03584nas a2200481   4500000000100000008004100001653001100042653002200053653002600075653001900101653000900120653001500129653001100144653001100155653001600166653001100182653002100193653003300214653002800247653002100275653001000296653001300306653001200319653001000331653001500341100001600356700001300372700001800385700001200403700001200415700001300427700001200440700001900452700001200471700001400483700001100497700001500508245012300523300001300646490000700659520242200666022001403088       2008                            d10aUganda10aTreatment Outcome10aSentinel Surveillance10aonchocerciasis10aMale10aIvermectin10aInfant10aHumans10aFilaricides10aFemale10aEndemic Diseases10aDrug Administration Schedule10aCross-Sectional Studies10aChild, Preschool10aChild10aCameroon10aAnimals10aAdult10aAdolescent1 aKatabarwa M1 aEyamba A1 aHabomugisha P1 aLakwo T1 aEkobo S1 aKamgno J1 aKuete T1 aNdyomugyenyi R1 aOnapa A1 aSalifou M1 aNtep M1 aRichards F00aAfter a decade of annual dose mass ivermectin treatment in Cameroon and Uganda, onchocerciasis transmission continues.  a1196-2030 v133 a<p><strong>OBJECTIVE: </strong>To evaluate the effectiveness of 10 years' annual single dose ivermectin treatment on onchocerciasis transmission in hyperendemic areas of Cameroon and Uganda.</p>

<p><strong>METHODS: </strong>Baseline nodule and microfilaria ('skin snip') prevalence data were available from 10 hyperendemic sentinel communities in Cameroon (from 1996) and hyperendemic 20 sentinel communities in Uganda (from 1993). We returned to these villages in 2005, 10 months after the last annual ivermectin distribution, to repeat the cross-sectional surveys. Each sentinel community reported a mean interval treatment coverage of eligible persons of &gt;88% (range 37-100%). Data were analyzed for more than 6200 person examinations. In Cameroon, 719 people &gt;or=10 years were examined at the baseline survey in 1996 and 838 at the follow-up survey in 2005. In Uganda, 1590 people &gt;or=10 years were examined at the baseline survey in 1993 and 2122 people at the follow-up survey in 2005. We also examined children under 10 in Cameroon (1996, n = 185; 2005, n = 448) and Uganda (1993, n = 177; 2005, n = 130). In Uganda, the vitality of worms was judged using standard histological criteria in 80 nodules excised in 2005.</p>

<p><strong>RESULTS: </strong>The prevalence of microfilaria carriers among older children and adults (&gt;or=10 years) in Cameroon sentinel communities dropped from 70.1% to 7.04% (P &lt; 0.0001) over the 10-year treatment period; that of nodule carriers from 58% to 9.55% (P &lt; 0.0001). Similarly, in Uganda, the prevalence of microfilaria carriers fell from 71.9% to 7.49% (P &lt; 0.0001) over the 13-year treatment period, and that of nodule carriers from 53.21% to 9.66% (P &lt; 0.0001). The number of microfilaria carriers among children &lt;10 years in Cameroon decreased from 29.73% to 3.8% (P &lt; 0.0001), and in Uganda from 33.89% to 3.1% (P &lt; 0.0001). In 2005, worms excised from nodules in Uganda, 81.4% of males remained alive, and 64% of females, with 24% of them inseminated.</p>

<p><strong>CONCLUSION: </strong>A decade or more of annual single dose ivermectin treatment in hyperendemic areas has reduced onchocerciasis to 'hypoendemicity', but onchocerciasis transmission persists. For now, annual treatment with ivermectin should be continued in formerly mesoendemic and hyperendemic zones.</p>

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