Onchocerciasis, also known as river blindness, infects 26 million people who are living near the fast moving rivers and streams in Africa. Ninety-nine percent of all river blindness cases are found in Africa. In the 1970’s, the disease was so widespread in some African river communities that up to half of all adults were blinded, and many fled the fertile river valleys. The socio-economic impact of this migration was so severe that it prompted the creation of the Onchocerciasis Control Programmed (OCP) (Global, 2015).

 

In 1974, the Onchocerciasis Control Programme (OCP) was formally launched. It was aimed to stop onchocerciasis from being a public health problem (Akande, 2003). During its peak, it covered 30 million people in 11 countries. Through air-borne spraying of insecticides, it reduced the black fly population drastically along with the use of a drug called invermectin (aka Mectizan) to treat the infected population. The OCP eliminated onchocerciasis as a public health problem. The OCP, a joint effort of the World Health Organization (WHO), the World Bank, the United Nations Development Programme, and the UN Food and Agriculture Organization, was considered to be a success, and came to an end in 2002. Although, there is continued monitoring that is being done which ensures onchocerciasis cannot reinvade the area of the OCP (Akande, 2003).    

 

There have been various treatment approaches to control the disease in individual patients and at the community level in the Americas (Gustavsen et al., 2011). Surgical removal of the subcutaneous nodules that contain the adult parasites was conducted mainly in the past. However, not all nodules are easily visible and palpable since some of them are deeper in the tissue, making removal difficult and frequently missed, and also removal, when possible, is painful to the patient. As a result, surgical control of onchocerciasis is difficult to conduct on a large-scale, community level. The first pharmaceutical treatments used were diethylcarbamazine (DEC) and suramin. However, treatment with these two drugs can create serious side effects, including blindness in patients with advanced onchocercal eye disease and renal failure in the case of suramin, making them unattractive treatment options, especially for wide-scale use at a community level (Gustavsen et al., 2011).

 

The current treatment for onchocerciasis was founded in 1988. A United States based multinational pharmaceutical firm known as Merck, offered to donate the medication called Mectizan (Akande, 2003). Mectizan (aka invermectin) paralyses and kills the microfilariae that causes the itching, fever, arthritis, lymphadenopathy, and oedema. Intense skin itching is eventually relieved, and the progression towards blindness is halted. The drug actually does not kill the adult worms, but it does prevent them for a limited time from producing additional offspring (Wikipedia, 2016). The drug prevents morbidity and transmission for up to several months. Mectizan is an effective medication because it only needs to be taken once or twice a year, no refrigeration needed, and has a wide margin of safety, with the result that it has been widely given by minimally trained community health workers (Wikipedia, 2016).

 

In 1992, the Onchocerciasis Elimination Programme for the Americas, which also relies on invermectin, was launched (Wikipedia, 2016).

 

In 1995, the African Programme for Onchocerciasis Control (APOC) was founded by a group of nongovernmental organizations, governments, and United Nations agencies, with the World Health Organization overseeing it. The APOC partnership, which also includes the Carter Center, has given out 500 million invermectin treatments between 1995 and 2010 (Landau, 2013). By doing this, it has reduced the rate of river blindness by 73% since its inception (Global, 2015). It’s been anticipated that between the years 2011-2015, the APOC will have a greater impact in Africa and the countries that are infected by this horrible disease (Landau, 2013).

 

It’s hard to determine the current infection rate in Africa, however the treatments have the parasite under control. There is no vaccine for this disease; the only way to prevent it is by avoiding being bitten by the black flies. Individuals in areas where onchocerciasis is prevalent are urged to use insect repellent and wear the proper clothing that will expose the least amount of skin.