Serosurveillance to Monitor Onchocerciasis Elimination: The Ugandan Experience

David Oguttu Vector Control Division, Ministry of Health, Kampala, Uganda; The Carter Center, Kampala, Uganda; Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama; Department of Global Health, University of South Florida, Tampa, Florida; The Carter Center, Atlanta, Georgia

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Edson Byamukama Vector Control Division, Ministry of Health, Kampala, Uganda; The Carter Center, Kampala, Uganda; Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama; Department of Global Health, University of South Florida, Tampa, Florida; The Carter Center, Atlanta, Georgia

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Charles R. Katholi Vector Control Division, Ministry of Health, Kampala, Uganda; The Carter Center, Kampala, Uganda; Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama; Department of Global Health, University of South Florida, Tampa, Florida; The Carter Center, Atlanta, Georgia

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Peace Habomugisha Vector Control Division, Ministry of Health, Kampala, Uganda; The Carter Center, Kampala, Uganda; Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama; Department of Global Health, University of South Florida, Tampa, Florida; The Carter Center, Atlanta, Georgia

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Christine Nahabwe Vector Control Division, Ministry of Health, Kampala, Uganda; The Carter Center, Kampala, Uganda; Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama; Department of Global Health, University of South Florida, Tampa, Florida; The Carter Center, Atlanta, Georgia

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Monica Ngabirano Vector Control Division, Ministry of Health, Kampala, Uganda; The Carter Center, Kampala, Uganda; Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama; Department of Global Health, University of South Florida, Tampa, Florida; The Carter Center, Atlanta, Georgia

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Hassan K. Hassan Vector Control Division, Ministry of Health, Kampala, Uganda; The Carter Center, Kampala, Uganda; Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama; Department of Global Health, University of South Florida, Tampa, Florida; The Carter Center, Atlanta, Georgia

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Thomson Lakwo Vector Control Division, Ministry of Health, Kampala, Uganda; The Carter Center, Kampala, Uganda; Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama; Department of Global Health, University of South Florida, Tampa, Florida; The Carter Center, Atlanta, Georgia

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Moses Katabarwa Vector Control Division, Ministry of Health, Kampala, Uganda; The Carter Center, Kampala, Uganda; Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama; Department of Global Health, University of South Florida, Tampa, Florida; The Carter Center, Atlanta, Georgia

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Frank O. Richards Vector Control Division, Ministry of Health, Kampala, Uganda; The Carter Center, Kampala, Uganda; Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama; Department of Global Health, University of South Florida, Tampa, Florida; The Carter Center, Atlanta, Georgia

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Thomas R. Unnasch Vector Control Division, Ministry of Health, Kampala, Uganda; The Carter Center, Kampala, Uganda; Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama; Department of Global Health, University of South Florida, Tampa, Florida; The Carter Center, Atlanta, Georgia

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Uganda is the only African country whose onchocerciasis elimination program uses a two-pronged approach of vector control and mass drug distribution. The Ugandan program relies heavily upon the use of serosurveys of children to monitor progress toward elimination. The program has tested over 39,000 individuals from 11 foci for Onchocerca volvulus exposure, using the Ov16 ELISA test. The data show that the Ov16 ELISA is a useful operational tool to monitor onchocerciasis transmission interruption in Africa at the World Health Organization (WHO) recommended threshold of < 0.1% in children. The Ugandan experience has also resulted in a re-examination of the statistical methods used to estimate the boundary of the upper 95% confidence interval for the WHO prevalence threshold when all samples tested are negative. This has resulted in the development of Bayesian and hypergeometric statistical methods that reduce the number of individuals who must be tested to meet the WHO criterion.

Author Notes

* Address correspondence to Thomas R. Unnasch, Global Health Infectious Disease Research, Department of Global Health, University of South Florida, 3720 Spectrum Blvd., Suite 304, Tampa, FL 33612. E-mail: tunnasch@health.usf.edu

Financial support: John Moores provided critical financial support for establishing the Uganda onchocerciasis molecular laboratory and launching the 2007 elimination field activities.

Authors' addresses: David Oguttu, Vector Control Division, Ministry of Health, Kampala, Uganda, E-mail: dguttu@gmail.com. Edson Byamukama and Peace Habomugisha, The Carter Center Uganda, Kampala, Uganda, E-mails: edson.navs@gmail.com and provia5@hotmail.com. Charles R. Katholi, Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, E-mail: ckatholi@uab.edu. Christine Nahabwe, Monica Ngabirano, and Thomson Lakwo, Vector Control Division, Ministry of Health, Kampala, Uganda, E-mails: ch.nahabwe@gmail.com, ngabiranomonica@ymail.com, and tlakwo@gmail.com. Hassan K. Hassan and Thomas R. Unnasch, Global Health Infectious Disease Research, Department of Global Health, University of South Florida, Tampa, FL, E-mails: hhassan@health.usf.edu and tunnasch@health.usf.edu. Moses Katabarwa and Frank O. Richards, Emory University and The Carter Center, Atlanta, GA, E-mails: mkataba@emory.edu and frich01@emory.edu.

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