migrans cutânea 0.7% (0.2-2.0). 0% e 0%; tungíase 51.3% (47.0-55.5), 52.1% (47.6-56-5) e 31.2% (27.3-35.4).
A ivermectina foi bem tolerada. Os efeitos adversos (mais comumente dor abdominal e náusea) foram raros e de natureza leve ou moderada, resolvendo-se em todos os casos espontaneamente.
Os dados mostram pela primeira vez, que o tratamento em massa com ivermectina – uma droga até esse momento usada principalmente para o tratamento em massa contra filarioses – é efetivo e seguro para o controle simultâneo de verminoses intestinais e de doenças parasitárias. A ivermectina utilizada em duas doses em tratamento em massa pode ser uma estratégia efetiva para o controle de ecto e enteroparasitoses em populações de baixo poder aquisitivo. Os efeitos do tratamento permaneceram por um período prolongado.

Jorg Heukelbach *

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Para comunicarse con Jorg Heukelbach mencionar a SIIC como referencia:
Rua Prof. Costa Mendes 1608, 5° Andar, 60430-140, Fortaleza, Ceará, Brasil
Fono: 85 32888045; Fax: 85 32783093
samsa@mcanet.com.br

SELECTIVE MASS TREATMENT WITH IVERMECTIN TO CONTROL INTESTINAL HELMINTHIASES AND PARASITIC SKIN DISEASES IN A SEVERELY AFFECTED POPULATION

Título en portugués
TRATAMENTO EM MASSA SELETIVO COM IVERMECTINA PARA CONTROLAR VERMINOSES INTESTINAIS E DOENÇAS ECTOPARASITÁRIAS EM UMA POPULAÇÃO SEVERAMENTE AFETADA

Autores
Jorg Heukelbach

Clasificado en siicsalud