Identifying co-endemic areas for major filarial infections in sub-Saharan Africa: seeking synergies and preventing severe adverse events during mass drug administration campaigns
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 oncho...
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doaj-f05db2660bd24021aac0325429e31dae2020-11-25T01:38:35ZengBMCParasites & Vectors1756-33052018-01-0111111110.1186/s13071-018-2655-5Identifying co-endemic areas for major filarial infections in sub-Saharan Africa: seeking synergies and preventing severe adverse events during mass drug administration campaignsJorge Cano0Maria-Gloria Basáñez1Simon J. O’Hanlon2Afework H. Tekle3Samuel Wanji4Honorat G. Zouré5Maria P. Rebollo6Rachel L. Pullan7Department of Disease Control, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical MedicineLondon Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St Mary’s campus), Imperial College LondonLondon Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St Mary’s campus), Imperial College LondonResearch Foundation in Tropical Medicine and the EnvironmentDepartment of Biochemistry and Microbiology, University of BueaFormer African Programme for Onchocerciasis Control ProgrammeExpanded Special Programme for Elimination of Neglected Tropical Diseases (ESPEN)Department of Disease Control, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical MedicineAbstract 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.http://link.springer.com/article/10.1186/s13071-018-2655-5FilariasisOnchocerciasisLymphatic filariasisLoiasisSevere adverse eventsIvermectin |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Jorge Cano Maria-Gloria Basáñez Simon J. O’Hanlon Afework H. Tekle Samuel Wanji Honorat G. Zouré Maria P. Rebollo Rachel L. Pullan |
spellingShingle |
Jorge Cano Maria-Gloria Basáñez Simon J. O’Hanlon Afework H. Tekle Samuel Wanji Honorat G. Zouré Maria P. Rebollo Rachel L. Pullan 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 Filariasis Onchocerciasis Lymphatic filariasis Loiasis Severe adverse events Ivermectin |
author_facet |
Jorge Cano Maria-Gloria Basáñez Simon J. O’Hanlon Afework H. Tekle Samuel Wanji Honorat G. Zouré Maria P. Rebollo Rachel L. Pullan |
author_sort |
Jorge Cano |
title |
Identifying co-endemic areas for major filarial infections in sub-Saharan Africa: seeking synergies and preventing severe adverse events during mass drug administration campaigns |
title_short |
Identifying co-endemic areas for major filarial infections in sub-Saharan Africa: seeking synergies and preventing severe adverse events during mass drug administration campaigns |
title_full |
Identifying co-endemic areas for major filarial infections in sub-Saharan Africa: seeking synergies and preventing severe adverse events during mass drug administration campaigns |
title_fullStr |
Identifying co-endemic areas for major filarial infections in sub-Saharan Africa: seeking synergies and preventing severe adverse events during mass drug administration campaigns |
title_full_unstemmed |
Identifying co-endemic areas for major filarial infections in sub-Saharan Africa: seeking synergies and preventing severe adverse events during mass drug administration campaigns |
title_sort |
identifying co-endemic areas for major filarial infections in sub-saharan africa: seeking synergies and preventing severe adverse events during mass drug administration campaigns |
publisher |
BMC |
series |
Parasites & Vectors |
issn |
1756-3305 |
publishDate |
2018-01-01 |
description |
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. |
topic |
Filariasis Onchocerciasis Lymphatic filariasis Loiasis Severe adverse events Ivermectin |
url |
http://link.springer.com/article/10.1186/s13071-018-2655-5 |
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