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• W2021094558 abstract "Bioko is the only island known in the world with endemic onchocerciasis. The island's rural communities consist of villages and cocoa plantations inhabited by Bubi and Fang ethnic groups. The aim of this study was to evaluate the impact of 8 years of vertical ivermectin distribution on the prevalence and intensity of Onchocerca volvulus infection in the rural population by means of pre- (1989) and post-long term treatment (1998) epidemiological surveys. In both surveys, the entire population of 12 randomly selected communities (1723 and 1082 individuals) was examined. The mean ivermectin therapeutic coverage for the 8 years was 53.2%. Iliac crest skin snips were used for differential diagnosis between O. volvulus and Mansonella streptocerca. The crude O. volvulus infection prevalence before ivermectin intervention was 74.5% (1284/1723); after the intervention it was 38.4% (415/1082). The Community Microfilarial Load (CMFL) before and after ivermectin intervention was 28.29 microfilariae/snip vs. 2.32 microfilariae/snip. The reduction in prevalence and CMFL after eight annual rounds of ivermectin treatment corroborates the drug microfilaricidal activity and good tolerability. In the pre-treatment survey, the prevalence was higher in the Bubi group (77.1%, 1126/1461); post-treatment it was higher among the Fang (51.1%, 92/180). The reduction in prevalence and intensity of O. volvulus infection differed between ethnic groups and communities. Bioko est la seule île dans le monde connue comme étant endémique pour l'onchocercose. Les communautés rurales de l’île consistent en villages et plantations de cacao habités par les groupes ethniques Bubi et Fang. Le but de cette étude était d’évaluer l'impact de 8 années de distribution verticale d'ivermectine sur la prévalence et l'intensité de l'infection àOnchocerca volvulus dans la population rurale, au moyen d'enquêtes épidémiologiques avant (1989) et après (1998) une longue période de traitement. Dans toutes les deux enquêtes, la population entière de 12 communautés sélectionnées aléatoirement (1723 versus 1082 individus) a été examinée. La couverture moyenne du traitement à l'ivermectine durant les 8 années était de 53,2%. Les biopsies cutanées exsangues au-dessus des crêtes iliaques ont été utilisées pour le diagnostic différentiel entre O. volvulus et Mansonella streptocerca. La prévalence brute de l'infection àO. volvulusétait de 74,5% (1284/1723) avant et de 38,4% (415/1082) après l'intervention à l'ivermectine. La charge de microfilaire communautaire avant l'intervention était de 28,29 microfilaire/crête contre 2,32 après. La réduction de la prévalence et de la charge de microfilaire communautaire après 8 années de traitement à l'ivermectine corrobore avec l'activité microfilaricide et la bonne tolérance du médicament. Dans l'enquête avant le traitement, la prévalence était plus élevée dans le groupe Bubi (77,1%; 1126/1461), après traitement, elle était plus élevée dans le groupe Fang (51,1%; 92/180). La réduction de la prévalence et de l'intensité de l'infection àO. volvulus varie selon le groupe ethnique et la communauté. Bioko es la única isla del mundo endémica para oncocercosis. Las comunidades rurales de la isla consisten en poblados y plantaciones de cocoa, habitadas por los grupos étnicos Bubi y Fang. El objetivo de este estudio era evaluar el impacto de 8 años de distribución vertical de ivermectina entre la población rural, sobre la prevalencia e intensidad de infección por Onchocerca volvulus. Con este fin se realizaron encuestas epidemiológicas antes (1989) y después de tratamiento a largo plazo (1998). En ambas encuestas se examinó a toda la población de doce comunidades elegidas al azar (1723 y 1082 individuos). La media de la cobertura terapéutica para los 8 años fue del 53.2%. Se utilizaron biopsias cutáneas de la cresta ilíaca para el diagnóstico diferencial entre O. volvulus y Mansonella streptocerca. La prevalencia cruda de infección por O. volvulus antes de la intervención con ivermectina era del 74.5% (1284/1723); después de la intervención era del 38.4% (415/1082). La carga de microfilarias comunitaria (CMC), antes y después de la intervención con ivermectina, fue de 28.29 microfilarias/biopsia versus 2.32 microfilarias/biopsia. La reducción en la prevalencia y la CMC después de 8 rondas anuales de tratamiento con ivermectina, corroboran tanto la actividad microfilaricida del medicamento como su buena tolerancia. En la encuesta realizada antes del tratamiento, la prevalencia era mayor en el grupo Bubi (77.1%,1126/1461), mientras que el la realizada post-tratamiento fue mayor entre los Fang (51.1%,92/180). La reducción en la prevalencia e intensidad de infección por O. volvulus difirió entre grupos étnicos y comunidades. Onchocerciasis is a major tropical skin and blinding disease caused by the filarial parasite Onchocerca volvulus transmitted by Simulium species (WHO 1995). Ivermectin (Mectizan®) is an effective, well-tolerated microfilaricidal drug for the treatment of onchocerciasis, for individual and long-term mass treatment to communities in endemic areas (WHO 1991, 1995). Onchocerciasis is present in Equatorial Guinea on both the island of Bioko and the mainland (Mas et al. 1996; Echeverria et al. 2000), being an important public health problem on Bioko. Epidemiological and clinical surveys have identified a forest onchocerciasis focus affecting the whole island (Mas et al. 1995, Moser et al. 2002). The vector is a unique isolated Bioko form within the Simulium squamosum subcomplex, closely related to S. yahense (Wilson et al. 1994; Post et al. 1995, 2003). Vector status was studied by Cheke et al. (1997) and 25 (11%) of 226 rivers prospected around the island contained larvae and pupae of the S. damnosum complex (McCall et al. 1998). Ecologically, Bioko is the only island known in the world with endemic onchocerciasis. In 1990, an onchocerciasis control project on Bioko was launched with the aim of eliminating onchocerciasis as a public health problem with long-term ivermectin mass treatment in all 52 island communities. An ivermectin treatment strategy was followed from 1990 until 1997 by a mobile team. In 1998, a Community Ivermectin Directed Treatment (CIDT) was started following the recommendations of the African Programme for Onchocerciasis Control (APOC) (Remme 1995). The aim of the study was to evaluate the impact of 8 years of ivermectin treatment on the prevalence and intensity of O. volvulus infection in the rural population of this unique isolated environment by means of pre (1989) and post-long term treatment (1998) surveys. Mass ivermectin treatment efficiency is basically evaluated by assessing the prevalence and intensity of infection measured by microfilariae (Mf) counts in skin snips (Remme et al. 1989; Collins et al. 1992; Alley et al. 1994; Boussinesq et al. 1997; Guderian et al. 1997). General geographic (including a map of the island), climatologic, demographic, ethnographic and socioeconomic data of Bioko related to onchocerciasis have been described by Mas et al. (1995, 1996). The island rural community settlements consisted of: (a) villages, mainly made up of the Bubi ethnic group, indigenous to the island and (b) cocoa plantation living quarters ‘patios’, inhabited mainly by Fang, an ethnic group originally from the mainland, but who had progressively settled on Bioko since the last century, maintaining tribal village and family links and some frequent journeys to the mainland. Administratively some villages incorporate a neighbouring ‘patio’ resulting in a Bubi-Fang population. Since the mid-1990s, offshore oil exploitation of the Island of Bioko has produced some socioeconomic changes with a consequent depopulation of the rural areas to the town of Malabo for better jobs related to the oil industry. In addition, population internal migration from the mainland to Bioko has increased because of an improvement in transportation facilities. No perceptible changes were observed in the bio-ecology of the onchocerciasis vector, and no vector control operations were initiated before the post-treatment survey. The whole population of 12 communities selected randomly around the island were surveyed in the pre- and post-long term ivermectin treatment: Baho Grande, Basakato, Basupú, Belebú, Bokoko Avendaño, Bokoko Drumen, Boloko, Bombe, Ehoko, Riaba, Rilaja and Ureka. From 90% to 100% of the approximate total population of each community participated and were skin snipped in both surveys. In the pre-treatment survey the population studied was 1723. In the post-treatment survey, adults with an island residence history of less than 8 years were excluded to potentially ensure that they had been treated the whole period, arising to a total of 1082 individuals studied. The linkage of the individuals’ records in both surveys was done based on names and surnames. Even though in Africa these variables are not very adequate to link databases, the Christian tradition inherited from the Spanish in Equatorial Guinea ensures identification of each inhabitant by the two surnames, the first one inherited from the father and the second from the mother, with the names collected in the archives of the Roman Catholic Church. In addition, the study team established good relationships with the different community heads that helped them to validate the recruitments. All inhabitants were asked for identification data (including, name and surnames, age, gender, ethnic group and length of residence on the island). Two skin snips from the iliac crests were taken from each individual using a Walser corneoscleral punch and incubated for 24 h in isotonic saline in microtitration plates. O. volvulus Mf were then counted under a low power microscope (×40). When Mf were very numerous, an aliquot was counted. Differential diagnosis was done with the skin Mf Mansonella streptocerca. Crude prevalence was calculated according to the percentage of positive Mf skin snips. The individual microfilarial load for each individual (arithmetic mean of the microfilarial counts of the two skin snips) and crude intensity of infection (geometric mean of microfilarial load among individuals with positive counts) were determined. Community microfilarial load (CMFL) was calculated as the adjusted geometric mean of microfilarial load among adults of 20 years of age and older in the community, including those with negative counts (Remme et al. 1986). Changes in prevalence of infection due to the 8 years of ivermectin intervention were determined with the odds ratio (OR) and changes in intensity by Mf geometric mean ratio (MGMR). This was performed with the ‘treatment’ variable consisting of two categories: pre- and post-treatment. The OR measures the intensity of the association between the onchocerciasis prevalence and the 8 years of ivermectin treatment. An OR significantly >1 means a significant association between intervention and a reduction in the prevalence. MGMR measures the intensity of infection ratio of the geometric mean of pre-treatment vs. post-treatment. In order to have unbiased estimations of the OR and the MGMR, two linear models were adjusted for both variables (prevalence and intensity of infection) controlling confounding and interacting variables with the treatment. It was also taken into account that the data collected presented dependence in two levels: first, the data was grouped into communities, thus the responses of the population from the same community could not be treated independently since the study concerns infectious disease. The Generalized Linear Mixed Models (GLMM) (Breslow & Clayton 1993) was used to control these dependencies including the community as a random effect. Second, the independence of the data was violated since some people were measured twice (pre- and post-long-term treatment). For this fact a covariance pattern between observations occurring in the same individual was specified within the total variance matrix. Quantile–quantile plots of the Pearson conditional residuals were used to assess the goodness of fit of the models. To fit the models the GLIMMIX macro and the MIXED procedure implemented in SAS were used. Long-term annual mass ivermectin treatment was established from 1990 to 1997. Every year a mobile treatment team visited all rural communities prior to the ivermectin treatment to mobilize the population. Ivermectin was distributed according to community size and facilities: at a central place, in the school or house by house. After 1993 ivermectin was also distributed in the neighbourhood health centres, house by house and in the headquarters of the onchocerciasis control project in the town of Malabo. A single individual dose (150 μg/kg of body weight) was administered using the standard exclusion criteria (WHO 1995) to reduce the prevalence and intensity of onchocerciasis infection in all communities. A treatment card indicating the next treatment date was given to each patient. Treatment compliance was measured in terms of total number of oral tablets administered in each community in each round. Adverse effects after ivermectin treatment were treated and followed for a minimum of 2 days. This study was conducted as part of the monitoring of the ivermectin treatment control of onchocerciasis in Equatorial Guinea. Survey participants were included after informed verbal consent from them and from local community authorities. Authorization and official credential were obtained from the Ministry of Health and Welfare of the country. Totals of 1723 and 1082 individuals from the 12 communities were registered in the pre- and post-treatment surveys, respectively. Only 303 (28%) of the individuals examined were present in both surveys; these were more Bubi than Fang, and more males than females (Table 1). The 15 to 19-year-old age group was the most reduced (Figure 1). In the communities the age of the population ranged between 0 and 99 years in the pre-treatment survey and 0 and 98 years in the post-treatment survey (Figure 2). Population distribution by ago groups in the pre- and post-treatment surveys. Percentages were calculated over the total number of people for each survey (1989 and 1998). Population distribution by community in the pre- and post-treatment surveys. Percentages were calculated over the total number of people for each survey (1989 and 1998). The mean therapeutic coverage for the 8 years was 53.2%. The therapeutic coverage per year was: 49% (1990), 53% (1991), 54% (1992), 55% (1993), 62% (1994), 59% (1995), 46% (1996) and 48% (1997). During the whole treatment period, it was not possible to control how many yearly rounds of ivermectin treatment each individual received. The crude O. volvulus infection prevalence before ivermectin intervention was 74.5% (1284/1723) and 38.4% (415/1082) after (Table 1). Prevalence decreased in both sexes, with males having higher values than females both pre- (76.1%, 683/898) and post-treatment (42.9%, 220/574) (Table 1). In the pre-treatment survey, the prevalence was higher in the Bubi group (77.1%, 1126/1461); post-treatment it was higher among the Fang (51.1%, 92/180). In the post-treatment survey, the prevalence in the Bubi group decreased in both sexes, however it decreased more slightly in Fangs (Table 1), indicating that the treatment could be interacting with the ethnicity. Prevalence fell in all age groups. The crude prevalence in both surveys rose until the age of 15 years with a trend to remain constant in both sexes thereafter, although lower in females (Figure 3). Crude prevalence of O. volvulus infection by age group and gender in the pre- and post-treatment surveys (1989 and 1998). In almost all communities, prevalence was higher and more homogenous in the pre-treatment surveys (Figure 4). This fact intensified the hypothesis of including the community as a random effect in the statistical model and also interacting with the treatment. Crude prevalence of O. volvulus infection of the communities in the (a) pre- and (b) post-treatment surveys (1989 and 1998). Point estimates and 95% confidence intervals. The OR point estimates and 95% confidence intervals deduced from the GLMM model are shown in Tables 2 and 3. The prevalence among males in both surveys was significantly higher than females and the prevalence among children under 5 years was significantly lower than the prevalence among older inhabitants (Table 2). No differences in treatment intervention were found between gender and age groups. Parameter estimates for ethnic group and community are shown in Table 3. The prevalence decreased more markedly among the Bubi. The prevalence among the Bubi decreased significantly in all the communities but the prevalence of the Fang did not do so in Basupu, Bokoko Avendaño, Bokoko Drumen, Bombe, Ehoko, Rilaja and Riaba. The CMFL before ivermectin intervention was 28.29 Mf/snip (95% CI: 24.68–32.43) and 2.32 Mf/snip (95% CI: 2.08–2.58) after. Crude intensity of infection before ivermectin intervention was 32.7 and 4.2 Mf/snip after (Table 1). In the pre-treatment survey, intensity of infection was greater in males, while it seemed to be similar in both sexes post-treatment (Table 1). In the pre-treatment survey, intensity of infection was higher among Bubi than Fang, and similar in females of both ethnic groups. In the post-treatment survey, values were slightly higher in the Fang group, it was similar in males of both ethnic groups, and higher in Fang women (Table 1). In the pre-treatment survey, the female curve of age groups was below that of the males, with practically no difference after long-term treatment (Figure 6). Intensity of infection by communities was very heterogeneous in the pre-treatment survey and decreased to around 5 Mf/snip in the post-treatment (Figure 7). It is again reasonable to introduce the community as a random effect and also interacting with treatment. Crude intensity of O. volvulus infection (MF/snip geometric mean) by age group and gender in the pre- and post-treatment surveys (1989 and 1998). Crude intensity of O. volvulus infection (Mf/snip) by community (villages) in the (a) pre- and (b) post-treatment surveys (1989 and 1998). Point estimates and 95% confidence intervals. The MGMR deduced from the model selected to evaluate the ivermectin intervention for intensity of infection is shown in Tables 2 and 3. Once more, the intensity of infection among males in both surveys was significantly higher than in females and the intensity of infection among children under 5 years was significantly lower than the intensity among older inhabitants (Table 2). As seen in prevalence evaluation no differences were found in treatment intervention between gender and age groups. The intensity of infection significantly decreased for both ethnic groups in all communities, although the decrease was again higher in the Bubi (Table 3). Before ivermectin intervention, more than 50% of the population had more than 40 Mf/snip and some reached values higher than 1000 Mf/snip. However, after long-term treatment, about 40% of the population had less than 2 Mf/snip with none of the population having more than 100 Mf/snip (Figure 5). Distribution of O. volvulus infection burden by individuals in the pre- and post-treatment surveys (1989 and 1998). The transmission level was determined by skin snips taken from children under 5 years (not eligible for ivermectin treatment). As deduced from the statistical models, ivermectin treatment impact on the whole population did not interact with the age groups, which means that the decrease of prevalence and intensity of infection was similar in all age groups, including children under 5 years, which were not treated with ivermectin. In 1989, 29.70% (98/330) of this age group were Mf positive, while in 1998 decreased to 13.89% (20/144). The Microfilarial load (MFL geometric mean in positive and negative skin snips) in these children fell from 1.93 in 1989 to 1.22 in 1998, which is a reduction of 37%. The reduction in the prevalence and intensity of infection after eight annual rounds of ivermectin treatment corroborates the drug microfilaricidal activity and good tolerability as described by Prod'hom et al. (1990); Alley et al. (1994); Boussinesq et al. (1997); Newell (1997); Guderian et al. (1997). In the pre-treatment survey, onchocerciasis prevalence was higher among the Bubi than the Fang. This was probably due to the permanent settlement of the Bubi in rural Bioko involving long-term transmission and cumulative O. volvulus infection compared to the temporary and internal migratory behaviour of the Fangs with lower man—vector contact. Similar findings were observed in Equator by the interaction between the Amerindian ethnic group Chachi and the Afroamerican community (Guderian et al. 1983). In the post-treatment survey, the disease ethnic endemicity reversed. The prevalence reduction was lower among the Fangs (OR ranging from 0.8 to 6.4, Table 2) probably due to the low treatment round participation since low settlement permanence in the seasonal cocoa harvesting jobs allows mobility into and outside the island. To the contrary, the reduction in prevalence was more important in the Bubi (OR ranging from 2.9 to 24.5, Table 2) due to high treatment compliance. The prevalence reduction was greater in the Baho Grande, Basakato, Basupú, Belebú, Ehoko and Ureka communities where the Bubi ethnic group was predominant. In contrast, the prevalence reduction was lower in almost all predominant Fang communities, where treatment compliance was low among some individuals working in the plantations on the treatment day, with the exception of Boloko, an isolated ‘patio’ with difficult accessibility. Despite the importance of the treatment-ethnicity interaction, the prevalence reduction differences may also be explained by the distinctive treatment participation due to a complexity of factors including: endemicity level, disease burden and severity perception; settlement permanence, sensitization, specific treatment benefits; local authority interest, commitment and influence and post-treatment adverse effects. As with the prevalence, intensity of infection reduction was greater in the Bubi ethnic group (MGMR ranging from 6.5 to 14.9, Table 2) than in the Fang (MGMR ranging from 2.7 to 6.1), but in this case the reduction was significant in all communities. In the post-long term treatment survey, the intensity of infection was very low and similar in both ethnic groups and communities. The skin Mf life span is about 1–2 years (Duke 1993). This time period may produce a skin Mf age structure consisting in young Mf in-flow from adult worm females, skin Mf reservoir and out-flow mature Mf disappearing by death and reabsorption, and vector Mf intake. Ivermectin is a skin microfilaricidal and it has been suggested that the drug also causes an irreversible decline in Mf production of around 30% per treatment (Plaisier et al. 1995; Basañez & Ricárdez-Esquinca 2001). After several annual treatments, the skin Mf reservoir tends to disappear and the skin is re-colonized only by young Mf from drug-affected adult female worms. However, when skin Mf abundance is low, their distribution may be random or aggregate. The intensity of infection is a spatial density indicator limited to the technique used, in this case the skin snip. At these low intensity levels the probability of finding skin Mf is very low and the results could give false negatives. Both prevalence and intensity of infection dropped among the children under 5 years who had never been treated with an anti-filarial drug. This transmission decrease is probably due to the reduction of the skin Mf reservoir after long–term ivermectin treatment. In the pre-treatment survey, infection was more common in males, probably because of greater exposure during agricultural work. Onchocerciasis is considered a public health problem when the CMFL exceeds 5–10 Mf/snip (WHO 2001). After long-term treatment in Bioko the CMFL decreased from 28.29 to 2.32 Mf/snip. The results show the effectiveness of ivermectin in controlling onchocerciasis as a public health problem. Although the therapeutic coverage was relatively low and only 28% of the population was present in both surveys, treatment intervention was the only factor associated with O. volvulus transmission that changed during the period under study. However, this situation depends on the duration of the therapeutic coverage and transmission, provided that drug resistance does not appear. New treatment strategies and vector elimination projects should be taken into account if onchocerciasis elimination is to be achieved in Bioko. We are grateful to the AECI and S.M.O.of Malta for their financial support, to the Mectizan Donation Program for their free donation of ivermectin, and to Dr. P. Rojas and the other WHO representatives in Equatorial Guinea for their drug-handling facilities. Our special thanks to Donna Pringle for her help in preparing the manuscript. We are particularly grateful to the Ministry of Health and Social Welfare and the people of Equatorial Guinea for their assistance and hospitality." @default.
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• W2021094558 title "Reduction in the prevalence and intensity of infection in Onchocerca volvulus microfilariae according to ethnicity and community after 8 years of ivermectin treatment on the island of Bioko, Equatorial Guinea" @default.
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• W2021094558 cites W1993933204 @default.
• W2021094558 cites W2011601336 @default.
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• W2021094558 cites W2084881364 @default.
• W2021094558 cites W2112978803 @default.
• W2021094558 cites W2117824521 @default.
• W2021094558 cites W2121770182 @default.
• W2021094558 cites W2149994114 @default.
• W2021094558 cites W2463359715 @default.
• W2021094558 cites W4244611409 @default.
• W2021094558 cites W1999179776 @default.
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