CDTI

The main strategy, to reach the goal to eliminate onchocerciasis as a disease of public health importance, is the Community Directed Treatment with Ivermectin (CDTI). In CDTI the main partner in the implementation is the community. Instead of having health personnel take all decisions and implement all aspects of the project, the community themselves direct the process. They will decide if they want the Mectizan® distributed in their community, when the distribution will take place, how the distribution will be done (from house to house or at a certain time in a specified location) and they will choose the persons who will perform the distribution in the community. The health workers will provide the necessary training and guidance to the community that is necessary.

Mectizan®

In 1987 Merck & Co., ltd. made the commitment to donate Mectizan® (also known by its generic name Ivermectin) to as many as needed for as long as needed. This was not only a major breakthrough for the onchocerciasis program but also an unprecedented event in public health. Before the availability of Mectizan® there was no safe drug for treatment or prevention of onchocerciasis.

An annual single dose of Mectizan® is effective in reducing the microfilarial density in the skin to near zero for up to 12 months. This means that when the blackfly bites an infected person there will not be any microfilaria left to ingest

250 millionth donation of Mectizan®

On the 5th September 2002 the 250 millionth dose of Mectizan® was donated. HKI was very honoured to have this dose distributed in its project area in Tanzania. The dose was jointly administered by the Vice President of Tanzania, Dr. Mohamed Ali Shein and the CEO of Merck & Co., Inc., Mr. Raymond Gillmartin.

THE BENEFITS OF MECTIZAN®:

1. Kills microfilaria (small worms)
2. Prevents onchocerciasis symptoms
3. Stops the symptoms and improves the patient's health. It:
* prevents vision from worsening, and sometimes may improve vision.
* prevents and provides relief from itching and other skin-related symptoms associated with the disease.
4. Expels intestinal worms.

MECTIZAN® LIMITATIONS:

It is important that patients understand the limitations of Mectizan® in order to avoid disappointment due to unrealistic expectations. In general, Mectizan® has no effect on:
1. existing skin nodules
2. depigmented skin
3. extremely wrinkled skin
4. leopard skin
5. blindness
6. macrofilaria (adult worms), which live 10 to 15 years. This is the why people must take Mectizan® for several years while waiting for the natural death of macrofilaria.

EVERYBODY IN A COMMUNITY INFECTED WITH ONCHOCERCIASIS SHOULD TAKE MECTIZAN®, EXCEPT:

" very sick individuals, or individuals too weak to walk
" pregnant women.
" children under 5 years or under 90 cm
" women who gave birth less than 8 days ago.

In the communities the dosage of Mectizan® is determined by the height of a person. The table below shows the correct dosage.

Patient's height (cm)	Number of tablets per person
Less than 90	None
90 – 119	1
120 – 140	2
141 – 158	3
159+	4