The onchocerciasis endgame

On July 23, 2009, in onchocerciasis, public health, research, by Karen Grepin

Most infectious disease control programs have a well defined epidemiological end point target. For polio the goal is eradication, for lymphatic filariasis it is elimination, but for other diseases the goal is simply to control the disease to the point where it is no long a public health problem either because the infectious agent is simply too prevalent or because the costs associated with going the last mile are too great.

Currently the goal of onchocerciasis – or river blindness – control in Africa is to reduce the disease to the point where it is no longer a public health problem. In most of Africa, progress towards this goal is achieved through annual and semi-annual mass treatment of communities with ivermectin using the community directed treatment approach developed and advocated by APOC.

It is therefore really exciting news that research conducted by Jan Remme and colleagues in Mali and Senegal and published this month in PLoS Neglected Tropical Diseases suggests that elimination of the disease might also be possible. In two regions in Mali and Senegal, which have been benefitting from ivermectin treatment for years through vestiges of the former OCP program, treatment was stopped and then about a year and a half later researchers investigated subsequent transmission. They were able to conclude that transmission had been successfully interrupted in the areas.

Of course, what works in one area will not certainly work in a another, but it is exciting news that given the current treatment strategies in use in most onchocerciasis endemic regions an endgame – elimination – might be achievable. Coupled with the news that a new macrofilariacide is in field trials and that doxycycline might also be useful to target the adult worms, this is has been a really good year for onchocerciasis control. Thanks to decades of effort from hardworking entomologists and parasitologists this disease might be on its way out – for good.

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