General adverse effects

Acute symptoms, often flu-like or affecting the skin, are related almost entirely to the release of toxic products and allergens from the killed filariae, and can affect two-thirds of patients; in conditions in which this type of reaction does not occur one may suspect that the drug is ineffective. The mechanism of the effects also explains why they tend to occur early and sometimes briefly, that is immediately after the microfilariae die. For similar reasons, these effects are most severe in patients with a high microfilaria count (24).

Despite the sometimes transient and apparently tolerable nature of the skin effects, they can persist in patients requiring long-term treatment, for example for onchocer-ciasis, and under these conditions they are sufficient to impair compliance with treatment (SEDA-21, 317).

The effects of age, sex, dosing round, time of day, and distance from the nurse monitor on adverse event reporting during mass ivermectin administration in Achi in South-East Nigeria have been examined (25). There was a significant increase in adverse reporting with age, but not sex. Fewer adverse effects were reported after starting at night than after starting by day. There was no significant effect of distances up to 1 km on adverse events reporting. Both compliance and adverse reporting were less after the second dosing round than after the first. These variables should be included in the standardization of adverse events reporting.

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