{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:32:49Z","timestamp":1787031169918,"version":"build-2736575974"},"reference-count":28,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,7,5]]},"abstract":"<jats:p>\n                    Ivermectin treatment can cause central nervous system adverse events (CNS-AEs) in persons with very high-density\n                    <jats:italic>Loa loa<\/jats:italic>\n                    microfilaremia (\u2265 30,000 mf\/mL blood). Hypoendemic onchocerciasis areas where\n                    <jats:italic>L. loa<\/jats:italic>\n                    is endemic have been excluded from ivermectin mass drug administration programs (MDA) because of the concern for CNS AEs. The rapid assessment procedure for\n                    <jats:italic>L. loa<\/jats:italic>\n                    (RAPLOA) is a questionnaire survey to assess history of eye worm. If \u2265 40% of respondents report eye worm, this correlates with \u2265 2% prevalence of very high-density loiasis microfilaremia, posing an unacceptable risk of CNS-AEs after MDA. In 2016, we conducted a\n                    <jats:italic>L. loa<\/jats:italic>\n                    study in 110 ivermectin-na\u00efve, suspected onchocerciasis hypoendemic villages in southern Nigeria. In previous RAPLOA surveys these villages had prevalences between 10% and 67%. We examined 10,605 residents using the LoaScope, a cell phone\u2013based imaging device for rapidly determining the microfilaria (mf) density of\n                    <jats:italic>L. loa<\/jats:italic>\n                    infections. The mean\n                    <jats:italic>L. loa<\/jats:italic>\n                    village mf prevalence was 6.3% (range 0\u201329%) and the mean individual mf count among positives was 326 mf\/mL. The maximum individual mf count was only 11,429 mf\/mL, and among 2,748 persons sampled from the 28 villages with \u2265 40% RAPLOA, the \u2265 2% threshold of very high\n                    <jats:italic>Loa<\/jats:italic>\n                    mf density could be excluded with high statistical confidence (\n                    <jats:italic>P<\/jats:italic>\n                    &lt; 0.01). These findings indicate that ivermectin MDA can be delivered in this area with extremely low risk of\n                    <jats:italic>L. loa<\/jats:italic>\n                    \u2013related CNS-AEs. We also concluded that in Nigeria the RAPLOA survey methodology is not predictive of \u2265 2% prevalence of very high-density\n                    <jats:italic>L. loa<\/jats:italic>\n                    microfilaremia.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.18-0163","type":"journal-article","created":{"date-parts":[[2018,5,15]],"date-time":"2018-05-15T03:01:03Z","timestamp":1526353263000},"page":"116-123","source":"Crossref","is-referenced-by-count":21,"title":["In Southern Nigeria Loa loa Blood Microfilaria Density is Very Low Even in Areas with High Prevalence of Loiasis: Results of a Survey Using the New LoaScope Technology"],"prefix":"10.4269","volume":"99","author":[{"given":"Emmanuel","family":"Emukah","sequence":"first","affiliation":[{"name":"The Carter Center, Owerri, Nigeria;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay J.","family":"Rakers","sequence":"additional","affiliation":[{"name":"The Carter Center, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barminas","family":"Kahansim","sequence":"additional","affiliation":[{"name":"The Carter Center, Jos, Nigeria;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel S.","family":"Miri","sequence":"additional","affiliation":[{"name":"The Carter Center, Jos, Nigeria;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bertram E. B.","family":"Nwoke","sequence":"additional","affiliation":[{"name":"Parasitology Department, Imo State University, Owerri, Nigeria;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Griswold","sequence":"additional","affiliation":[{"name":"The Carter Center, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yisa","family":"Saka","sequence":"additional","affiliation":[{"name":"Federal Ministry of Health, Abuja, Nigeria;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ifeoma","family":"Anagbogu","sequence":"additional","affiliation":[{"name":"Federal Ministry of Health, Abuja, Nigeria;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Davies","sequence":"additional","affiliation":[{"name":"Federal Ministry of Health, Abuja, Nigeria;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cephas","family":"Ityonzughul","sequence":"additional","affiliation":[{"name":"The Carter Center, Jos, Nigeria;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"D\u2019Ambrosio","sequence":"additional","affiliation":[{"name":"University of California Berkeley, Berkeley, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Bakalar","sequence":"additional","affiliation":[{"name":"University of California Berkeley, Berkeley, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel A.","family":"Fletcher","sequence":"additional","affiliation":[{"name":"University of California Berkeley, Berkeley, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Nutman","sequence":"additional","affiliation":[{"name":"National Institute of Health, Bethesda, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Kamgno","sequence":"additional","affiliation":[{"name":"Centre for Research on Filariasis, Yaound\u00e9, Cameroon;"},{"name":"Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaound\u00e9, Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank O.","family":"Richards","sequence":"additional","affiliation":[{"name":"The Carter Center, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Acta Trop","first-page":"S100","article-title":"Elimination of human onchocerciasis: history of progress and current feasibility using ivermectin (Mectizan\u00ae) monotherapy","volume":"120","author":"Cupp","year":"2011"},{"key":"b2","series-title":"Adv Parasitol","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/S0065-308X(05)61009-3","article-title":"Control of 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uncertainty","volume":"101","author":"Diggle","year":"2007"},{"key":"b17","series-title":"Acta Trop","first-page":"S81","article-title":"Integrated rapid mapping of onchocerciasis and loiasis in the Democratic Republic of Congo: impact on control strategies","volume":"120","author":"Tekle","year":"2011"},{"key":"b18","author":"Wanji","year":"2001"},{"key":"b19","series-title":"Parasit Vectors","first-page":"25","article-title":"Validation of the rapid assessment procedure for loiasis (RAPLOA) in the Democratic Republic of Congo","volume":"5","author":"Wanji","year":"2012"},{"key":"b20","series-title":"PLoS Negl Trop Dis","first-page":"e1210","article-title":"The geographic distribution of Loa loa in Africa: results of large-scale implementation of the Rapid Assessment Procedure for Loiasis (RAPLOA)","volume":"5","author":"Zoure","year":"2011"},{"key":"b21","series-title":"Sci Transl Med","first-page":"286re4","article-title":"Point-of-care quantification of blood-borne filarial parasites with a mobile phone microscope","volume":"7","author":"D\u2019Ambrosio","year":"2015"},{"key":"b22","series-title":"Am J Trop Med Hyg","first-page":"1056","article-title":"Loa loa microfilarial periodicity in ivermectin-treated patients: comparison between those developing and those free of serious adverse events","volume":"81","author":"Kamgno","year":"2009"},{"key":"b23","series-title":"N Engl J Med","first-page":"2044","article-title":"A test-and-not-treat strategy for onchocerciasis in Loa loa-endemic areas","volume":"377","author":"Kamgno","year":"2017"},{"key":"b24","author":"Federal Ministry of Health, Nigeria","year":"2017"},{"key":"b25","series-title":"Bull World Health Organ","first-page":"852","article-title":"Rapid assessment method for prevalence and intensity of Loa loa infection","volume":"80","author":"Takougang","year":"2002"},{"key":"b26","series-title":"Korean J Parasitol","first-page":"153","article-title":"Assessment of loiasis and outcomes of ivermectin masstreatment in Ijebu-North, Nigeria","volume":"49","author":"Hassan","year":"2011"},{"key":"b27","author":"Anonymous","year":"2016"},{"key":"b28","author":"World Health Organization\/Department of Control of Neglected Tropical Diseases","year":"2012"}],"container-title":["The American Journal of Tropical Medicine and 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