EPIDEMIOLOGIC MASS

TREATMENT
Dr Arulita Ika Fibriana M.Kes (Epid)
DEFINITION
Epidemiologic mass treatment is the
presumptive treatment of individuals
or populations with a high likelihood of
having disease.
Treatment is dependent not on the
presence of symptoms or signs, nor
on results of laboratory tests, but on
increased risk of exposure.
INTRODUCTION
A wide range of terminology : mass
treatment, selective mass treatment,
presumptive treatment, empiric
prophylaxis/treatment.
Mass treatment is the application of
epidemiologic treatment to general
populations based on high overall community
prevalence.
The more focused epidemiologic treatment of
higher-risk sub-populations (such as sex
workers, migrant workers or military) is
referred to herein as targeted presumptive
treatment.
Either population-based mass treatment or
targeted presumptive treatment can be
carried out once or periodically over time.

INTRODUCTION
Antibiotics or antimicrobial drugs can be
given on an epidemiologic basis to
treat presumed disease in persons at
risk of being infected (presumptive
treatment) or to prevent future infection
in persons with continued high levels of
exposure (prophylaxis treatment).
In practice, because exposure is
generally high in populations with high
prevalence, presumptive administration
of antibiotics probably has both
treatment and prophylactic effects.
Where accurate, affordable, rapid
diagnostics are available, individuals
can be selected for screening on
epidemiologic grounds, with treatment
reserved for those with positive results
Targeted screening and treatment
is related.

MASS TREATMENT ON
EPIDEMIOLOGICAL PRACTICE (STDs
CONTROL PROGRAM)
STD control strategy at healthcare
facilities is restricted by the extent to
which people recognize that they are
infected and present for care, as well as
by the availability of STD services and
resources to provide STD screening.
Most women, and many men, with STDs
are asymptomatic, and many of those
with symptoms may seek care in the
informal sector.
Age and ethnicity may affect access or
perceived access to health care.

MASS TREATMENT ON
EPIDEMIOLOGICAL PRACTICE (STDs
CONTROL PROGRAM)
Mass treatment addresses these
limitations by treating whole
populations (GENERAL
POPULATION APPROACH/
population-based mass treatment)
regardless of symptoms, clinical signs,
or healthcare-seeking behavior, and
therefore should have a significant
impact on the size of the disease
reservoir.
MASS TREATMENT ON
EPIDEMIOLOGICAL PRACTICE (STDs
CONTROL PROGRAM)
Targeted presumptive treatment takes a
different approach.
Core group theory argues that individuals are
not equal when it comes to STD
transmission.
Rates of partner change influence
susceptibility to infection and chance of
subsequent transmission, vary widely within
populations;
Most people have few partners, relatively low
risk of STD exposure, and limited opportunity
to transmit acquired infections to
susceptibles.
MASS TREATMENT ON
EPIDEMIOLOGICAL PRACTICE (STDs
CONTROL PROGRAM)
Core groups, on the other hand, are
defined as subgroups within the
population with rates of partner change
sufficient to maintain an STD
reproductive rate of greater than one ( A
reproductive rate greater than one in any
population group leads to epidemic
growth).
Bridging populations, (clients of sex
workers), assure continued transmission
between core and noncore groups.

Despite differences in approach, population-
based mass treatment and targeted
presumptive treatment strategies share the
same basic disease control objectives.
The primary objective has been to achieve a
rapid reduction in disease prevalence.
Therefore, epidemiologic treatment
strategies are temporary or emergency
measures.
To maintain reduced prevalence levels, other,
more sustainable, control measures, such as
primary prevention and improved case
management, must be in place.
Because of more frequent partner
change in the core, STD control
strategies that target core groups are
potentially much more efficient than
general population approaches.

Presumptive treatment of the most
epidemiologically important core
groups more cost-effective
approach to reducing STD prevalence
than general population mass
treatment.