@article{fdi:010071379,
  title = {{A} test-and-not-treat strategy for onchocerciasis in loa loa-endemic areas},
  author = {{K}amgno, {J}. and {P}ion, {S}{\'e}bastien and {C}hesnais, {C}{\'e}dric and {B}akalar, {M}. {H}. and {D}'{A}mbrosio, {M}. {V}. and {M}ackenzie, {C}. {D}. and {N}ana-{D}jeunga, {H}. {C}. and {G}ounoue-{K}amkumo, {R}. and {N}jitchouang, {G}. {R}. and {N}wane, {P}. and {T}chatchueng-{M}bouga, {J}. {B}. and {W}anji, {S}. and {S}tolk, {W}. {A}. and {F}letcher, {D}. {A}. and {K}lion, {A}. {D}. and {N}utman, {T}. {B}. and {B}oussinesq, {M}ichel},
  editor = {},
  language = {{ENG}},
  abstract = {{BACKGROUND} {I}mplementation of an ivermectin-based community treatment strategy for the elimination of onchocerciasis or lymphatic filariasis has been delayed in {C}entral {A}frica because of the occurrence of serious adverse events, including death, in persons with high levels of circulating {L}oa loa microfilariae. {T}he {L}oa{S}cope, a field-friendly diagnostic tool to quantify {L}. loa microfilariae in peripheral blood, enables rapid, point-of-care identification of persons at risk for serious adverse events. {METHODS} {A} test-and-not-treat strategy was used in the approach to ivermectin treatment in the {O}kola health district in {C}ameroon, where the distribution of ivermectin was halted in 1999 after the occurrence of fatal events related to {L}. loa infection. {T}he {L}oa{S}cope was used to identify persons with an {L}. loa microfilarial density greater than 20,000 microfilariae per milliliter of blood, who were considered to be at risk for serious adverse events, and exclude them from ivermectin distribution. {A}ctive surveillance for posttreatment adverse events was performed daily for 6 days. {RESULTS} {F}rom {A}ugust through {O}ctober 2015, a total of 16,259 of 22,842 persons 5 years of age or older (71.2% of the target population) were tested for {L}. loa microfilaremia. {A}mong the participants who underwent testing, a total of 15,522 (95.5%) received ivermectin, 340 (2.1%) were excluded from ivermectin distribution because of an {L}. loa microfilarial density above the risk threshold, and 397 (2.4%) were excluded because of pregnancy or illness. {N}o serious adverse events were observed. {N}onserious adverse events were recorded in 934 participants, most of whom (67.5%) had no detectable {L}. loa microfilariae. {CONCLUSIONS} {T}he {L}oa{S}cope-based test-and-not-treat strategy enabled the reimplementation of community-wide ivermectin distribution in a heretofore "off limits" health district in {C}ameroon and is a potentially practical approach to larger-scale ivermectin treatment for lymphatic filariasis and onchocerciasis in areas where {L}. loa infection is endemic.},
  keywords = {{CAMEROUN}},
  booktitle = {},
  journal = {{N}ew {E}ngland {J}ournal of {M}edicine},
  volume = {377},
  numero = {21},
  pages = {2044--2052},
  ISSN = {0028-4793},
  year = {2017},
  DOI = {10.1056/{NEJM}oa1705026},
  URL = {https://www.documentation.ird.fr/hor/fdi:010071379},
}