RESUMEN Objetivos. Presentar el estado del conocimiento sobre las características epidemiológicas de la tungiasis en la Región de las Américas. Métodos. Se hizo una búsqueda de publicaciones sobre las características epidemiológicas de la tungiasis en la Región en las bases de datos PubMed y LILACS en el período comprendido entre enero del 2007 y junio del 2021. Además, se realizó una búsqueda bibliográfica manual de artículos sobre las características epidemiológicas de la tungiasis. Resultados. Se analizaron en total 83 artículos que contenían información pertinente sobre casos de tungiasis y su distribución geográfica, prevalencia y factores de riesgo, ciclo de vida, lugares donde se produce la transmisión y aspectos zoonóticos. Se investigaron en detalle los ciclos de vida dentro y fuera del huésped. En ciertos contextos, la totalidad del ciclo de vida se completa en espacios cerrados, lo que permite la transmisión durante todo el año. Se notificaron casos en 10 países, con 71% de los casos notificados en Brasil. En la población general, la prevalencia varió entre 1,0% y 82,6% según el entorno. La prevalencia específica por edad indica que la población infantil y las personas mayores tienen la mayor carga de morbilidad. Los estudios relativos a los factores de riesgo indican que la tungiasis está relacionada con la pobreza extrema. Conclusiones. En la Región, hay lagunas importantes en la información y el conocimiento sobre la tungiasis. Es necesario comprender la carga, las características epidemiológicas, la distribución, la magnitud, los factores de riesgo relacionados y los reservorios, entre otros factores, para elaborar y aplicar medidas de control integradas adaptadas al contexto y los patrones de transmisión en las comunidades afectadas.

ABSTRACT Objectives. To present the state-of-the-knowledge on the epidemiology of tungiasis in the Region of the Americas. Methods. A search of publications on the epidemiology of tungiasis in the Americas was performed in PubMed and LILACS databases from January 2007 to June 2021. In addition, a manual literature search on articles on the epidemiology of tungiasis was performed. Results. A total of 83 articles were analyzed which contained relevant information on tungiasis cases and their geographical distribution, prevalence and risk factors, life cycle, sites where transmission takes place, and zoonotic aspects. The on-host and off-host life cycles have been researched in detail. In certain contexts, the whole life cycle is completed indoors enabling transmission around the whole year. Cases were reported from 10 countries; 71% of them were from Brazil. In the general population, the prevalence varied between 1.0% and 82.6% according to the settings. Age-specific prevalence indicated that children and the elderly bear the highest disease burden. Risk factor studies indicate that tungiasis is associated with severe poverty. Conclusions. In the Americas, there are important gaps in information and knowledge of tungiasis. Understanding the burden, epidemiology, distribution, magnitude, related risk factors, and reservoirs, among others, is needed to develop and implement integrated control measures tailored to the context and patterns of transmission in the affected communities.

RESUMO Objetivos. Apresentar o estado do conhecimento sobre a epidemiologia da tungíase na Região das Américas. Métodos. Realizou-se uma pesquisa de estudos publicados de janeiro de 2007 a junho de 2021 sobre a epidemiologia da tungíase nas Américas nas bases de dados PubMed e LILACS, bem como uma pesquisa bibliográfica manual de artigos sobre a epidemiologia da tungíase. Resultados. Analisou-se um total de 83 artigos com informações de interesse sobre casos de tungíase e sua distribuição geográfica, prevalência e fatores de risco, ciclo vital, locais de transmissão e aspectos zoonóticos. Os ciclos vitais dentro e fora do hospedeiro foram pesquisados em detalhes. Em determinados contextos, todo o ciclo vital ocorre em ambientes fechados, o que possibilita a transmissão durante todo o ano. Relataram-se casos de 10 países; 71% deles no Brasil. Na população em geral, a prevalência variou de 1,0% a 82,6%, de acordo com o local. A prevalência específica por idade mostrou que a maior carga de doença ocorre em crianças e pessoas idosas. Estudos dos fatores de risco indicam que a tungíase está associada à extrema pobreza. Conclusões. Nas Américas, existem importantes lacunas de informação e conhecimento sobre a tungíase. É necessário compreender fatores como carga, epidemiologia, distribuição, magnitude, fatores de risco relacionados e reservatórios, entre outros, para desenvolver e implementar medidas integradas de controle adequadas ao contexto e aos padrões de transmissão nas comunidades afetadas.

ABSTRACT Epidermal parasitic skin diseases encompass scabies, pediculosis, cutaneous larva migrans, myiasis, and tungiasis. Tungiasis is probably the most neglected of all Neglected Tropical Diseases (NTD). It occurs in South America, the Caribbean and Sub-Saharan Africa and affects marginalized populations where people live in extreme poverty. In endemic communities the prevalence can be up to 30% in general population and 85% in children. Over time, chronic pathology develops characterized by hyperkeratosis, edema around the nail rim, fissures, ulcers, deformation and loss of nails. This leads to a pattern of disabilities, eventually resulting in impairment of mobility.Dimeticones are a family of silicon oils with a potential to kill parasites located on top or inside the epidermis by a physical mode of action. They are considered the treatment of choice for pediculosis capitis and pediculosis pubis. With regard to tungiasis, the so called rear abdominal cone of the parasites has been identified as a target for treatment with dimeticones. NYDA®, a mixture of two dimeticones with different viscosity, is the only dimeticone product for which data on the mode of action, efficacy and safety with regard to tungiasis exists. The product has been shown highly effective against embedded sand fleas, even in very intense infection with more than 500 parasites situated on top of each other. A randomized controlled trial showed that seven days after a targeted application of NYDA® 97% (95% CI 94-99%) of the embedded sand fleas had lost all signs of viability.Comprehensive toxicological investigations on the dimeticones contained in NYDA® showed that there is practically no risk of embryotoxicity, fetotoxicity, teratogenicity, and other toxicity. The safety of dimeticones was also demonstrated in clinical trials with a total of 106 participants with tungiasis, in which not a single adverse event was observed.

OBJECTIVE: To generate evidence on the effectiveness of household-wide treatment for preventing the transmission of pediculosis capitis (head lice) in resource-poor communities. METHODS: We studied 132 children without head lice who lived in a slum in north-eastern Brazil. We randomized the households of the study participants into an intervention and a control group and prospectively calculated the incidence of infestation with head lice among the children in each group. In the intervention group, all of the children's family members who lived in the household were treated with ivermectin; in the control group, no family member was treated. We used the χ2 test with continuity correction or Fisher's exact test to compare proportions. We performed survival analysis using Kaplan-Meier estimates with log rank testing and the Mann-Whitney U test to analyse the length of lice-free periods among sentinel children, and we used Cox regression to analyse survival data on a multivariate level. We also carried out a subgroup analysis based on gender. FINDINGS: Children in the intervention group remained free from infestation with head lice significantly longer than children in the control group. The median infestation-free period in the intervention group was 24 days (interquartile range, IQR: 11-45), as compared to 14 days (IQR: 11-25) in the control group (P = 0.01). Household-wide treatment with ivermectin proved significantly more effective among boys than among girls (P = 0.005). After treatment with ivermectin, the estimated number of annual episodes of head lice infestation was reduced from 19 to 14 in girls and from 15 to 5 in boys. Female sex and extreme poverty were independent risk factors associated with a shortened disease-free period. CONCLUSION: In an impoverished community, girls and the poorest of the poor are the population groups that are most vulnerable for head lice infestation. To decrease the number of head lice episodes per unit of time, control measures should include the treatment of all household contacts. Mass treatment with ivermectin may reduce the incidence of head lice infestation and associated morbidity in resource-poor communities.

OBJETIVO: Demostrar la eficacia del tratamiento de todos los miembros del domicilio para prevenir la transmisión de la pediculosis capitis en comunidades pobres. MÉTODOS: Estudiamos 132 niños sin pediculosis capitis que vivían en barrios de chabolas en el nordeste del Brasil. Aleatoriamente, asignamos los domicilios de los participantes en el estudio a un grupo de intervención o a un grupo de control y calculamos prospectivamente la incidencia de pediculosis capitis en los niños de uno y otro grupo. En el grupo de intervención se trataron con ivermectina todos los miembros de la familia que vivían en el mismo hogar que el niño; en el grupo de control no se trató ningún miembro de la familia. Para comparar las proporciones utilizamos la prueba de la χ2 con corrección de continuidad o la prueba exacta de Fisher. Se utilizaron las estimaciones de Kaplan-Meier con prueba de rango logarítmico para analizar la supervivencia; la U de Mann-Whitney para analizar la duración de los periodos libres de pediculosis entre los niños centinela, y la regresión de Cox para efectuar un análisis multivariado de los datos sobre la supervivencia. Asimismo, realizamos un análisis de subgrupos en función del sexo. RESULTADOS: Los niños del grupo de intervención se mantuvieron sin pediculosis capitis durante más tiempo que los del grupo de control. La duración mediana del periodo libre de infestación fue de 24 días (intervalo intercuartílico, IIC: 11-45) en el grupo de intervención, y 14 días (IIC: 11-25) en el grupo de control (P = 0,01). El tratamiento de todos los miembros del domicilio con ivermectina fue significativamente más eficaz en los niños que en las niñas (P = 0,005). Después del tratamiento con ivermectina, el número estimado de episodios anuales de pediculosis capitis se redujo de 19 a 14 en las niñas, y de 15 a 5 en los niños. El sexo femenino y la pobreza extrema fueron factores de riesgo independientes asociados a un acortamiento del periodo libre de infestación. CONCLUSIÓN: En una comunidad pobre, las niñas y los más pobres son los grupos de población más vulnerables a la infestación por piojos. Para reducir el número de episodios de pediculosis capitis por unidad de tiempo, las medidas de control deben incluir el tratamiento de todos los contactos domésticos. El tratamiento masivo con ivermectina puede reducir la incidencia de la infestación por piojos de la cabeza y de la morbilidad asociada en comunidades con escasos recursos.

OBJECTIF: Prouver l'efficacité du traitement de l'ensemble des membres des foyers pour prévenir la transmission des poux de tête (pediculosis capitis) dans les communautés pauvres. MÉTHODES: Nous avons étudié 132 enfants dépourvus de poux et vivant dans un bidonville du Nord-est du Brésil. Nous avons réparti aléatoirement les foyers des participants à l'étude entre un groupe d'intervention et un groupe témoin et nous avons calculé de manière prospective l'incidence de l'infestation par des poux de tête chez les enfants de chacun des groupes. Dans le groupe d'intervention, tous les membres de la famille des enfants vivant dans le foyer ont été traités par l'ivermectine; dans le groupe témoin, aucun des autres membres de la famille n'a été traité. Nous avons utilisé le test du χ2 avec correction de continuité ou le test de Fischer exact pour comparer les proportions d'enfants infestés. Nous avons utilisé des estimations de Kaplan-Meier avec un test de rang logarithmique pour réaliser une analyse de survie, le test de Mann-Whitney pour étudier la durée des périodes exemptes de poux chez les enfants sentinelles et la régression de Cox pour effectuer une analyse multivariée des données de survie. Nous avons également procédé à une analyse en sous-groupes en fonction du sexe. RÉSULTATS: Les enfants appartenant au groupe d'intervention sont restés exempts de poux de tête significativement plus longtemps que les enfants du groupe témoin. La durée médiane sans infestation dans le groupe d'intervention était de 24 jours (intervalle interquartile, IIQ : 11-45), contre 14 jours (IIQ = 11-25) dans le groupe témoin (p = 0,01). Le traitement par l'ivermectine de l'ensemble des membres des foyers s'est révélé significativement plus efficace chez les garçons que chez les filles (p = 0,005). Après un traitement par l'ivermectine, le nombre annuel estimé d'épisodes d'infestation par des poux de tête avait diminué pour passer de 19 à 14 chez les filles et de 15 à 5 chez les garçons. Le sexe féminin et l'extrême pauvreté étaient des facteurs de risque indépendants associés à la brièveté des périodes sans infestation. CONCLUSION: Dans une communauté pauvre, les filles et les plus pauvres parmi les pauvres sont les groupes de population les plus vulnérables à l'infestation par des poux de tête. Pour réduire le nombre d'épisodes d'infestation par des poux de tête par unité de temps, les mesures de lutte contre ces parasites doivent inclure le traitement de tous les contacts domestiques. Un traitement de masse par l'ivermectine peut faire diminuer l'incidence de cette infestation et la morbidité associée dans les communautés pauvres.

Epidermal parasitic skin diseases (EPSD) are a heterogeneous category of infectious diseases in which parasite-host interactions are confined to the upper layer of the skin. The six major EPSD are scabies, pediculosis (capitis, corporis and pubis), tungiasis and hookworm-related cutaneous larva migrans. We summarize the current knowledge on EPSD and show that these diseases are widespread, polyparasitism is common, and significant primary and secondary morbidity occurs. We show that poverty favours the presence of animal reservoirs, ensures ongoing transmission, facilitates atypical methods of spreading infectious agents and increases the chances of exposure. This results in an extraordinarily high prevalence and intensity of infestation of EPSD in resource-poor populations. Stigma, lack of access to health care and deficient behaviour in seeking health care are the reasons why EPSD frequently progress untreated and why in resource-poor populations severe morbidity is common. The ongoing uncontrolled urbanization in many developing countries makes it likely that EPSD will remain the overriding parasitic diseases for people living in extreme poverty. We advocate integrating control of EPSD into intervention measures directed against other neglected diseases such as filariasis and intestinal helminthiases.

Las parasitosis epidérmicas (PE) son un grupo heterogéneo de enfermedades infecciosas en las que la interacción parásito-huésped se limita a la capa superior de la piel. Las seis PE principales son la escabiosis, las pediculosis (de cuero cabelludo, cuerpo y pubis), la tungiasis y la larva migrans cutánea por anquilostoma. En este resumen acerca de los conocimientos actuales sobre las PE se explica que estas enfermedades están muy extendidas, que el poliparasitismo es un problema frecuente, y que la morbilidad primaria y secundaria asociada es importante. Se muestra que la pobreza favorece la aparición de reservorios animales, la continuidad de la transmisión de los agentes infecciosos y las formas atípicas de propagación de éstos, aumentando así las probabilidades de exposición. Esto da lugar a una prevalencia e intensidad muy elevadas de este tipo de infestaciones en las poblaciones con pocos recursos. La estigmatización, la falta de acceso a los servicios de salud y una escasa tendencia a la búsqueda de atención sanitaria explican que las PE evolucionen con frecuencia en ausencia de tratamiento y que en las poblaciones con recursos escasos los casos de morbilidad grave sean comunes. La urbanización no planificada que se da en muchos países en desarrollo lleva a pensar que las PE seguirán siendo las enfermedades parasitarias predominantes entre las personas que viven en una situación de pobreza extrema. Recomendamos que las medidas de control de las PE se integren en las medidas de intervención dirigidas contra otras enfermedades desatendidas como la filariasis y las helmintiasis intestinales.

Les maladies parasitiques de l'épiderme constituent une catégorie hétérogène de maladies infectieuses, dans lesquelles les interactions parasite-hôte sont confinées dans la couche supérieure de la peau. Les six principales maladies de ce type sont la gale, la pédiculose (de la tête, du corps et du pubis), la tungiase et les larva migrans cutanées dues à des ankylostomes. Nous présentons un résumé des connaissances actuelles sur les maladies parasitiques de l'épiderme et montrons que les maladies sont très répandues, s'intègrent souvent dans un polyparasitisme et sont à l'origine d'une morbidité primaire et secondaire importantes. Nous montrons également que la pauvreté favorise la présence de réservoirs animaux, permet à la transmission de se poursuivre, facilite la propagation des agents infectieux par des méthodes atypiques et accroît la probabilité d'exposition. Il en résulte une prévalence et une intensité extraordinairement élevées de l'infestation des populations pauvres par les maladies parasitiques de l'épiderme. La stigmatisation, le manque d'accès aux soins de santé et le comportement négatif face à la nécessité de consulter expliquent pourquoi ces maladies progressent souvent sans être traitées et entraînent couramment une morbidité très lourde parmi les populations démunies. L'urbanisation non contrôlée qui sévit dans de nombreux pays en développement maintiendra probablement les maladies parasitiques de l'épiderme parmi les principales parasitoses touchant les personnes vivant dans l'extrême pauvreté. Nous préconisons d'intégrer la lutte contre ces maladies dans les interventions visant les autres maladies négligées, telles que la filariose et les helminthiases intestinales.

Foi conduzido um estudo em uma favela urbana no Brasil com o objetivo de comparar a sensibilidade, especificidade, valor preditivo positivo (VPP) e valor preditivo negativo (VPN) do auto-diagnóstico de pediculose com a inspeção visual. Dos 175 indivíduos incluídos, 77 (44%) apresentavam pediculose. Para o auto-diagnóstico, a sensibilidade (80.5%), a especificidade (91.8%), o VPP (88.6%) e o VPN (85.7%) foram altos. A sensibilidade da inspeção visual foi 35.1%. Profissionais de saúde podem utilizar o auto-diagnóstico como uma ferramenta diagnóstica para estimar de forma acurada a prevalência de pediculose em uma comunidade, como também para monitorar estratégias de controle da doença.

To compare sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of self-diagnosis for head lice infestation with visual inspection, we conducted a study in an urban slum in Brazil. Individuals were asked about active head lice infestation (self-diagnosis); we performed visual inspection and thereafter wet combing (gold standard). Of the 175 individuals included, 77 (44%) had an active head lice infestation. For self-diagnosis, sensitivity (80.5%), specificity (91.8%), PPV (88.6%) and NPV (85.7%) were high. Sensitivity of visual inspection was 35.1%. Public health professionals can use self-diagnosis as a diagnostic tool, to estimate accurately prevalence of pediculosis in a community, and to monitor ongoing intervention strategies.

Population-based data on sexually transmitted infections (STI), bacterial vaginosis (BV), and candidiasis reflect the epidemiological situation more accurately than studies performed in specific populations, but such data are scarce. To determine the prevalence of STI, BV, and candidiasis among women of reproductive age from a resource-poor community in Northeast Brazil, a population-based cross sectional study was undertaken. All women from seven hamlets and the centre of Pacoti municipality in the state of Ceará, aged 12 to 49 years, were invited to participate. The women were asked about socio-demographic characteristics and genital symptoms, and thereafter examined gynaecologically. Laboratory testing included polymerase chain reaction (PCR) for human papillomavirus (HPV), ligase chain reaction (LCR) for Chlamydia trachomatis and Neisseria gonorrhoeae, ELISA for human immunodeficiency virus (HIV), venereal disease research laboratory (VDRL) and fluorescent treponema antibody absorption test (FTA-ABS) for syphilis, and analysis of wet mounts, gram stains and Pap smears for trichomoniasis, candidiasis, and BV. Only women who had initiated sexual life were included in the analysis (n = 592). The prevalences of STI were: HPV 11.7% (95% confidence interval: 9.3-14.7), chlamydia 4.5% (3.0-6.6), trichomoniasis 4.1% (2.7-6.1), gonorrhoea 1.2% (0.5-2.6), syphilis 0.2% (0.0-1.1), and HIV 0%. The prevalence of BV and candidiasis was 20% (16.9-23.6) and 12.5% (10.0-15.5), respectively. The most common gynaecological complaint was lower abdominal pain. STI are common in women in rural Brazil and represent an important health threat in view of the HIV pandemic.

A tungíase, ectoparasitose causada pela pulga Tunga penetrans, é endêmica em comunidades brasileiras de baixo poder aquisitivo. Neste estudo foram identificados habitantes de uma favela urbana em Fortaleza com carga parasitária elevada. Número de lesões, localização, estadiamento e patologias associadas foram registrados. Os 142 indivíduos identificados apresentaram condições de moradia extremamente precárias. Contou-se no total 3.445 lesões localizadas nos pés (mediana = 17 lesões; máximo = 98 lesões). Quase sem exceção, os indivíduos apresentaram deformações ungueais e edema e mais de 70% dor e fissuras. Perda de unha foi observada em 46% dos casos e deformação de dígitos em 25%; 42% apresentaram abscessos e 59% queixaram-se de dificuldade de andar. Nossos dados mostram que a tungíase em comunidade urbana de baixa renda típica no nordeste brasileiro está associada a patologia grave. A doença precisa ser reconhecida como problema de saúde pública na região estudada e em outras áreas endêmicas semelhantes.

The parasitic skin disease tungiasis, caused by the jigger flea Tunga penetrans, is endemic in low-income communities in Brazil. In this study, inhabitants of a shantytown in Fortaleza, northeastern Brazil, who had an elevated parasite load, were identified. The number of lesions, localization, staging and associated diseases were recorded. The 142 individuals identified were living in extremely precarious housing conditions. A total of 3,445 lesions located on the feet were counted (median = 17 lesions; maximum = 98 lesions). Almost without exception, the individuals had nail deformation and edema, and more than 70% presented with pain and fissures. There was nail loss in 46%; deformation of the digits in 25%; abscesses in 42%; and complaints of walking difficulty in 59%. Our data show that tungiasis in this low-income urban community typical of northeastern Brazil was associated with severe morbidity. Tungiasis needs to be recognized as a public health problem in this study area and other similar endemic areas.

Tungiasis is a parasitic skin disease widespread in resource-poor urban and rural communities in Brazil. Inhabitants of an urban slum in Northeast Brazil were examined for the presence of tungiasis lesions and followed-up twice a week for a period of three weeks. Each time the number, stages, and topographic localization of lesions were recorded on a documentation sheet. The infestation rate (number of newly embedded sand fleas per individual and day) remained stable during the observation period. The infestation rate was significantly related to the intensity of infestation (total number of lesions present) (rho = 0.70, p < 0.0001) and the proportion of viable lesions (rho = 0.28, p < 0.0001). The results indicate that in an endemic area the infestation intensity and the proportion of viable lesions can be used as a proxy to assess the exposure of individuals at risk for tungiasis. Persistently high infestation rates during the transmission season favour the use of prevention measures against invading sand fleas (such as a repellent) rather than a drug to kill already embedded parasites.

Tungiasis is an ectoparasitosis causing considerable pathology in endemic areas. Standard therapy consists of removing the embedded parasite with a sterile needle. There is no effective chemotherapy at hand. To fill this gap, a double-blinded randomized controlled trial with oral ivermectin was conducted. A total of 54 individuals (27 in the placebo group, 27 in the ivermectin group) was followed up for seven days. They presented a total of 192 lesions. Patients received either ivermectin (300 µg/kg body weight at a single dose, repeated after 24 h) or placebo. Outcome measures included the clinical stage of lesion, presence of erythema, pain, itching, signs of viability of the parasite, and total lysis of flea. The ratio of fleas with total lysis per total number of fleas was slightly higher in the ivermectin group; however, this difference was not statistically significant. There was no significant difference in any of the other outcome measures between the treatment and the placebo group. The results show that oral ivermectin is without any clinically significant efficacy against embedded sand fleas at the dose given.

The aim of this study was to describe spatial patterns of the distribution of leprosy and to investigate spatial clustering of incidence rates in the state of Ceará, Northeast Brazil. The average incidence rate of leprosy for the period of 1991 to 1999 was calculated for each municipality of Ceará. Maps were used to describe the spatial distribution of the disease, and spatial statistics were applied to explore large- and small-scale variations of incidence rates. Three regions were identified in which the incidence of leprosy was particularly high. A spatial gradient in the incidence rates was identified, with a tendency of high rates to be concentrated on the North-South axis in the middle region of the state. Moran's I statistic indicated that a significant spatial autocorrelation also existed. The spatial distribution of leprosy in Ceará is heterogeneous. The reasons for spatial clustering of disease rates are not known, but might be related to an heterogeneous distribution of other factors such as crowding, social inequality, and environmental characteristics which by themselves determine the transmission of Mycobacterium leprae.

OBJECTIVE: To assess the short-term and long-term impact of selective mass treatment with ivermectin on the prevalence of intestinal helminthiases and parasitic skin diseases in an economically depressed community in north-east Brazil. METHODS: An intervention was carried out in a traditional fishing village in north-east Brazil where the population of 605 is heavily affected by ectoparasites and enteroparasites. The prevalence of intestinal helminths was determined by serial stool examination and the prevalence of parasitic skin diseases by clinical inspection. A total of 525 people out of a target population of 576 were treated at baseline. The majority of these were treated with ivermectin (200 µg/kg with a second dose given after 10 days). If ivermectin was contraindicated, participants were treated with albendazole or mebendazole for intestinal helminths or with topical deltamethrin for ectoparasites. Follow-up examinations were performed at 1 month and 9 months after treatment. FINDINGS: Prevalence rates of intestinal helminthiases before treatment and at 1 month and 9 months after mass treatment were: hookworm disease 28.5%, 16.4% and 7.7%; ascariasis 17.1%, 0.4% and 7.2%; trichuriasis 16.5%, 3.4% and 9.4%; strongyloidiasis 11.0%, 0.6% and 0.7%; and hymenolepiasis 0.6%; 0.4% and 0.5%, respectively. Prevalence rates of parasitic skin diseases before treatment and 1 month and 9 months after mass treatment were: active pediculosis 16.1%, 1.0% and 10.3%; scabies 3.8%, 1.0% and 1.5%; cutaneous larva migrans 0.7%, 0% and 0%; tungiasis 51.3%, 52.1% and 31.2%, respectively. Adverse events occurred in 9.4% of treatments. They were all of mild to moderate severity and were transient. CONCLUSION: Mass treatment with ivermectin was an effective and safe means of reducing the prevalence of most of the parasitic diseases prevalent in a poor community in north-east Brazil. The effects of treatment lasted for a prolonged period of time.

OBJETIVO: Evaluar el impacto del tratamiento masivo selectivo con ivermectina, a corto y a largo plazo, en la prevalencia de las helmintiasis intestinales y las parasitosis cutáneas en una comunidad económicamente deprimida del noreste del Brasil. MÉTODOS: Se llevó a cabo una intervención en un pueblo tradicional de pescadores del noreste del Brasil cuya población, de 605 habitantes, está gravemente afectada por diversos ectoparásitos y enteroparásitos. La prevalencia de los helmintos intestinales se determinó mediante examen coproparasitoscópico seriado, y la prevalencia de las parasitosis cutáneas, mediante inspección clínica. En total se trató al principio del estudio a 525 personas, de una población destinataria de 576. La mayoría de ellas fueron tratadas con ivermectina (200 µg/kg de peso, con una segunda dosis al cabo de 10 días). Cuando la ivermectina estaba contraindicada, el participante era tratado con albendazol o mebendazol si tenía helmintos intestinales, o con deltametrina tópica si tenía ectoparásitos. Los exámenes de seguimiento se realizaron al cabo de un mes y 9 meses del tratamiento. RESULTADOS: Las tasas de prevalencia de las helmintiasis intestinales antes del tratamiento y al cabo de un mes y 9 meses del tratamiento masivo fueron las siguientes: anquilostomiasis, 28,5%, 16,4% y 7,7%; ascariasis, 17,1%, 0,4% y 7,2%; tricuriasis, 16,5%, 3,4% y 9,4%; estrongiloidiasis, 11,0%, 0,6% y 0,7%; y himenolepiasis, 0,6%, 0,4% y 0,5%, respectivamente. Las tasas de prevalencia de las parasitosis cutáneas antes del tratamiento y al cabo de un mes y 9 meses del tratamiento masivo fueron las siguientes: pediculosis activa, 16,1% 1,0% y 10,3%; sarna, 3,8%, 1,0% y 1,5%; larva migrans cutánea, 0,7%, 0% y 0%; y tungiasis, 51,3%, 52,1% y 31,2%, respectivamente. Se registraron acontecimientos adversos en el 9,4% de los tratamientos, todos ellos entre leves y moderados y de carácter transitorio. CONCLUSIÓN: El tratamiento masivo con ivermectina fue un método eficaz y seguro de reducción de la prevalencia de la mayoría de las enfermedades parasitarias prevalentes en una comunidad pobre del noreste del Brasil. El tratamiento tuvo efectos prolongados.

OBJECTIF: Evaluer l'impact à court et à long terme d'un traitement de masse sélectif par l'ivermectine sur la prévalence des helminthiases intestinales et des dermatoses parasitaires dans une communauté économiquement défavorisée du nord-est du Brésil. MÉTHODES: Une intervention a été réalisée dans un village de pêcheurs traditionnel du nord-est du Brésil dont la population (605 habitants) est sévèrement touchée par des ectoparasites et des parasites intestinaux. La prévalence des helminthes intestinaux a été déterminée par examen en série de selles et celle des dermatoses parasitaires par inspection clinique. Au total, 525 personnes sur les 576 de la population cible ont été traitées en début d'intervention. La plupart ont reçu de l'ivermectine (200 µg/kg, avec une deuxième dose au bout de 10 jours). Lorsque l'ivermectine était contre-indiquée, les participants étaient traités par l'albendazole ou le mébendazole contre les helminthes intestinaux ou par la deltaméthrine en application locale contre les ectoparasites. Des examens de contrôle ont été réalisés 1 mois et 9 mois après le traitement. RÉSULTATS: La prévalence des diverses helminthiases intestinales avant le traitement et au bout d'un mois et de 9 mois après le traitement était, respectivement, de : ankylostomiase 28,5 %, 16,4 % et 7,7 % ; ascaridiase 17,1 %, 0,4 % et 7,2 % ; trichocéphalose 16,5 %, 3,4 % et 9,4 % ; strongyloïdose 11,0 %, 0,6 % et 0,7 % ; et hyménolépiase 0,6 %, 0,4 % et 0,5 %. La prévalence des diverses dermatoses parasitaires avant le traitement et au bout d'un mois et de 9 mois était, respectivement, de : pédiculose active 16,1 %, 1,0 % et 10,3 % ; gale 3,8 %, 1,0 % et 1,5 % ; larva migrans cutanée 0,7 %, 0 % et 0 % ; et tungose 51,3 %, 52,1 % et 31,2 %. Des effets indésirables ont été observés avec 9,4 % des traitements. Il s'agissait dans tous les cas d'effets passagers, de gravité faible à modérée. CONCLUSION: Le traitement de masse par l'ivermectine était un moyen efficace et sans danger pour réduire la prévalence de la plupart des affections parasitaires présentes dans une communauté pauvre du nord-est du Brésil, et ses effets étaient durables.

Doenças ectoparasitárias como a escabiose, a pediculose, a tungíase e a larva migrans cutânea são hiperendêmicas em inúmeras comunidades carentes no Brasil, e não raramente associadas à severidade considerável. Entretanto, programas que priorizem o controle de ectoparasitas não existem em nível de saúde pública no país. Como conseqüência da alta contagiosidade, de manejo inadequado, de negligência tanto da população como dos profissionais de saúde e/ou da presença de reservatórios animais, além de ciclos de vida complexos, o controle efetivo das ectoparasitoses é um desafio para a saúde pública. Aqui discutimos possíveis medidas de intervenção para o controle de doenças ectoparasitárias em comunidades afetadas, baseadas em tratamento em massa, educação em saúde e, caso se aplique, na erradicação dos reservatórios animais.

Parasitic skin diseases such as scabies, pediculosis, tungiasis, and cutaneous larva migrans are hyperendemic in the numerous poor communities in Brazil and are commonly associated with considerable morbidity. However, programs to control ectoparasites are non-existent in the country's public health system. Due to neglect of these diseases by the population itself and health care professionals, the diseases' highly contagious characteristics, and lack of effective treatment and/or presence of animal reservoirs together with a complex life cycle, effective control of ectoparasites is an enormous public health challenge. This article discusses potential measures to control parasitic skin diseases in affected communities, based on mass treatment, health education, and (when applicable) eradication of animal reservoirs.

Doenças ectoparasitárias como a escabiose, a pediculose, a tungíase e a larva migrans cutânea são hiperendêmicas em inúmeras comunidades carentes no Brasil, e não raramente associadas à severidade considerável. Entretanto, programas que priorizem o controle de ectoparasitas não existem em nível de saúde pública no país. Como conseqüência da alta contagiosidade, de manejo inadequado, de negligência tanto da população como dos profissionais de saúde e/ou da presença de reservatórios animais, além de ciclos de vida complexos, o controle efetivo das ectoparasitoses é um desafio para a saúde pública. Aqui discutimos possíveis medidas de intervenção para o controle de doenças ectoparasitárias em comunidades afetadas, baseadas em tratamento em massa, educação em saúde e, caso se aplique, na erradicação dos reservatórios animais.

Parasitic skin diseases such as scabies, pediculosis, tungiasis, and cutaneous larva migrans are hyperendemic in the numerous poor communities in Brazil and are commonly associated with considerable morbidity. However, programs to control ectoparasites are non-existent in the country's public health system. Due to neglect of these diseases by the population itself and health care professionals, the diseases' highly contagious characteristics, and lack of effective treatment and/or presence of animal reservoirs together with a complex life cycle, effective control of ectoparasites is an enormous public health challenge. This article discusses potential measures to control parasitic skin diseases in affected communities, based on mass treatment, health education, and (when applicable) eradication of animal reservoirs.