1 | African Programme for Onchocerciasis Control

African Programme for Onchocerciasis Control

(WHO/APOC)

Remaining mapping challenges

for Oncho and Loa

17-18 November 2013

COR-NTD meeting, Washington DC

Outline

• Objective of APOC

• Mapping of oncho for the delineation of treatment boundaries

– Steps

– Survey methods

– Status of implementation

– Results of parasitological surveys

• Assessing the intensity Loa loa infection

• Way forward

• Challenges

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… to have established, by 2015, a country-led system capable of

eliminating onchocerciasis as a public health problem in endemic

countries, both those within the geographical area covered by

APOC’s mandate and those in ex-OCP area that are causing

concern.

Objective of APOC

Phasing-out and exit strategy 2008-2015

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Pre-control oncho endemicity map

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Pre-control oncho endemicity map and areas under CDTI

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Mapping of oncho for the delineation of

treatment boundaries

• Objective:

Conduct additional epidemiological surveys in areas with nodule prevalence <20% (previously known as hypo-endemic areas) in order to decide on the need of extending treatment for onchocerciasis elimination.

• Method:

Skin biopsy on individuals 5 years old and above

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Steps

• Development of guidelines for revising IVM treatment boundaries

• Workshop for selection of areas and villages to be surveyed (March 2013)

• Support to some NOTFs in finalizing the selection and developing plan of action and budget (Cameroon, Nigeria, Chad, Equatorial Guinea, DRC, Gabon)

• Conduct of surveys with technical and financial support from APOC Trust Fund (since June 2013)

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Mapping needs for oncho treatment boundaries

• Surveys completed in

– Cameroon • completed in Littoral and South regions

• Ongoing in Centre and East regions

– Burundi

– Chad

– Equatorial Guinea (Mainland)

• Surveys to be conducted in 2014

– Angola

– CAR

– Congo

– DRC

– Ethiopia

– Gabon (in collaboration with CNTD/Liverpool)

– Nigeria

– Mozambique (borders with Tanzania and

Malawi)

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Cameroon (Littoral and South): 22 Villages selected and surveyed

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Cameroun (Littoral and South): results of parasitological surveys

District Village Bassin Census. Exam. Attendance rate ( %)

Positive

Crude prev. %

Stand prev. %

CMFL

REGION DU LITTORAL

DIBOMBARI BENGSE NKAM 160 111 69,38 1 0.9 0.7 0.00

DIBOMBARI YABEA NKAM 150 91 60,67 2 2.2 1.5 0.05

DIBOMBARI BWADIBO MOUNGO 324 169 52,16 5 3.0 2.1 0.06

EDEA DIBONGO SANAGA 282 166 58,87 30 18.1 10.8 0.34

EDEA KM 11 SANAGA 355 174 49,01 5 2.9 1.9 0.07

EDEA MBONGO 2 DIBAMBA 435 243 55,86 7 2.9 2.0 0.06

EDEA MOUANKO SANAGA 276 109 39,49 1 0.9 0.7 0.02

EDEA MARIEMBERG SANAGA 197 89 45,18 3 3.4 1.9 0.08

Sub-total 1 8 villages 2179 1152 52,87 54 0.9 – 18.1 0.7 - 10,8 0 - 0.031

REGION DU SUD

KRIBI DEHANE NYONG 293 131 44,71 8 6.1 4.8 0.11

KRIBI MINTOM NTEM 152 74 48,68 1 1.4 0.8 0.01

KRIBI AFAN ESSO KYE NTEM 190 79 41,58 0 0.0 0.0 0.00

MVANGAN MINKOUMOU MBOUAN 443 194 43,79 4 2.1 1.6 0.03

EBOLOWA MVILA YEVOL MVILA 251 163 64,94 2 1.2 1.6 0.03

EBOLOWA EKOUMDOUM MVILA 363 209 57,58 3 1.4 1.4 0.02

KRIBI AKOM 1 KIENKE 443 237 53,50 1 0.4 0.2 0.00

LOLODORF BIKOE 1 LEKOUNDJE 391 262 67,01 2 0.8 0.6 0.00

LOLODORF ELON EFOM 320 155 48,44 3 1.9 1.0 0.02

KRIBI MAKOURE LEKOUNDJE 392 244 62,24 12 4.9 3.0 0.06

LOLODORF MOUGUE MOUGUE 135 62 45,93 1 1.6 0.4 0.01

LOLODORF KOUAMPBOER MVILA 282 131 46,45 2 1.5 0.5 0.02

LOLODORF NSOLA NSOLA 251 122 48,61 5 4.1 1.8 0.01

LOLODORF TYANGO TYANGO 205 90 43,90 1 1.1 0.3 0.01

Sub-total 2 14 villages 4111 2153 52,37 45 0 - 6.1 0 - 4.8 0 - 0.11

Total 1+2 22 villages 6290 3305 52,54 99 0 - 18.1 0 - 10.8 0 - 0.31

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Cameroon (Littoral and South): standardized mf prevalence in the 22 villages

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Because of high loiasis prevalence,

ensure LF+Oncho treatment in

Edea district using alternative

method

Cameroon (Littoral and South): Ensure Oncho+LF treatment in Edea district using alternative method

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It may be usefull to selected few

more villages in South region

Chad: 23 Villages selected and surveyed

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Chad: results of parasitological surveys

N° VILLAGE BASSIN DISTRICT Census Exam. Attendance

rate % Positive

Crude prev. %

Stand prev. %

CMFL

1 GABRI-NGOLO LOGONE LAI 251 221 88.0 0 0 0 0

2 TCHAKANDJILE LOGONE LAI 232 210 90.5 0 0 0 0

3 BOUMOU LOGONE LAI 233 182 78.1 0 0 0 0

4 MISSERE LOGONE LAI 266 207 77.8 0 0 0 0

5 LEO BIDIM ARIWI GOUNOU-GAYA 240 199 82.9 0 0 0 0

6 MADI GOUH KOLON FIANGA 242 231 95.5 0 0 0 0

7 NGUIRFI MANKIROU FIANGA 321 229 71.3 0 0 0 0

8 KAKINGA GONRINA DOBA 486 259 53.3 0 0 0 0

9 NDOKOBO PENDE BODO 283 227 80.2 0 0 0 0

10 BEKODO II PENDE BODO 255 214 83.9 0 0 0 0

11 BEPARA PENDE BODO 231 184 79.7 1 0,5 0 0

12 BELADJIA LOGONE BENOYE 318 166 52.2 0 0 0 0

13 NDOU LOGONE BENOYE 414 280 67.6 0 0 0 0

14 BAO GUENI BENOYE 478 302 63.2 0 0 0 0

15 BOUROU KAREIGNE BENOYE 433 319 73.7 0 0 0 0

16 MOUROUGOULAYE CHARI GOUNDI 611 448 73.3 0 0 0 0

17 KOUMAYE CHARI GOUNDI 565 432 76.5 0 0 0 0

18 PARIS SAKO M0N0 KOUMRA 243 201 82.7 0 0 0 0

19 NGANGARA CHARI GOUNDI 565 468 82.8 0 0 0 0

20 MATEKAGA CHARI GOUNDI 446 379 85.0 1 0,26 0 0

21 TCHIRE AGAMI KELO 287 254 88.5 0 0 0 0

22 BERTE KABIA KELO 267 240 89.9 0 0 0 0

23 ZAMRE ADI KELO 363 329 90.6 0 0 0 0

Total 8030 6181 77.0 2

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Chad: standardized mf prevalence in the 23 villages

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Chad: No extension needed yet

• Increase the sample size of Phase 1b epi evaluation to

cover theses areas

• Ensure IVM+ALB distribution is implemented for LF

(if low infection of loa loa is confirmed)

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Burundi: 20 Villages selected and surveyed

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Burundi: results of parasitological surveys

N° District Village Bassin Census Exami Atendance rate (%)

Positive Crude prev.

% Stand

prev. % CMFL

1 Kabezi Magara II Ruzibazi 519 146 28.1 0 0 0

2 Muramvya Kirinzi(Mubura) Mucece 789 177 22.4 0 0 0

3 Kabezi Gihangange

(Migera) karonké 826 230 27.8 0 0

4 Kabezi Kabezi kanyamanzi 886 337 38 0 0 0

5 Giteranyi Butihinda Pas de riviére 491 212 43.2 0 0 0

6 Giteranyi Rugese Nyamabuno 534 307 57.5 0 0 0

7 Kiyonza Kiyonza Kayaru 346 205 59.2 0 0 0

8 Nyabikere Buyaga Ruvubu 364 240 65.9 0 0 0

9 Mutaho Murongwe Mubarazi 220 158 71.8 0 0 0

10 Mutaho Ntunda (Jenda) Ruvyironza 504 279 55.4 0 0 0

11 BDS Rutana Gitaba Muyovozi 286 176 61.5 0 0 0

12 Ryansoro Muyuga (Kibagara Ruvyironza 202 142 70.3 0 0 0

13 DS Rutana Musongati

(Buhinga) nyamabuye 288 169 58.7 0 0 0

14 Ryansoro Jungwe Ruvyironza 344 229 66.6 0 0 0

15 Kankuzo Nyamugari Ruru 233 144 61.8 0 0 0

16 Butezi Titi Kayogoro 186 126 67.7 0 0 0

17 BDS

Makamba Dunga (Rusovu) Rukoziri 195 100 51.3 0 0 0

18 Rumonge Mugina (Ruvuga) Nyengwe 223 129 57.8 0 0 0

19 BDS

Nyanzalac Buheka Rwaba 565 359 63.5 1 0,27 0,3 0,00756

20 Rumonge Kigwena Nyengwe 581 347 59.7 1 0,28 0,2 0,00783

Totaux 8582 4212 49.1 2 18

Burundi: standardized mf prevalence in the 20 villages

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Burundi: Additional villages selected for ongoing epi. evaluation

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Eq. Guinea: results of parasitological surveys N° VILLAGE Bassin Province District POPULATION mf

Census

Exam Positive Crude Prev (%)

Stand. Prev (%)

CMFL

1 Minang Minang et Bang Litoral Kogo 118 82 0 0 0 0

2 Nko’ho Mofom et Kongu é Litoral Kogo 106 76 0 0 0 0

3 Midjobo Anvom Onvong/Midjobo Litoral Kogo 39 21 0 0 0 0

4 Minang Woro Litoral Mbini 76 47 0 0 0 0

5 King King Litoral Mbini 75 45 0 0 0 0

6 Mbomo Bolo Litoral Mbini 228 121 0 0 0 0

7 Afana Afana Litoral Bata 63 31 0 0 0 0

8 Nfonga Ecucu et Kiri Litotral Bata 65 24 0 0 0 0

9 Alum San José Ecucu Litoral Bata 140 81 0 0 0 0

10 Nvom Gnamiquielé et Nvom Centro Sur Nienfang 105 57 0 0 0 0

11 Micomasi Gnaméyiri /Mbea / Woro

Centro Sur Nienfang 58 40 0 0 0 0

12 Ayene Aseng Centro Sur Nienfang 203 84 0 0 0 0

13 Leng Chiwo/Milong/Woro Centro Sur Evinayong 51 26 0 0 0 0

14 Ayantangan Otongmegna Centro Sur Evinayong 89 63 0 0 0 0

15 Téguete Tegue Centro Sur Evinayong 27 9 0 0 0 0

16 Akurnam Esacora Mbihi Centro Sur Akurenam 47 28 0 0 0 0

17 Esong Neng Centro Sur Akurenam 69 53 0 0 0 0

18 Ayem Kan Centro Sur Akurenam 105 52 0 0 0 0

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Eq. Guinea: results of parasitological surveys N° VILLAGE Bassin Province District POPULATION mf

Census Exam Positive Crude Prev (%)

Stand. Prev (%)

CMFL

19 Adjamboga Abla Welen Zas Akonibe 113 66 0 0 0 0

20 Engong Etoho Ekang Welen Zas Akonibe 144 104 0 0 0 0

21 Ebom Abang Welen Zas Akonibe 106 90 0 0 0 0

22 Alum Oyeck Abang Welen Zas Nzork 67 42 0 0 0 0

23 Oveng Obolo Welen Zas Nzork 72 49 0 0 0 0

24 Abama Ntele Welen Zas Nzork 19 16 0 0 0 0

25 Asok Wéle Welen Zas Mongomo 112 52 3 5.76 7.0 0.03

26 Noakiegne N’noha Welen Zas Mongomo 54 31 0 0 0 0

27 Bisobinam Mebega/Eboho Welen Zas Mongomo 59 37 0 0 0 0

28 Alum Mvie/Wele Welen Zas Mongomo 77 59 0 0 0 0

29 Oveng Asem Woro Welen Zas Mongomo 57 43 0 0 0 0

30 Ndong Bidoa Anvam Welen Zas Mongomo 89 27 0 0 0 0

31 Nzamaduru Ndo Otongo/Bimbiles Welen Zas Anisock 78 29 0 0 0 0

32 Belabelaba Woro Welen Zas Anisock 108 72 0 0 0 0

33 Mbaragun Medjama/Alomo/Wele

Kie Ntem Nsok Somo 215 85 1 1.18 1.8 0.05

34 Abiara Esatop Moi Kie Ntem Nsok Somo 72 39 0 0 0 0

35 Bitet Eseng Bolo Kie Ntem Ebibeyin 74 39 0 0 0 0

36 Asok Otong Ngamba/Mongu/Kie

Kie Ntem Ebibeyin 67 35 1 2.85 1.8 0.015

37 Misa Cdo Memeac Kie Ntem Ebibeyin 92 44 0 0 0 0

38 Ebang Cdo Ncalor/Kie Kie Ntem Ebibeyin 70 46 0 0 0 0

39 Chaman Cdo Bono Kie Ntem Mikomeseng 59 41 1 2.43 1.8 0.012

40 Mokom Cdo Sunga/Loho Kie Ntem Mikomeseng 130 56 0 0 0 0

TOTAL 3598 2042 6 0 – 7%

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Eq. Guinea: standardized mf prevalence in 40 villages

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Eq. Guinea: standardized mf prevalence in 40 villages

• Select 10 – 15 villages for additional survey

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Assessing the intensity of loa loa infection

• Objective:

Assess the intensity of loa loa infection in the areas that may require extension of treatment for oncho elimination.

Surveys conducted in a coordinated manner with the oncho surveys for treatment boundaries.

• Method:

Thick blood film method for loa loa infection on individuals 5 years old and above.

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Map of the estimated prevalence of eye worm history in Africa

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CDTI area and villages surveyed using RAPLOA

In most of the countries:

non-CDTI areas have been covered

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The intensity of loa loa infection is not known

Surveys for loa loa infection needs: • Surveys completed, reading of slides

being completed:

– Cameroon (Littoral and South regions) • completed in Littoral and South regions

• Ongoing in Centre and East regions

– Chad

– Equatorial Guinea (Mainland)

• Surveys to be conducted in 2014

– Angola

– CAR

– Congo

– DRC

– Gabon (in collaboration with CNTD/Liverpool)

– Nigeria

– Equatorial Guinea (borders with Cameroon

and Gabon)

– Cameroon (refinement)

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Summary • Cameroon

– Standardized oncho mf prevalence 0 – 10.8% – Treatment for LF+Oncho is needed in Edea district using alternative method – Consider entomological assessment to confirm source of infection – Select more villages in South region and conduct survey

• Chad – Standardized oncho mf prevalence 0 % – During phase 1b epi evaluation surveys, include villages at the border of the

CDTI area – Ensure IVM+ALB treatment for LF is launched in Benoye, Deresia, Laï, Bohobe

and Boum Kebir districts (if low infection of loa loa is confirmed)

• Burundi – Standardized oncho mf prevalence 0 – 0.3% – Surveys in additional villages selected ongoing

• Equatorial Guinea – Standardized oncho mf prevalence 0 – 7% – Select additional villages at the border with Cameroon and Gabon – Consider entomological assessment to confirm source of infection

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Summary

In all the surveyed areas, there was an decrease in the endemicity of oncho where initial nodule prevalence was < 20% (hypo-endemic), even no treatment has been conducted.

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Way forward

• Implement surveys in the remaining countries (Angola, CAR,

Congo, DRC, Ethiopia, Gabon, Nigeria, Mozambique) in 2014

• Complete the reading of slides for loa loa infection in Cameroon,

Chad and Equatorial Guinea

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Main challenges

• Funding

– APOC budget was supposed to reduce drastically from 2013 to meet the closure of the Programme in 2015, while there is need to conduct additional surveys.

• Strengthen laboratory capacity of countries for the diagnosis of oncho infection and entomological assessment.

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Thank you

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