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Cunningham LJ, Odoom J, Pratt D, Boatemaa L, Asante-Ntim N, Attiku K, Banahene B, Osei-Atweneboana M, Verweij JJ, Molyneux D, Stothard RJ, Adams ER. Expanding molecular diagnostics of helminthiasis: Piloting use of the GPLN platform for surveillance of soil transmitted helminthiasis and schistosomiasis in Ghana. PLoS Negl Trop Dis 2018; 12:e0006129. [PMID: 29370166 PMCID: PMC5784883 DOI: 10.1371/journal.pntd.0006129] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 08/17/2017] [Accepted: 11/22/2017] [Indexed: 01/13/2023] Open
Abstract
The efforts to control and eradicate polio as a global health burden have been successful to the point where currently only three countries now report endemic polio, and the number of cases of polio continues to decrease. The success of the polio programme has been dependant on a well-developed network of laboratories termed the global polio laboratory network (GPLN). Here we explore collaborative opportunities with the GPLN to target two of the 18 diseases listed as a neglected tropical diseases (NTD) namely soil transmitted helminthiasis (STH) and Schistosomiasis (SCH). These were chosen based on prevalence and the use of faecal materials to identify both polio, STH and SCH. Our study screened 448 faecal samples from the Ghana GPLN using three triplex TaqMan assays to identify Ascaris lumbricoides, Necator americanus, Ancylostoma spp, Trichuris trchiura, Strongyloides stercoralis and Schistosoma spp. Our results found a combined helminth prevalence of 22%. The most common helminth infection was A. lumbricoides with a prevalence of 15% followed by N. americanus (5%), Ancylostoma spp. (2.5%), Schistosoma spp. (1.6%) and S. stercoralis (1%). These results show that it is possible to identify alternative pathogens to polio in the samples collected by the GPLN platform and to introduce new diagnostic assays to their laboratories. The diagnostic methods employed were also able to identify S. stercoralis positive samples, which are difficult to identify using parasitological methods such as Kato-Katz. This study raises the possibility of collaboration with the GPLN for the surveillance of a wider range of diseases which would both benefit the efforts to control the NTDs and also increase the scope of the GPLN as a diagnostic platform. The successful campaign being waged against polio has eliminated the disease from most countries where it was once endemic. With this success, it is anticipated that the disease will be eradicated in the coming years with only 37 cases being reported in 2016. Although the efforts to control polio are successful there are a number of low-profile, but no less serious disease, that are still highly prevalent throughout the world. These diseases have been termed the neglected tropical diseases (NTD) and this study aims to test the suitability of the Global Polio Laboratory Network (GPLN) as a platform to screen for two of the NTDs, soil transmitted helminthiasis (STH) and schistosomiasis (SCH). To test the suitability of the samples collected by the GPLN and the suitability of the laboratories themselves 448 samples from the Ghanaian GPLN laboratory were screened with multiplex TaqMan assays for the following six helminth types: Ascaris lumbricoides, Necator americanus, Ancylostoma spp, Trichuris trchiura, Strongyloides stercoralis and Schistosoma spp. Using this method this study was able to identify a prevalence of 22% for the combined helminth infection. The most common infection was A. lumbricoides with a prevalence of 15% followed by N. americanus (5%), Ancylostoma spp. (2.5%), Schistosoma spp. (1.6%) and S. stercoralis (1%). The success of this study indicates that this may be a cost-effective method to passively screen a country for STH and SCH and its success in identifying S. stercoralis infections makes it especially useful as this parasite is hard to identify using traditional surveillance techniques.
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Affiliation(s)
- Lucas J. Cunningham
- Parasitology Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
| | - John Odoom
- Virology Department, Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | - Deborah Pratt
- Virology Department, Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | - Linda Boatemaa
- Virology Department, Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | - Nana Asante-Ntim
- Virology Department, Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | - Keren Attiku
- Virology Department, Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | - Bismarck Banahene
- Virology Department, Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | - Mike Osei-Atweneboana
- Department of Environmental Biology and Health, Council for Scientific and Industrial Research, Accra, Ghana
| | - Jaco J. Verweij
- Laboratory for Medical Microbiology and Immunology, St Elisabeth Hospital, Tilburg, the Netherlands
| | - David Molyneux
- Parasitology Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Russell J. Stothard
- Parasitology Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Emily R. Adams
- Parasitology Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Hamidu BA, Jenner TE, Asiedu LJ, Osei-Atweneboana M. THE EFFICACY OF ALBENDAZOLE AGAINST SOIL-TRANSMITTED HELMINTHS AND THE IMPACT OF MASS DRUG ADMINISTRATION OF ALBENDAZOLE AND IVERMECTIN ON HEALTH STATUS. BMJ Glob Health 2017. [DOI: 10.1136/bmjgh-2016-000260.155] [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: 11/03/2022] Open
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Frempong KK, Walker M, Cheke RA, Tetevi EJ, Gyan ET, Owusu EO, Wilson MD, Boakye DA, Taylor MJ, Biritwum NK, Osei-Atweneboana M, Basáñez MG. Does Increasing Treatment Frequency Address Suboptimal Responses to Ivermectin for the Control and Elimination of River Blindness? Clin Infect Dis 2016; 62:1338-1347. [PMID: 27001801 PMCID: PMC4872292 DOI: 10.1093/cid/ciw144] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 03/10/2016] [Indexed: 11/18/2022] Open
Abstract
The first 3 years of biannual ivermectin distribution in Ghana have substantially reduced Onchocerca volvulus infection levels in 10 sentinel communities, but longitudinal analysis indicates that some communities are still consistently responding suboptimally to treatment, with implications for onchocerciasis elimination. Background. Several African countries have adopted a biannual ivermectin distribution strategy in some foci to control and eliminate onchocerciasis. In 2010, the Ghana Health Service started biannual distribution to combat transmission hotspots and suboptimal responses to treatment. We assessed the epidemiological impact of the first 3 years of this strategy and quantified responses to ivermectin over 2 consecutive rounds of treatment in 10 sentinel communities. Methods. We evaluated Onchocerca volvulus community microfilarial intensity and prevalence in persons aged ≥20 years before the first, second, and fifth (or sixth) biannual treatment rounds using skin snip data from 956 participants. We used longitudinal regression modeling to estimate rates of microfilarial repopulation of the skin in a cohort of 217 participants who were followed up over the first 2 rounds of biannual treatment. Results. Biannual treatment has had a positive impact, with substantial reductions in infection intensity after 4 or 5 rounds in most communities. We identified 3 communities—all having been previously recognized as responding suboptimally to ivermectin—with statistically significantly high microfilarial repopulation rates. We did not find any clear association between microfilarial repopulation rate and the number of years of prior intervention, coverage, or the community level of infection. Conclusions. The strategy of biannual ivermectin treatment in Ghana has reduced O. volvulus microfilarial intensity and prevalence, but suboptimal responses to treatment remain evident in a number of previously and consistently implicated communities. Whether increasing the frequency of treatment will be sufficient to meet the World Health Organization's 2020 elimination goals remains uncertain.
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Affiliation(s)
- Kwadwo K Frempong
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon
| | - Martin Walker
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London
| | - Robert A Cheke
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London.,Natural Resources Institute, University of Greenwich at Medway, Chatham Maritime, United Kingdom
| | | | - Ernest Tawiah Gyan
- Council for Scientific and Industrial Research, Water Research Institute, Accra
| | - Ebenezer O Owusu
- Department of Animal Biology and Conservation Science, University of Ghana, Legon
| | - Michael D Wilson
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon
| | - Daniel A Boakye
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon
| | - Mark J Taylor
- Department of Parasitology, Liverpool School of Tropical Medicine, United Kingdom
| | | | | | - María-Gloria Basáñez
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London
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Debrah AY, Specht S, Klarmann-Schulz U, Batsa L, Mand S, Marfo-Debrekyei Y, Fimmers R, Dubben B, Kwarteng A, Osei-Atweneboana M, Boakye D, Ricchiuto A, Büttner M, Adjei O, Mackenzie CD, Hoerauf A. Doxycycline Leads to Sterility and Enhanced Killing of Female Onchocerca volvulus Worms in an Area With Persistent Microfilaridermia After Repeated Ivermectin Treatment: A Randomized, Placebo-Controlled, Double-Blind Trial. Clin Infect Dis 2015; 61:517-26. [PMID: 25948064 PMCID: PMC4518165 DOI: 10.1093/cid/civ363] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 03/23/2015] [Indexed: 11/23/2022] Open
Abstract
Sub-optimal responses to ivermectin (IVM) have emerged. Targeting the Onchocerca volvulus Wolbachia endosymbionts with doxycycline is effective in clearing microfilariae in onchocerciasis patients with persistent microfilaridermia and in enhanced killing of adult worms after repeated standard IVM treatment. Background. Ivermectin (IVM) has been the drug of choice for the treatment of onchocerciasis. However, there have been reports of persistent microfilaridermia in individuals from an endemic area in Ghana after many rounds of IVM, raising concerns of suboptimal response or even the emergence of drug resistance. Because it is considered risky to continue relying only on IVM to combat this phenomenon, we assessed the effect of targeting the Onchocerca volvulus Wolbachia endosymbionts with doxycycline for these individuals with suboptimal response. Methods. One hundred sixty-seven patients, most of them with multiple rounds of IVM, were recruited in areas with IVM suboptimal response and treated with 100 mg/day doxycycline for 6 weeks. Three and 12 months after doxycycline treatment, patients took part in standard IVM treatment. Results. At 20 months after treatment, 80% of living female worms from the placebo group were Wolbachia positive, whereas only 5.1% in the doxycycline-treated group contained bacteria. Consistent with interruption of embryogenesis, none of the nodules removed from doxycycline-treated patients contained microfilariae, and 97% of those patients were without microfilaridermia, in contrast to placebo patients who remained at pretreatment levels (P < .001). Moreover, a significantly enhanced number of dead worms were observed after doxycycline. Conclusions. Targeting the Wolbachia in O. volvulus is effective in clearing microfilariae in the skin of onchocerciasis patients with persistent microfilaridermia and in enhanced killing of adult worms after repeated standard IVM treatment. Strategies can now be developed that include doxycycline to control onchocerciasis in areas where infections persist despite the frequent use of IVM. Clinical Trials Registration. ISRCTN 66649839.
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Affiliation(s)
- Alexander Yaw Debrah
- Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology Kumasi Centre for Collaborative Research in Tropical Medicine, Ghana
| | - Sabine Specht
- Institutes for Medical Microbiology, Immunology and Parasitology
| | - Ute Klarmann-Schulz
- Institutes for Medical Microbiology, Immunology and Parasitology Medical Biometry, Informatics and Epidemiology, University of Bonn, Germany
| | - Linda Batsa
- Kumasi Centre for Collaborative Research in Tropical Medicine, Ghana
| | - Sabine Mand
- Institutes for Medical Microbiology, Immunology and Parasitology
| | | | - Rolf Fimmers
- Medical Biometry, Informatics and Epidemiology, University of Bonn, Germany
| | - Bettina Dubben
- Institutes for Medical Microbiology, Immunology and Parasitology
| | | | | | - Daniel Boakye
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra
| | - Arcangelo Ricchiuto
- Institutes for Medical Microbiology, Immunology and Parasitology Medical Biometry, Informatics and Epidemiology, University of Bonn, Germany
| | | | - Ohene Adjei
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Charles D Mackenzie
- Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, United Kingdom
| | - Achim Hoerauf
- Institutes for Medical Microbiology, Immunology and Parasitology
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Wilson MD, Osei-Atweneboana M, Boakye DA, Osei-Akoto I, Obuobi E, Wiafe C, Kiszewski A. Efficacy of DEET and non-DEET-based insect repellents against bites of Simulium damnosum vectors of onchocerciasis. Med Vet Entomol 2013; 27:226-231. [PMID: 23167529 DOI: 10.1111/j.1365-2915.2012.01054.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Coping strategies including smoke screens are used against nuisance bites of Simulium damnosum Theobald (Diptera:Simuliidae) in onchocerciasis endemic communities. To find more effective alternatives, the efficacy of commercially available N,N-diethyl-3-methylbenzamide (DEET) products with active concentrations of 9.5, 13, 25, 50 and 98.1-100% and 'NO MAS,' (active component: para-menthane-3,8-diol and lemon grass oil) were tested at Bui-Agblekame, Ghana. A Latin square study design was implemented using eight groups of two vector collectors each, who used repellents (treatment), mineral oil or nothing each day until the end of the study. Flies were caught and their numbers each hour recorded using the standard methods for onchocerciasis transmission studies. T-tests were used to compare the mean duration of protection and a one-way analysis of variance controlling for catchers and repellents was performed. Tukey's test was used to compare protection by repellents and mineral oil. The highest percentage protection was 80.8% by NO MAS and the least 42.5% by the 13% DEET product. The period of absolute protection was 5 h by NO MAS and 1 h by 50% DEET product. No significant increase in protection was offered beyond 25% active DEET products and no significance was observed in terms of catcher × repellent effect (F = 1.731, d.f. = 48, P = 0.209).
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Affiliation(s)
- M D Wilson
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon-Accra, Ghana.
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Taylor MJ, Awadzi K, Basáñez MG, Biritwum N, Boakye D, Boatin B, Bockarie M, Churcher TS, Debrah A, Edwards G, Hoerauf A, Mand S, Matthews G, Osei-Atweneboana M, Prichard RK, Wanji S, Adjei O. Onchocerciasis Control: Vision for the Future from a Ghanian perspective. Parasit Vectors 2009; 2:7. [PMID: 19154624 PMCID: PMC2639371 DOI: 10.1186/1756-3305-2-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 01/21/2009] [Indexed: 11/10/2022] Open
Abstract
Since 1987 onchocerciasis control has relied on the donation of ivermectin (Mectizan(R), Merck & Co., Inc.) through the Mectizan Donation Programme. Recently, concern has been raised over the appearance of suboptimal responses to ivermectin in Ghana - highlighting the potential threat of the development of resistance to ivermectin. This report summarises a meeting held in Ghana to set the research agenda for future onchocerciasis control. The aim of this workshop was to define the research priorities for alternative drug and treatment regimes and control strategies to treat populations with existing evidence of suboptimal responsiveness and define research priorities for future control strategies in the event of the development of widespread ivermectin resistance.
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Affiliation(s)
- Mark J Taylor
- Molecular and Biochemical Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK.
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