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ONCHOCERCIASIS, DRUG RESISTANCE - GHANA
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International Society for Infectious Diseases
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Date: Thu 19 Jul 2007
Source: Reuters Alertnet [edited]
<http://www.alertnet.org/thenews/newsdesk/N14265481.htm>


The parasite that causes river blindness appears to be developing
resistance to the only drug widely available to treat it, researchers
said on Thursday [19 Jul 2007]. They said their findings raise
concerns of a resurgence of a disease that has been effectively
controlled in many parts of Africa. River blindness, or
onchocerciasis, is an eye and skin disease caused by the filaria
worm. It is transmitted to humans by blackflies breeding along
fast-flowing tropical rivers and streams.

In humans, the adult female worm produces thousands of baby or larval
worms that spread throughout the body, causing skin lesions and
blindness. The disease affects 18 million people worldwide. It has
been controlled for nearly 2 decades through annual doses of a drug
developed by Merck & Co. called ivermectin, or Mectizan, which also
treats the severe skin itching caused by the disease.

Researchers at McGill University in Montreal, Canada, writing in the
journal The Lancet, report that the parasite is starting to resist
treatment with ivermectin. "Because it doesn't eliminate the
parasite, it requires treatment at least every year, and that doesn't
get rid of it. It just reduces transmission," said Roger Prichard of
the Institute of Parasitology, who led the study. "With resistance,
that breaks down, and we expect to see the disease becoming a problem
again," he said.

Prichard and colleagues studied 2501 people in 20 communities in
Ghana, West Africa. They found infection remained common despite
annual treatments.

The researchers also studied skin samples from 342 people in 10
communities who had tested positive before treatment and at 90 and
180 days after treatment. Although the drug cleared 100 percent of
the worm larvae in 99 percent of those treated, they found
significant repopulation of the larvae in 4 out of 10 communities
after 90 days. "In some communities, we were seeing relatively rapid
repopulation, which is not what you should see," Prichard said in a
telephone interview. "Just knowing there is the development of
resistance is important because it gives a bit of a spur to efforts
to fast-track alternative approaches," he said.

A Wyeth drug for heartworm in dogs called moxidectin is in Phase II
clinical trials in humans, but Prichard said the drug is in the same
chemical family as ivermectin, which may hurt its chances at treating
resistant parasites. Dr. Peter Hotez of George Washington University
said the development of resistance highlights the risks of having
only one drug in the toolbox. "This finding represents a wake-up call
that any parasite control program that relies on a single
antimicrobial agent is always at risk of derailment," Hotez wrote in
a commentary.

--
Communicated by:
Sidi Coulibaly <sidi_couly@yahoo.ca>

[The report refers to the following paper in the Lancet:
Osei-Atweneboana MY, Eng JK, Boakye DA, Gyapong JO, Prichard RK.
Prevalence and intensity of _Onchocerca volvulus_ infection and
efficacy of ivermectin in endemic communities in Ghana: a two-phase
epidemiological study. Lancet 2007;369:2021-9.

Ivermection has been a safe and efficient drug for control of
onchocerciasis for more than 2 decades. Ivermectin belongs to the
macrocyclic lactone family of anthelmintics and works by blocking
ligand-gated chloride channels, like the glutamate and GABA channels.
Changes in the amino acid sequence and expression of these channels
may cause resistance to the macrocyclic lactones in laboratory
models, and there is no reason to believe that _Ochocerca volvulus_
is different. The extended use of ivermectin in mass treatment
programs over many years should be expected to result in the
development of resistance, and what is more surprising is that it has
taken so many years. - Mod.EP

affected countries in Africa:

For images and more information see:
<http://www.onchohki.org>
- Mod.JW]

Infos zur Flussblindheit hier

Gruß
Birgitt

ONCHOCERCIASIS - Cameroon: IVERMECTIN RESISTANCE
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A ProMED-mail post
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Date: Sat 2 Feb 2008
Source: Medical News Today [edited]
<http://www.medicalnewstoday.com/articles/95902.php>


Resistance to ivermectin emerging in onchocerciasis
-----------------------------------
Onchocerciasis is an infection caused by _Onchocerca volvulus_, a parasite
nematode worm transmitted to humans by a species of black fly of the
Simulium genus whose larvae develop in fast-flowing rivers. Infected
subjects suffer not only from severe skin lesions but also eye damage that
can lead to irreversible loss of sight, hence the name "river blindness".

A huge majority -- 99 per cent -- of the 37 million people infected by the
parasite live in sub-Saharan Africa.

Ivermectin, a medicine capable of killing the parasite embryos (the
microfilariae) circulating in the organism of patients and temporarily
interrupting the nematode's reproduction, is the only treatment used for
onchocerciasis control.

Since 1995, the African Programme for Onchocerciasis Control (APOC) has
been covering 19 of the continent's 28 countries hit by the disease. Access
to this treatment is possible for 70 million people and has significantly
diminished the onchocerciasis-induced morbidity.

However, the doubling of cases of infection in certain communities of Ghana
between 2000 and 2005, in spite of annual treatments, created fear of the
emergence of ivermectin-resistant strains. Such apprehension appears
particularly justified in that a high degree of therapeutic cover is
achieved during mass distribution campaigns and hence only a tiny part of
the parasite population targeted remains unexposed to drug treatment pressure.

Since 1994, a team of IRD researchers, working jointly with Cameroon
researchers and others from McGill University of Montreal, has been
monitoring a cohort of Cameroon patients benefiting from repeated
treatments with ivermectin. Regular parasite sampling from these subjects
was performed over a 13 year period in order to determine the changes in
the genetic structure of _Onchocerca volvulus_ populations.

Each occasion involved measurement of the genotype frequency of
heterozygotes and homozygotes for the gene coding beta-tubulin, a protein
involved in the organization of the parasite's cells. The team focused on
this particular gene because it acts as a marker of resistance to
ivermectin in other nematode species parasitic on cattle. As a control,
they monitored the changes in genotype frequency of 2 other genes, known
for their high evolutionary stability over time.

The proportion of homozygotes and heterozygotes for these 2 genes remained
stable throughout the investigation, but the situation was completely
different for the beta-tubulin gene. Between 1994 and 1998, the percentage
of parasites showing a genotype homozygous for this gene fell from 79 to 31
per cent in subjects receiving quarterly treatment with ivermectin. At the
same time, the proportion of heterozygous genotypes changed in the opposite
sense, rising from 21 to 69 per cent.

These results could be the sign of adaptation of nematode worm populations
to repeated treatments using this drug. The research team inferred that the
parasites showing a genotype homozygous for beta-tubulin are more
susceptible to it. As courses of treatment progressed, they would therefore
gradually disappear, to the benefit of the more resistant heterozygous strains.

Ivermectin's effect on microfilariae, other than its direct one, is to
prevent them from leaving the uterus of adult worms, for several months
after treatment: this is its embryostatic effect. Post-treatment, there
were more microfilariae in the uterus of homozygous female parasites than
in those of heterozygous females. This could mean that, in the latter, the
microfilariae succeed in leaving the uterus, as they usually do in the
absence of treatment, and therefore that the embryostatic effect of
ivermectin would be diminished. Contrary to the effect anticipated, the
repeated exposure to treatments could in this way select those worms more
able to keep up the production of new generations. Nevertheless, the drug's
direct action on the microfilariae appeared not to change, and hence, for
the moment, there is no reason to call into question the current control
strategy against the disease based on annual treatments with ivermectin.

Affirmation of the results requires further investigations, starting from
new cohorts subjects infected by _Onchocerca volvulus_ who have not yet
been treated with ivermectin. This type of approach should bring more
information on the risks of the parasite's resistance to this drug. If such
risks were confirmed, then the whole onchocerciasis control strategy would
probably have to be revised. Nevertheless, for many years to come,
ivermectin could well remain the sole drug applicable for mass treatment in
measures to control river blindness.

[article adapted by Medical News Today from original press release.]

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[Resistance in _Onchocerca volvolus_ against ivermection was reported from
Ghana in 2007 (ProMED-mail: "Onchocerciasis, drug resistance - Ghana
20070719.2319").

The new report from Cameroon underliness that the problem may be widespread
throughout the countries in Africa, which have used regular mass treatment
with ivermectin as the primary method for onchocerciasis control.

Other recent studies on Ivermection resistance in _Onchocerca volvulus_ are:
Bourguinat C, et al. P-glycoprotein-like protein, a possible genetic marker
for ivermectin resistance selection in Onchocerca volvulus. Mol Biochem
Parasitol 2007; Dec 14 [Epub ahead of print], and
Lustigman S, McCarter JP. Ivermectin resistance in Onchocerca volvulus:
toward a genetic basis. PLoS Negl Trop Dis 2007; 1(1): e76.
doi:10.1371/journal.pntd.0000076
<http://www.plosntds.org/article/info%3A ... td.0000076>.

An illustration of the life cycle of Onchocerca volvulus can be found at
<http://www.dpd.cdc.gov/dpdx/HTML/Filariasis.htm>. - Mod.EP]

ONCHOCERCIASIS - COTE D'IVOIRE: (YAMOUSSOUKRO)
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A ProMED-mail post
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Thu 20 Nov 2008
Source: AFP via Mail and Guardian Online [edited]
<http://www.mg.co.za/article/2008-11-20- ... te-divoire>


The black flies that transmit river blindness have reemerged in parts
of Ivory Coast, sparking a fresh campaign to ensure villagers can
work their fields without fear.

Health workers are handing out a drug -- whose distribution was
stopped 3 years ago -- that prevents the worst effects of the
disease, irreversible loss of vision.

"These tablets stop you from going blind," said local nurse Mamadou
Kone. But some local people who recall the past are pushing for more
radical measures.

"The situation before was dramatic," recalled Konan Kouadio, a
villager in his 70s wearing large, tinted spectacles to conceal his
own sightless eyes. "We had many blind people in the heart of the community."

For villages like his Kouadioa-Allaikro, in the centre of this West
African country, black flies are not only a debilitating health
scourge but a financial drain as well.

Agriculture is one of Ivory Coast's main sources of wealth, and the
people in this region produce food crops and cocoa that are vital not
only to their own livelihoods but to the country's economy as well.

The disease was curtailed in the past by dousing insecticide along
the local river, but such measures were stopped in 1992 due to lack
of funds, according to Ivorian authorities.

In March 2008, the country's National Programme Against Blindness
(PLNCE) conducted an epidemiological study in 15 villages and
confirmed that the black flies were back in force.

"The flies have multiplied," said nurse Kone. "The villagers can't
get to their plantations from February to May."

Although the bolder residents still venture out, they risk being
bitten. But as community health worker Raphael Konan Kouadio pointed
out their dilemma: "You can't abandon your crops or you are going to
die of hunger."

An estimated 500 000 people are at risk with the resurgence of the
flies, which now haunt a zone that extends 15 km (nearly 10 miles)
around the river.

The disease, transmitted by black flies of _Simulium_ species whose
bite can be extremely unpleasant, has in the past devastated local communities.

In the 1970s and '80s, villagers bitten by the insects as they worked
in fields near the rivers gradually lost sight, as the worm larvae
transmitted by the bite hatched and grew.

Though the disease is endemic in central and west Africa, fertile
river areas are the most dangerous, because they are the insects'
natural habitat; they lay their eggs in fast-flowing waters. Hence,
the popular name for the disease that is more correctly called
onchocerciasis, which can also produce a disfiguring skin
inflammation and intense itching.

But Kouadio-Allaikro is only one of many villages in this district,
at the mouth of the Kossou hydroelectric dam in the Yamoussoukro
region, where the flies have returned.

"The onchocerciasis situation is more and more worrying in the zones
extending south of the forest, where 15 percent (of the population)
has been affected," said Souleymane Yeo, who heads up the PLNCE programme.

For him, the distribution of the anti-parasitic drug ivermectine,
which started in September 2008, came not a moment too soon. Local
villagers knew it would allow them to get back to working the fields
and fishing the rivers. "Onchocerciasis no longer turns people blind
thanks to the distribution of these medicines," said Emery Patrice
Bosso, of Helen Keller International, which finances programmes
against the disease.

But there remain practical problems on the ground, for as good as the
treatment may be, getting the medicines out to the villages is no easy task.

"The work of volunteers is no longer guaranteed," said Kouadio,
himself a volunteer. The main problem is the lack of transport to get
to the most far-flung villages. "I cover 10 villages without even a
motorbike," he said. And as much as he wants to do the work, he said
he could not carry on under current conditions.

Though thankful for the drugs, some local people would like to see
the return of the weapon the government used to fight the disease
effectively in the past. They want the length of the river again to
be dosed with insecticide.

--
Communicated by:
ProMED-mail Rapporteur Susan Baekeland

[Onchocerciasis, African river blindness, is caused by a nematode,
_Onchocerca volvulus_, transmitted to humans by blackflies. The adult
worms are found in subcutaneous nodules where they produce
microfilariae, which migrate in tissues, especially the skin and eye.
Inflammation in the eye results in blindness or reduced eyesight.

The Onchocerciasis Control Program in West Africa (OCP) was launched
in 1974 and covered 30 million people in 11 countries at its peak
<http://www.who.int/apoc/onchocerciasis/ ... index.html>.
The OCP was closed in 2002, when most countries within the program
area had a prevalence of onchocerciasis of less than 5 percent,
including the Ivory Coast (see maps at the WHO URL shown above).
Ivory Coast has been through a civil war over the past years, which
probably has affected the national control program, and it is likely
that this and the closure of the OCP contribute to the emergence of
onchocerciasis in Ivory Coast.

About Yamassoukro:
<http://da.wikipedia.org/wiki/Yamoussoukro>.
- Mod.EP]

New drug being tested in Africa for river blindness
01.07.2009 - WHO

GENEVA -- A clinical trial is being launched in three African countries of a drug that could eliminate onchocerciasis, or river blindness, one of the leading infectious causes of blindness across Africa. The drug, moxidectin, is being investigated for its potential to kill or sterilize the adult worms of Onchocerca volvulus, which cause onchocerciasis.

"This is a devastating illness that has plagued 30 African countries for centuries, in particular the populations in the most remote areas 'beyond the end of the road'," says Dr Uche Amazigo, Director of the African Programme for Onchocerciasis Control (APOC). "Over 100 million people are at risk of infection with onchocerciasis in Africa and a few small areas in the Americas and Yemen."

Onchocerciasis is also called river blindness because the black fly which transmits the disease breeds in fast flowing rivers, and blindness is the most incapacitating symptom of the disease which also causes debilitating skin disease.

The development of moxidectin for onchocerciasis is being conducted through a collaboration of the Special Programme for Research and Training in Tropical Diseases (TDR), which is administered by WHO, with Wyeth Pharmaceuticals. The work ranges from the development of a formulation for human use and initial studies in healthy volunteers, to clinical studies and community studies in Africa.

TDR is building the capacity and managing the clinical trials in Africa. If the development is successful and results in a positive scientific opinion from the European Medicines Evaluation Agency, Wyeth with the assistance of WHO will request approval by regulatory authorities in the countries where onchocerciasis is endemic.

Promising data

Dr Henrietta Ukwu, Vice President of Wyeth Pharmaceuticals, says, "Wyeth is committed to improving access to innovative drugs and biologics around the globe including in the developing world. The moxidectin data have been promising so far, and as the programme moves into larger phase III studies, we are hopeful that moxidectin will constitute a significant advance against this devastating disease.”

TDR will be working with African investigators and institutions for the trial, enrolling 1500 people at four sites in Ghana, Liberia and the Democratic Republic of the Congo. Preparation has been ongoing since 2007 and include building a clinical research centre in Lofa County in Liberia and in Nord-Kivu in the Democratic Republic of the Congo. Buildings not used since the war in Ituri in the Democratic Republic of the Congo have been renovated. All centres have been provided with necessary equipment and the research teams trained on how to conduct the trial according to international standards.

TDR's Director Dr Robert Ridley says, "We work with national authorities and country partners to build research capacity and infrastructure. The training we provide to researchers and health care professionals and the experience they gather during the TDR-sponsored studies enables them to conduct other clinical research later on, strengthening the health research systems in those countries."

The trial will take place over the next two and a half years. Currently, the disease is controlled by ivermectin, which has been donated for more than 20 years by the pharmaceutical company Merck & Co. for use in onchocerciasis endemic countries. Treatment with ivermectin has enabled significant progress in the control of onchocerciasis, and currently reaches more than 60 million people in Africa annually.

However, ivermectin kills the O. volvulus larvae but not the adult worms, so annual treatments for an extended period of time (at least 11-14 years) are required to ensure disease control. Since moxidectin kills not only the larvae but also sterilizes or kills the adult worms, it has the potential to interrupt the disease transmission cycle within around six annual rounds of treatment. The drug could be distributed through the community-directed mechanisms set up in collaboration among APOC, African control programmes, and NGOs for the distribution of ivermectin.

Gruß
Birgitt

Elimination of river blindness feasible
21.07.2009 - WHO

GENEVA - The first evidence that onchocerciasis elimination is feasible with ivermectin treatment was published today in the open-access journal PLoS Neglected Tropical Diseases. Onchocerciasis is also called river blindness because the blackfly which transmits the disease breeds in rivers; it often blinds people, as well as causing debilitating skin disease. Over 37 million people are infected, often living in poor, rural African communities.

"This evidence is an historic milestone -- it has far-reaching implications for the fight against this disease. Prior to this study we did not know if we would ever be able to stop treatment," says Uche Amazigo, the Director of the African Programme for Onchocerciasis Control (APOC). APOC is the organization charged with implementing control of the disease across Africa.

The multi-country study showed that treatment with ivermectin stopped further infections and transmission in 3 specific areas in Africa where the disease has existed continuously (an endemic area).

Annual treatments to prevent resurgence

Ivermectin kills the larvae but not the adult worms of Onchocerca volvulus, the parasite that causes the disease, so annual or biannual treatments are required to prevent resurgence. Merck & Co., the company that discovered and manufactures the drug, agreed in 1987 to donate the drug free of charge to countries where onchocerciasis is endemic. This has resulted in annual treatments to all eligible community members – over 60 million people were treated in 26 African countries in 2008. But although this large-scale treatment has enabled the control of onchocerciasis in Africa, it has not been clear whether it could also be used to eliminate infection and transmission to the extent that treatment with ivermectin could be safely stopped. Many scientists have doubted whether onchocerciasis elimination with ivermectin is feasible in Africa, where more than 99% of cases are found.

This new study in three areas in Mali and Senegal where onchocerciasis was endemic has now provided the first evidence of the feasibility of onchocerciasis elimination with ivermectin in some endemic areas in Africa. Previously, it was thought that elimination of onchocerciasis was only possible in the limited, isolated areas in the Americas where the disease is endemic.

However, the studies showed that after 15 to 17 years of six-monthly or annual treatments, only a few infections remained in the human population. Transmission levels were below predicted thresholds for elimination, so treatment was subsequently stopped in test areas and follow-up evaluations after 1.5 to 2 years showed that no further infections or transmission occurred.

Further studies needed

Although further studies are needed to determine to what extent these findings can be extrapolated to other areas in Africa, the principle of onchocerciasis elimination with ivermectin treatment has been established. Dr Robert Ridley, Director of TDR, the Special Programme for Research and Training in Tropical Diseases (that coordinated the study), said, "This is an excellent example of how research like this can not only provide important answers to major health questions, but with this type of partnership, can also help develop research capacity in low-income countries."

As a result of the study, the board of APOC has already adopted a new objective for the programme to determine where and when treatment can be safely stopped in the 16 African countries where APOC is supporting mass ivermectin treatment programmes.

The studies were undertaken by research teams from the ministries of health of Mali and Senegal, in collaboration with the WHO Multi-Disease Surveillance Centre in Burkina Faso. Main funding for the study was provided by the Bill & Melinda Gates Foundation. The study was coordinated by TDR, a co-sponsored programme of UNICEF, UNDP, the World Bank and WHO.

TDR conducted much of the earlier research to prove that this drug was safe and effective. The partnership with Merck & Co. the MECTIZAN Donation Program, WHO, APOC and the national control programmes is considered an early model of the numerous public-private partnerships that have sprung up in the last decade.

Gruß
Birgitt

Onchozerkose: Flussblindheit fast besiegt
22.07.2009 - Ärzteblatt

Dakar – Fast unbemerkt von der Weltöffentlichkeit ist es gelungen, die Onchozerkose, eine wichtige Ursache der Erblindung in Zentralafrika, deutlich zurückzudrängen. Über ihre Erfolge berichten die beteiligten Forscher in PloS Neglected Tropical Diseases (2009; doi:10.1371/journal.pntd.0000497).

In Afrika soll es noch etwa 300.000 Menschen geben, die nach früheren Infektionen mit Onchocerca volvulus erblindet sind. Der Nachwuchs dieser Parasiten, die Mikrofilarien, haben die unangenehme Eigenschaft, sich zu Tausenden auf Wanderschaft im subkutanen Gewebe zu begeben. Einige erreichen die Cornea des Augapfels. Es kommt zur Keratitis und im schlimmsten Fall zu einer Hornhauttrübung und zur Erblindung ... mehr
_______________________________________

Und hier die Publikation in PloS Neglected Tropical Diseases 2009:

Feasibility of Onchocerciasis Elimination with Ivermectin Treatment in Endemic Foci in Africa: First Evidence from Studies in Mali and Senegal


Gruß
Birgitt

In pictures: River blindness in Nigeria
09.08.2010 - BBC

About 18 million people around the world are believed to be infected with river blindness. Photographer Kate Holt has been documenting the work of the international development NGO Sightsavers in Nigeria ... mehr mit Fotostrecke

Gruß
Birgitt

ONCHOCERCIASIS - GHANA (ASHANTI)
********************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Mon 20 Sep 2010
Source: Ghana News [edited]
<http://news.myjoyonline.com/health/201009/52532.asp>


Increasing risk of onchocerciasis the Abofour forest
----------------------------------------------------
The lives of more than 2500 residents of Asuboi,
a farming community in the Offinso Municipality
in the Ashanti Region are at risk of river
blindness unless government and benevolent organizations intervene.

Health officials say over 70 per cent of the
population is infected following the invasion of black flies in the area.

Many people especially children are plagued with
all manner of skin disorders including rashes and
lesions, which cause intense itching.

The inability of health workers to reach the
people with medical care due to poor road network
appears to be a huge impediment to addressing this precarious health situation.

An international charity organization, Sight
Savers International, estimates about 140 million
people in Africa are at risk of river blindness,
known medically as onchocerciasis.

Experts say that the disease, which is caused
mainly by the filarial worm _Onchocerca
volvulus_, is transmitted through bites from
infected black flies. The black flies are
adaptable in fast flowing rivers in Sub-Sahara Africa.

The Asuboi Township is located in the middle of
the thick Abofour Forest, about 50 miles or 80
kilometers from Kumasi. The community is
sandwiched by 2 fast flowing rivers, Subin and Nkyereade.

Though the Offinso Municipal Assembly has
provided the community with a mechanized
bore-hole, the majority of residents especially
those in nearby hamlets prefer to fetch water
from the river. And they share the water with
cattle. They complain the sitting of the
bore-hole in a steep area, about 1.5 kilometers
[0.9 mi] from Asuboi is not ideal.

The road to Asuboi is unmemorable, with deep
gullies that make it difficult for road users to
ply, virtually cutting the community from the
rest of the municipality. The easiest means to
reach the community is by bicycle or motorbikes
which also become dangerous and a nightmarish
adventure in sunny or rainy weather.

Though strange rashes and signs of river
blindness are common among the people they appear
to have no idea about their predicament.
Ignorantly, they resort to the use of traditional
methods such as warm water and locally made balms
for the treatment of the complicated medical condition.

Out of fear of the strange condition, many
residents have been seeking solace in the
Assembly Member for the area for virtually
non-existence support. Assemblyman for Kwapanin
Electoral area, Philip Amponsah Boakye is tired
of receiving complaints because according to him, there is little he can do.

He cannot fathom why it has taken health experts
so much a time to respond to the needs of the
community. Out of nothing, he directs some
affected residents to the nearby health center at
Abofuor, about 30 kilometers [approx 19 mi] which
health experts say lacks facilities to conduct
any proper scientific examinations into onchocerciasis.

"There are many children, even adults who have
got the rashes. You can see so many children with
rashesŠ Even their skins are getting black. Still
people are getting infested. I want to appeal to
the Central government to take immediate action
if not, the people here all of them can be blind
and it is very risky," he said.

The Municipal Health Directorate appears to have
little support for the residents at Asuboi.
Though tests carried out 4 months ago under the
Rapid Epidemical Mapping for onchocerciasis
programme, established widespread prevalence,
officials say there is little they could do.

Bernard Oppong, Municipal Disease Control
Officer, though describing the community as a
high transmission area, his outfit dares not to
go because the road is inaccessible.

"Once the community is located within the thick
forest, access to the community is a problem and
for that matter, donors who will support us with
drugs (ivermectin) and other logistics for this
treatment wouldn't be able to access the
community and this is creating a problem here" he explained.

Meanwhile, the Municipal Chief Executive for
Offinso, Victor Amponsah, says his attention has
been drawn to the development, and that steps are
being taken to address the problem. He says the
assembly will ensure routine reshaping of roads
in the municipality to create access to communities.

Under the African Programme for Onchocerciasis
Control the World Health Organization estimates
the sight of 800 000 people will have been saved by the end of 2010.

The people of Asuboi, however, can only hope for a miracle to save them.

[Byline: Ohemeng Tawiah, Nhyira Fm-Kumasi]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Please refer to our comment in the 2008 posting
Onchocerciasis - Cote d'Ivoire: (Yamoussoukro)
20081120.3665 where the Onchocerciasis Control
Programme, OCP, 1974-2002 is discussed.

Onchocerciasis, African river blindness, is
caused by a nematode, _Onchocerca volvulus_,
transmitted to humans by black flies. The adult
worms are found in subcutaneous nodules where
they produce microfilariae, which migrate in
tissues, especially the skin and eye.
Inflammation in the eye results in blindness or
reduced eyesight
(<http://www.cdc.gov/ncidod/dpd/parasites ... efault.htm).
- Mod.EP]

[Maps of Ghana are available at
<http://www.lib.utexas.edu/maps/africa/ghana_pol96.jpg>
and the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/r/09ic>. - Sr.Tech.Ed.MJ]

Von der Flussblindheit sind derzeit 37 Millionen Menschen betroffen, vorwiegend in den tropischen Gebieten Afrikas. Mit Antibiotika kann man die Krankheit aber behandeln, obwohl diese ja nur gegen Bakterien, nicht aber gegen vielzellige Würmer wirken sollten. Der Erreger, der Fadenwurm aus der Familie der Onchocaercidae, ist aber von Bakterien abhängig, die in seinen Zellen leben – sterben sie, stirbt auch das Jugendstadium der Würmer und die geschlechtsreifen Individuen können sich nicht mehr vermehren. Nun haben Forscher herausgefunden, warum der Nematode ohne das Bakterium nicht leben kann: Es liefert seinem Symbionten Energie und verwirrt außerdem das Immunsystem des Wirts, den der Fadenwurm befallen hat. Zu diesem Ergebnis kamen Forscher des Institute of Infection and Global Health an der University of Liverpool [...] Der Erreger der Flussblindheit wird von Kriebelmücken (Simuliidae) übertragen.

Bakterium ist Kraftwerk des Flussblindheit-Erregers
24.08.2012 - spektrum

Gruß
Birgitt