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146 THIRD WHO REPORT ON NEGLECTED TROPICAL DISEASES *** Burden and distribution More than 99% of the about 37 million people infected with O. volvulus live in 31 sub- Saharan African countries (Angola, Benin, Burkina Faso, Burundi, Cameroon, the Central African Republic, Chad, Congo, Côte d’Ivoire, the Democratic Republic of the Congo, Equatorial Guinea, Ethiopia, Gabon, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Malawi, Mali, Mozambique, Niger, Nigeria, Rwanda, Sierra Leone, Senegal, Sudan, South Sudan, Togo, Uganda and the United Republic of Tanzania), representing about 120 million people at risk in 2012. The infection also occurs in Yemen and in four out of six original endemic countries in Latin America (the Bolivarian Republic of Venezuela, Brazil, Guatemala and Mexico). Fig. 4.12.1 shows the global distribution of onchocerciasis in 2014. Fig. 4.12.1 Distribution of onchocerciasis, worldwide, 2014 Meso-or hyper-endemic (prevalence > 20%) Hypo-endemic (prevalence < 20%) Endemic countries (former OCP countries) Non-endemic countries Not applicable
*** THE DISEASES − CHAPTER 4 147 Progress towards Roadmap targets The Onchocerciasis Elimination Program in the Americas (OEPA) was launched in 1992 with the goal of interrupting onchocerciasis transmission in six endemic countries in Latin America by 2015, in accordance with resolutions CD48.R12 and CD49.R19 of the Pan American Health Organization Directing Council. In 2013, Colombia became the first country in Latin America verified by WHO as having achieved elimination of onchocerciasis (1). Verification was successfully conducted by an international verification team in Ecuador in May 2014; WHO announced in September 2014 that Ecuador had become the second country in Latin America to have eliminated onchocerciasis (2). During its last meeting in 2014, the OEPA Programme Coordinating Committee concluded that Mexico and Guatemala have successfully completed post-treatment surveillance. Both countries are now compiling national dossiers and are expected to file formal applications to WHO for independent verification in 2015. Ministers of health from the Bolivarian Republic of Venezuela and Brazil signed on 20 May 2014 a new bilateral agreement aimed at enhancing coordinated cross-border health interventions required to interrupt transmission in the Yanomami area shared by the two countries (3). The African Programme for Onchocerciasis Control (APOC) started in 1995 and targets endemic countries that were not covered by the former Onchocerciasis Control Programme (OCP). Its mandate was later expanded to cover also some ex-OCP countries where transmission was still ongoing. During 2012, about 100 million people were treated with ivermectin in 24 African countries where community-directed treatment with ivermectin is being implemented, representing 76% therapeutic coverage (4). Although national interruption of transmission has not been recorded in any country in Africa to date, mass distribution of ivermectin has been halted in some areas, including nine districts in Uganda (Bududa, Bushenyi, Kabarole, Kyenjojo, Manafwa, Maracha, Mbale, Mitooma and Siromko), two districts in Mali (Bougouni and Yanfolila) and one district in Sudan (Abu Hamed) (5–9). By 2020, 12 countries are expected to have eliminated onchocerciasis successively (Niger, Senegal, Malawi, Burundi, Chad, Kenya, Mali, Benin, Guinea, Guinea-Bissau, Sierra Leone and Togo). Despite these achievements and expectations, some challenges persist in Africa, notably in sustaining high coverage, particularly in conflict and post-conflict zones as well as in areas where loiasis is co-endemic, and in preventing cross-border transmission among endemic countries. According to the national action plan for onchocerciasis elimination in Yemen, which was prepared and adopted in June 2013, mass drug administration and vector control interventions will be launched in due course. In the interim, clinical cases have been treated for the past two decades. In 2012, a total of 51 505 patients were treated with ivermectin. Government commitment and enhanced support from partners will facilitate achieving elimination of onchocerciasis in Yemen by 2020 instead of the initial (2015) target.
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