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Richards F, Rizzo N, Diaz Espinoza CE, Monroy ZM, Crovella Valdez CG, de Cabrera RM, de Leon O, Zea-Flores G, Sauerbrey M, Morales AL, Rios D, Unnasch TR, Hassan HK, Klein R, Eberhard M, Cupp E, Domínguez A. One Hundred Years After Its Discovery in Guatemala by Rodolfo Robles, Onchocerca volvulus Transmission Has Been Eliminated from the Central Endemic Zone. Am J Trop Med Hyg 2015; 93:1295-304. [PMID: 26503275 PMCID: PMC4674249 DOI: 10.4269/ajtmh.15-0364] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 07/17/2015] [Indexed: 11/07/2022] Open
Abstract
We report the elimination of Onchocerca volvulus transmission from the Central Endemic Zone (CEZ) of onchocerciasis in Guatemala, the largest focus of this disease in the Americas and the first to be discovered in this hemisphere by Rodolfo Robles Valverde in 1915. Mass drug administration (MDA) with ivermectin was launched in 1988, with semiannual MDA coverage reaching at least 85% of the eligible population in > 95% of treatment rounds during the 12-year period, 2000-2011. Serial parasitological testing to monitor MDA impact in sentinel villages showed a decrease in microfilaria skin prevalence from 70% to 0%, and polymerase chain reaction (PCR)-based entomological assessments of the principal vector Simulium ochraceum s.l. showed transmission interruption by 2007. These assessments, together with a 2010 serological survey in children 9-69 months of age that showed Ov16 IgG4 antibody prevalence to be < 0.1%, meeting World Health Organization (WHO) guidelines for stopping MDA, and treatment was halted after 2011. After 3 years an entomological assessment showed no evidence of vector infection or recrudescence of transmission. In 2015, 100 years after the discovery of its presence, the Ministry of Health of Guatemala declared onchocerciasis transmission as having been eliminated from the CEZ.
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Affiliation(s)
- Frank Richards
- River Blindness Elimination Program, The Carter Center, Atlanta, Georgia; Centro de Estudios en Salud of the Universidad del Valle de Guatemala (UVG), Guatemala City, Guatemala; Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala; Onchocerciasis Elimination Program for the Americas (OEPA), The Carter Center, Guatemala City, Guatemala; Global Health Infectious Disease Program, Department of Global Health, University of South Florida, Tampa, Florida; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Entomology and Plant Pathology, Auburn University, Auburn, Alabama
| | - Nidia Rizzo
- River Blindness Elimination Program, The Carter Center, Atlanta, Georgia; Centro de Estudios en Salud of the Universidad del Valle de Guatemala (UVG), Guatemala City, Guatemala; Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala; Onchocerciasis Elimination Program for the Americas (OEPA), The Carter Center, Guatemala City, Guatemala; Global Health Infectious Disease Program, Department of Global Health, University of South Florida, Tampa, Florida; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Entomology and Plant Pathology, Auburn University, Auburn, Alabama
| | - Carlos Enrique Diaz Espinoza
- River Blindness Elimination Program, The Carter Center, Atlanta, Georgia; Centro de Estudios en Salud of the Universidad del Valle de Guatemala (UVG), Guatemala City, Guatemala; Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala; Onchocerciasis Elimination Program for the Americas (OEPA), The Carter Center, Guatemala City, Guatemala; Global Health Infectious Disease Program, Department of Global Health, University of South Florida, Tampa, Florida; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Entomology and Plant Pathology, Auburn University, Auburn, Alabama
| | - Zoraida Morales Monroy
- River Blindness Elimination Program, The Carter Center, Atlanta, Georgia; Centro de Estudios en Salud of the Universidad del Valle de Guatemala (UVG), Guatemala City, Guatemala; Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala; Onchocerciasis Elimination Program for the Americas (OEPA), The Carter Center, Guatemala City, Guatemala; Global Health Infectious Disease Program, Department of Global Health, University of South Florida, Tampa, Florida; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Entomology and Plant Pathology, Auburn University, Auburn, Alabama
| | - Carol Guillermina Crovella Valdez
- River Blindness Elimination Program, The Carter Center, Atlanta, Georgia; Centro de Estudios en Salud of the Universidad del Valle de Guatemala (UVG), Guatemala City, Guatemala; Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala; Onchocerciasis Elimination Program for the Americas (OEPA), The Carter Center, Guatemala City, Guatemala; Global Health Infectious Disease Program, Department of Global Health, University of South Florida, Tampa, Florida; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Entomology and Plant Pathology, Auburn University, Auburn, Alabama
| | - Renata Mendizabal de Cabrera
- River Blindness Elimination Program, The Carter Center, Atlanta, Georgia; Centro de Estudios en Salud of the Universidad del Valle de Guatemala (UVG), Guatemala City, Guatemala; Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala; Onchocerciasis Elimination Program for the Americas (OEPA), The Carter Center, Guatemala City, Guatemala; Global Health Infectious Disease Program, Department of Global Health, University of South Florida, Tampa, Florida; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Entomology and Plant Pathology, Auburn University, Auburn, Alabama
| | - Oscar de Leon
- River Blindness Elimination Program, The Carter Center, Atlanta, Georgia; Centro de Estudios en Salud of the Universidad del Valle de Guatemala (UVG), Guatemala City, Guatemala; Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala; Onchocerciasis Elimination Program for the Americas (OEPA), The Carter Center, Guatemala City, Guatemala; Global Health Infectious Disease Program, Department of Global Health, University of South Florida, Tampa, Florida; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Entomology and Plant Pathology, Auburn University, Auburn, Alabama
| | - Guillermo Zea-Flores
- River Blindness Elimination Program, The Carter Center, Atlanta, Georgia; Centro de Estudios en Salud of the Universidad del Valle de Guatemala (UVG), Guatemala City, Guatemala; Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala; Onchocerciasis Elimination Program for the Americas (OEPA), The Carter Center, Guatemala City, Guatemala; Global Health Infectious Disease Program, Department of Global Health, University of South Florida, Tampa, Florida; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Entomology and Plant Pathology, Auburn University, Auburn, Alabama
| | - Mauricio Sauerbrey
- River Blindness Elimination Program, The Carter Center, Atlanta, Georgia; Centro de Estudios en Salud of the Universidad del Valle de Guatemala (UVG), Guatemala City, Guatemala; Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala; Onchocerciasis Elimination Program for the Americas (OEPA), The Carter Center, Guatemala City, Guatemala; Global Health Infectious Disease Program, Department of Global Health, University of South Florida, Tampa, Florida; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Entomology and Plant Pathology, Auburn University, Auburn, Alabama
| | - Alba Lucia Morales
- River Blindness Elimination Program, The Carter Center, Atlanta, Georgia; Centro de Estudios en Salud of the Universidad del Valle de Guatemala (UVG), Guatemala City, Guatemala; Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala; Onchocerciasis Elimination Program for the Americas (OEPA), The Carter Center, Guatemala City, Guatemala; Global Health Infectious Disease Program, Department of Global Health, University of South Florida, Tampa, Florida; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Entomology and Plant Pathology, Auburn University, Auburn, Alabama
| | - Dalila Rios
- River Blindness Elimination Program, The Carter Center, Atlanta, Georgia; Centro de Estudios en Salud of the Universidad del Valle de Guatemala (UVG), Guatemala City, Guatemala; Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala; Onchocerciasis Elimination Program for the Americas (OEPA), The Carter Center, Guatemala City, Guatemala; Global Health Infectious Disease Program, Department of Global Health, University of South Florida, Tampa, Florida; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Entomology and Plant Pathology, Auburn University, Auburn, Alabama
| | - Thomas R Unnasch
- River Blindness Elimination Program, The Carter Center, Atlanta, Georgia; Centro de Estudios en Salud of the Universidad del Valle de Guatemala (UVG), Guatemala City, Guatemala; Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala; Onchocerciasis Elimination Program for the Americas (OEPA), The Carter Center, Guatemala City, Guatemala; Global Health Infectious Disease Program, Department of Global Health, University of South Florida, Tampa, Florida; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Entomology and Plant Pathology, Auburn University, Auburn, Alabama
| | - Hassan K Hassan
- River Blindness Elimination Program, The Carter Center, Atlanta, Georgia; Centro de Estudios en Salud of the Universidad del Valle de Guatemala (UVG), Guatemala City, Guatemala; Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala; Onchocerciasis Elimination Program for the Americas (OEPA), The Carter Center, Guatemala City, Guatemala; Global Health Infectious Disease Program, Department of Global Health, University of South Florida, Tampa, Florida; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Entomology and Plant Pathology, Auburn University, Auburn, Alabama
| | - Robert Klein
- River Blindness Elimination Program, The Carter Center, Atlanta, Georgia; Centro de Estudios en Salud of the Universidad del Valle de Guatemala (UVG), Guatemala City, Guatemala; Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala; Onchocerciasis Elimination Program for the Americas (OEPA), The Carter Center, Guatemala City, Guatemala; Global Health Infectious Disease Program, Department of Global Health, University of South Florida, Tampa, Florida; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Entomology and Plant Pathology, Auburn University, Auburn, Alabama
| | - Mark Eberhard
- River Blindness Elimination Program, The Carter Center, Atlanta, Georgia; Centro de Estudios en Salud of the Universidad del Valle de Guatemala (UVG), Guatemala City, Guatemala; Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala; Onchocerciasis Elimination Program for the Americas (OEPA), The Carter Center, Guatemala City, Guatemala; Global Health Infectious Disease Program, Department of Global Health, University of South Florida, Tampa, Florida; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Entomology and Plant Pathology, Auburn University, Auburn, Alabama
| | - Ed Cupp
- River Blindness Elimination Program, The Carter Center, Atlanta, Georgia; Centro de Estudios en Salud of the Universidad del Valle de Guatemala (UVG), Guatemala City, Guatemala; Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala; Onchocerciasis Elimination Program for the Americas (OEPA), The Carter Center, Guatemala City, Guatemala; Global Health Infectious Disease Program, Department of Global Health, University of South Florida, Tampa, Florida; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Entomology and Plant Pathology, Auburn University, Auburn, Alabama
| | - Alfredo Domínguez
- River Blindness Elimination Program, The Carter Center, Atlanta, Georgia; Centro de Estudios en Salud of the Universidad del Valle de Guatemala (UVG), Guatemala City, Guatemala; Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala; Onchocerciasis Elimination Program for the Americas (OEPA), The Carter Center, Guatemala City, Guatemala; Global Health Infectious Disease Program, Department of Global Health, University of South Florida, Tampa, Florida; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Entomology and Plant Pathology, Auburn University, Auburn, Alabama
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