Administration of Triclabendazole Is Safe and Effective in Controlling Fascioliasis in an Endemic Community of the Bolivian Altiplano

Background: The Bolivian northern Altiplano is characterized by a high prevalence of Fasciola hepatica infection. In order to assess the feasibility, safety and efficacy of large-scale administration of triclabendazole as an appropriate public health measure to control morbidity associated with fascioliasis, a pilot intervention was implemented in 2008. Materials and Methods: Schoolchildren from an endemic community were screened for fascioliasis and treated with a single administration of triclabendazole (10 mg/kg). Interviews to assess the occurrence of adverse events were conducted on treatment day, one week later, and one month after treatment. Further parasitological screenings were performed three months after treatment and again two months later (following a further treatment) in order to evaluate the efficacy of the intervention. Results: Ninety infected children were administered triclabendazole. Adverse events were infrequent and mild. No serious adverse events were reported. Observed cure rates were 77.8% after one treatment and 97.8% after two treatments, while egg reduction rates ranged between 74% and 90.3% after one treatment, and between 84.2% and 99.9% after two treatments. The proportion of high-intensity infections (≥400 epg) decreased from 7.8% to 1.1% after one treatment and to 0% after two treatments. Conclusion: Administration of triclabendazole is a feasible, safe and efficacious public health intervention in an endemic community in the Bolivian Altiplano, suggesting that preventive chemotherapy can be applied to control of fascioliasis. Further investigations are needed to define the most appropriate frequency of treatment. Author Summary: Fascioliasis is highly prevalent in the northern Altiplano of Bolivia. We wanted to ascertain whether a preventive chemotherapy approach, involving the large-scale distribution of triclabendazole within endemic communities, would be feasible for controlling morbidity associated with this disease. Consequently, we implemented a pilot intervention among schoolchildren in a community near Lake Titicaca and assessed this intervention's safety (by evaluating the occurrence of adverse events following treatment) and its efficacy (by measuring changes in prevalence and intensity of infection). Adverse events on treatment day, and one week and one month later were infrequent and mild, and no serious adverse events were reported. We observed cure rates of 77.8% after one treatment and 97.8% after two treatments, egg reduction rates of 74–90.3% after one treatment and 84.2–99.9% after two treatments, and a decrease in the proportion of high-intensity infections (≥400 epg) from 7.8% to 1.1% after one treatment and to 0% after two treatments. We conclude that administration of triclabendazole is a safe and efficacious public health intervention for control of fascioliasis in an endemic community in the Bolivian Altiplano. Preventive chemotherapy with triclabendazole, without individual-level diagnosis and treatment, appears therefore as a feasible option. However, further investigation is needed to define the most appropriate frequency of treatment.