# Prevention and improved management of serious neurological adverse events during praziquantel-based mass drug administration in a Taenia solium endemic area: Experiences from Madagascar

## TL;DR

This paper describes how Madagascar safely conducted large-scale drug campaigns using praziquantel by implementing a program to prevent and manage neurological side effects.

## Contribution

A practical program to minimize and manage neurological adverse events during praziquantel mass drug administration in T. solium endemic areas.

## Key findings

- A program including training, awareness, and surveillance reduced neurological adverse events during two MDA campaigns.
- Out of 280,305 people treated, only 10 experienced neurological side effects, all of which were successfully managed.
- The approach in Madagascar can serve as a model for other T. solium endemic regions using praziquantel.

## Abstract

Mass drug administration (MDA) programs involving praziquantel are used in public health programs to control diseases such as schistosomiasis, taeniasis caused by Taenia solium, opisthorchiasis and clonorchiasis. Praziquantel is a systemically distributed anthelmintic drug also used to treat neurocysticercosis (NCC) caused by the larval stages of T. solium in the central nervous system. The doses of praziquantel used in MDA are low compared to those used for the treatment of NCC, but in people with latent NCC (without symptoms or signs), there is a potential risk of neurological adverse events (AE) due to the development of inflammation around the cysts following administration. In Madagascar two large MDA campaigns aimed at T. solium were conducted using praziquantel in the Vakinankaratra region. Prior to the first MDA campaign, we implemented a program designed to minimize the occurrence of neurological AE and improve their management, which included training of health agents and community workers as well as health centres staff, population awareness, post-MDA active and passive surveillance and the supply of basic medicines to health centres. This program was repeated for the second MDA campaign. A total of 117,216 and 163,089 people were treated during the first and second MDA campaign respectively, with 10 participants experiencing serious AE, which were successfully managed. The beneficial results from our program in Madagascar can help other programs and countries using MDA with praziquantel in T. solium endemic areas to improve the safety of these campaigns.

Mass drug administration (MDA) with praziquantel is an important tool to combat several diseases, including taeniasis caused by the adult form of Taenia solium. The larvae of T. solium frequently infects the central nervous system of humans, causing neurocysticercosis. Since praziquantel is active not only on the adult form of the parasite, but also on its larval form, there are risks of neurological adverse events (seizures or symptoms of intracranial hypertension) if individuals who are treated for possible taeniasis, have neurocysticercosis. These adverse events are infrequent but can be life-threatening if not managed promptly in a correct manner. In Madagascar we set up a program to minimise those neurological adverse events, quickly identify them if they occurred, and to manage them appropriately. Following the implementation of this program, two MDA campaigns were carried out. A total of 280,305 people received treatment, with 10 experiencing neurological side effects. All cases were well managed, and all are now in good health. Here we describe our experiences, as we believe they can be useful to other programs using praziquantel in T. solium endemic areas.