Mapping of lymphatic filariasis in loiasis areas: A new strategy shows no evidence for Wuchereria bancrofti endemicity in Cameroon.

Samuel Wanji,Glory Ngongeh,Helen Storey,Kerstin Fischer,Narcisse V Ngandjui,Patrick W Chounna Ndongmo,Peter U Fischer,Joseph R Fauver,Kurt C Curtis,Jerome Fru,Mathias Eyong Esum,Raphael Awah Abong,Charles W Goss,Fanny F Fombad,Gordon Takop Nchanji,Daphne Lew,Peter Ivo Enyong,Abdel Jelil Njouendou,Amuam Andrew Mbeng

doi:10.1371/journal.pntd.0007192

Abstract

BackgroundMapping of lymphatic filariasis (LF) caused by Wuchereria bancrofti largely relies on the detection of circulating antigen using ICT cards. Several studies have recently shown that this test can be cross-reactive with sera of subjects heavily infected with Loa loa and thus mapping results in loiasis endemic areas may be inaccurate.Methodology/Principal findingsIn order to develop an LF mapping strategy for areas with high loiasis prevalence, we collected day blood samples from 5,001 subjects residing in 50 villages that make up 6 health districts throughout Cameroon. Antigen testing using Filarial Test Strip (FTS, a novel platform that uses the same reagents as ICT) revealed an overall positivity rate of 1.1% and L. loa microfilaria (Mf) rates of up to 46%. Among the subjects with 0 to 8,000 Mf/ml in day blood, only 0.4% were FTS positive, while 22.2% of subjects with >8,000 Mf/ml were FTS positive. A Mf density of >8,200 Mf/ml was determined as the cut point at which positive FTS results should be excluded from the analysis. No FTS positive samples were also positive for W. bancrofti antibodies as measured by two different point of care tests that use the Wb123 antigen not found in L. loa. Night blood examination of the FTS positive subjects showed a high prevalence of L. loa Mf with densities up to 12,710 Mf/ml. No W. bancrofti Mf were identified, as confirmed by qPCR. Our results show that high loads of L. loa Mf in day blood are a reliable indicator of FTS positivity, and Wb123 rapid test proved to be relatively specific.Conclusions/SignificanceOur study provides a simple day blood-based algorithm for LF mapping in loiasis areas. The results indicate that many districts that were formerly classified as endemic for LF in Cameroon are non-endemic and do not require mass drug administration for elimination of LF.

Highlights

Lymphatic filariasis (LF) is a neglected tropical disease that is targeted for elimination
The results indicate that many districts that were formerly classified as endemic for lymphatic filariasis (LF) in Cameroon are non-endemic and do not require mass drug administration for elimination of LF
Our results show that high L. loa Mf in day blood (> 8,200 Mf/ml) are a predictor for FTS positivity and rapid antibody tests specific for W. bancrofti can be used to confirm the absence of W. bancrofti

Summary

Introduction

Lymphatic filariasis (LF) is a neglected tropical disease that is targeted for elimination. The Global Program to Eliminate Lymphatic Filariasis (GPELF) has made substantial progress in a number of countries, but it lags behind in others, especially in countries in western and central Africa [1, 2]. For most areas in sub-Saharan Africa, a combination of ivermectin with albendazole is used for MDA. In western and central Africa where the filarial parasite Loa loa is highly co-endemic, twice yearly MDA with albendazole is recommended [3]. The latter strategy has different dynamics for reduction of infection than ivermectin combined with albendazole, but was recently shown to be effective for the local elimination of LF [4]. Several studies have recently shown that this test can be cross-reactive with sera of subjects heavily infected with Loa loa and mapping results in loiasis endemic areas may be inaccurate

Methods

Results

Discussion

Conclusion