title: Successful control of onchocerciasis with community-based ivermectin distribution in the Rio Santiago focus in Ecuador.
abstract: Onchocerciasis is a major blinding disease in equatorial Africa and Central and South America. Ivermectin is a safe and effective drug in the treatment of this disease and now forms the basis of disease control in most endemic areas. We report the findings of long-term control of this infection in the Río Santiago focus in Ecuador, between January 1990 and December 1996, using a strategy of giving ivermectin treatments biannually in hyperendemic communities and annually in meso- and hypoendemic communities. Ivermectin was administered by local health workers from each community. A high level of compliance to ivermectin was achieved, with 81.9% to 98.0% of those eligible receiving the drug at each treatment instance. The impact of ivermectin therapy was monitored using a cohort of 120 randomly selected infected individuals from 8 hyperendemic communities. The geometric mean microfilarial density of this group declined from 19.3 to 0 mf/mg over the 84-month observation period. Ivermectin had a significant impact on anterior segment ocular disease, acute onchodermatitis and sowda. The rate of infection of blackflies declined from 1.1% in 1989-0.08% in 1996, which is below the vectorial capacity of the Simulium vector and, as no new nodules were detected after 1994 and no children under 5 became infected over the observation period, it is likely that the transmission of this infection was interrupted in the study area.
authors.affiliation: National Onchocerciasis Control Programme, Ministerio de Salud Publica, Quito, Ecuador.
authors.forename: R H
authors.initials: RH
authors.lastname: Guderian
authors.forename: M
authors.initials: M
authors.lastname: Anselmi
authors.forename: M
authors.initials: M
authors.lastname: Espinel
authors.forename: T
authors.initials: T
authors.lastname: Mancero
authors.forename: G
authors.initials: G
authors.lastname: Rivadeneira
authors.forename: R
authors.initials: R
authors.lastname: Proaño
authors.forename: H M
authors.initials: HM
authors.lastname: Calvopiña
authors.forename: J C
authors.initials: JC
authors.lastname: Vieira
authors.forename: P J
authors.initials: PJ
authors.lastname: Cooper
mesh_terms: D000818:Animals; D002675:Child, Preschool; D015331:Cohort Studies; D003153:Community Health Services; D004484:Ecuador / Q000453:epidemiology; D005369:Filaricides / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007559:Ivermectin / Q000627:therapeutic use*; D009855:Onchocerciasis / Q000188:drug therapy* / Q000453:epidemiology; D015995:Prevalence; D011897:Random Allocation; D012843:Simuliidae
chemical_list: D005369:Filaricides; D007559:Ivermectin