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2018, 93, 541–552 No 41 Weekly epidemiological record Relevé épidémiologique hebdomadaire 12 OCTOBER 2018, 93th YEAR / 12 OCTOBRE 2018, 93e ANNÉE No 41, 2018, 93, 541–552 http://www.who.int/wer Progress towards Progrès vers l’élimination Contents eliminating onchocerciasis de l’onchocercose dans 541 Progress towards in the WHO Region la Région OMS des Amériques: eliminating onchocerciasis in the WHO Region of of the Americas: advances progrès dans la cartographie the Americas: advances in mapping the Yanomami de la zone du foyer Yanomami in mapping the Yanomami focus area focus area 544 Guidance for evaluating Onchocerciasis (river blindness) is caused L’onchocercose (cécité des rivières) est provo- progress towards elimination by the parasitic worm Onchocerca volvulus, quée par Onchocerca volvulus, ver parasitaire of measles and rubella which is transmitted by Simulium species transmis par certaines espèces de Simulium black flies that breed in fast-flowing (simulies) qui se reproduisent dans les rivières Sommaire rivers and streams. In the human host, et les cours d’eau rapides. Chez l’hôte humain, adult male and female O. volvulus worms les adultes mâles et femelles d’O. volvulus s’en- 541 Progrès vers l’élimination become encapsulated in subcutaneous capsulent dans des «nodules» fibreux sous- de l’onchocercose dans fibrous “nodules”, and fertilized females cutanés et les femelles fécondées produisent la Région OMS des Amériques: progrès dans la cartographie produce embryonic microfilariae, which des microfilaires embryonnaires qui migrent de la zone du foyer Yanomami migrate to the skin, where they are vers la peau où elles sont ingérées par des 544 Orientations pour évaluer ingested by the black fly vectors during simulies vectrices lors d’un repas de sang. les progrès réalisés en vue a blood-meal. In the vector, the microfi- À l’intérieur du vecteur, les microfilaires se de l’élimination de la rougeole lariae develop into the infectious L3 stage, développent jusqu’au stade infectieux L3, et la et de la rubéole at which time they can be transmitted to simulie peut alors transmettre ces formes infec- the next human host via subsequent tantes au prochain hôte humain par piqûre. Le bites. The parasite has no environmental parasite n’a ni réservoir dans l’environnement reservoir or nonhuman hosts. Microfi- ni hôte non humain. Les microfilaires lariae cause severe itching and disfigur- provoquent un prurit sévère, des maladies cuta- ing skin disease and may enter the eye, nées défigurantes et peuvent pénétrer l’œil où causing visual loss and blindness in some elles entraînent une perte de vision, voire la individuals. Ivermectin (MectizanR) is a cécité chez certaines personnes. L’ivermectine safe, effective oral microfilaricide donated (MectizanR) est un microfilaricide sûr et effi- by the Mectizan Donation Program since cace par voie orale offert par le Mectizan Dona- 1987 to control or eliminate onchocercia- tion Program depuis 1987 pour lutter contre sis through community-wide mass drug l’onchocercose au moyen de pro-grammes administration (MDA). The drug rapidly d’administration massive de médicaments kills the microfilariae, and, with repeated (AMM) à l’échelle communautaire. Ce médica- rounds of treatment with high coverage, ment tue rapidement les microfilaires et, grâce it can stop transmission and increase à des tournées répétées de traitement ayant une mortality in adult worms. In the Ameri- couverture suffisante, il peut interrompre la cas, over 500 000 persons were initially transmission et augmenter la mortalité chez les infected or at risk of infection in 6 coun- vers adultes. Dans les Amériques, il y avait à tries: Brazil, Colombia, Ecuador, Guate- l’origine plus de 500 000 personnes infectées ou WORLD HEALTH mala, Mexico and the Bolivarian Republic exposées au risque dans 6 pays: Brésil, Colombie, ORGANIZATION of Venezuela. To date, 94% of the original Équateur, Guatemala, Mexique et République Geneva at-risk population is now free of oncho- bolivarienne du Venezuela. À ce jour, 94% de la ORGANISATION MONDIALE cerciasis, and 4 of the 6 countries (Colom- population à risque au départ est désormais DE LA SANTÉ bia, Ecuador, Guatemala and Mexico) débarrassée de l’onchocercose et 4 des 6 pays Genève have been verified by WHO to have (Colombie, Équateur, Mexique et Guatemala) ont successfully eliminated transmission. The réussi à éliminer la transmission, ainsi que Annual subscription / Abonnement annuel final region of transmission of onchocer- l’OMS l’a vérifié. La dernière région de transmis- Sw. fr. / Fr. s. 346.– ciasis in the Americas is in a remote area sion de l’onchocercose dans les Amériques 10.2018 (the Yanomami focus area, YFA) on the subsiste dans une zone isolée (la «zone du foyer ISSN 0049-8114 border of Brazil and the Bolivarian yanomami»), à la frontière entre le République Printed in Switzerland Republic of Venezuela. bolivarienne du Venezuela et le Brésil. 541 The Yanomami focus area La zone du foyer yanomami The YFA is the cross-border zone of onchocerciasis Il s’agit d’une zone transfrontalière de transmission de l’on- transmission comprising the South focus of the Bolivarian chocercose comprenant le foyer sud de la République boliva- Republic of Venezuela and the Amazonas focus of Brazil. rienne du Venezuela et le foyer de l’Amazone au Brésil. Son The Yanomami are the nomadic indigenous people who nom provient de celui de la population autochtone nomade live in communities scattered over approximately vivant en communautés éparpillées sur environ 230 000 km2 230 000 km2 of savannah and Amazon rainforest along de savane et de forêt humide amazonienne le long de la fron- the border between the two countries. About 32 467 indi- tière entre les 2 pays. L’AMM cible 2 à 4 fois par an environ viduals living in 615 small villages, called “shabonos” or 32 467 personnes vivant dans 615 petits villages appelés “malocas”, are targeted for MDA 2 or 4 times a year. In «shabonos» ou «malocas». En 2017, 67 292 traitements par 2017, 67 292 ivermectin treatments were given in the l’ivermectine ont été donnés dans la zone du foyer yanomami, YFA: 17 409 as twice a year treatment and 49 883 as 17 409 dans le cadre de l’AMM 2 fois par an et 49 883 dans le 4 times a year treatment. The success with which MDA cadre de l’AMM 4 fois par an. L’AMM a été exécutée avec un reached the 85% treatment goal depended on location succès variable pour atteindre l’objectif de 85% de couverture of villages, the availability of resources and infrastruc- selon la localisation des villages, la disponibilité des ressources ture (including air transport and landing strips), Yano- et les infrastructures (y compris les transports aériens et les mami migratory patterns and weather conditions. pistes d’atterrissage), les habitudes migratoires des Yanoma- mis et les conditions météorologiques. In order to achieve the programme’s disease elimination Pour avancer vers les objectifs d’élimination du programme, goals, several initiatives were launched in 2017: plusieurs initiatives ont été lancées en 2017: 1) études anthro- (i) anthropological studies to learn more about the pologiques pour en savoir plus sur les Yanomamis (déplace- Yanomami (mobility patterns and community sociopo- ments et liens sociopolitiques des communautés); 2) inten- litical relationships); (ii) recruitment and training of sification du recrutement et de la formation d’agents de more indigenous health agents (IHAs) to help provide santé autochtones pouvant aider à dispenser les traitements ivermectin treatment and other health care; (iii) recovery par l’ivermectine et d’autres soins; 3) récupération et main- and maintenance of airstrips in the Venezuelan South tenance des pistes d’atterrissage dans le foyer sud au Vene- focus; and (iv) meetings between the 2 national zuela; et 4) réunions entre les 2 programmes nationaux pour programmes to better define the onchocerciasis endemic mieux définir la zone d’endémie de l’onchocercose à couvrir. area to be covered. An accurate picture of the Yanomami Il n’est pas facile de dresser un tableau exact de la population population targeted for onchocerciasis treatment was yanomamie ciblée pour le traitement de l’onchocercose, difficult to achieve, as their settlements are changing 2 caractéristiques intrinsèques des campements yanomamis constantly in composition and mobility. In 2017, the étant des changements constants dans la composition et la Brazilian and Venezuelan onchocerciasis elimination mobilité. En 2017, les programmes vénézuélien et brésilien programmes agreed on an essential update and detailed d’élimination de l’onchocercose ont reconnu que le besoin maps of all communities in the YFA, including geograph- d’obtenir des cartes actuelles et détaillées de toutes les ical coordinates, treatment and epidemiological data, communautés de la zone était fondamental. Les coordonnées vector species, health posts, airstrips and mobility géographiques, les données sur les traitements et l’épidémio- patterns. In order to amalgamate the data collected logie, les espèces vectorielles, les postes de santé, les pistes through the years by the programmes on both sides of d’atterrissage et les habitudes de déplacement seront incluses, the border, technical onchocerciasis staff and geograph- avec d’autres variables, dans ces cartes détaillées. Afin de ical information system (GIS) experts held two meetings réunir les données collectées au cours des ans par les in 2018 to choose a common GIS platform and to unify programmes opérant des 2 côtés de la frontière, les person- their data. The meetings were held in Guatemala City, nels techniques vénézuéliens et brésiliens pour l’onchocer- Guatemala, in January, and Rio de Janeiro, Brazil, in cose et les experts du système d’information géographique March. The meetings resulted in an updated database (SIG) ont tenu 2 réunions en 2018 pour choisir une plate- of YFA community coordinates and their pre-MDA forme SIG commune et unifier leurs données.
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