African Programme for Onchocerciasis Control (WHO/APOC)

Remaining mapping challenges for Oncho and Loa

17-18 November 2013 COR-NTD meeting, Washington DC

1 | African Programme for Onchocerciasis Control 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

2 Objective of APOC

Phasing-out and exit strategy 2008-2015

… 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.

3 Pre-control oncho endemicity map

4 Pre-control oncho endemicity map and areas under CDTI

5 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

6 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 (, Nigeria, , , DRC, )

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

7 Mapping needs for oncho treatment boundaries

• Surveys completed in • Surveys to be conducted in 2014 – Cameroon – Angola • completed in Littoral and South regions • Ongoing in Centre and East regions – CAR – Burundi – Congo – DRC – Chad – Ethiopia – Equatorial Guinea (Mainland) – Gabon (in collaboration with CNTD/Liverpool) – Nigeria

– Mozambique (borders with Tanzania and Malawi)

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

9 Cameroun (Littoral and South): results of parasitological surveys

Attendanc Positi Crude prev. Stand prev. District Village Bassin Census. Exam. e rate ( %) ve % % CMFL REGION DU LITTORAL BENGSE 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 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 2 435 243 55,86 7 2.9 2.0 0.06 EDEA 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 DEHANE NYONG 293 131 44,71 8 6.1 4.8 0.11 KRIBI 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 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 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

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

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

Because of high loiasis prevalence, ensure LF+Oncho treatment in Edea district using alternative method

It may be usefull to selected few more villages in

12 Chad: 23 Villages selected and surveyed

13 Chad: results of parasitological surveys

Attendance Crude Stand N° VILLAGE BASSIN DISTRICT Census Exam. Positive CMFL rate % prev. % prev. % 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

14 Chad: standardized mf prevalence in the 23 villages

15 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)

16 Burundi: 20 Villages selected and surveyed

17 Burundi: results of parasitological surveys Atendanc Crude prev. Stand CMFL N° District Village Bassin Census Exami Positive e rate (%) % prev. % 1 Kabezi Magara II Ruzibazi 519 146 28.1 0 0 0 2 Muramvya Kirinzi(Mubura) Mucece 789 177 22.4 0 0 0 Gihangange 3 Kabezi karonké 826 230 27.8 0 0 (Migera) 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 Musongati 13 DS Rutana nyamabuye 288 169 58.7 0 0 0 (Buhinga) 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 BDS 17 Dunga (Rusovu) Rukoziri 195 100 51.3 0 0 0 Makamba 18 Rumonge Mugina (Ruvuga) Nyengwe 223 129 57.8 0 0 0 BDS 19 Buheka Rwaba 565 359 63.5 1 0,27 0,3 0,00756 Nyanzalac 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

19 Burundi: Additional villages selected for ongoing epi. evaluation

20 Eq. Guinea: results of parasitological surveys

N° VILLAGE Bassin Province District POPULATION mf Cens Exam Positive Crude Stand. CMFL us Prev (%) Prev (%) 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 / Centro Sur Nienfang 58 40 0 0 0 0 Woro 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

21 Eq. Guinea: results of parasitological surveys

N° VILLAGE Bassin Province District POPULATION mf Census Exam Positive Crude Stand. CMFL Prev (%) Prev (%) 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 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/Wel Kie Ntem Nsok Somo 215 85 1 1.18 1.8 0.05 e 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 Kie Ntem Ebibeyin 67 35 1 2.85 1.8 0.015 Ngamba/Mongu/Kie 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%

22 Eq. Guinea: standardized mf prevalence in 40 villages

23 Eq. Guinea: standardized mf prevalence in 40 villages

• Select 10 – 15 villages for additional survey

24 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.

25 Map of the estimated prevalence of eye worm history in Africa

26 CDTI area and villages surveyed using RAPLOA

In most of the countries: non-CDTI areas have been covered

The intensity of loa loa infection is not known

27 Surveys for loa loa infection needs: • Surveys completed, reading of slides • Surveys to be conducted in 2014 being completed: – Angola – Cameroon (Littoral and South regions) – CAR • completed in Littoral and South regions • Ongoing in Centre and East regions – Congo – Chad – DRC – Equatorial Guinea (Mainland) – Gabon (in collaboration with CNTD/Liverpool) – Nigeria

– Equatorial Guinea (borders with Cameroon and Gabon) – Cameroon (refinement)

28 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

29 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.

30 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

31 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.

32 Thank you

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