Co-endemicity of loiasis and onchocerciasis in rain forest communities in southwestern Nigeria.
Ojurongbe O, Akindele AA, Adeleke MA, Oyedeji MO, Adedokun SA, Ojo JF, Akinleye CA, Bolaji OS, Adefioye OA, Adeyeba OA -PLoS neglected tropical diseases(2015)
pntd.0003633.g001:Map of Osun State showing the three senatorial districts and the communities within the districts that were selected for the study.
View Article:PubMed Central - PubMed
Affiliation:Department of Medical Microbiology & Parasitology, Ladoke Akintola University of Technology, Osogbo, Nigeria.
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Article
Collection
Results
Bottom Line:There was a significant variation in the prevalence (2.1% to 33.3%) of onchocerciasis in the communities studied (p = 0.001).Five (41.7%) of the studied communities had a prevalence that is equal to or greater than 20%.Evaluation of the interruption of onchocerciasis transmissions in this region using all the indicators set forth by WHO is therefore suggested.
Abstract

Background: Loiasis is currently receiving attention as a disease of public health importance because of the possibility of increased risk of developing neurologic serious adverse event following mass ivermectin treatment against onchocerciasis in individual co-infected with Onchocerca volvulus and Loa loa.

Methodology/principal findings: Rapid assessment procedure for loiasis (RAPLOA) was conducted in 12 communities covering the 3 senatorial districts of Osun State, Nigeria. A total of 960 people were interviewed for history of eye worm using the WHO guidelines for rapid assessment. The survey confirmed the presence of loiasis in all the 12 communities with 4 in Osun East/Ife south senatorial district being at high risk with a prevalence of over 40%. Based on the RAPLOA results, communities within Osun East/Ife south senatorial district were selected for microfilaraemic assessment of L. loa and O. volvulus. A total of 1115 and 1091 individuals were screened for L. loa and O. volvulus microfilaria worms respectively. 160 (14.3%) had L. loa microfilaria detected in their blood with 8 (5.0%) individuals having L. loa loads above 8000 mf/ml. 166 (15.2%) subjects had O. volvulus microfilaria (range 4-504 mf/ml) detected in their skin snip. 30 (2.69%) subjects were co-infected with both L. loa and O. volvulus. There was a significant variation in the prevalence (2.1% to 33.3%) of onchocerciasis in the communities studied (p = 0.001). Five (41.7%) of the studied communities had a prevalence that is equal to or greater than 20%.

Conclusions/significance: Low prevalence of onchocerciasis and loiasis co-infection in this study suggests that loiasis may not pose a serious epidemiological threat to the continuous distribution and sustainability of ivermectin for the treatment of onchocerciasis. Evaluation of the interruption of onchocerciasis transmissions in this region using all the indicators set forth by WHO is therefore suggested.

Mentions
Osun State is situated in the tropical rain forest zone. It covers an area of approximately 14,875 sq km and lies between latitude 7° 30′ 0″ N and longitude 4° 30′ 0″ E. There are two seasons, the rainy season from April to October and the dry season from November to March. The state is covered by secondary forest and in the northern part, the derived Savannah mosaic predominates. Forest vegetation could be found along the river valleys and streams found across the State. The economy of Osun State is agro-based with farming being the predominant occupation of the people. Osun State comprises of 30 Local Government Areas (LGAs); geopolitically stratified into three Senatorial districts and each Senatorial district consists of at least 8 (LGAs) (Fig. 1). Rapid Epidemiological Mapping of Onchocerciasis (REMO) was conducted in the state in 1996 and annual mass ivermectin distribution started in 2000 and it is still ongoing. The treatment coverage since inception increased gradually from 42% in 2000 to 100% in 2008 [17] and this has been sustained in the state for the last four years. Following the REMO result, the state was classified as hyperdermic. Mass Ivermectin distribution started in 1998 and all the Local government areas of the State have been receiving annual mass ivermectin treatment till date. From a database of all endemic communities, a list was generated, out of which four communities in each senatorial district were randomly selected for RAPLOA by balloting (Table 1). Based on the outcome of the RAPLOA, Osun East senatorial district was found to be endemic and later selected for parasitological examination of Loa loa and O. volvulus infections. For the parasitological survey, 12 communities were then selected from Osun East senatorial district.
MeSH
Major
Filaricides/adverse effects/therapeutic use*
Loiasis/diagnosis/drug therapy/epidemiology*
Onchocerciasis/diagnosis/drug therapy/epidemiology*
Minor
Adolescent
Adult
Aged
Aged, 80 and over
Animals
Child
Child, Preschool
Coinfection/diagnosis/drug therapy/epidemiology
Endemic Diseases
Female
Humans
Ivermectin/therapeutic use
Loa/isolation & purification
Male
Middle Aged
Nigeria/epidemiology
Onchocerca volvulus/isolation & purification
Prevalence
Public Health
Rainforest
Young Adult