Abstract
BackgroundOnchocerciasis is a leading cause of blindness worldwide, hence elimination of the infection is an important health priority. Community-based treatment programs with ivermectin form the basis of control programs for the disease in Latin America. The long-term administration of ivermectin could eliminate Onchocerca volvulus infection from endemic areas in Latin America.MethodsA strategy of annual to twice-annual treatments with ivermectin has been used for onchocerciasis in endemic communities in Ecuador for up to 14 years. The impact of ivermectin treatment on ocular morbidity, and O. volvulus infection and transmission was monitored in seven sentinel communities.ResultsOver the period 1990–2003, high rates of treatment coverage of the eligible population were maintained in endemic communities (mean 85.2% per treatment round). Ivermectin reduced the prevalence of anterior segment disease of the eye to 0% in sentinel communities and had a major impact on the prevalence and transmission of infection, with possible elimination of infection in some foci.ConclusionThe distribution of ivermectin in endemic communities in Ecuador might have eliminated ocular morbidity and significant progress has been made towards elimination of the infection. A strategy of more frequent treatments with ivermectin may be required in communities where the infection persists to achieve the objective of elimination of the infection from Ecuador. The elimination of the infection from an endemic country in Latin America would be a major public health achievement and could stimulate the implementation of elimination strategies in other endemic countries.
Highlights
Onchocerciasis is a leading cause of blindness worldwide, elimination of the infection is an important health priority
The Onchocerciasis Elimination Program for the Americas (OEPA) has coordinated the distribution of ivermectin since 1991 in the six endemic countries in Latin America (Brazil, Colombia, Ecuador, Guatemala, Mexico and Venezuela) with two principal goals: to eliminate morbidity caused by onchocerciasis by 2007 and to eliminate the infection where possible using a strategy of mass treatment of endemic communities with ivermectin [5]
The National Program for Onchocerciasis Elimination in Ecuador has pioneered the use of community health workers to distribute ivermectin and the integration of ivermectin distribution within primary health care activities
Summary
Onchocerciasis is a leading cause of blindness worldwide, elimination of the infection is an important health priority. Community-based treatment programs with ivermectin form the basis of control programs for the disease in Latin America. The long-term administration of ivermectin could eliminate Onchocerca volvulus infection from endemic areas in Latin America. Onchocerciasis is an important blindness-causing disease resulting from infection by the filarial parasite Onchocerca volvulus, transmitted by Simulium blackflies. It has been suggested that the infection could be eliminated from the Americas, through twiceannual treatments with ivermectin to greater than 85% of the eligible population at risk for onchocerciasis over a period of 10–15 years, via the interruption of the transmission of infection and death of adult parasites by senescence [7]
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