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Abstract：
In West and Central Africa, there is a need to establish the prevalence of Wuchereria bancrofti in areas that are co-endemic for Loa loa, in order to implement the appropriate strategies to scale-up interventions for the elimination of lymphatic filariasis (LF). Due to the risk of severe adverse events (SAEs) to ivermectin in individuals with high L. loa microfilaraemia, the current strategy recommended by the World Health Organization (WHO) is twice yearly mass drug administration (MDA) with albendazole, supplemented by vector control targeting the Anopheles vectors. Defining W. bancrofti prevalence in areas co-endemic with L. loa is complicated by the cross-reactivity of rapid diagnostic immunochromatographic card tests (ICT), widely used for LF mapping, in individuals with high L. loa microfilaraemia. This has probably resulted in the overestimation of LF prevalence, triggering the implementation of MDA strategies, which may be unnecessary and wasteful of the limited resources for elimination programme implementation. Here we review the literature and present historical evidence, which uniformly highlight low or no prevalence of W. bancrofti infection and/or clinical LF cases across five Central African countries, in more than 30 different geographical areas covering 280 individual sites and > 22,000 individuals tested within high risk L. loa areas. This highlights the very limited information available on LF prevalence in L. loa areas, and potentially has major policy implications, which could shift the focus towards revised mapping criteria to verify low or no W. bancrofti prevalence in high risk L. loa areas. In this situation, revising the current WHO strategy from MDA, to focus more on ensuring high and effective vector control, through insecticide treated/long-lasting impregnated bednets (ITNs/LLINs), integration of point-of-care test-and-treat options into health systems, and consolidating closer links with the malaria control programme may be a more effective and appropriate use of the limited resources and drug donations available for LF elimination.
摘要：
在西非和中非，有必要在Loaloa共同流行的地区确定Wucherriabancrofti的流行程度，为了实施适当的策略来扩大消除淋巴丝虫病（LF）的干预措施。由于严重不良事件（SAEs）的伊维菌素的个人与高L.loa微丝血症的风险，世界卫生组织（WHO）推荐的当前策略是每年两次使用阿苯达唑进行大规模药物管理（MDA），辅以靶向按蚊载体的载体控制。在与L.loa共同流行的地区定义W.bancrofti患病率因快速诊断免疫色谱卡测试（ICT）的交叉反应性而变得复杂，广泛用于LF映射，在高L.loa微丝血症患者中。这可能导致对LF患病率的高估，触发MDA策略的实施，这可能是不必要的，也是对执行淘汰计划的有限资源的浪费。在这里，我们回顾文献并提出历史证据，这一致地突出了五个中非国家的班克氏杆菌感染和/或临床LF病例的低患病率或无患病率，在30多个不同的地理区域中，覆盖了280个单独的地点，并且在高风险的L.loa地区进行了>22,000个人的测试。这突出了关于L.loa地区LF患病率的信息非常有限，并可能产生重大的政策影响，这可能会将重点转移到修订的映射标准上，以验证高风险L.loa地区的W.bancrofti患病率较低或没有W.bancrofti患病率。在这种情况下,从MDA修订当前的世卫组织战略，为了更加专注于确保高效的媒介控制，通过杀虫剂处理/长效浸渍蚊帐(驱虫蚊帐/长效蚊帐)，将即时测试和治疗方案纳入卫生系统，巩固与疟疾控制方案的更密切联系可能是更有效和适当利用可用于消除LF的有限资源和药物捐赠。
