VÿORLD HEALTH ORGA NIZATION ORCANISATION MONDIALE DE LA SANTE ONCHOCERCIASIS CONTROL PROGRAMME IN WEST AFRICA PROGRAMME DE LUTTE CONTRE L'ONCHOCERCOSE EN AFRIQUE DE L'OUEST EXPERT ADVTSORY COMMITTEE OCP/EAC|5.5 Fifteenth session ORIGINAL: FRENCH Ouaeadouqou. 6-10 June 1994 PRESENTATION OF VCU ACTIVITIES IN 1993.1994 The main meetings of the Vector Control Unit (VCU) are those of the eastern and western which are normally held in November. They make it possible to sum up the different VCU results for presentation to the JPC in December. The meeting of national hydrobiologists and that of the Ecological group are held in January and early February. Finally, in May, the AREM (Research) and lnsecticide meetings precede that of the Expert Advisory Committee. This document therefore takes into account only the summary of the zonal meetings as presented to the JPC as well as a brief presentation of the meeting of the Ecological Group presented in detail in the meeting's report submitted to the Expert Advisory Committee. The AREM and lnsecticide meetings, which were held recently in Bouake, will be presented by Dr C. Back, the VCU Research Coordinator. The VCU larviciding operations, which are aimed at interrupting the transmission by eliminating the vector, were carried out satisfactorily in 1993 as well as in the 1994 dry season. The six operational insecticides were used in rotation on the different treated river basins, taking into account the discharge, the specific qualities of each of the larvicides and cost-effectiveness. For example, Figure I shows a dry-season larviciding concerning the 13th week, i.e., from 29 March to 4 April. During that week, some 3,500 km of river.were treated in the Western Zone, while larviciding was suspended completely for three weeks this year in the Eastern Zone because of the good entomological results. Only two insecticides were used, i.e., B.t. H-14, a biological insecticide without any toxicity on the non-target fauna but whose use becomes costly when the discharge is above 15 m3/s., and Abate or temephos which is also not very toxic to the non-target fauna and whose carry and dosage allow it to be used at discharges reaching 400 m3/s. The entomological results are excellent since out of the 1,502 females caught at the 143 catching points, only one was infective and contained one infective larva of Onchocerca volvulus (Fig.2). OCP/EAC I5.T gage 2 2 In the rainy season (Fig.3), the 36th week, i.e., 6-12 September, saw the larviciding of some 11,000 km of river. It should be noted that this time 8,000 km were treated in the Eastern Tane and only 3,000 in the Western Zone where suspensions were made durirng the high-water period because the larval breeding sites were flooded and the entomological results excellent. The six operational insecticides were used, with a predominance of pyraclofos, Abate and phoxim. The two high-water insecticides, permethrin and carboor,rlfan, were used cautiously because of their toxicity on the non-target fauna. The entomological situation is also quite satisfactory since out of the 4,410 females caught on 153 crtching points only two were infective and contained three infective larvae of Onchocerca v0livulus (Fig.a). It should, however, be admitted that the entomological situation has not been so perfect each week. The annual results that have been obtained since 1990 havc been summarized and the weekly mean number of infective females and infective larvae calculated for each year. On Fig.5 can be observed the rapid decrease in the rcsidual transmission, from 34 infective females and 109 infective larvae per week in 1990 tro nine infective females and22 infective larvae per week in 1993 (the DNA-probe correction even gives, for 1993, six infective females and 14 infective larvae of O. volvulus per week). In an area of one million square km populated by some 30 million individuals living in an endemic zone, this residual transmission appears to be quite negligible. However, it hasl to be maintained for a sufficiently long time at such a level so that the human parasite re§ervoir would disappear. It appears clearly that such a rapid decrease in the residual transmission is due not only to the good larviciding results but also to the large-scale ivermectin treatment§ which considerably reduce the source of blackfly infection by a massive destruction of the microfilariae in the skin of patients. A good illustration of this combined effect of the wo control techniques is given in Fig 6. We have grouped together the entomological results of four catching points in the original area and three catching points in the western extension area. In the first case, only larviciding was available. Before the beginning of larviciding in 1975 (Fig.7), the number of infective larvae was 61.4 per 1,000 Parous blackflies caught. After five years of control, this number wtrs still 48.6 infective larvae per 1,000 parous females, i.e., a decrease of.Z|Vo. In Guinea, before the beginning of the treatment, there were 41.2 infective larvae per 1,000 parous, while after three to four years of combined larviciding/ivermectin treatment, this number fell to 9.5 infective lan*ae per 1,000 parous, i.e., a transmission decrease of 77Vo. Will this combined treatment reduce the Programme's duration? Theoretically, the answer is no because there is no proof at present that repeated ivermectin treatments reduce the life span of the adult worms (12 yCars on average, maximum 14-15 years). In practice, this hypothesis is likely because recent studies show that repeated ivermectin treatments considerably reduce the fecundity of the adult worrns though not killing them. One should, however, be cautious. Only the prevalence rate or level of incidence of the disease in the field could give a clear answer to this important question. ocP/EAcr5.5 ' paSe 3 Another subject of satisfaction to the Programme is the perfect functioning of the DNA-probe laboratory installed in Bouake, Côte d'lvoire. It now makes it possible to regularly identiÿ all infective larvae collected in the Programme area. Fig.8 gives an overview of the percentages of Onchocerca volvulus found on different catching points. On the whole, 65Vo of the identified larvae belong to this species, the remaining 35Vo being animal Onchocerca most of which belong to the Onchocerca ochengi species, a boüne parasite (Fig.9). The results between forest and savanna strains of the parasite are more diffÏcult to interpret but, on the whole, the confirmed identification of the forest strain corresponds quite well to the identification of the corresponding blackfly vector species (Fig.10). All these results lead to the obtention of Annual Transmission Potentials (APTs) for which we could, initially, examine the ATPs due to all the species of the Simulium damnosum complex (Fig. 11). It appears clearly that the residual transmission is due mainly to the forest species. In fact, if the transmission due to the savanna species alone (Fig. 12) is considered, out of.212 catching point. monitored regularly, not even one has an ATP above 100. Furthermore,65Vo of the 212 catching points have a nil savanna ATP. These good results have led to the definitive cessation of larviciding in almost the whole of the original area. Following a recommendation of the Expert Advisory Committee, post-control studies have been conducted systematically since 1990. As many blackfly catches as possible are made, for a period of two years, on the selected points where the transmission was particularly intense (Fig. 13), in order to know their infectivity rate precisely. The mathematical model and statistical calculations have shown that the risk of recrudescence of transmission and therefore a fortiori of the disease was practically nil for an infectivity rate below one infective female per 1,000 parous females caught. Out of the 14 points studied or being studied, 10 have an infectivity between 0 and 0.83, which is quite satisfactory, while two have an acceptable rate, arouncl 1 (1.08 and 1.17). They are two areas where many untreated migrants have settled. They are at present under ivermectin treatment. Finally, larviciding has been resumed on two points, Keremou (Mekrou) and Batie (Black Volta). New epidemiological surveys in these areas will make it possible to identiÿ the villages where the prevalence of the disease is not yet sufficiently low. They will be brought under ivermectin treatment and the larviciding will be suspended again. Some examples of post-control results are given in Fig. 14 to.l8. At lrraba bridge, the situation is good (infectivity rate of 0.51) despite the numerous migrants. At Porga (infectiüty rate of 0.60) and Konina (0 infectivity), the DNA-probe analyses have enabled a great presence of Onchocerca ochengi to be observed. It should be noted that during the last meeting of the Ecological Group in Bamako, a seventh operational insecticide, Vectron (OMS 3002), wæ approved for discharges above 15 m3/s. (Fig.l9). The importance of this ad<litional insecticide resides in the fact that it belongs to the pseudo-pyrethroid family while, up till then, for discharges between 15 and J ocP/EAcrs.( page 4 -'' 70 m3/s. only three insecticides all belonging to the organophosphate family were available(Fig.20). in case of appearance of a possible cross-resistance to these three orgânophosphates, there was therefore a risk to the success of the larviciding operations. With tt is new insecticide belonging to a completely different family, this rbk has disappeared. The impact of this new larvicide on the non-target fauna is con§idered accep-table by the Ecological Group. It is comparable to that of pyraclofos which OCP has dreâdy been using for the past three years. However, because of its recent introduction as an opLrational lirvicide, Vectron will be the subject of a very specific study by the hydrôbiologists in 1994. In üew of its price (US $ 21/litre), carry @ to 7 km) and dosage 1ô.OO t7m3/"s.), this insecticide could be used at a discharge benvèen 15 and 2C[-i250 m3/s. To finish with larvicide research, it should be noted that the Abbot comptny has developed new experimental oily formulations of B.t. H-14 which have proved to bç seven to eigtrt times moie effective than the present formulations. If these formulations can be produced industrially, this would allow B.t. H.14 to be used with the same advantage§ as the èhemical insecticides, without the disadvantages of toxicity, however little it is. It can therefore be concluded, on the whole, that the results obtained are very sarisfactory but that caution and vigilance should still be the order of the day so that the Participating Countries could tak. over with confidence the maintenance of the Programme's achievements. ,o -\. J\ <.) ( r\. \ """"':'.... 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