Onchocerciasis Elimination Program for the Americas — OEPA – October 2005

1. Onchocerciasis Elimination Program for the Americas— OEPA –October 2005 Lymphatic Filariasis Elimination in the Americas 5th Regional Program Review Group (RPRG) Meeting(San José, Costa Rica)

2. Onchocerciasis Elimination Program for the Americas (OEPA) Headquartered in Guatemala, OEPA is the technical and coordinating body of a multi-national, multi-agency coalition that acts under the 1991 Resolution XIV of XXXV Directing Council of the Pan American Health Organization calling for the elimination of all onchocerciasis morbidity from the Americas by the year 2007.

3. Partnership Organizational Chart 57th WHA, May 19, 2004 IACO 2003, Cartagena, Colombia MDP/ Merck & Co. CDC Lions Club Carter Center Gates Foundation PAHO/ WHO NGDO & OTHERS PCC Programmatic Directorship OEPA Executor Country Programs Brazil Colombia Ecuador Guatemala Mexico Venezuela

4. Geographic Distribution of Onchocerciasis in the Americas VENEZUELA: 1 9. North-eastern Focus 2 MEXICO 8. North-central Focus 3 4 10. Southern Focus (Amazonas/Bolivar) GUATEMALA 5 7 6 BRAZIL: MEXICO: 11. Amazonas-Roraima Focus 1. Oaxaca Focus 2. Northern Chiapas Focus (YANOMAMI Area) 3. Southern Chiapas Focus 8 9 GUATEMALA: 4. Cuilco Focus (Huehuetenango) VENEZUELA 5. Central Focus: - Sololá, - Suchitepéquez - Chimaltenango COLOMBIA: COLOMBIA 6. Escuintla , Guatemala Focus 10 12. López de Micay Focus 12 7. Santa Rosa Focus 11 ECUADOR: 13 13. Esmeraldas/ Pichincha Focus - Cayapas River BRAZIL ECUADOR - Santiago River - Onzole River - Satellite Foci: (Canandé and others)

5. Percentage of the Ultimate Treatment Goal (2) by Focus, 2004 *UTG(2): UTG multiplied by two.

6. OEPA Strategy (wording from WHO Certification Document) 6-monthly mass distributions of Mectizan® in all endemic areas, covering at least 85% of the eligible population. Two primary goals: • First, to eliminate morbidity due to infection with O. volvulus in the six-country programme by the year 2007. This is also stated as elimination of onchocerciasis as a public health problem by the year 2007. • Second, to eliminate parasite transmission in those countries or foci where feasible. No time limit is specified.

7. Criteria for Certification of Elimination(wording from WHO Certification Document)4. 1. Elimination of Morbidity • Absence of reversible lesions in the anterior segment of the eye (punctate keratitis, microfilariae in the anterior chamber). A 5-year cumulative incidence rate of less than 1 new case per 1000 is acceptable • It must be remembered that permanent eye lesions, as well as some severe skin or lymphatic lesions, are irreversible. Such “old morbidity” cannot be eliminated except bydeath.

8. 4 .2. Elimination of Transmission and Infection 4. 2. 1. Entomology The absence, or near absence, of infective-stage larvae in the vector population as determined by PCR in a minimum sample size of 10,000 flies for each endemic community tested.

9. 4. 2. 2. Human Epidemiology(Children) The absence of detectable infection (as evidenced by microfilariae, nodules, immunological or other proven tests) in untreated children reaching the age of 5. A 5-year cumulative incidence rate of less than 1 new case per 1000 susceptible children is acceptable.

10. 4. 2. 3. Human Epidemiology (Migrants) The absence of detectable infection in untreated, new residents who have migrated into an endemic area where transmission has been interrupted (1 new case per 1000 susceptible individuals).

12. SIMON: A simulation of numbers of infected persons in the population of Corriente Grande following continual six-monthly distribution of ivermectin. Proportion of non- receivers 2.0%. Each line represents one of 100 model replicates. Adult Worm Negative

13. SIMON: A generated probability of eliminating all living female O. volvulus from the human population of Corriente Grande, expressed as the proportion of uninfected persons remaining in the population each year Source: Davies, 2005, unpublished