Abstract

BackgroundIn 2012, the World Health Organization set goals for the elimination of onchocerciasis transmission by 2020 in selected African countries. Epidemiological data and mathematical modelling have indicated that elimination may not be achieved with annual ivermectin distribution in all endemic foci. Complementary and alternative treatment strategies (ATS), including vector control, will be necessary. Implementation of vector control will require that the ecology and population dynamics of Simulium damnosum (sensu lato) be carefully considered.MethodsWe adapted our previous SIMuliid POPulation dynamics (SIMPOP) model to explore the impact of larvicidal insecticides on S. damnosum (s.l.) biting rates in different ecological contexts and to identify how frequently and for how long vector control should be continued to sustain substantive reductions in vector biting. SIMPOP was fitted to data from large-scale aerial larviciding trials in savannah sites (Ghana) and small-scale ground larviciding trials in forest areas (Cameroon). The model was validated against independent data from Burkina Faso/Côte d’Ivoire (savannah) and Bioko (forest). Scenario analysis explored the effects of ecological and programmatic factors such as pre-control daily biting rate (DBR) and larviciding scheme design on reductions and resurgences in biting rates.ResultsThe estimated efficacy of large-scale aerial larviciding in the savannah was greater than that of ground-based larviciding in the forest. Small changes in larvicidal efficacy can have large impacts on intervention success. At 93% larvicidal efficacy (a realistic value based on field trials), 10 consecutive weekly larvicidal treatments would reduce DBRs by 96% (e.g. from 400 to 16 bites/person/day). At 70% efficacy, and for 10 weekly applications, the DBR would decrease by 67% (e.g. from 400 to 132 bites/person/day). Larviciding is more likely to succeed in areas with lower water temperatures and where blackfly species have longer gonotrophic cycles.ConclusionsFocal vector control can reduce vector biting rates in settings where a high larvicidal efficacy can be achieved and an appropriate duration and frequency of larviciding can be ensured. Future work linking SIMPOP with onchocerciasis transmission models will permit evaluation of the impact of combined anti-vectorial and anti-parasitic interventions on accelerating elimination of the disease.

Highlights

  • In 2012, the World Health Organization set goals for the elimination of onchocerciasis transmission by 2020 in selected African countries

  • Calibration and validation The calibrated model captured the majority of observed daily biting rate (DBR) within the 95% Ninety five percent credible interval (CI) for both savannah (dominant vector S. damnosum (s.s.)) and forest contexts (Fig. 2a, b)

  • Scenario analysis Larvicidal efficacy and effectiveness of implementation scenarios Efficacy and effectiveness in savannah settings The mean of the estimated posterior of larvicidal efficacy in the Asubende study was 99% for the savannah-calibrated model. This model predicted a proportional reduction in DBR after 4 or 10 larviciding treatments every 7 days of, respectively, 97% and 100%

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Summary

Introduction

In 2012, the World Health Organization set goals for the elimination of onchocerciasis transmission by 2020 in selected African countries. The Onchocerciasis Control Programme in West Africa (OCP, 1974–2002), initially an anti-vectorial intervention in 11 countries, averted 600,000 cases of preventable blindness and made 25 million hectares of land habitable and productive [5]. The African Programme for Onchocerciasis Control (APOC, 1995–2015), mainly an anti-parasitic intervention in the remaining endemic African countries, averted an estimated 17.4 million disability-adjusted life years (DALYs) [6]. Mass drug administration (MDA) through community-directed treatment with ivermectin (CDTI) has saved an estimated 500,000 DALYs every year at US$7 per DALY [6, 10]. None of these programmes, led to regional elimination of O. volvulus by the time of their closure

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