Onchocerciasis

Ada C. Quiñones, MPH studentWalden UniversityPu6165-1Instructor: Dr Rebecca HeickSummer,2010

(River Blindness)

The Scientist (2010)Online Image, August 7,2010Retrieved from: www.thescientist.com

Goal The goal of this presentation is to convince

different health organizations to work together in order to find effective methods for reducing the incidence and prevalence of River Blindness worldwide.

The intended audience includes individuals from:

The Carter Center River Blindness Program

World Health Organization(WHO)

Centers for Disease Control and Prevention: Division of Parasitic Diseases (CDC)

The International Eyes Foundation Program

Mectizan Donation Programs

Lions Club International

General Public

ObjectiveEducate the general public about

Onchocerciasis (River Blindness)

Educate the public about potential health impact

Convince professionals of the need for public health interventions

Introduction River Blindness is

primarily an African disease, common in central Africa, especially in villages near rivers and streams.

OCP/World Health Organization(1997)Online Image, August 7,2010Retrieved from: https://apps.who.int/ocp/slides/index.htm

Centers for Disease Control and Prevention[CDC]September, 2008). Onchocerciasis Retrieved from: http://www.cdc.gov/ncidod/dpd/parasites/onchocerciasis/factsht_onchocerciasis.htm#prevention

sis/factshtonchocerciasis.htm#what

These flies breed in fast-flowing streams and rivers, increasing the risk of infection to individuals living nearby, hence the common name of “ River Blindness".

Adult Black Fly (Simulium yahense) with Onchocerca volvulus emerging from the insect's antenna. The parasite is responsible for the disease known as River Blindness in Africa. Image provided courtesy of the USDA under Public Domain.http://serc.carleton.edu/microbelife/k12/microbes_within/resources.html

Centers for Disease Control and Prevention[CDC]September, 2008). Onchocerciasis Retrieved from: http://www.cdc.gov/ncidod/dpd/parasites/onchocerciasis/factsht_onchocerciasis.htm#prevention

sis/factshtonchocerciasis.htm#what

Geography DistributionThirty countries of AfricaAmericas

Ecuador Mexico Brazil Venezuela ColombiaYemen

Centers for Disease Control and Prevention[CDC]September, 2008). Onchocerciasis Retrieved from: http://www.cdc.gov/ncidod/dpd/parasites/onchocerciasis/factsht_onchocerciasis.htm#prevention

sis/factshtonchocerciasis.htm#what

Unite for Sight Inc.Online Image, August 7,2010Retrieved from: www.uniteforsight.org

Life cycle

Centers for Disease Control and Prevention[[CDC](2008)Online Image, August 7,2010Retrieved from: http://www.dpd.cdc.gov/dpdx

Onchocerca volvulusOnchocerca volvulus was probably introduced to the Americas by African slaves .

Humans appear to be the only natural definitive host.

Adult worms move under the skin, where they become encapsulated by host reaction. 

Robert, L.S., & Janovy ,J.(1996). Foundations of Parasitology (5th ed). USA: Wm.C. Brown publishers

OCP/World Health Organization(1997)Online Imagen, August 7,2010Retrieved from:https://apps.who.int/ocp/slides/index.htm

Symptoms Infected persons may be without symptoms.

Those with symptoms will usually have one or more of the three manifestations:

Skin rash Eye lesions Subcutaneous bumps under the skin

The most serious manifestation consists of lesions in the eye that can progress to blindness.(CDC,2008).

Centers for Disease Control and Prevention[CDC] 2008). Onchocerciasis Retrieved from: http://www.cdc.gov/ncidod/dpd/parasites/onchocerciasis/factshtonchocerciasis.htm#what

Robert, L.S., & Janovy ,J.(1996). Foundations of Parasitology (5th ed). USA: Wm.C. Brown publishers

Clinical Presentation Onchocercomas Skin changes Ocular envolment Immune System Effect

Garcia, L.S.(2007). Diagnostic medical parasitology (5thed) .Washington, D.C: ASM Press

OCP/World Health Organization(1997)Online Imagen, August 7,2010Retrieved from: https://apps.who.int/ocp/slides/index.htm

OCP/World Health Organization(1997)Online Imagen, August 7,2010Retrieved from: https://apps.who.int/ocp/slides/index.htm

OCP/World Health Organization(1997)Online Imagen, August 7,2010Retrieved from: https://apps.who.int/ocp/slides/index.htm

Incidence and Prevalence Onchocerciasis is the second leading cause of preventable blindness in the

world.

More than 17.7 million people worldwide are infected, and 109 million people are at risk.

Visual impairments occur in 500,000 of these people, including 270,00 cases of blindness.

Over 90% of the disease occurs in Africa, with the rest occurring in six countries in Latin America, Yemen and the Arabian Peninsula .

Centers for Disease Control and Prevention[CDC]September, 2008). Onchocerciasis Retrieved from: http://www.cdc.gov/ncidod/dpd/parasites/onchocerciasis/factsht_onchocerciasis.htm#prevention

sis/factshtonchocerciasis.htm#what

Mortality and MorbidityWithin the human body, the adult female

worm (macrofilaria) produces thousands of baby or larval worms (microfilariae), which migrate in the skin and the eye and are the cause of morbidity.(WHO,2007).

While mortality rates for onchocerciasis are null, the personal costs, and social and economic burdens are high(WHO,2007).

Socio-economic Impact• Hinders agriculture productivity

• Generate massive economic losses

• Imposes a disproportionate disease burden on poor rural communities

• It creates stigma

• Onchocerciasis causes and perpetuates poverty

World Health Organization [WHO], (2010). Onchocerciasis. Retrieved from: http://www.who.int/topics/onchocerciasis/en/

PreventionBlack flies bite during the day.

The best prevention is to avoid infective bites of the black fly by:

Using insecticides such as DEETWearing long sleeve shirts and pants.

Centers for Disease Control and Prevention[CDC]September, 2008). Onchocerciasis Retrieved from: http://www.cdc.gov/ncidod/dpd/parasites/onchocerciasis/factsht_onchocerciasis.htm#prevention

sis/factshtonchocerciasis.htm#what

DiagnosticsSerologic testing for antibodiesBloodless skin snipsPCR (Polymerase Chain Reaction)Slit lamp examinationMazzoti test

Garcia, L.S.(2007). Diagnostic medical parasitology (5thed) .Washington, D.C: ASM Press

Traveler RiskRisk of infection is greater in:

Adventure travelers Missionaries, Peace Corps volunteers

Centers for Disease Control and Prevention[CDC]September, 2008). Onchocerciasis Retrieved from: http://www.cdc.gov/ncidod/dpd/parasites/onchocerciasis/factsht_onchocerciasis.htm#prevention sis/factshtonchocerciasis.htm#what

TreatmentSurgical RemovalIvermectinRemoval of enlarged regional lymph glandsDECSuraminAmocarzineMebendazole and flubendanzole

Robert, L.S., & Janovy ,J.(1996). Foundations of Parasitology (5th ed). USA: Wm.C. Brown

Centers for Disease Control and Prevention[CDC]September, 2008). Onchocerciasis Retrieved from: http://www.cdc.gov/ncidod/dpd/parasites/onchocerciasis/factsht_onchocerciasis.htm#prevention sis/factshtonchocerciasis.htm#what

Garcia, L.S.(2007). Diagnostic medical parasitology (5thed) .Washington, D.C: ASM Presspublishers

OCP/World Health Organization(1997)Online Imagen, August 7,2010Retrieved from: https://apps.who.int/ocp/slides/index.htm

Additional Resource Higher Institute of Health of Bengo

http://www.portalangop.co.ao/motix/en_us/noticias/saude/2010/5/25/Bengo-hosts- seminar-fight-against-river-blindness,7ace8f84-fb33-464b-a0ca-5745d6202bb7.html

  The Carter Center River Blindness program http://www.cartercenter.org/health/river_blindness/index.html  World Health Organization (WHO) http://www.who.int/topics/onchocerciasis/en/  Breakthroughs magazine http://nature.berkeley.edu/breakthroughs/break_feature1_su08.php  Lions club international http://www.lionsclubs.org/EN/lci-foundation/our- programs/sightfirst/initiatives/lcif-gr-river-blindness.php  The international eyes foundation program http://www.iefusa.org/riverblind.shtml  MAP International http://www.map.org/site/PageServer?pagename=SP_Uganda_River_Blindness

Mectizan Donation Program

http://www.merck.com/corporate-responsibility/access/access-developing-emerging/mectizan-donation-riverblindness/

Centers for Disease Control and Prevention[ http://www.cdc.gov/ncidod/dpd/parasites/onchocerciasis/factshtonchocerciasis.htm#what

Reference Centers for Disease Control and Prevention[[CDC].(2008). Onchocerciasis

Retrieved from: http://www.cdc.gov/ncidod/dpd/parasites/onchocerciasis/factshtonchocerciasis.htm#what

Basáñez, M.G., Sébastien, D.S.,Churcher, T.S., Breitling L.P., Little,M.P., Boussinesq, M. (2006). River Blindness: A success story under threat? Plos Medicine,3(9), 1454-1460

Boatin,B.A., & Richard F.O Jr. (2006). Control of Onchocerciasis. Advance in Parasitology 61. 349-394.

Gárcia, L.S.(2007). Filarial nematodes.In Gárcia,L.S., Diagnostic Medical Parasitology (5thed.) (pp341-348). Washington, D.C: ASM Press/

Hall, L.R., & Pearlam,E. (1999). Pathogenesis of Onchorcercal keratitis (River Blindness). Clinical Microbiology Reviews,12 (3), 445-453.

Moller, D. W.(2005).Rodents and Insects. In Moeller,D.W. Environmental Health (3rd ed.). (pp 258).Boston: Harvard University Press.

Murray, P.R., Baron, E.J., Jorgensen, J.H., Landry, M.J., & Pealler, M.A.(2007).Manual of Clinical Microbiology, D. C: ASM Press

Rea, P.A., Zhang,V., & Baras, Y.S. (2010) .Ivermectin and River Blindness. American Scientist,98.

294-303

Reference Robert, L.S., & Janovy ,J.(1996). Nematodes:Filaroidea, In Robert, L.S., &

Janovy, J., Foundations of Parasitology (5th ed).(pp. 452-456). USA: Wm.C. Brown publishers

Terranova, M., Padovese, V., Klaus, S., and Morrone, A.(2007). Onchocerciasis in Tigray. International Society of Dermatology, 46, 39-41

Thylefors, B., Alleman, M. M.,& Twum-Danso, N.A.Y. (2008). Operational lessons from 20 years of the Mectizan donation program for the control of Onchocerciasis. Tropical Medicine and international health, 13(5), 689- 696

Wagbatsoma, V.A., & Okojie, O.H. (May, 2004). Psychosocial effects of river blindness in a rural community in Nigeria. The Journal of the Royal Society for the Promotion of Health 124 ,134-136,

  World Health Organization [WHO], (1979). Environmental Health Criteria 9:

DDT and its derivates. World Health Organization [WHO], (2010). Onchocerciasis.

Retrieved from: http://www.who.int/topics/onchocerciasis/en/

Thank you