Progress report of the World Health Organization for 2001: January - October 2001

------ Onchocerciasis Control Programme in West Africa Programme de Lutte contre I'Onchocercose en Afrique de I'Ouest JOINT PROGRAMME COMMITTEE Office of the Chairman JOINT PROGRAMME COMMITTEE Twenty-second session Washington l0-l I December 2001 JPC . CCP COMITE CONJOINT DU PROGRAMME Bureau du Pr6sident JPC22.2 ORIGINAL: FRENCH October 2001 I f I ,i Provisional agenda item 5 P,BocRnss,, REPORT OF THE WONTU I,TH'ORCA}{IZATION FOR 2OOI (January - October 2001) f - ,ii ^d I rl :,- 3 i1 I # ::tl{ntt' r( fr{ ,F t|,1 .l l. *s --!I|I|IF TABLE OF CONTENTS Page EXECUTIVE SUMMARY ..... VECTOR CONTROL Climatic conditions ...... WHO/AFRO Support to OCP activities. INTERDI SC IPLTNARY RESEARCH Insecticides................ Parasite identification ............. I 4 4 4 6 7 7 8 Aircraft fleet and aerial operations Insecticides and Control strategy. Hydrology and teletransmission Entomological surveillance and evaluation network.... I Monitoring of the aquatic environment .............. IVERMECTIN (MECTIZAN9 DISTRIBUTION AND EPIDEMIOLOGI IVERMECTIN TREATMENT.... ...1............ CAL ACTIVITIES.,.... ,.. I I .. I I .. l3EPIDEMIOLOGICAL EVALUATION........... Epidemiological surveillance in the original Programme area.................. TRANSFER OF ACTIVITIES TO THE PARTICIPATING COUNTRIES Epidemiological evaluation in the extension areas of the Programme ...16 ...17Ophthalmological Evaluations. BIOSTATISTICS AND INFORMATION SYSTEM.. t7 t4 t9 l9 Training.... ...18 ... 18 ...19 Study of blackfly migratory movements and of the genetic variability of the vector and parasite populations.............. Special entomological studies........ Diagnostic tests for the surveillance of onchocerciasis... Epidemiological modelling.......... MACROFIL CHEMOTHERAPY PROJECT. ADMINISTRATION AND SUPPORT SERVICES............. Objectives, organisation and operation of services Administration costs Budget and finance Personnel.. Supplies and services ................ Transport and communications. LIAISON, TNFORMATION AND ADVOCACY ACTIVITIES............. With the Participating Countries........... With OCP and APOC Statutory bodies With the Donors...... With the Evergreen Helicopter Company.. With the scientific community With the general public. Advocacy of activities Documentation Bank .... Institutional relations .... I 20 2t 22 23 23 24 29 29 29 30 30 30 31 3r 3l 32 32 32 32 JJ 5J JJ 34 34Meetings and seminars................ - ____ r"a-- JPC22.2 Page I EXECUTIVE SUMMARY a) The main activities that were carried out in the 2000-2001 period as well as progress made are summarised as follows: As in 1999, the dry season was marked in 2001 by a deficit in rainfall and weaker river flows in all of the basins compared to the same period in 2000. b) The total length of rivers likely to have aerial or ground treatment in 2001 for tansmission control will increase from 11 698 km in 1999 to t3 760 km in 2001. c) The number of helicopters under contract in 2001 ranged from a maximum of five to four in March and May, and three in April. No aerial treatment was carried out in the Eastern Zone for five weeks, from 19 March to22 Apil200l, due to the good entomological situation. In the Westem Zorre onthe other hand, there was no aerial larviciding for three weeks, from l0 to 30 September 2001. This year however, the number of flight hours used during the first nine months of the year has been on the increase (+130.8 hours) compared to the same period during the previous year. This situation is due to (i) the intensification of the treatments and their extension to certain tributaries in order to solve the entomological problems encountered and (ii) an increased use of B.r H-14, an insecticide whose effective dose remains high compared to that of the chemical insecticides. e) The strategy of rotation of the seven insecticides that are available to OCP (temephos, phoxim, pyraclofos, B.t. H-14, permethrin, carbosulfan and etofenprox) continued to be used in order to prevent black fly resistance and to limit the impact of the treatments on the non- target aquatic fauna. However, since June 1999, emphasis has been placed on the use of five main insecticides: B.t. H-14, temephos, pyraclofos, permethrin and etofenprox. The two other larvicides remain available and are used in the rotation strategy when the suscepibility situation and / or hydrological conditions so require. The OCP hydrological monitoring network currently consists of I l0 limnimetric stations of which 54 are equipped with Argos tele-beacons. The monitoring of this network is now the responsibility of four hydrological brigades comprising two national brigades in Guinea (based at Kankan and Faranah), and two OCP brigades (based at Kara and Odiennd). These brigades, with the assistance of the Coordinator of hydrological activities stationed at the Programme's Headquarters in Ouagadougou, ensure (i) the maintenance of the Argos beacons and their redeployment, (ii) the maintenance of the hydrometric stations, (iii) the measurement of the discharges in order to readjust the former hydrograph charts. Overall, the results of the entomological evaluation were satisfactory in all of the basins treated in 2000 where 10 catching points out of the 107 regularly monitored showed an Annual Transmission Potential (ATP) of Onchocerca volvulzs above 100. In 2001, this number stands for the moment at six, pending identification of parasites by the Molecular Biology Laboratory (MBL). As for the transmission of human onchocerca (O. volvulus)by the savanna species of S. damnosum, it is for the moment above 100 infective larvae per person per year in five of these catching points (including Asubendd), against one in 2000. These results may well change by the end of the year with the identification of the parasites by the Molecular Biology Laboratory. d) D g) I -q-' JPC22.2 Page2 h) The fish populations in the treated watercourses of Guinea and COte d'Ivoire showed a general upward trend, and a relative stability respectively. On the other hand on the Pru in Ghana, the regular fall in the catches observed since 1987 seems to have ceased in 1998199 and a clear upward trend was recorded in 2000. Moreover, their coefficients of condition were stable as in the previous years. The aquatic entomofauna at the stations under larviciding showed overall low densities and was dominated by the Hydropsychidae and Chironomidae. On the rivers no longer under treatment, when the parameters of the quality of the aquatic habitat were good, signs of recolonization by some taxa which had been affected by the larvicide treatments were noted, especially Neoperla sp and the Tricorythidae, as opposed to 1999. The Oligoneuriidae on the other hand were still absent from the samples. The activities of the Molecular Biology Laboratory continued in 2001 in the following fields: i) support to operations by the identification (by virtue of specific probes of the DNA of Onchocerca species and O.volvulus strains) of the infective larvae of the parasite collected from infective black flies, or from microfilariae in man, ii) improved knowledge of the pathogenicity of the collected parasites, iii) training of national staff in the identification of the parasites through DNA probes, and of the vectors through the heteroduplex and micro satellite techniques. The results of the study on the vector/parasite compatibility indicate a low level of compatibility between the O. volvulus strains in the two patients from Sierra Leone and the population of S. sirbanum encottntered at Morigbddougou (parasitic productivity = 0.16 %). However, this population shows a more significant vectorial capacity in the onchocerciasis patients from Guinea and Mali (parasitic productivity :2.64 Yo and 1.56 yo), although the latter had a definitely lower parasitic load than those from Sierra Leone. The partial analysis of black fly samples collected from the principal foci of migration (except Sierra Leone for insecurity reasons) revealed the presence of at least three populations of S. sirbanum in the study area. Only one of these populations seems to be involved in the seasonal migrations from the south-west (northern Sierra Leone) to the north-east (Guinea-Mali) at the beginning of the rainy season, with the help of the upward movement of the Inter tropical Front (I.T. F.), and in the opposite direction at the beglnning of the dry season with the help of the harmattan winds. 1) The studies on the early detection of recrudescence and those on the impact of ivermectin on transmission continued under the direction of the national entomologists of the Participating countries. These studies showed: (i) that the entomologists trained by OCP are able to conduct these studies in their respective countries and; (ii) that a black fly collection network at the national level can work well. The rare cases of malfunction in the forwarding of the black flies to the Molecular Biology Laboratory were corrected. The infectivity rates recorded in these studies were generally satisfactory except in Chiasa on the Kulpawn-Mole in Ghana where the value was above the acceptable threshold figure of 0.5 infective females for 1000 females caught. m) CDTI activities were continued in the different countries that practise it. Therapeutic coverages were overall acceptable. The same applies to geographic coverages but the objective of 100% treatment of the villages has not yet been reached in all of the Progrlamme area. The mean geographic coverage registered with the partial results is 77%. That for mean therapeutic coverage is 72Yo. D i) k) I JPC22.2 Page 3 n) o) p) s) q) r) A clear improvement was observed in the results of the epidemiological evaluations carried out in 526 villages of 10 Participating Countries, in the original and the extension areas. The prevalence levels are 0 or less than l0o/o in most of the basins. After five years of ivermectin treatment the prevalences registered in the Bougouriba basin (Burkina Faso) in l0 villages in 2001 range from 0.30% to 6.70/o. When the recrudescence was detected in 1995, the prevalences varied from 0% to 53Yo in this basin. The prevalence which was 64.5Yo in 1995 in Titira in the Upper Keran basin (Togo) came down to 21.7%o in 2001. In Mali, the epidemiological results are satisfactory except in one village in the Bafing basin (Dagari village) with 43.8% of prevalence. In the extension area, the prevalence is 35.9% n Agbogbome and 22.1% in Aguigadji in the Oueme basin (Benin). A prevalence of 35.5% was observed in Cobuncara in Rio Corubal basin (Guinea Bissau). Even if in the zones of special intervention the prevalence levels are not yet those expected, they are on the decline and there is a need to intensifr ivermectin distribution in these ffeas. In Tinkisso basin (Guinea) the prevalence was 50.7% in 1987 in Kamakan in 1987 andOYo in 2001. The transfer of the data to the countries continued this year with particular emphasis on The reinforcement of the training of the national teams. Training sessions were organizedul- Ouagadougou for the epidemiologists and in the bases for the entomologists. This fraining was related to the cleaning and updating of the data banks of the epidemiological and entomological evaluations, and of CDTI. Particular attention was given to the computer input of the longitudinal data accumulated on ivermectin distribution and to the analysis of the epidemiological data. OCP provided the national teams with more powerful additional computer equipment to help with analysis of mapping data. They were also trained in the exploitation of the Geographical lnformation Systems (GIS) for this analysis. During the year 60 fellowships were provided for training in Public Health, Molecular biology, Epidemiology, Entomology and Management of Health Services. The Programme and the partners supported the training/retraining of 1066 health workers and 34 033 community distributors in the countries. The data management skill development continued during this period by the training of 7 persons from 4 participating countries. The OCP Documentation Centre has been busy putting in place a data bank which would be easily accessible and exploitable after the closing of the Programme. This information will also be available on Internet. The integration and decentralization of activities continued in the countries with varying degrees of success. Teams responsible for the implementation of the residual activities are now available and have been trained to the operational level in almost all the countries. The Programme continued to sensitise the countries not only for the rapid and effective integration of the residual activities into their national disease control systems, but also for the funding of these after the closing of OCP at the end of 2002. JPC22,2 Page 4 VECTOR CONTROL Climatic conditions I . The first five months of the year 2001 which correspond to the dry season were marked by a decrease in rainfall and weaker river flows in all of the basins compared to the same period in 2000. It should be noted, however, that the rains in 2000 came earlier and were more abundant as compared to 1999. Early rains were rare and came later in 2001. Aircraft fleet and aerial operations 2. 2001 is the third year of the last four-year aerial spraying contract that is signed between WHO and the < Evergreen Helicopters Inc. )) (EHI) company. As in 2000, a maximum of five helicopters are under contract this year, and WHO guarantees the company the use of 3001.6 flight hours at a rate of 53.6 hours per month for each helicopter contracted. Due to the fluctuations in the intensity of the aerial spraying operations, only three helicopters were under contract in April and four in March and May 2001. 3. Generally, the number of flight hours actually used each year is very close to the number of guaranteed hours. Thus in 2000, the helicopters used 3,004.2 flight hours for larviciding as against 3,019.2 hours in 1999. This year however, the number of flight hours consumed during the first nine months of the year was in the increase (+130.8 hours) compared to the same period in the previous year as shown in Table 1. This situation is due to (i) the intensification of the treatments in order to solve the entomological difficulties encountered on certain rivers and (ii) an increased use of B./ H-14, an insecticide whose effective dose remains high compared to that of the chemical insecticides. 4. Indeed, the total consumption of insecticides from January to September 2001 increased by almost 5%o compared to the same period in 2000 (Table 2). This increase is mainly the reflection of the increased use of B.t. H-14 mentioned above (+15%) to the detriment of the chemical insecticides (-6%), due to a relatively protracted dry season and to the instituted strategy of increased use of biological insecticides. This strategy is aimed at not only controlling black fly resistance or minimizing the risks of development of black fly larvae resistance to the organophosphorous insecticides, but also at reducing the pressure of the chemical insecticides on the non-target aquatic fauna. 5. The only aerial larviciding operations still going on in the original Programme area are those on the tributaries of the Oti in Togo (K6ran, Kara and M6), which were added in 1995 to the basins of the South-Eastern Extension. However, ground larviciding continued on the Dienkoa in Burkina Faso during the period concerned under the supervision of the national team and with technical and financial support from OCP. 6. In the Southern Extension in C6te d'ivoire, only the middle course of the Sassandra and its tributaries the Bagb6 and Bafing are still under larviciding. In the Western Extension, aerial larviciding continued only on the rivers in Guinea. The Niger near Bamako and its tributaries continued to be treated from the ground by the national team of Mali with technical and financial support from the Programme. JPC22.2 Page 5 Table 1. Consumption of flight hours for treatments from January to September 2001 and comparison with the previous period Flieht hours Difference between 2001 and 2000 Difference (in Us$)MONTH 2000 2001 January 255.8 289 33.2 37383.2 February 329.8 349.5 19.7 22t82.2 March 275.2 267.7 -7.5 -8445 April 101.9 98. I -3.8 -4278.8 Mav 183.6 297.4 I13.8 128138.8 June 231.6 285 s3.4 60128.4 July 208.8 224.6 15.8 t7790.8 August 389.2 250.7 - 138.5 -l 5595 1 September 139 183.7 44.7 50332.2 Total 2114.9 2245.7 130.8 147280.8 Table 2. Larvicide consumption from January to September 2001 and comparison with the previous period. Larvicides Quantities used (litres) Difference Jan.- sept. 2000 Jan.- sept. 2001 (in litres) (in US$) Temephos 17t86 16209 -977 -16751 Vectobac I 03684 74400 -29284 -168087 Teknar 71135 r27tot 55965 33 13 l5 Phoxim tt682 5558 -6124 -94804 Permethrin 103s2 7416 -2936 -32232 Carbosulfan 7625 729 -6896 -14357t Pyraclofos 9359 8626 -734 -19401 Etofenprox 8774 12011 3237 78181 Total 239797 2s2049 12253 -6s3s0 7. In the whole of the Programme area, the total length of rivers likely to be treated by both aerial and ground larviciding for the prevention of transmission increased slightly with the inclusion of certain seasonal rivers in the treatments in order to better control black fly densities. This total length thus increased from I I ,698 km in I 999 to 13 ,7 60 km in 2001 . However, no aerial treatment was carried out in the Eastern Zone for five weeks, from 19 March to 22 April 2001, due to a satisfactory entomological situation. In the Western Zone on the other hand, there was no aerial larviciding for three weeks, from l0 to 30 September 2001. On the whole, the highest larviciding coverage was recorded between 25 June and lst July (26th week). JPC22.2 Page 6 Figure l: Larvicide coverage in 2001 ( { -r1 ntrrtrrrrraE RMar. trila. .r.r- _ Oround Yaaior conftol Lut..nllY.dod.ll. .u rol r;r1' " ga[onrl ir.rlmanl / Trail.hanl raironniar - Prrant OCP boundary(oileln.l. w.rt.rn. touih.m and ronrt oncho axtanjon boundary) Llmlt. .otu.tla OCP (al,a lnltbl., .xt.nrions ou.tl. rud.l oncfio{roda da rorat) Odgin.l Prcgr.m6a araa boundary/ Lihita ai.a initial. Waiarn and soqlhah axtantion ataa boundary / Limita d.t .i.ntionJ ouad ai 3ud. Insecticides and Control strategy 8. The insecticide rotation strategy with the seven insecticides available to OCP (temephos, phoxim, pyraclofos, B.t. H-14, permethrin, carbosulfan and etofenprox) continued to be applied in order to prevent black fly resistance and to limit the impact of laviciding on the non-target aquatic fauna. However, since June 1999, B.t. H-14, temephos, pyraclofos, permethrin and etofenprox have been the five main insecticides in use. The two other insecticides remain available and are used in the rotation strategy when the situation of black fly susceptibility and / or hydrological conditions so require. 9. The implementation of this strategy resulted in an improvement, or at least a stabilization of the black fly susceptibility situation in most of the basins. Thus, at those points where susceptibility tests were conducted in the Eastern Zone (Ekpla on the Sio, Angolin Pahou on the Ou6md, Toutionga on the Oti and Djodji on the Gban Hou), no decrease in the susceptibility of black fly larval populations to the organophosphorous compounds was suspected. In the Western Zone, black fly susceptibility to these products clearly improved on the Milo at Morigbddougou where the situation went from intermediate in December 1999 to normal in April 2001 for the 3 organophosphorous compounds used by the Programme. The susceptibility situation of black fly populations remains relatively stable on the Niger in the Tienfala area (normal susceptibility to temephos and phoxim, intermediate susceptibility to pyraclofos). On the Tinkisso on the other hand, a slight decrease of black fly susceptibility to temephos was observed at Deind6ra where the situation went from normal to intermediate from June 1999 to January 2001 . --, JPC22.2 Page 7 10. In the basin of the Upper Sassandra in C6te d'ivoire, black fly susceptibility to temephos remains satisfactory on the tributary Bagb6 at Ngolodougou, and intermediate on the main Sassandra in the Sorotana/Igesco area. On the other hand, a relative decrease of this susceptibility was observed at Bac Semien, where the situation went from normal in July 2000 to intermediate in June 2001. Downstream from this point, the presence of larval populations not very sensitive to the organophosphorous compounds was noted through a diagnostic test carried out at Pi6bli. I 1. The low level of black fly susceptibility to temephos observed on the Upper Sassandra seems to be related to the clear predominance of S. damnosum s.s, the savanna species most involved in resistance to temephos in the original Programme area. It represents more than 90 o/o of the larval populations tested at Igesco and Piebli, and about 77 % and 83 % respectively at Bac Semien and N'golodougou. No sign of resistance or decrease of blackfly susceptibility was noted with respect to the other insecticides used by the Programme, namely: carbosulfan, permethrin, etofenprox and Bacillus thuringiensis H-14. 12. It should be noted that the strategy in the use of B.t H-14 was slightly modified to take into account the current performance of the commercial formulations. Thus, preference is given to B.t. H-14 for the treatments during the periods of low water level up to discharges of 50 m'/s, which results in a relative increase in the consumption of this product compared to the others as indicated in the section on aerial operations. Hydrology and teletransmission 13. The OCP hydrological monitoring network currently consists of I l0 limnimetric stations of which 54 are equipped with Argos tele-beacons. The monitoring of this network falls on four hydrological brigades including two national brigades in Guinea (based at Kankan and Faranah), and two OCP brigades (based at Kara and Odienn6). These brigades, with the assistance of the Coordinator of hydrological activities stationed at the Programme's Headquarters in Ouagadougou, ensure (i) the maintenance of the Argos beacons and their redeployment, (ii) the maintenance of the hydrometric stations, (iii) the measurement of the discharges in order to readjust the former hydrography charts. 14. The satellite reception stations are located at Odienn6 and Kara, the two aerial operations bases, as well as in Ouagadougou at the Programme's Headquarters (back-up station). Entomological surveillance and evaluation network 15. Since 1999, the entomological evaluation network in the treated zones has comprised 107 catching points which are visited regularly. Each week, 54 of these points are monitored (point A) and the other 53 every fortnight (point B). However, in a number of river basins (Oti and its tributaries, Ou6m6, Upper NigerAvlafou and Tinkisso), catches were organized on demand in occasional monitoring points (test catching points) for the purpose of finding explanation or solutions to specific entomological problems raised during the weekly briefings. 16. On the whole, the results of the entomological evaluation were satisfactory in all of the treated zones of the Programme. While in 2000, 10 catching points showed an annual transmission potential (ATP) of Onchocerca volvalus above 100, this year this number stands for the moment at 6 (noting that all the identifications of infective larvae are not yet completed), and concerns the localities of Asubend6 on the Pru in Ghana (ATP:105), Djabata (ATP:223) and Kaboua (ATP:343) on the Okpara, M'B6t6koukou on the Ou6m6 (ATP:308) in Benin, Faya (ATP: 119) on the Faya and Tienfala (ATP: 239) on the middle course of the Niger in Mali (Figure 2). As for the transmission of O. volwlus by the savanna species of S. darnnosunt, it is above 100 infective larvae per person per 'qElF'- JPC22,2 Page 8 year at five of these catching points for the moment (Asubend6, Djabata, Kaboua, Faya and Tienfala) this year (Figure 3), against one in 2000 (Vialadougou on the Sassandra in C6te d'Ivoire). The high transmission which was observed in Vialadougou in 2000 did not occur this year. On the other hand, the situation worsened at Fifa this year with a particularly high transmission in February. 17. If the specific interventions carried out on the Mafou and the tributaries of the Oti (intensification of larviciding coverage and distribution of Mectizan) were successful, thus making it possible to bring down the ATPs below the 100 threshold level of tolerance these last years, the same does not fully apply on the Pru. These basins continue to be the subject of particular attention and the corrective measures that were taken have been reinforced, especially on the Tinkisso by the involvement of the VCU research team, in order to bring, as soon as possible, the transmission down to an acceptable level. 18. Overall, the transmission remained relatively low during the dry season when no infective female was caught in all of the zones treated during weeks 13 and 14 (from 26 March to 08 April). It was most significant during week 26 (from 25 June to 01 July ) with a total of 19 infective females caught carrying 31 infective larvae. 19. Blackfly densities decreased relatively or remained at the same level as in 2000 in all of the basins under larviciding except for the Mafou and Tinkisso basins in Guinea. Some larviciding failures which were not detected in time by the entomological prospection teams, caused a considerable increase of blackfly densities in February 2001 (4,480 bites per person per month this year on the Tinkisso at Fifa against 857 in 2000 ; 1225 bites per person per month this year on the Mafou at Yalawa against 318 in 2000) and in June 2001 on the Tinkisso (1691 bites per person per month this year against 535 in 2000). Monitoring of the aquatic environment 20. Aquatic monitoring activities are continuing in four countries of the Programme area: Burkina Faso, COte d'Ivoire, Ghana and Guinea. In the treated zone, it is exclusively carried out by the national hydrobiology teams through letters of agreement signed by the Programme with the last three countries. 21. The hydrobiology service of the Programme which coordinates these activities also conducts studies to evaluate the recolonization potential of the watercourses no longer under treatment in Burkina Faso. In addition it ensures the liaison between the teams in the field and the Ecological Group and is responsible for the entry and partial processing of the data. With respect to the exploitation of the data, the transfer of this activity to the national teams is almost completed with the provision of computer equipment to these teams. 22. The results of the aquatic monitoring were satisfactory on the whole (Figures 4 and 5). The specific richness and the catches per unit effort (CPUEs) of fish populations in the treated watercourses in Guinea have shown an overall upward trend since 199511996 at all monitoring stations. In C6te d'Ivoire, the specific richness recorded in 200012001 was also on the rise compared to the two previous years. Thus at Pont frontidre, on the L6raba, a specimen of Heterotis niloticus was found for the first time in the nets. As for the catches per unit effort, the rise noted since 1994 stabilized in 2000 on the three stations. In Ghana, the regular downward trend in the catches observed since 1987 at Asubende on the Pru seems to have stopped in 1998199 and a definite upward trend was recorded in 2000. In all of the fish monitoring stations, no disappearance of any species was reported and the coefficients of condition of the various species were stable as in the previous years. JPC22.2 Page 9 Figure 2 : Partial Annual Transmission Potentials (ATP) in treated area (all species) January to September 2001 Figure 3 : Partial Annual Transmission Potentials (ATP) in treated area (savanna species) January to September 2001 Espaces savanicoles du complexe simulium damnosum infecl6es par Onchocerca yoluJlus Simulium damnosum complex savanna species infectsd trilh Onchocerca volyulus Vrb3tm {d sat sn ?xlmin ta bondty / Lirlc dcs cxtasins rusi d srr. Origind ftogrm r@ bqr(hy / Lhlr *c iti* PAT /AIP <1mO o o o o m-399 1(D799 >flr Presst OCP bqnd{y (siiral, westdn, sor.thsn ild lqcd oclE axtilshn bqr|d{y) Lirls .ctrdc OCP (.|. hllalc,.xtmsims rud, sud .i mlr6rcos6 dc lqa) 1 00-1 99 l /Gddn ard sqihsn ciffiim n6. bMduy / Lirit6 d6s oxtorcins Md d sud. Orighal Progrm rea hrEdy / Lidtc aic hiliale ,T /ATP Especes du complexe simulium damnosum infocl6ss par Onchocsrca volvulus Simulium damnosum complex species infected wilh Onchocerca v0lvulus fuesarl OCP bulddy (orund, rcsdn, sdlhcrn md lilast mho cxlcri*m bdnduy) LInIa frluclG OCP (alc hlhlc, cxlcrcidls drsi, sud 6l mlEerc6e d6 ltrA) <1m 18199 zx}3s9 4fiI799 >8m - .-{ JPC22.2 Page 10 Figure 4 Trends of the catches per unit effort (CPUEs) at some of the monitoring stations Figure 5 : Evolution of the species richness of the fish fauna at some of the monitoring stations 85 86 87 08 89 90 91 92 9, gil 95 96 95 97 98 99 00 01 s.mpllng D.t.3 c.nsa on th. c omoa trom 1 976 to 200 1 t3 ?5 7t 79 8t 03 85 87 39 9r 93 95 97 99 01 E E G o Eo; ' o E E G o Eo o! Sempling Drtos 0 0 't6000 t{000 12000 10000 r 8000 , 6000 4000 2000 25000 20000 15000 10000 5000 Mrndlrn. on tha 3 rnklrlnl trom 1985 to 2001 85 86 87 88 89 90 9t 92 9l 94 95 96 96 9' 9t t9 00 01 oansa on th. comoa from 1975 to 2o0l t, ts tl ,t tl l, ag t7 lt tt t, t5 t7 tt 0t S.mp llng D sl.i o o4 o oa E z semPllnt D.t.3 50 {5 , 40 '3 tt 3. 30!zs -20 E 15 :ro =s 0 4a tt la 2t 20 t5 t0 I 0 23. The aquatic entomofauna of the stations under larviciding showed overall low densities and was dominated by the Hydropsychidae and Chironomidae. The Ephemeroptera (Heptageniidae, Oligoneuriidae, Tricorythidae) and Neoperla sp were the most affected during the period of larvicide treatments. On the rivers no longer under treatment, when the parameters of the quality of the aquatic habitat are satisfactory, signs of recolonization by some taxa which had been affected by larviciding were noted, especially Neoperla sp and the Tricorythidae. The Oligoneuriidae on the other hand were still absent from the samples. 24. As the deterioration of the quality of the aquatic habitat is perceptible at most of the monitoring stations, the West African Fresh Water Biodiversity Conservation and Ecosystem Management Project to be implemented in the oncho-freed zones, elaborated in 2000 and submitted to the Global Environment Facility for financing, should contribute to the awareness raising of the riverine populations for the conservation and restoration of their environment. 25. The valorization of the aquatic monitoring activities was intensified. In addition to articles to be published in international reviews, a booklet for the "general public" on these activities is in the process of being published and a summary of the scientific results is in preparation with the collaboration of members of the Ecological Group and external experts. Bout30ula on th. Milo f?om 1985 to 2001 JPC22.2 Page 11 IVERMECTIN (MECTIZAN@) DISTRIBUTION AND EPIDEMIOLOGICAL ACTIVITIES IvrnurcrrN TREATMENT 26. The Community-Directed Treatment with Ivermectin (CDTI) approach is currently effective in all the countries where distribution is being carried out. CDTI was, unfortunately, derailed in Sierra Leone and Guinea Bissau for a number of years, though activities have, since 2000, partially resumed in Sierra Leone. In Guinea Bissau, activities resumed in 2001 in the Rio Corubal basin, where epidemiological evaluation was carried out in June 2001, to be followed up later with ivermectin treatment. 27. During the period under review, the Programme gave financial and technical assistance to countries by helping in re-training, particularly, the staff of peripheral health centres as well as community distributors. Almost all the villages have distributors, who undertake ivermectin distribution in their respective local communities. These distributors are chosen by the communities, who decide on how distribution is to be carried out: either door-to-door or distribution at an assembly point. It is the duty of health personnel to train distributors. The health personnel are trained by the national team, the regional team or the district team, which is in charge of onchocerciasis control. It is the duty of health personnel to train distributors. The health personnel are trained by the national team, the regional team or the district team, which is in charge of onchocerciasis control. 28. Treatment was carried out in areas, which hitherto were hyper and mesoendemic, as was the case in the previous years. Figure 6 shows the Programme areas under ivermectin treatment. In the northern part of the Western extension of the Programme in Guinea, Mali and Senegal, CDTI is the only control method used to control onchocerciasis. CDTI is also applied in some parts of the original Programme area. The areas in question are the basins of the Dienkoa, the Bougouriba and the Black Volta (Mouhoun) in the district of Batie in Burkina Faso, the basins of the Oti-Pendjari, the Sota Alibori in Benin, the Oti and the tributaries in Togo, the basins of the Sissili, the Kulpawn- Mole, and the lower Black Volta in Ghana, the basins of the Comoe, the N'Zi/Bandama, the Sassandra and the Marahoue in Cote d'Ivoire, as well as the basins of the Kankelaba, the Bagoe and the East Baoule in Mali. Several of these basins and that of the Gambia and the Senegal undergo two rounds of annual treatment. 29. With the exception the health staff members that have newly been posted to the endemic areas, and the new community distributors, all the staff members involved in the CDTI, especially those in the districts, have been re-trained on the optimum use of ivermectin. Supervision and follow-up on distribution were under the care of health personnel at the peripheral level, who are in charge of the villages under CDTI in their area of intervention. They also collected data on each village under treatment, and wrote a report to the district chief medical officers. The latter, in turn, wrote summary reports to the national Coordinators. In most of the countries, supervision and follow-up of major actors were regularly carried out in order to minimize errors and to give the front-line actors the needed support. The technicians/nurses are the first to manage any serious side effects that would be reported by community distributors. No serious adverse reaction was reported during the period under review. JPC22.2 Page 12 30. Members of national teams carried out training and re-training, in order to better consolidate CDTI implementation, in collaboration with the OCP and NGOs. The first stage was to train trainers, including doctors and senior nurses of health posts of area under the distribution programme. The second stage was the training of community distributors by health workers. In the past year, all the countries that applied CDTI, with the exception of Guinea Bissau carried out training/re-training sessions. Training resumed in Sierra Leone through workshops intended for district chief medical officers, then for nurses as part of the resumption of ivermectin distribution activities. This year 34,033 community distributors, 1066 health workers i.e. 238 district medical officers and 828 other persons were trained or retrained in CDTI in the health centres. To date, about 250 doctors, more than 2,500 technicians/nurses and other auxiliary health workers, and more than 55,000 community distributors have undergone training or re-training in the various countries. The re-training of health workers is carried out according to the needs identified during supervision. Supervision is more or less regular, depending on the country. 31. As in the previous years, NGOs gave technical and/or financial assistance for CDTI implementation, by participating in the follow-up, supervision and training/re-training of technicians/nurses and community distributors. Among the NGOs are Sight Savers International in Mali, Ghana and Guinea; the Organization for the Prevention of Blindness (OPC) in Mali, Guinea and Senegal. Helen Keller Worldwide (Formerly Helen Keller International or HKI), which continues to assist participating countries in the area of Information, Education and Communication in onchocerciasis, and collaborates with the latter in implementing several activities toward enhancing CDTI. It also gives assistance to the countries in the area of communication (Telephone, Internet, e-mail), training, supervision and follow-up. 32. Almost seven million persons in 24,340 villages and hamlets were treated by ivermectin under the CDTI approach in 2001. The proportion of villages that are actually covered as against the number of villages scheduled for treatment in the endemic health districts varies from one country to another. This ranges between 33%o and l00o/o, with an average of 77 o/o (Table 3). The average therapeutic coverage or percentage of people treated, as against the reckoned population in all the countries that effected treatment, is about 72oh, with rates fluctuating between 5lo/o and 82%o, depending on the country. In 2001, villages in the basin of the Bougouriba in Burkina Faso, of the Gambia in Senegal, and of the tributaries of the Oti in Togo underwent two rounds of treatment, with a geographical coverage of about 90%. 33. Ivermectin distribution is currently extended to all the eligible forest areas in Guinea, Ghana and southern COte d'Ivoire, where training of community distributors is underway. There is a considerable increase in the number of villages and populations under CDTI, as against the projections of 1997 and 1998, when CDTI started. The progress made is satisfactory overall, though there are disparities among countries, or even in the same country. The results shown are partial because of the difficulty of retum of the data from the peripheral level. The results for C6te d'Ivoire are also partial. The low coverages observed are due to the civil strife in the country. JPC22.2 Page 13 Table 3: Treatment with ivermectin in 2001 34. From April 25 to May 27 200I, a group of three external consultants and a national coordinator, in collaboration with the national teams of host countries, assessed the progress of CDTI in Benin, Ghana, Guinea and Mali. Additionally, three members of the Expert Advisory Committee of the Programme undertook a field visit in C6te d'Ivoire, Guinea, Mali and Togo in some areas that need special attention prior to or after the end of the Programme, such as areas of the basins of the Niger, the Mafou and the Keran. These visits were especially centred on the entomological situation, ground larviciding and the progress of CDTI activities. Despite some reported constraints, the surveys generally confirmed the installation of CDTI in the countries. It is, however, obvious that additional efforts need to be made with a view to arriving at a better geographical and therapeutic coverage, especially in countries such as C6te d'Ivoire and Ghana. 35. In 2001, all the countries, except Guinea Bissau, ordered ivermectin tablets, which they need for treating people in the endemic areas directly from the Mectizan Donation Programme (MDP). The supplies were directly received by these countries themselves, with the support of the WHO representations, and integrated into their national systems of drug distribution. Sierra Leone and Cote d'Ivoire ordered and received their first ivermectin supplies from MDP in 2001. EPIDEMIOLOGICAL EVALUATION 36. The concerted efforts of the various countries and OCP helped to train epidemiological evaluation teams of onchocerciasis at the central and decentralized,levels in each country. In some countries, OCP technicians participated in evaluations in order to ensure training or re-training of national technicians, and to conduct quality control of evaluation/surveillance. The surveillance make it possible to assess the epidemiological situation of onchocerciasis in the villages of the original Programme area, where larviciding has ceased. In the west and southeast extension areas, as well as in the specific areas of the original area solely under ivermectin distribution or combined with larviciding, the evaluations enable impact assessment of the activities. 37. From January to September 2001, 526 vlllages were evaluated in 10 Participating countries of OCP in both the original and extension areas, i.e. 39 in Benin, 11 in Burkina Faso (21 additional sentinel villages will be evaluated before the end of 2001), 35 in C6te d'Ivoire, 75 in Ghana,96 rn Guinea, 37 in Guinea Bissau, 109 in Mali, 13 in Niger, 31 in Senegal and 80 in Togo. The approach used in all these evaluations was the same as that used in the past, i.e. the classic parasitological approach of skin snip, which enables the prevalence, level of infection and the appearance of new infections to be determined. The latter are defined as infections that occur in children under five, Country No. of villages Projected Treated Geographic coverage Population Total census Treated Therapeutic coYerage Benin Burkina Faso C6te d'Ivoire Ghana Guinea Mali Senegal Sierra Leone Togo 3,194 313 1,685 ) 7)') 7,443 3,502 602 452 4,427 2,193 313 559 1,3 18 7,274 2,629 602 331 3,602 67% t00% 33% 75% 98% 75% 100% 62 8t% 1,310,661 20t,4ll 326,979 1,586,058 2,684,964 1,400,490 156,988 89,297 1,870,052 1,017,867 164,467 182,715 805,969 2,127,756 L,103,320 124,159 55,254 1,334,320 78% 82% 56% 5t% 79% 79% 79% 62% 7t% Total 24,340 16,628 770h g,626,900 6,gl5rg27 72o/o ( JPC22,2 Page 14 who did not undergo ivermectin treatment, or individuals who, hitherto, were tested negative during two consecutive evaluations. Apart from the skin snip parasitological approach, the DEC patch test was used in some villages of the Programme area. The series of epidemiological evaluations of the current year will complete the cross-section evaluation, which started in 1997, with a view to obtaining an overview of the overall epidemiological situation in all the areas under the Programme before the latter ends. Figure 7 shows epidemiological results of the period in question from September 2000 to September 2001. Epidemiological surveillance in the original Programme area 38. More than 140 sentinel villages that are located in the original Programme area were evaluated by national teams during the period under review in Benin, Burkina Faso, Cote d'Ivoire, Ghana, Mali, Niger and Togo. The outcome of these evaluations are generally excellent in most of these basins under epidemiological surveillance, with a prevalence rate of 0o/o rn most of the villages. In the basins that are still under ivermectin treatment, such as those of the Oti/Pendjari and its tributaries, the maximum prevalence rates in the villages that were evaluated in 2001 are 3.72o/o in Benin (Porga-village),l0.lo/o (Moalla) in Ghana and 21.7% (Titira) in Togo. In the Black Volta basin in Ghana, the maximum prevalence rate is 14.3o/o (Hiampenika). 39. In the villages that were evaluated in 2001 in the original area in Burkina Faso in Dienkoa basin, which is still under ground larviciding, combined with CDTI, the epidemiological situation is excellent with zero prevalence rates generally. No new cases have been reported. Larviciding will cease in this basin by the end of 2001. On the Bougouriba/Black Volta basin, the highest prevalence rates are 6.6o/o in Mouvielo and 7 .9oh in Salibor, with microftlaia loads that are almost zero. 40. In Niger, the epidemiological situation is still excellent. The epidemiological evaluation carried out in 2001 shows zero prevalence rates in the basins of the Diamongou, the Niger and the Sirba. 41. In the basins of the N'Zi and the Black Volta in C6te d'Ivoire, the results are generally satisfactory. The results obtained in 10 villages that were evaluated in March and April 2001 show prevalence rates that fluctuate between 0o/o and 7.7% (Namilohokaha) in the N'Zi basin, and 0.7'h and l.7o/o in the Black Volta basin. 42. In Ghana, the epidemiological results are excellent, with zero prevalence rates in the villages that were evaluated in the Sissili and Red Volta basin. On the contrary, the epidemiological situation is still not satisfactory in the basins of the Black Volta (143%) of the Daka (13.7%- l5.l%) and of the Kulpawn/Mole (27.5%). However, the trends are generally downward, as compared to the previous results. Appropriate measures, coupled with increased follow-up for CDTI are being carried out by the national team of Ghana, so as to improve the geographical coverage of villages, as well as the therapeutic coverage of the population under ivermectin treatment. I JPC22.2 Page 15 rL-, Zom<fiHffiaMiD lbE the 6. tnIffi Pfur d'un t Ct.m.m p.r D Fonn ,ffi irlrd.d iith.ffiimtormd Zm3 d. io.& hobi tu hhaffiaffiiD OCP !oundail(oilalnal. E lah. to{tham and toratt oncho od.Bion boundary) Limit. OCP (alra Inilial.. arianjonr ou.rt tud .t oochoo.roor. d. foral) Oilqin.l ProO,.hh. ar.. bound.ry / Limit. .in initi.lc Oriqinal and rattan and routham axtanrion araa boundrry Limita aira initirl. .t.xt.nrionr ouart alrud. l{.llo n.l b ound.d.r / F rontiar.t Figure 6 : Large scale ivermectin distribution in 2001 Figure 7 :Prevalence of microfilariae in villages evaluated between 1999-2001 PREVALET{CE OF iIICROFILARIAE IT{ VILLAGES EVALUATED BETWEEN 1999 . 2OO1 II{ OCP PREVAI.ETICE EII TICROFILAIRES DES VILLAGES EVALUES EilTRE 1999 - 2OO1 A L'OCP o o o o.5 5.1-15 15.t.3) 30.t€o >@ o o Cou6 daru OCP boundary (orlqinal. wsstsrn, soulhern and forel oncho extension Limits OCP (airB inilial8, Extsnsions ouesl sud sl onchocercose de forat) Original Programme aroa boundary / Limile air8 iniliale Oriqinal and wsstam and southBm extension area boundary Limlte airs initiala Bt extansions ou€sl el sud. National boundarias I Frontidres -FFr l- l,i,:".1 ffi re -J JPC22.2 Page 16 Epidemiological evaluation in the extension areas of the Programme 43. In the southern extension in C6te d'Ivoire, the epidemiological evaluations that were carried out in 2001 in the Sassandra basin, which are still under seasonal larviciding, combined with ivermectin distribution, gave satisfactory results. Prevalence rates, which vary between 0o/o and 6.3yo, remain low, as was the case in the previous period. Microfilaria loads are around zero. Larviciding will end in the basin in December 2001. On the Comoe and the Marahoue, the results are equally good. The same goes for the evaluated villages in the N'Zi and Bandama basins, where the villages of Youbouebo (N'Zi) and Gbogbobo (Bandama) have prevalence rates of 11.8 and 14.7% respectively. 44. An epidemiological survey was conducted in June 2001 in Guinea Bissau in the Rio Geba and Rio Corubal basins after more than four years of cessation of ivermectin distribution. There was zero prevalence in the 12 villages evaluated in the Rio Geba basin. In the Rio Corubal basin prevalence rates are mostly nil or close to zero, except the village of Cobuncara with a prevalence rate of 35.6% (56.7% in 1990 and 10.8% in 1997), Cuatche with a prevalence rate of 23.6% (22.3% in 1990 and 2.2Yo in 1997), 11.8% in Queue in 2001 (57.3% in 1990 and l.7oA in 1997). Further investigations are on course to better understand and confirm these results. 45. In Guinea, out of the 96 villages that were evaluated between February and August200l,76 are located in the basins under both larviciding and ivermectin treatment. The results are quite satisfactory, and prevalence rates are nil in most of the villages that were evaluated in the basins under larviciding combined with ivermectin treatment, such as Milo-Niandan, Mongo-Kaba, Sankarani and Tinkisso-Bakoye. The maximum prevalence recorded in the basin of the Niger in Walia-Dabourou is l5.6Yo.In Moussoni-Sambouya in the Mafou, prevalence is 6Yo, while it is 7 .3o/o in Banfokoro in the basin of the Tinkisso. In Kamakan in this basin, the prevalence rate which was 50.7% in 1987 in nil in 2001. 46. In the basins with only ivermectin distribution in Guinea, the results are excellent in the Bafing basins, where maximal prevalence is 3.6 in 9 villages. The epidemiological situation is also satisfactory in the basin of the Koulountou-Kolilba and the Kolente. 47. In Senegal, simple epidemiological evaluations were carried out in April and May 2001 in 31 villages in the basins of the Faleme, the Gambia and the Koila-Kabe, which have been solely under ivermectin treatment since 1988. The results of these epidemiological surveys remain excellent in all the villages that were evaluated, with rates varying between )Yo and 4.1 in Diyala- Bakary in the Gambia basin. In the Faleme basin, the highest prevalence rates are 3.7Yoin Frandi and 3.60/o in Bambadji. They are zero in 20 out of the 31 villages that were evaluated. All the infections were found in patients that were more than 20 years old. No new infections were observed in these basins. 48. In the basins of the south-east extension of Togo and Benin, which are still under larviciding combined with ivermectin distribution, the epidemiological evaluations that were conducted this year give good overall epidemiological trends. In Benin, a prevalence rate of 35.9% was recorded in the basin of the Oueme (in Agbogbome and 22.1% in Aguigadji), 19.20 in the Teron/Oueme basin (in Azraou),15.gYo in the Okpara basin (in Waria). 'E IJPC22.2 Page 17 49. The other villages that were evaluated in the basins of the Okpara, Terou, Adjiro, Zou Agbado, Oli, Koufo in Benin, and those of the basins of the Amou, Anie, Mono, Ogou, Chra, Gban- Houo, Zio and Todje in Togo show generally satisfactory epidemiological trends, except in some villages: 16.7% in the Amou basin (in Igbo-Amou),15.7o/o in the Gban-Houo basin (in Kemedisso), 16.3% (in Klo-Mayondi) and 14.9% (in Kpime-Seva) in the Todje basin. These figures, though relatively high, are better than those recorded during the previous evaluations. Ophthalmological Evaluations 50. An ophtalmological evaluation was carried out in November 2000 in Asubende (Ghana) to assess the impact of the combined larvicide and ivermectin control on onchocerciasis eye lesions in this focus. Results showed regression and stability of anterior and posterior lesions respectively. No ocular microfilariae was found. BIOSTATISTICS AND INFORMATION SYSTEM 51. The transfer of data-processing tools (equipment, software and data) to the Participating Countries remains a priority for the PET Unit. Thus the Biostatistics and Information Systems (BIS) sub-unit continued this activity during the period under review, by refining the programmes of consultation and analysis of entomo-epidemiological data. BIS also continued to coordinate the processing of entomological and epidemiological evaluation data, namely data input and validation, which are carried out by staff of the technical units, and to play a major role in computer assistance within the Programme (maintenance of the various equipment and programmes, local network and related services such as the Internet and the electronic mail system). This assistance also had to do with computer training, management of the different data banks and their backup. 52. As in the previous years, BIS continued to update the various data banks by supplementing the existing data with information collected on the parasite, the vector and ivermectin treatment. It carried out the routine analyses of ophthalmological data, of epidemiological survey data on the effects of ivermectin and of the data collected during the evaluations of new diagnostic tools such as the DEC patch test, the serological test, and the DNA research-based test in skinsnipping. Particular emphasis was put this year on the collection and analysis of data on ivermectin treatment from 1987 to date. 53. In order to strengthen the operational capacities of the Participating Countries of the Programme in epidemiological data management, BIS equipped each country with more powerful computer units. It also continued the training of their technicians so that they will be able to sort, input, validate and analyse the data collected during the epidemiological evaluations or ivermectin treatments. This data will be reviewed with OCP in order to update the central data bank, the review of which is still a BIS priority. To facilitate the use of the computers in the Participating Countries, BIS continued the development of a simple and practical programme. This programme allows the input and consultation of epidemiological and CDTI results both at the village and health district levels. It also allows the integrated analysis of epidemiological, entomological and ivermectin treatment data. 54. The use of the Geographical Information System (GIS) is mainly based on the Maplnfo and ArcView software which are rather fairly difficult to leam. Consequently, the HealthMap unit of WHO in Geneva in collaboration with OCP developed a simple and practical module for the decision makers and technicians of the Participating Countries. This tool allows for integrated spatial analysis of the data collected under onchocerciasis control (epidemiological, entomological and ivermectin treatment). As part of the transfer of skills to the countries, the training on this module will be intensified for the different national coordinations. =!EF JPC22.2 Page 18 55. Computer-based activities continued to be on the increase within the Programme. The previous local network was extended to include the APOC Programme. A specialized link was installed for the Documentation Centre. Access to Internet (Web, e-mail...) is permanent and accessible to all staff. The training of OCP / APOC staff in Word, PowerPoint, Excel and Internet continued. The staff of the Documentation Centre was trained in the use of a new documentary software, BiblioMaker. In addition to the functions of input and consultation of bibliographical references, this software also allows the consultation of documents via Internet. The installation of the new Web site is being frnalized. TRANSFER OF ACTIVITIES TO THE PARTICIPATING COUNTRIES 56. The transfer of residual activities of the Programme to the Participating Countries continued in order to strengthen their capacities to ensure an effective take over of these activities after 2002. Activities for controlling morbidity, detection and management of recrudescence are being integrated into national multidisease epidemiological surveillance systems. It is fairly advanced in most of the countries. OCP being concerned with the acceleration and effectiveness of this integration also assisted the countries in this field, as in the past, by giving them technical, logistic and financial support during the period under review. 57. In addition, training, sensitization of government authorities and the general public, support for operational research, and the transfer to each country of data pertaining to it were continued. For the implementation of its plan of action, OCP, as usual, worked in close collaboration with the WHO Regional Office for Africa and the WHO Headquarters. 58. Besides, contacts between OCP and the Participating Countries were reinforced; i) on the one hand, through several meetings with the National Coordinators. The annual National Coordinators meeting as organized in the past was replaced by more efficient meetings in restricted groups of countries having common problems. Thus the National Coordinators and National Entomologists of Benin, Burkina Faso, Ghana, Niger and Togo met from 12 to 14 March, those of C6te.d'Ivoire, Guinea and Mali from 18 to 20 April, and those of Guinea Bissau, Senegal and Sierra Leone from 7 to 9 May 2001 in Ouagadougou; ii) by organizing hands-on training sessions at the Programme's Headquarters for members of the national teams of the different countries; iii) through missions and meetings in the countries. Training 59. In order to guarantee the success of the transfer process, the Programme pursued its training policy by awarding, during the period under review, fellowships to the nationals of the Participating Countries for specialization in areas related to onchocerciasis control activities, administration, management of health services and public health. Between September 1999 and August 2001, OCP awarded a total of 60 fellowships. These were medium and long-term fellowships, which were distributed as follows: Epidemiology (14), Management of health services (4), Molecular biology (2), Entomology (11), Public health (28), and General administration (1). This training is part of the training plan that covers the 1998-2002 period, which most countries submitted and discussed with the Programme, and which is being implemented. This brings the number of OCP fellowships to about 571, since 197 4 when the Programme was started. 60. As in the previous years, OCP continues to give greater importance to "on-the-job and field" training in the main areas of onchocerciasis control such as : entomology, methodology of TPC22.2 Page 19 epidemiological evaluation and surveillance, and ivermectin distribution. Special emphasis continues to be laid on the training of National Coordinators and other workers of the national teams in the OCP methodology for the collection of onchocerciasis epidemiological data, the analysis and interpretation of active entomo-epidemiological surveillance data" and on the initiation of the workers concerned to the use of computers. 61. With the exception of Siena Leone, all the countries have undertaken the training and retraining of agents in the methodology of epidemiological surveillance/evaluation during epidemiological surveys that were carried out in the villages during the past period. In addition to the skin snip, the practical aspects of the use of the DEC patch test in the field was emphasized during these training sessions. To date, in total, more than 300 technicians, nurses and other paramedical workers, and more than 50 doctors have been trained in their respective areas of intervention in the countries. The effective use of this staff trained in the context of decentralized epidemiological surveillance/evaluation and integrated into the national multi-disease surveillance system is ongoing in all the countries, with the aim of ensuring the effective take over of these activities at all levels, especially at the health district, region or zone levels. WHO/AFRO Support to OCP activities 62. Collaboration between the OCP-APOC Programmes and WHO was further strengthened. It concerned, inter alia, the search for the most appropriate solutions to the problems which will be generated by the closure of the OCP Programme at the end of 2002, after 28 years of existence. [n relation to this closure, the Regional Director of WHO for Africa set up a Working Group made up of WHO-AFRO and OCP/APOC senior staff. A first meeting was held in Ouagadougou at the OCP Headquarters from 19 to22 March, then a second meeting took place from I I to 15 June 2001. The role of the Working Group as laid down by Regional Director is to hold talks with the staff, to study the documents of the Programme and to inventory its movable and real property in order to submit proposals for its utilization or future allocation at the end of the Programme. Two reports have already been submitted to the Regional Director. Another working session of the Working Group is scheduled to take place in the near future. 63. Offices of WHO representations continue to give support to national Oncho control programmes in the I I OCP countries, and contribute, to a large extent, to efforts made by Ministries of Health toward the effective integration of Oncho control activities into national health systems. WHO Representations and their epidemiologists in the OCP countries also give active support to the national teams. 64. The Regional Office continues to accelerate the process of setting up the Multidisease Surveillance Centre. It has started appointing staff to the centre with a view to an imminent start of its activities. INTERDISCPLINARY RESEARCH Insecticides 65. One of the problems encountered with Bacillus thuringiensis H-14 is its instability over time. Field trials in rivers were therefore undertaken at the end of last year with improved formulations of Vectobac@ l2AS produced by the Valent BioSciences company and of Teknar HP-D produced by Thermo Trilogie/Agrisense kept in storage for about 15 months in the central depot of the Odienn6 base in C6te d'lvoire. The iests were carried out at discharges of 43 m3/s for the Vectobac@ and 47 m3ls for the Teknar@. The batches concerned were used at the dose of 0.54 JPC22.2 Page20 litre/m3/s, i.e. at % of the normal operational dose; they had been tested in rivers earlier in November 1999,i.e. approximately 3 months after their delivery in OCP. The results (Figure 8) show the good stability of Teknar@ (with a carry that can be estimated between 3 and 8 km at the discharge of 47 m'/s;, as well as a non negligible stability of Vectobac@ with a carry of about 2.5 km at discharges ranging between 43 and 51.55 m3/s lthere was a slight increase of the discharge during the test). On the basis of these results, the operational use of Vectobac@ at the dose of 0.54 litre/ m'/s lsimilarly to Teknar@) can no longer be precluded. 66. With regard to the chemical insecticides, the collaboration initiated in 1999 with the PHYTAGRI company permitted the recent evaluation by the Programme of a new experimental formulation of temephos. The data collected at the end of the-first phases of this evaluation (test of spontaneous dispersion and laboratory evaluation of effectiveness on S. damnosum s.l.lartae) are very encouraging insofar as we have a good spontaneous dispersion of the product as well as rather competitive indices of its effectiveness (CLso and CLge respectively of 9.79.mg/l/s and 55.14 mgVs against 10.23 mgVs and 58.32 mg[s for the operational batch). Trials in rivers with this new formulation will be carried out in basins harbouring susceptible black fly populations as soon as a suffrcient quantity of the product is sent to us by the firm. Parasite identification 67. Activities of the Molecular Biology Laboratory continued in 2001 in the following areas: i) operational support through the identification (using DNA probes specific to the Onchocerca a Figurc t: Comprison of clficmy of two fomruletioru d Brillus thurinsicnrir H-14 of 15 mmthr old appllcd to a domgc of 054Um3/rcc (75 9o d the opcradmal dmagc) ln Octobcr 2000. VECTOBAC 12AS Bendama blanc (88500) 43 tn3/sec Level of elllcacy 95 I a il L Es7 dl LE{ 3E TLF- '' \h HF i, llrnd :m r'blax(,'bit")ti {- :nr *'r- 19 0 0135 l,[ r,t 2*5 3 3,9 5.7 Dtrtencc (km) 1 E2 92 10,3 altlrr trt !!!Iaall talraaa!!aa!ar IJPC22.2 Page 2I species and O. volvulus strain), of the infective larvae of the parasite collected from infective blackflies, or in microfilariae taken from humans, ii) improving current knowledge about the pathogenicity levels of the parasites collected, iii) training of nationals in the identification of parasites through DNA probes and in the identification of vectors through the heteroduplex and microsatellite techniques. 68. The determination of the prevalence of the infection from pool screening of blackflies through the specific DNA probes continued in 2001. Particular emphasis was put on increased take over of this activity by the countries. The forwarding of the samples of blackflies from the villages to the Molecular Biology Laboratory for example was done in most of the cases through a national circuit identified by the countries which assume the responsibility for it. The results recorded were communicated to the countries with which exchanges took place on the interpretation of these results and the operational decisions to be derived from them. 69. In connection with the development of diagnostic tools for the detection of resistance to ivermectin, the collection of microfilariae continued in 2001 with particular emphasis on the search for microfilariae from patients having taken ivermectin six times (or more). In addition, the evaluation of the Diethylcarbamazine (DEC) patch test continued with the participation of the Molecular Biology Laboratory in trials aimed at reducing the observation time to less than 12 hours, and in training of trainers in the use of the test. Study of blackfly migratory movements and of the genetic variability of the vector and parasite populations 70. A good knowledge of the bio-ecological characteristics of the vector and parasite populations seems more and more a need that cannot be ignored if we want to maintain the achievements of the Programme. To this end, studies were initiated on blackfly migratory movements and on the dynamics of the transmission of onchocerciasis. These investigations which are still ongoing concern primarily the populations of the S. sirbanum species which, although of the savanna type, is encountered in all of the biogeographic zones of the Programme due to its involvement in migratory movements of great amplitude. They should make it possible to highlight the incidence of the genetic variability of this ubiquitous species on its vectorial capacity with respect to the parasitic strains it could come across in the various foci of seasonal migration, particularly those covering, from the south-west to the north-east, the regions of Northern Sierra Leone, of the basin of the Upper Niger in Guinea and of the middle course of the Niger in Mali. 71. Samples of blackflies (larvae and adults) collected during the period of migration in the basins concerned were analyzed using the techniques of identification currently used by the Programme (cytotaxonomy and molecular biology techniques primarily). In addition, the vectorial capacity of the blackfly population found at Morigb6dougou (a point located on the Milo river in Guinea) was evaluated with respect to the O. volvulus strains that were identified in six onchocerciasis patients selected from the 3 main foci of migration mentioned above, on the basis of two patients per focus. It should be noted, however, that the patients from Sierra Leone were rather from the centre of the country instead of the North due to the difficulties of access to this area. Furthermore, their average microfilarial loads (92 mfls and 68 mf/s) were much higher than those of the patients from Guinea (18 mf/s and12 mf/s) and from Mali (23 mf/s and 0.5 mf/s). 72. The results show a low level of compatibility between the O. volvulus strains found in the two patients from Sierra Leone and the S. sirbanum population encountered at Morigb6dougou (parasitic productivity: 0.16 %). This population on the other hand shows a more significant vectorial capacity (Figure 9) in the onchocerciasis patients from Guinea and Mali (parasitic JPC22,2 Page 22 productivity :2.64 o/o and 1.56 oh), although these latter patients definitely had fewer parasites than those from Sierra Leone. 73. With regard to the blackfly movements, the partial analysis of samples of blackflies collected from the main foci of migration (except Sierra Leone for insecurity reasons) reveals the presence of at least three S. sirbanum populations in the study area. Only one of these populations seems to be involved in the seasonal migrations which take place from the south-west (Northern Sierra Leone) to the north-east (Guinea-Mali) at the beginning of the rainy season, with the help of the upward movement of the Intertropical Front (I.T. F.), and in the opposite direction at the beginning of the dry season with the help of the harmattan winds. 74. This study is being conducted in collaboration with external institutions: the University of Alabama at Birmingham (USA) and the Institut de Recherche pour le Development (IRD) in Montpellier (France) for the genetic differentiation of the blackfly populations; the Noguchi Memorial Institute for Medical Research, University of Ghana in Accra for the cytotaxonomic identifications. Special entomological studies 75. The studies aimed at the early detection of recrudescence and those on the impact of ivermectin on transmission continued under the supervision of the national entomologists of the { Figure 9: Development of parasites in flies fed on onchocerciasis patients from Guinea, Sierra Leone and Mali : tt i {t li :r t( l! It .lr G ih Jr t lt llurrirvl *l lftr +rrtrll{ d.r€l.Pilrr !l .t t J.T I l1' ll ur rtr{B rI ih. p{r}rtlr {l(r{ l.Irr. nl 100 80 60 .10 20 0 r0 6-3 h Jt-l J5-? Ilurdim oil tlrt I ruii. d.!tdolrmmi (R= 2,64 Yo) Petirnts fronr Guince 4-lt I dl :{ I E Prrrritcr loetl Efi o (R = 1,56 Yo) E', rf Itrc" EPrrr.!lr{ lrtd Patirnts frorn Meli I t.4: t-dJ l-lr Petirnts firrn Sirrr:e Leont (R = 0,16 Yo) t E', ol llre. Et'rrrrrt('{vr{ : l: t-l JPC22.2 Page23 Participating countries. These studies showed the capacity of the national entomologists trained by OCP to conduct these studies in their respective countries, and the possibility for a national network of collection and transfer of the blackflies to function properly. The rare cases of dysfunction in the transfer of the blackflies to the Molecular Biology Laboratory have been corrected. The entomological information system between the national teams and the laboratory has thus begun to be operational. The results recorded were generally satisfactory except in Chiasa on the Kulpawn- Mole where the infectivity rate remains above the acceptable threshold level of 0.5 infective females for 1000 females caught. This information was communicated to the people in charge of the control progrzlmme in Ghana for an improvement of the distribution of ivermectin in this zone. 76. In 2001 the experimental treatment of the Oti was carried out for 6 weeks (from the 4th to the 9th week i.e. during the period from 22 January to 4 March 2001); 3 cycles of treatment with pyraclofos and 3 with Teknar@ were carried out. The purpose of these experimental treatments which were carried out for the 4th consecutive year (from 1998 to 2001) is to prevent the settlement on the main Oti of the blackflies transported by the harmattan (winds from the North-East) which come from the untreated areas of northern Benin (Pendjari, M6krou, Alibori and Sota). From week 9 (beginning of March), ground treatments with Teknar@ were carried out by boat or by canoe on the main Oti until May 2001. 77. The high densities of blackflies recorded particularly on the Tinkisso in June led us to undertake investigations to identify the origin of the phenomenon in order to take the necessary action. Joint prospections by the national teams/staff of the entomological research unit of the Programme and test catches were undertaken on the main course, the tributaries and in the adjacent basins taking into account the direction of the monsoon winds. Treatment failures seem to be one of the key factors which contribute to the increase in blackfly densities in the basins. Diagnostic tests for the surveillance of onchocerciasis 78. Skin snipping remains the principal method used for epidemiological surveillance and evaluations. The countries continue to couple it with the diethylcarbamazine (DEC) patch test as an alternative diagnostic method. All national teams except those from Sierra Leone and Guinea Bissau have been trained to use this method which has given satisfactory results. The training of operational level staff is done during epidemiological surveys. Research is ongoing in a bid to improve this test, so as to obtain a "prepacked" " transdermal drug delivery" form of presentation to facilitate its use in the field. 79. Field studies of the serological test based on the detection of IgG4 antibodies to OV-16 were performed in several different endemic settings in OCP. The test is very easy to perform (finger prick blood, 15 minutes incubation/reaction time, visual readout), and it does not require special equipment. These preliminary results suggest that this test may be a useful new tool for the specific diagnosis of onchocerciasis in the clinic. Its usefulness for monitoring control programmes in the field is under study. Epidemiological modelling 80. The recommendations made in 1999 during the review of the epidemiological modelling focused on three main points, namely (i) the in-depth analysis of evaluation data of the Programme, in a more integrated and multidisciplinary manner, by including simulation of the control operations with observed data from the Vector Control Unit, priority being given to the study of the impact of the combination of vector control and ivermectin treatment in the eastern and westem extension areas; (ii) reviewing the quantification of the parameters of the model pertaining to the development of the parasite, and to its dynamics in man and in the vector, based on the knowledge of control I ".qFF JPC22.2 Page 24 history in the Programme area, including anecdotal information, and (iii) applying the ONCHOSIM model for the simulation of zones, where mixed populations of the vector, including forest vectors, live together. These recommendations were addressed this year, in collaboration with the public health department of the Erasmus University of Rotterdam, Holland. There were fruitful exchanges between the Rotterdam team and OCP. 81. The integrated analysis of data, using ONCHOSIM, continued through the use of the new guidelines and priorities that were discussed with the University of Rotterdam. A direct application would be to make available to countries guides for decision-making in the form of epidemiological predictions by ONCHOSIM based on the various control strategies used before and after OCP. MACROFIL CHEMOTHERAPY PROJECT Goals 82. The goal of MACROFIL (FILARIASES R&D) is to develop or optimize tools for the detection, evaluation and treatment of onchocercisais. 83. The primary emphasis is on discovery and development of a treatment that could be used in the context of the Onchocerciasis control programmes, and would result in permanent sterilization or killing of adult worns. 84. The secondary emphasis is in discovering molecular indicators in Onchocerca volvulus that could be correlated with a non responsive or ivermectin resistant parasite. This knowledge will be used to develop a field tool for the control prograrnmes to detect ivermectin resistance if or when it may occur. In conjunction with this, targeted clinical observations/studies in the field are undertaken to asses if ivermectin resistance in patients is occurring or not. Clinical activities 85. combinations Dr. K. Awadzi of the Onchocerciasis Chemotherapy Research Centre (OCRC) concluded two key clinical studies: i) The safety, pharmacokinetics, microfilaricidal and macrofilaricidal effect of co- administration of ivermectin and albendazole'. The combinations were equipotent to ivermectin alone in their effect against the microfilariae; they did not offer advantage over ivermectin on the effects on the reproductive activity of the adult female worms or worrn viability. The combinations of drugs were well tolerated and did not produce more severe adverse effects than ivermectin alone. No pharmacokinetic drug interactions were detected. ii) The safety and pharmacokinetics levamisole plus ivermectin and levamisole plus albendazol : As above, no advantage over ivermectin alone was detected. The results of these studies are being prepared for publication. 86. Moxidectin .' Moxidectin is a registered animal health product (American Home Products through American Cyanamid) for which the effect on experimental filariases animal models has been extensively studied by TDR sponsored scientists. Following informal consultations with I a -!r-tr. JPC22.2 Page 25 American Home Products through its Wyeth-Ayerst Research Division the available data were considered adequate to justify a drug development programme. A human clinical study in healthy normal (O. volvulus negative) volunteers in I-iK to evaluate safety, tolerability and pharmacokinetics of moxidectin has been initiated (ongoing). Based on the results from this study (January 2002) a decision to proceed with the clinical development of this product as a tool for onchocerciasis control will be discussed between the "Company", APOC, OCP, and TDR. The costs of the clinical studies will be covered through MACROFIL, while the commercial partner will be responsible for all aspects related to the pharmaceutical development and product registration. The end point that will be pursued by this development programme is the demonstration that treatment of Onchocerca infected individuals with single dose of moxidectin will result in longlasting disappearance of microfilaria from the skin (death or perrnanent sterilization of adult worms). This effect must be achieved with safety and tolerability comparable to or better than that of ivermectin. 87. Wolbachia: long term use of antibiotics as potential chemotherapeutic agents against filariases. i) Doxltcltcline.' A recent study from the Bernhard Nocht-Institute for Tropical Medicine, Hamburg, Germany, has shown that administration of doxycycline (daily 100 mg oral dose) for at least 6 weeks to Onchocerca volvulrzs infected patients (previously treated with ivermectin in Ghana), resulted in disappearance of skin microfilaria that lasted at least 18 months. It is assumed that this effect is associated with the antibiotic effect of doxycycline on Wolbachia, an endosymbiont of filarial parasites. Based on this clinical observation, several clinical research proposals addressing further clinical examination of this antibiotic in onchocerca infected patients have been submitted to TDR. After a critical review it was decided not to endorse further clinical studies with doxycycline primarily because there was no indication that shorter treatment periods would be effective or that higher doses would be more effective. In addition even if proven effective, the long term use of doxycycline was seen as not compatible with the needs and limitations imposed by the nature of the onchocerciasis control prograrnmes. The contraindication of use during early pregnancy would impose pregnancy exclusion or prevention of pregnancy during the length of the treatment (6 weeks). Due to similar contraindication in children they would be excluded from the therapeutic benefit as well. Furthermore, long-term use of doxycycline could provide selective pressure towards drug resistance in life threatening microorganisms. On the other hand it was recognized that doxycycline could be considered for specific case management of individual onchocerciasis patients or in special communities. Based on these discussions it was acknowledged that Wolbachia represents a suitable target and it was recommended that the drug discovery group in TDR conduct appropriate studies to identify suitable drug candidates against Wolbachia (see below). ii) Rifampicin : Experimental observations in animals have shown that rifampicin, a commonly used drug in the treatment of tuberculosis and also as an antirickettsial agent, is effective against Wolbachia. To further validate the Wolbachia as a target for treatment of filariases we have promoted a human clinical study aimed to evaluate the brugian filariasis infection in patients with pulmonary tuberculosis who are currently being included in the Directly Observed Treatment - Short course (DOTS) programme. These patients are receiving rifampicin for a period of six months. A case study of patients arriving for TB treatment at the tuberculosis unit in T.D.Medical College Hospital (departments of Internal Medicine, Chest and Tuberculosis, Paediatrics and the District T.B.Centre), in collaboration with the Filariasis Chemotherapy Unit at Allepey, India has been initiated. Patients are screened for microfilariae (night blood examination) before they receive DOTS (including rifampicin) and those who -JPC22.2 Page 26 have microfilaria due to Brugia malayi infection will be evaluated at intervals of two, four and six months. The study will assess the long-term efficacy (reduction of blood microfilaria) of a therapy containing rifampicin without interfering with the tuberculosis treatment. 88. Human pharmacokinetic safebt and efficaclt studies of albendazole + ivermectin / DEC combinations in LF.' Clinical studies relevant for the Global LF elimination programme and its integration within the Onchocerciasis control programmes were initiated and are ongoing: i) Albendazole *ivermectin: safety, efficacy in LF and intestinal helminthes study in Pemba Island (Dr. M. Dahoma). 1000 subjects including LF positive. The treatment phase of this study has been completed; currently the patients are being followed for the efficacy and safety. The study is expected to be completed by December 2001. ii) Albendazole + DEC: pharmacokinetics, safety study (Dr. K. Shenoy) This study demonstrated that there is no pharmacokinetic interaction between albendazole and DEC. iii) Albendazole+DEC: safety, efficacy and PK (Dr. N. Kshirsagar) 1400 subjects from a LF endemic region in India have been treated, the study results will be available December 2001. 89. Clinical studv to evaluate individuals from selected OCP areas with skin microfilarial profiles not congruent with the expected results after repeated ivermectin treatments 90. The epidemiological and entomological analysis of data from OCP highlighted that some individuals from the Bui-Black Volta and Pru (Ghana) areas, despite having received ivermectin 9 or more times, still had skin microfilarial loads above those that were expected (10 or more microfilariae/snip). From consultations between OCP, OCRC, Ghana National Onchocerciasis Control programme, TDR and experts from the Noguchi Institute for Medical Research in Ghana it was decided to study these individuals. Under strict clinical observation (at OCRC) these individuals were treated with the recommended normal dose of ivermectin. To determine if the drug was appropriately absorbed and metabolised, drug blood levels were determined. In addition the drug effect on the parasites was also determined by quantifying skin microfilariae before and after treatment as well as by quantifying and evaluating microfilarial survival in black flies. Furtherrnore, ocular examination and nodule ultrasonography and histopathology to determine the viability and fertility of adult worns will be measured. The isolated parasites from these patients will be examined by the team of molecular biologists who will look for changes in key genes. The study was initiated in April 2001 and results are expected for July 2002. Pre-clinical research activities Ivermectin resistance detection tool 91. The objective of this project is to develop a PCR-based assay to detect ivermectin resistance by assessing shifts in the allele frequencies at loci that may serve as markers for ivermectin resistance in O.volvulus. Two focused teams are collaborating, one in West Africa undertaking fieldwork (see above clinical work) and one international undertaking laboratory studies. During the first year of the project the identification of candidate genes associated with ivermectin resistance in Haemonchus contortus and C. elegans was completed. 92. In the second year (reporting year), candidate O. volvulus genes from adult and microfilaria material from "unselected" (ivermectin untreated areas) and ivermectin exposed areas were t a aJPC22.2 Page 27 examined for polymorphism. "Association analysis" of selected markers from these samples were conducted. In addition a DNA preparation method compatible with the present method of sample collection during routine field activities (skin snips or Black flies) was developed in conjunction with the OCP Laboratory team in Ouagadougou. 93. During the third year (2002), genes showing polymorphism will be evaluated for development of a PCR assay to detect the presence of alleles more frequent in ivermectin selected areas. At the end of the third year a "proof of concept" PCR assay to detect allelic changes in O. volvulus candidate genes will be completed. Ootimisation of DEC skin oatch test 94. Unfortunately, this project has been on hold because the negotiations regarding the development of a standardized product based on a transdermal drug delivery technology from a German company have not progressed as expected. Recent direct conversations between Dr. B. Liese and the management of this company have brought the potential partners back on the negotiation table and the R & D activities for prototype production have been initiated.. Drug discovery activities Inhibitors aqainst filarial and Wolbachia soecific aminoacvl-tRNA svnthetases 95. Structure-based drug design has revolutionized the development of new therapeutics for microbial infections, HIV and cmcer. This provides a unique opportunity for a university-based collaboration lead by Dr. Michael Kron (Michigan State University) to design and test inhibitors of a filarial parasite enzpe known as an aminoacyl-tRNA synthetase (AARS). This enzyme is a novel validated molecular target for anti-infective drugs discovery, recognized by those in the pharmaceutical industry responsible for development of new antibacterial and antifungal drugs. The team is applying four new technologies to identify inhibitors of an AARS from the human parasite: o Production of recombinant enz]yrr,e and purification on a large scale. The enzymes have proven stable enough for use in robotic "high throughput screening" formats, in which enzyme inhibition is measured after exposure to each of thousands of different potential chemical inhibitors. o Use of a drug design methodology called SLIDE (Screening for Ligands with Induced-Fit Docking, Efficiently ) developed at Michigan State University has previously been applied only in the private sector pharmaceutical industry. This method performs computer based screening of chemical databases and predicts the best candidate enzyme inhibitor by attempts to "dock" them into the 3-dimensional structure of the protein target. . Successful determination of the three dimensional atomic structure of a filarial AARS, through partnership with Dr. Stephen Cusack, Director of the European Molecular Biology Laboratory Grenoble Outstation crystallography group. This is the first such enzyme structure ever solved. o Collaboration with synthetic organic chemists committed to drug design (Oslo, Norway and Christchurch, New Zealand) providing the opportunity to synthesize and optimize the molecular "scaffolds" identified by other methods. Synthesized or natural compounds identified by different screening methods are tested again in vitro to see if they inhibit recombinant enzyme or in vivo for activity against adult worms maintained in culture. These steps provide feedback to refine each phase of the inhibitor design cycle. JPC22.2 Page 28 96. Approximately 100,000 potential inhibitors of the filarial enzyme have been analyzed, and we have secured the methods to continue analysis of up to 400,000 more. The research has identified 17 new chemical structures (synthetic and natural products) that inhibit parasite AARS, as lead antifilarial compounds for further study. The successful implementation of our drug discovery strategy has drawn the attention of an intemational pharmaceutical company, Basilea Inc. (the anti- infective company spun-off from Roche), that has pledged its future support by providing medical chemistry advice as well as access to its private collection of novel chemical libraries. 97 . Similarly, to find lead compounds to klll Wolbachia, the team has cloned and are expressing a very unique AARS from the Wolbachia living within adult female Brugia malayi parasites. After purification of this enzyme the above described strategy will be followed: - determination of the Wolbachia AARS structure, use of SLIDE and high throughput screening. 98. Thus, by careful selection of an interdisciplinary and multinational research team, a unique molecular target and incorporation of new technologies of great interest to private sector goals for "profitable disease drug discovery," we are making important strides toward rational development of anti-filarial and anti-Wolbachia drugs. Wole parasite drug screening in in vitro or in vivo. 99. Substances from available chemical libraries as well as specific substances (antibiotics) are examined in the Laboratory of S. Townson. Compounds are first examined in in vitro 5 day assay against male Onchocerca gutturosa.. This has been useful in identifying 5 antibiotics (rifampicin, minocycline, doxycycline, clofazamine and ethambutol) with significant anti-Onchocerca activity. Active compounds are further tested in vivo against Onchocerca microfilariae in mice and against transplanted Brugia pahangi macrofilariae in jirds. Positive compounds are further evaluated in Brugia pahangi in dogs. 100. While a substantial number of known drugs from the animal health anti-helmintic area have been examined in the above models, no new leads have been identified. It is assumed that due to the fact that the currently relevant drugs used for management of animal parasitosis are threatened by resistance, the "for profit" research based drug discovery companies must have several new compounds in the "pipeline". Unfortunately, due to the high potential commercial value these are not being made available for evaluation against the human parasites. Project management 101. The MACROFIL activities are conducted within the operational frame of Product Research and Development of TDR. The Drug Discovery Research group manages activities related to compound screening and discovery of new targets. Evaluation of progress and decisions regarding scientific validity are performed by a Steering Committee composed of experts in the area of drug discovery. The clinical activities and product development are conducted through Product Development Teams, which are assessed by TDR PRD Research & Development committee. 102. During the reporting period the project has operated with a budget of US $ $1.71m. This represents a reduction of $390 000 compared to previous years. This reduction is reflected in significant lessening of drug discovery activities. Since Filariases R & D products are entering into late phase development, it is expected that the budgetary requirements will increase substantially. With the anticipated termination of OCP at the end of 2002 and uncertainty of future funding, it is difficult to plan and prioritise long term R & D activities. a tJPC22.2 Page29 ADMINISTRATION AND SUPPORT SERVICES Objectives, organisation and operation of services 103. The role of the Finance and Administration Unit is to support activities of the operational, technical and scientific units of OCP. It manages the Programme's infrastructure, as well as its human, financial, and material resources, in accordance with its means. The unit manages also translation and the organisation of statutory meetings. It offers services in purchases, finance, personnel management, transport and communication and general administration. During the period under review, the unit gave assistance towards the achievement of the following objectives: i) Training in the use of software such as Word, Excel and PowerPoint, Internet and electronic mail for administrative assistants and secretaries of OCP ii) Training of one technician at Philips in the Netherlands for the utilisation and maintenance of OCP interpretation material iii) Continuation of the sensitization and re-training session on road safety for drivers of the Programme, with a view to keeping down the number of road accidents. Administration costs 104. The Administration costs of the Programme are defined as those relating to budget items that have to do with the Office of the Director, Administration and Support services in Ouagadougou and Geneva. For the years 1996 through 2000, expenditure on these support costs, as well as the percentage these expenses represent in the overall Programme budget is shown in the following table: Table 4: Programme Administration Cost from 1996 to 2000 (US$) 105. It must be recalled that the rate of expenditure as compared to overall expenditure of the Programme dropped from 14.78Yo in 1999 to 14.35o/o in 2000. Administration costs in 2000 dropped by 10.43% as against those of 1999. Further steps are being taken to keep expenditure Categories 1996 1997 ,1998 r99s 2000 Direstods office 767 161 763 847 879 727 688 230 609 851 Administration and Support Services Ouagadougou 1 842 570 1 715 580 1 345 471 1 169 398 1 046 313 Support $ervices Geneva 348 451 311 467 360 068 363 532 333 212 Overal I Administration costs 2 958 182 2790 894 2 585 266 2 221 160 1 989 376 Totalof Programme expenditure 21 792 694 21 110 457 17 206 221 15 025 927 1 3 860 579 % Admlnistration costs 13,57 yo 13,22oh 15,03 yo 14,78 yo 14,35 o/o tPC22.2 Page 30 under control, especially in the area of personnel. This consists in replacing vacant positions with short-term or temporary Special Services Agreement contracts, which are less expensive, as compared to WHO contracts. Budget and finance 106. In 2000, the exchange rate of the US dollar went from 653 CFA francs in January to 758 francs in December. The average rate for 2000 was 708 CFA francs. The 2000 budget was drawn up on the basis of a prudent exchange rate of US$ 1 : 550. As a safety measure, the 2001 budget was also drawn up on the basis of an exchange rate of US$ 1 :600 CFA francs. 107. The Finance section operates 14 bank accounts in the eleven participating countries of the Programme, and reconciles them on a monthly basis of the accounts sent in by the National teams and the Eastern and Western operational zones. There are all indications that good accounting standards and practices were respected this year too. 108. As in the past, the Budget and Finance section took over the accounting operations of the APOC prograrnme, with respect to all payments, fund transfers for the various projects in the 19 Programme countries, accounting records of data, as well as the monitoring of budget outlay. 109. The Budget and Finance section continued to benefit from Headquarters support for operating and updating the new ROAII computerized system. The update of the accounting databank is done by OCP staff in Ouagadougou. Personnel 110. The Personnel section continued to give assistance and expertise to OCP and APOC in the area of recruitment, especially for the latter, as well as in the renewal of temporary contracts (secretaries, assistants and drivers) during periods of intense activity. 111. Given the impending closure of the OCP Programme, the section has started making arrangements to facilitate the gradual disengagement of personnel. Efforts are being made to find ways of means to assist some staff members to deal with the closure of the Programme . Supplies and services ll2. This section manages all purchases of goods and services of the Programme, deals with the maintenance of projects' inventories and the disposal of items, which are no longer useful or in excess of the Programme's needs. It also supervises administrative services such as office management, air travel and visas, mail registry and distribution, and fax and telephone. It also supervises the contractors to whom we have out-sourced security and cleaning services. 113. Several meetings were, once again, held in the OCP conference room this year. The Supplies and Services section gave the necessary administrative and logistic support for the successful holding of these meetings. It technically ensured the renewal of obsolete interpretation equipment. Il4. The Purchases section processed 710 purchase orders on behalf of OCP and APOC, for 881 items bought locally over the period, in the sum of US$ 1,257,832. Also, 196 purchase orders to the tune of US$ 3 924 762 were processed by the central purchases unit of WHO in Geneva. t 5 TJPC22.2 Page 3t Transport and communications 115. This section is responsible for managing the vehicle fleet of the entire Programme area, which currently has 218 vehicles. It is also in charge of the telecommunication network made up of 45 stations of radio/teletypes, 5 warehouses of spare-parts and 5 fuel storage tanks with a total capacity of nearly 60,000 liters. 116. The policy of reducing the fleet is being carried out as vector control activities are being scaled down, and as countries take over responsibility for the detection and control of onchocerciasis. ll7 . The vehicle fleet, made up of 81% of 4WDs, was operational at 90o/o. Three-quarters of the vehicles were put at the disposal of national teams for PET and VCU activities. Following the withdrawal of 35 old vehicles from circulation, and the transfer of 2 other ones to Participating countries, the fleet has been reduced by nearly 1,4.5o/o, as compared to the previous year. 118. The section managed stock of the central warehouse in Ouagadougou, which stores more than 30,000 different items, and which supplies the other regional centres with spare-parts. These stocks have helped to put a lot of vehicles back on the road. Purchases in this sector are presently frozen, and a review of these stocks is planned in view of the closure of the Programme. 119. With respect to telecommunications, and except for Guinea-Bissau, all the Programme participating country capitals have radios, which widens the network to 45 stations. LIAISON, INFORMATION AND ADVOCACY ACTIVITIES 120. Year 2001 is the penultimate year of a long and very active life for OCP. For twenty seven years, the Programme has managed to build and consolidate as diversified as fruitful cooperation and partnerships. It has promoted sound and dynamic solidarity, developed extended and multidisciplinary know-how on contact with the field and various experts throughout the world. It was successful in holding very high the torch and being the voice of the weakest, of the poorest and finally, of the victims of onchocerciasis. l2l. It developed channels of communication which largely facilitated its activities, its expertise and its contacts with the operational bases, the Participating Countries and different experts and institutions throughout the world. It was able to generate sound collaboration with the countries concerned with Oncho control and set in motion an operational dynamics for an adequate transfer and maintenance of the achievements of the Programme after the December 2002 deadline. 122. The pooling together of the respective efforts made it possible for all the stakeholders to contribute and reinforce the initiatives and operations carried out by OCP. With the Participating Countries 123. The Ecological Group and the Hydrobiologists of the 11 Participating Countries of OCP had their annual statutory meeting this year in Accra, in Ghana from 5 to 9 March 2OOI. This 22"d session of the Ecological Group laid particular stress on the " West African Freshwater Biodiversity Conservation and Ecosystem Management Project " (WAFEM). This project which JPC22.2 Page 32 seeks financing from the Global Environment Fund (GEF) will contribute to improving the quality of life of the rural populations, victims in the past of river blindness. 124. Dr. Boakye A. Boatin, Director of OCP, visited the Eastern Zone of the Programme covering Benin, Burkina Faso, Ghana, Niger and Togo from 20 to 25 February 2001. At a few months from the end of Programme, the Director initiated this visit in order to discuss with the national authorities, to sensitize them on the need for maintaining the achievements of the Programme and to encourage the staff of these countries who will be in charge of implementing the activities after the end of OCP in 2002. He undertook a similar visit in the countries of the Western Zone of the Programme, later in the year. 125. The annual meeting of the operational zones would bring together, from 22 to 26 October 2001, in Bobo-Dioulasso, Burkina Faso, all the National Coordinators, the National entomologists of the 11 Participating Countries and OCP technical officers. The meeting made it possible to review the critical problems of the Programme and to consider future prospects. Several other meetings brought together the National Coordinators in Ouagadougou for the same purpose during this year. With OCP and APOC Statutory bodies 126. From 18 to 19 January 2OOl, the Director of OCP took part in the 92'd session of the Committee of Sponsoring Agencies in Washington DC in the USA. He then took part from 31 March to l't April 2001 in the 93'd session in Faris, in the 94th rn Geneva and the 95th in Rome. From 7 to 9 March, was held in Ouagadougou, the 17th meeting of APOC with its partner NGDOs. The meeting of the Technical Consultative Committee of APOC was held during the same month, from 12 to 16 March, also in Ouagadougou. From 4 to 8 June 2001 was held at the Programme Headquarters the 22nd session of the Expert Advisory Committee. With the Donors I27 . The Director regularly represented the OCP at the meetings of the Committee of Sponsoring Agencies with the Donors in order to secure the funds necessary for the proper implementation of the activities of the Programme. With the Evergreen Helicopter Company 128. On 2 May 2001, a consultative meeting was held at OCP Headquarters between OCP and the Evergreen Helicopter Company. Year 2001 being the penultimate year of the OCP, this meeting had a strategic importance for the two partners in the fight against onchocerciasis. With the scientific community 129. The active participation of the OCP in various scientific meetings proceeds from the will to communicate and collaborate with scientists from different backgrounds throughout the world. Thus the Director of OCP took part during the period under review in several high level meetings among which were the Mectizan Expert Committee meeting in Atlanta, USA, from 13 to I7 January 2OOl, the Hydrobiologists' meeting and the 22nd session of the Ecological Group from 3 to 10 March 200I, and the meeting on ivermectin resistance from 25 to 28 April 2001 in Accra, Ghana, and the WHO/OCP cosponsored conference on Filariasis/Onchocerciasis in Hamburg, Germany from September 1 8-22, 2001. t .t aJPC22.2 Page 33 With the general public 130. From 12 to 14 April 200I, the OCP Communication Section took part in a workshop organized for Communication Officers of UN Agencies in Burkina Faso. This workshop aimed at better preparing these Communication officers for the new Communication and Information Sciences (CIS) so they can give better support to UNDAF (United Nations Development Assistance Framework) and ensure the promotion of UN System activities. 131. OCP has in the year produced official statements and press releases, as well as articles for the sensitization of the general public on onchocerciasis control which were published in local newspapers. Video cassettes and photographs on the activities of OCP were made in order to perpetuate the actions of the Programme and to document the process of its development. 132. The OCP/APOC Programmes and the Multidisease Surveillance Centre being set up were the subject of TV broadcasts in the programme CANAL ONU. 133. OCP and APOC were honoured on Thursday 1" March 2001 by the visit of His Excellency the Minister of Health of Burkina Faso, Mr. Pierre Tapsoba, with whom the personnel had profitable exchanges. Advocacy of activities 134. As always, OCP took a very active part in the activities of various sub-commissions of the UN Agencies present in Burkina Faso, namely: those concerned with administration, emergencies, communication, management of the programmes, HIV/AIDS, staff associations. 135. OCP initiated and maintained very useful contacts with the national and international Medias, the national and international press correspondents, Fr6quence and CANAL ONU, political authorities, and the representatives of the different U.N. Agencies and International Institutions. This year four (4) issues of Oncho News were produced which dealt, inter alia, with the work of the Expert Advisory Committee (EAC) and the Committee of Sponsoring Agencies (CSA) in 2001. 136. In terms of in-house communication, the Sensitization and Support Committee (SSC) set up by OCP continued its staff information and mobilization activities in relation to the closure of the Programme in December 2002. With the efforts and support of the OCP Management and of the Working Group specially set up by the Regional Director of WHO/AFRO to deal with issues related to the closure of OCP, one notes greater serenity among the staff as far as the problem of the approaching end of the Programme is concerned. Documentation Bank 137. The technical documents and files of the Programme are currently the subject of an important project initiated in September 1999. This project aims at storing the data collected by the Programme for 28 years of activity on an adapted electronic medium, in order to ensure their conservation, filing, accessibility and fast consultation. 138. To this end, missions of documentary cleaning, reorganization and treatment of the files were carried out in the operational bases (Kara, Parakou, Hohoe) in November 2000 and in Odienn6 in February and August-September 2001. t I JPC22,2 Page 34 139. In March, a dataprocessing specialist from the WHO/Headquarters Library in Geneva came to Ouagadougou to train the staff of the Documentation Centre in the use of the BiblioMaker software for the recording of bibliographical data and in the Pixview software for scanning documents. Following this training, more than | 672 documents, or 25 080 pages were scanned. Through the use of the BiblioMaker system, 300 documents have already been recorded. 140. During the period under review, the Centre was intensely patronized by external users. It recorded 602 regtilar external users, including especially students and trainees from the health schools, doctors, experts and consultants from various organizations and institutions of medical research. It loaned out 320 documents to homes, and distributed 25 029 documents (scientific articles, OCP/APOC handouts, documentation on the DNA Laboratory, on the Documentation Centre, OCP/APOC brochures and posters). The Centre also distributed 20 video cassettes to partners, including cassettes of the documentary " The Eyes of Hope ". Documentary units based in Ouagadougou received more than 600 publications by WHO and the OCP Programme. l4l. For the purpose of sensitizing the general public on onchocerciasis control, film shows were organized for junior and senior secondary school students. The Documentation Centre also took part in exhibitions of documents and photographs during national and intemational events such as the Panafrican Film Festival of Ouagadougou (FESPACO), held in Ouagadougou from 24February to 3 March 2001. Institutional relations I42. As usual, the Documentation Centre maintained good relations with several other documentation units of research organisations in the country. Thus, besides the inter-library loaning it practices, the Centre participates in the project of creating national and inter-African documentation networks. Among these networks are the National Health Information Network of Burkina, which comprises the documentation centres and libraries of : the WHO office in Burkina, the National School of Health, the Faculty of Health Sciences, the National Malaria Control Centre, the Francophone Publishing and Distribution System (SYFED) Centre, the West African Health Organization (former OCCGE), the Research and Development Institute (IRD - former ORSTOM) and OCP/APOC. Mention could also be made of the participation of the Centre in the "Index Medicus Africain" project, which is a documentary outcome of the "Association pour I'Information et les Bibliothdques de Sant6 en Afrique (AIBSA) : Association for Health Information and Libraries in Africa. 143. As in the previous years, the WHO/AFRO and the WHO/tIQ libraries responded favourably to numerous requests for documents, such as periodicals, books and technical reports. Meetings and seminars 144. The Programme received on 1 1 and 18 January 2001 respectively, the visit of two groups of health and medical students from the School of Public Health of the University of Legon, Accra, Ghana. The officer in charge of the Documentation Centre attended the congress of Pr6IIFLA (International Federation of Library Association and Institutions) from 14 to 16 August 2001 in Canada where she participated in a meeting on the techniques of management and marketing applicable to documentation and information systems. ? 5 l , ,i ,ffi ,,, \e..i :,iH q (. I d Y : 0' I' 1t 'lr lrir I ;J ,T I t. I , :{ ir i. ! t t I I I s F i a .i r a I H \ World Health Organisation Organisation Mondiale de la Sant6 Onchocerciasis Control Programme in West Africa Programme de Lutte contre I'Onchocercose en Afrique de l'Ouest Ouagadougou - Burkina Faso T6l6phone : (226) s+2s 5s/5s/60 T6lex : 524r BF Fax : (226) s4 28 15 E-mail : nanaa@.oncho.oms.bf t a 1lt 'ry---vr \ t -:t , t