Module 5 Programme operations and Logistics · Module 5 Programme operations and Logistics Session 5.5.2: Management of Adverse events due to Mectizan in Loa loa co-infection areas

District Level Management NTD Training Course Meeting NTD STAG, 29-30 April 2013, Geneva, Switzerland 1

District Level Management NTD Training Course

Module 5 Programme operations and Logistics

Session 5.5.2:

Management of Adverse events due to

Mectizan in Loa loa co-infection areas

Revision:1.6.2015(Global version)



• To equip implementers at the district level with the

knowledge and skills on case definitions of adverse events related to treatment with ivermectin in Loa loa endemic areas and how to manage them

Session 5.5: Purpose



By the end of the session, participants will be able to: • Define Mectizan intake related adverse events by defining categories, clinical symptoms, risks factors, etc. • Learn management of adverse events related to Mectizan in Loa loa areas.

• Effectively plan management of adverse events at all level

Learning objectives



Co-endemicity of Loa Loa with LF and ONCHO

Loa loa co-endemic countries to use their country mapping



Background information on Loiasis

Loiasis is a filarial disease caused by the presence of the Loa loa. • Transmission : - Loiasis vector is a yellow fly called Chrysops (Horsefly). Geographic distribution: -Loa loa is endemic in the forest areas of Angola, Cameroon, Democratic Republic of Congo, Congo, Central African Republic, Chad, Nigeria, Gabon, Equatorial Guinea mainland, Sudan (map) Symptom of Loiasis is characterized by:

itching in urticaria, the « Calabar » oedema of the hands; sub-conjunctival migration of the adult worm that may lead to eye

oedema and eye redness.

•



Types of Adverse Events due to Loa loa

MINOR ADVERSE EVENTS :

Generally, these events disappear after 2 or 3 days following their occurrence without treatment. The following could be noted: Itching, skin eruption ;

Fever, Headache, muscular and articulation pains, fatigue, dizziness ;

Blurred vision; localized or generalized inflammatory oedemas.



Types of Adverse events due to Loa loa

MODERATE ADVERSE EVENTS :

The following could be noted:

- Intense headache ; - Generalized pains ; - Diarrhea that may cause dehydration - Intense fatigue and prolonged immobilization ; - More acute dizziness.



Types of Adverse events due to Loa loa

SEVERE ADVERSE EVENTS

• Additionally, orthostatic hypotension, encephalopathies generally occur in patients infested by Loa loa and who had received Mectizan® treatment.

• Neurological symptoms and signs occur in the first 5 days after taking Mectizan®. In some cases, the patient begins to complain of disorders within 24 hours, following the treatment.

They consist of: - Severe lombalgies ;

- High fever ; - Intense headache ; - Generalized myalgies ; - Difficulties standing or walking.



Types of Adverse events

SEVERE ADVERSE EVENTS Then, the following symptoms take hold progressively: - Behaviour disorder and loss of sense of orientation ; - Painful and continuous headache ;

- Panic attacks and Stupor - Obnubilation ; - Coma - palpebral conjunctival hemorrhage could be noted in many cases - retinal hemorrhages could be observed.



Risk factors

The risk of SAEs occurrence increases with intensity of Loa loa

count in blood. The risk of developing an encephalopathy, it is significant when

the Loa loa microfilaria prior to taking Mectizan® is above 30 000 mf/ml



Alert signs of Loiasis

Conjunctival hemorrhage (red eye): These hemorrhages can be noticed by lowering the lower eyelid or by inverting, the higher eyelid. Behaviour disorders: Behaviour disorders, are often distinctive and occur with an incoherent language. The patient will complain about people around them with no reason. Severe lumbagos: severe lumbagos occurs before neurological disorders would set in. Patients complain and tell you “ my back is broken into two pieces”. It is sometimes so painful that the patient can’t stand up any longer.



Management of Adverse events

MANAGEMENT OF MINOR AND MODERATE ADVERSE EVENTS

Symptoms Treatment

Fever antipyretics (paracetamol)

Pains antalgics (paracétamol)

Itching antihistaminics (Chlorpheniramin ou promethazin)

Dizziness Bed rest

Intense fatigue Rest, food, multi –vitamins

Diarrhea Oral rehydration salt (ORS) or Sugar-Salt Solution (SSS)

NB: Tranfer patient to referral hospital if worsening and sings and symptoms lasts more than 3 to 4 days.



Supportive activities to manage Loa loa-Ivermetin events

1. Capacity building of health personnel in early identification and management of adverse events including Job-aides to each category of health workers

2. Sensitization of community members on

• potential occurrence adverse events

• the frequency of their occurrence and duration of signs

and symptoms

• steps to be taken in moderate and severe cases



Supportive activities to manage Loa loa –Ivermection events

Key message to Loa loa co-endemic population: • Inform red eye after ivermectin distribution and /or any other symptoms to community

drug distributor (CDD) immediately • If CDD is not available, go to nearest health facility • Do not get panickey and spread rumors

Key message to Community drug distributors: In case of adverse event(minor-moderate-severe), counsel the affected individual

Advice appropriate immediate steps and refer to nearest health center

In case of severe adverse event, urgently inform the nurse and refer the patient to the referral hospital.

Plan daily visit to community after MDA for about a week daily if possible to suspect early adverse events



Session 5.5: Key message

• Adverse events(AE/SAE) of mild to severe may occur in individuals after Invermection administration in Loa loa co-endemic area

• Post-MDA surveillance facilitates to recognize AE/SAE early stage for better clinical management

• Community members should be made aware of AE/SAE before the MDA

Documents

Module 5 Programme operations and Logistics · Module 5 Programme operations and Logistics Session 5.5.2: Management of Adverse events due to Mectizan in Loa loa co-infection areas