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EDITORIAL
Year : 2013  |  Volume : 5  |  Issue : 1  |  Page : 1-2

Historic victory against onchocerciasis in Sudan


National Coordinator for Prevention of Blindness, Sudan

Date of Web Publication21-Sep-2013

Correspondence Address:
Kamal Hashim Binnawi
National Coordinator for Prevention of Blindness
Sudan
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DOI: 10.4103/1858-540X.118637

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How to cite this article:
Binnawi KH. Historic victory against onchocerciasis in Sudan. Sudanese J Ophthalmol 2013;5:1-2

How to cite this URL:
Binnawi KH. Historic victory against onchocerciasis in Sudan. Sudanese J Ophthalmol [serial online] 2013 [cited 2019 Nov 18];5:1-2. Available from: http://www.sjopthal.net/text.asp?2013/5/1/1/118637

"Sudan's achievement is the latest evidence helping overturn the long-held assumption that river blindness is too pervasive in Africa to be eliminated. The Carter Center congratulates the Sudan Ministry of Health for its vision and success in halting river blindness in Abu Hamad." Jimmy Carter

Sudan announced that transmission of river blindness (onchocerciasis) in the Abu Hamad focus has stopped. Abu Hamad is among the first areas in Africa to demonstrate that intensified mass treatment with Ivermectin (Mectizan® ), generously donated by Merck, [1],[2] can interrupt transmission of this debilitating disease. [3]

Onchocerciasis was first discovered to be endemic in Abu Hamad in the late 1950s, [4] but the disease likely has plagued people living in this area for centuries. Abu Hamad is the world's northernmost and the longest focus of onchocerciasis. [5] It extends for more than 300 km along the Nile in the desert of northern Sudan, which is part of great Sahara.

Onchocerciasis is one of the neglected tropical diseases (NTDs) and the second leading infectious cause of blindness in the world. [6] It is caused by the parasitic worm Onchocerca volvulus that is transmitted from person to person through the bites of a small black fly (Simullium) that breeds in rapidly flowing waters along fertile riverbanks, such as those along the Nile. The disease is rarely fatal, but, in advanced stages, causes intense itching, skin disfiguration and untreatable loss of vision. [7] With over 120,000 people at risk for river blindness in Abu Hammed, the disease used to have an enormous negative economic and social impact.

In partnership with The Carter Center, [8] Sudan's national onchocerciasis control program (NOCP) worked with community volunteers to revitalize the control program and transform it into a strategic onchocerciasis elimination program. Community-directed treatment with Ivermectin (CDTI) strategy was used to conduct mass drug administration (MDA) since the early 1990s as part of the African Program for Onchocerciasis Control (APOC). Sudan, inspired by the successes achieved in the Americas, [9],[10],[11] accepted the elimination challenge in 2006 and started biannual mass distribution of Ivermectin, with very high geographical and therapeutic coverage rates. [12]

Africa accounts for 99% of the world's river blindness. [13],[14] Located in River Nile and Northern states, Abu Hamad, being an isolated and remote focus, made it an ideal location to demonstrate the feasibility of river blindness elimination in Africa. The program in Abu Hamad relied on community volunteers to disseminate health education messages in addition to MDA. The program is credited for its innovative inclusion of local women to provide Ivermectin treatments to their extended families, which greatly improved the treatment coverage rates compared with early stages where volunteers were predominantly males.

In May 2012, the Sudanese federal ministry of health hosted a workshop in Khartoum to review findings from Abu Hamad. Decision makers, leaders, international experts and partners participated in that workshop. The presented data were evaluated by the experts and onchocerciasis interruption of transmission in Abu Hamad was confirmed and officially declared. In accordance with the World Health Organization guidelines, [15] the ministry will conduct 3 years of posttreatment surveillance before complete elimination of the disease can be declared in Abu Hamad. To help ensure elimination, a sophisticated molecular diagnostic laboratory at the ministry in Khartoum is competently carrying out sophisticated surveillance tests, [16] thanks to The Carter Center's generosity in establishing the laboratory and training the Sudanese staff locally and in USA. At the same time, health workers are raising local awareness about why MDA is no longer needed during this 3-year period. Once health authorities are assured that the disease indeed is eliminated, resources that were once earmarked for river blindness control can be redirected to other health needs.

Sudan has four known foci of onchocerciasis: [17],[18],[19] Abu Hamad in the northern part, Glabat in Eastern Sudan (previously known as Sundus), Radom in South Darfur and Khor Yaboos in South blue Nile. CDTI activities have also been intensified in Galabat to interrupt transmission, including health education and increased Mectizan treatments to twice per year. Currently, control activities continue in Al Radom (South Darfur state). No CDTI in Khor Yabous (Southern blue Nile state) has been reported, it being a hypoendemic focus. In total, MDA is provided regularly to 267,000 persons in 320 communities in Sudan.

The strong partnerships between the local communities of Abu Hamad, the Sudan Federal Ministry of Health, the health ministries of River Nile and Northern states, The Carter Center, Lions Clubs International Foundation through its Sight First Initiative, Merck and the Mectizan Donation Program, Michigan State University, the University of South Florida, the APOC and many other partners were critical to achieve success in Abu Hamad.

 
  References Top

1.Colatrella B. The Mectizan Donation Program: 20 years of successful collaboration-a retrospective. Ann Trop Med Parasitol 2008;102(Suppl 1):7-11.  Back to cited text no. 1
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2.Thylefors B, Alleman MM, Twum-Danso NA. Operational lessons from 20 years of the Mectizan Donation Program for the control of onchocerciasis. Trop Med Intl Heallth 2008;13:689-96.  Back to cited text no. 2
    
3.Cupp EW, Sauerbrey M, Richards F. Elimination of human onchocerciasis: History of progress and current feasibility using ivermectin (Mectizan) monotherapy. Acta Trop 2011;120:100-8.   Back to cited text no. 3
    
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5.Williams JF, Abu Yousif AH, Ballard M, Awad R, el Tayeb M, Rasheed M. Onchocerciasis in Sudan: The Abu Hamed focus. Trans R Soc Trop Med Hyg 1985;79:464-8.  Back to cited text no. 5
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6.Pion SD, Kamgno J, Demanga-Ngangue, Boussinesq M. Excess mortality associated with blindness in the onchocerciasis focus of the Mbam Valley, Cameroon. Ann Trop Med Parasitol 2002;96:181-9.  Back to cited text no. 6
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7.Kayembe DL, Kasonga DL, Kayembe PK, Mwanza JC, Boussinesq M. Profile of eye lesions and vision loss: A cross-sectional study in Lusambo, a forest-savanna area hyperendemic for onchocerciasis in the Democratic Republic of Congo. Trop Med Int Health 2003;8:83-9.  Back to cited text no. 7
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8.Richards FO, Miri ES, Katabarwa M, Eyamba A, Sauerbrey M, Zea-Flores G, et al. The Carter Center's assistance to river blindness control programs: Establishing treatment objectives and goals for monitoring ivermectin delivery systems on two continents. Am J Trop Med Hyg 2011;65:108-14.  Back to cited text no. 8
    
9.Thylefors B, Alleman M. Towards the elimination of onchocerciasis.Ann Trop Med Parasit 2006;100:733-46.   Back to cited text no. 9
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10.Sauerbrey M. The Onchocerciasis Elimination Program for the Americas (OEPA). Ann Trop Med Parasitol 2008;102(Suppl 1):25-30.  Back to cited text no. 10
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11.Blanks J, Richards F, Beltran F, Collins R, Alvarez E, Zea Flores G, et al. The Onchocerciasis Elimination Partnership for the Americas: A history of partnership. Rev Panam Salud Publica 1998;3:367-74.   Back to cited text no. 11
    
12.World Health Organization: InterAmerican Conference on Onchocerciasis, 2010: progress towards eliminating river blindness in WHO's Region of the Americas. Wkly Epidemiol Rec 2011;86:417-24.  Back to cited text no. 12
    
13.Prost A, Hervouet JP, Thylefors B. Epidemiologic status of onchocerciasis. Bull World Health Organ 1979;57:655-62.  Back to cited text no. 13
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14.Choyce DP. Ocular Onchocerciasis in Central America, Africa and the British Isles. Trans R Soc of Trop Med Hyg 1964;58:11-36.  Back to cited text no. 14
    
15.World Health Organization. Certification of Elimination of Human Onchocerciasis: Criteria and Procedures. Geneva: World Health Organization; 2001. p. 1-36.  Back to cited text no. 15
    
16.Higazi TB, Zarroug I, Mohamed HA, Mohamed WA, Deran TC, Aziz N, et al. Polymerase chain reaction pool screening used to compare prevalence of infective black flies in two onchocerciasis foci in northern Sudan. Am J Trop Med Hyg 2011;84:753-6.  Back to cited text no. 16
    
17.Abdalla R, Baker EA. A new focus of onchoceriasis in the Sudan. Trop Geogr Med 1975;27:365-70  Back to cited text no. 17
    
18.Ghalib H, Mackenzie C, Williams J, Elsheikh H, Kron M. Severe onchocercal dermatitis in Ethiopian border region of Sudan. Ann Trop Med Parasitol 1987;81:405-19.  Back to cited text no. 18
    
19.Higazi TB, Katholi CR, Mahmoud BM, Baraka OZ, Mukhtar MM, Qubati YA, et al. Onchocerca volvulus: Genetic diversity of parasite isolates from Sudan. Exp Parasitol 2001;97:24-34.  Back to cited text no. 19
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