Nodding syndrome—we can now prevent it

Colebunders, Robert; Irani, Julia; Post, R.J.

doi:10.1016/j.ijid.2016.01.016

Cited by 23 publications

(27 citation statements)

References 30 publications

(37 reference statements)

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“…For example, in a study from 1991 in Kyarusozi sub-county in western Uganda, 91% of the epilepsy cases were below the age of 19 [22]. This epilepsy age shift towards older age groups after several years of annual Ivermectin distribution is an argument that Ivermectin may reduce the incidence of epilepsy in children [23]. …”

Section: Discussionmentioning

confidence: 99%

High prevalence of epilepsy in onchocerciasis endemic regions in the Democratic Republic of the Congo

et al. 2017

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BackgroundAn increased prevalence of epilepsy has been reported in many onchocerciasis endemic areas. The objective of this study was to determine the prevalence of epilepsy in onchocerciasis endemic areas in the Democratic Republic of the Congo (DRC) and investigate whether a higher annual intake of Ivermectin was associated with a lower prevalence of epilepsy.Methodology/Principle findingsBetween July 2014 and February 2016, house-to-house epilepsy prevalence surveys were carried out in areas with a high level of onchocerciasis endemicity: 3 localities in the Bas-Uele, 24 in the Tshopo and 21 in the Ituri province. Ivermectin uptake was recorded for every household member. This database allowed a matched case-control pair subset to be created that enabled putative risk factors for epilepsy to be tested using univariate logistic regression models. Risk factors relating to onchocerciasis were tested using a multivariate random effects model. To identify presence of clusters of epilepsy cases, the Kulldorff's scan statistic was used. Of 12, 408 people examined in the different health areas 407 (3.3%) were found to have a history of epilepsy. A high prevalence of epilepsy was observed in health areas in the 3 provinces: 6.8–8.5% in Bas-Uele, 0.8–7.4% in Tshopo and 3.6–6.2% in Ituri. Median age of epilepsy onset was 9 years, and the modal age 12 years. The case control analysis demonstrated that before the appearance of epilepsy, compared to the same life period in controls, persons with epilepsy were around two times less likely (OR: 0.52; 95%CI: (0.28, 0.98)) to have taken Ivermectin than controls. After the appearance of epilepsy, there was no difference of Ivermectin intake between cases and controls. Only in Ituri, a significant cluster (p-value = 0.0001) was identified located around the Draju sample site area.ConclusionsThe prevalence of epilepsy in health areas in onchocerciasis endemic regions in the DRC was 2–10 times higher than in non-onchocerciasis endemic regions in Africa. Our data suggests that Ivermectin protects against epilepsy in an onchocerciasis endemic region. However, a prospective population based intervention study is needed to confirm this.

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Section: Discussionmentioning

confidence: 99%

High prevalence of epilepsy in onchocerciasis endemic regions in the Democratic Republic of the Congo

et al. 2017

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“…An age shift of epilepsy cases to older age groups after the introduction of ivermectin was reported in an onchocerciasis endemic region of Nigeria [14]. These observations suggest that administration of ivermectin may prevent OAE and NS [12]. If ivermectin can be shown to have a preventive effect for OAE, then onchocerciasis control programs would gain strength in their efforts towards elimination.…”

Section: Can Onchocerciasis Treatment With Ivermectin Prevent Oae?mentioning

confidence: 94%

“…Another possibility is that OAE is an autoimmune encephalitis caused by antibodies crossreacting with OV or Wolbachia. Johnson et al have suggested that neurotoxic leiomodin-1 antibodies crossreacting with OV tropomyosin could be causing NS [12]. Idro in a recent study in Uganda, detected serum antibodies against voltage-gated potassium channel (VGKC)-complex proteins more often in patients with NS compared with healthy controls [13].…”

Section: The Following Key Research Questions Remain To Be Answeredmentioning

confidence: 99%

“…Since the introduction of biannual mass treatment with ivermectin in 2012, no new NS cases and fewer new epilepsy cases have been observed in Northern Uganda [12]. An age shift of epilepsy cases to older age groups after the introduction of ivermectin was reported in an onchocerciasis endemic region of Nigeria [14].…”

Section: Can Onchocerciasis Treatment With Ivermectin Prevent Oae?mentioning

confidence: 99%

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Nodding Syndrome in Onchocerciasis Endemic Areas

Colebunders

Hendy

Oijen

2016

Trends in Parasitology

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“…In addition, onchocerciasis causes serious skin conditions such as severe itching, erythematous rashes, de-pigmentation including "lizard skin", secondary infections after itchy areas are scratched, palpable nodules containing the adult worms, "hanging groin" and the condition known as "sowda". There are also associations between onchocerciasis and epilepsy and dwarfism and, in addition, there is circumstantial evidence that the affliction known as "nodding disease" is associated with onchocercal infections [4]. Excess mortality attributable to onchocerciasis has been reported [5,6,7].…”

Section: Introductionmentioning

confidence: 99%

Factors affecting onchocerciasis transmission: lessons for infection control

Cheke

2017

Expert Review of Anti-infective Therapy

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Introduction: Onchocerca volvulus infects in excess of 15 million people. The vectors are Simulium blackflies, varieties of which differ in their ecologies, behaviour and vectorial abilities. Control of the vectors and mass administrations of ivermectin have succeeded in reducing prevalences with elimination achieved in some foci, particularly in Central and southern America. In Africa, progress towards elimination has been less successful.Areas covered: Even with community directed treatment with ivermectin (CDTI), control has been difficult in African areas with initial prevalences in excess of 55%, especially if only annual treatments are dispensed. This is partly attributable to insufficient coverage, but the appearance of incipiently resistant non-responding parasites and lack of attention to vector biology in modelling and planning outcomes of intervention programmes have also played their parts, with recrudescence now appearing in some treated areas. Expert commentary:The biology of onchocerciasis is complex involving different vectors with differing abilities to transmit parasites, diverse pathologies related to geographical and parasite variations and endosymbionts in both parasite and vector. Modelling to predict epidemiological and control outcomes is addressing this complexity but more attention needs to be given to the vectors' roles to further understanding of where and when control measures will succeed.

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Nodding syndrome—we can now prevent it

Cited by 23 publications

References 30 publications

High prevalence of epilepsy in onchocerciasis endemic regions in the Democratic Republic of the Congo

High prevalence of epilepsy in onchocerciasis endemic regions in the Democratic Republic of the Congo

Nodding Syndrome in Onchocerciasis Endemic Areas

Factors affecting onchocerciasis transmission: lessons for infection control

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