Onchocerciasis Elimination Update and Committees in END in Africa Countries

November 30th, 2017

Togo's Mo River. Fast flowing rivers are good breeding sites for the black flies that spread onchocerciasis.

Togo’s Mo River: Fast flowing rivers are good breeding sites for the black flies that spread onchocerciasis. Photo: FHI 360

Human onchocerciasis (oncho), or river blindness, is a disease caused by Onchocerca volvulus, a parasitic microscopic worm transmitted by black flies (called Simulium), that affects the skin and eye, and can end in irreversible blindness. The disease is known as ‘river blindness’ because the vector (black flies or Simulium) are insects that breed in fast-flowing rivers and streams and bite humans near these sites.

Although the World Health Organization (WHO) verified elimination of oncho in Colombia (2013), Ecuador (2014), Mexico (2015), and Guatemala (2016), the disease is currently of public health importance in 31 countries in sub-Saharan Africa, two countries in Latin America (in the Yanomami area in the Amazonian regions of Brazil and Venezuela), and in Yemen.

Since oncho is considered one of the leading causes of blindness in many African countries, the global oncho elimination program is currently receiving enormous support from non-governmental organizations; donors such as the United States Agency for International Development (USAID), the United Kingdom’s Department for International Development (DFID), and the Bill and Melinda Gates Foundation (BMGF); and Merck & Co., Inc.’s Mectizan Donation Program, which is providing the medicine used to treat the disease (ivermectin or Mectizan) free of charge for as long as needed.

Origin and END in Africa Support for Onchocerciasis Elimination Committees

Participants register for an onchocerciasis survey in Twifo-Adi-Mokwa district, Central region, Ghana. Photo: FHI 360

Participants register for an onchocerciasis survey in Twifo-Adi-Mokwa district, Central region, Ghana. Photo: FHI 360

Based on experiences in the Americas and Africa, WHO developed guidelines in 2016 for stopping mass drug administration (MDA) and verifying elimination of human oncho. One of the recommendations in the guidelines is that Ministries of Health (MOH) of the affected countries establish oncho elimination committees (OECs) for independent oversight of national efforts around oncho elimination. These committees should consist of international and national experts who can guide national oncho programs to make optimal strategic decisions through the review of program data.

Since 2016, the END in Africa project has been working with the national oncho programs of 6 countries—Burkina Faso, Cote d’Ivoire, Ghana, Niger, Sierra Leone, and Togo—to facilitate the formation of OECs. Five of the 6 project countries (Burkina Faso, Ghana, Niger, Sierra Leone, and Togo) now have fully functional OECs with international and national oncho experts.

The END in Africa project provides the following support to the OECs of project countries:

  1. Coordination of OEC meetings
  2. Financial support for OEC meetings, including covering the costs of external experts
  3. Technical support for the implementation of meeting recommendations
  4. Active participation in OEC meetings as a member/observer

Oncho Update from END in Africa Countries

Burkina Faso: Burkina Faso estimated in 1984 that approximately one million people were at risk of oncho, with an estimated 35,000–40,000 people already blind from the disease. A national program for oncho was created in 1991 in Burkina Faso to coordinate oncho control efforts in the 34 districts (out of the country’s 70 total districts) that were considered endemic. Currently, only 6 of the previous 34 oncho-endemic districts are still considered endemic. Burkina Faso’s goal is to eliminate oncho, which is one of several neglected tropical diseases (NTD) found in the country, by 2025. Per WHO recommendations, the country created an NTD steering committee and a technical committee in 2015, to improve NTD coordination mechanisms. An oncho elimination subcommittee was also set up and held its first two meetings in April 2016 and January 2017. The technical subcommittee will meet twice a year until 2025 to evaluate progress toward oncho elimination and provide recommendations on the way forward.

Cote d’Ivoire is still in the early phase of NTD/oncho program implementation. It plans to establish an OEC in 2018.

Ghana: Oncho control in Ghana started in 1974. Following limited and inconsistent treatment, remapping for oncho was conducted in 2009. This exercise found that 85 districts should be treated and 131 districts did not need treatment. In line with the goal of eliminating oncho by 2025, the MOH established an OEC to guide the elimination of oncho in Ghana. This 14-member committee of local and international experts and had its first meeting in December 2016. Following an OEC recommendation, the country conducted a nationwide reassessment for oncho in April–May 2017 in 304 communities within 154 districts. Based on the results of this reassessment, the OEC recommended that 41 additional districts must be treated for oncho, bringing the total number of districts to be treated for oncho from 85 to 126.

Niger: Oncho control started in Niger in 1976, and successful control efforts in the 1970s, 1980s, and 1990s resulted in a remarkable reduction in disease prevalence, from 70% in 1976, to 0.25% in 1996. By 2002, oncho prevalence in Niger reached 0%, and prevalence has remained at 0% since then. Oncho transmission is believed to have been interrupted and blindness due to oncho is no longer a problem in Niger. As such, MDA has not been conducted for that disease in Niger since 2002. National oncho control efforts are now focused on demonstrating the absence of the disease in the country using WHO-recommended strategies. Per WHO recommendations, an OEC was established to provide technical advisory support to help Niger complete its disease elimination dossier. Niger’s OEC held its first meeting in January 2017. The committee of national and international oncho experts will continue to meet at least once per year (or as needed) to resurvey oncho data and guide the country toward demonstrating the absence of the disease and conducting surveillance thereafter.

Sierra Leone: Mapping for oncho in Sierra Leone was completed between 2003 and 2005 that showed that 12 of Sierra Leone’s 14 districts should be treated for oncho. A technical advisory committee (TAC) for NTDs (including oncho) was set up in 2016 to guide the national NTD program on the way forward for the elimination of oncho and other NTDs. The TAC has held three meetings since its inception, and the next TAC meeting is scheduled for December 2017.

Togo: MDA for oncho is conducted annually in 17 of the 32 oncho-endemic districts and twice-yearly in the other 15 districts. In March 2016, Togo’s Minister of Health officially established an OEC that is composed of Togolese experts as well as three international oncho experts. This committee is independent of the country’s National Onchocerciasis Control Program and it makes recommendations to that program based on a review of available data. It has met four times since its inception and it is next scheduled to meet in January 2018, when it will review the results of stop-MDA assessments conducted in the 4 oncho-endemic districts of one region (Maritime) and decide whether MDA can be stopped in this region.