“Test and not treat” for onchocerciasis control in a Loa loa endemic area
“Test and not treat” for onchocerciasis control in a Loa loa endemic area
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罗阿罗阿流行区盘尾丝虫病控制的“测试而非治疗”
DOI：
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发表时间：
2017
影响因子：
158.5
通讯作者：
M. Boussinesq
中科院分区：
文献类型：
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作者：
J. Kamgno;S. Pion;C. Chesnais;M. Bakalar;Michael V. D’Ambrosio;C. Mackenzie;H. Nana;Raceline Gounoue;G. Njitchouang;P. Nwane;Jules B. Tchatchueng‐Mbouga;S. Wanji;W. Stolk;D. Fletcher;A. Klion;T. Nutman;M. Boussinesq
背景在中部非洲，以伊维菌素为基础的消除盘尾丝虫病或淋巴丝虫病的社区治疗战略的实施被推迟，因为在循环中的微丝虫病患者中发生了严重的不良事件，包括死亡。LoaScope是一种现场友好的诊断工具，用于量化外周血液中的L.Loa微丝虫病，使快速、即时地识别有严重不良事件风险的人成为可能。方法在喀麦隆奥科拉卫生区对伊维菌素的治疗采用一种试验即不治疗的策略，1999年发生与洛亚乳杆菌感染有关的致死事件后，停止了伊维菌素的分发。LoaScope被用来识别L.LoA微丝虫病密度超过每毫升血液20,000微丝虫的人，这些人被认为有发生严重不良事件的风险，并将他们排除在伊维菌素分布之外。每天积极监测治疗后不良事件，连续6天。结果从2015年8月至10月，在22,842名5岁及以上人群中，共检测了16,259人(占目标人口的71.2%)。在接受检测的参与者中，共有15522人(95.5%)接受了伊维菌素治疗，340人(2.1%)因L.LoA微丝虫病密度超过风险阈值而被排除在伊维菌素分配之外，397人(2.4%)因怀孕或疾病而被排除在外。未观察到严重不良反应。在934名参与者中记录了非严重的不良事件，其中大多数(67.5%)没有检测到Lloa微丝虫。结论：基于LoaScope的测试和不治疗策略使伊维菌素在喀麦隆迄今为止的“禁区”卫生区重新实施了社区范围的伊维菌素分配，并成为在L.Loa感染流行地区更大规模的伊维菌素治疗淋巴丝虫病和盘尾丝虫病的潜在实用方法。(资金来自比尔和梅琳达·盖茨基金会等。)
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.)