Study shows elimination of river blindness feasible

 

Geneva, Switzerland (PANA) - The first evidence that onchocerciasis (river blind ness) elimination is feasible with ivermectin treatment was published Tuesday in the open-access journal PLoS Neglected Tropical Disease s, according to a statement from the World Health Organisation (WHO).

"This evidence is an historic milestone -- it has far-reaching implications for the fight against this disease. Prior to this study we did not know if we would ever be able to stop treatment," said Uche Amazigo, the Director of the Af rican Programme for Onchocerciasis Control (APOC). APOC is the organization charged with implementing control of the disease across Africa.

The multi-country study showed that treatment with ivermectin stopped further in fections and transmission in 3 specific areas in Africa, where the disease has existed continuously (an endemic area).

Onchocerciasis, called river blindness because the blackfly which transmits the disease breeds in rivers; often blinds people, as well as causing debilitating skin disease. Over 37 million people are infected, often living in poor, rural A frican communities.

Ivermectin kills the larvae but not the adult worms of Onchocerca volvulus, the parasite that causes the disease, so annual or biannual treatments are required t o prevent resurgence.

Merck & Co., Inc., the company that discovered and manufactures the drug, agreed in 1987 to donate the drug free of charge to countries where onchocerciasis is e ndemic. This has resulted in annual treatments to all eligible community members – over 60 million people were treated in 26 African countries in 2008.

But although this large scale treatment has enabled the control of onchocerciasi s in Africa, it has not been clear whether it could also be used to eliminate in f ection and transmission to the extent that treatment with ivermectin could be safely stoppe d. Many scientists have doubted whether onchocerciasis elimination with ivermec t in is feasible in Africa, where more than 99% of cases are found.

This new study in three areas in Mali and Senegal, where onchocerciasis was ende mic, has now provided the first evidence of the feasibility of onchocerciasis el i mination with ivermectin in some endemic areas in Africa.

Previously it was thought that elimination of onchocerciasis was only possible i n the limited, isolated areas in the Americas where the disease is endemic. Howe v er, the studies showed that after 15 to 17 years of six monthly or annual treatments , only a few infections remained in the human population.

Transmission levels were below predicted thresholds for elimination, so treatmen t was subsequently stopped in test areas and follow-up evaluations after 1.5 to 2 years showed that no further infections or transmission occurred.

Although further studies are needed to determine to what extent these findings c an be extrapolated to other areas in Africa, the principle of onchocerciasis eli m ination with ivermectin treatment has been established.

Dr Robert Ridley, Director of TDR, the Special Programme for Research and Traini ng in Tropical Diseases (that coordinated the study), said, "This is an excellen t example of how research like this can not only provide important answers to major health qu estions, but with this type of partnership, can also help develop research capac i ty in low income countries."

As a result of the study, the board of APOC has already adopted a new objective for the programme to determine where and when treatment can be safely stopped in

the 16 African countries where APOC is supporting mass ivermectin treatment prog rams.

The studies were undertaken by research teams from the ministries of health of M ali and Senegal, in collaboration with the WHO Multi-Disease Surveillance Centre

in Burkina Faso.
 
Geneva - 21/07/2009
 
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