1921
Volume 99, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Ivermectin treatment can cause central nervous system adverse events (CNS-AEs) in persons with very high-density microfilaremia (≥ 30,000 mf/mL blood). Hypoendemic onchocerciasis areas where is endemic have been excluded from ivermectin mass drug administration programs (MDA) because of the concern for CNS AEs. The rapid assessment procedure for (RAPLOA) is a questionnaire survey to assess history of eye worm. If ≥ 40% of respondents report eye worm, this correlates with ≥ 2% prevalence of very high-density loiasis microfilaremia, posing an unacceptable risk of CNS-AEs after MDA. In 2016, we conducted a study in 110 ivermectin-naïve, suspected onchocerciasis hypoendemic villages in southern Nigeria. In previous RAPLOA surveys these villages had prevalences between 10% and 67%. We examined 10,605 residents using the LoaScope, a cell phone–based imaging device for rapidly determining the microfilaria (mf) density of infections. The mean village mf prevalence was 6.3% (range 0–29%) and the mean individual mf count among positives was 326 mf/mL. The maximum individual mf count was only 11,429 mf/mL, and among 2,748 persons sampled from the 28 villages with ≥ 40% RAPLOA, the ≥ 2% threshold of very high mf density could be excluded with high statistical confidence ( < 0.01). These findings indicate that ivermectin MDA can be delivered in this area with extremely low risk of –related CNS-AEs. We also concluded that in Nigeria the RAPLOA survey methodology is not predictive of ≥ 2% prevalence of very high-density microfilaremia.

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References

  1. Cupp EW, Sauerbrey M, Richards F, , 2011. Elimination of human onchocerciasis: history of progress and current feasibility using ivermectin (Mectizan®) monotherapy. Acta Trop 120 (Suppl 1): S100S108. [Google Scholar]
  2. Boatin BA, Richards FO, Jr., 2006. Control of onchocerciasis. Adv Parasitol 61: 349394. [Google Scholar]
  3. World Health Organization, 2017. Summary of global update on preventive chemotherapy implementation in 2016: crossing the billion. Wkly Epidemiol Rec 92: 589593. [Google Scholar]
  4. Herricks JR, 2017. The global burden of disease study 2013: what does it mean for the NTDs? PLoS Negl Trop Dis 11: e0005424. [Google Scholar]
  5. Mectizan Donation Program, 2017. Available at: https://www.mectizan.org/achievements. Accessed December 21, 2017.
  6. Katabarwa M, Richards F, , 2014. Twice-yearly ivermectin for onchocerciasis: the time is now. Lancet Infect Dis 14: 373374. [Google Scholar]
  7. Diawara L, 2009. Feasibility of onchocerciasis elimination with ivermectin treatment in endemic foci in Africa: first evidence from studies in Mali and Senegal. PLoS Negl Trop Dis 3: e497. [Google Scholar]
  8. Kelly-Hope LA, Unnasch TR, Stanton MC, Molyneux DH, , 2015. Hypo-endemic onchocerciasis hotspots: defining areas of high risk through micro-mapping and environmental delineation. Infect Dis Poverty 4: 36. [Google Scholar]
  9. Mectizan Donation Program, 1996. Central Nervous System (CNS) Complications of Loiasis and Adverse CNS Events Following Treatment: Report of an Invited Consultation. October 2–3, 1995, Atlanta, GA: Mectizan Donation Program.
  10. Boussinesq M, Gardon J, , 1997. Prevalences of Loa loa microfilaraemia throughout the area endemic for the infection. Ann Trop Med Parasitol 91: 573589. [Google Scholar]
  11. Boussinesq M, Gardon J, Gardon-Wendel N, Kamgno J, Ngoumou P, Chippaux JP, , 1998. Three probable cases of Loa loa encephalopathy following ivermectin treatment for onchocerciasis. Am J Trop Med Hyg 58: 461469. [Google Scholar]
  12. Kamgno J, Boussinesq M, Labrousse F, Nkegoum B, Thylefors BI, Mackenzie CD, , 2008. Encephalopathy after ivermectin treatment in a patient infected with Loa loa and Plasmodium spp. Am J Trop Med Hyg 78: 546551. [Google Scholar]
  13. Gardon J, Gardon-Wendel N, Demanga N, Kamgno J, Chippaux JP, Boussinesq M, , 1997. Serious reactions after mass treatment of onchocerciasis with ivermectin in an area endemic for Loa loa infection. Lancet 350: 1822. [Google Scholar]
  14. Addiss DG, Rheingans R, Twum-Danso NA, Richards FO, , 2003. A framework for decision-making for mass distribution of Mectizan(R) in areas endemic for Loa loa. Filaria J 2 (Suppl 1): S9. [Google Scholar]
  15. Twum-Danso NA, , 2003. Loa loa encephalopathy temporally related to ivermectin administration reported from onchocerciasis mass treatment programs from 1989 to 2001: implications for the future. Filaria J 2 (Suppl 1): S7. [Google Scholar]
  16. Diggle PJ, 2007. Spatial modelling and the prediction of Loa loa risk: decision making under uncertainty. Ann Trop Med Parasitol 101: 499509. [Google Scholar]
  17. Tekle AH, Zoure H, Wanji S, Leak S, Noma M, Remme JH, Amazigo U, , 2011. Integrated rapid mapping of onchocerciasis and loiasis in the Democratic Republic of Congo: impact on control strategies. Acta Trop 120 (Suppl 1): S81S90. [Google Scholar]
  18. Wanji S, , 2001. Rapid Assessment Procedures for Loiasis: Report of a Multi-centre Study. Geneva, Switzerland: UNDP/World Bank/World Health Organization Special Programme for Research & Training in Tropical Diseases.
  19. Wanji S, Akotshi DO, Mutro MN, Tepage F, Ukety TO, Diggle PJ, Remme JH, , 2012. Validation of the rapid assessment procedure for loiasis (RAPLOA) in the Democratic Republic of Congo. Parasit Vectors 5: 25. [Google Scholar]
  20. Zoure HG, Wanji S, Noma M, Amazigo UV, Diggle PJ, Tekle AH, Remme JH, , 2011. The geographic distribution of Loa loa in Africa: results of large-scale implementation of the Rapid Assessment Procedure for Loiasis (RAPLOA). PLoS Negl Trop Dis 5: e1210. [Google Scholar]
  21. D’Ambrosio MV, 2015. Point-of-care quantification of blood-borne filarial parasites with a mobile phone microscope. Sci Transl Med 7: 286re4. [Google Scholar]
  22. Kamgno J, Pion SD, Mackenzie CD, Thylefors B, Boussinesq M, , 2009. Loa loa microfilarial periodicity in ivermectin-treated patients: comparison between those developing and those free of serious adverse events. Am J Trop Med Hyg 81: 10561061. [Google Scholar]
  23. Kamgno J, 2017. A test-and-not-treat strategy for onchocerciasis in Loa loa-endemic areas. N Engl J Med 377: 20442052. [Google Scholar]
  24. Federal Ministry of Health, Nigeria, 2017. Nigeria Onchocerciasis Elimination Plan. Abuja, Nigeria: Federal Ministry of Health.
  25. Takougang I, 2002. Rapid assessment method for prevalence and intensity of Loa loa infection. Bull World Health Organ 80: 852858. [Google Scholar]
  26. Hassan AA, Akinsanya B, Iyase N, Owagboriaye FO, , 2011. Assessment of loiasis and outcomes of ivermectin masstreatment in Ijebu-North, Nigeria. Korean J Parasitol 49: 153159. [Google Scholar]
  27. Anonymous, 2016. Communiqué of the 5th Onchocerciasis Elimination Committee (NOEC). December 14–16, 2016, Barcelona Hotel, Abuja, Nigeria.
  28. World Health Organization/Department of Control of Neglected Tropical Diseases, 2012. Provisional Strategy for Interrupting Lymphatic Filariasis Transmission in Loiasis-endemic Countries: Report of the Meeting on Lymphatic Filariasis, Malaria and Integrated Vector Management. Accra, Ghana: WHO.
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  • Received : 22 Feb 2018
  • Accepted : 04 Apr 2018
  • Published online : 14 May 2018

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