ONCHOCERCIASIS DISEASE RIVER BLINDNESS Candace Wells MPH Student

ONCHOCERCIASIS DISEASE (RIVER BLINDNESS) Candace Wells, MPH Student Walden University PUBH 6145 -4 Dr. Robert Marino Winter Term, 2010

After this presentation… � Define Onchocerciasis �Where does the name River Blindness come from � Who and how one becomes infected � Signs and symptoms � Know where is incidence and prevalence greatest � Describe prevention and control measures

What is River Blindness? � Infection caused by parasitic worm Onchocerca volvulus � Spread by Simulium blackfly � Breads rapidly in fast flowing streams Black Fly adult � Infection causes blindness http: //entoplp. okstate. edu/d dd/insects/blackflies. htm The Centers for Disease Control and Prevention[CDC] (2010 a). Onchocerciasis-Disease. Retrieved from http: //www. cdc. gov/parasites/onchocerciasis/disease. html

How are we infected Blackfly deposits O. volvulus into skin when attempting to extract blood. � Lives in fibrous nodules under skin where females can reproduce � Develop within the fly to infective stages, then transmissible to others � Adult larvae is detectable in the skin 10 to 20 months after initial infection. � The Centers for Disease Control and Prevention[CDC] (2010 a). Onchocerciasis-Disease. Retrieved from http: //www. cdc. gov/parasites/onchocerciasis/disease. ht ml

Signs and symptoms � Some do not exhibit symptoms � Others show: �Itchy skin rashes �Nodules under skin �Vision changes

Endemic where? � Basanez et al (2006) reports O. volvulus is endemic in 27 sub-Saharan African countries, Yemen, 6 Latin countries. � Estimated 37 million carry the disease, 90 million at risk in Africa Basanez, M. G. , Pion, S. D. S. , Churcher, T. S. , Breitling, L. P. , Little, M. P. , Boussinesq, M, (2006). River Blindness: A success Story under Threat? Plos Medicine (3), 9, 1454 -1460.

Disease burden � Repeated years of exposure, lesions may lead to irreversible blindness and disfigurative skin diseases � 50% of men in West African countries over the age of 40 have been blinded by this disease � Estimated annual economic loss in the 1970 s was $30 million World Health Organization [WHO] (2010). Prevention of Blindess and Visual Impairment: Onchocerciasis (river blindess)-Disease information. Retrieved from: http: //www. who. int/blindness/partnerships/onchocerciasis_disease_informati on/en/index. html

Onchocerciasis Control Program (OCP) � Launched by WHO in 1974 �In collaboration with World Bank, the United Nations Development Programme (UNDP) and Food and Agriculture Organization (FAO) �Stretched over 1, 200, 000 km 2 to protect 30 million people in 11 countries World Health Organization [WHO] (). Prevention of Blindess and Visual Impairment: Onchocerciasis (river blindess)-Disease information. Retrieved from http: //www. who. int/blindness/partnerships/onchocerciasis_disease_informatio n/en/index. html

OCP Previously based on spray of insecticides by helicopters and aircrafts � In 1987 control operations changed to larviciding combined with ivermectin treatment � Responsible for prevention of 600, 000 cases of blindness � Mass administration of ivermectin once or twice a year reduces morbidity and disability and also lowers transmission �

Control strategies cont Onchocerciasis Elimination Program for the Americas (OEPA) � Initiated in 1993 to eliminate all morbidity from Onchocerciasis in the six affected Latin American countries � Based on biannual mass invermectin distribution � African Programme for Onchocerciasis (APOC) � Launched in 1995 in order to recover the remaining 19 African countries not protected under OCP � Based on annual invermectin distribution � Basanez, M. G. , Pion, S. D. S. , Churcher, T. S. , Breitling, L. P. , Little, M. P. , Boussinesq, M, (2006). River Blindness: A success Story under Threat? Plos Medicine (3), 9, 1454 -1460.

Treatments in 2005 Brazil: 1. 8% of the population in need of treatment for onchocerciasis. � Provided 13, 483 treatments in during this year. � Reached 85% treatment coverage � Guatemala: 4 endemic foci, in which 39% of the population needing treatment � Provided 326, 646 invermectin treatment � Surpassed 85% treatment coverage � Ecuador: single endemic focus and 4. 5% of the population needing treatment � Provided 39, 385 invermectin treatments � Achieved a treatment coverage of >85% � World Health Organization [WHO] (2006). Weekly epidemiological record (30) 293 -296.

Prevention � The best prevention is to avoid being bitten by infected blackfly �By using DEET on exposed skin � Wearing long sleeve shirts and pants � Wearing permethrin treated clothing � No Vaccine available � No drug available

Conclusion Onchocerciasis is a disease worth noting. With the help of the control programs such as the OCP, APOC, and OEPA, this disease is well on its way to being non-existent.

Questions/ Comments � For any questions or comments please feel free to contact me at: �Candace. wells@waldenu. edu

References: The Centers for Disease Control and Prevention[CDC] (2010 a). Onchocerciasis-Disease. Retrieved from http: //www. cdc. gov/parasites/onchocerciasis/disease. ht ml � The Centers for Disease Control and Prevention [CDC] (2010 b). Onchocerciasis FAQs. Retrieved from http: //www. cdc. gove/parasites/onchocerciasis/gen_info/ faqs. html � World Health Organization [WHO] (). Prevention of Blindness and Visual Impairment: Onchocerciasis Control Programme (OCP). Retrieved from http: //www. who. int/blindness/partnerships/onchocercias is_OCP/en/index. html �

References cont… Basanez, M. G. , Pion, S. D. S. , Churcher, T. S. , Breitling, L. P. , Little, M. P. , Boussinesq, M, (2006). River Blindness: A success Story under Threat? Plos Medicine (3), 9, 1454 -1460. � World Health Organization [WHO] (2010). Prevention of Blindess and Visual Impairment: Onchocerciasis (river blindess)-Disease information. Retrieved from http: //www. who. int/blindness/partnerships/onchoce rciasis_disease_information/en/index. html � World Health Organization [WHO] (2006). Weekly epidemiological record (30) 293 -296. �

For Further Reading The Carter Center (2011). River Blindness Program. http: //www. cartercenter. org/health/river_blindness/i ndex. html � The World Bank (2011). African Program for Onchocerciasis Control, Phase II. http: //go. worldbank. org/EEZUW 32 F 20 � Hall, L. R. , Pearlman, E, (1999). Pathogenesis of Onchocercal Keratitis (River Blindness). Clinical Microbiology Reviews (12), 3, 445 -453. �