NYDA

NYDA® is a blend of two different viscosities of dimeticone (a medical name for a silicone oil also known as dimethicone and polydimethylsiloxane). In scientific tests in Uganda and Kenya, NYDA has proved highly effective against jiggers.

Whisper is seeking permission from the Ugandan government to import NYDA to help with its work in combatting jiggers. It would be used by Whisper’s outreach team; potentially it could also be distributed to VHT workers, other health workers, appropriate staff in schools and similar community organisations, and to individual patients.

Mode of Action

NYDA works physically by entering the airways of the jigger by capillary action and suffocating the insect. It does not act as a chemical poison.

A few drops of NYDA applied to the jigger is typically enough to kill it¹. NYDA is particularly effective in the early stages of infestation when the insect’s need for oxygen is high. In a study in Kenya² 88% of early stage jiggers were killed by a single application of NYDA, compared with 65% of late stage jiggers.

NYDA can kill headlice in minutes, or under a minute in the laboratory and its action on jiggers appears to be similarly rapid. The video below shows NYDA being absorbed by a headlouse.

(embedded media not migrated: youtube>2HQP85aYfus)

Benefits

As a non-surgical treatment for jiggers, NYDA is painless, so people will no longer avoid treatment. It provides an alternative to home extraction of jiggers using non-sterile sharp objects, which is considered a possible transmission mechanism for HIV and hepatitis.

NYDA is quite cost-effective. In the EU it can be bought at retail for EUR 10.90³ (UGX 44000) for 100ml, although as a charity Whisper should not have to pay VAT on medicines. Assuming a drop size of 0.05ml and 2 drops to treat each jigger, this should be sufficient to treat around 1000 jiggers. Small children in rural areas often have 50 jiggers in various stages of development, so 1000 jiggers = 20 children.

Because of its physical mode of action, the insects are unlikely to develop resistance to NYDA.

Approvals

At the time of writing (April 2016), drug approval for Nyda in Uganda is imminent.

NYDA is approved in the EU and Canada as a treatment for head lice. In Germany it is the market leading treatment for head lice. It can be bought without prescription from pharmacies.

In Uganda it would need to be officially approved by Uganda’s National Drug Authority; this would cost an initial registration fee of $1250 and then $500 annually, plus another $4000 annually for inspection visits to Pohl-Boskamp’s factories in Germany. Manufacture by a local licensee might be a cheaper long-term option.

Drugs can sometimes be used in Uganda without registration and there is a form to apply for a special exemption:

In exceptional circumstances and to meet specialized needs, drugs not contained in the EDLU or UNF may be allowed for donation provided that:

They are supplied for use by an individual patient or specialized department of a health institution.
They have not at any time been rejected for registration in Uganda.

Suppliers

Nyda is widely available in Europe without prescription. The French retail pharmacy Cocooncenter usually has the best retail prices; they don’t ship to Uganda. Durbin can supply Nyda wholesale but only the 50ml size.

In April 2016, Pohl-Boskamp offered us Nyda at EUR28.2 per litre, for a minimum of 860 litres. We would need to arrange delivery from Hamburg.

Precautions

Dimeticones (NYDA’s main ingredient) are not absorbed through the skin and are widely and safely used in infant medicines, cosmetics, shampoos and hair sprays.

The main hazard is flammability. NYDA contains two different dimeticones: a highly volatile one which evaporates within a couple of minutes when applied to the skin (and which is highly inflammable) and another one with a higher viscosity (which remains on the skin for an hour or so). NYDA should never be applied when there is a (cooking) fire or somebody is smoking a cigarette. It should be kept out of the reach of children.

NYDA must not be used in people with known allergies (hypersensitivity) to any of its ingredients. For a complete ingredient listing, see the Composition section below.

Clinical studies have been performed with children; it is considered safe for children of any age, and for pregnant and breastfeeding mothers.

Patients should be warned to not use NYDA near the eyes or mucosa membranes (nose or mouth). If product gets into their eyes, patients should immediately rinse for 10-15 minutes with water.

NYDA is for external use only and patients should be warned to avoid inhaling or ingesting it.

If NYDA is spilled accidentally, there is a danger of slipping. Spillages should therefore be cleaned up immediately.

Composition

Medicinal Ingredients:

Dimeticone 100 cSt ⁴

Non-medicinal Ingredients:

Alpha-terpineol
Corymbia citriodora (boabo oil)
Jojoba wax
low viscosity dimeticone and triglycerides.

Manufacturer

NYDA is manufactured by:

G. Pohl-Boskamp GmbH & Co. KG
Kieler Straße 11
25550 Hohenlockstedt, Germany
http://www.pohl-boskamp.com

NYDA product infomation websites:

Feldmeier H, Nordin P, Ngomi N, George Mukone Mudanga,Thielecke M (2014) Treatment of tungiasis with dimeticone: A targeted topical application is superior to wetting the skin of the whole foot. Poster describing study conducted in Bulidha sub-county, Busoga Region, Uganda. ↩
Thielecke M, Nordin P, Ngomi N, Feldmeier H (2014) Treatment of Tungiasis with Dimeticone: A Proof-of-Principle Study in Rural Kenya PLoS Negl Trop Dis 8(7): e3058.doi:10.1371/journal.pntd.0003058 ↩
http://www.cocooncenter.co.uk/nyda-ultra-100ml/12353.html ↩
cSt or centiStokes is a unit of kinematic viscosity, that is to say a measure of how easily a liquid pours, with lower numbers pouring more easily. Water is around 1 cSt, vegetable oil 40 cSt, runny honey 2000 cSt ↩