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Contact Lens & Anterior Eye : the... Jun 2024Demodex blepharitis, often overlooked in ocular surface disease, involves Demodex mites, prevalent ectoparasites on human skin. Current treatments may not effectively... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Demodex blepharitis, often overlooked in ocular surface disease, involves Demodex mites, prevalent ectoparasites on human skin. Current treatments may not effectively eliminate these mites, prompting a need for targeted therapies. Lotilaner, an antiparasitic agent, shows promise. This systematic review and meta-analysis assesses 0.25% lotilaner ophthalmic solution's efficacy in reducing Demodex mite populations and its impact on ocular surface inflammation in Demodex blepharitis patients.
METHODS
A comprehensive literature search was performed in the PubMed and Cochrane Library databases from inception until February 2024 to identify relevant trials investigating the use of lotilaner in patients with Demodex blepharitis. The included studies were assessed for quality, and a meta-analysis was conducted to determine the overall treatment effects of lotilaner. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated for binary variables. All statistical analyses were performed using the R Statistical Software.
RESULTS
Five studies met the inclusion criteria and were included in this systematic review and meta-analysis. Lotilaner demonstrated significant efficacy in Collarette Cure [OR = 6.64; 95 % CI 3.78 to 11.04; p < 0.00001, I = 62 %] %], clinically meaningful collarette reduction [OR = 6.21; 95 % CI 3.67 to 10.49; p < 0.00001, I = 90 %], and achieving at least 1-grade collarette improvement [OR = 5.12; 95 % CI (2.96 to 8.88); p < 0.00001, I = 90 %] compared to the placebo group. The treatment also resulted in mite eradication [OR = 6.18; 95 % CI 4.67 to 6.18; p < 0.00001, I = 34 %], reduction in mite density [OR = 9.37; 95 % CI 5.36 to 16.36; p < 0.00001, I = 84 %], and erythema cure [OR = 2.29; 95 % CI 2.24 to 3.39; p < 0.00001, I = 5 %] and composite cure [OR = 7.05; 95 % CI 3.66 13. 61; p < 0.00001, I = 11 %]. The study suggests that lotilaner is a promising therapeutic option for collarette and associated symptoms, but the high heterogeneity in some outcomes and limited long-term data warrant further research to confirm its effectiveness and safety.
CONCLUSION
This systematic review and meta-analysis provides robust evidence supporting the efficacy of 0.25% lotilaner ophthalmic solution in treating Demodex blepharitis. Approval of this targeted therapy represents a significant milestone in ophthalmology and offers a promising treatment option for patients with Demodex blepharitis. Eye care professionals should consider the potential benefits of lotilaner in managing and alleviating the symptoms associated with Demodex infestations on the eyelids. Further research and long-term follow-up studies are warranted to assess the safety and effectiveness of lotilaner in treating Demodex blepharitis.
Topics: Blepharitis; Mite Infestations; Randomized Controlled Trials as Topic; Humans; Animals; Eye Infections, Parasitic; Ophthalmic Solutions; Mites; Treatment Outcome; Antiparasitic Agents
PubMed: 38514290
DOI: 10.1016/j.clae.2024.102148 -
PLoS Neglected Tropical Diseases Mar 2024Abdominal ultrasound imaging is an important method for hepatic schistosomiasis diagnosis and staging. Several ultrasound staging systems have been proposed, each...
BACKGROUND
Abdominal ultrasound imaging is an important method for hepatic schistosomiasis diagnosis and staging. Several ultrasound staging systems have been proposed, each attempting to standardise schistosomal periportal fibrosis (PPF) diagnosis. This review aims to establish the role of ultrasound in the diagnosis and staging of schistosomal PPF, and to map the evolution of ultrasound staging systems over time, focusing on internal validation and external reproducibility.
METHODS
A systematic search was undertaken on 21st December 2022 considering the following databases: PubMed/MEDLINE (1946-present), Embase (1974-present), Global Health (1973-present), Global Index Medicus (1901-present), and Web of Science Core Collection-Science Citation Index Expanded (1900-present) and the Cochrane Central Register of Controlled Trials (1996-present). Case reports, systematic reviews and meta-analyses, and studies exclusively using transient or shear-wave elastography were excluded. Variables extracted included study design, study population, schistosomal PPF characteristics, and diagnostic methods. The PRISMA-ScR (2018) guidelines were followed to inform the structure of the scoping analysis.
RESULTS
The initial search yielded 573 unique articles, of which 168 were removed after screening titles and abstracts, 43 were not retrieved due to full texts not being available online or through inter-library loans, and 170 were excluded during full text review. There were 192 remaining studies eligible for extraction. Of the extracted studies, 61.8% (76/123) of studies that reported study year were conducted after the year 2000. Over half of all extracted studies (59.4%; 114/192) were conducted in Brazil (26.0%; 50/192), China (18.8%; 36/192) or Egypt (14.6%; 28/192). For the species of schistosome considered, 77.6% (149/192) of studies considered S. mansoni and 21.4% (41/192) of studies considered S. japonicum. The ultrasound staging systems used took on three forms: measurement-based, feature-based and image pattern-based. The Niamey protocol, a measurement and image pattern-based system, was the most used among the staging systems (32.8%; 63/192), despite being the most recently proposed in 1996. The second most used was the Cairo protocol (20.8%; 40/192). Of the studies using the Niamey protocol, 77.8% (49/63) only used the image patterns element. Where ultrasound technology was specified, studies after 2000 were more likely to use convex transducers (43.4%; 33/76) than studies conducted before 2000 (32.7%; 16/49). Reporting on ultrasound-based hepatic diagnoses and their association with clinical severity was poor. Just over half of studies (56.2%; 108/192) reported the personnel acquiring the ultrasound images. A small number (9.4%; 18/192) of studies detailed their methods of image quality assurance, and 13.0% (25/192) referenced, discussed or quantified the inter- or intra-observer variation of the staging system that was used.
CONCLUSIONS
The exclusive use of the image patterns in many studies despite lack of specific acquisition guidance, the increasing number of studies over time that conduct ultrasound staging of schistosomal PPF, and the advances in ultrasound technology used since 2000 all indicate a need to consider an update to the Niamey protocol. The protocol update should simplify and prioritise what is to be assessed, advise on who is to conduct the ultrasound examination, and procedures for improved standardisation and external reproducibility.
Topics: Humans; Point-of-Care Systems; Reproducibility of Results; Liver Cirrhosis; Ultrasonography; Schistosomiasis
PubMed: 38507368
DOI: 10.1371/journal.pntd.0012033 -
Future Microbiology 2024To determine the prevalence of ocular toxoplasmosis among people living with HIV through a systematic review and meta-analysis. A literature search was conducted,... (Meta-Analysis)
Meta-Analysis Review
To determine the prevalence of ocular toxoplasmosis among people living with HIV through a systematic review and meta-analysis. A literature search was conducted, estimating pooled prevalence and performing quality assessment, outlier, influential and meta-regression analyses. Twenty-nine studies were included in the analysis, revealing that the rate of ocular toxoplasmosis among people living with HIV was 0.37% (95% CI: 0.2-0.6). Substantial heterogeneity was observed among the studies. Despite analyzing continuous variables, including year of publication, proportion of males, mean age and proportion of patients receiving antiretroviral therapy, no statistically significant associations were found. This study provides an overview of the prevalence of ocular toxoplasmosis in people living with HIV, emphasizing the need for further research to uncover factors contributing to its development.
Topics: Humans; HIV Infections; Prevalence; Toxoplasmosis, Ocular; Male; Female; Toxoplasma
PubMed: 38507297
DOI: 10.2217/fmb-2023-0215 -
World Neurosurgery Jun 2024Postoperative complications, exemplified by surgical site infections, are commonplace in the realm of daily surgical interventions. Conversely, certain infectious... (Review)
Review
Postoperative complications, exemplified by surgical site infections, are commonplace in the realm of daily surgical interventions. Conversely, certain infectious entities, such as cerebral myiasis (CM), are distinctly rare. This report elucidates the clinical presentation of a 74-year-old female afflicted with a CSF fistula, within the context of a preceding surgical microvascular decompression employing a suboccipital craniotomy approach. Notably, the course of evaluation and treatment unveiled an intraoperative manifestation of severe CM. This case report underscores the critical significance of prompt identification, precise diagnostic elucidation, and comprehensive multidisciplinary management to optimize patient outcomes in instances of CM. Furthermore, a systematic literature review on CM supplements this report, contributing to the understanding of this infrequent complication.
Topics: Humans; Female; Aged; Myiasis; Craniotomy; Microvascular Decompression Surgery
PubMed: 38503402
DOI: 10.1016/j.wneu.2024.03.044 -
Acta Tropica May 2024Cyclospora cayetanensis (C. cayetanensis) is a significant pathogen that causes diarrheal illness and causes large foodborne diarrhea outbreaks in the USA and Canada.... (Meta-Analysis)
Meta-Analysis
Cyclospora cayetanensis (C. cayetanensis) is a significant pathogen that causes diarrheal illness and causes large foodborne diarrhea outbreaks in the USA and Canada. However, there is currently a lack of published meta-analysis on the prevalence of C. cayetanensis infection in the global population. A real estimation of a disease prevalence should always be done on the basis of studies designed for that purpose. We conducted a comprehensive search of various databases for articles pertaining to the prevalence of C. cayetanensis infection in humans, spanning from the inception of these databases to March 10, 2023. Utilizing a random effects model, we estimated the prevalence of C. cayetanensis infection in humans. Our analysis included a total of 150 datasets sourced from 42 different countries, which were ultimately selected for the final quantitative assessment. The prevalence of C. cayetanensis infection in humans worldwide was estimated to be 3.4 % (5636/166,611). Notably, Africa exhibited the highest prevalence rate at 5.9 % (606/11,068). Further subgroup analysis revealed a significantly higher infection rate in humans residing in low-income countries (7.6 %, 83/921) compared to those in lower-middle-income countries (4.8 %, 3280/48,852), upper-middle-income countries (2.9 %, 2194/99,419), and high-income countries (0.4 %, 79/17,419). The results indicate that the global prevalence of C. cayetanensis infection in humans is relatively low, despite its extensive geographical distribution and children were found to be more susceptible to C. cayetanensis infection compared to those adults. Sensitivity analysis revealed that one study significantly affects the prevalence of C. cayetanensis, which was adjusted to 2.9 % (4017/160,049; 95 % CI: 2.7-3.1 %) by excluding this study. The findings highlight the relatively high prevalence of C. cayetanensis infection in low-income countries and among humans with diarrhea, particularly in Africa. Consequently, routine surveillance for intestinal protozoa is crucial in these regions.
Topics: Humans; Africa; Cyclospora; Cyclosporiasis; Diarrhea; Feces; Prevalence
PubMed: 38492874
DOI: 10.1016/j.actatropica.2024.107175 -
BMC Public Health Mar 2024Malaria is one of the most common causes of morbidity and mortality in developing countries including Ethiopia. Mass distribution of insecticide-treated nets and indoor... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Malaria is one of the most common causes of morbidity and mortality in developing countries including Ethiopia. Mass distribution of insecticide-treated nets and indoor residual spray for high malaria risk groups are the major prevention measures in different countries. Achievement of the malaria elimination plan is highly determined by the level of effective utilization of intervention measures. However, there is scarce information showing the national level of insecticide-treated nets utilization.
OBJECTIVE
To estimate the pooled prevalence of insecticide-treated nets utilization in Ethiopia, 2023.
METHOD
A Systematic Review and Meta-analysis employed to assess the utilization of long-lasting insecticidal nets in Ethiopia. Published articles were searched from Google Scholar, PubMed, Web Sciences, CINAHIL, EMBASE, and Scopus. The collected articles were screened for data extraction and further analysis using preferred reporting items for systematic review and meta-analysis (PRISMA) flow chart. The quality of each study was assessed using the Jonna Briggs Institute (JBI) checklist. The data were extracted using Microsoft Excel and exported to STATA version 17.0 for analysis. The overall pooled prevalence of long-lasting insecticidal nets utilization was determined using a random effects model.
RESULT
Out of 1657 articles reviewed, only 21 of them were eligible for final analysis. All of the included studies were used to estimate the pooled prevalence of long-lasting insecticidal net utilization. The point prevalence of LLIN utilization ranged from 14.23 to 91.9%. The Meta-analysis estimated that the overall pooled prevalence of insecticidal nets utilization among all study participants in Ethiopia was 56.26% (95%CI: 44.04-68.48%). Subgroup analysis revealed that insecticidal nets utilization was relatively highest in the Amhara region [63.0, 95%CI (37.0-89.0%)] and during 2020-2023 [61, 95% CI (53.0-69.0%)].
CONCLUSION
Long-lasting insecticidal nets utilization in Ethiopia is lower than the national target plan. Hence, it needs extra follow-up and intervention to enhance its utilization.
Topics: Humans; Insecticides; Ethiopia; Insecticide-Treated Bednets; Malaria; Academies and Institutes; Mosquito Control
PubMed: 38491483
DOI: 10.1186/s12889-024-18344-w -
BMJ Open Mar 2024Invasive non-typhoidal (iNTS) disease is a significant health concern in sub-Saharan Africa. While our knowledge of a larger-scale variation is growing, understanding...
BACKGROUND
Invasive non-typhoidal (iNTS) disease is a significant health concern in sub-Saharan Africa. While our knowledge of a larger-scale variation is growing, understanding of the subnational variation in iNTS disease occurrence is lacking, yet crucial for targeted intervention.
METHOD
We performed a systematic review of reported occurrences of iNTS disease in sub-Saharan Africa, consulting literature from PubMed, Embase and Web of Science published since 2000. Eligibility for inclusion was not limited by study type but required that studies reported original data on human iNTS diseases based on the culture of a normally sterile site, specifying subnational locations and the year, and were available as full-text articles. We excluded studies that diagnosed iNTS disease based on clinical indications, cultures from non-sterile sites or serological testing. We estimated the probability of occurrence of iNTS disease for sub-Saharan Africa on 20 km × 20 km grids by exploring the association with geospatial covariates such as malaria, HIV, childhood growth failure, access to improved water, and sanitation using a boosted regression tree.
RESULTS
We identified 130 unique references reporting human iNTS disease in 21 countries published from 2000 through 2020. The estimated probability of iNTS occurrence grids showed significant spatial heterogeneity at all levels (20 km × 20 km grids, subnational, country and subregional levels) and temporal heterogeneity by year. For 2020, the probability of occurrence was higher in Middle Africa (0.34, 95% CI: 0.25 to 0.46), followed by Western Africa (0.33, 95% CI: 0.23 to 0.44), Eastern Africa (0.24, 95% CI: 0.17 to 0.33) and Southern Africa (0.08, 95% CI: 0.03 to 0.11). Temporal heterogeneity indicated that the probability of occurrence increased between 2000 and 2020 in countries such as the Republic of the Congo (0.05 to 0.59) and Democratic Republic of the Congo (0.10 to 0.48) whereas it decreased in countries such as Uganda (0.65 to 0.23) or Zimbabwe (0.61 to 0.37).
CONCLUSION
The iNTS disease occurrence varied greatly across sub-Saharan Africa, with certain regions being disproportionately affected. Exploring regions at high risk for iNTS disease, despite the limitations in our data, may inform focused resource allocation. This targeted approach may enhance efforts to combat iNTS disease in more affected areas.
Topics: Humans; Child; Salmonella Infections; Salmonella; Typhoid Fever; Malaria; Africa South of the Sahara
PubMed: 38485477
DOI: 10.1136/bmjopen-2023-080501 -
The Lancet. Global Health Apr 2024The geographical, demographic, and socioeconomic distributions of malaria and malnutrition largely overlap. It remains unknown whether malnutrition affects the efficacy... (Meta-Analysis)
Meta-Analysis
Does acute malnutrition in young children increase the risk of treatment failure following artemisinin-based combination therapy? A WWARN individual patient data meta-analysis.
BACKGROUND
The geographical, demographic, and socioeconomic distributions of malaria and malnutrition largely overlap. It remains unknown whether malnutrition affects the efficacy of WHO-recommended artemisinin-based combination therapies (ACTs). A previous systematic review was inconclusive as data were sparse and heterogeneous, indicating that other methodological approaches, such as individual patient data meta-analysis, should be considered. The objective of this study was to conduct such a meta-analysis to assess the effect of malnutrition (wasting and stunting) on treatment outcomes in children younger than 5 years treated with an ACT for uncomplicated falciparum malaria.
METHODS
We conducted a meta-analysis of individual patient data from studies identified through a systematic review of literature published between 1980 and 2018 in PubMed, Global Health, and Cochrane Libraries (PROSPERO CRD42017056934) and inspection of the WorldWide Antimalarial Resistance Network (WWARN) repository for ACT efficacy studies, including children younger than 5 years with uncomplicated falciparum malaria. The association of either acute (wasting) or chronic (stunting) malnutrition with day 42 PCR-adjusted risk of recrudescence (ie, return of the same infection) or reinfection after therapy was investigated using Cox regression, and with day 2 parasite positivity using logistic regression.
FINDINGS
Data were included from all 36 studies targeted, 31 from Africa. Of 11 301 eligible children in 75 study sites, 11·5% were wasted (weight-for-height Z score [WHZ] <-2), and 31·8% were stunted (height-for-age Z score [HAZ] <-2). Decrease in WHZ was associated with increased risk of day 2 positivity (adjusted odds ratio 1·12, 95% CI 1·05-1·18 per unit; p=0·0002), treatment failure (adjusted hazard ratio [AHR] 1·14, 95% CI 1·02-1·26, p=0·016), and reinfection after therapy (AHR 1·09, 1·04-1·13, p=0·0003). Children with milder wasting (WHZ -2 to -1) also had a higher risk of recrudescence (AHR 1·85, 1·29-2·65, p=0·0008 vs WHZ ≥0). Stunting was not associated with reduced ACT efficacy.
INTERPRETATION
Children younger than 5 years with acute malnutrition and presenting with uncomplicated falciparum malaria were at higher risk of delayed parasite clearance, ACT treatment failure, and reinfections. Stunting was more prevalent, but not associated with changes in ACT efficacy. Acute malnutrition is known to impact medicine absorption and metabolism. Further study to inform dose optimisation of ACTs in wasted children is urgently needed.
FUNDING
Bill & Melinda Gates Foundation.
TRANSLATION
For the French translation of the abstract see Supplementary Materials section.
Topics: Child; Humans; Child, Preschool; Antimalarials; Reinfection; Artemisinins; Malaria, Falciparum; Malaria; Treatment Failure; Malnutrition; Recurrence; Growth Disorders
PubMed: 38485430
DOI: 10.1016/S2214-109X(24)00003-2 -
Journal of Ethnopharmacology Jun 2024Cordyceps sinensis (CS) is a fungus parasitic on lepidopteran larvae which is often used to treat lung diseases and regulate immune function. (Meta-Analysis)
Meta-Analysis
ETHNOPHARMACOLOGICAL RELEVANCE
Cordyceps sinensis (CS) is a fungus parasitic on lepidopteran larvae which is often used to treat lung diseases and regulate immune function.
AIM OF THE STUDY
This review aimed to evaluate the efficacy of CS in the adjuvant treatment of lung cancer.
MATERIALS AND METHODS
As of June 2022, the electronic database search was conducted in PubMed, EMBASE, Cochrane Library, China Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Database and China Science Journal Database (VIP database). Randomized clinical trials (RCTs) that evaluated the efficacy of CS as an adjuvant treatment for lung cancer were included. After the quality evaluation, meta-analysis was performed with Stata 16.0 software.
RESULTS
A total of 12 RCTs with 928 patients were identified for this meta-analysis, which showed that as an adjuvant treatment, CS has the following advantages in the treatment of lung cancer: (1) Improved tumor response rate (TRR) (RR: 1.17, 95%CI: 1.05-1.29,P = 0.00); (2) improved immune function, including increased CD4 (MD: 4.98, 95%CI: 1.49-8.47, P = 0.01), CD8 (MD: 1.60, 95%CI: 0.40-2.81, P = 0.01, I = 0.00%), NK (MD: 4.17, 95%CI: 2.26-6.08, P = 0.00), IgA (MD: 1.29, 95%CI: 0.35-2.24, P = 0.01), IgG (MD: 3.95, 95%CI: 0.98-6.92, P = 0.01) and IgM (MD: 6.44, 95%CI: 0.63-12.26, P = 0.03); (3) improved patients' quality of life based on the mean ± SD of Karnofsky Performance Status (KPS) (MD: 8.20, 95%CI: 6.87-9.53, P = 0.00); (4) reduced the incidence of adverse drug reactions (ADRs), including the incidence of myelosuppression (RR: 0.38, 95%CI: 0.19-0.75, P = 0.01), leukopenia (RR: 0.76, 95%CI: 0.63-0.92, P = 0.00), and thrombocytopenia (RR: 0.52, 95%CI: 0.31-0.86, P = 0.01) (5) reduced the incidence of radiation pneumonitis (RR: 0.74, 95%CI: 0.62-0.88, P = 0.00). However, the number of improved patients based on KPS (RR: 1.47, 95%CI: 0.98-2.20, P = 0.06) were similar between two groups, liver and renal damage (RR: 0.32, 95%CI: 0.09-1.10, P = 0.07) and gastrointestinal adverse reactions (RR: 0.80, 95%CI: 0.47-1.37, P = 0.42) as well. Subgroup analysis showed that CS could increase the TRR in the treatment with 6 g/d and 21 days/3-4 cycles.
CONCLUSION
Compared with conventional treatment, adjuvant treatment with CS of lung cancer not only improve TRR, QOL and immune function, but also reduce the incidence of ADRs and radiation pneumonitis. The optimal usage may be 6 g/d and 21 days/3 to 4 cycles.
PROSPERO REGISTRATION NO
CRD42022333681.
Topics: Humans; Cordyceps; Drugs, Chinese Herbal; Leukopenia; Lung Neoplasms; Radiation Pneumonitis; Randomized Controlled Trials as Topic
PubMed: 38484953
DOI: 10.1016/j.jep.2024.118044 -
The Lancet. Global Health May 2024WHO has proposed elimination of transmission of onchocerciasis (river blindness) by 2030. More than 99% of cases of onchocerciasis are in sub-Saharan Africa. Vector... (Meta-Analysis)
Meta-Analysis
Elimination of transmission of onchocerciasis (river blindness) with long-term ivermectin mass drug administration with or without vector control in sub-Saharan Africa: a systematic review and meta-analysis.
BACKGROUND
WHO has proposed elimination of transmission of onchocerciasis (river blindness) by 2030. More than 99% of cases of onchocerciasis are in sub-Saharan Africa. Vector control and mass drug administration of ivermectin have been the main interventions for many years, with varying success. We aimed to identify factors associated with elimination of onchocerciasis transmission in sub-Saharan Africa.
METHODS
For this systematic review and meta-analysis we searched for published articles reporting epidemiological or entomological assessments of onchocerciasis transmission status in sub-Saharan Africa, with or without vector control. We searched MEDLINE, PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, African Index Medicus, and Google Scholar databases for all articles published from database inception to Aug 19, 2023, without language restrictions. The search terms used were "onchocerciasis" AND "ivermectin" AND "mass drug administration". The three inclusion criteria were (1) focus or foci located in Africa, (2) reporting of elimination of transmission or at least 10 years of ivermectin mass drug administration in the focus or foci, and (3) inclusion of at least one of the following assessments: microfilarial prevalence, nodule prevalence, Ov16 antibody seroprevalence, and blackfly infectivity prevalence. Epidemiological modelling studies and reviews were excluded. Four reviewers (NM, AJ, AM, and TNK) extracted data in duplicate from the full-text articles using a data extraction tool developed in Excel with columns recording the data of interest to be extracted, and a column where important comments for each study could be highlighted. We did not request any individual-level data from authors. Foci were classified as achieving elimination of transmission, being close to elimination of transmission, or with ongoing transmission. We used mixed-effects meta-regression models to identify factors associated with transmission status. This study is registered in PROSPERO, CRD42022338986.
FINDINGS
Of 1525 articles screened after the removal of duplicates, 75 provided 282 records from 238 distinct foci in 19 (70%) of the 27 onchocerciasis-endemic countries in sub-Saharan Africa. Elimination of transmission was reported in 24 (9%) records, being close to elimination of transmission in 86 (30%) records, and ongoing transmission in 172 (61%) records. I was 83·3% (95% CI 79·7 to 86·3). Records reporting 10 or more years of continuous mass drug administration with 80% or more therapeutic coverage of the eligible population yielded significantly higher odds of achieving elimination of transmission (log-odds 8·5 [95% CI 3·5 to 13·5]) or elimination and being close to elimination of transmission (42·4 [18·7 to 66·1]) than those with no years achieving 80% coverage or more. Reporting 15-19 years of ivermectin mass drug administration (22·7 [17·2 to 28·2]) and biannual treatment (43·3 [27·2 to 59·3]) were positively associated with elimination and being close to elimination of transmission compared with less than 15 years and no biannual mass drug administration, respectively. Having had vector control without vector elimination (-42·8 [-59·1 to -26·5]) and baseline holoendemicity (-41·97 [-60·6 to -23·2]) were associated with increased risk of ongoing transmission compared with no vector control and hypoendemicity, respectively. Blackfly disappearance due to vector control or environmental change contributed to elimination of transmission.
INTERPRETATION
Mass drug administration duration, frequency, and coverage; baseline endemicity; and vector elimination or disappearance are important determinants of elimination of onchocerciasis transmission in sub-Saharan Africa. Our findings underscore the importance of improving and sustaining high therapeutic coverage and increasing treatment frequency if countries are to achieve elimination of onchocerciasis transmission.
FUNDING
The Bill & Melinda Gates Foundation and Neglected Tropical Diseases Modelling Consortium, UK Medical Research Council, and Global Health EDCTP3 Joint Undertaking.
TRANSLATIONS
For the Swahili, French, Spanish and Portuguese translations of the abstract see Supplementary Materials section.
Topics: Humans; Onchocerciasis; Ivermectin; Onchocerciasis, Ocular; Mass Drug Administration; Seroepidemiologic Studies; Africa South of the Sahara
PubMed: 38484745
DOI: 10.1016/S2214-109X(24)00043-3