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| 1 | High prevalence of epilepsy in onchocerciasis endemic health areas in Democratic Republic of the Congo显示文摘Background:A high prevalence of epilepsy has been observed in many onchocerciasis endemic regions.This study is to estimate the prevalence of active epilepsy and exposure to Onchocerca volvulus infection in a rural population in Ituri province,Democratic Republic of Congo.Methods:In August 2016,a community-based cross-sectional study was conducted in an onchocerciasis endemic area in the rural health zone of Logo,Ituri Province.Households within two neighbouring health areas were randomly sampled.To identify persons with epilepsy,a three-stage approach was used.In the first stage,all individuals of the selected households were screened for epilepsy by non-medical field workers using a validated 5-item questionnaire.In the second and third stage,suspected cases of epilepsy were examined by non-specialist medical doctors,and by a neurologist,respectively.A case of epilepsy was defined according to the 2014 International League Against Epilepsy(ILAE)guidelines.Exposure to O.volvulus was assessed by testing for IgG4 antibodies to an O.volvulus antigen(OV16 Rapid Test,)in individuals aged 3 years and older.Results:Out of 1389 participants included in the survey,64 were considered to have active epilepsy(prevalence 4.6%)(95%confidence interval[CI]:3.6-5.8).The highest age-specific epilepsy prevalence estimate was observed in those aged 20 to 29 years(8.2%).Median age of epilepsy onset was 10 years,with a peak incidence of epilepsy in the 10 to 15 year-old age group.OV16 test results were available for 912 participants,of whom 30.5%(95%CI,27.6-33.6)tested positive.The prevalence of OV16 positivity in a village ranged from 8.6 to 68.0%.After adjusting for age,gender and ivermectin use,a significant association between exposure to onchocerciasis and epilepsy was observed(adjusted odds ratio=3.19,95%CI:1.63-5.64)(P<0.001).Conclusions:A high prevalence of epilepsy and a significant association between epilepsy and exposure to O.volvulus were observed in the population in Ituri province,Democratic Republic of Congo.There is an urgent need to implement a CDTI programme and to scale up an epilepsy treatment and care programme. | Evy Lenaerts Michel Mandro Deby Mukendi Patrick Suykerbuyk Housseini Dolo Deogratias Wonya’Rossi Françoise Ngave Chellafe Ensoy-Musoro Anne Laudisoit An Hotterbeekx Robert Colebunders | 2018 | Infectious Diseases of Poverty2018，7，1： | 5 |
| 2 | High prevalence of epilepsy in two rural onchocerciasis endemic villages in the Mahenge area,Tanzania,after 20 years of community directed treatment with ivermectin显示文摘Background:Epilepsy is a neurological disorder with a multitude of underlying causes,which may include infection with Onchocerca volvulus,the parasitic worm that causes human onchocerciasis.A survey carried out in 1989 revealed a high prevalence of epilepsy(1.02%overall,ranging from 0.51 to 3.71%in ten villages)in the Mahenge area of Ulanga district,an onchocerciasis endemic region in south eastern Tanzania.This study aimed to determine the prevalence and incidence of epilepsy following 20 years of onchocerciasis control through annual community directed treatment with ivermectin(CDTI).Methods:The study was conducted in January 2017 in two suburban and two rural villages in the Mahenge area.Door-todoor household visits were carried out by trained community health workers and data assistants to screen for persons suspected of having epilepsy,using a standardised questionnaire.Persons with suspected epilepsy were then interviewed and examined by a neurologist for case verification.Onchocerciasis associated epilepsy was defined as epilepsy without an obvious cause,with an onset of seizures between the ages of 3-18 years in previously healthy children.In each village,fifty males aged≥20 years were tested for onchocerciasis antibodies using an OV16 rapid test and were examined for presence of onchocerciasis nodules.Children aged 6-10 years were also tested using OV16 tests.Results:5117 individuals(median age 18.5 years,53.2%female)from 1168 households were screened.244(4.8%)were suspected of having epilepsy and invited for neurological assessment.Prevalence of epilepsy was 2.5%,with the rural villages having the highest rate(3.5%vs 1.5%),P<0.001.Overall incidence of epilepsy was 111 cases(95%CI:73-161)per 100000 person-years,while that of onchocerciasis associated epilepsy was 131(95%CI:70-223).Prevalence of OV16 antibodies in adult males and among children 6-10 years old was higher in rural villages than in suburban villages(76.5%vs 50.6,and 42.6%vs 4.7%respectively),(P<0.001),while overall prevalence of onchocerciasis nodules was 1.8%.Conclusions:This survey revealed a high prevalence and incidence of epilepsy in two rural onchocerciasis endemic villages in the Mahenge area.Despite 20 years of CDTI,a high prevalence of OV16 antibodies in children aged 6-10 years suggests on-going O.volvulus transmission.Reasons for the persistence of on-going parasite transmission in the Mahenge area need to be investigated. | Bruno P.Mmbando Patrick Suykerbuyk Mohamed Mnacho Advocatus Kakorozya William Matuja Adam Hendy Helena Greter Williams H.Makunde Robert Colebunders | 2018 | Infectious Diseases of Poverty2018，7，1： | 4 |
| 3 | Epidemiology of onchocerciasis-associated epilepsy in the Mbam and Sanaga river valleys of Cameroon:impact of more than 13 years of ivermectin显示文摘Background:A high epilepsy prevalence has been reported in several onchocerciasis-endemic villages along the Mbam and Sanaga river valleys in Cameroon,including Bilomo and Kelleng.We sought to determine the prevalence of epilepsy in these two villages following more than 13 years of community-directed treatment with ivermectin(CDTI).Methods:Door-to-door surveys were performed on the entire resident population in the villages in August 2017 and January 2018.Epilepsy was diagnosed using a 2-step approach:administration of a standardized 5-item questionnaire followed by confirmation by a neurologist.Previously published diagnostic criteria for onchocerciasis-associated epilepsy(OAE)were used.Ov16 serology was done for children aged 7-10 years to assess onchocerciasis transmission.Findings were compared with previous data from these two villages.Results:A total of 1525 individuals(1321 in Bilomo and 204 in Kelleng)in 233 households were surveyed in both villages.The crude prevalence of epilepsy was 4.6%in Bilomo(2017)and 7.8%in Kelleng(2018),including 12(15.6%of cases)persons with epilepsy(PWE)with nodding seizures.The age and sex-standardized prevalence in Kelleng decreased from 13.5%in 2004 to 9.3%in 2018(P<0.001).The median age of PWE shifted from 17(IQR:12-22)years to 24(IQR:20-30)years in Bilomo(P<0.001);and slightly from 24(IQR:14-34)years to 28(IQR:21.25-36.75)years in Kelleng(P=0.112).Furthermore,47.6%of all tested children between 7 and 10 years had Ov16 antibodies.Conclusions:There is a decrease in epilepsy prevalence after 13 years and more of CDTI in both villages.The age-shift observed in PWE suggests that ivermectin may prevent OAE in younger residents.Ov16 seropositivity in children indicates ongoing onchocerciasis transmission possibly due to suboptimal control measures.Our findings support the existence of OAE in Cameroon and highlight the need to strengthen onchocerciasis elimination programs. | Joseph Nelson Siewe Fodjo Godwin Tatah Earnest Njih Tabah Leonard Ngarka Leonard Njamnshi Nfor Samuel Eric Chokote Michel KMengnjo Fidele Dema Aurelien Tele Sitouok Grace Nkoro Felicien ENtone Anne-Cecile Zoung-Kanyi Bissek Cedric BChesnais Michel Boussinesq Robert Colebunders Alfred K.Njamnshi | 2018 | Infectious Diseases of Poverty2018，7，1： | 3 |
| 4 | Burden of onchocerciasis-associated epilepsy:first estimates and research priorities显示文摘Background:Since the 1990s,evidence has accumulated of an increased prevalence of epilepsy in onchocerciasisendemic areas in Africa as compared to onchocerciasis-free areas.Although the causal relationship between onchocerciasis and epilepsy has yet to be proven,there is likely an association.Here we discuss the need for disease burden estimates of onchocerciasis-associated epilepsy(OAE),provide them,detail how such estimates should be refined,and discuss the socioeconomic impact of OAE,including a cost-estimate for anti-epileptic drugs.Main body:Providing OAE burden estimates may aid prevention of epilepsy in onchocerciasis-endemic areas by inciting and informing collaboration between onchocerciasis control programmes and mental health services.Epilepsy not only massively impacts the health of those affected,but it also carries a high socioeconomic burden for the households and communities involved.We used previously published geospatial estimates of onchocerciasis in Africa and a separately published logistic regression model quantifying the association between onchocerciasis and epilepsy to estimate the number of OAE cases.We then applied disability weights for epilepsy to quantify the burden in terms of years of life lived with disability(YLD)and estimate the cost of treatment.We estimate that in 2015 roughly 117000 people were affected by OAE across onchocerciasis-endemic areas previously under the African Programme for Onchocerciases control(APOC)mandate where OAE has ever been reported or suspected,and another 264000 persons in onchocerciasis-endemic areas where OAE has never been investigated before.The total number of YLDs due to OAE was 39300 and 88700 in these areas respectively,based on a weighted mean disability weight of 0.336.The burden of OAE is approximately 13%of the total YLDs attributable to onchocerciasis and 10%of total YLDs attributable to epilepsy.We estimated that by 2015 the total costs of treatment with antiepileptic drug for OAE cases would have been a minimum of 12.4 million US$.Conclusions:These estimates suggest a considerable health,social and economic burden of OAE in Africa.The treatment and care for people with epilepsy,especially in hyperendemic onchocerciasis areas with high epilepsy prevalence thus requires more financial and human resources. | Natalie V.S.Vinkeles Melchers Sarah Mollenkopf Robert Colebunders Michael Edlinger Luc E.Coffeng Julia Irani Tresor Zola Joseph N.Siewe Sake Jde Vlas Andrea S.Winkler Wilma A.Stolk | 2018 | Infectious Diseases of Poverty2018，7，1： | 3 |
| 5 | Low prevalence of epilepsy and onchocerciasis after more than 20 years of ivermectin treatment in the Imo River Basin in Nigeria显示文摘Background:High epilepsy prevalence and incidence have been reported in areas with high onchocerciasis transmission.Recent findings suggest that proper community-directed treatment with ivermectin(CDTI)is potentially able to prevent onchocerciasis-associated epilepsy(OAE).We assessed the epilepsy prevalence and onchocerciasis transmission in two Nigerian villages following more than 20 years of CDTI.Methods:A cross-sectional door-to-door survey was performed in two villages in the Imo River Basin reported to be mesoendomic for onchocerciasis(Umuoparaodu and Umuezeala).Individuals were screened for epilepsy using a validated 5-item questionnaire.Persons suspected to have epilepsy were examined by a neurologist or a physician with training in epilepsy for confirmation.Onchocerciasis was investigated via skin snip microscopy and rapid diagnostic tests for Ov16 antibodies.Results were compared with previous findings from the Imo river basin.Results:A total of 843 individuals from 257 households in the two villages were encountered.We detected four persons with epilepsy(PWE)giving a crude epilepsy prevalence of 0.5%.This finding differs from observations reported 14 years ago which showed an epilepsy prevalence of 2.8%in the neighbouring village of Umulolo(P=0.0001),and 1.2%from 13 villages in the Imo river basin(P=0.07).The seroprevalence of Ov16 antibodies was found to be 0%.Only 4.6%of skin snips were positive compared to 26.8%in previous surveys(P<0.0001).Ivermectin mass distribution coverage in the study sites in 2017 was 79.7%.Conclusions:A low epilepsy and onchocerciasis prevalence was observed following more than 20 years of CDTI in the Imo River Basin.Absence of Ov16 antibodies indicates minimal transmission of onchocerciasis.These results contrast with observations from areas of high onchocerciasis transmission,where epilepsy prevalence and incidence remain high.Findings from this study suggest that sustained efforts could eventually achieve elimination of onchocerciasis in these villages. | Joseph N.F.Siewe Chinyere N.Ukaga Ernest O.Nwazor Murphy O.Nwoke Modebelu C.Nwokeji Blessing C.Onuoha Simon O.Nwanjor Joel Okeke Kate Osahor Lilian Chimechefulam Ann I.Ogomaka Augustine A.Amaechi Chika I.Ezenwa Monika N.Ezike Chidimma I.kpeama Ogechi Nwachukwu Austine I.Eriama-Joseph Berthram E.B.Nwoke Robert Colebunders | 2019 | Infectious Diseases of Poverty2019，8，1： | 2 |
| 6 | Ebola haemorrhagic fever: a review 显示文摘 | Colebunders R Borchert M | 2000 | J Infect2000，40，1： | 1 |
| 7 | Ebola Haemorrhagic Fever – a Review显示文摘 | R. Colebunders M. Borchert | 2000 | Journal of Infection2000，，1： | 1 |
| 8 | Tuberculosis immune reconstitution inflammatory syndrome in countries with limited resources显示文摘 | Colebunders R John L Huyst V | 2006 | Int J Tuberc Lung Dis2006，10，9： | 1 |
| 9 | Tuberculosis immune reconstitution inflammatory syndrome in countries with limited resources 显示文摘 | Colebunders R John L Huyst V | 2006 | Int J Tuberc Lung Dis2006，10，9： | 1 |
| 10 | Cross-sectional study of oral Candida carriage in a human immunodeficiency virus (HIV)-seropositive population:predisposing factors,epidemiology and antifungal susceptibility显示文摘 | Schoofs AG Odds FC Colebunders R | 1998 | Mycoses1998，41，3： | 1 |
| 11 | Management of co-infection with HIV and TB显示文摘 | Colebunder R Lambert ML | 2002 | BMJ2002，324，7341： | 1 |
| 12 | Ebola haemorrhagic fever-a review显示文摘 | Colebunders R Borchert M | 2000 | J Infect2000，，40： | 1 |
| 13 | Tuberculosis immune reconstitution inflammatory syndrome in countries with limited resources显示文摘 | Colebunders R John L Huyst V | 2006 | Int J Tuberc Lung Dis2006，10，9： | 1 |
| 14 | Community perceptions of epilepsy and its treatment in an onchocerciasis endemic region in Ituri,Democratic Republic of Congo显示文摘Background:A recent study in the Logo and Rethy health zones in the Ituri Province in the Democratic Republic of Congo(DRC)reported that the majority of the persons with epilepsy(PWE)had not been treated with anti-epileptic medication(AEM)or had stopped treatment.Prior to the implementation of an epilepsy treatment programme in these health zones,this study investigated the perceptions and experiences regarding epilepsy and its treatment amongst community leaders,PWE and/or their families,traditional healers and health professionals.Methods:A total of 14 focus group discussions(FGD)and 39 semi-structured interviews(SSI)were conducted with PWE and/or their family members,community leaders,traditional healers,and health professionals in the Logo and Rethy health zones during February 2-19,2017.Results:In the two health zones,the clinical signs of convulsive epilepsy were recognized by community members.However,a variety of misconceptions about epilepsy were identified including the beliefs that epilepsy is a family-related condition,a contagious disease,is transmitted by insects,saliva or by touching a person of the same sex during seizures,or is caused by evil spirits and witchcraft.The role of traditional healers in spreading these beliefs was revealed.The study also reported sexual abuse on PWE,stigmatisation of PWE and loss of productivity of PWE and their families.Some PWE had been using AEM and traditional treatment but were not convinced about the efficacy of these treatment options.The lack of training of health providers about epilepsy care,financial barriers in obtaining AEM,and the shortage of AEM at primary health facilities were revealed.As remedies,the community requested access to a decentralized center for epilepsy treatment.They also proposed using churches and community health workers as communication channels for information about epilepsy.Conclusions:Clinical signs of convulsive epilepsy were recognized by the community in the Logo and Rethy health zones but many misconceptions about epilepsy were identified.A comprehensive community-based epilepsy treatment programme with an affordable uninterrupted AEM supply needs to be established.Such a programme should address stigma,misconceptions,sexual abuse and foster the rehabilitation of PWE to alleviate poverty. | Housseini Dolo Michel Mandro Deogratias Wonya’Rossi Francoise Ngave Jessica Fraeyman Joseph NSiewe Patrick Suykerbuyk Robert Colebunders | 2018 | Infectious Diseases of Poverty2018，7，1： | 1 |
| 15 | The World Health Organization road map for neglected tropical diseases 2021-2030:implications for onchocerciasis elimination programs显示文摘In its new roadmap for neglected tropical diseases,the World Health Organization proposes three important strategic shifts:(i)Stronger accountability which shifting from process to impact indicators;(ii)Intensified cross-cutting approaches;and(iii)Stronger country ownership.In this paper we discuss the implementation of these three strategies in the setting of a high onchocerciasis disease burden in South Sudan. | Melissa Krizia Vieri Makoy Yibi Logora Kamran Rafiq Robert Colebunders | 2021 | Infectious Diseases of Poverty2021，10，3： | 1 |
| 16 | Management of co-infection with HIV and TB显示文摘 | Colebunders R Lambert ML | 2002 | BMJ2002，324，7341： | 1 |
| 17 | Current thinking on the management of tuberculosis显示文摘 | Ivan Bastian Rick Stapledon Robert Colebunders | 2003 | Current Opinion in Pulmonary Medicine2003，，3： | 1 |
| 18 | Ebola haemorrhagic fever-a review显示文摘 | Colebunders R Borchert M | 2000 | J Infect2000，40，： | 1 |
| 19 | Acute schistosomiasis in travelers returning from Mali显示文摘 | Colebunders R Verstraeten T Van Gompel A | 1995 | J Travel Med1995，2，4： | 1 |
| 20 | Treatment and prevention of multidrug-resistant tuberculosis显示文摘 | Colebunders R | 1999 | Drugs1999，58，4： | 1 |
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