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Identifying co-endemic areas for major filarial infections in sub-Saharan Africa: seeking synergies and preventing severe adverse events during mass drug administration campaigns.
Parasit Vectors. 2018 01 31; 11(1):70.PV

Abstract

BACKGROUND

Onchocerciasis and lymphatic filariasis (LF) are major filarial infections targeted for elimination in most endemic sub-Saharan Africa (SSA) countries by 2020/2025. The current control strategies are built upon community-directed mass administration of ivermectin (CDTI) for onchocerciasis, and ivermectin plus albendazole for LF, with evidence pointing towards the potential for novel drug regimens. When distributing microfilaricides however, considerable care is needed to minimise the risk of severe adverse events (SAEs) in areas that are co-endemic for onchocerciasis or LF and loiasis. This work aims to combine previously published predictive risk maps for onchocerciasis, LF and loiasis to (i) explore the scale of spatial heterogeneity in co-distributions, (ii) delineate target populations for different treatment strategies, and (iii) quantify populations at risk of SAEs across the continent.

METHODS

Geographical co-endemicity of filarial infections prior to the implementation of large-scale mass treatment interventions was analysed by combining a contemporary LF endemicity map with predictive prevalence maps of onchocerciasis and loiasis. Potential treatment strategies were geographically delineated according to the level of co-endemicity and estimated transmission intensity.

RESULTS

In total, an estimated 251 million people live in areas of LF and/or onchocerciasis transmission in SSA, based on 2015 population estimates. Of these, 96 million live in areas co-endemic for both LF and onchocerciasis, providing opportunities for integrated control programmes, and 83 million live in LF-monoendemic areas potentially targetable for the novel ivermectin-diethylcarbamazine-albendazole (IDA) triple therapy. Only 4% of the at-risk population live in areas co-endemic with high loiasis transmission, representing up to 1.2 million individuals at high risk of experiencing SAEs if treated with ivermectin. In these areas, alternative treatment strategies should be explored, including biannual albendazole monotherapy for LF (1.4 million individuals) and 'test-and-treat' strategies (8.7 million individuals) for onchocerciasis.

CONCLUSIONS

These maps are intended to initiate discussion around the potential for tailored treatment strategies, and highlight populations at risk of SAEs. Further work is required to test and refine strategies in programmatic settings, providing the empirical evidence needed to guide efforts towards the 2020/2025 goals and beyond.

Authors+Show Affiliations

Department of Disease Control, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK. jorge.cano@lshtm.ac.uk.London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St Mary's campus), Imperial College London, London, UK.London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St Mary's campus), Imperial College London, London, UK.Research Foundation in Tropical Medicine and the Environment, Buea, Cameroon.Department of Biochemistry and Microbiology, University of Buea, P.O. Box 63, Buea, Cameroon. Research Foundation in Tropical Medicine and the Environment, Buea, Cameroon.Former African Programme for Onchocerciasis Control Programme, Ouagadougou, Burkina Faso.Expanded Special Programme for Elimination of Neglected Tropical Diseases (ESPEN), Brazzaville, Republic of Congo.Department of Disease Control, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29382363

Citation

Cano, Jorge, et al. "Identifying Co-endemic Areas for Major Filarial Infections in sub-Saharan Africa: Seeking Synergies and Preventing Severe Adverse Events During Mass Drug Administration Campaigns." Parasites & Vectors, vol. 11, no. 1, 2018, p. 70.
Cano J, Basáñez MG, O'Hanlon SJ, et al. Identifying co-endemic areas for major filarial infections in sub-Saharan Africa: seeking synergies and preventing severe adverse events during mass drug administration campaigns. Parasit Vectors. 2018;11(1):70.
Cano, J., Basáñez, M. G., O'Hanlon, S. J., Tekle, A. H., Wanji, S., Zouré, H. G., Rebollo, M. P., & Pullan, R. L. (2018). Identifying co-endemic areas for major filarial infections in sub-Saharan Africa: seeking synergies and preventing severe adverse events during mass drug administration campaigns. Parasites & Vectors, 11(1), 70. https://doi.org/10.1186/s13071-018-2655-5
Cano J, et al. Identifying Co-endemic Areas for Major Filarial Infections in sub-Saharan Africa: Seeking Synergies and Preventing Severe Adverse Events During Mass Drug Administration Campaigns. Parasit Vectors. 2018 01 31;11(1):70. PubMed PMID: 29382363.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Identifying co-endemic areas for major filarial infections in sub-Saharan Africa: seeking synergies and preventing severe adverse events during mass drug administration campaigns. AU - Cano,Jorge, AU - Basáñez,Maria-Gloria, AU - O'Hanlon,Simon J, AU - Tekle,Afework H, AU - Wanji,Samuel, AU - Zouré,Honorat G, AU - Rebollo,Maria P, AU - Pullan,Rachel L, Y1 - 2018/01/31/ PY - 2017/11/15/received PY - 2018/01/16/accepted PY - 2018/2/1/entrez PY - 2018/2/1/pubmed PY - 2018/8/25/medline KW - Albendazole KW - DEC KW - Filariasis KW - GIS KW - Ivermectin KW - Loiasis KW - Lymphatic filariasis KW - Mapping KW - Onchocerciasis KW - Severe adverse events SP - 70 EP - 70 JF - Parasites & vectors JO - Parasit Vectors VL - 11 IS - 1 N2 - BACKGROUND: Onchocerciasis and lymphatic filariasis (LF) are major filarial infections targeted for elimination in most endemic sub-Saharan Africa (SSA) countries by 2020/2025. The current control strategies are built upon community-directed mass administration of ivermectin (CDTI) for onchocerciasis, and ivermectin plus albendazole for LF, with evidence pointing towards the potential for novel drug regimens. When distributing microfilaricides however, considerable care is needed to minimise the risk of severe adverse events (SAEs) in areas that are co-endemic for onchocerciasis or LF and loiasis. This work aims to combine previously published predictive risk maps for onchocerciasis, LF and loiasis to (i) explore the scale of spatial heterogeneity in co-distributions, (ii) delineate target populations for different treatment strategies, and (iii) quantify populations at risk of SAEs across the continent. METHODS: Geographical co-endemicity of filarial infections prior to the implementation of large-scale mass treatment interventions was analysed by combining a contemporary LF endemicity map with predictive prevalence maps of onchocerciasis and loiasis. Potential treatment strategies were geographically delineated according to the level of co-endemicity and estimated transmission intensity. RESULTS: In total, an estimated 251 million people live in areas of LF and/or onchocerciasis transmission in SSA, based on 2015 population estimates. Of these, 96 million live in areas co-endemic for both LF and onchocerciasis, providing opportunities for integrated control programmes, and 83 million live in LF-monoendemic areas potentially targetable for the novel ivermectin-diethylcarbamazine-albendazole (IDA) triple therapy. Only 4% of the at-risk population live in areas co-endemic with high loiasis transmission, representing up to 1.2 million individuals at high risk of experiencing SAEs if treated with ivermectin. In these areas, alternative treatment strategies should be explored, including biannual albendazole monotherapy for LF (1.4 million individuals) and 'test-and-treat' strategies (8.7 million individuals) for onchocerciasis. CONCLUSIONS: These maps are intended to initiate discussion around the potential for tailored treatment strategies, and highlight populations at risk of SAEs. Further work is required to test and refine strategies in programmatic settings, providing the empirical evidence needed to guide efforts towards the 2020/2025 goals and beyond. SN - 1756-3305 UR - https://www.unboundmedicine.com/medline/citation/29382363/Identifying_co_endemic_areas_for_major_filarial_infections_in_sub_Saharan_Africa:_seeking_synergies_and_preventing_severe_adverse_events_during_mass_drug_administration_campaigns_ L2 - https://parasitesandvectors.biomedcentral.com/articles/10.1186/s13071-018-2655-5 DB - PRIME DP - Unbound Medicine ER -