[A case of cross infection by Onchocerca volvulus and Onchocerca ochengi in Simulium damnosum S.L]

During a routine entomological survey conducted within the framework of the Program to Control Onchocerciasis in West Africa, a female simulium forest fly was found to be contaminated by 13 Onchocerca volvulus larvae and 7 Onchocerca ochengi larvae. The two Onchocerca species were identified using specific DNA probes. We speculate that cross infection could be related either to behavioral factors, e.g. interruption of blood meals on two different hosts, or developmental factors, e.g. asynchronous development of parasites of the same species or specific differences in the duration of parasite cycles. Further study will be needed to determine the incidence and scope of cross infection in areas where accurate assessment of the impact of vector control on transmission of onchocerciasis in man is required.

[Systemic action of ivermectin on Culex quinquefasciatus and Simulium squamosum]

The mortality of Culex quinquefasciatus mosquitoes having fed ten days earlier on a chicken treated by 2,000 micrograms/kg of ivermectin (about ten times the therapeutic dosage) is about 25% higher than the mortality recorded on mosquitoes having fed on a non treated chicken. This systemic effect occurs only if the blood meal takes place between 7 and 31 hours after the administration of the drug. However, no systemic effect is recorded either with the C. quinquefasciatus mosquito or with the Simulium squamosum black fly when they are fed on human beings treated at the therapeutic dose.

Pool screen polymerase chain reaction for estimating the prevalence of Onchocerca volvulus infection in Simulium damnosum sensu lato: results of a field trial in an area subject to successful vector control

Detection of infective parasites in the vector population can be an early indicator of recrudescence in areas freed of new cases of onchocerciasis. However, dissection of vector black flies is inefficient in areas subject to effective control. Recently, a polymerase chain reaction (PCR)-based assay has been used to detect a single Onchocerca volvulus-infected black fly in pools containing large numbers of uninfected flies. This method had not been validated on wild-caught black flies in an area subject to effective vector control. Here, we report a method of restricting the pool screen PCR assay to infectious parasites and the results of a field test in an area subject to long-term vector control. The prevalence of infection determined by dissection did not differ from that determined by pool screen PCR. The results suggest that the PCR assay may be a useful tool for epidemiologic surveillance for 0. volvulus infection.

Environmental Assessment of Larvicide Use in the Onchocerciasis Control Programme

The objective of the Onchocerciasis Control Programme (OCP) is to eliminate onchocerciasis as a disease of public importance and as an obstacle to socio-economic development. The OCP was initially based solely on the control of the blackfly vector, Simulium damnosum sensu lato, by insecticide spraying of the breeding sites on river systems, where larval stages develop. Results of monitoring the environmental effects and the process of risk assessment for new insecticides are reviewed. The achievements of this strategy are outlined here by Davide Calamari, Laurent Yameogo, Jean-Marc Hougard and Christian Leveque.

Long-term quantitative ecological assessment of insecticides treatments in four African rivers: a methodological approach

In West Africa different insecticides had been applied in selected river areas for the reduction of the blackfly populations vectors of Onchocerca volvulus, a parasite causing blindness. To evaluate the possible long term effects of the larvicides on the non target fauna an aquatic monitoring programme has been up from the initial phase of the project. Addressing the attention to the invertebrates data collected in four countries during a maximum period ranging from 1977 to 1996, this paper shows and discusses the data analysis strategy for the measure and interpretation of the biological variation. In particular the application of quantitative ecological analysis methods: Principal Component Analysis, rank abundance models and the community diversity indexes, is critically discussed and comments are given to the ecological interpretation of the results.

Blackfly control: what choices after onchocerciasis?

Blackflies are reappearing in areas of West Africa where they used to be controlled with insecticides because they were vectors of the parasite Onchocerca volvulus. Even though they no longer transmit onchocerciasis in these areas they can hinder optimal land use through their biting behaviour. The authors discuss the problems associated with resuming the use of insecticides to control the blackfly and recommend that ground treatment be restricted to areas where it is likely to be effective on a continuing basis. In communities lacking technical and financial resources the only alternative consists of individual protection through the use of repellents or protective clothing.

The impact of Mectizan on the transmission of onchocerciasis

For many years there was no suitable drug available for the control of onchocerciasis. The advent of Mectizan (ivermectin, MSD; an effective microfilaricide), its registration in October 1987 for the treatment of human onchocerciasis, and its suitability for large-scale application were major break-throughs in the control of human onchocerciasis via chemotherapy. Several studies, both fly-feeding experiments and community trials, have established that Mectizan treatment causes a significant reduction in the transmission of infection. Although long-term treatment in some isolated foci (such as occur in the New World and in some hypo- and meso-endemic areas elsewhere) appears to interrupt transmission, more prolonged treatment is required to prove if transmission can be stopped. Advantage could be taken of the significant impact of Mectizan on transmission by giving treatment while or just before transmission by blackflies is most intense.

Impact of treatments with Bacillus sphaericus on Anopheles populations and the transmission of malaria in Maroua, a large city in a savannah region of Cameroon

Simultaneously with a control of breeding sites primarily for Culex quinquefasciatus and secondarily for anophelines with Bacillus sphaericus in the town of Maroua (120,000 inhabitants) in North Cameroon, a survey of anopheline populations and of transmission rates of malaria was performed. Monthly night catches in 8 districts of the town emphasized the relation between the biting rate by Anopheles in the districts and two main factors. One factor was the distance of a district from the breeding sites, i.e., natural flooded areas along the periphery of the town or artificial breeding sites (ditches, puddles) filled with rain water during the rainy season and with water from the water network throughout the year. The second factor was the density of the habitation that reduced dispersal of female mosquitoes from the breeding sites and the risk for inhabitants to be injected because of scattered bites. The treatment with B. sphaericus was followed by a delay (2 months) in the beginning of the transmission period and a decrease in the incidence of malaria cases studied in a health facility of the town. It thus seems to be possible to reduce malaria transmission by applying B. sphaericus to the breeding sites, but this requires a good knowledge of the location and dynamics of breeding sites and an improved formulation of the pesticide.

Control of Culex quinquefasciatus (Diptera: Culicidae) with Bacillus sphaericus in Maroua, Cameroon

Two strategies were tested to control Culex quinquefasciatus with Bacillus sphaericus in Maroua (population 130,000), Cameroon. The treatment of all potential breeding sites (27,000) with B. sphaericus during the dry season caused up to a 90% reduction in the adult biting rate. Because of the short persistence of B. sphaericus and the occurrence of new breeding sites, unacceptable levels of adult biting rates were reached again in 5 months. In the second strategy, two treatments per year of the most productive breeding sites (10,000) stopped the biting rate increase during the rainy season. The results were only partially successful because of variations in B. sphaericus toxicity. The first treatment required 1,200 man-days of work vs. 200 for the simplified treatments. The density of breeding sites depends on the rainfall and the presence of a tap-water network. A sustained control program of Cx. quinquefasciatus will depend upon the dynamics of the principal breeding sites and an improved formulation of B. sphaericus.

Patterns of epidemiology and control of onchocerciasis in west Africa

This paper summarizes the work of the Onchocerciasis Control Programme (OCP) in West Africa, a programme which over a 22 year history has reduced the public health problems of blinding onchocerciasis in eleven countries of West Africa through vector control and, more recently, ivermectin distribution. The paper emphasizes the different approaches to control the programme has developed in the different parts of the programme area which have been determined by the epidemiology of the disease (savanna/forest form), the migratory characteristics of the vectors, intensity of the disease before commencement of treatment, the combined impact of vector control and ivermectin and the likelihood of infiltration of infective blackflies from outside the programme area. The programme has constantly monitored the impact of operations on the trends in prevalence, incidence, annual transmission potential, ocular morbidity and species of fly populations, and as a result, has identified areas where special interventions are required until the programme comes to an end in 2002. The paper illustrates the changes in intensity of infection as measured by community microfilarial load and annual transmission potential over the duration of the programme control activities. The paper also defines and justifies the control strategies in different areas and identifies areas for special interventions.

[Health indicators of a population in an agro-industrial complex of southern Cameroon]

An agro-industrial program involving sugar cane farming was established in Mbandjock (Cameroon) in the 1960's. We studied the impact of this development project on the health of the population by determining the prevalence and distributions of the major parasitic diseases according to district, ethnic origin, age and sex. Three main conclusions can be drawn. First, in the study area, economic development was not associated with deteriorating health conditions. Indeed, the incidence of parasitic disease was lower in Mbandjock than in surrounding areas. Second, imported diseases (loaiasis and schistosomiasis for example) did not develop locally despite the large population concentrations created by the implantation of the agro-industrial complex. Third, endemic parasitic diseases (malaria, onchocerciasis and intestinal infection by helminths or protozoan) were found only in a few districts. Thus, integrated control measures should be taken in these areas as a priority.

Drastic reduction of populations of Simulium sirbanum (Diptera: Simuliidae) in central Sierra Leone after 5 years of larviciding operations by the Onchocerciasis Control Programme

The major vectors of the blinding form of human onchocerciasis in West Africa are two blackfly species, Simulium sirbanum and Simulium damnosum s.s. (Diptera: Simuliidae), identified at the adult stage as the 'savanna group' of the Simulium damnosum complex. In 1988, in the central part of Sierra Leone, the average daily biting rate (females/man/day) by savanna blackflies (mostly S. sirbanum) during the peak of the dry season (April-May) was 59.9, making up 69.1% of total captures on average. There was evidence of a strong long-range immigration of adult females of S. sirbanum through eastern Guinea in the dry season, with a reverse movement towards Guinea in the rainy season. Therefore, in 1989, the World Health Organization's Onchocerciasis Control Programme (OCP) extended its vector control operations from central West Africa to rivers of central and northern Sierra Leone, and to rivers of eastern Guinea. Four years of efficient larviciding drastically reduced adult populations of S. sirbanum in Sierra Leone. In the peak of the dry seasons of 1993 and 1994, the average biting rate by savanna blackflies in central Sierra Leone had dropped to 1.0, making up only 4.3% of total captures on average. Yearly biting rates by S. sirbanum in central Sierra Leone were therefore reduced to 2% of their pre-intervention levels. Based on larval samples, the S. sirbanum has been replaced by two forest species, S. leonense in the south and S. squamosum in the north. Since 1992, it has been possible to calculate accurate transmission rates for blinding onchocerciasis, based on DNA-probe identifications. From 1993, the risk of transmission has not only been reduced by vector control but also by mass distribution of ivermectin to rural communities. In terms of control strategy, the authors conclude that larviciding operations could be alleviated in central Sierra Leone without increasing the risk of blinding onchocerciasis transmission, as long as the migration of S. sirbanum through eastern Guinea and northern Sierra Leone is prevented.

[The necessity of conducting to the end the activities of vector control in the onchocerciasis control program in west Africa: recall of the stakes and proposal of a minimum budget for the period 1998-2002]

After a brief presentation of the Onchocerciasis Control Programme in West Africa (OCP), the authors realize the health and socioeconomic consequences that could follow a cessation of larvicide treatment before 2002 in the south-eastern and western extensions of the Programme. Taking into account that OCP activities are theoretically supported until 1997, but aware of financial constraints that will probably increase from now to 2002, this paper proposes an a minima estimation of the residual vector control activities for a "phasing out" spread out for five years (1998-2002). These estimations essentially concern the larvicide coverage, the insecticides used, the entomological surveillance, the logistical support and their financial aspects. As far as 48 U.S. $ million amount for 5 years are concerned, the budget allocated for vector control activities should not exceed the third of the global amount allocated to OCP for the actual fourth financial phase of the Programme (1992-1997).

[Control of onchocerciasis vectors in West Africa: description of the logistics adapted for a large-scale public health program]

The Onchocerciasis Control Programme (OCP) in West Africa, launched in 1974, includes 11 participating countries and covers more than one million square kilometres. The aim of the OCP is to control blinding onchocerciasis (river blindness) which is caused by the savannah strain of Onchocerca volvulus transmitted by the Simulium damnosum complex. There is no effective macrofilaricide, so vector control to prevent the transmission of the parasite remains the method of choice, despite the availability of ivermectin, a drug which controls ocular morbidity. The potential value of vector control has been demonstrated by the original programme: 14 years activity has eliminated the disease as a public health problem in the areas included. This strategy requires adapted logistical support involving (i) widespread insecticide coverage (27,000 km of river are treated by the OCP during the rainy season), (ii) frequent (weekly) application of larvicide and (iii) prolonged intervention due to the life-span of the worm in the human reservoir, estimated to be approximately 14 years. We describe the vector control operations and their organisation 20 years after the initiation of the OCP. The OCP can be divided into 5 areas of logistic activity. The first covers activities involving insecticide and fuel management for the OCP as a whole: assessment of the requirements for the following year, ordering from insecticide and petrol suppliers, stocking fuel and insecticide at the depots covering the area. The second activity is the treatment of rivers with insecticide. This includes treating the ground with larvicide, the aerial operations run by an independent company supplying 12 helicopters on contract to the OCP, and use of satellite beacons for retransmitting of hydrological data. The third activity is monitoring the impact of larvicides on both the target (adult and larval S. damnosum) and on other fauna (fish, crustaceans and other insects). The fourth activity is field data collection and its processing. This involves a data transmission network to facilitate stock management insecticide application and entomological and hydrological surveillance using computer systems. The fifth activity is the coordination of vector control operations, technical and administrative staff and estimations of the funds available to the Vector Control Unit. The logistic aspects of other large-scale-insect-control programmes world-wide are considered, and the possibility of using the OCP as a model for such programmes (both public health and agricultural) is assessed.

[ Onchocerciasis control program in West Africa: socioeconomic development and risk of recrudescence of transmission. 1. Experimental study of the transmission of Onchocerca volvulus strains from Southwestern Sierra Leone by Simulium sirbanum]

As part of the return of savanna migrants installed since a long time in forest regions, in the south of Sierra Leone, we carried out an experimental study about a cross-transmission between Simulium sirbanum from Missira (West-Mali) and the forest strain of Onchocerca volvulus in the south-west of Sierra Leone. This study will allow to know if there is a risk of onchocerciasis transmission recrudescence in relation to the reinstallation of these migrants in their native region. Because of the very high limitation to the forest strain of O. volvulus microfilariae output of the peritrophic membrane reduction with savanna black-flies and according to the very low mature parasite out put of S. sirbanum with this strain observed along this experimentation, the forest strain of O. volvulus from the south Sierra Leone appears maladjusted to S. sirbanum, the main vector of onchocerciasis in savanna regions. This observation implicates a very low intensity of transmission for this forest strain by savanna onchocerciasis vectors. The return of savanna migrants in their native region, installed in the south Sierra Leone since several decades, could not be, in a short time, an origin of onchocerciasis recrudescence in savanna regions of the Onchocerciasis Control Programme area cleaned by an effective vector control carried out since 1975 sustained now by a chemotherapeutic treatment reducing the human parasite reservoir. However, the preservation of this acquired necessitates an epidemiological supervision increased, because the interactions between the vector and the parasite for a long time could carry away a mutual adaptation and a sickness recrudescence.

[Onchocerciasis control program in West Africa: socioeconomic development and risk of recrudescence of transmission. 2. Experimental study of the transmission of Onchocerca volvulus strains from Southwestern Sierra Leone by Simulium yahense and Simulium squamosum]

The movements of human populations towards the mining wealth of the northern parts of Sierra Leone are favorable to a high contact rate between onchocerciasis patients coming from the south-western area of this country and the vector species Simulium yahense and Simulium squamosum which assume the essential of onchocerciasis transmission in the above-mentioned mining area. In fact, the Onchocerca volvulus strains concerned by this contact seem to be more pathogenic than those locally transmitted. In order to assess the danger it could represent for the Onchocerciasis Control Programme in West Africa, we carried out the experimental study of transmission which may result from this contact when more or less infected onchocerciasis patients are involved. The results indicated that this transmission by S. yahense may reach high proportions only when heavily infected onchocerciasis patients are implicated. We took also notice of the low capacity of S. squamosum to transmit the O. volvulus strains from the south-western Sierra Leone, irrespective of the microfilarial load of patients. Thus, in the most favorable conditions of a high parasite-vector contact of the study, involvement of S. yahense and onchocerciasis patients with high skin microfilarial loads is the only occurrence to which a high risk of intensive transmission may be related. The authors consider that the probability of such a risk occurring will be drastically reduced, due to the considerable decrease of skin microfilarial loads in human communities which regularly have the advantage of ivermectin (Mectizan) mass treatments.

[Importance and role of spreading larvicides on the soil in river beds for the control program against onchocerciasis in west Africa]

The control of blackfly is based on larvicide spraying in rivers where the insects breed and their larval stages are vulnerable. The first technique for large-scale operations, consists of using aircraft in the same way as for mosquito control and crop protection operations. The second technique, which will be discussed in this paper, consists of ground treatment of rivers, either directly with a container or with a spraying pump or by boat spraying insecticide in cross strip. In areas of West Africa where onchocerciasis is still prevalent, ground treatment is done to support aerial operations and to a lesser extent to control nuisance in areas where the endemicity of the disease is low. In onchocerciasis-freed zones, control of blackfly aims only at suppressing the nuisance in order to enhance the socio-economic development in areas at unfair disadvantage. This distinction is important for determining the responsibilities of various groups. Vector control to interrupt the transmission of onchocerciasis is the mandate of OCP while the control of nuisance is the responsibility, depending on the circumstances, of the private sector, the government and/or village communities. In this paper, we have attempted to highlight the objectives of such treatments, the responsibilities of various groups and the prospects in West African countries located in the Onchocerciasis Control Programme area. We also present the situation of ground larviciding in countries outside the Programme, in temperate as well as tropical conditions, in order to provide some basis for the development of ground treatment strategies in the OCP area.

Criteria for the selection of larvicides by the Onchocerciasis Control Programme in west Africa

One of the weekly decisions the Onchocerciasis Control Programme has to make, in its operations in 11 west African countries, is the selection of one insecticide out of the six used that is most appropriate to the river stretches to be treated. This decision depends on several criteria, linked not only to the compounds themselves but also the hydrological conditions and blackfly populations involved. Given the great number of breeding sites (gites) to be treated, in 23,000 km of rivers at the height of the rainy season, this paper identifies the parameters needed to facilitate the choice of insecticide and to optimize the larviciding in terms of cost effectiveness, management of resistance and minimizing the environmental impact.

[Factors affecting the efficacy of 2 growth regulator compounds, OMS 3010 (phenoxycarb) and OMS 3019 (ethoxypyridine), on larvae of the Simulium damnosum complex]

Two insect growth regulators (IGR'S) acting as juvenile hormone analogs (JHA'S), OMS 3010 (phenoxycarb) and OMS 3019 (ethoxypyridine) were selected after a screening of several compounds proposed by industry on black fly larvae of the Simulium damnosum complex (Diptera: Simuliidae) the vector of onchocerciasis in West Africa. Bioassays were designed to study two parameters: larval age and exposure time. The results showed that these compounds are more efficient on old larvae (6th and 7th instars) than young larvae (3rd, 4th and 5th instars). However, exposure time seems essential. The black fly larvae live in fast running water courses. Thus, it is difficult to insure a prolonged exposure time in natural conditions. Though being active on black fly larvae, three factors are limiting the prospects for operational use of these two compounds: high dosages, limited effectiveness on young instar larvae and exposure time.

[Campaign against Culex quinquefasciatus using Bacillus sphaericus: results of a pilot project in a large urban area of equatorial Africa]

Culex quinquefasciatus, which is sometimes the vector of Bancroft's filariasis, is a harmful mosquito, the immature stages of which live in collections of waste water resulting from human activity. Larval control, the most appropriate method, is at present carried out with chemical insecticides. But the toxicity of these compounds, together with phenomena of resistance, and the cost of substitute insecticides have turned research towards products of biological origin, and one of the most promising is a liquid concentrate of Bacillus sphaericus strain 2362. This was applied experimentally over an area of 200 hectares in a large city in the south of Cameroon, characterized by a short dry season during which mosquito density is at its highest. Spraying was carried out every three months for a year in a concentration of 10 g/m2 and its efficacy evaluated at the level of adult mosquitos through an indirect system of capture on human baits. The results of this study show, in essence, a reduction by 52.7% in the number of females captured in the overall study area treated, and that the impact of treatment is greater during the period of high mosquito density (55.1%) than in the low density period (40.7%). After analysis of the full set of results, the authors conclude that the pattern of rainfall, the conditions in which the insecticide is applied and reinvasions of mosquitos from untreated areas were the principal factors limiting the efficacy of this control campaign.(ABSTRACT TRUNCATED AT 250 WORDS)

[Small-scale evaluation of the efficacy of growth-regulating insecticides on larvae of the Simulium damnosum complex (Diptera: Simuliidae)]

The efficacy of insect growth regulators was assessed in small scale tests on larvae of the Simulium damnosum complex (Diptera: Simuliidae) in the Ivory Coast. Three compounds [OMS 2015 (triflumuron), OMS 3009 (teflubenzuron), OMS 3013 (chlorfluazuron)] belong to the group of benzoylphenyl-urea substitutes; these IGR's are supposed to inhibit chitin synthesis. Two other compounds are Juvenile Hormone Analogs (JHA's) (OMS 3007 and OMS 3019). The last compound (OMS 3010) is a phenoxycarbamate. The first three compounds had a low efficacy on blackfly larvae, which is consistent with the literature data for another compound of this group: diflubenzuron. The other three compounds (OMS 3007, OMS 3010 and OMS 3019) were much more efficient, OMS 3010 and OMS 3019 showing high activity at low concentrations. These results would justify further studies on the effect of larval age and exposure parameters, and eventually full scale river tests.

Twenty-five years of blackfly control in a localized moist forest area of Cameroon: a review

The high number of blackfly bites in a moist forest area of Cameroon, around the Sanaga river, was causing considerable nuisance and had led to a local ground-based larval control campaign. We have reviewed the 25 years of almost uninterrupted weekly larvicide applications in this area and emphasized the problems related to application difficulties, environmental pollution and blackfly resistance to the insecticides. Although the number of larvicidal compounds readily available is now limited, the future of blackfly control at this site does not seem to pose real technical difficulties because of its economic importance (hydroelectric dam) and the progress made in the fields of resistance management, search for new insecticide molecules and development of new control methods.

[Effect of a sublethal dose of an insect growth regulator on the physiology of onchocercosis vectors]

In most of the large scale vector control programs, the larviciding operations are not fully successful, resulting in a surviving vector population due to the use of sublethal doses. This problem leads the authors to study the effect of such doses upon the future of the residual population in order to know if it represents an epidemiologically dangerous population. One insect growth regulator was selected to study this phenomenon using Onchocerca volvulus as the parasite and Simulium damnosum s.l. as the vector. The experiment was conducted under field conditions by treating a river of a savanna area in north Cameroon where onchocerciasis remains endemic. The sublethal doses yielding 20% in adult blackflies from treated larvae was determined and the effects on physiological and vectorial capacities were assessed. The authors also carried out observations on the peritrophic membrane formation and the passage of microfilariae into the hemocele. The observation of flies fed on Onchocerca after larval treatment showed that this insecticide had a light effect on female longevity but did not induce any modifications in the life cycle of the parasite. An unusual high proportion of infected females, observed by the authors, is probably due to an anomaly in the phenomenon of limitation. However, the histological analysis showed to the evidence that no apparent difference between treated and untreated blackflies was observed although the process of blood meal digestion seemed slightly altered in treated flies.