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Rapid integrated clinical survey to determine prevalence and co-distribution patterns of lymphatic filariasis and onchocerciasis in a Loa loa co-endemic area: The Angolan experience.
Parasite Epidemiol Control. 2017 Aug; 2(3):71-84.PE

Abstract

The Republic of Angola is a priority country for onchocerciasis and lymphatic filariasis (LF) elimination, however, the co-distribution of the filarial parasite Loa loa (loiasis) is a significant impediment, due to the risk of severe adverse events (SAEs) associated with ivermectin used in mass drug administration (MDA) campaigns. Angola has a high risk loiasis zone identified in Bengo Province where alternative interventions may need to be implemented; however, the presence and geographical overlap of the three filarial infections/diseases are not well defined. Therefore, this study conducted a rapid integrated filarial mapping survey based on readily identifiable clinical conditions of each disease in this risk zone to help determine prevalence and co-distribution patterns in a timely manner with limited resources. In total, 2007 individuals from 29 communities in five provincial municipalities were surveyed. Community prevalence estimates were determined by the rapid assessment procedure for loiasis (RAPLOA) and rapid epidemiological mapping of onchocerciasis (REMO) together with two questions on LF clinical manifestations (presence of lymphoedema, hydrocoele). Overall low levels of endemicity, with different overlapping distributions were found. Loiasis was found in 18 communities with a prevalence of 2.0% (31/1571), which contrasted to previous results defining the area as a high risk zone. Onchocerciasis prevalence was 5.3% (49/922) in eight communities, and LF prevalence was 0.4% for lymphoedema (8/2007) and 2.6% for hydrocoeles (20/761 males) in seven and 12 communities respectively. The clinical mapping survey method helped to highlight that all three filarial infections are present in this zone of Bengo Province. However, the significant difference in loiasis prevalence found between the past and this current survey suggests that further studies including serological and parasitological confirmation are required. This will help determine levels of infection and risk, understand the associations between clinical, serological and parasitological prevalence patterns, and better determine the most appropriate treatment strategies to reach onchocerciasis and LF elimination targets in the loiasis co-endemic areas. Our results also suggest that the utility of the earlier RAPLOA derived maps, based on surveys undertaken over a decade ago, are likely to be invalid given the extent of population movement and environmental change, particularly deforestation, and that fine scale micro-mapping is required to more precisely delineate the interventions required defined by these complex co-endemicities.

Authors+Show Affiliations

Centro de Investigacao em Saude de Angola/Health Research Centre of Angola, Caxito, Angola. Lisbon School of Health Technology, Lisbon, Portugal.Centro de Investigacao em Saude de Angola/Health Research Centre of Angola, Caxito, Angola. Centre for Neglected Tropical Diseases, and Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK.National Directorate of Public Health, Ministry of Health, Angola.Centro de Investigacao em Saude de Angola/Health Research Centre of Angola, Caxito, Angola.College of Public Health, Department of Global Health, University of South Florida, Florida, USA.College of Public Health, Department of Global Health, University of South Florida, Florida, USA.College of Public Health, Department of Global Health, University of South Florida, Florida, USA.Centre for Neglected Tropical Diseases, and Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK.Centre for Neglected Tropical Diseases, and Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK.Centre for Neglected Tropical Diseases, and Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29774284

Citation

Brito, Miguel, et al. "Rapid Integrated Clinical Survey to Determine Prevalence and Co-distribution Patterns of Lymphatic Filariasis and Onchocerciasis in a Loa Loa Co-endemic Area: the Angolan Experience." Parasite Epidemiology and Control, vol. 2, no. 3, 2017, pp. 71-84.
Brito M, Paulo R, Van-Dunem P, et al. Rapid integrated clinical survey to determine prevalence and co-distribution patterns of lymphatic filariasis and onchocerciasis in a Loa loa co-endemic area: The Angolan experience. Parasite Epidemiol Control. 2017;2(3):71-84.
Brito, M., Paulo, R., Van-Dunem, P., Martins, A., Unnasch, T. R., Novak, R. J., Jacob, B., Stanton, M. C., Molyneux, D. H., & Kelly-Hope, L. A. (2017). Rapid integrated clinical survey to determine prevalence and co-distribution patterns of lymphatic filariasis and onchocerciasis in a Loa loa co-endemic area: The Angolan experience. Parasite Epidemiology and Control, 2(3), 71-84. https://doi.org/10.1016/j.parepi.2017.05.001
Brito M, et al. Rapid Integrated Clinical Survey to Determine Prevalence and Co-distribution Patterns of Lymphatic Filariasis and Onchocerciasis in a Loa Loa Co-endemic Area: the Angolan Experience. Parasite Epidemiol Control. 2017;2(3):71-84. PubMed PMID: 29774284.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rapid integrated clinical survey to determine prevalence and co-distribution patterns of lymphatic filariasis and onchocerciasis in a Loa loa co-endemic area: The Angolan experience. AU - Brito,Miguel, AU - Paulo,Rossely, AU - Van-Dunem,Pedro, AU - Martins,António, AU - Unnasch,Thomas R, AU - Novak,Robert J, AU - Jacob,Benjamin, AU - Stanton,Michelle C, AU - Molyneux,David H, AU - Kelly-Hope,Louise A, Y1 - 2017/05/07/ PY - 2017/03/31/received PY - 2017/05/04/revised PY - 2017/05/06/accepted PY - 2018/5/19/entrez PY - 2018/5/19/pubmed PY - 2018/5/19/medline KW - Angola KW - Elephantiasis KW - Filariasis KW - Hydrocoele KW - Ivermectin KW - LF KW - Loa loa KW - Loiasis KW - Lymphatic filariasis KW - Lymphoedema KW - Mapping KW - NTDs KW - Neglected tropical diseases KW - Nodules KW - Onchocerciasis KW - RAPLOA, REMO KW - SAEs KW - Severe adverse events KW - Sub-saharan Africa KW - Tropical eye worm SP - 71 EP - 84 JF - Parasite epidemiology and control JO - Parasite Epidemiol Control VL - 2 IS - 3 N2 - The Republic of Angola is a priority country for onchocerciasis and lymphatic filariasis (LF) elimination, however, the co-distribution of the filarial parasite Loa loa (loiasis) is a significant impediment, due to the risk of severe adverse events (SAEs) associated with ivermectin used in mass drug administration (MDA) campaigns. Angola has a high risk loiasis zone identified in Bengo Province where alternative interventions may need to be implemented; however, the presence and geographical overlap of the three filarial infections/diseases are not well defined. Therefore, this study conducted a rapid integrated filarial mapping survey based on readily identifiable clinical conditions of each disease in this risk zone to help determine prevalence and co-distribution patterns in a timely manner with limited resources. In total, 2007 individuals from 29 communities in five provincial municipalities were surveyed. Community prevalence estimates were determined by the rapid assessment procedure for loiasis (RAPLOA) and rapid epidemiological mapping of onchocerciasis (REMO) together with two questions on LF clinical manifestations (presence of lymphoedema, hydrocoele). Overall low levels of endemicity, with different overlapping distributions were found. Loiasis was found in 18 communities with a prevalence of 2.0% (31/1571), which contrasted to previous results defining the area as a high risk zone. Onchocerciasis prevalence was 5.3% (49/922) in eight communities, and LF prevalence was 0.4% for lymphoedema (8/2007) and 2.6% for hydrocoeles (20/761 males) in seven and 12 communities respectively. The clinical mapping survey method helped to highlight that all three filarial infections are present in this zone of Bengo Province. However, the significant difference in loiasis prevalence found between the past and this current survey suggests that further studies including serological and parasitological confirmation are required. This will help determine levels of infection and risk, understand the associations between clinical, serological and parasitological prevalence patterns, and better determine the most appropriate treatment strategies to reach onchocerciasis and LF elimination targets in the loiasis co-endemic areas. Our results also suggest that the utility of the earlier RAPLOA derived maps, based on surveys undertaken over a decade ago, are likely to be invalid given the extent of population movement and environmental change, particularly deforestation, and that fine scale micro-mapping is required to more precisely delineate the interventions required defined by these complex co-endemicities. SN - 2405-6731 UR - https://www.unboundmedicine.com/medline/citation/29774284/Rapid_integrated_clinical_survey_to_determine_prevalence_and_co_distribution_patterns_of_lymphatic_filariasis_and_onchocerciasis_in_a_Loa_loa_co_endemic_area:_The_Angolan_experience_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2405-6731(17)30015-6 DB - PRIME DP - Unbound Medicine ER -
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