• Joseph Kamgno, Sébastien D Pion, Cédric B Chesnais, Matthew H Bakalar, Michael V D'Ambrosio, Charles D Mackenzie, Hugues C Nana-Djeunga, Raceline Gounoue-Kamkumo, Guy-Roger Njitchouang, Philippe Nwane, Jules B Tchatchueng-Mbouga, Samuel Wanji, Wilma A Stolk, Daniel A Fletcher, Amy D Klion, Thomas B Nutman, and Michel Boussinesq.
• From the Center for Research on Filariasis and other Tropical Diseases (J.K., H.C.N.-D., R.G.-K., G.-R.N., P.N., J.B.T.-M.) and the Faculty of Medicine and Biomedical Sciences, University of Yaounde I (J.K.), Yaounde, and the Faculty of Health Sciences, Department of Microbiology and Parasitology, University of Buea, and Research Foundation for Tropical Diseases and Environment (REFOTDE), Buea (S.W.) - all in Cameroon; Institut de Recherche pour le Développement Unité Mixte Internationale 233-INSERM Unité 1175, Montpellier University, Montpellier, France (S.D.P., C.B.C., M.B.); the Department of Bioengineering and the Biophysics Program, University of California, Berkeley, Berkeley (M.H.B., M.V.D., D.A.F.); the Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing (C.D.M.); the Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (W.A.S.); the Chan Zuckerberg Biohub, San Francisco (D.A.F.); and the Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD (A.D.K., T.B.N.).
• N. Engl. J. Med. 2017 Nov 23; 377 (21): 2044-2052.

BackgroundImplementation of an ivermectin-based community treatment strategy for the elimination of onchocerciasis or lymphatic filariasis has been delayed in Central Africa because of the occurrence of serious adverse events, including death, in persons with high levels of circulating Loa loa microfilariae. The LoaScope, a field-friendly diagnostic tool to quantify L. loa microfilariae in peripheral blood, enables rapid, point-of-care identification of persons at risk for serious adverse events.MethodsA test-and-not-treat strategy was used in the approach to ivermectin treatment in the Okola health district in Cameroon, where the distribution of ivermectin was halted in 1999 after the occurrence of fatal events related to L. loa infection. The LoaScope was used to identify persons with an L. loa microfilarial density greater than 20,000 microfilariae per milliliter of blood, who were considered to be at risk for serious adverse events, and exclude them from ivermectin distribution. Active surveillance for posttreatment adverse events was performed daily for 6 days.ResultsFrom August through October 2015, a total of 16,259 of 22,842 persons 5 years of age or older (71.2% of the target population) were tested for L. loa microfilaremia. Among the participants who underwent testing, a total of 15,522 (95.5%) received ivermectin, 340 (2.1%) were excluded from ivermectin distribution because of an L. loa microfilarial density above the risk threshold, and 397 (2.4%) were excluded because of pregnancy or illness. No serious adverse events were observed. Nonserious adverse events were recorded in 934 participants, most of whom (67.5%) had no detectable L. loa microfilariae.ConclusionsThe LoaScope-based test-and-not-treat strategy enabled the reimplementation of community-wide ivermectin distribution in a heretofore "off limits" health district in Cameroon and is a potentially practical approach to larger-scale ivermectin treatment for lymphatic filariasis and onchocerciasis in areas where L. loa infection is endemic. (Funded by the Bill and Melinda Gates Foundation and others.).

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