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Objectives  This longitudinal comparative study investigated the effect of preventive chemotherapy ( PC ) on covert tissue changes associated with lymphatic filariasis ( LF ) among young people living in an  LF ‐endemic area in Myanmar.    Methods  Tissue compressibility and extracellular free fluid in the lower limbs of people aged 10–21 years were measured using indurometry and bioimpedance spectroscopy ( BIS ). Baseline measures were taken in October 2014, annual mass drug administration ( MDA ) of  PC  was delivered in December, and in March 2015 further  PC  was offered to  LF ‐positive cases who had missed  MDA . Follow‐up measures were taken in February and June 2015.    Results  A total of 50 antigen‐positive cases and 46 antigen‐negative controls were included. Self‐reported  PC  consumption was 60.1% during 2014  MDA  and 66.2% overall. At second follow‐up, 24 of 34 cases and 27 of 43 controls had consumed  PC . Significant and clinically relevant between‐group differences at baseline were not found post‐ PC . Bayesian linear mixed models showed a significant change in indurometer scores at both calves for antigen‐positive cases who consumed any  PC  (dominant calf: −0.30 [95%  CI  −0.52, −0.07],  P  < 0.05 and non‐dominant calf: −0.35 [95%  CI  −0.58, −0.12],  P  < 0.01). Changes in antigen‐negative participants or those not consuming  PC  were not significant.    Conclusion  This study is the first attempt to use simple field‐friendly tools to track fluid and tissue changes after treatment of asymptomatic people infected with  LF . Results suggested that  PC  alone is sufficient to reverse covert lymphatic disturbance. Longer follow‐up of larger cohorts is required to confirm these improvements and whether they persist over time. These findings should prompt increased efforts to overcome low  PC  coverage, which misses many infected young people, particularly males, who are unaware of their infection status, unmotivated to take  PC  and at risk of developing lymphoedema. Indurometry and  BIS  should be considered in assessment of lymphatic filariasis‐related lymphedema.

Preventive chemotherapy reverses covert, lymphatic‐associated tissue change in young people with lymphatic filariasis in Myanmar