Abstract
The transition from onchocerciasis control to elimination requires country programmes to rethink their approach to a variety of activities as they move from addressing morbidity to addressing transmission of the parasite. Although the 2016 WHO guidelines provide extensive recommendations, it was beyond the scope of the document to provide guidance on all aspects of the transition. This paper will discuss some of the important issues that programmes are grappling with as they transition to elimination and provide some potential approaches that programmes can use to address them. Although there are some data to support some aspects of the suggested approaches, operational research will be needed to generate data to support these approaches further and to determine how programmes could best tailor them to their own unique epidemiological challenges. Good communication between the national programmes and the broader global programme will facilitate the clear articulation of programmatic challenges and the development of the evidence to support programme decision-making.
Highlights
River blindness, or onchocerciasis, is caused by the filarial nematode Onchocerca volvulus, which is transmitted by the bite of infected blackflies from the Similium genus
More than 198 million people live in areas that are endemic for the parasite, and nearly 132 million people received treatment with ivermectin in 2016.1,12 Treatment is no longer needed for 1.4 million people and has been stopped; four countries have been verified by WHO as having eliminated transmission.[2,6,7,8]
Entomological evaluations with O-150 poolscreen PCR23,24 of blackflies in all transmission zone (TZ) are recommended as part of monitoring and evaluation (M&E) in Phase 1, but may not be immediately practical, given the current laboratory capacity to support these evaluations
Summary
Onchocerciasis, is caused by the filarial nematode Onchocerca volvulus, which is transmitted by the bite of infected blackflies from the Similium genus. In order for countries to eliminate the transmission of onchocerciasis, country programmes must implement MDA in all areas where the transmission of the parasite occurs This first requires elimination mapping, which is an evaluation of the current situation of onchocerciasis endemicity in all areas where transmission may occur and where ivermectin MDA has not been implemented. Either approach requires consideration of where to implement MDA (e.g. does the presence of any transmission in a district require treatment of the entire district?), cross-border issues and the population that should be evaluated during a single transmission assessment.[16] Programmes need to move away from thinking in terms of hyper-, meso- and hypo-endemic when making decisions on where to implement MDA. In areas where lymphatic filariasis (LF) is co-endemic and where MDA for LF is occurring, elimination mapping could be performed in a manner integrated to or coordinated with the first LF transmission assessment
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