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Table 1 Potential mass drug administration (or test-and-treat) strategies according to the co-endemicity of filarial infections in Africa

From: Identifying co-endemic areas for major filarial infections in sub-Saharan Africa: seeking synergies and preventing severe adverse events during mass drug administration campaigns

Onchocerciasis Lymphatic filariasis (LF) Loiasis, based on EWHa
Non-endemic Low (<  20%) Moderate (20–40%)b High (≥ 40%)
Non-endemic Endemic DEC + ALB+IVM DEC + ALB+IVM IVM + ALB Enhancedc ATS: T&T ALB (2/year) + ITN ATS: T&T
Endemic Endemic IVM + ALB IVM + ALB IVM + ALB Enhanced ATS: T&T IVM + ALB +ITN (T&T) Enhanced & MMd ATS: T&T
Non-endemic IVM IVM IVM Enhanced ATS: T&T ATS: T&T Enhanced + MM
  1. aIf assessment of loiasis is based on thick-smear or CellScope Loa, the alternative treatment strategy (ATS) of Test & Treat (T&T) will exclude those with > 30,000 microfilariae/ml and will treat the remainder with ivermectin (IVM). Those excluded from IVM treatment can be offered doxycycline or albendazole twice a year
  2. bRe-assessment (by RAPLOA or by parasitological methods) if distance to area with high EWH prevalence is below certain threshold (i.e. 10 km)
  3. cThe term ‘Enhanced’ refers to post-treatment monitoring of severe adverse events (SAEs). For interruption of transmission, the duration of treatment (e.g. number of rounds) will be determined in part by the level of pre-control LF and/or onchocerciasis endemicity. Treatment coverage (of the total population) should be at least 65% for LF and 80% for onchocerciasis; non-adherence to treatment should be minimised
  4. dEnhanced & MM (enhanced surveillance of potential loiasis-related SAEs and medical monitoring at the community for five day safter MDA treatment)
  5. Abbreviations: ALB albendazole, ATS alternative treatment strategy, DEC diethylcarbamazine, EWH eye worm history, IVM ivermectin, ITN insecticide-treated nets, LF lymphatic filariasis, MDA mass drug administration, RAPLOA rapid assessment procedure for Loa loa, SAE severe adverse event, T&T Test (for loiasis) and treat those not at risk of SAEs (quantify L. loa microfilaraemia and treat those with < 30,000 mf/ml)