'Test and not treat' for onchocerciasis control in a Loa loa endemic area
| Autor: | Amy D. Klion, Michel Boussinesq, Thomas B. Nutman, Raceline Gounoue-Kamkumo, Guy-Roger Njitchouang, Joseph Kamgno, Daniel A. Fletcher, Charles D. Mackenzie, Wilma A. Stolk, Samuel Wanji, Jules B Tchatchueng-Mbouga, Hugues C. Nana-Djeunga, Michael V. D’Ambrosio, Matthew H. Bakalar, Sébastien D. S. Pion, Cédric B Chesnais, Philippe Nwane |
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| Přispěvatelé: | Public Health |
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Endemic Diseases 030231 tropical medicine Elephantiasis Onchocerciasis 03 medical and health sciences Loa Elephantiasis Filarial Loiasis 0302 clinical medicine Ivermectin Internal medicine parasitic diseases medicine Animals Humans Cameroon 030212 general & internal medicine Child Adverse effect Microfilariae Lymphatic filariasis Aged Microscopy Video Antiparasitic Agents biology business.industry Central africa General Medicine Middle Aged medicine.disease biology.organism_classification Antiparasitic agent Blood Logistic Models Filaricides Immunology Mass Drug Administration Female Loa loa business medicine.drug Research Article |
| Zdroj: | The New England Journal of Medicine New England Journal of Medicine, 377(21), 2044-2052. Massachussetts Medical Society |
| ISSN: | 1533-4406 0028-4793 |
| Popis: | Implementation of an ivermectin-based community treatment strategy for the elimination of onchocerciasis or lymphatic filariasis has been delayed in Central Africa because of the occurrence of serious adverse events, including death, in persons with high levels of circulating Loa loa microfilariae. The LoaScope, a field-friendly diagnostic tool to quantify L. loa microfilariae in peripheral blood, enables rapid, point-of-care identification of persons at risk for serious adverse events.A test-and-not-treat strategy was used in the approach to ivermectin treatment in the Okola health district in Cameroon, where the distribution of ivermectin was halted in 1999 after the occurrence of fatal events related to L. loa infection. The LoaScope was used to identify persons with an L. loa microfilarial density greater than 20,000 microfilariae per milliliter of blood, who were considered to be at risk for serious adverse events, and exclude them from ivermectin distribution. Active surveillance for posttreatment adverse events was performed daily for 6 days.From August through October 2015, a total of 16,259 of 22,842 persons 5 years of age or older (71.2% of the target population) were tested for L. loa microfilaremia. Among the participants who underwent testing, a total of 15,522 (95.5%) received ivermectin, 340 (2.1%) were excluded from ivermectin distribution because of an L. loa microfilarial density above the risk threshold, and 397 (2.4%) were excluded because of pregnancy or illness. No serious adverse events were observed. Nonserious adverse events were recorded in 934 participants, most of whom (67.5%) had no detectable L. loa microfilariae.The LoaScope-based test-and-not-treat strategy enabled the reimplementation of community-wide ivermectin distribution in a heretofore "off limits" health district in Cameroon and is a potentially practical approach to larger-scale ivermectin treatment for lymphatic filariasis and onchocerciasis in areas where L. loa infection is endemic. (Funded by the Bill and Melinda Gates Foundation and others.). |
| Databáze: | OpenAIRE |
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