Investigation of Four Cases of Stevens-Johnson Syndrome among Participants in a Mass Drug Administration Campaign with Sulfadoxine-Pyrimethamine and Primaquine in Haiti, 2020

Am J Trop Med Hyg. 2023 May 1;108(6):1140-1144. doi: 10.4269/ajtmh.22-0625. Print 2023 Jun 7.

Abstract

In 2018, a mass drug administration (MDA) campaign for malaria elimination was piloted in Haiti. The pilot treated 36,338 people with sulfadoxine-pyrimethamine (SP) and primaquine; no severe adverse events were detected. In 2020, another MDA campaign using the same medications was implemented to mitigate an upsurge in malaria cases during the COVID-19 pandemic. Four cases of Stevens-Johnson syndrome (SJS) were identified among the 42,249 people who took the medications. Three of these individuals required hospitalization; all survived. In addition to SP ingestion, an investigation of potential causes for increased SJS cases identified that all four cases had human leukocyte antigens A*29 and/or B*44:03, another known risk factor for SJS. Additionally, three of the four case individuals had antibodies to SARS-CoV-2, and the fourth may have been exposed around the same time. These findings raise the possibility that recent SARS-CoV-2 infection may have contributed to the increased risk for SJS associated with SP exposure during the 2020 campaign.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Antimalarials* / adverse effects
  • COVID-19*
  • Drug Combinations
  • Haiti / epidemiology
  • Humans
  • Malaria* / drug therapy
  • Malaria* / epidemiology
  • Malaria* / prevention & control
  • Mass Drug Administration
  • Pandemics
  • Primaquine / adverse effects
  • Pyrimethamine / adverse effects
  • SARS-CoV-2
  • Stevens-Johnson Syndrome* / drug therapy
  • Stevens-Johnson Syndrome* / epidemiology
  • Stevens-Johnson Syndrome* / etiology
  • Sulfadoxine / adverse effects

Substances

  • fanasil, pyrimethamine drug combination
  • Primaquine
  • Antimalarials
  • Pyrimethamine
  • Sulfadoxine
  • Drug Combinations