Epidemiological evaluation of onchocerciasis along Ogun River System, southwest Nigeria.

BACKGROUND & OBJECTIVE: Epidemiological studies were carried out to assess the prevalence and community microfilarial load (CMFL) of onchocerciasis after repeated annual treatment with ivermectin along Ogun river System, southwest Nigeria. METHOD: Skin snips were taken from consented participants in 11 selected communities along the River system. The microfilarial load of the community was estimated. RESULTS: The prevalence and CMFL varied significantly in the communities (p <0.05). The prevalence of onchocerciasis ranged from 19.1 to 45.6%, while the CMFL ranged from 0.11 to 1.03 microfilariae per skin snip. The CMFL recorded was <5 microfilariae per skin snip, i.e. recognized by WHO as threshold value in certifying the communities to be free of onchocerciasis as public health problem, thus, signifying the possibility of onchocerciasis elimination in the study area. CONCLUSION: Efforts should therefore be intensified to achieve improved ivermectin coverage and compliance in annual ivermectin treatment in order to completely eliminate onchocerciasis as a public health problem in the studied communities.

African programme for Onchoceriasis control: ophthalmological findings in Bushenyi, Uganda.

BACKGROUND: The overall prevalence of blindness from Onchoceriasis in Bushenyi is relatively low, most of which is to be found in the elderly. Onchoceriasis is a major health problem in Africa. The Community-Directed treatment with invermectin is a control strategy to address the problem, but baseline data are generally lacking in several countries. OBJECTIVE: To describe baseline ophthalmological data in order to assess the impact of Community-Directed with Ivermectin (CDTI) in Uganda. METHODS: The study site was in Bushenyi, Western Uganda. In a cross-sectional study, 367 persons aged 10 years or older from seven selected villages received eye examination using a standardised protocol and Wu-Jones Motion Sensitivity Testing (MSST). Besides MSST, other information sought included visual acuity, slit lamp examination, testicular opacities and intraocular presence. RESULTS: Of the 367 subjects, 219(57.2%) were males. Subjects less than 25 years of age were 104(28.3). The prevalence of blindness were 1.9% while 4.1% was visually impaired by acuity criteria alone. A further 9.1% had moderate visual field loss while 2.8% had severe field loss. There was no case of anterior chamber microfilaria but dead microfilariae were seen in two cases. Punctate keratitis was present in 1.8% with sclerosing keratitis was twice as common at 3.8%. Optic atrophy was also relatively common at 12.4%, while chorioretinitis was present in 3.3%. CONCLUSION: There was an apparent paucity of acute onchocerciasis-related lesions but a significant presence of irreversible onchocerciasis-related lesions. The most significant problem requiring intervention would appear to be cataract.

Prevalence and distribution of ocular onchocerciasis in three ecological zones in Nigeria.

The African Programme for Onchocerciasis Control (APOC) sponsored a baseline study in Nigeria between 1998 and 1999 on the prevalence and distribution of Onchocerciasis. The randomly selected 1,064 subjects in the baseline study underwent detailed eye examination in Cross River (rain forest), Taraba (savanna) and Kogi (forest-savanna) States. This paper compares and contrasts the public health significance of ocular onchocerciasis in these ecological zones. A blindness prevalence of 2.4% was recorded in the study, onchocerciasis being responsible for 30.2% of the bilaterally blind subjects. Onchocerciasis-induced blindness prevalence was relatively high in the rain forest and forest savanna zones of Cross River and Kogi States, Cross River having the highest site-specific prevalence (50.0%), followed by Kogi (41.7%). Taraba recorded only 27.3%. Other conditions identified included glaucoma, optic nerve disease and cataract rates of which were also found to be high among the population (6.9%, 6.5 % and 8.9% respectively). Anterior segment onchocercal lesions, punctate and sclerosing keratitis were the predominant features of the infection in the savanna zone (14.1% and 6.3% respectively), while posterior segment lesions were much more common in the forest zone. The need to sustain the present efforts to control onchocerciasis through mass ivermectin treatment is recommended.

The elimination of the onchocerciasis vector from the island of Bioko as a result of larviciding by the WHO African Programme for Onchocerciasis Control.

The island of Bioko is part of the Republic of Equatorial Guinea and is the only island in the World to have endemic onchocerciasis. The disease is hyperendemic and shows a forest-type epidemiology with low levels of blindness and high levels of skin disease, and the whole population of 68,000 is estimated to be at risk. Control of onchocerciasis began in 1990 using ivermectin and this yielded significant clinical benefits but transmission was not interrupted. Feasibility and preparatory studies carried out between 1995 and 2002 confirmed the probable isolation of the vector on the island, the high vectorial efficiency of the Bioko form of Simulium yahense, the seasonality of river flow, blackfly breeding and biting densities, and the distribution of the vector breeding sites. It was proposed that larviciding should be carried out from January to April, when most of the island's rivers were dry or too low to support Simulium damnosum s.l., and that most rivers would not need to be treated above 500 m altitude because they were too small to support the breeding of S. damnosum s.l. Larviciding (with temephos) would need to be carried out by helicopter (because of problems of access by land), supplemented by ground-based delivery. Insecticide susceptibility trials showed that the Bioko form was highly susceptible to temephos, and insecticide carry was tested in the rivers by assessing the length of river in which S. damnosum s.l. larvae were killed below a temephos dosing point. Regular fly catching points were established in 1999 to provide pre-control biting densities, and to act as monitoring points for control efforts. An environmental impact assessment concluded that the proposed control programme could be expected to do little damage, and a large-scale larviciding trial using ground-based applications of temephos (Abate 20EC) throughout the northern (accessible) part of the island was carried out for five weeks from 12 February 2001. Following this, a first attempt to eliminate the vectors was conducted using helicopter and ground-based applications of temephos from February to May 2003, but this was not successful because some vector populations persisted and subsequently spread throughout the island. A second attempt from January to May 2005 aimed to treat all flowing watercourses and greatly increased the number of treatment points. This led to the successful elimination of the vector. The last biting S. damnosum s.l. was caught in March 2005 and none have been found since then for more than 3 years.

Special intervention zones.

The Special Intervention Zones (SIZ) of the former Onchocerciasis Control Programme (OCP) were launched in December 2002, following the closure of the OCP, to sustain the momentum that had been gained for onchocerciasis control through Mectizan distribution and vector control. The donation of Mectizan in 1987 was fortuitous for the OCP, as vector control had become costly and ineffective in certain areas. Mectizan distribution benefitted the populations affected by onchocerciasis, who saw improvements to their health. When the SIZ were launched, Mectizan distribution became the primary strategy for onchocerciasis control. Good coverages with Mectizan mass treatments have been achieved and maintained in most of the SIZ, leading to dramatic reductions in both the prevalences and intensities of onchocercal infection. The control efforts in the SIZ in Sierra Leone and some areas of Ghana and Togo, however, need to be strengthened. Although the SIZ closed at the end of 2007, the Mectizan distributions will continue until 2012.

Elimination of the Djodji form of the blackfly Simulium sanctipauli sensu stricto as a result of larviciding by the WHO Onchocerciasis Control Programme in West Africa.

Cytotaxonomic identifications of larvae of members of the Simulium damnosum Theobald (Diptera: Simuliidae) complex collected in forest zones of southeast Ghana and southwest Togo between 1977 and 1996 showed that the Djodji form of Simulium sanctipauli Vajime & Dunbar, a vector of onchocerciasis, was eliminated in 1988 by larvicide operations conducted by the World Health Organization (WHO) Onchocerciasis Control Programme (OCP) in West Africa. No members of the form were identified amongst 997 larvae collected up to 8 years after systematic control operations began in February 1988. The results are discussed in relation to estimates of the numbers of samples required to certify elimination and the possibility that other members of the S. damnosum complex were also eliminated by the OCP.

[African Program for Onchocerciasis Control (APOC): Onchocerca volvulus transmission by Simulium damnosum s. l. in two regions of the Central African Republic]. / Programme africain de lutte contre l'onchocercose (APOC): transmission d'Onchocerca volvulus par Simulium damnosum s. l. dans deux régions de la République Centrafricaine.

Entomological baseline data were collected in the villages of Zinga and Boali-Falls in Central African Republic (CAR) in view of the long term impact assessment of community-directed treatment with ivermectin (CDTI). Morphological determinations revealed that flies caught in both sites belong to the sub-group Sou/Sq. In Boali, the nuisance was relatively high with biting rates averaging 243 bites/man/day, with a parous rate of 61.6% and a crude annual transmission potential (ATP) of 8,259 infective larvae/man/year; and the average number of infective larvae per 1,000 parous flies was 177. In Zinga, the mean biting rate was 191 bites/man/day, with a parous rate of 51.6%, a crude ATP of 3,422, and 86 infective larvae per 1,000 porous flies. In conclusion, the vectorial capacity and the entomological indices recorded are characteristic of high onchocerciasis transmission zones. However, some of the infective larvae found, maybe of animal origin, need identification to better determine the real level of endemicity.

The current status of onchocerciasis in the forest/savanna transition zone of Côte d'Ivoire.

Onchocerca volvulus exists in at least two strains in West Africa, while its black-fly vectors consist of sibling species, dwelling in the savanna and forest/transition zones. In transition and degraded forest zones both parasite strains and different sibling species of the vector can be sympatric. The strain of parasite in infected humans and in vector black-flies was determined in two bioclimes along the Bandama river of Côte d'Ivoire. The upper Bandama is located in the savanna bioclime while the Middle Bandama is located in a degraded forest zone. At both sites, savanna-dwelling sibling species of the Simulium damnosum sensu lato species complex predominated. The severe-strain of O. volvulus was the predominant strain at both sites. However, severe-strain parasites represented a significantly larger proportion of those found in the vector population than in the human population in the degraded forest of the Middle Bandama. These data suggest that in degraded forest areas recently invaded by savanna-dwelling species of S. damnosunz s.l. transmission of the severe-strain of the parasite might be more efficient than transmission of the mild-strain.

Onchocerciasis in West Africa after 2002: a challenge to take up.

Initially planned for a 20 year life time, the Onchocerciasis Control Programme in West Africa (OCP) will have finally continued its activities for nearly three decades (vector control alone from 1975 to 1989, then vector control and/or therapeutic treatment until 2002). Although onchocerciasis is no longer a problem of public health importance nor an obstacle to socio-economic development in the OCP area, the control of this filariasis is not over because OCP never aimed at eradication, neither of the parasite (Onchocerca volvulus), nor of its vector (Simulium damnosum s.l.). In 2003, the eleven Participating countries of OCP will take over the responsibility of carrying out the residual activities of monitoring and the control of this disease. This mission is of great importance because any recrudescence of the transmission could lead in the long run to the reappearance of the clinical signs of onchocerciasis, if not its most serious manifestations. For epidemiological and operational reasons, and given the disparity in national health policies and infrastructures, the capacities of the countries to take over the residual activities of monitoring and control of onchocerciasis are very unequal. Indeed, the interventions to be carried out are very different from one country to another and the process of integrating the residual activities into the national health systems is not taking place at the same pace. This inequality among the countries vis-a-vis the challenges to be met does not, however, prejudge the epidemiological situation after 2002 whose evolution will also depend on the effectiveness of the provisions made before that date by OCP, then after 2002, by the Regional Office for Africa of the World Health Organization which is currently setting up a sub-regional multidisease surveillance centre.

Deforestation and the spatio-temporal distribution of savannah and forest members of the Simulium damnosum complex in southern Ghana and south-western Togo.

Spatio-temporal data on cytotaxonomic identifications of larvae of different members of the Simulium damnosum complex collected from rivers in southern Ghana and south-western Togo from 1975 until 1997 were analysed. When the data were combined, the percentages of savannah blackflies (S. damnosum sensu stricto and S. sirbanum) in the samples were shown to have been progressively increasing since 1975. The increases were statistically significant (P < 0.001), but the rates of increase were not linear. Further analyses were conducted according to the collection seasons and locations of the samples, to account for possible biases such as savannah flies occurring further south in the dry season or a preponderance of later samples from northern rivers having more savannah flies. These analyses showed that the increasing trend was statistically significant (P < 0.0001) only during the periods April to June and October to December. The presence of adult savannah flies carrying infective larvae (L3) indistinguishable from those of Onchocerca volvulus in the study zone was confirmed by examinations of captured flies. The percentages of savannah flies amongst the human-biting populations and the percentages with L3s in the head were higher during dry seasons than wet seasons and the savannah species were found furthest south (5 degrees 25'N) in the dry season. Comparisons of satellite images taken in 1973 and 1990 over a study area in south-western Ghana encompassing stretches of the Tano and Bia rivers demonstrated that there have been substantial increases in urban and savannah areas, at the expense of forest. This was so not only for the whole images but also for subsamples of the images taken at 1, 2, 4, 8 and 16 km distant from sites alongside the River Tano. At every distance from the river, the percentages of pixels classified as urban or savannah have increased in 1990 compared with 1973, while those classified as degraded or dense forest have decreased. The possibility that the proportionate increases in savannah forms of the vectors of onchocerciasis, and hence in the likelihood of the transmission of savannah strains of the disease in formerly forested areas, were related to the decreases in forest cover is discussed.

Long-term assessment of insecticides treatments in West Africa: aquatic entomofauna.

For the control of the Onchocerca volvulus vector in West Africa, up to 18,000 km of rivers from 1975 and up to 50,000 km from 1989 had been partly sprayed weekly with insecticides as part of the Onchocerciasis Control Programme (OCP). To evaluate the possible short-term and long-term effects of the application of insecticides on the non-target fauna, an aquatic monitoring programme was set up during the initial phase of the programme. By analysing the invertebrate data, which were collected using various sampling strategies from four different countries between 1977 and 1996, this paper evaluates the long-term changes of the invertebrate populations with respect to their taxonomic composition as well as their trophic structures. The discussed results of the applied numerical analysis strategy suggest that neither the taxonomic nor the trophic structures are greatly altered from the range of biological, flow-related variation that normally occurs in the studied river systems. This allows us to conclude that the biological variation found here is ecologically acceptable.

Analysis of the effects of rotational larviciding on aquatic fauna of two Guinean rivers: the case of permethrin.

Within the Onchocerciasis Control Programme about 50,000 km of west African rivers have been regularly sprayed with larvicides to control the vector of dermal filariasis caused by Onchocerca volvulus. Since the beginning of the programme invertebrates and fish data were collected to monitor adverse effects on non-target organisms. The regular series of biological and hydrological data collected in two Guinean rivers were analysed to evaluate the effects of rotational larviciding with particular attention to permethrin, as preliminary acute toxicology tests and semi-field experiments suggest it has stronger effects on non-target fauna in respect to other larvicides. Invertebrates and fish variations in biomass and species richness are seasonal and flow-related and the results presented here do not support any evidence of specific effects of permethrin application on the biological targets monitored. Larvicide applications influence community structures, putting pressure on some taxonomic groups, causing, for example, the rarefaction of some taxa. In spite of the above results, the scarcity of some invertebrate systematic units does not result in a significant reduction of total invertebrate density because of the corresponding increase in other systematic units. In nature the studied aquatic communities would rarely be in equilibrium because of frequent natural stresses, such as drought and spate events, the biological variations discussed are to be considered ecologically acceptable.

Eliminating onchocerciasis after 14 years of vector control: a proved strategy.

From 1976 through 1989, weekly aerial spraying operations against blackflies were carried out along the rivers of a wide savanna area of West Africa (approximately 700,000 km(2)) where onchocerciasis was hyperendemic. The level of endemicity began to decrease significantly after 4 years of vector control and became very low in 1989. This situation has been maintained without any vector control activity or chemotherapy, and no incidence of any new cases has been detected. An ophthalmological study carried out in 2000 has confirmed these good results, showing only cicatricial ocular lesions in the examined population. These results led to the conclusion that 14 years of vector control may achieve long-term elimination of onchocerciasis, even in the absence of chemotherapy, provided that the treated areas are not subjected to any contamination by exogenous parasites carried in infected humans or flies.

Risk assessment of etofenprox (Vectron) on non-target aquatic fauna compared with other pesticides used as Simulium larvicide in a tropical environment.

Within the rotational scheme developed by the Programme to fight the resistance of Simulium damnosum to chemical larvicides, there was an operational gap at discharges between 5 and 70 m3 s(-1) for the treatment of rivers where resistance to organophosphates was present. The use of permethrin and carbosulfan was precluded because of risk of environmental impact and, Bacillus thuringiensis ser. H-14 treatments were not envisageable due to cost and logistics constraints. Among the possible complementary groups of larvicides tested, the pseudo-pyrethroids, held promise, because of a mode of action similar to that of pyrethroids, but along with a usually lower toxicity for fish. Etofenprox, one of the pseudo-pyrethroids tested, shows a global detachment of non-target insects in 24 h close to that of pyraclofos, an organo-phosphorus compound (27 against 23%). In laboratory conditions, six times the operational dose which is 0.03 mg l(-1) 10 min, is needed to cause 50% mortality of Caridina sp. (a small shrimps species) and 30 times this same dose for 95% mortality. For fish species, a safety margin of 400-800 times the operational dose is observed for Oreochromis niloticus and 200-400 times for Tilapia zillii.

Pool screen polymerase chain reaction for estimating the prevalence of Onchocerca volvulus infection in Simulium damnosum sensu lato: results of a field trial in an area subject to successful vector control.

Detection of infective parasites in the vector population can be an early indicator of recrudescence in areas freed of new cases of onchocerciasis. However, dissection of vector black flies is inefficient in areas subject to effective control. Recently, a polymerase chain reaction (PCR)-based assay has been used to detect a single Onchocerca volvulus-infected black fly in pools containing large numbers of uninfected flies. This method had not been validated on wild-caught black flies in an area subject to effective vector control. Here, we report a method of restricting the pool screen PCR assay to infectious parasites and the results of a field test in an area subject to long-term vector control. The prevalence of infection determined by dissection did not differ from that determined by pool screen PCR. The results suggest that the PCR assay may be a useful tool for epidemiologic surveillance for 0. volvulus infection.

Long-term quantitative ecological assessment of insecticides treatments in four African rivers: a methodological approach.

In West Africa different insecticides had been applied in selected river areas for the reduction of the blackfly populations vectors of Onchocerca volvulus, a parasite causing blindness. To evaluate the possible long term effects of the larvicides on the non target fauna an aquatic monitoring programme has been up from the initial phase of the project. Addressing the attention to the invertebrates data collected in four countries during a maximum period ranging from 1977 to 1996, this paper shows and discusses the data analysis strategy for the measure and interpretation of the biological variation. In particular the application of quantitative ecological analysis methods: Principal Component Analysis, rank abundance models and the community diversity indexes, is critically discussed and comments are given to the ecological interpretation of the results.

The impact of Mectizan on the transmission of onchocerciasis.

For many years there was no suitable drug available for the control of onchocerciasis. The advent of Mectizan (ivermectin, MSD; an effective microfilaricide), its registration in October 1987 for the treatment of human onchocerciasis, and its suitability for large-scale application were major break-throughs in the control of human onchocerciasis via chemotherapy. Several studies, both fly-feeding experiments and community trials, have established that Mectizan treatment causes a significant reduction in the transmission of infection. Although long-term treatment in some isolated foci (such as occur in the New World and in some hypo- and meso-endemic areas elsewhere) appears to interrupt transmission, more prolonged treatment is required to prove if transmission can be stopped. Advantage could be taken of the significant impact of Mectizan on transmission by giving treatment while or just before transmission by blackflies is most intense.

Blackfly control: what choices after onchocerciasis?

Blackflies are reappearing in areas of West Africa where they used to be controlled with insecticides because they were vectors of the parasite Onchocerca volvulus. Even though they no longer transmit onchocerciasis in these areas they can hinder optimal land use through their biting behaviour. The authors discuss the problems associated with resuming the use of insecticides to control the blackfly and recommend that ground treatment be restricted to areas where it is likely to be effective on a continuing basis. In communities lacking technical and financial resources the only alternative consists of individual protection through the use of repellents or protective clothing.

PIP: Biting insects can be a major inconvenience to people and can even cripple socioeconomic development. Since the transmission of Onchocerca can be blocked by destroying the blackfly vector in its larval stage, blackfly control has been practiced in West Africa since 1975 at the regional level as part of the Onchocerciasis Control Program. Since development of the insect from egg to nymph rarely takes longer than 1 week, spraying is conducted at weekly intervals. Treatments are delivered mainly from the air due to the large number of breeding sites and the difficulty of reaching most of them overland. Vector control remains the preferred approach to onchocerciasis control in regions open to reinfection by blackflies from untreated areas in which the disease is hyperendemic. Aerial spraying, however, has ceased in regions where there is virtually no longer any risk of contracting onchocerciasis. Blackflies are therefore reappearing in areas of West Africa where they used to be controlled with insecticides. Even though these flies no longer transmit onchocerciasis in the areas, their biting behavior can thwart the optimal use of land. With certain exceptions, controlling blackflies is not necessarily the best way of ensuring the long-term development of areas freed from onchocerciasis. Since commercially available products, usually based upon pyrethroids, are too expensive for most communities concerned, and protective clothing is unfeasible due to their high cost and the tropical climate, an inventory of locally-used repellents is being prepared for use.

Environmental assessment of larvicide use in the onchocerciasis control programme.

The objective of the Onchocerciasis Control Programme (OCP) is to eliminate onchocerciasis as a disease of public importance and as an obstacle to socio-economic development. The OCP was initially based solely on the control of the blackfly vector, Simulium damnosum sensu lato, by insecticide spraying of the breeding sites on river systems, where larval stages develop. Results of monitoring the environmental effects and the process of risk assessment for new insecticides are reviewed. The achievements of this strategy are outlined here by Davide Calamari, Laurent Yameogo, Jean-Marc Hougard and Christian Leveque.