Filariasis in Africa—treatment challenges and prospects

Hoerauf, Achim; Pfarr, Kenneth; Mand, Sabine; Debrah, Alexander Yaw; Specht, Sabine

doi:10.1111/j.1469-0691.2011.03586.x

Cited by 126 publications

(86 citation statements)

References 51 publications

(61 reference statements)

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“…The endemicity and wide distribution of Loa loa filariasis (loiasis) in Central Africa is a major concern for national onchocerciasis programmes supported by the African Programme for Onchocerciasis Control (APOC) and non-governmental development organisation (NGDOs) due to the increased risk of severe adverse events (SAEs) associated with the mass distribution of ivermectin (Mectizan®) [1,2]. L. loa is transmitted to humans by Tabanid flies of the genus Chrysops spp.…”

Section: Resultsmentioning

confidence: 99%

“…Standard MDA includes ivermectin and albendazole [2], however, in areas where LF is co-endemic with L. loa the national programme will need to implement the recommended alternative strategy of twice yearly albendazole and bed nets/long-lasting insecticidal nets (LLINs) in order to reduce the risk of SAEs [26]. In selected areas further mapping at a micro-level is necessary to ensure the most appropriate interventions are distributed to those most at risk.…”

Section: Discussionmentioning

confidence: 99%

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Innovative tools for assessing risks for severe adverse events in areas of overlapping Loa loa and other filarial distributions: the application of micro-stratification mapping

Kelly-Hope

Cano

Stanton

et al. 2014

Parasites & Vectors

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BackgroundThe wide distribution of Loa loa infection (loiasis) throughout the Democratic Republic of Congo (DRC) is a major obstacle to the plans to eliminate onchocerciasis and lymphatic filariasis (LF) because the standard drug regime is dependent on ivermectin, which cannot be used in co-endemic areas due to the risk of severe adverse events (SAEs). A better understanding of the micro-epidemiology, overlapping low and high risk areas, and how they relate to SAEs is critical to ensure safe and effective treatment.FindingsBased on published data from the Bas Congo Province in DRC, this study used geographical information systems (GIS) to re-map and analyse onchocerciasis and loiasis prevalence (<20%, 20 to 40%, >40%) at 144 sites in relation to health district areas reporting SAEs. The new maps highlighted the contrasting patterns of the high prevalence sites, and significant geographical overlap between low onchocerciasis and high loiasis sites. Statistical analyses found that sites with medium to high loiasis prevalence were 10 to 16 times more likely to be in a SAE area than those with low prevalence of loiasis. Sites where both onchocerciasis and loiasis prevalence was >20% were also associated with SAE areas.ConclusionsCollaborative efforts between the national onchocerciasis and LF programmes are critical as plans to scale interventions are moving forward and thus, alternative strategies needed in loiasis co-endemic areas which may include the new L. loa test and treat strategy using the Cellscope, or interventions such as integrated vector management, or anti Wolbachia therapy using doxycycline.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Innovative tools for assessing risks for severe adverse events in areas of overlapping Loa loa and other filarial distributions: the application of micro-stratification mapping

Kelly-Hope

Cano

Stanton

et al. 2014

Parasites & Vectors

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“…The main strategy for treatment and control of LF is annual mass drug administration with DEC or with ivermectin (together with albendazole) in areas where onchocerciasis is coendemic. In some cases, doxycycline therapy successfully reduced parasite burdens by eliminating the bacterial endosymbiont Wolbachia ,33 but it is unclear if this approach can be scaled for purposes of mass drug administration.…”

Section: Lymphatic Filariasismentioning

confidence: 99%

Impact of vectorborne parasitic neglected tropical diseases on child health

et al. 2016

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Chagas disease, leishmaniasis, onchocerciasis and lymphatic filariasis are all vectorborne neglected tropical diseases (NTDs) that are responsible for significant disease burden in impoverished children and adults worldwide. As vectorborne parasitic diseases, they can all be targeted for elimination through vector control strategies. Examples of successful vector control programmes for these diseases over the past two decades have included the Southern Cone Initiative against Chagas disease, the Kala-azar Control Scheme against leishmaniasis, the Onchocerciasis Control Programme and the lymphatic filariasis control programme in The Gambia. A common vector control component in all of these programmes is the use of adulticides including dichlorodiphenyltrichloroethane and newer synthetic pyrethroid insecticides against the insect vectors of disease. Household spraying has been used against Chagas disease and leishmaniasis, and insecticide-treated bed nets have helped prevent leishmaniasis and lymphatic filariasis. Recent trends in vector control focus on collaborations between programmes and sectors to achieve integrated vector management that addresses the holistic vector control needs of a community rather than approaching it on a disease-by-disease basis, with the goals of increased efficacy, sustainability and cost-effectiveness. As evidence of vector resistance to currently used insecticide regimens emerges, research to develop new and improved insecticides and novel control strategies will be critical in reducing disease burden. In the quest to eliminate these vectorborne NTDs, efforts need to be made to continue existing control programmes, further implement integrated vector control strategies and stimulate research into new insecticides and control methods.

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“…WHO currently estimates about 37 million people to be infected with O. volvulus, mainly in sub-Saharan Africa, with more than 100 million people at risk of infection [1,2]. There are two divergent types of immune responses: the hyperreactive sowda form with low worm burden due to an overwhelming immune response and strong symptoms, and the hyporesponsive generalized form with high worm burden but few symptoms [3].…”

Section: Introductionmentioning

confidence: 99%

Differential induction of Th2- And Th1-associated responses by filarial antigens and endosymbioticWolbachiain a murine model of river blindness

Gentil¹,

Hoerauf²,

Pearlman³

2012

European Journal of Microbiology and Immunology

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Immune responses to filarial parasites like the river blindness inducing Onchocerca volvulus are obscured by combined reactions to the filarial nematodes themselves and their endosymbiont bacteria Wolbachia. Overall, infection with filarial nematodes induces a strong Th2 response characterized by IL-5 production and to a lesser degree a Th1 response and IFNγ production. Neutrophil and eosinophil infiltration into the corneal stroma are hallmark features of Onchocerca volvulus stimulation in a mouse model of river blindness. To determine the splenic and corneal response to filarial antigens in the absence of Wolbachia, C57BL/6 mice were immunized subcutaneously with either endosymbiotic Wolbachia alone, a soluble extract from the filaria Acanthocheilonema viteae that does not contain Wolbachia, or both, and injected into the corneal stroma. Neutrophil and eosinophil infiltration into the cornea was assessed by immunohistochemistry. In addition, Th1-and Th2-associated responses to filaria or Wolbachia were investigated by determining IL-5 and IFN-γ production by splenocytes. We found that A. viteae in the absence of Wolbachia induced IL-5 production and eosinophil infiltration, but not IFN-γ. Conversely, Wolbachia induced IFN-γ production and no migration of eosinophils. There was no difference in neutrophil infiltration. Together, these findings demonstrate a distinct Th-associated phenotype induced by filaria and Wolbachia.

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Filariasis in Africa—treatment challenges and prospects

Cited by 126 publications

References 51 publications

Innovative tools for assessing risks for severe adverse events in areas of overlapping Loa loa and other filarial distributions: the application of micro-stratification mapping

Innovative tools for assessing risks for severe adverse events in areas of overlapping Loa loa and other filarial distributions: the application of micro-stratification mapping

Impact of vectorborne parasitic neglected tropical diseases on child health

Differential induction of Th2- And Th1-associated responses by filarial antigens and endosymbioticWolbachiain a murine model of river blindness

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