Table 1 Recommended Action Items
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 |