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Satellite mapping of loa loa prevalence in relation to ivermectin use in west and central Africa (p 1077)
September 20, 2000A research letter published in this week's issue of THE LANCET describes a satellite mapping technique in Africa which can identify areas where high loa loa endemicity may adversely affect the safe and effective distribution of ivermectin for the control of river blindness (onchocerciasis).
The drug ivermectin has been widely distributed throughout west Africa for the control of onchocerciasis. However, severe adverse reactions to this drug have occurred in areas of Cameroon endemic for another parasitic worm loa loa. These severe adverse reactions now constrain the public-health use of this drug in the forest habitat of the loa loa vector.
The rapid epidemiological mapping of onchocerciasis (REMO) programme is being used to select areas for targeting of a community-directed treatment initiative for ivermectin. However, severe reactions to ivermectin have been reported in patients with high blood concentrations of loa loa; prevalence rates of loa loa of 20% or more have been proposed as an indicator of communities where severe adverse reactions to ivermectin might occur.
Madeline Thomson and colleagues used geographical data to identify high risk areas of loa loa infection. Maps for the REMO programme were overlaid, and areas of extensive overlap were identified in Cameroon and the Democratic Republic of Congo.
Madeline Thomson comments: "The development of a predictive model of areas and populations where adverse reactions to ivermectin are probable is essential if a substantial public-health problem is to be solved".
Contact: Dr Madeline Thomson, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L9 5QA, UK; T) +44 (0)151 708 9393; F) +44 (0)151 708 8733; E) mthomson@liv.ac.uk
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