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. 2018 Mar 28;7(1):21.
doi: 10.1186/s40249-018-0406-7.

From river blindness control to elimination: bridge over troubled water

Robert Colebunders  1 , Maria-Gloria Basáñez  2 , Katja Siling  3   4 , Rory J Post  4   5 , Anke Rotsaert  1 , Bruno Mmbando  6 , Patrick Suykerbuyk  1 , Adrian Hopkins  7
Affiliations
Free PMC article

From river blindness control to elimination: bridge over troubled water

Robert Colebunders et al. Infect Dis Poverty. .
Free PMC article

Abstract

Background: An estimated 25 million people are currently infected with onchocerciasis (a parasitic infection caused by the filarial nematode Onchocerca volvulus and transmitted by Simulium vectors), and 99% of these are in sub-Saharan Africa. The African Programme for Onchocerciasis Control closed in December 2015 and the World Health Organization has established a new structure, the Expanded Special Project for the Elimination of Neglected Tropical Diseases for the coordination of technical support for activities focused on five neglected tropical diseases in Africa, including onchocerciasis elimination.

Aims: In this paper we argue that despite the delineation of a reasonably well-defined elimination strategy, its implementation will present particular difficulties in practice. We aim to highlight these in an attempt to ensure that they are well understood and that effective plans can be laid to solve them by the countries concerned and their international partners.

Conclusions: A specific concern is the burden of disease caused by onchocerciasis-associated epilepsy in hyperendemic zones situated in countries experiencing difficulties in strengthening their onchocerciasis control programmes. These difficulties should be identified and programmes supported during the transition from morbidity control to interruption of transmission and elimination.

Keywords: Community drug distributors; Control; Elimination; Epilepsy; Incidence; Monitoring & evaluation; Onchocerciasis; Prevalence.

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Conflict of interest statement

Authors’ information

Robert Colebunders is Professor of Infectious Diseases at the Global Health Institute, University of Antwerp, Belgium, with current research focussing on identifying the cause of nodding disease syndrome and epilepsy in onchocerciasis endemic regions. Maria-Gloria Basáñez is Professor of Neglected Tropical Diseases at the School of Public Health, Imperial College London, currently focussing on the development of NTD mathematical models and their application in public health policy and practice. At the time of contributing to this paper, Katja Siling was a research assistant at the Institute of Tropical Medicine of the University of Antwerp for a multi-disciplinary project investigating the link between onchocerciasis and epilepsy in Cameroon, Tanzania, and Uganda; she is currently pursuing a doctorate in public health at the London School of Hygiene and Tropical Medicine (LSHTM). Rory J Post is an expert on onchocerciasis vectors and their genetics, and member of a number of onchocerciasis elimination committees, with affiliations at the Liverpool John Moores University and the LSHTM. Anke Rotsaert is studying under the supervision of Prof Colebunders at the University of Antwerp. Bruno Mmbando is at the National Institute for Medical Research (NIMR), Tanzania, with research interests in vector-borne and infectious diseases of poverty. Patrick Suykerbuyk is a post-doctoral researcher at the Global Health Institute, University of Antwerp, working on the epidemiology and disease burden of NTDs. Adrian Hopkins was the director of the Mectizan Donation Program until 2016 and is now a consultant on neglected and disabling diseases of poverty.

Ethics approval and consent to participate

Not applicable

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Improving weak onchocerciasis (oncho) elimination programmes. At the core of this effort is the recognition that some of these programmes may not reach elimination goals in the 2020/2025 time horizons but, if strengthened, they can still achieve substantial reductions in morbidity and mortality due to onchocerciasis. This requires (clockwise) the identification of under-performing programmes and investigation of the causes for this, with particular emphasis on improving the geographic (and therapeutic) coverage as well as treatment uptake and compliance. Monitoring and evaluation approaches should be improved with optimised use of current and novel tools; one such tool could be the recognition of early stage morbidity (e.g. prevalence of epilepsy in children) linked with serological markers of exposure
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