Oral Presentation 20th Lancefield International Symposium on Streptococci and Streptococcal Diseases 2017

Feasibility and safety of mass co-administration of azithromycin and ivermectin to control trachoma and scabies: the AIM study (#14)

Lucia Romani 1 , Handan Wand 1 , Margot Whitfeld 1 , Oliver Sokana 2 , Titus Nasi 2 , Daniel Engelman 3 , Michael Marks 4 , John Kaldor 1 , Andrew Steer 3
  1. UNSW Sydney, Sydney, NSW, Australia
  2. Ministry of Health, Honiara, Solomon Islands
  3. Murdoch Childrens Research Institute, Melbourne, VIC, Australia
  4. London School of Troopical Medicine and Hygiene, London, United Kingdom

Mass drug administration (MDA) has made a major contribution to the public health control of neglected tropical diseases across the world. In the Solomon Islands, trachoma MDA with azithromycin was implemented in nine out of 10 provinces. When the program was extended to the province of Choiseul, we had an opportunity to investigate the feasibility and safety of co-administering ivermectin to control scabies and impetigo, endemic in the Pacific region. The drug delivery infrastructure used the framework for trachoma. The MDA regimen was a single dose of oral azithromycin combined with a single dose of oral ivermectin. A second dose of ivermectin was given a week later to ensure elimination of scabies. Participants in 10 randomly selected villages were asked to undergo skin examination to determine the baseline prevalence of scabies and impetigo. The study enrolled 26,188 participants, 99% of the total resident population. Of those, 98.2% received azithromycin and 98.5% received a first dose of ivermectin. A second dose of ivermectin was received by 83.7% of participants. In the survey villages, baseline scabies prevalence was 18.7% and highest in children aged 5-9 years (34%). Impetigo was present in 24.8% of participants, and highest in the 5-9 age group (46.4%). There were no serious adverse events. Adverse events were noted in 2.6% of the study population. This is the world’s largest scabies MDA and the first large scale co-administration of Ivermectin and Azithromycin. Co-administration of ivermectin and azithromycin appears to be safe, well tolerated and feasible.