One Hundred Years After Its Discovery in Guatemala by Rodolfo Robles, Onchocerca volvulus Transmission Has Been Eliminated from the Central Endemic Zone.
We report the elimination of Onchocerca volvulus transmission from the Central Endemic Zone (CEZ) of onchocerciasis in Guatemala, the largest focus of this disease in the Americas and the first to be discovered in this hemisphere by Rodolfo Robles Valverde in 1915. Mass drug administration (MDA) with ivermectin was launched in 1988, with semiannual MDA coverage reaching at least 85% of the eligible population in > 95% of treatment rounds during the 12-year period, 2000-2011. Serial parasitological testing to monitor MDA impact in sentinel villages showed a decrease in microfilaria skin prevalence from 70% to 0%, and polymerase chain reaction (PCR)-based entomological assessments of the principal vector Simulium ochraceum s.l. showed transmission interruption by 2007. These assessments, together with a 2010 serological survey in children 9-69 months of age that showed Ov16 IgG4 antibody prevalence to be < 0.1%, meeting World Health Organization (WHO) guidelines for stopping MDA, and treatment was halted after 2011. After 3 years an entomological assessment showed no evidence of vector infection or recrudescence of transmission. In 2015, 100 years after the discovery of its presence, the Ministry of Health of Guatemala declared onchocerciasis transmission as having been eliminated from the CEZ.
River Blindness Elimination Program, The Carter Center, Atlanta, Georgia; Centro de Estudios en Salud of the Universidad del Valle de Guatemala (UVG), Guatemala City, Guatemala; Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala; Onchocerciasis Elimination Program for the Americas (OEPA), The Carter Center, Guatemala City, Guatemala; Global Health Infectious Disease Program, Department of Global Health, University of South Florida, Tampa, Florida; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Entomology and Plant Pathology, Auburn University, Auburn, Alabama frank.richards@emory.edu.
Frank
F
Richards
River Blindness Elimination Program, The Carter Center, Atlanta, Georgia; Centro de Estudios en Salud of the Universidad del Valle de Guatemala (UVG), Guatemala City, Guatemala; Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala; Onchocerciasis Elimination Program for the Americas (OEPA), The Carter Center, Guatemala City, Guatemala; Global Health Infectious Disease Program, Department of Global Health, University of South Florida, Tampa, Florida; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Entomology and Plant Pathology, Auburn University, Auburn, Alabama.
Nidia
N
Rizzo
River Blindness Elimination Program, The Carter Center, Atlanta, Georgia; Centro de Estudios en Salud of the Universidad del Valle de Guatemala (UVG), Guatemala City, Guatemala; Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala; Onchocerciasis Elimination Program for the Americas (OEPA), The Carter Center, Guatemala City, Guatemala; Global Health Infectious Disease Program, Department of Global Health, University of South Florida, Tampa, Florida; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Entomology and Plant Pathology, Auburn University, Auburn, Alabama.
Carlos Enrique
CE
Diaz Espinoza
River Blindness Elimination Program, The Carter Center, Atlanta, Georgia; Centro de Estudios en Salud of the Universidad del Valle de Guatemala (UVG), Guatemala City, Guatemala; Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala; Onchocerciasis Elimination Program for the Americas (OEPA), The Carter Center, Guatemala City, Guatemala; Global Health Infectious Disease Program, Department of Global Health, University of South Florida, Tampa, Florida; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Entomology and Plant Pathology, Auburn University, Auburn, Alabama.
Zoraida Morales
ZM
Monroy
River Blindness Elimination Program, The Carter Center, Atlanta, Georgia; Centro de Estudios en Salud of the Universidad del Valle de Guatemala (UVG), Guatemala City, Guatemala; Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala; Onchocerciasis Elimination Program for the Americas (OEPA), The Carter Center, Guatemala City, Guatemala; Global Health Infectious Disease Program, Department of Global Health, University of South Florida, Tampa, Florida; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Entomology and Plant Pathology, Auburn University, Auburn, Alabama.
Carol Guillermina
CG
Crovella Valdez
River Blindness Elimination Program, The Carter Center, Atlanta, Georgia; Centro de Estudios en Salud of the Universidad del Valle de Guatemala (UVG), Guatemala City, Guatemala; Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala; Onchocerciasis Elimination Program for the Americas (OEPA), The Carter Center, Guatemala City, Guatemala; Global Health Infectious Disease Program, Department of Global Health, University of South Florida, Tampa, Florida; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Entomology and Plant Pathology, Auburn University, Auburn, Alabama.
Renata Mendizabal
RM
de Cabrera
River Blindness Elimination Program, The Carter Center, Atlanta, Georgia; Centro de Estudios en Salud of the Universidad del Valle de Guatemala (UVG), Guatemala City, Guatemala; Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala; Onchocerciasis Elimination Program for the Americas (OEPA), The Carter Center, Guatemala City, Guatemala; Global Health Infectious Disease Program, Department of Global Health, University of South Florida, Tampa, Florida; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Entomology and Plant Pathology, Auburn University, Auburn, Alabama.
Oscar
O
de Leon
River Blindness Elimination Program, The Carter Center, Atlanta, Georgia; Centro de Estudios en Salud of the Universidad del Valle de Guatemala (UVG), Guatemala City, Guatemala; Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala; Onchocerciasis Elimination Program for the Americas (OEPA), The Carter Center, Guatemala City, Guatemala; Global Health Infectious Disease Program, Department of Global Health, University of South Florida, Tampa, Florida; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Entomology and Plant Pathology, Auburn University, Auburn, Alabama.
Guillermo
G
Zea-Flores
River Blindness Elimination Program, The Carter Center, Atlanta, Georgia; Centro de Estudios en Salud of the Universidad del Valle de Guatemala (UVG), Guatemala City, Guatemala; Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala; Onchocerciasis Elimination Program for the Americas (OEPA), The Carter Center, Guatemala City, Guatemala; Global Health Infectious Disease Program, Department of Global Health, University of South Florida, Tampa, Florida; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Entomology and Plant Pathology, Auburn University, Auburn, Alabama.
Mauricio
M
Sauerbrey
River Blindness Elimination Program, The Carter Center, Atlanta, Georgia; Centro de Estudios en Salud of the Universidad del Valle de Guatemala (UVG), Guatemala City, Guatemala; Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala; Onchocerciasis Elimination Program for the Americas (OEPA), The Carter Center, Guatemala City, Guatemala; Global Health Infectious Disease Program, Department of Global Health, University of South Florida, Tampa, Florida; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Entomology and Plant Pathology, Auburn University, Auburn, Alabama.
Alba Lucia
AL
Morales
River Blindness Elimination Program, The Carter Center, Atlanta, Georgia; Centro de Estudios en Salud of the Universidad del Valle de Guatemala (UVG), Guatemala City, Guatemala; Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala; Onchocerciasis Elimination Program for the Americas (OEPA), The Carter Center, Guatemala City, Guatemala; Global Health Infectious Disease Program, Department of Global Health, University of South Florida, Tampa, Florida; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Entomology and Plant Pathology, Auburn University, Auburn, Alabama.
Dalila
D
Rios
River Blindness Elimination Program, The Carter Center, Atlanta, Georgia; Centro de Estudios en Salud of the Universidad del Valle de Guatemala (UVG), Guatemala City, Guatemala; Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala; Onchocerciasis Elimination Program for the Americas (OEPA), The Carter Center, Guatemala City, Guatemala; Global Health Infectious Disease Program, Department of Global Health, University of South Florida, Tampa, Florida; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Entomology and Plant Pathology, Auburn University, Auburn, Alabama.
Thomas R
TR
Unnasch
River Blindness Elimination Program, The Carter Center, Atlanta, Georgia; Centro de Estudios en Salud of the Universidad del Valle de Guatemala (UVG), Guatemala City, Guatemala; Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala; Onchocerciasis Elimination Program for the Americas (OEPA), The Carter Center, Guatemala City, Guatemala; Global Health Infectious Disease Program, Department of Global Health, University of South Florida, Tampa, Florida; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Entomology and Plant Pathology, Auburn University, Auburn, Alabama.
Hassan K
HK
Hassan
River Blindness Elimination Program, The Carter Center, Atlanta, Georgia; Centro de Estudios en Salud of the Universidad del Valle de Guatemala (UVG), Guatemala City, Guatemala; Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala; Onchocerciasis Elimination Program for the Americas (OEPA), The Carter Center, Guatemala City, Guatemala; Global Health Infectious Disease Program, Department of Global Health, University of South Florida, Tampa, Florida; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Entomology and Plant Pathology, Auburn University, Auburn, Alabama.
Robert
R
Klein
River Blindness Elimination Program, The Carter Center, Atlanta, Georgia; Centro de Estudios en Salud of the Universidad del Valle de Guatemala (UVG), Guatemala City, Guatemala; Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala; Onchocerciasis Elimination Program for the Americas (OEPA), The Carter Center, Guatemala City, Guatemala; Global Health Infectious Disease Program, Department of Global Health, University of South Florida, Tampa, Florida; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Entomology and Plant Pathology, Auburn University, Auburn, Alabama.
Mark
M
Eberhard
River Blindness Elimination Program, The Carter Center, Atlanta, Georgia; Centro de Estudios en Salud of the Universidad del Valle de Guatemala (UVG), Guatemala City, Guatemala; Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala; Onchocerciasis Elimination Program for the Americas (OEPA), The Carter Center, Guatemala City, Guatemala; Global Health Infectious Disease Program, Department of Global Health, University of South Florida, Tampa, Florida; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Entomology and Plant Pathology, Auburn University, Auburn, Alabama.
Ed
E
Cupp
River Blindness Elimination Program, The Carter Center, Atlanta, Georgia; Centro de Estudios en Salud of the Universidad del Valle de Guatemala (UVG), Guatemala City, Guatemala; Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala; Onchocerciasis Elimination Program for the Americas (OEPA), The Carter Center, Guatemala City, Guatemala; Global Health Infectious Disease Program, Department of Global Health, University of South Florida, Tampa, Florida; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Entomology and Plant Pathology, Auburn University, Auburn, Alabama.
Alfredo
A
Domínguez
D000818:Animals; D002675:Child, Preschool; D060740:Disease Eradication; D005123:Eye / Q000469:parasitology; D005260:Female; D005369:Filaricides / Q000627:therapeutic use; D006166:Guatemala / Q000453:epidemiology; D006801:Humans; D007300:Insect Control; D007303:Insect Vectors / Q000469:parasitology; D007559:Ivermectin / Q000627:therapeutic use; D008297:Male; D017181:Onchocerca volvulus; D009855:Onchocerciasis / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D012843:Simuliidae / Q000469:parasitology; D012867:Skin / Q000469:parasitology
D005369:Filaricides; D007559:Ivermectin