Uganda annual NOTF secretariat technical report to Technical Consultative Committee (TCC): January 2008

/ 5c' &K t INATION SURVEILLANCE ACTIVITIES IN ASWA AND SIISA SUB.FOCI IN ITWARA FOCUS, KABAROLE DISTRICT, WESTERN UGANDA. ORIGINAL: English r1z I lcr-26 eviC 3rrl' esa UP, AHU, SFlB F"1 il Lr,-biR 3i; Ao. r Aaf rtLsr i Y1.illc; I NOTF: UGANIDACOUNTRY/: UGANTDA Approval vearz 2007 Renortine Period (Month/Year): JAI\IUARY 2008 Proiect year of this reporfi (circle) 1 2 3 4 5 6 13 t4 8 9 tOlllz Oate s,rUmitteA: Zgth January 2008 ANNUAL NOTF SECRETARIAT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) To APOC Management by 31 Januarv for March TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) il ANNUAL NOTF SECRETARIAT TECHNICAL REPORT TO TECHNICAL CONSULTATTVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country : UGANDA National Coordinator Name: Dr. R. N Signature NOTF Chair Date: 29th January 2008 Signature: Wtd!(*... Date: L:lon..*:.:,..Wt Kl-r' Qz^O:- This report has been prepared by Name: Mr. T.L. Lakrryo Designation: Senior Entomologist Signature: -e^,D.'4 Date29h January 2008 I TABLE OF GONTENTS FOLLOW UP ON TCC RECOMMENDATIONS EXECUTIVE SUMMARY SECTION 1 : BACKGROUND |NFORMATION....... 1 .0 Geography and socioeconomic background.............. 1.1 The vector... 1.2 Background to the current report SECTION 2: POST-ELIMINATION SURVEILLANCE IMPLEMENTATION ....... 6 2.0 Aquatic survey for S. neaveiimmature stages..... ............. 6 2.1 Adult fly catches at established sites. .................7 2.2 Overview of vector elimination activities in the focus ......7 2.4 RESULTS ........ 2.4.1 Aquatic survey for S. neaveiimmature stages..... 2.4.2 Adult fly catches at established sites........ 2.4.3 Overview of vector elimination activities in the focus 2.5 DTSCUSSTON ............... 11 2.5.1 Recommendations of TTC 25............ .... 11 2.5.2 Aquatic surveys, adult catches and review of elimination status............ 12 SECTION 3: AGHIEVEMENTS, STRENGTHS, CHALLENGES ETC. 13 3 4 5 5 6 6 7 7I 9 3.0 Achievements.... 3. 1 Strengths........... 3.2 Opportunities.... 3.3 Constraints 3.5 Recommendations ............. 3.6 Action plan and budget for the next 12 months 3.7 Acknowledgements .... 3.8 References........ 13 13 13 13 14 14 14 15 2 WHO/APOC, 20 January 2008 FOLLOW UP ON TCC RECOMMENDATIONS TCC session: 25 held on 10'15 September 2OOl Number of Reconanenddion in the Report TCC RECOMMENDAIION ACTIONS TAKEN BY THE NOTF SECREruRIAT FOR TCC/A-POC MGT USE ONLY Two Initiation of the procedures for certification of vector elimination. TCC of APOC to draft criteria for certification so as to guide NOTF and other relevant stakeholders. Budgets for potential entomological activities tlat may have to be conducted in the focus should be integrated into the Mininnrm Activity Package. NOTF will offrcially write a request letter to the respective Chief Administrative officers to incorporate post- elimination surveillance activities in their district plan once the period of certification is made clear by APOC. , WHO/APOC, 20 Januarv 2008 EXECUTIVE SUMMARY Itwara focus is located around the ltwara forest reserve about 25 km northeast of Fort Portal, the headquarters of Kabarole district. The focus was hyper endemic of onchocerciasis with S. neavei s.s. as vector breeding in Sogohi, Siisa and Aswa river systems. This main focus is not completely isolated from the two secondary foci on the Siisa and Aswa river systems to the east. Following the cessation of surveillance activities in the main focus, effort has been focused on the two secondary foci. During the period under review, out of the 3,983 crabs caught from the key checkpoints in Aswa sub-focus, all were negative for Simulium neaveiimmature stages. Similarly, in Siisa sub-focus, the 1 ,122 crabs caught were negative for immature stages of S. neavei. Also at the three operational catching sites, no adult S. neavei was caught. Based on these data, it can be assumed that onchocerciasis transmission has been interrupted in the two sub-foci of Siisa and Aswa. Since now more than 4 years, it is possible that the vector has been eliminated. With a vector free status for over 4 years and ivermectin treatments for 14 years, onchocerciasis should be on a rapid decline and the status must be quite different from other foci with single intervention. Furthermore, observing from infestation trend of fresh water crabs (Potamonautes aloysiisabaudiae) caught in the last 4 years (2O04-2OO7), none of the over 23,000 was positive. This provides a clear evidence of transmission interruption and vector disappearance in the two sub-foci. lt is therefore proposed that post-elimination surveillance activities be conducted four times in a year and this should be incorporated into the district health plans for 2008/9 so that it becomes the responsibilities of the respective districts. And TCC of APOC to draft modalities for the certification of elimination of S. neavei vector in this focus. 4 WHO/APOC, 20 January 2008 SECTION 1: BACKGROUND INFORMATION 1.0 Geography and socioeconomic background Onchocerciasis in Kabarole district is situated to the northern part bordering Kibale district and part of the same focus straddles into Kyenjojo district. Simulium neaveis.s. used to be the only vector in this focus before the plan to control the vector began in 1995. This main focus is not completely isolated from the two secondary foci on the Siisa river system and the Aswa River to the east. The Siisa river area is mainly of a savanna type with subsistence farming and large cattle ranch reaching the Muzizi River to the north. The main source of vector breeding was in the lower Siisa in the Muhangi Forest Reserve, but breeding sites extended high up into cultivated areas in Siisa itself and tributaries of Kyasa and Muhabura. At the moment there is little forest left along the streams due to drastic ongoing deforestation and it is surprising that S. neavei used to survive in this area. The Aswa sub-focus borders the breeding area of S. neavei to the east. Most important sources of the vectors were found in the lower part of the river where it passes the Muhangi Forest Reserve and up to 100% of the crabs were positive for immature stages of S. neavei before river treatment started. River dosing and monitoring continued in these sub-foci but were seriously hindered by insecurities in the area. For instance, activities had to be interrupted several times for several months (from July 1997 to August 1998, September to December 1999). These problems prevented river treatments and monitoring in particular of the lower parts of Siisa and Aswa. This resulted into general delay in detecting a productive breeding site for S. neaveiin a stretch along R. Musabira and a set back in planned elimination activities. 5 WHO/APOC, 20 January 2008 1.1 The vector Simulium neaveis. sfr. was the only vector of O. volvulus in the focus. lt belongs to the S. neaveigroup of species (Subgenus Lewisellum), which develop in an obligate phoretic association with river crabs. The crab Potamonautes aloysiisabaudiae is the phoretic host of S.neavei in the sub-foci. 1.2 Background to the current report A project to eliminate the vector using the larvicide temephos was initiated by GTZin 1995. By the end of 1995 S. neaveis.s had already disappeared in ltwara main focus. However, due to insecurities in the sub-foci of Aswa and Siisa there had been interruption in dosing and monitoring activities. These in turn resulted into a general delay to eliminate the S. neaveivector from river systems in Aswa and Siisa. The present report highlight post-elimination surveillance activities that had been undertaken in these sub-foci in 2OOT.Prospects for vector elimination in these sub-foci are discussed and appropriate recommendations made. SECTION 2: POST-ELIMINATION SURVEILLANCE IMPLEMENTATION 2.0 Aquatic survey for S. neavei immature stages Crab collection and examinations were conducted at key checkpoints in the two secondary foci of Aswa and Siisa. This is one of the methods used to monitor the level of infestation. River crabs were caught using a local metal designed funnel shaped basket traps baited with meat (Raybould, 1969) which were left in the river/stream for about an hour or overnight then examined for crabs carrying larvae and pupae of S. neavei. The information was entered in designed crab forms 6 WHO/APOC, 20 January 2008 2.1 Adult fly catches at established sites. Full day (07:00 to 18:00) fly catches on human bait were carried out usually eight times a month by locally recruited vector collectors at the three established catching sites of Siisa, Andrew's, Tourist (D, E, F; Fig.1) in the two sub-foci. Numbers of flies caught were recorded on hourly basis. Other non-vector species were also recorded. 2.2Overuiew of vector elimination activities in the focus A summary of the trend of crab collection and examination in the two sub-foci of Siisa and Aswa was compiled since 1998 when APOC started to support vector elimination in ltwara focus. 2.3 lvermectin treatment in the sub-foci Treatment record for ivermectin was obtained from the District Onchocerciasis coordinator. This was to show the trend in therapeutic treatment coverage over years. 2.4 RESULTS 2.4.1 Aquatic survey for S. neavei immature stages The results of crab collection and examinations from key check points in the two secondary foci of Siisa and Aswa is shown in Table 1 and Annex 1. !n Aswa sub-focus out of the 3,983 crabs caught from key checkpoints were all-free of S. neaveiimmature stages. Similarly, in Siisa sub-focus, from the three checkpoints sampled, 1,122 crabs were caught and all were negative. 7 WHO/APOC, 20 January 2008 Table 1: Crab collection and examinations in Aswa and Siisa sub-foci, Kabarole district, western Uganda: 2OOl Month Aswa sub-focus Siisa sub-focus 2OOl Number of crabs Number of crabs Caught Positive o/o+Ya Caught Positive olo+ve May June Jul. Aug. sep, Oct Nov Dec 685 501 555 526 455 410 423 428 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 191 77 129 206 118 158 153 90 0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Total 3,983 0 0.0 1,122 0 0.0 %= percentag€, *vc = positive 2.4.2 Adult fly catches at established sites The results of adult fly collections at the three established catching sites are shown in Table 2. There has been no adult S. neaveicaught in any of the three sites (D, E, F, Fig: 1) during the period under review. In Siisa and Tourist catching sites, following the disappearance of S. neaver, S. damnosum started showing up and have remained the only species being caught by the vector collectors with some few S. vorax. I WHO/APOC, 20 January 2008 Table 2: Adult S. neavei catches at the three sites in Siisa and Aswa sub- foci, Kabarole district, Western Uganda. Month (2007) Catching sites May June July August September October November December Siisa 0 0 0 0 0 0 0 0 Tourist 0 0 0 0 0 0 0 0 Andrew's 0 0 0 0 0 0 0 0 Total 2.4.3 Overview of vector elimination activities in the focus The numbers of crabs, which were examined from 1998 to 2OO7 and add up to more than 49,000, are summarized in Table 3. The Table further shows how the infestation rates in the river systems declined and when the sub-foci were probably vector free. 000 I WHO/APOC, 20 January 200E Table 3: Overview of the numbers of river crabs Potamonaufes aloysiisabaudiae examined in the secondary focifrom 1998 to 2007 and percentages of crabs carrying immature stages ol Simulium neavei. Sub focus Siisa Aswa Total Rivers Siisa system Aswa Muko +Musab Year No. crabs %+ve No. crabs olorYa No. crabs % +ve 1 998 1 999 2000 2001 2002 2003 2004 2005 2006 2007 993 1 383 1488 841 1461 2118 2096 1302 1 358 1122 0.4 0.1 0.1 0.1 0.3 0.0 0.0 0.0 0.0 0.0 541 1114 3005 2290 1440 3454 3823 2228 2333 2318 18.0 3.1 1.0 0,4 0.1 0.1 0.0 0.0 0.0 0.0 n.d 90 627 1M1 1364 2305 2393 1012 1 50s 1665 n.d 0.0 24.7 0.2 26.3 0.1 0.0 0.0 0.0 0.0 1 534 2587 5120 5666 4572 7877 8312 4542 51 96 51 05 Total 14162 22il6 12402 19110 tuko = Mukondr rivcr; Musrb = llusabin dver; n.d = no datr; 1y6 = positivc 2.4.4lvermectin treatment in the sub-foci ln Kabarole district only one sub-county is endemic of onchocerciasis with forty communities. Community based ivermectin treatment started in 1991 in partnership with the affected communities, GTZ and Ministry of Health. Later CDTI strategy was introduced by APOC in 1998, they supported for 5 years and this funding ceased in February 2004. Since then the sustainability of CDTI is by the District Local Government. However, in the last four years the therapeutic treatment coverage had been maintained above the required 65% and the mean treatment coverage is79.3o/o (Fig 1). t0 WHO/APOC, 20 Januarv 2008 Fig.1: Annual ivemectin treatment coverage in Kabarole district lor frO&-2OO7 30000 25000 20000 'r5000 1moo 5000 0 2004 2005 2006 ITotal pop ETreated --%cov, 2.5 DISCUSSION 2.5.1 Recommendations of TTC 25 Post-elimination surveillance activities continued in the two sub-foci as was earlier recommended by TTC 23. This post-elimination surveillance was @nducted for 8 months within the period under review. The results do confirm that transmission of onchocerciasis in these sub-foci is possibly permanently interrupted. Since surveillance activities have stopped in ltwara main focus, it is a clear sign that plans for certification of elimination of vector should be in place. This would need the involvement of relevant stakeholders at national and international level. The Ministry of Health Uganda closely with WHO needs to form a committee of very high integrity for certification of elimination in this focus that will be tasked with responsibilities of drafting the required national modalities. However, the committee will be guided by the technical criteria for certification of elimination drawn by the TCC of APOC. As post-elimination E .9 G a oe G oF 83 82 8'l 80 7e$ o o 78$ 77 76 75 74 2007 YeaI ll WHO/APOC, 20 Januarv 2008 a surveillance activities become much reduced in a year, say once or twice, for sustainability purposes, the respective districts may in future have to take up these responsibilities thus the need for incorporating it in their work plans. 2.5.2 Aquatic surveys, adult catches and review of elimination status. The results of aquatic surveys and adult catches gave very strong evidence of vector elimination since no adult fly was caught or immature stages of S. neavei were detected in the several crabs caught. There was no sign of any re- colonization of the two sub-foci, where river treatments were suspended at the end of 2003. Equally there was no measurable transmission of onchocerciasis in these sub-foci since more than 4 years. Following our past surveillance trend, the last positive crab with one larvae was encountered in R. Mukonda on the 14th April 2003. And based on this data, it is now possible to confidently say transmission has ceased in the sub-foci. This has further been complemented by the fact that none of the more than 23,000 crabs caught and examined in the last 4 years (ZOC/-2OOT) was positive providing clear evidence of vector disappearance. However, the delay in achieving transmission interruption in the eastern sub-foci of Siisa and Aswa was attributed to the insecurity that was prevailing in the late 1990's. It is proposed that post-elimination surveillance in the sub-foci be maintained four times a year and this should be the responsibilities of the respective districts and has to be incorporated in their budget for 2008/9. However, the modality for certification of elimination already initiated with MOH and WHO should adopt a sustainable surveillance plan. 12 WHO/APOC, 20 January 2008 2.5.3 Gonclusions Post-elimination surveillance has revealed no sign of S. neavei in the two sub- foci according to the available data. lt possible that transmission has completely ceased since now more than 4 years. The sub-foci have now maintained a vector free status for four years. lt is therefore proposed that post-elimination surveillance activities be incorporated in the respective district budgets as modalities for elimination certiflcation is being worked out by the relevant stakeholders at various levels.. SECTION 3: ACHIEVEMENTS, STRENGTHS, CHALLENGES ETC. 3.0 Achievements o Maintaining S.neavei vector free status for over four years in Siisa and Aswa sub-foci. . No adult S.neaveiwas caught in the three existing monitoring sites during the period under review. 3.1 Strengths o Competent committed field staff based in Kabarole and Kyenjojo districts. . Support from the respective District Health Officers in the post-elimination surveil lance activities. 3.2 Opportunities o Uganda being one of the NTD fast track countries 3.3 Constraints . Regular breakdown of field motorcycles affecting the implementation of field activities. l3 WHO/APOC, 20 Januarv 2008 3.4 Challenges . Disbursement of funds for post-elimination surveillance by districts or Health subdistricts. 3.5 Recommendations Districts/HSD should incorporate post-elimination activities in their budgets. The TCC of APOC draft elimination certification criteria so as to guide the MOH elimination certification committee. 3.6 Action plan and budget for the next 12 months The action plan for the next 12 months for Aswa and Siisa sub-foci is shown in Annex 2. 3.7 Acknowledgements We thank the African Programme for Onchocerciasis Control (APOC) for their continuous financial support made it possible for post-elimination surveillance to be conducted in the sub-foci. We are grateful to WHO/Uganda for coordination and ensuring that activities were executed in time. The Kabarole and Kyenjojo districts field-based Vector Control officers are also thanked for their interest and commitment in all aspects of the post-elimination surveillance activities. The work would have been impossible without the untiring cooperation of the entomological assistants and the vector collectors. We are also indebted to the respective District Health Officers for their support in terms of logistics during the field operations. o o 14 WHO/APOC, 20 January 2008 3.8 Reference Raybould, J.N. (1969). Studies on the immature stages of the Simulium neavei Roubaud complex and their associated crabs in Eastern Usambaras in Tanzania. Investigations in rivers and larger streams. Annals Tropical Medicine and Pa ra sitol og y, 63: 269-287 l5 WHO/APOC, 20 Januarv 2008 l Crab collection and examinatron by river and srte from May-Decembet 2007 in Aswa and Srrsa sub-foci. Number of crabs Caught Positive %+ve Number of Rrver Srte Date Larvae Pupae Cases Srrsa 3983 1 122 51 05 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0for all sub-foci Nilusabrra Aswa Aswa Mukonda tVlukonda Aswa Aswa Aswa Musabrra Aswa l\,4ukonda l\,4ukonda Aswa Aswa Musablra Aswa Aswa Ivlu konda I\,4u konda Aswa Musabrra Aswa Aswa sub-focus Andrew's pornt Ncumbr Kyamutunzr Tounst pornt Wateflng Habyanmana's Butrme's Farm Gaugrng pornt Kyamutunzr Ncumbr Andrew's pornt Watenng Habyarrmana's I\/paro Andrew's pornt Ncumbr Butrme's Farm Gaugrng pornt Habyarrmana's Waterlng Kyamutunzr Ncumbr Andrew's pornt Butrme's Farm Gaugrng pornt Ir,4paro Kyamutunzr Watenng Habyaflmana s Ncumbr Andrew's pornt Butrme's Farm Gaugrng pornt Watenng Habyarrmana's Kyamutunzr Kyamutunzr Ncumbr Andrew's pornt Habyarrmana's Wateflng Andrew's pornt Tounst pornt Ncumbr Kyamutunzr Habyarrmana s Waterrng Tounst pornt lr4 paro Ncumbr Habyarrmana's Gaugrng pornt Butrme's Farm Total 25t5 2515 )alq )a1q 30/5 30/5 31t5 31/5 2516 2716 2716 2916 2ndl7 17 t7 1717 1917 19t7 2017 2017 27t8 2718 29t8 2918 30/8 30/8 31/8 31t8 1719 1719 1 8/9 1 8/9 1 9/9 1 9/9 20t9 16110 17 t10 17110 18t 10 18t10 18111 18111 18111 19/11 20t11 21t11 '18t12 18112 20112 20t12 2111? 21t12 125 79 88 32 152 59 100 50 83 63 133 80 92 50 62 77 69 65 111 136 72 108 73 82 51 18 100 22 44 81 74 68 44 89 97 42 8'1 60 130 107 5b 59 92 47 82 JO 59 49 100 84 100 3983 [,4u konda l\,4ukonda l\4usabrra Mukonda Mukonda usabrra Aswa I\/u konda Mukonda Aswa Aswa Itilusabrra Aswa I\,4u konda l\4ukonda Aswa I\4usabrra Mukonda Aswa Aswa 16 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 aSrrsa Srsa Kyasa [iluhabu ra Srrsa Srrsa tvluhabu ra Srrsa Srrsa tvluha bu ra Srrsa Srrsa Srrsa Srrsa Srrsa l\,4uhabura Srrsa Srrsa Kyasa Kyasa Sirsa sub-focus Catechrst Kanyantonzr crossrng [,4uhabura cf Entry pornt Kanyantonzr crossrng Catechrst Entry pornt Catechrst Kanyantonzr crossrng Entry pornt Catechrst Kanyantonzr crossrng Kyasa cf Catechrst Kanyantonzr crossrng Entry pornt Kanyantonzr crossrng Catechrst [/uhabura cf Footcrossrng Total 28t5 2815 2216 25/6 18t7 18/7 3117 2818 28/8 20t9 21t9 2119 4th/1 0 15/10 15t10 19t11 20t11 20t11 19t12 19112 58 IJJ 63 14 43 50 Jb 119 22 51 45 44 68 4b 3o 51 72 122 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 q 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0I t7 ,t /,.F'\a \n /)t /-^\ ,9- -e Y (; rf lrl = tn- ".1t .^l "l' I €'l Jr I I "'-r'I Ir\l ;_ 5 .:) C o *Lzq')o .-) 'J q - 'Joq + AA I (/) c) .= a C,)C =a)oL- _o a)\>(] a) e a_-t: :l \aJ C- - -\ c)(.r\ :^ ' v)o)>tcv) (ll v# 2 '- 'r- OCI(-\C' ,a5<Its ,^ -ov) P L .C CUocuO- c/) oa 0) -Cc)rr I\J* r o)iI t\ -t-4 \ AN/' t ^:-li\ tuo>/ n6e tr-r ,;7 (-l .-, \ : i t V, 5 L C L o ll -o = e L c- A \ I I I ,( .1 rJ .-\ lj-\\C\(.: \, :a \ t- o) 'L,) a L :l t_ I a \7 ,A C. 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