BACKGROUND Around 2007, a nodding syndrome (NS) epidemic appeared in onchocerciasis-endemic districts of northern Uganda, where ivermectin mass distribution had never been implemented. This study evaluated the effect of community-directed treatment with ivermectin (CDTI) and ground larviciding of rivers initiated after 2009 and 2012 respectively, on the epidemiology of NS and other forms of epilepsy (OFE) in some districts of northern Uganda. METHODS In 2012, a population-based community survey of NS/epilepsy was carried out by the Ugandan Ministry of Health in Kitgum and Pader districts. In August 2017, we conducted a new survey in selected villages of these districts and compared our findings with the 2012 data. In addition, two villages in Moyo district (where CDTI was ongoing since 1993) served as comparative onchocerciasis-endemic sites in which larviciding had never been implemented. The comparison between 2012 and 2017 prevalence and cumulative incidence were done using the Fisher's and Pearson's Chi-square tests at 95% level of significance. RESULTS A total of 2138 individuals in 390 households were interviewed. In the selected villages of Kitgum and Pader, there was no significant decrease in prevalence of NS and OFE between 2012 and 2017. However, the cumulative incidence of all forms of epilepsy decreased from 1165 to 130 per 100 000 persons per year (P = 0.002); that of NS decreased from 490 to 43 per 100 000 persons per year (P = 0.037); and for OFE from 675 to 87 per 100 000 persons per year (P = 0.024). The median age of affected persons (NS and OFE) shifted from 13.5 (IQR: 11.0-15.0) years in 2012 to 18.0 (IQR: 15.0-20.3) years in 2017; P <  0.001. The age-standardized prevalence of OFE in Moyo in 2017 was 4.6%, similar to 4.5% in Kitgum and Pader. CONCLUSIONS Our findings support the growing evidence of a relationship between infection by Onchocerca volvulus and some types of childhood epilepsy, and suggest that a combination of bi-annual mass distribution of ivermectin and ground larviciding of rivers is an effective strategy to prevent NS and OFE in onchocerciasis-hyperendemic areas.

中文翻译：

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实施盘尾丝虫病控制措施后，乌干达北部盘尾丝虫病流行地区的点头综合征和其他形式的癫痫的患病率和发病率。

背景技术在2007年左右，乌干达北部的盘尾丝虫病流行地区出现了点头综合征（NS）流行病，该地区从未实施伊维菌素的大规模分布。这项研究评估了分别在2009年和2012年开始的伊维菌素（CDTI）社区定向治疗和河流地面幼虫对乌干达北部某些地区的NS和其他形式的癫痫病（OFE）的流行病学影响。方法2012年，乌干达卫生部在Kitgum和Pader地区进行了基于人群的NS /癫痫病社区调查。2017年8月，我们在这些地区的选定村庄进行了一项新调查，并将我们的发现与2012年的数据进行了比较。此外，Moyo区的两个村庄（自1993年以来一直在CDTI开展工作）用作比较盘尾丝虫病的流行场所，从未实施过幼虫杀灭。使用Fisher和Pearson的卡方检验对2012年和2017年的患病率和累积发生率进行比较，显着性水平为95％。结果采访了390个家庭的2138个人。在选定的Kitgum和Pader村庄中，NS和OFE的患病率在2012年至2017年之间没有显着下降。但是，所有形式的癫痫病的累积发生率从每年每10万人中1165例下降到130例（P = 0.002） ）; NS的比率从每年每10万人490人减少到43人（P = 0.037）；对于OFE，从每年每10万人的675上升到87（P = 0.024）。受影响人群的中位年龄（NS和OFE）从2012年的13.5（IQR：11.0-15.0）岁转变为2017年的18.0（IQR：15.0-20.3）岁; P ＜0.001。2017年Moyo的按年龄标准化的OFE患病率为4.6％，与Kitgum和Pader的4.5％相似。结论我们的发现支持越来越多的证据表明，盘尾丝虫感染与某些类型的儿童癫痫之间存在相关性，并建议每两年一次伊维菌素的质量分布与河流地面幼虫的结合是预防NS和OFE的有效策略。盘尾丝虫病高流行区。