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.

Impact of combined large-scale ivermectin distribution and vector control on transmission of Onchocerca volvulus in the Niger basin, Guinea.

As part of the WHO Onchocerciasis Control Programme in West Africa (OCP), the attack phase of operations in the Niger basin in Guinea began in 1989 with the simultaneous use of ivermectin and vector control. Larvicide applications coupled with annual large-scale ivermectin distribution have greatly reduced blackfly infectivity (by 78.8% for the number of infective larvae per 1000 parous flies). The combination of vector control and ivermectin has permitted excellent control of transmission. In the original OCP area, it took 6-8 years of vector control alone to obtain an equivalent decrease in blackfly infectivity. For the same number of flies caught, transmission was much higher in areas where ivermectin had not been distributed. The combined use of ivermectin and vector control has opened up new prospects for carrying out OCP operations with, notably, the possibility of reducing larviciding operations.

PIP: As part of the World Health Organization Onchocerciasis Control Programme in West Africa (OCP), the attack phase of operations in the Niger basin in Guinea began in 1989 with the simultaneous use of ivermectin and vector control. All the 16 catching points were in holoendemic foci: 8 in the Niger basin in Guinea and 8 in the original OCP area (Mali, Ivory Coast, Ghana, and Burkina Faso). The data were analyzed according to prevalence of microfilariae in the skin and the mean community microfilarial load (CMFL). Between 1990 and 1992 the number of people in the villages treated increased by a factor of 6. In 1992 a total of 91,840 persons were treated in 550 villages. The study covered 10 years, during which 34,492 blackflies were caught at the 8 sites, 87.8% of which were parous. Larvicide applications coupled with annual large-scale ivermectin distribution had greatly reduced blackfly infectivity (by 78.8% for the number of infective larvae per 1000 parous flies; the number infective larvae in the head fell by 75.7% compared with the 1986-87 data before treatment began). After 2 years of large-scale ivermectin treatment, the reduction was 64.6%. In February and March of 1992 a defective larvicide worsened the situation. The average transmission potential during this period in Guinea was 7.3 compared with 93.7 for the original area. For the same number of blackflies caught, transmission in the original area was 5.6 times higher. The combination of vector control and ivermectin permitted excellent control of transmission. In the original OCP area, it took 6-8 years of vector control alone to obtain an equivalent decrease in blackfly infectivity. For the same number of flies caught, transmission was much higher in areas where ivermectin had not been distributed. The combined use of ivermectin and vector control has opened up new prospects for carrying out OCP operations with the possibility of reducing larviciding operations.

[The necessity of conducting to the end the activities of vector control in the onchocerciasis control program in west Africa: recall of the stakes and proposal of a minimum budget for the period 1998-2002]. / De la nécessité de mener à terme les activités de lutte antivectorielle du programme de lutte contre l'onchocercose en Afrique de l'Ouest: rappel des enjeux et proposition d'un budget a minima pour la période 1998-2002.

After a brief presentation of the Onchocerciasis Control Programme in West Africa (OCP), the authors realize the health and socioeconomic consequences that could follow a cessation of larvicide treatment before 2002 in the south-eastern and western extensions of the Programme. Taking into account that OCP activities are theoretically supported until 1997, but aware of financial constraints that will probably increase from now to 2002, this paper proposes an a minima estimation of the residual vector control activities for a "phasing out" spread out for five years (1998-2002). These estimations essentially concern the larvicide coverage, the insecticides used, the entomological surveillance, the logistical support and their financial aspects. As far as 48 U.S. $ million amount for 5 years are concerned, the budget allocated for vector control activities should not exceed the third of the global amount allocated to OCP for the actual fourth financial phase of the Programme (1992-1997).

[Control of onchocerciasis vectors in West Africa: description of the logistics adapted for a large-scale public health program]. / La lutte contre les vecteurs de l'onchocercose en Afrique de l'Ouest: description d'une logistique adaptée a un programme de santé publique de grande envergure.

The Onchocerciasis Control Programme (OCP) in West Africa, launched in 1974, includes 11 participating countries and covers more than one million square kilometres. The aim of the OCP is to control blinding onchocerciasis (river blindness) which is caused by the savannah strain of Onchocerca volvulus transmitted by the Simulium damnosum complex. There is no effective macrofilaricide, so vector control to prevent the transmission of the parasite remains the method of choice, despite the availability of ivermectin, a drug which controls ocular morbidity. The potential value of vector control has been demonstrated by the original programme: 14 years activity has eliminated the disease as a public health problem in the areas included. This strategy requires adapted logistical support involving (i) widespread insecticide coverage (27,000 km of river are treated by the OCP during the rainy season), (ii) frequent (weekly) application of larvicide and (iii) prolonged intervention due to the life-span of the worm in the human reservoir, estimated to be approximately 14 years. We describe the vector control operations and their organisation 20 years after the initiation of the OCP. The OCP can be divided into 5 areas of logistic activity. The first covers activities involving insecticide and fuel management for the OCP as a whole: assessment of the requirements for the following year, ordering from insecticide and petrol suppliers, stocking fuel and insecticide at the depots covering the area. The second activity is the treatment of rivers with insecticide. This includes treating the ground with larvicide, the aerial operations run by an independent company supplying 12 helicopters on contract to the OCP, and use of satellite beacons for retransmitting of hydrological data. The third activity is monitoring the impact of larvicides on both the target (adult and larval S. damnosum) and on other fauna (fish, crustaceans and other insects). The fourth activity is field data collection and its processing. This involves a data transmission network to facilitate stock management insecticide application and entomological and hydrological surveillance using computer systems. The fifth activity is the coordination of vector control operations, technical and administrative staff and estimations of the funds available to the Vector Control Unit. The logistic aspects of other large-scale-insect-control programmes world-wide are considered, and the possibility of using the OCP as a model for such programmes (both public health and agricultural) is assessed.

[ Onchocerciasis control program in West Africa: socioeconomic development and risk of recrudescence of transmission. 1. Experimental study of the transmission of Onchocerca volvulus strains from Southwestern Sierra Leone by Simulium sirbanum]. / Le programme de lutte contre l'onchocercose en Afrique de l'ouest: développement socio-économique et risque de recrudescence de la transmission. 1. Etude éxperimentale de la transmission des souches d'Onchocerca volvulus du sud-ouest de la Sierra Leone par Simulium sirbanum.

As part of the return of savanna migrants installed since a long time in forest regions, in the south of Sierra Leone, we carried out an experimental study about a cross-transmission between Simulium sirbanum from Missira (West-Mali) and the forest strain of Onchocerca volvulus in the south-west of Sierra Leone. This study will allow to know if there is a risk of onchocerciasis transmission recrudescence in relation to the reinstallation of these migrants in their native region. Because of the very high limitation to the forest strain of O. volvulus microfilariae output of the peritrophic membrane reduction with savanna black-flies and according to the very low mature parasite out put of S. sirbanum with this strain observed along this experimentation, the forest strain of O. volvulus from the south Sierra Leone appears maladjusted to S. sirbanum, the main vector of onchocerciasis in savanna regions. This observation implicates a very low intensity of transmission for this forest strain by savanna onchocerciasis vectors. The return of savanna migrants in their native region, installed in the south Sierra Leone since several decades, could not be, in a short time, an origin of onchocerciasis recrudescence in savanna regions of the Onchocerciasis Control Programme area cleaned by an effective vector control carried out since 1975 sustained now by a chemotherapeutic treatment reducing the human parasite reservoir. However, the preservation of this acquired necessitates an epidemiological supervision increased, because the interactions between the vector and the parasite for a long time could carry away a mutual adaptation and a sickness recrudescence.

[Onchocerciasis control program in West Africa: socioeconomic development and risk of recrudescence of transmission. 2. Experimental study of the transmission of Onchocerca volvulus strains from Southwestern Sierra Leone by Simulium yahense and Simulium squamosum]. / Le programme de lutte contre l'onchocercose en Afrique de l'ouest: développement socio-économique et risque de recrudescence de la transmission. 2. Etude éxpérimentale de la transmission des souches d'Onchocerca volvulus du sud-ouest de la Sierra Leone par Simulium yahense et Simulium squamosum.

The movements of human populations towards the mining wealth of the northern parts of Sierra Leone are favorable to a high contact rate between onchocerciasis patients coming from the south-western area of this country and the vector species Simulium yahense and Simulium squamosum which assume the essential of onchocerciasis transmission in the above-mentioned mining area. In fact, the Onchocerca volvulus strains concerned by this contact seem to be more pathogenic than those locally transmitted. In order to assess the danger it could represent for the Onchocerciasis Control Programme in West Africa, we carried out the experimental study of transmission which may result from this contact when more or less infected onchocerciasis patients are involved. The results indicated that this transmission by S. yahense may reach high proportions only when heavily infected onchocerciasis patients are implicated. We took also notice of the low capacity of S. squamosum to transmit the O. volvulus strains from the south-western Sierra Leone, irrespective of the microfilarial load of patients. Thus, in the most favorable conditions of a high parasite-vector contact of the study, involvement of S. yahense and onchocerciasis patients with high skin microfilarial loads is the only occurrence to which a high risk of intensive transmission may be related. The authors consider that the probability of such a risk occurring will be drastically reduced, due to the considerable decrease of skin microfilarial loads in human communities which regularly have the advantage of ivermectin (Mectizan) mass treatments.

[Importance and role of spreading larvicides on the soil in river beds for the control program against onchocerciasis in west Africa]. / L'importance et le rôle des épandages larvicides au sol dans l'aire du Programme de lutte contre l'onchocercose en Afrique de l'Ouest.

The control of blackfly is based on larvicide spraying in rivers where the insects breed and their larval stages are vulnerable. The first technique for large-scale operations, consists of using aircraft in the same way as for mosquito control and crop protection operations. The second technique, which will be discussed in this paper, consists of ground treatment of rivers, either directly with a container or with a spraying pump or by boat spraying insecticide in cross strip. In areas of West Africa where onchocerciasis is still prevalent, ground treatment is done to support aerial operations and to a lesser extent to control nuisance in areas where the endemicity of the disease is low. In onchocerciasis-freed zones, control of blackfly aims only at suppressing the nuisance in order to enhance the socio-economic development in areas at unfair disadvantage. This distinction is important for determining the responsibilities of various groups. Vector control to interrupt the transmission of onchocerciasis is the mandate of OCP while the control of nuisance is the responsibility, depending on the circumstances, of the private sector, the government and/or village communities. In this paper, we have attempted to highlight the objectives of such treatments, the responsibilities of various groups and the prospects in West African countries located in the Onchocerciasis Control Programme area. We also present the situation of ground larviciding in countries outside the Programme, in temperate as well as tropical conditions, in order to provide some basis for the development of ground treatment strategies in the OCP area.

[Evaluation of control measures against Simuliidae in the framework of the OCP (Onchocerciasis Control Program)]. / Evaluation des moyens de lutte contre les simulies dans le cadre du programme OCP (Onchocerciasis Control Programme).

To control the vector S. damnosum s.l., the Onchocerciasis Control Programme in West Africa (OCP) uses larvicides which are sprayed mainly by air. Despite the more or less reversible resistance of some species of the S. damnosum complex to the organophosphorus compounds (temephos and chlorphoxim), the Programme has succeeded in finding effective replacement insecticides. These larvicides, which are used in rotation, taking into account the river discharges, blackfly species present, and their susceptibility to the different insecticides, have made it possible to maintain the good results obtained by the Programme. Through vector control alone, OCP has been able to bring the disease under control in more than 90% of the initial area. Resettlement is taking place on the fertile lands which were formerly deserted because of onchocerciasis and many socioeconomic development projects are currently being carried out. The extensions made towards the western and the southern parts of the Programme area and the use of ivermectin, a microfilaricide, will enable these results to be improved further.