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Luna P, Martinez LZL, Lalla AT, Addiss D, Penney N. Photovoice Lessons from a Peruvian Program in Combatting Stigma for Caregivers of Children with Disabilities. Prog Community Health Partnersh 2022; 16:527-540. [PMID: 36533502 DOI: 10.1353/cpr.2022.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Access to resources for children with disabilities and their caregivers are lacking worldwide, especially for low-and middle-income countries, especially those of Latin origin. Furthermore, decreased social visibility coupled with minimal support available for caregivers can negatively affect their overall mental well-being. Limited community-based participatory research has been done to understand the experiences of caregivers and identify effective measures of support. OBJECTIVES To explore the impact of childhood disabilities on caregiver well-being and to assess how interactions between caregivers and their community affect their mental well-being. METHODS This study used photovoice and community-based participatory research methodology. We recruited participants who had children enrolled in a rehabilitative program called Rehabilitation with Hope, located in Huancayo, Peru. Participants were given three photo assignments concerning their experiences as caregivers and they presented their photos at photo discussions after each assignment. We used thematic analysis to identify the main themes that arose from the discussions. RESULTS Four main themes were identified: stigma, social support, self-esteem, and effects of photovoice. Caregivers often felt stigmatized by the community due to their child's disability. However, they found a stronger sense of social support and overall improved sense of self-esteem through the program and participation in photovoice. CONCLUSIONS The results of this study suggest the effects of stigma on caregivers may be mitigated through enhanced social support and self-esteem. Additionally, photovoice is an effective tool to combat community stigma by allowing caregivers to share their narratives.
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Luna P, Martinez LZL, Lalla AT, Addiss D, Penney N. Photovoice Lessons from a Peruvian Program in Combatting Stigma for Caregivers of Children with Disabilities. Prog Community Health Partnersh 2022; 16:e13-e14. [PMID: 36533495 DOI: 10.1353/cpr.2022.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Grant L, Reid C, Buesseler H, Addiss D. A compassion narrative for the sustainable development goals: conscious and connected action. Lancet 2022; 400:7-8. [PMID: 35780795 DOI: 10.1016/s0140-6736(22)01061-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/08/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Liz Grant
- Global Health Academy, University of Edinburgh, Edinburgh EH8 9AG, UK.
| | - Corinne Reid
- Global Health Academy, University of Edinburgh, Edinburgh EH8 9AG, UK
| | | | - David Addiss
- The Task Force for Global Health, Decatur, GA, USA
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Dilliott D, Addiss D, Thickstun C, Djima AM, Comoe E, Thompson L, Neema S, Amuyunzu-Nyamongo M, Wung-Buh A, McFarland D, Gyapong M, Krentel A. A mixed-methods exploration into the resilience of community drug distributors conducting mass drug administration for preventive chemotherapy of lymphatic filariasis and onchocerciasis in Côte d'Ivoire and Uganda. PLOS Glob Public Health 2022; 2:e0000700. [PMID: 36962463 PMCID: PMC10022276 DOI: 10.1371/journal.pgph.0000700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/06/2022] [Indexed: 11/18/2022]
Abstract
Volunteer community drug distributors (CDDs) have been vital to progress made in the elimination of onchocerciasis and lymphatic filariasis; two neglected tropical diseases amenable to preventive chemotherapy (PC-NTDs). However, formative work in Côte d'Ivoire and Uganda revealed that CDDs can encounter considerable challenges during mass drug administration (MDA). CDDs must be resilient to overcome these challenges, yet little is known about their resilience. This mixed-methods study explored the resilience of CDDs in Côte d'Ivoire and Uganda. The characteristics and experiences of 248 CDDs involved in the 2018 MDAs in Côte d'Ivoire (N = 132) and Uganda (N = 116) were assessed using a micronarrative survey. Thematic analysis of CDDs' micronarratives was used to identify challenges they encountered during MDA. Resilience was assessed using the Connor-Davidson Resilience Scale 25 (CD-RISC-25). Variables from the micronarrative survey found to be individually associated with mean CD-RISC-25 score (P<0.05) through bivariate analyses were included in a multiple linear regression model. Post-hoc, country-specific analyses were then conducted. Thematic analysis showed that CDDs encountered a wide range of challenges during MDA. The aggregate model revealed that CDDs who had positive relationships or received support from their communities scored higher on the CD-RISC-25 on average (P<0.001 for both), indicating higher resilience. These trends were also observed in the country-specific analyses. Mean CD-RISC-25 scores were unaffected by variations in district, age, gender, and length of involvement with the NTD program. Community support during MDA and positive community-CDD relationships appear to be associated with CDDs' personal capacity to overcome adversity. Involving communities and community leadership in the selection and support of CDDs has the potential to benefit their well-being. This study establishes the CD-RISC-25 as a useful tool for assessing the resilience of CDDs. Further research is needed to understand, promote, and support the resilience of this valuable health workforce, upon which NTD programs depend.
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Affiliation(s)
| | - David Addiss
- NTD Support Center, Task Force for Global Health, Decatur, Georgia, United States of America
| | - Charles Thickstun
- Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Adam Mama Djima
- Programme National de Lutte contre la Schistosomie, les Géo-Helminthiases et la Filariose Lymphatique, Ministère de la Santé et de l'Hygiène Publique, Abidjan, Côte d'Ivoire
| | - Esther Comoe
- Programme National de Lutte contre la Schistosomie, les Géo-Helminthiases et la Filariose Lymphatique, Ministère de la Santé et de l'Hygiène Publique, Abidjan, Côte d'Ivoire
| | - Lakwo Thompson
- Onchocerciasis Control Programme, Ministry of Health, Kampala, Uganda
| | | | | | | | - Deborah McFarland
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Margaret Gyapong
- Center for Health Policy and Implementation Research, Institute for Health Research, University for Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Alison Krentel
- Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Abstract
BACKGROUND Leprosy control achieved dramatic success in the 1980s-1990s with the implementation of short course multidrug therapy, which reduced the global prevalence of leprosy to less than 1 in 10 000 population. However, a period of relative stagnation in leprosy control followed this achievement, and only limited further declines in the global number of new cases reported have been achieved over the past decade. MAIN TEXT In 2016, major stakeholders called for the development of an innovative and comprehensive leprosy strategy aimed at reducing the incidence of leprosy, lowering the burden of disability and discrimination, and interrupting transmission. This led to the establishment of the Global Partnership for Zero Leprosy (GPZL) in 2018, with partners aligned around a shared Action Framework committed to achieving the WHO targets by 2030 through national leprosy program capacity-building, resource mobilisation and an enabling research agenda. GPZL convened over 140 experts from more than 20 countries to develop a research agenda to achieve zero leprosy. The result is a detailed research agenda focusing on diagnostics, mapping, digital technology and innovation, disability, epidemiological modelling and investment case, implementation research, stigma, post exposure prophylaxis and transmission, and vaccines. This research agenda is aligned with the research priorities identified by other stakeholders. CONCLUSIONS Developing and achieving consensus on the research agenda for zero leprosy is a significant step forward for the leprosy community. In a next step, research programmes must be developed, with individual components of the research agenda requiring distinct expertise, varying in resource needs, and operating over different timescales. Moving toward zero leprosy now requires partner alignment and new investments at all stages of the research process, from discovery to implementation.
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Affiliation(s)
- Peter Steinmann
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
| | - Courtenay Dusenbury
- Global Partnership for Zero Leprosy, Task Force for Global Health, Decatur, GA, USA
| | - David Addiss
- Focus Area for Compassion and Ethics, Task Force for Global Health, Decatur, GA, USA
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Cools P, van Lieshout L, Koelewijn R, Addiss D, Ajjampur SSR, Ayana M, Bradbury RS, Cantera JL, Dana D, Fischer K, Imtiaz R, Kabagenyi J, Lok J, McCarthy J, Mejia R, Mekonnen Z, Njenga SM, Othman N, Shao H, Traub R, Van Esbroeck M, Vercruysse J, Vlaminck J, Williams SA, Verweij JJ, van Hellemond JJ, Levecke B. First international external quality assessment scheme of nucleic acid amplification tests for the detection of Schistosoma and soil-transmitted helminths, including Strongyloides: A pilot study. PLoS Negl Trop Dis 2020; 14:e0008231. [PMID: 32544158 PMCID: PMC7319349 DOI: 10.1371/journal.pntd.0008231] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 06/26/2020] [Accepted: 03/17/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Nucleic acid amplification tests (NAATs) are increasingly being used as diagnostic tools for soil-transmitted helminths (STHs; Ascaris lumbricoides, Trichuris trichiura, Necator americanus, Ancylostoma duodenale and A. ceylanicum), Strongyloides stercoralis and Schistosoma in human stool. Currently, there is a large diversity of NAATs being applied, but an external quality assessment scheme (EQAS) for these diagnostics is lacking. An EQAS involves a blinded process where test results reported by a laboratory are compared to those reported by reference or expert laboratories, allowing for an objective assessment of the diagnostic performance of a laboratory. In the current study, we piloted an international EQAS for these helminths (i) to investigate the feasibility of designing and delivering an EQAS; (ii) to assess the diagnostic performance of laboratories; and (iii) to gain insights into the different NAAT protocols used. METHODS AND PRINCIPAL FINDINGS A panel of twelve stool samples and eight DNA samples was validated by six expert laboratories for the presence of six helminths (Ascaris, Trichuris, N. americanus, Ancylostoma, Strongyloides and Schistosoma). Subsequently this panel was sent to 15 globally dispersed laboratories. We found a high degree of diversity among the different DNA extraction and NAAT protocols. Although most laboratories performed well, we could clearly identify the laboratories that were poorly performing. CONCLUSIONS/SIGNIFICANCE We showed the technical feasibility of an international EQAS for the NAAT of STHs, Strongyloides and Schistosoma. In addition, we documented that there are clear benefits for participating laboratories, as they can confirm and/or improve the diagnostic performance of their NAATs. Further research should aim to identify factors that explain poor performance of NAATs.
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Affiliation(s)
- Piet Cools
- Laboratory of Parasitology, Ghent University, Merelbeke, Belgium
| | - Lisette van Lieshout
- Leiden University Medical Center, Leiden, The Netherlands
- Dutch Foundation for Quality Assessment in Medical Laboratories, Nijmegen, The Netherlands
| | - Rob Koelewijn
- Dutch Foundation for Quality Assessment in Medical Laboratories, Nijmegen, The Netherlands
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - David Addiss
- The Task Force for Global Health, Decatur, Georgia, United States of America
| | | | | | - Richard S. Bradbury
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | - Kerstin Fischer
- Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Rubina Imtiaz
- Children Without Worms, Decatur, Georgia, United States of America
| | - Joyce Kabagenyi
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - James Lok
- University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - James McCarthy
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Rojelio Mejia
- Baylor College of Medicine, Houston, Texas, United States of America
| | | | | | | | - Hongguang Shao
- University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | | | | | - Jozef Vercruysse
- Laboratory of Parasitology, Ghent University, Merelbeke, Belgium
| | - Johnny Vlaminck
- Laboratory of Parasitology, Ghent University, Merelbeke, Belgium
| | - Steven A. Williams
- Smith College, Northampton, Massachusetts, United States of America
- University of Massachusetts, Amherst, Massachusetts, United States of America
| | | | - Jaap J. van Hellemond
- Dutch Foundation for Quality Assessment in Medical Laboratories, Nijmegen, The Netherlands
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Bruno Levecke
- Laboratory of Parasitology, Ghent University, Merelbeke, Belgium
- * E-mail:
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Hinman AR, Addiss D, Caplan A, Carlson LM, Lavery JV, Orenstein WA. Vaccine Trials in Schools: We Must Not Ignore Progress. Am J Public Health 2019; 109:219-220. [PMID: 30649954 DOI: 10.2105/ajph.2018.304798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Alan R Hinman
- Alan R. Hinman is with the Center for Vaccine Equity, Task Force for Global Health, Decatur, GA. David Addiss is with the Task Force for Global Health. Arthur Caplan is with the Division of Medical Ethics, New York University School of Medicine, New York, NY. Lisa M. Carlson is with the Dean's Office, Emory University School of Medicine, Atlanta, GA. James V. Lavery is with the Hubert Department of Global Health, Emory University School of Medicine, Rollins School of Public Health. Walter A. Orenstein is with the Departments of Medicine, Epidemiology, Pediatrics, and Global Health, Emory University School of Medicine, Rollins School of Public Health, and the Emory Vaccine Center, Atlanta
| | - David Addiss
- Alan R. Hinman is with the Center for Vaccine Equity, Task Force for Global Health, Decatur, GA. David Addiss is with the Task Force for Global Health. Arthur Caplan is with the Division of Medical Ethics, New York University School of Medicine, New York, NY. Lisa M. Carlson is with the Dean's Office, Emory University School of Medicine, Atlanta, GA. James V. Lavery is with the Hubert Department of Global Health, Emory University School of Medicine, Rollins School of Public Health. Walter A. Orenstein is with the Departments of Medicine, Epidemiology, Pediatrics, and Global Health, Emory University School of Medicine, Rollins School of Public Health, and the Emory Vaccine Center, Atlanta
| | - Arthur Caplan
- Alan R. Hinman is with the Center for Vaccine Equity, Task Force for Global Health, Decatur, GA. David Addiss is with the Task Force for Global Health. Arthur Caplan is with the Division of Medical Ethics, New York University School of Medicine, New York, NY. Lisa M. Carlson is with the Dean's Office, Emory University School of Medicine, Atlanta, GA. James V. Lavery is with the Hubert Department of Global Health, Emory University School of Medicine, Rollins School of Public Health. Walter A. Orenstein is with the Departments of Medicine, Epidemiology, Pediatrics, and Global Health, Emory University School of Medicine, Rollins School of Public Health, and the Emory Vaccine Center, Atlanta
| | - Lisa M Carlson
- Alan R. Hinman is with the Center for Vaccine Equity, Task Force for Global Health, Decatur, GA. David Addiss is with the Task Force for Global Health. Arthur Caplan is with the Division of Medical Ethics, New York University School of Medicine, New York, NY. Lisa M. Carlson is with the Dean's Office, Emory University School of Medicine, Atlanta, GA. James V. Lavery is with the Hubert Department of Global Health, Emory University School of Medicine, Rollins School of Public Health. Walter A. Orenstein is with the Departments of Medicine, Epidemiology, Pediatrics, and Global Health, Emory University School of Medicine, Rollins School of Public Health, and the Emory Vaccine Center, Atlanta
| | - James V Lavery
- Alan R. Hinman is with the Center for Vaccine Equity, Task Force for Global Health, Decatur, GA. David Addiss is with the Task Force for Global Health. Arthur Caplan is with the Division of Medical Ethics, New York University School of Medicine, New York, NY. Lisa M. Carlson is with the Dean's Office, Emory University School of Medicine, Atlanta, GA. James V. Lavery is with the Hubert Department of Global Health, Emory University School of Medicine, Rollins School of Public Health. Walter A. Orenstein is with the Departments of Medicine, Epidemiology, Pediatrics, and Global Health, Emory University School of Medicine, Rollins School of Public Health, and the Emory Vaccine Center, Atlanta
| | - Walter A Orenstein
- Alan R. Hinman is with the Center for Vaccine Equity, Task Force for Global Health, Decatur, GA. David Addiss is with the Task Force for Global Health. Arthur Caplan is with the Division of Medical Ethics, New York University School of Medicine, New York, NY. Lisa M. Carlson is with the Dean's Office, Emory University School of Medicine, Atlanta, GA. James V. Lavery is with the Hubert Department of Global Health, Emory University School of Medicine, Rollins School of Public Health. Walter A. Orenstein is with the Departments of Medicine, Epidemiology, Pediatrics, and Global Health, Emory University School of Medicine, Rollins School of Public Health, and the Emory Vaccine Center, Atlanta
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Addiss D, Sarah V, Negussu N, Emerson P. Safe mass drug administration and trachoma elimination. Community Eye Health 2019; 32:37. [PMID: 31649434 PMCID: PMC6802476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- David Addiss
- Director: Focus Area for Compassion and Ethics (FACE), Task Force for Global Health, Decatur, GA, USA
| | - Virginia Sarah
- Global Partnerships Executive, The Fred Hollows Foundation, London, UK
| | - Nebiyu Negussu
- Neglected Tropical Diseases Team Leader: Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Paul Emerson
- Director, International Trachoma Initiative, Task Force for Global Health, Decatur, GA, USA
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Stillwaggon E, Sawers L, Rout J, Addiss D, Fox L. Economic Costs and Benefits of a Community-Based Lymphedema Management Program for Lymphatic Filariasis in Odisha State, India. Am J Trop Med Hyg 2016; 95:877-884. [PMID: 27573626 PMCID: PMC5062793 DOI: 10.4269/ajtmh.16-0286] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 07/07/2016] [Indexed: 11/12/2022] Open
Abstract
Lymphatic filariasis afflicts 68 million people in 73 countries, including 17 million persons living with chronic lymphedema. The Global Programme to Eliminate Lymphatic Filariasis aims to stop new infections and to provide care for persons already affected, but morbidity management programs have been initiated in only 24 endemic countries. We examine the economic costs and benefits of alleviating chronic lymphedema and its effects through a simple limb-care program. For Khurda District, Odisha State, India, we estimated lifetime medical costs and earnings losses due to chronic lymphedema and acute dermatolymphangioadenitis (ADLA) with and without a community-based limb-care program. The program would reduce economic costs of lymphedema and ADLA over 60 years by 55%. Savings of US$1,648 for each affected person in the workforce are equivalent to 1,258 days of labor. Per-person savings are more than 130 times the per-person cost of the program. Chronic lymphedema and ADLA impose a substantial physical and economic burden on the population in filariasis-endemic areas. Low-cost programs for lymphedema management based on limb washing and topical medication for infection are effective in reducing the number of ADLA episodes and stopping progression of disabling and disfiguring lymphedema. With reduced disability, people are able to work longer hours, more days per year, and in more strenuous, higher-paying jobs, resulting in an important economic benefit to themselves, their families, and their communities. Mitigating the severity of lymphedema and ADLA also reduces out-of-pocket medical expense.
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Affiliation(s)
| | - Larry Sawers
- Department of Economics, American University, Washington, District of Columbia
| | - Jonathan Rout
- Church's Auxiliary for Social Action (CASA), Bhubaneswar, India
| | - David Addiss
- Children Without Worms, Task Force for Global Health, Decatur, Georgia
| | - LeAnne Fox
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
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Mues KE, Lammie PJ, Klein M, Kleinbaum DG, Addiss D, Fox LM. Changes in Antibody Levels during and following an Episode of Acute Adenolymphangitis (ADL) among Lymphedema Patients in Léogâne, Haiti. PLoS One 2015; 10:e0141047. [PMID: 26492462 PMCID: PMC4619626 DOI: 10.1371/journal.pone.0141047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 10/02/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction Episodes of acute adenolymphangitis (ADL) are often the first clinical sign of lymphatic filariasis (LF). They are often accompanied by swelling of the affected limb, inflammation, fever, and general malaise and lead to the progression of lymphedema. Although ADL episodes have been studied for a century or more, questions still remain as to their etiology. We quantified antibody levels to pathogens that potentially contribute to ADL episodes during and after an episode among lymphedema patients in Léogâne, Haiti. We estimated the proportion of ADL episodes hypothesized to be attributed to specific pathogens. Methods We measured antibody levels to specific pathogens during and following an ADL episode among 41 lymphedema patients enrolled in a cohort study in Léogâne, Haiti. We calculated the absolute and relative changes in antibody levels between the ADL and convalescent time points. We calculated the proportion of episodes that demonstrated a two-fold increase in antibody level for several bacterial, fungal, and filarial pathogens. Results Our results showed the greatest proportion of two-fold changes in antibody levels for the carbohydrate antigen Streptococcus group A, followed by IgG2 responses to a soluble filarial antigen (BpG2), Streptococcal Pyrogenic Exotoxin B, and an antigen for the fungal pathogen Candida. When comparing the median antibody level during the ADL episode to the median antibody level at the convalescent time point, only the antigens for Pseudomonas species (P-value = 0.0351) and Streptolysin O (P-value = 0.0074) showed a significant result. Conclusion Although our results are limited by the lack of a control group and few antibody responses, they provide some evidence for infection with Streptococcus A as a potential contributing factor to ADL episodes. Our results add to the current evidence and illustrate the importance of determining the causal role of bacterial and fungal pathogens and immunological antifilarial response in ADL episodes.
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Affiliation(s)
- Katherine E. Mues
- Department of Epidemiology, Rollins School of Public Health and Laney Graduate School, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
| | - Patrick J. Lammie
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mitchel Klein
- Department of Epidemiology, Rollins School of Public Health and Laney Graduate School, Emory University, Atlanta, Georgia, United States of America
| | - David G. Kleinbaum
- Department of Epidemiology, Rollins School of Public Health and Laney Graduate School, Emory University, Atlanta, Georgia, United States of America
| | - David Addiss
- Task Force for Global Health, Decatur, Georgia, United States of America
| | - LeAnne M. Fox
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Montresor A, Addiss D, Albonico M, Ali SM, Ault SK, Gabrielli AF, Garba A, Gasimov E, Gyorkos T, Jamsheed MA, Levecke B, Mbabazi P, Mupfasoni D, Savioli L, Vercruysse J, Yajima A. Methodological Bias Can Lead the Cochrane Collaboration to Irrelevance in Public Health Decision-Making. PLoS Negl Trop Dis 2015; 9:e0004165. [PMID: 26492178 PMCID: PMC4619606 DOI: 10.1371/journal.pntd.0004165] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Antonio Montresor
- Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - David Addiss
- Children Without Worms, Task Force for Global Health, Decatur, Georgia, United States of America
| | - Marco Albonico
- WHO Collaborating Centre for Neglected Tropical Diseases, Public Health Laboratory Ivo de Carneri, Zanzibar, United Republic of Tanzania
| | - Said Mohammed Ali
- WHO Collaborating Centre for Neglected Tropical Diseases, Public Health Laboratory Ivo de Carneri, Zanzibar, United Republic of Tanzania
| | - Steven K. Ault
- Neglected Infectious Diseases, Pan American Health Organization, World Health Regional Office for the Americas, Washington, DC, United States of America
| | - Albis-Francesco Gabrielli
- Neglected Tropical Diseases, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Amadou Garba
- Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Elkhan Gasimov
- Malaria, Other Vectorborne and Parasitic Diseases, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Theresa Gyorkos
- WHO Collaborating Centre for Research and Training in Parasite Epidemiology and Control, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Mohamed Ahmed Jamsheed
- Vector-Borne and Neglected Tropical Diseases Control, World Health Organization Regional Office for South-East Asia, New Delhi, India
| | - Bruno Levecke
- WHO Collaborating Centre for the Monitoring of Anthelminthic Drug Efficacy for Soil-Transmitted Helminthiasis, Department of Virology, Parasitology and Immunology, University of Ghent, Ghent, Belgium
| | - Pamela Mbabazi
- Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Denise Mupfasoni
- Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Lorenzo Savioli
- Global Schistosomiasis Alliance and Public Health Laboratory Ivo de Carneri, Zanzibar, United Republic of Tanzania
| | - Jozef Vercruysse
- WHO Collaborating Centre for the Monitoring of Anthelminthic Drug Efficacy for Soil-Transmitted Helminthiasis, Department of Virology, Parasitology and Immunology, University of Ghent, Ghent, Belgium
| | - Aya Yajima
- Malaria, Other Vectorborne and Parasitic Diseases, World Health Organization, Regional Office for Western Pacific, Manila, Philippines
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Gallo K, Mikhailov A, Hailemeskal MB, Koporc K, Mbabazi PS, Addiss D. Contributions of non-governmental organizations to WHO targets for control of soil-transmitted helminthiases. Am J Trop Med Hyg 2013; 89:1186-9. [PMID: 24166039 DOI: 10.4269/ajtmh.13-0277] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Soil-transmitted helminthiases (STH) may affect up to 1 billion children globally. The World Health Organization (WHO) recommends regular preventive chemotherapy for at-risk individuals. The WHO Preventive Chemotherapy (PCT) Databank tracks annual treatments reported by national Ministries of Health (MOHs) to evaluate progress to coverage goals. Non-governmental organizations (NGOs) deliver STH treatments; the extent to which they are included in MOH reports to the WHO is unclear. The Global NGO Deworming Inventory solicited treatment reports from NGOs to compare with the PCT Databank. In 2010, NGOs delivered 65.4 million STH treatments, which is an estimated 25.1% of the total delivered. Of these treatments, 23.3 million (35.6%) were not reported to the WHO; 22.3 million (95.7%) were from countries that had not submitted STH treatment reports to the WHO. Reporting from NGOs to MOHs and from MOHs to the WHO should be strengthened to ensure that progress to WHO treatment goals is monitored with better completeness and assessed accurately.
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Affiliation(s)
- Kerry Gallo
- Children Without Worms, Task Force for Global Health, Decatur, Georgia; World Health Organization, Geneva, Switzerland
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Figueredo-Silva J, Norões J, Addiss D, Dreyer G. Sex ratio ofWuchereria bancroftiin surgical specimens from an endemic area of Brazil. Annals of Tropical Medicine & Parasitology 2013; 102:229-38. [PMID: 18348777 DOI: 10.1179/136485908x278757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- J Figueredo-Silva
- Núcleo de Ensino e Pesquisa em Patologia, Universidade Estadual do Piauí, Teresina, PI, Brazil
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Davey G, Bockarie M, Wanji S, Addiss D, Fuller C, Fox L, Mycoskie M, Gruin M, Tsegaye A, Tekola Ayele F, Newport M. Launch of the international podoconiosis initiative. Lancet 2012; 379:1004. [PMID: 22423883 DOI: 10.1016/s0140-6736(12)60427-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Addiss D. The 6th Meeting of the Global Alliance to Eliminate Lymphatic Filariasis: A half-time review of lymphatic filariasis elimination and its integration with the control of other neglected tropical diseases. Parasit Vectors 2010; 3:100. [PMID: 20961435 PMCID: PMC2984583 DOI: 10.1186/1756-3305-3-100] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 10/20/2010] [Indexed: 11/10/2022] Open
Abstract
The 6th Meeting of the Global Alliance to Eliminate Lymphatic Filariasis (GAELF6) was held 1-3 June, 2010 in Seoul, Korea, with 150 participants from 38 countries. The year 2010 marks the midpoint between the first GAELF meeting, in 2000, and the World Health Organization (WHO) 2020 goal of global elimination of lymphatic filariasis (LF) as a public health problem. The theme of the meeting, "Half-time in LF Elimination: Teaming Up with Neglected Tropical Diseases (NTDs)," reflected significant integration of LF elimination programmes into a comprehensive initiative to control NTDs. Presentations on LF epidemiology, treatment, research, and programmes highlighted both accomplishments and remaining challenges.The WHO strategy to interrupt LF transmission is based on annual mass drug administration (MDA) using two-drug combinations. After mapping the geographic distribution of LF, MDA is implemented for ≥ 5 years, followed by a period of post-MDA surveillance, and, ultimately, verification of LF elimination. Morbidity management further reduces disease burden.Of 81 countries considered LF-endemic in 2000, 52 (64.2%) have begun MDA; 10 (12.3%) others with low-level transmission are unlikely to require MDA. In 2008, ~695 million people were offered treatment (51.7% of the at-risk population); ~496 million participated. Approximately 22 million people have been protected from LF infection and disease, with savings of ~US $24.2 billion. Morbidity management programmes have been implemented in 27 (33.3%) countries.Significant challenges to LF elimination remain. These include: initiating MDA in the remaining 19 countries that require it; achieving full geographic coverage in countries where MDA has started; finding alternative strategies to address the problem of Loa loa co-endemicity in Central Africa; developing strategies to treat urban populations; initiating and sustaining MDA in settings of armed conflict; developing refined guidelines and procedures for stopping MDA, for post-MDA surveillance, and for verifying the elimination of LF; and integrating morbidity management into all LF elimination programmes. Scientific research and enhanced advocacy for NTDs remain critical for addressing these challenges.GAELF6 was characterized by enthusiasm and recognition that "teaming up with NTDs" offers opportunities for new partnerships, fresh perspectives, enhanced advocacy, and greater programmatic integration in a rapidly changing global health environment.
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Affiliation(s)
- David Addiss
- Holos Associates, 1626 Grove St, Kalamazoo, MI 49006 USA.
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Person B, Addiss D, Bartholomew LK, Meijer C, Pou V, Gonzálvez G, Van Den Borne B. “Can It Be That God Does Not Remember Me”:A Qualitative Study on the Psychological Distress, Suffering, and Coping of Dominican Women With Chronic Filarial Lymphedema and Elephantiasis of the Leg. Health Care Women Int 2008; 29:349-65. [DOI: 10.1080/07399330701876406] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Talbot JT, Mathieu E, Direny A, Streit T, Addiss D, Viall A, Lammie PJ, de Rochars MB. Predictors of Compliance in Mass Drug Administration for the Treatment and Prevention of Lymphatic Filariasis in Leogane, Haiti. Am J Trop Med Hyg 2008. [DOI: 10.4269/ajtmh.2008.78.283] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Talbot JT, Viall A, Direny A, de Rochars MB, Addiss D, Streit T, Mathieu E, Lammie PJ. Predictors of compliance in mass drug administration for the treatment and prevention of lymphatic filariasis in Leogane, Haiti. Am J Trop Med Hyg 2008; 78:283-288. [PMID: 18256430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
The global strategy for the elimination of lymphatic filariasis (LF) is based on annual mass drug administration (MDA) to interrupt transmission. Noncompliance with MDA represents a serious programmatic obstacle for the LF program because systematically noncompliant individuals may serve as a reservoir for the parasite and permit recrudescence of infection. Using a survey questionnaire concerning practices, beliefs, and attitudes towards MDA, we assessed differences between noncompliant individuals and compliant individuals in Leogane, Haiti (n = 367) after four years of treatment. A logistic regression model showed the odds of being noncompliant were significantly increased for women (odds ratio = 2.74, 95% confidence interval = 1.12-6.70), as well as for people who lacked knowledge about both LF and programs to eliminate infection. Public health programs should be designed to target people who are at risk for systematic noncompliance.
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Affiliation(s)
- Jeffrey T Talbot
- Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
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Person B, Bartholomew LK, Addiss D, van den Borne B. Disrupted social connectedness among Dominican women with chronic filarial lymphedema. Patient Educ Couns 2007; 68:279-86. [PMID: 17707609 DOI: 10.1016/j.pec.2007.06.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Revised: 06/27/2007] [Accepted: 06/30/2007] [Indexed: 05/16/2023]
Abstract
OBJECTIVE The objectives of this paper were to identify specific factors associated with intact or disrupted social connectedness among Dominican women with chronic filarial lymphedema and better understand the impact of disrupted connectedness on their lives. METHODS Data were collected through 28 individual interviews and 3 focus group discussions of 28 women from filariasis-endemic areas of the Dominican Republic presenting with lymphedema of one or both legs. RESULTS The confluence of chronic and acute stressors with severity of lymphedema lead women to rely on others for social support. Women described complications of aging, disability, reduced social networks, and inability to adhere to cultural scripts as contributing to disrupted social connectedness. CONCLUSION Social disconnectedness appears to exacerbate the negative consequences of living with lymphedema among women. Social connectedness and cultural scripts often define a social role for women that transcend physical deformity and disability, while disrupted social connectedness contributes to social isolation, depressive symptoms, and poor health outcomes. PRACTICE IMPLICATIONS Further behavioral research into the contribution of intact social connectedness to resiliency and coping is warranted in order to develop effective interventions for women. Identifying women with disrupted social connectedness and engaging them in behavioral interventions to enhance natural social networks and create new or enhanced social support opportunities may mitigate the negative effects of social disconnectedness and improve quality of life.
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Affiliation(s)
- Bobbie Person
- National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, MS-C14, Atlanta, GA 30333, USA
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Person B, Addiss D, Bartholomew LK, Meijer C, Pou V, Gonzálvez G, van den Borne B. A qualitative study of the psychosocial and health consequences associated with lymphedema among women in the Dominican Republic. Acta Trop 2007; 103:90-7. [PMID: 17638614 DOI: 10.1016/j.actatropica.2007.05.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Accepted: 05/20/2007] [Indexed: 11/19/2022]
Abstract
To date, few studies have addressed the sequelae of lymphatic filariasis, a mosquito-transmitted disease, on the quality of life of affected women in the Americas. In this qualitative study, we conducted 28 semi-structured interviews and 3 focus groups of women with lymphedema or elephantiasis of the leg living in filariasis-endemic areas of the Dominican Republic. Women in our study described a spectrum of consequences associated with their lymphedema but physical, functional, and psychological limitations were not always associated with severity of lymphedema. Data suggests that management frameworks need to be expanded to address women's explanatory models of illness, the cultural practices of seeking traditional healers for initial care, psychological distress, coping strategies unique to women, and the practice of self treating with antibiotics without medical supervision. Further research to better understand the depth and breadth of psychological states and coping strategies of women; the health seeking and self-management practices; and the strain on social support networks of women is needed in order to assist health program planners in establishing culturally tailored and gender-specific interventions for Dominican women.
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Affiliation(s)
- Bobbie Person
- National Center for Prevention, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, MS-C14, Atlanta, GA 30333, USA.
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Dreyer G, Addiss D, Williamson J, Norões J. Efficacy of co-administered diethylcarbamazine and albendazole against adult Wuchereria bancrofti. Trans R Soc Trop Med Hyg 2006; 100:1118-25. [PMID: 16860830 DOI: 10.1016/j.trstmh.2006.04.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Revised: 04/04/2006] [Accepted: 04/04/2006] [Indexed: 11/21/2022] Open
Abstract
Although diethylcarbamazine (DEC) and albendazole are recommended to interrupt transmission of Wuchereria bancrofti, little is known about the macrofilaricidal effect of this drug combination. Forty-seven men with W. bancrofti infection were randomly assigned to receive a single dose of either DEC alone (6 mg/kg) (n=25) or a combination of DEC (6 mg/kg) and albendazole (400 mg) (n=22). Physical examinations for scrotal nodules (resulting from worm death) and ultrasound examinations (to detect living adult worms) were performed before treatment and 7, 14, 30, 45, 60, 90, 180, 270 and 360 days after treatment. Blood was examined for microfilariae before and 30 days and 360 days after treatment. Seven days post treatment, intrascrotal nodules were detected at the site of 21 (46.7%) adult worm nests in men who received DEC alone compared with 2 (6.1%) sites in men who received DEC and albendazole (P=0.002). One year after treatment, 10 (22.2%) original adult worm nests remained detectable by ultrasound among men who received DEC alone compared with 18/32 (56.3%) nests among men who received both drugs (P=0.016). Microfilaraemia prevalence and density decreased to a similar extent in both groups. Addition of albendazole appeared to decrease the macrofilaricidal effect of DEC against W. bancrofti, with no detectable enhancement in microfilarial suppression.
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Affiliation(s)
- Gerusa Dreyer
- NEPAF, Hospital das Clínicas, Universidade Federal de Pernambuco, Av Prof Moraes Rego s/n, Cidade Universitária, CEP 50740-900, Recife PE, Brazil.
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Dreyer G, Addiss D, Gadelha P, Lapa E, Williamson J, Dreyer A. Interdigital skin lesions of the lower limbs among patients with lymphoedema in an area endemic for bancroftian filariasis. Trop Med Int Health 2006; 11:1475-81. [PMID: 16930270 DOI: 10.1111/j.1365-3156.2006.01687.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES An estimated 15 million persons suffer from lymphoedema of the leg in filariasis-endemic areas of the world. A major factor in the progression of lymphoedema severity is the incidence of acute dermatolymphangioadenitis (ADLA), which is triggered by bacteria that gain entry through damaged skin, especially in the toe web spaces ('interdigital skin lesions'). Little is known about the epidemiology of these skin lesions or about patients' awareness of them. METHODS We interviewed and examined 119 patients (89% women) with lymphoedema of the leg in Recife, Brazil, an area endemic for bancroftian filariasis. RESULTS We detected 412 interdigital skin lesions in 115 (96.6%) patients (mean, 3.5 lesions per patient, range 0-8). The number of interdigital skin lesions was significantly associated with lymphoedema stage (P<0.001) and frequency of ADLA (P<0.0001). Only 20 (16.8%) patients detected their own interdigital skin lesions or considered them abnormal. Patients reported a mean of 3.6 ADLA episodes during the previous 12 months (range, 0-20); reported ADLA incidence was associated with lymphoedema stage (P<0.0001) and the number of interdigital skin lesions detected by the examining physician (P<0.0001). CONCLUSIONS These data suggest that interdigital skin lesions are a significant risk factor for ADLA and that persons with lymphoedema in filariasis-endemic areas are unaware of their presence or importance. Prevention of ADLA through prompt recognition and treatment of interdigital skin lesions will require that patients be taught to identify lesions, especially between the toes and to recognize them as abnormal.
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Affiliation(s)
- Gerusa Dreyer
- Núcleo de Ensino, Pesquisa e Assistência em Filariose-NEPAF, Universidade Federal de Pernambuco, Recife, Brazil.
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McPherson T, Persaud S, Singh S, Fay MP, Addiss D, Nutman TB, Hay R. Interdigital lesions and frequency of acute dermatolymphangioadenitis in lymphoedema in a filariasis-endemic area. Br J Dermatol 2006; 154:933-41. [PMID: 16634898 DOI: 10.1111/j.1365-2133.2005.07081.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Lymphatic filariasis (LF) is a mosquito-borne nematode infection that causes permanent lymphatic dysfunction in virtually all infected individuals and clinical disease in a subset of these. One major sequel of infection is lymphoedema of the limbs. Lymphoedema of the leg affects an estimated 15 million persons in LF-endemic areas worldwide. Acute dermatolymphangioadenitis (ADLA) in people with filarial lymphoedema causes acute morbidity and increasingly severe lymphoedema. Episodes of ADLA are believed to be caused by bacteria, and it has been shown that entry lesions in the skin play a causative role. Clinical observations suggest that interdigital skin lesions of the feet, often assumed to be fungal, may be of particular importance. OBJECTIVES To investigate the epidemiology and aetiology of interdigital lesions (IDL) of the feet in filarial lymphoedema. METHODS The frequency and mycological aetiology of IDL in 73 patients with filarial lymphoedema were compared with 74 individuals without lymphoedema in a region of Guyana highly endemic for Wuchereria bancrofti. RESULTS More than 50% of patients with lymphoedema had one or more IDL (odds ratio 2.69; 95% confidence interval 1.31-5.66; P<0.005 compared with controls). The number of lesions was the strongest predictor of frequency of ADLA. Only 18% of the lesions had positive microscopy or culture for fungi (dermatophytes and Scytalidium). CONCLUSIONS These findings highlight the importance of interdigital entry lesions as risk factors for episodes of ADLA and have implications for the control of morbidity from filarial lymphoedema.
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Affiliation(s)
- T McPherson
- Department of Mycology, St John's Institute of Dermatology. King's College, London, UK
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Dreyer G, Addiss D, Norões J. Does longevity of adult Wuchereria bancrofti increase with decreasing intensity of parasite transmission? Insights from clinical observations. Trans R Soc Trop Med Hyg 2005; 99:883-92. [PMID: 16165175 DOI: 10.1016/j.trstmh.2005.05.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2005] [Revised: 05/05/2005] [Accepted: 05/26/2005] [Indexed: 10/25/2022] Open
Abstract
To interrupt transmission of Wuchereria bancrofti, a parasite that causes lymphatic filariasis, mass treatment of at-risk populations with antifilarial drugs is recommended for 4-6 years, the minimum estimated adult worm lifespan. Factors associated with adult worm longevity are unknown. In Recife, Brazil, we conducted a retrospective cohort study of 57 men whose adult W. bancrofti were not sensitive to diethylcarbamazine and who were followed with semi-annual physical examinations (to detect intrascrotal nodules, indicative of adult worm death) and ultrasound examinations (to detect the 'filaria dance sign' (FDS), indicative of living adult worms). After 5 years, the FDS remained detectable in 10 (24.4%) of 41 adult worm nests in 25 men from areas of high filariasis transmission intensity and in 30 (90.9%) of 33 nests in 32 men from areas of low transmission (P<0.001). New nodules and adult worm nests were detected only in men from high-transmission areas. Of 30 men who were microfilaria-positive initially and whose FDS remained detectable after 5 years of follow-up, 19 (63.3%) remained microfilaria-positive in 5 ml blood (mean density, 0.4 per ml). In conclusion, survival of adult W. bancrofti is inversely associated with transmission intensity. These findings have implications for filariasis elimination and research.
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Affiliation(s)
- Gerusa Dreyer
- Centro de Pesquisas Aggeu Magalhães, FIOCRUZ, and NEPAF, Hospital das Clínicas, Universidade Federal de Pernambuco, Av. Prof. Moraes Rego s/n, Cidade Universitária, CEP 50670-420, Recife PE, Brazil.
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Abstract
BACKGROUND Mass treatment with albendazole co-administered with another antifilarial drug is part of a global programme to eliminate lymphatic filariasis. We sought reliable evidence of the effects of albendazole on the disease and the parasite. OBJECTIVES To summarize the effects of albendazole alone or in combination with antifilarial drugs for clinical treatment and community control of lymphatic filariasis. SEARCH STRATEGY We searched the Cochrane Infectious Diseases Group Specialized Register (August 2005), CENTRAL (The Cochrane Library Issue 3, 2005), MEDLINE (1966 to August 2005), EMBASE (1974 to August 2005), LILACS (1982 to August 2005), and reference lists. We also contacted researchers, the World Health Organization, and GlaxoSmithKline. SELECTION CRITERIA Randomized and quasi-randomized controlled trials of albendazole alone or combined with another antifilarial drug for treating individuals with lymphatic filariasis, or for reducing transmission in endemic communities. DATA COLLECTION AND ANALYSIS Two authors independently assessed eligibility and trial quality, and extracted data. Authors contacted investigators for missing information or clarification. MAIN RESULTS Seven trials including 6997 participants (995 with detectable microfilariae) met the criteria. A comparison of albendazole and placebo detected no effect on microfilariae prevalence (920 participants; 3 trials); one trial (499 participants) reported significantly lower microfilariae density at six months. Albendazole performed slightly worse than ivermectin in two trials (436 participants). Compared with diethylcarbamazine (DEC), two small trials (56 participants) found little difference in microfilariae prevalence over an extended follow up. One larger trial (502 participants) found a statistically significant effect for DEC at six months, but none at three months. Microfilariae prevalence and density were statistically significantly lower with the combination of albendazole and ivermectin compared with ivermectin alone in two of three trials (649 participants). Two trials compared albendazole plus DEC with DEC alone and found no statistically significant difference in microfilariae prevalence, though one trial favoured the combination at six months (relative risk 0.62, 95% confidence interval 0.32 to 1.21; 491 participants). This trial also found a statistically significant reduction in microfilariae density. AUTHORS' CONCLUSIONS There is insufficient evidence to confirm or refute that albendazole co-administered with DEC or ivermectin is more effective than DEC or ivermectin alone in clearing microfilariae or killing adult worms. Albendazole combined with ivermectin appears to have a small effect on microfilaraemia, but this was not consistently demonstrated. The effect of albendazole against adult and larval filarial parasites, alone and in combination with other antifilarial drugs, deserves further rigorous research.
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Affiliation(s)
- Julia Critchley
- Liverpool School of Tropical Medicine, International Health Research Group, Pembroke Place, Liverpool, Merseyside, UK L3 5QA.
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Critchley J, Addiss D, Ejere H, Gamble C, Garner P, Gelband H. Albendazole for the control and elimination of lymphatic filariasis: systematic review. Trop Med Int Health 2005; 10:818-25. [PMID: 16135187 DOI: 10.1111/j.1365-3156.2005.01458.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The Global Programme to Eliminate Lymphatic Filariasis recommends albendazole in combination with other antifilarial drugs. This systematic review examines albendazole in treatment and control of lymphatic filariasis. DATASOURCES: The Cochrane Controlled Trials Register, MEDLINE and EMBASE to April 2005; contacting experts, international organisations and drug manufacturers. METHODS Randomised or quasi-randomised controlled trials included; two reviewers independently assessed eligibility, quality, and extracted data. We calculated the relative risk of microfilaraemia (mf) prevalence using fixed effect, or random effects model in case of heterogeneity. RESULTS Six trials met inclusion criteria. Three trials compared albendazole with placebo: no effect was demonstrated on mf prevalence, but density was lower in one of the three studies at 6 months. Three trials added albendazole to ivermectin, with no demonstrable effect; prevalence tended to be lower at 4--6 months but not at 12 months (4--6 months; RR 0.49, 95% CI 0.18 to 1.39, n=255, 2 trials; 12 months: RR 1.00, 95% CI 0.88 to 1.13, n=348, 2 trials). Mf density was significantly lower in two of the three trials; one of two trials measuring density at 12 months showed a difference. Three trials added albendazole to diethylcarbamazine; two were small trials with no difference demonstrated; the third study tended to favour combination at 6 months (RR=0.62, 95% CI 0.32 to 1.21, n=491), with a significant difference for density. CONCLUSIONS The effect of albendazole against adult and larval filarial parasites, alone and in combination with other antifilarial drugs, deserves further rigorous research.
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Abstract
BACKGROUND Mass treatment with albendazole, co-administered with another antifilarial drug, is being promoted as part of a global programme to eliminate lymphatic filariasis. OBJECTIVES To assess the effects of albendazole on patients or populations with filarial infection, and on morbidity in patients with filarial infection; and to assess the frequency of adverse events for albendazole both given singly or in combination with another antifilarial drug (diethylcarbamazine or ivermectin). SEARCH STRATEGY We searched the Cochrane Infectious Disease Group's trial register (September 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2003), MEDLINE (September 2003), EMBASE (September 2003), LILACS (September 2003); and checked the reference lists and contacted experts, international organizations, and a pharmaceutical company. SELECTION CRITERIA Randomized and quasi-randomized controlled trials of albendazole singly or in combination with anti-filarial drugs in people or populations with lymphatic filariasis. DATA COLLECTION AND ANALYSIS Two reviewers assessed eligibility and trial methodological quality. We calculated relative risks (RR) with 95% confidence intervals (CI) for binary outcomes, and where appropriate, combined them in a meta-analysis using the fixed effect model or random effects model. MAIN RESULTS Four small studies met the inclusion criteria (a total of 2473 children and adults, of whom 536 had detectable microfilariae). No effect of albendazole on microfilaraemia was demonstrated in two studies (placebo controlled, RR 0.97, 95%CI 0.87 to 1.09, n = 195). When compared to ivermectin, albendazole performed worse (RR 0.84, 95% CI 0.72 to 0.98, 2 studies of patients initially microfilariae positive, n = 198). When compared to diethylcarbamazine, no statistically significant difference was detected, but numbers were small (n = 56). Two studies compared albendazole plus ivermectin to ivermectin alone on the presence of microfilaraemia. Results were mixed: one study showed the combination to be more effective (RR 0.27, 95% CI 0.11 to 0.70, n = 52), but the other did not demonstrate a statistically significant difference (RR 1.04, 95% CI 0.87 to 1.25, n = 145). A further study compared albendazole plus diethylcarbamazine to diethylcarbamazine alone and did not demonstrate a difference on microfilaraemia prevalence (RR 1.57, 95% CI 0.44 to 5.60, n=35). No study examined the effects of the drugs on adult worms. REVIEWER'S CONCLUSIONS There is insufficient reliable research to confirm or refute whether albendazole alone, or co-administered with diethylcarbamazine or ivermectin, has an effect on lymphatic filariasis.
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Noroes J, Addiss D, Cedenho A, Figueredo-Silva J, Lima G, Dreyer G. Pathogenesis of filarial hydrocele: risk associated with intrascrotal nodulescaused by death of adult Wuchereria bancrofti. Trans R Soc Trop Med Hyg 2003; 97:561-6. [PMID: 15307427 DOI: 10.1016/s0035-9203(03)80029-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Although testicular hydrocele is the most common clinical manifestation of bancroftian filariasis, its pathogenesis is poorly understood, as is its relationship to inflammatory scrotal nodules following death of adult Wuchereria bancrofti. Between 1994 and 1998, we prospectively determined the incidence and clinical evolution of nodule-associated acute hydrocele in men attending 2 outpatient clinics in Recife, Brazil who were infected with W. bancrofti, had living adult worms detectable by ultrasound in the intrascrotal lymphatic vessels, and were scheduled for treatment with 6 mg/kg diethylcarbamazine (DEC). A total of 132 men developed 173 scrotal nodules 1-7 (mean 4.2) d after DEC treatment and another 47 developed 58 spontaneous nodules before they received DEC treatment. These 179 men with a single 'nodule event' (simultaneous development of > or =1 scrotal nodules) were followed-up by serial physical and ultrasound examinations for 18 months. Overall, 40 (22.3%) men developed acute hydrocele, 3 of whom underwent biopsy and hydrocele repair. Of the remaining 37 men, 9 (24.3%) developed chronic hydrocele and 28 had acute hydrocele resolution within 14-210 (mean 60.9) d. Rate of chronic hydrocele was similar for men who received DEC and those with spontaneous nodules. Seventeen (42.5%) men with hydrocele had multiple scrotal nodules, compared with 28 (20.1%) men who did not develop hydrocele (P= 0.007). Of 134 men with single nodules, superior paratesticular nodules were found in 56.5% and 29.7% of those with and without hydrocele, respectively (P = 0.02). Acute hydrocele occurs frequently following death of adult W. bancrofti and single episodes of scrotal nodule formation. Chronic hydrocele may develop following 5.1% of these episodes.
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Affiliation(s)
- Joaquim Noroes
- Serviço de Urologia, Departamento de Cirurgia, Universidade Federal de Pernambuco, Recife, Brazil.
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Dreyer G, Addiss D, Roberts J, Norões J. Progression of lymphatic vessel dilatation in the presence of living adult Wuchereria bancrofti. Trans R Soc Trop Med Hyg 2002; 96:157-61. [PMID: 12055805 DOI: 10.1016/s0035-9203(02)90288-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Bancroftian filariasis, a mosquito-transmitted disease commonly known as elephantiasis, is caused by infection with the parasite Wuchereria bancrofti. Infection with this parasite can induce a broad array of chronic debilitating and socially stigmatizing conditions, but the pathogenesis of this morbidity remains obscure. Recent evidence indicates that in filariasis-endemic areas the primary lesion is not lymphatic vessel obstruction but, rather, dilatation. To determine the extent to which lymphatic dilatation occurs in the presence of living adult W. bancrofti, we performed longitudinal ultrasonographic measurements in 80 men (mean age 24 years) in Brazil who had a total of 107 W. bancrofti nests detectable by ultrasound. Initial mean lymphatic vessel diameter at the site of the worms was 3.4 mm (range, 0.7-11.3), and was greater in men with 2 or more nests (3.9 mm) than in those with only one nest (3.0 mm, P = 0.003). During the study period (2-35 months, mean, 13.7), lymphatic vessel diameter increased at the site of 92 (86.0%) adult worm nests. Mean rate of increase of lymphatic vessel diameter was 1.2 mm per person-year (range, 0-0.93 mm per month). In a general linear model, no factors, including treatment with antifilarial drugs, were significantly associated with rate of vessel diameter increase. Thus, lymphatic vessel dilatation progress in the presence of living adult W. bancrofti; the rate of this progression is heterogeneous. These data suggest that lymphatic dilatation will continue to progress in most infected persons even after mass treatment with currently recommended antifilarial drugs. In addition to interrupting transmission, the global programme for elimination of lymphatic filariasis should address the potential for disease progression in persons who remain infected with adult W. bancrofti.
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Affiliation(s)
- Gerusa Dreyer
- Núcleo de Ensino Pesquisa e Assistência em Filariose, NEPAF, Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Brazil.
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Dreyer G, Norões J, Addiss D, Santos A, Medeiros Z, Figueredo-Silva J. Bancroftian filariasis in a paediatric population: an ultrasonographic study. Trans R Soc Trop Med Hyg 1999; 93:633-6. [PMID: 10717753 DOI: 10.1016/s0035-9203(99)90078-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Little is known about lymphatic filariasis or the anatomical location of adult Wuchereria bancrofti in children. Seventy-eight children from Greater Recife, 23 microfilaria-positive and 55 microfilaria-negative in approximately 60 microL blood, underwent ultrasound examinations of the major superficial lymphatic vessels of the limbs, scrotal area (boys), and breast area (girls). The characteristic movements of adult worms, known as the filaria dance sign (FDS), were detected in 11 (14.1%) children. In 9 boys, the FDS was detected in lymphatic vessels of the scrotal area (8, ages 14-16) and the inguinal cord (1, age 11). In girls, the FDS was detected in a crural lymphatic vessel and an axillary lymph node. FDS detection was more common in boys (P = 0.06), older children (P = 0.001), and children with microfilaraemia (P = 0.05). Diffuse lymphangiectasia was visualized in 4 boys (ages 14-16) and 2 children had clinical signs of filariasis. These ultrasonographic findings associate W. bancrofti with both infection and disease in children.
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Affiliation(s)
- G Dreyer
- Departamento de Parasitologia, Centro de Pesquisas Aggeu Magalhaes, Recife, Brazil
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Dreyer G, Santos A, Noroes J, Addiss D. Proposed panel of diagnostic criteria, including the use of ultrasound, to refine the concept of 'endemic normals' in lymphatic filariasis. Trop Med Int Health 1999; 4:575-9. [PMID: 10499081 DOI: 10.1046/j.1365-3156.1999.00440.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although living adult Wuchereria bancrofti worms can be detected by ultrasound examination of the scrotal area in approximately 80% of men infected with this filarial parasite, the location of the adult worms in the remaining 20% remains unclear. To determine this, 32 individuals who had W. bancrofti microfilaraemia but no adult worms detectable on ultrasound were treated with diethylcarbarmazine (DEC), either with a single 6 mg/kg dose (n = 13) or with a 12-day course of 6 mg/kg per day (n = 19). They were then monitored with serial physical and ultrasound examinations. Thirteen (41%) subjects developed small, single scrotal nodules 12 h to 7 days after treatment; this rate was unaffected by the dose of DEC. No nodules were detected outside the scrotal area. All 5 men with lymphangiectasia suspected on ultrasound before treatment developed scrotal nodules, compared to 8 (29.6%) of 27 men without ultrasonographic evidence (P = 0.006). Thus, using both ultrasound and 'provocative' treatment with DEC, adult W. bancrofti can be detected in the scrotal area of an estimated 88% of infected men. Because no single diagnostic test for W. bancrofti infection is completely sensitive, a panel of tests, including ultrasound, is proposed to identify with greater accuracy 'endemic normals' for immunological and epidemiological studies.
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Affiliation(s)
- G Dreyer
- Departamento de Parasitologia, Centro de Pesquisas Aggeu Magalhaes-FIOCRUZ, Universidade Federal de Pernambuco, Recife, Brazil
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Dreyer G, Santos A, Noroes J, Amaral F, Addiss D. Ultrasonographic detection of living adult Wuchereria bancrofti using a 3.5-MHz transducer. Am J Trop Med Hyg 1998; 59:399-403. [PMID: 9749633 DOI: 10.4269/ajtmh.1998.59.399] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Adult Wuchereria bancrofti can be readily detected by ultrasound in the lymphatic vessels of the spermatic cord with a 7.5-MHz transducer, but most ultrasound machines in developing countries are equipped with 3.5-MHz transducers. To assess the potential for ultrasound as a tool for diagnosis and epidemiologic assessment in lymphatic filariasis, we compared the performance of 3.5-MHz and 7.5-MHz transducers in 61 men in Recife, Brazil. All men had three ultrasound examinations using a 3.5 MHz transducer and an examination with a 7.5-MHz probe. Using the 7.5-MHz transducer, adult W. bancrofti were detected in 41 men; 81 adult worm nests were detected. Sixty-four (79%) nests were detected with the 3.5-MHz probe, each on all three examinations. The 3.5-MHz probe correctly identified 35 (85.4%) of 41 men as infected; sensitivity increased with lymphatic vessel diameter. Ultrasonographic examination with a 3.5-MHz transducer is a sensitive method for detection of adult W. bancrofti in men and merits consideration as a tool for rapid epidemiologic assessment.
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Affiliation(s)
- G Dreyer
- Departamento de Parasitologia, Centro de Pesquisas Aggeu Magalhaes-FIOCRUZ, Recife, PE, Brazil
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Abstract
Few studies have addressed the social and behavioural aspects of lymphatic filariasis. The research reported here investigated the ethnographic context of filarial elephantiasis among women in Léogane, Haiti, and focused on explanatory models of the illness, the impact of the disease on women's lives, and the difficulties patients experienced in following a therapeutic regimen provided at a local hospital. Qualitative data were collected through focus group and individual interviews and direct observation of patients enrolled in the treatment programme. Results indicate that traditional understanding and treatment for the disease are prevalent in the community, although biomedical explanations are gaining credence as a consequence of long-term filariasis control activities in this area. Women's lives are substantially burdened both socially and economically by the physical impairment of elephantiasis, most notably in the loss of income due to restrictions on mobility. The degree of social discrimination encountered varies by the timing of onset of symptoms in the life course. Difficulties encountered with the physical therapy regimen included maintenance of the compressive bandage and availability of suitable foot wear. Similarities between these findings and those reported for other parts of the world are noted. Recommendations from the study cite the need for community education and peer support activities to provide a knowledge base and support structure for current and future intervention programmes.
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Affiliation(s)
- J Coreil
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa 33612, USA
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Dreyer G, Addiss D, Santos A, Figueredo-Silva J, Norões J. Direct assessment in vivo of the efficacy of combined single-dose ivermectin and diethylcarbamazine against adult Wuchereria bancrofti. Trans R Soc Trop Med Hyg 1998; 92:219-22. [PMID: 9764338 DOI: 10.1016/s0035-9203(98)90754-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
When ivermectin and diethylcarbamazine (DEC) are given simultaneously in a single dose to persons with Wuchereria bancrofti infection, the resulting suppression of microfilaraemia is more profound and sustained than when either drug is given alone. To assess whether this effect is a result of enhanced macrofilaricidal efficacy, we used ultrasound to monitor the adult worms in the scrotal area of men with W. bancrofti microfilaraemia. Twenty-one men were treated simultaneously with DEC (6 mg/kg) and either 200 micrograms/kg or 400 micrograms/kg of ivermectin (11 and 10 men, respectively). Ten other men received a single 200 micrograms/kg dose of ivermectin followed 5 d later by a 6 mg/kg dose of DEC (sequential treatment). All men became amicrofilaraemic after treatment and all except one remained so for one year. Cessation of adult worm movement, indicative of death of all the adult worms in a given 'nest', was observed in none of 30 nests in men who received simultaneous treatment and in 3 of the 19 nests (16%) in the men who received sequential treatment (P = 0.05). Scrotal nodules were detected in 5 of 21 men (24%) who received simultaneous treatment and in 8 men (80%) who received sequential treatment (P < 0.01). Thus, co-administration of ivermectin with DEC seems to interfere with the macrofilaricidal action of DEC. These findings have implications both for treatment of the individual patient and for community-based drug distribution programmes designed to interrupt transmission of W. bancrofti.
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Affiliation(s)
- G Dreyer
- Departamento de Parasitologia, Centro de Pesquisas Aggeu Magalhaes-FIOCRUZ, Recife, PE, Brazil
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Colley DG, Addiss D, Chitsulo L. Schistosomiasis. Bull World Health Organ 1998; 76 Suppl 2:150-1. [PMID: 10063700 PMCID: PMC2305680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Affiliation(s)
- D G Colley
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Addiss D. Lymphatic filariasis. Bull World Health Organ 1998; 76 Suppl 2:145-6. [PMID: 10063698 PMCID: PMC2305672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Affiliation(s)
- D Addiss
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Affiliation(s)
- G Dreyer
- Departamento de Parasitologia, Centro de Pesquisas Aggeu Magalhaes-FIOCRUZ, Recife, Brasil
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Norões J, Dreyer G, Santos A, Mendes VG, Medeiros Z, Addiss D. Assessment of the efficacy of diethylcarbamazine on adult Wuchereria bancrofti in vivo. Trans R Soc Trop Med Hyg 1997; 91:78-81. [PMID: 9093637 DOI: 10.1016/s0035-9203(97)90405-3] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
To assess directly the effect of various doses of diethylcarbamazine (DEC) on adult Wuchereria bancrofti, 31 infected men were randomly assigned to receive an initial single DEC dose of 1 mg/kg (n = 7), 6 mg/kg (n = 10), or 12 mg/kg (n = 14). Beginning 7 d later, the dosage of DEC and duration of treatment were progressively increased for 7-10 weeks. Physical examinations were performed to detect scrotal nodules and the scrotal area was examined by ultrasound (7.5 MHz transducer) to monitor the 'filaria dance sign' (FDS), the characteristic pattern of adult worm movement. Of 53 adult worm 'nests' that were detected by ultrasound, 22 (41.5%) were DEC-sensitive (FDS became non-detectable and a nodule became palpable at the site); 20 (37.7%) were not sensitive (FDS remained unchanged and detectable and no nodule developed), and 11 (20.8%) showed mixed responses (FDS remained detectable but a palpable nodule developed). All but one sensitive or mixed response occurred within 1 week after the initial single dose. Of 39 'nests' in men who initially received a single 6 or 12 mg/kg dose of DEC, 20 (51.3%) had sensitive responses compared to 2 (14.3%) of 14 'nests' in men who received a single 1 mg/kg dose (P = 0.04). Above 6 mg/kg, the macrofilaricidal effect of DEC did not increase with dose; a significant proportion of adult W. bancrofti were not susceptible to DEC during the study period.
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Affiliation(s)
- J Norões
- Servico de Urologia, Hospital das Clinicas, Universidade Federal de Pernambuco, Recife, Brazil
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Rocha A, Addiss D, Ribeiro ME, Norões J, Baliza M, Medeiros Z, Dreyer G. Evaluation of the Og4C3 ELISA in Wuchereria bancrofti infection: infected persons with undetectable or ultra-low microfilarial densities. Trop Med Int Health 1996; 1:859-64. [PMID: 8980602 DOI: 10.1111/j.1365-3156.1996.tb00123.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The recently developed Og4C3 ELISA, which detects circulating Wuchereria bancrofti antigen, appears promising for use in epidemiological surveys, but its sensitivity is unknown in persons with ultra-low microfilarial densities. We used the Og4C3 to test the sera of 282 persons who were microfilaria-positive in 1-16 ml of blood, 18 persons who were microfilaria-negative but who had ultrasonographic or biopsy evidence of adult W. bancrofti infection, and 63 lifelong residents of a non-endemic area of Brazil. A total of 276 (97.9%) persons with detectable microfilaraemia tested positive (optical density > 0.033). At microfilarial densities of < 1, 1-30, and > 30 microfilariae per ml of blood, the sensitivity of the Og4C3 was 72.2, 97.6 and 100%, respectively (chi 2-test for trend, P < 10(-6)). The assay was positive in 66.7% of amicrofilaraemic persons with evidence of adult worm infection and in one (1.6%) of 63 residents of the non-endemic area (specificity, 98.4%). Our findings support the increasingly widespread use of the Og4C3 for field investigations and epidemiological assessments. However, the sensitivity of the assay may be low in persons who are microfilaria-negative or with densities of < 1 microfilaria per ml.
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Affiliation(s)
- A Rocha
- Departamento de Parasitologia, Centro de Pesquisas Aggeu Magalhaes-FIOCRUZ, Recife, Brazil
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Dreyer G, Fernandes-Silva E, Alves S, Rocha A, Albuquerque R, Addiss D. Patterns of detection of Strongyloides stercoralis in stool specimens: implications for diagnosis and clinical trials. J Clin Microbiol 1996; 34:2569-71. [PMID: 8880521 PMCID: PMC229319 DOI: 10.1128/jcm.34.10.2569-2571.1996] [Citation(s) in RCA: 101] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Reported efficacies of drugs used to treat Strongyloides stercoralis infection vary widely. Because diagnostic methods are insensitive, therapeutic trials generally require multiple negative posttreatment stool specimens as evidence of drug efficacy. However, only a single positive stool specimen is usually required for study enrollment. To determine the reproducibility of detection of S. stercoralis larvae in the stool, 108 asymptomatic infected men submitted 25 g of fresh stool once a week for eight consecutive weeks for examination by the Baermann technique. During the 8-week study, 239 (27.7%) of 864 stool specimens were positive for S. stercoralis. Rates of detection of larvae in the stool specimens ranged from eight of eight specimens in 3 (2.8%) men to none of eight specimens in 36 (33.3%) men. Of 43 men for whom S. stercoralis was detected in at least two of the first four stool specimens, only 1 (2.3%) man tested negative on all of the next four specimens. In comparison, of 29 men who had detectable larvae in only one of the first four specimens, 22 (75.9%) tested negative on all of the next four samples. Thus, if these 29 men had been enrolled in a therapeutic trial between the first and second sets of four specimens, the efficacy of a drug with no activity against this parasite would have been estimated to be 76%. These data suggest that patterns of S. stercoralis detection vary widely among infected persons and that intermittent larval shedding can lead to inflated estimates of drug efficacy. Before a patient is entered in a clinical trial of drug efficacy, four consecutive stool specimens should be examined for S. stercoralis; only persons with two or more positive specimens should be enrolled.
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Affiliation(s)
- G Dreyer
- Departamento de Parasitologia, Centro de Pesquisas Aggeu Magalhaes-FIOCRUZ, Recife, Brazil
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Dreyer G, Norões J, Rocha A, Addiss D. Detection of living adult Wuchereria bancrofti in a patient with tropical pulmonary eosinophilia. Braz J Med Biol Res 1996; 29:1005-8. [PMID: 9181082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Tropical pulmonary eosinophilia (TPE) is a relatively unusual and diagnostically challenging manifestation of infection with Wuchereria bancrofti. The pathogenesis of TPE remains unclear, although immune hyperresponsiveness to the microfilarial stage of the parasite is thought to play an essential role. Microfilariae are almost never detected in the peripheral blood of persons with TPE and living adult worms have not been reported. Thus, no parasitologic marker has existed with which to assess the effectiveness of antifilarial treatment. In 1986, a 74-year old man from Olinda, Pernambuco, Brazil, developed classic signs and symptoms of filarial TPE. Within 48 h after beginning treatment with diethylcarbamazine (DEC), the drug of choice for TPE, his symptoms dramatically improved. He remained symptom-free until June 1994, when he again developed signs and symptoms of TPE. To visualize the adult worm and monitor the macrofilaricidal effectiveness of DEC treatment, ultrasound examinations of the scrotal area were performed before, during, and for 6 months after treatment. These examinations revealed diffuse dilatation of the lymphatic vessels of the spermatic cord and movements characteristic of living adult W. bancrofti known as the "filaria dance sign". Although the patient responded clinically to treatment, no change was noted in the filaria dance sign throughout the observation period. Visualization of adult W. bancrofti by ultrasound can be used to monitor the parasitologic effectiveness of treatment for TPE and to explore the relationship between death of the adult worm and recurrence of symptoms.
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Affiliation(s)
- G Dreyer
- Departamento de Parasitologia, Centro de Pesquisas Aggeu Magalháes-FIOCRUZ, Recife, Brasil
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Norões J, Addiss D, Santos A, Medeiros Z, Coutinho A, Dreyer G. Ultrasonographic evidence of abnormal lymphatic vessels in young men with adult Wuchereria bancrofti infection in the scrotal area. J Urol 1996; 156:409-12. [PMID: 8683691 DOI: 10.1097/00005392-199608000-00019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE We determined the prevalence and magnitude of dilatation of the lymphatic vessels of the spermatic cord in men infected with Wuchereria bancrofti, which is known major cause of hydrocele in the tropics. MATERIALS AND METHODS Scrotal ultrasound was performed with a 7.5 MHz, transducer in 78 men from Recife, Brazil (endemic for filariasis) and in 15 from a nonendemic area. RESULTS Among men from Recife the lymphatic vessels were dilated (1.3 to 15.0 mm., mean 3.8) at the location of the adult worm. Vessel diameter was not associated with hydrocele. CONCLUSIONS Lymphatic dilation was observed in all men with ultrasonographically detectable W. bancrofti infection, even those who were asymptomatic.
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Affiliation(s)
- J Norões
- Hospital das Clinicas, UFPE, Centro de Pesquisas Aggeu Magalhaes-FIOCRUZ, Recife, Brasil
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Dreyer G, Addiss D, Noroes J, Amaral F, Rocha A, Coutinho A. Ultrasonographic assessment of the adulticidal efficacy of repeat high-dose ivermectin in bancroftian filariasis. Trop Med Int Health 1996; 1:427-32. [PMID: 8765448 DOI: 10.1046/j.1365-3156.1996.d01-79.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Since diethylcarbamazine, the drug recommended for treatment of lymphatic filariasis, seems only partially effective against the adult worm, intense interest persists in identifying a macrofilaricidal drug for this infection. To evaluate directly in vivo the macrofilaricidal activity of repeat high-dose ivermectin, 15 men who had living adult Wuchereria bancrofti detected in the scrotal area by ultrasound were treated with 400 micrograms/kg of ivermectin at 2-week intervals for 6 months (total dose, 4.8 mg/kg). Serial ultrasound examinations were performed before, during, and for 6 months after treatment. Profound suppression of microfilaraemia followed the first dose of ivermectin, but movements characteristic of the adult worm on ultrasound remained unchanged both in location and pattern. Even when given in total doses of 4.8 mg/kg, ivermectin appears to have no observable activity against adult W. bancrofti, although its ability to suppress microfilaraemia makes it potentially useful for the control of lymphatic filariasis.
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Affiliation(s)
- G Dreyer
- Departamento de Parasitologia, Centro de Pesquisas Aggeu Magalhäes-FIOCRUZ, Recife, Brazil
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Abstract
To determine the extent to which Wuchereria bancrofti infections can be detected in asymptomatic amicrofilaraemic men in Greater Recife, Brazil, we studied 100 asymptomatic men who were long-term residents (> or = 15 years) of this filariasis-endemic area and who were amicrofilaraemic in 60 microL of capillary blood collected at night. Increasing amounts (1, 5, and 10 mL) of venous blood were collected in consecutive weeks, filtered, and examined for microfilariae; 27 men were eventually found to be microfilariaemic and 10 remained amicrofilaraemic but were found to be carriers of living adult W. bancrofti by ultrasound examination of the scrotal area. Thus, 37% of 'amicrofilaraemic' men (in 60 microL of blood) were found to be infected by more thorough investigation. Ultrasound is a valuable tool to identify adult worm infections in amicrofilaraemic persons, particularly for evaluation of serological assays and immunological studies in which the distinction between 'amicrofilaraemic adult worm carriers' and 'endemic normal subjects' is critical.
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Affiliation(s)
- G Dreyer
- Departamento de Parasitologia, Cidade Universitaria, Recife, PE, Brazil
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45
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Affiliation(s)
- G Dreyer
- Departamento de Parasitologia, Cidade Universitária, Recife, PE, Brasil
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46
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Norões J, Addiss D, Amaral F, Coutinho A, Medeiros Z, Dreyer G. Occurrence of living adult Wuchereria bancrofti in the scrotal area of men with microfilaraemia. Trans R Soc Trop Med Hyg 1996; 90:55-6. [PMID: 8730313 DOI: 10.1016/s0035-9203(96)90478-2] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
To determine the frequency with which living adult Wuchereria bancrofti can be detected by ultrasound in the scrotal area of men with filarial infection, we used a 7.5 MHz transducer to perform weekly ultrasound examinations on 100 microfilaraemic men (18-34 years old) from Greater Recife, Brazil. The peculiar pattern of movement that characterizes the adult worm image on ultrasound (the filaria dance sign) was detected in the lymphatic vessels of the spermatic cord in 80 men (bilaterally in 29 men). Among 20 men with no filaria dance sign, the geometric mean microfilarial density was 68/mL, compared with 238/mL and 775/mL among those with unilateral and bilateral filaria dance signs, respectively (P = 0.0001). The lymphatic vessels of the spermatic cord appear to be a common, and perhaps the principal, site of adult W. bancrofti in men with asymptomatic microfilaraemia. Studies are needed to define the relationship between the presence of filarial worms in the scrotal area and the development of filaria-associated morbidity.
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Affiliation(s)
- J Norões
- Hospital das Clinicas, Universidade Federal de Pernambuco, Recife, Brazil
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47
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Dreyer G, Noroes J, Amaral F, Nen A, Medeiros Z, Coutinho A, Addiss D. Direct assessment of the adulticidal efficacy of a single dose of ivermectin in bancroftian filariasis. Trans R Soc Trop Med Hyg 1995; 89:441-3. [PMID: 7570894 DOI: 10.1016/0035-9203(95)90049-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Although the potent microfilaricidal activity of ivermectin is well established, its efficacy against adult Wuchereria bancrofti is unknown. We used longitudinal ultrasound examinations for periods of 3-9 months to assess directly the macrofilaricidal effect of a single 400 micrograms/kg dose of ivermectin in 15 men from Recife, Brazil who were infected with W. bancrofti. Before treatment, microfilarial densities ranged from 3 to 3098 microfilariae per mL of blood, and movements characteristic of the living adult worm (the 'filaria dance sign') were observed by ultrasound examination of the scrotal lymphatic vessels in all 15 men. Following treatment, microfilarial density was markedly reduced in all men, but the filaria dance sign remained unchanged in both location and pattern. Eight months after treatment, a dilated lymphatic vessel was surgically removed from one patient at the site of the filaria dance sign, and 3 intact adult worms were released. When given as a single 400 micrograms/kg dose, ivermectin had no observable effect on adult W. bancrofti. Therefore, prolonged suppression of microfilaraemia following treatment with ivermectin cannot be explained by a macrofilaricidal effect of the drug. Ultrasound is a valuable new tool for directly and rapidly assessing the macrofilaricidal efficacy of antifilarial drugs in lymphatic filariasis.
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Affiliation(s)
- G Dreyer
- Departamento de Parasitologia, CPqAM-FIOCRUZ, Recife, Brazil
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Hillis SD, Nakashima A, Amsterdam L, Pfister J, Vaughn M, Addiss D, Marchbanks PA, Owens LM, Davis JP. The impact of a comprehensive chlamydia prevention program in Wisconsin. Fam Plann Perspect 1995; 27:108-11. [PMID: 7672100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
An analysis using case reports, laboratory records of tests for C. trachomatis, and Hospital Discharge Summary data shows that, following implementation of a chlamydia prevention program in Wisconsin in 1985, statewide declines were observed in prevalence, incidence and complications of infection. In 1990, prevalence rates among teenage women peaked at 2,794 infections per 100,000 15-19-year-old females. Between 1987 and 1991 (a period of stable testing volume), the proportion of positive tests decreased in all age-groups for females (by 29-41%) and males (by 10-14%), and the incidence of new infections in women decreased in clinic populations by 27%-50%. Between 1986 and 1991, hospitalization rates declined by 33% for pelvic inflammatory disease and by 20% for ectopic pregnancy.
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Affiliation(s)
- S D Hillis
- Epidemic Intelligence Service, National Center for Prevention Services, Centers for Disease Control and Prevention, Atlanta, USA
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49
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Hills SD, Nakashima A, Amsterdam L, Pfister J, Vaughn M, Addiss D, Marchbanks PA, Owens LM, Davis JP. The Impact of a Comprehensive Chlamydia Prevention Program in Wisconsin. ACTA ACUST UNITED AC 1995. [DOI: 10.2307/2136107] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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50
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Dreyer G, Amaral F, Norões J, Medeiros Z, Addiss D. A new tool to assess the adulticidal efficacy in vivo of antifilarial drugs for bancroftian filariasis. Trans R Soc Trop Med Hyg 1995; 89:225-6. [PMID: 7778157 DOI: 10.1016/0035-9203(95)90506-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- G Dreyer
- Departamento de Parasitologia, Centro de Pesquisas Aggeu Magalhães/FIOCRUZ, Recife, Pernambuco, Brasil
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