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Table 1 Recommended Action Items

From: Report of a Scientific Working Group on Serious Adverse Events following Mectizan® treatment of onchocerciasis in Loa loa endemic areas

ACTION ITEM RELATIVE COST RELATIVE IMPORTANCE
1. Mapping   
   Updating country maps High/Moderate High
   RAPLOA implementation Low High
2. Pathogenesis and Clinical Aspects   
   Field case studies   
Serial sampling (blood, CSF) Moderate High
Quick response (telephone system) Moderate High
Better clinical definition Low High
Improve data forms etc. Low High
   Analysis of evolution of clinical picture to identify potential early warning signs Low High
   Research on HPCs   
Pathological specimens (with blood/serological correlates) Moderate High
Utility as early warning sign for PLERM Moderate High
Reliability of application by CDDs & community health workers Low High
   Support Local Loiasis Technical Advisor High High
   Hospital studies (more sophisticated sampling/testing) Moderate High
   Population studies   
Mdr1 and other genetic studies High Low
Food and alcohol toxicity surveys Moderate Moderate
   Post-mortem studies   
Core samples Low High
Immunohistology etc on AFIP/Marc Wéry samples Low High
Conjunctival samples Moderate Moderate
3. Epidemiologic Aspects   
   Use of GIS software to map SAE cases Low High
   Support epidemiologist specialized in cluster phenomena High High
   Research on RAPLOA techniques applied at individual level Low High
4. Pre-Treatment Approaches for L. loa endemic areas   
   Explore existing drugs with potential efficacy against L. loa Moderate High
   Albendazole – repeated doses Moderate Moderate
   Wolbachia (follow developments and respond where appropriate) (Low) (High)
   Steroids (hospital study) Moderate Moderate
   List of co-substrates for PGP and CYP3A4 potentially used locally Low Moderate
5. Animal Models   
   Primates in Cameroon   
To eventually lead to new therapies High (Pending))
To study pathogenesis High Low
   Mouse (should be secondary to primate studies) Moderate (Controversial)
   Dog (unlikely to be comparable) High Low
   In vitro studies (already being done at NIH) (High) (Medium)
6. SAE management improvement / best care methodology   
   Improve SAE surveillance & reporting system Low High
   Validation of activities, training, surveillance system Low High
   Development & assessment of risk management models (incl. for LF) Low High
   Education & counseling materials guided by community-based research Low High
   Simple algorithm card for recognition, referral & management Low High
7. Support research addressing expansion of programs to LF areas Low High