SIXTY-SEVENTH ANNUAL MEETING - ASTMH

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VOLUME 99OCTOBER 2018NUMBER 4 SUPPLEMENTSIXT Y- SEVENTHANNUAL MEETINGSheraton New Orleans and New Orleans Marriott New Orleans, LA USAOctober 28 – November 1, 2018ABSTRACT BOOK“There will be epidemics ”Six Dead, 17 Sick FromDrug-Resistant TBEBOLA: WORLD GOES ON RED ALERT-2014Cholera Epidemicin Yemen NowAffects OneMillion People-2017Spread of Spanish Flu Menaces War ProductionPanic as1,500-2017-1918Die ofMalariaCharity to Help Fight Ebola Out of Control Success in Tests of YellowMalaria in AfricaDeath Toll Growing as Influenza Fever Serum Reported-1932Brace forDengue-2017-2014-2010Dengue DengueClaims Many Score Victims-1918Officials: Texas Sees GrowingEVERYWHERENumber of Typhus CasesAfrican Countries to Plot New Malaria Vaccine-2017-2013-2017-2017Island Declares State of EmergencyZika Spreads Worldwide-2016Over Zika Virus, Dengue Fever Outbreak-2016ASTMH Annual MeetingCanceled Due toSpanish Flu Outbreak-1918QUARANTINE WANTEDas Yellow Fever Spreads-1878An AmericanPlague:Yellow FeverEpidemic of 1793-1998FDA Busts FakeMalaria MedicinesZIKA THREATON OURDOORSTEP-2016New Hopefor AIDS Drug-1996DIPHTHERIA:Why Is It Back?Been to an Ebola-affected country?Stay away from ASTMH meeting, Louisiana says-2014-2017Malaria Caseson the Rise inLast 3 Years-2005astmh.orgajtmh.org#TropMed18Supplement toThe American Journal of Tropical Medicine and Hygiene-2016

11SAFETY AND EFFICACY OF CO-ADMINISTEREDDIETHYLCARBAMZINE, ALBENDAZOLE AND IVERMECTIONDURING MASS DRUG ADMINISTRATION FOR LYMPHATICFILARIASIS IN HAITIChristine Dubray1, Anita D. Sircar1, Madsen Beau de Rochars2,Joshua Bogus3, Abdel N. Direny4, Jean R. Ernest5, Carl R. Fayette5,Katiuscia O’Brian6, Guy E. Pavilus5, Daniel F. Sabin5, Ryan E.Wiegand1, Gary J. Weil7, Jean F. Lemoine8Centers for Disease Control and Prevention, Atlanta, GA, United States,University of Florida, Gainesville, FL, United States, 3Washington Universityin St. Louis, St. Louis, MO, United States, 4RTI International, Washington,DC, United States, 5IMA World Health, Port-au-Prince, Haiti, 6WashingtonUniversity in St. Louis, St. Louis, MO, United States, 7Washington Universityin St, Louis, St. Louis, MO, United States, 8Ministry of Public Health andPopulation, Port-au-Prince, Haiti12Efficacy studies have shown that a single co-administered dose ofdiethylcarbamazine (DEC), albendazole (ALB) and ivermectin (IVM)is more effective eliminating Wuchereria bancrofti microfilariae (Mf)from the blood than DEC and ALB, which is currently used for massdrug administration (MDA). In Haiti, 23 communes still require MDA toeliminate lymphatic filariasis (LF) as a public health problem. In a clinicaltrial, we compared the safety and efficacy of a single dose of IVM (200μg/kg) DEC (6 mg/kg) ALB (400 mg) vs. a single dose of DEC (6 mg/kg) ALB (400 mg) administered to participants 5 years of age duringan MDA in Haiti. Ten localities were randomized into two treatment arms.Participants were monitored for adverse events (AE), parasite antigenemia,and Mf. Antigen positive participants were tested for Mf and included ayear later in an efficacy study. Overall, 3007 participants were includedin the 3-drug arm and 3009 in the 2-drug arm. Fewer participants in the3-drug arm (10.6%, 321/3007) experienced at least one AE comparedto the 2-drug arm (16.3%, 491/3009, p 0.001). In both arms, most AEswere mild and consisted of headaches, dizziness and abdominal pain.Three participants included in the 2-drug arm developed serious AE thatresolved within 48 hours. Before treatment, 8.0% (240/3006) of theparticipants in the 3-drug arm and 11.5% (346/3005, p 0.001) in the2-drug arm were antigen positive. Of those, 17.6% (42/239) in the 3-drugarm and 21.5% (73/340, p 0.25) in the 2-drug arm were Mf positive. Oneyear after treatment, 5.5% of the participants initially Mf positive in the3-drug arm were still microfilaremic compared to 23.7% (p 0.02) in the2-drug arm. Antigenemia persisted in 79.1% (159/201) of the participantstested in the 3-drug compared to 76.4% (217/291, p 0.24 in the 2-drugarm. In conclusion, the 3-drug therapy was more effective in eliminatingMf from the blood and fewer AEs were reported in the 3-drug arm thanin the 2-drug arm during the study in Haiti. Effective MDA coverage with3-drug therapy could accelerate the elimination of LF as a public healthproblem in the 23 communes still requiring MDA in Haiti.2FIRST COHORT STUDY TO INVESTIGATE THE ASSOCIATIONBETWEEN ONCHOCERCIASIS AND EPILEPSY PROVIDESSTRONG EVIDENCE FOR A CAUSAL RELATIONSHIPCédric B. Chesnais1, Hugues C. Nana-Djeunga2, Alfred K.Njamnshi3, Anne-Cécile Zoung-Kanyi Bissek4, Joseph Kamgno5,Robert Colebunders6, Michel Boussinesq1UMI 233 IRD – U1175 INSERM - Université de Montpellier, Montpellier,France, 2Centre for Research on Filariasis and other Tropical Diseases,Yaoundé, Cameroon, 3Neurology Department, Central Hospital/Faculty ofMedicine & Biomedical Sciences, The University of Yaoundé I, FMBS-UYI,Yaoundé, Cameroon; Brain Research Africa Initiative, BRAIN, Yaoundé,Cameroon, 4Dermatology Department, Chantal Biya Mother-Child Center/Ministry of Public Health/FMBS-UYI, Yaoundé, Cameroon, 5Centrefor Research on Filariasis and other Tropical Diseases; Public HealthDepartment, Faculty of Medicine and Biomedical Sciences, University of1Yaoundé I, Yaoundé, Cameroon, 6Global Health Institute, University ofAntwerp, Antwerp, BelgiumPrevious meta-analyses on the relationship between onchocerciasis andepilepsy suggested that the two conditions are closely associated bothat community and individual level. To tackle criticisms about the factthat these studies were cross-sectional, and that confounding factorsmight explain the relationship, we conducted a prospective cohort studyto assess the incidence of epilepsy according to the initial Onchocercavolvulus microfilarial density (Ov-MFD). The study was conducted in theMbam valley (Cameroon) where Ov MFD was measured in 1991-1993 inchildren by examination of skin snips. In 2017, seven villages with variableinitial community microfilarial loads (CMFL) were revisited to gatherinformation on the 858 children aged 5-10 years who had been examinedin these communities in 1991-1993. Information on the occurrence ofepilepsy between the initial parasitological survey and 2017 was collectedfrom the subjects themselves or from their relatives, using a standardized“5-questions” questionnaire. Data on the history of epilepsy could beobtained from 85.2% of the 858 targeted subjects. In 2017, the overallincidence rate of epilepsy in the cohort subjects was 350 per 100,000persons-years. Multivariable analyses taking into account age, sex, initialindividual Ov-MFD, and initial CMFL in the village of residence, wereperformed. Using the individuals who had no Ov microfilariae (mf) in theirskin in 1991-1993 as the reference group, the relative risks of havingdeveloped an epilepsy were 7.07, 11.26, 12.90, 20.00, 22.58, and 28.50in subjects with initial Ov-MFD of 1-5, 6-20, 21-50, 51-100, 101-200,and 200 mf/skin snip, respectively. Individual Ov MFD at childhood wasfound to be strongly associated with the risk of developing subsequentlyepilepsy. This study adds a temporal dimension and demonstrates a doseresponse effect supporting a causal relationship between onchocerciasisand epilepsy.3THE BURDEN OF SKIN DISEASE AND EYE DISEASE DUE TOONCHOCERCIASIS IN AFRICA FOR 2015 AND 2025Natalie V. Vinkeles Melchers1, Wilma A. Stolk1, Jan H. Remme2,Michele E. Murdoch3, Belén Pedrique4, Roel Bakker1, Sake J. deVlas1, Luc E. Coffeng11Erasmus MC, University Medical Center Rotterdam, Rotterdam,Netherlands, 2120 rue des Campanules, Ornex, France, 3Department ofDermatology, Watford General Hospital, Watford, Hertfordshire, UnitedKingdom, 4Drugs for Neglected Diseases initiative (DNDi), Geneva,SwitzerlandOnchocerciasis is now targeted for elimination through ivermectin massdrug treatment (MDA), after long-term morbidity control by the AfricanProgramme for Onchocerciasis Control (APOC: 1995-2015). Here weassess how this affected the prevalence and associated disease burdenfor 2015 and will affect that for 2025. We used the expanded diseaseframework within the individual-based mathematical model ONCHOSIMto estimate the prevalence of various onchocerciasis-associated clinicalmanifestations, focusing on onchocercal skin disease (OSD: severe itch,reactive skin disease (RSD), hanging groin, atrophy, and depigmentation)and onchocercal ocular disease (OOD: visual impairment, blindness). Themodel was quantified by reproducing pre-control associations betweenprevalence of disease and infection and age patterns. The distribution ofpre-control mean mf prevalence per APOC administrative area (“project”)was extracted from a published pixel-level onchocerciasis infection map.We simulated trends in prevalence of manifestations for various mfprevalences in 157 projects, accounting for project-level treatment history.Numbers of cases and disability-adjusted life years (DALYs) lost due toonchocerciasis were then calculated for each clinical manifestation perAPOC project, each time point, and stratified by age, sex, and endemicity.The total number of cases with any type of OSD was estimated to beapproximately 3,110,000 for 2015 (335,900 DALYs), and 370,500 for2025 (40,000 DALYs). The total number of cases with vision loss wasestimated to be approximately 234,700 for 2015 (18,500 DALYs), and51,700 for 2025 (2,900 DALYs). Out of all OSD cases in 2025, 15% from aastmh.org

2chronic disease, and 85% from an acute clinical manifestation (i.e. severeitch, RSD). By 2025, vision loss remains mainly a problem for savanna areas(96% of all vision loss). By 2025, most of the onchocerciasis burden isexpected to be in areas of DRC and Nigeria (39% of total DALYs). Theseareas might benefit most from alternative strategies or more efficienttargeting of patient-based treatments, given the limited human andfinancial resources available.4LYMPHATIC FILARIASIS ELIMINATION IN AMERICAN SAMOA- HOUSEHOLD CLUSTERING OF SEROPOSITIVE PERSONSAND IMPLICATIONS FOR SURVEILLANCE STRATEGIESColleen L. Lau1, Meru Sheel1, Sarah Sheridan1, Katherine Gass2,Kimberly Y. Won3, Saipale Fuimaono4, Patricia M. Graves5Research School of Population Health, The Australian National University,Canberra, Australia, 2Neglected Tropical Diseases Support Center, TheTask Force for Global Health, Decatur, GA, United States, 3Centers forDisease Control and Prevention, Division of Parasitic Diseases and Malaria,Atlanta, GA, United States, 4American Samoa Department of Health, PagoPago, American Samoa, 5College of Public Health, Medical and VeterinarySciences, James Cook University, Cairns, Australia1Under the Global Programme to Eliminate Lymphatic Filariasis, AmericanSamoa made significant progress toward interrupting transmissionof lymphatic filariasis (LF) by conducting seven rounds of mass drugadministration (MDA) from 2000-2006, and passing WHO recommendedTransmission Assessment Surveys (TAS) of Grade 1 & 2 school children in2011 & 2015. As antigen (Ag) prevalence drops to very low levels at theend stages of elimination efforts, detection of residual infected personsand/or Foci of ongoing transmission becomes increasingly challenging.WHO has therefore highlighted the need for cost-effective and innovativepost-MDA surveillance strategies for identifying residual infections andhigh-risk groups. In 2016, we conducted a TAS of Grade 1 & 2 (mostly6-7 year old) school children in American Samoa, in parallel with acluster survey of community members aged 8 years in 30 villages. Todetermine if household members of Ag-positive school children were ahigh-risk group, and therefore a potential focus for targeted surveillance,we compared Ag prevelance in household members aged 8 years withresults from the community survey. The Alere Filariasis Test StripTM wasused to detect circulating filarial Ag. Of 1143 school children and 2507participants in the community survey, 9 (0.8%, 95% CI 0.4-1.5%) and102 (4.1%, 95% CI 3.3-4.9%) were Ag-positive, respectively. Of the 65eligible household members, 58 (89%) were tested and 12 (20.7%, 95%CI 11.2-33.4%) were Ag-positive; Ag-positive household members wereidentified in 5 (55.6%) of the 9 households. Our findings indicate thathousehold members of Ag-positive school children have a significantlyhigher Ag prevalence than the general community (chi2 test, p 0.001) andshould be considered for targeted surveillance. Considering the significanthousehold-level clustering and the highly focal nature of LF transmission,future studies should explore the utility of snowball sampling of householdmembers and near neighbours of Ag-positive persons, including thoseidentified through opportunistic surveillance strategies such screeningprograms at work sites or health clinics.5RIVER BLINDNESS IN TOGO: PERFORMANCE OF THE OV-16RAPID DIAGNOSTIC TEST AND THE ELISA IN PREVIOUSLYHYPERENDEMIC FOCIEugene W. Liu1, Paul Cantey1, Koffi Padjoudoum2, Telou Gado2,Joseph Rubagumya1, Rachel Bronzan3, Michel G. Datagni4,Nicholas Ayebazibwe5, Danaya Bethea1, Guillherme Ogawa1,Vitaliano Cama1Centers for Disease Control and Prevention, Atlanta, GA, United States,Togo Onchocerciasis Control Program (PNLO), Kara, Togo, 3Health andDevelopment International, Newburyport, MA, United States, 4Health12and Development International, Lome, Togo, 5African Field EpidemiologyNetwork, Kampala, UgandaDecisions to stop mass drug administration (MDA) to eliminateonchocerciasis are based on evidence of interruption of parasitetransmission, such as absence of antibody to Ov-16 in children. In 2014,a rapid diagnostic test (RDT), became commercially available that can beperformed in the field using blood from a finger prick and can providereal-time results, compared to the currently accepted enzyme-linkedimmunosorbent assay (ELISA). Here we compare performance of the RDTto ELISA in two previously hyperendemic districts in Togo that underwent 20 years of MDA. In each selecte

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