Ivermectin Treatment Response in Onchocerca Volvulus Infected Persons with Epilepsy: A Three-Country Short Cohort Study

Dusabimana, Alfred; Bhwana, Dan; Raimon, Stephen; Mmbando, Bruno P.; Hotterbeekx, An; Tepage, Floribert; Mandro, Michel; Fodjo, Joseph Nelson Siewe; Abrams, Steven; Colebunders, Robert

doi:10.3390/pathogens9080617

Cited by 9 publications

(11 citation statements)

References 32 publications

(46 reference statements)

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“…Despite the WHO recommendation that ivermectin treatment should not be given to severely ill individuals, today it is universally accepted that epilepsy should not be considered a contraindication for ivermectin use. On the contrary, there is evidence that ivermectin, in particular when given twice a year, may decrease the frequency of seizures in O. volvulus -infected PWE [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

High Prevalence of Epilepsy in an Onchocerciasis-Endemic Area in Mvolo County, South Sudan: A Door-To-Door Survey

Raimon¹,

Dusabimana

Abd-Elfarag

et al. 2021

Pathogens

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In June 2020, a door-to-door household survey was conducted in Mvolo County, an onchocerciasis-endemic area in South Sudan. A total of 2357 households containing 15,699 individuals agreed to participate in the study. Of these, 5046 (32.1%, 95% CI: 31.4–32.9%) had skin itching and 445 (2.8%, 95% CI: 2.6–3.1%) were blind. An epilepsy screening questionnaire identified 813 (5.1%) persons suspected of having epilepsy. Of them, 804 (98.9%) were seen by a medical doctor, and in 798 (98.1%) the diagnosis of epilepsy was confirmed. The overall epilepsy prevalence was 50.8/1000 (95% CI: 47.6–54.4/1000), while the prevalence of nodding syndrome was 22.4/1000 (95% CI: 20.1–24.9/1000). Younger age, being male, skin itching, blindness, and living in a neighbourhood or village close to the Naam River were risk factors for epilepsy. The annual incidence of epilepsy was 82.8/100,000 (95% CI: 44.1–141.6/100,000). Among children 7–9 years old without epilepsy, 34% were Ov16 seropositive, suggesting high ongoing Onchocerca volvulus transmission, but only 41.9% of them took ivermectin during the last mass distribution. In conclusion, a high prevalence and incidence of epilepsy was observed in Mvolo, South Sudan. Strengthening of the onchocerciasis elimination programme is urgently needed in order to prevent epilepsy in this region.

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Section: Discussionmentioning

confidence: 99%

High Prevalence of Epilepsy in an Onchocerciasis-Endemic Area in Mvolo County, South Sudan: A Door-To-Door Survey

Raimon¹,

Dusabimana

Abd-Elfarag

et al. 2021

Pathogens

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“…carrying infective L3 stage parasites was found to be 0.57% (95% CI 0.43–0.74%) [ 50 ], similar to infective rates reported in the 1960s [ 51 ]. In 2019, the geometric mean microfilarial density among persons with epilepsy prior to the intake of ivermectin was lowest in the Mahenge villages compared with geometric mean microfilarial densities in Maridi, Aketi and the Logo health zone [ 37 ], suggesting a lower transmission in Mahenge compared to the other sites.…”

Section: Discussionmentioning

confidence: 99%

Surveillance for Onchocerciasis-Associated Epilepsy and OV16 IgG4 Testing of Children 6–10 Years Old Should Be Used to Identify Areas Where Onchocerciasis Elimination Programs Need Strengthening

Dusabimana

Fodjo

Ndahura³

et al. 2022

Pathogens

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To eliminate onchocerciasis-associated morbidity, it is important to identify areas where there is still high ongoing Onchocerca volvulus transmission. Between 2015 and 2021, door-to-door surveys were conducted in onchocerciasis-endemic villages in Cameroon, the Democratic Republic of Congo (DRC), Nigeria, South Sudan, and Tanzania to determine epilepsy prevalence and incidence, type of epilepsy and ivermectin therapeutic coverage. Moreover, children aged between six and 10 years were tested for anti-Onchocerca antibodies using the Ov16 IgG4 rapid diagnostic test (RDT). A mixed-effect binary logistic regression analysis was used to assess significantly associated variables of Ov16 antibody seroprevalence. A high prevalence and incidence of epilepsy was found to be associated with a high Ov16 antibody seroprevalence among 6–10-year-old children, except in the Logo health zone, DRC. The low Ov16 antibody seroprevalence among young children in the Logo health zone, despite a high prevalence of epilepsy, may be explained by a recent decrease in O. volvulus transmission because of a decline in the Simulium vector population as a result of deforestation. In the Central African Republic, a new focus of O. volvulus transmission was detected based on the high Ov16 IgG4 seropositivity among children and the detecting of nodding syndrome cases, a phenotypic form of onchocerciasis-associated epilepsy (OAE). In conclusion, Ov16 IgG4 RDT testing of 6–10-year-old children is a cheap and rapid method to determine the level of ongoing O. volvulus transmission and to assess, together with surveillance for OAE, the performance of onchocerciasis elimination programs.

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“…Despite the WHO recommendation that ivermectin treatment should not be given to severely ill individuals, nowadays it is universally accepted that epilepsy should not be considered a contra-indication for ivermectin use. On the contrary, there is evidence that ivermectin, in particular when given twice a year, may decrease the frequency of seizures in O. volvulus infected PWE [13].…”

Section: Discussionmentioning

confidence: 96%

Prevalence of Onchocerciasis-Associated Epilepsy in Mvolo County, South Sudan: A Door to Door Survey

Raimon¹,

Dusabimana²,

Abd-Elfarag³

et al. 2021

Preprint

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In June 2020, a door-to-door household survey was conducted in Mvolo County, an onchocerciasis endemic area in South Sudan. A total of 2,357 households containing 15,699 individuals agreed to participate in the study. Of these, 5,046 (32.1%, 95%CI: 31.4-32.9%) had skin itching and 445 (2.8%, 95% CI: 2.6-3.1%) were blind. An epilepsy screening questionnaire identified 813 (5.1%) persons suspected to have epilepsy. Of them, 804 (98.9%) were seen by a medical doctor and in 798 (98.1%) the diagnosis of epilepsy was confirmed. The overall epilepsy prevalence was 50.8/1000 (95% CI: 47.6-54.4/1000) and prevalence of nodding syndrome was 22.4/1000 (95% CI: 20.1-24.9/1000). Younger age, being male, skin itching, blindness and living in a village close to the Naam river were risk factors for epilepsy. The annual incidence of epilepsy was 82.8/100,000 (95% CI: 44.1-141.6/100,000). In conclusion, a high prevalence and incidence of epilepsy was observed in Mvolo, South Sudan. Strengthening the onchocerciasis elimination programme is urgently needed to prevent epilepsy in this region.

show abstract

Ivermectin Treatment Response in Onchocerca Volvulus Infected Persons with Epilepsy: A Three-Country Short Cohort Study

Cited by 9 publications

References 32 publications

High Prevalence of Epilepsy in an Onchocerciasis-Endemic Area in Mvolo County, South Sudan: A Door-To-Door Survey

High Prevalence of Epilepsy in an Onchocerciasis-Endemic Area in Mvolo County, South Sudan: A Door-To-Door Survey

Surveillance for Onchocerciasis-Associated Epilepsy and OV16 IgG4 Testing of Children 6–10 Years Old Should Be Used to Identify Areas Where Onchocerciasis Elimination Programs Need Strengthening

Prevalence of Onchocerciasis-Associated Epilepsy in Mvolo County, South Sudan: A Door to Door Survey

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