A milestone toward ending river blindness
Tuesday, March 31st, 2009Onchocerciasis (“river blindness”), caused by the filarial roundworm Onchocerca volvulus, is transmitted to humans by the bite of an infected black fly. The parasite causes eye damage that can lead to blindness and skin disease. Brought to the Americas from Africa by the slave trade, onchocerciasis is present in six countries in Latin America. The disease is caused by a round worm and is transmitted to humans by the bite of an infected black fly. Once in a human, the adult worms produce larvae that circulate through the body, causing itching or even blindness. Ivermectin, a drug that kills the larvae, is delivered by public health authorities in countries where the disease is present. If the larvae are killed, then the disease cannot be transmitted to more people. People living in the Escuintla-Guatemala focus, a region in Guatemala where the disease was common, have been taking ivermectin for many years. The Ministry of Health of Guatemala believes that onchocerciasis is no longer being transmitted in the area. To prove that there is no more transmission of the disease, researchers examined the eyes of residents of the area to see if they could find any evidence of the worms. They also conducted analyses of blood in school children to see if they had ever been exposed to the worm, and they caught thousands of black flies and tested them to see if they were infected. These evaluations found no evidence of transmission of the disease in the Escuintla-Guatemala focus. As a result, local public health authorities can stop giving ivermectin and invest their human resources in other important diseases.
Escuintla is now the second of four Guatemalan areas to have stopped the transmission of river blindness. To date eight of 13 endemic study areas in Latin America have ended the transmission of the disease, largely through health education and semiannual mass distribution of ivermectin. Ivermectin had been given to 85 percent of the at-risk Escuintla population of 50,000 since 2001 by the Guatemala Ministry of Public Health and Social Assistance (MPHSA). In 2007, the MPHSA, together with the Onchocerciasis Elimination Program for the Americas (OEPA), The Carter Center, the CDC and the Universidad del Valle de Guatemala launched an evaluation in Escuintla to determine whether transmission had been interrupted and if semiannual treatment could be suspended, following guidelines of the World Health Organization (WHO). This evaluation led to the recommendation that treatment could be halted. Escuintla has now begun a three-year surveillance phase to ensure that infection does not reoccur in the absence of ivermectin distribution.
Successful Interruption of Transmission of Onchocerca volvulus in the Escuintla-Guatemala Focus, Guatemala. 2009 PLoS Negl Trop Dis 3(3): e404
Elimination of onchocerciasis (river blindness) through mass administration of ivermectin in the six countries in Latin America where it is endemic is considered feasible due to the relatively small size and geographic isolation of endemic foci. We evaluated whether transmission of onchocerciasis has been interrupted in the endemic focus of Escuintla-Guatemala in Guatemala, based on World Health Organization criteria for the certification of elimination of onchocerciasis. We conducted evaluations of ocular morbidity and past exposure to Onchocerca volvulus in the human population, while potential vectors (Simulium ochraceum) were captured and tested for O. volvulus DNA; all of the evaluations were carried out in potentially endemic communities (PEC; those with a history of actual or suspected transmission or those currently under semiannual mass treatment with ivermectin) within the focus. The prevalence of microfilariae in the anterior segment of the eye in 329 individuals ($7 years old, resident in the PEC for at least 5 years) was 0% (one-sided 95% confidence interval [CI] 0–0.9%). The prevalence of antibodies to a recombinant O. volvulus antigen (Ov-16) in 6,432 school children (aged 6 to 12 years old) was 0% (one-sided 95% IC 0–0.05%). Out of a total of 14,099 S. ochraceum tested for O. volvulus DNA, none was positive (95% CI 0–0.01%). The seasonal transmission potential was, therefore, 0 infective stage larvae per person per season. Based on these evaluations, transmission of onchocerciasis in the Escuintla-Guatemala focus has been successfully interrupted. Although this is the second onchocerciasis focus in Latin America to have demonstrated interruption of transmission, it is the first focus with a well-documented history of intense transmission to have eliminated O. volvulus.
Related:
- River blindness and drug resistance
- Neglected Tropical Diseases in Latin America and the Caribbean
- Elimination of elephantiasis







