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One Hundred Years After Its Discovery in Guatemala by Rodolfo Robles, Onchocerca volvulus Transmission Has Been Eliminated from the Central Endemic Zone

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  • 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
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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.

Author Notes

* Address correspondence to Frank Richards Jr., River Blindness Elimination Program, The Carter Center, One Copenhill, 453 Freedom Parkway, Atlanta, GA 30307. E-mail: frank.richards@emory.edu

Financial support: The Guatemalan program received financial support from the Guatemalan Government and the Pan American Health Organization, and from 1993 to 2014 through OEPA/The Carter Center that included grants from the Lions Clubs International Foundation, the Bill and Melinda Gates Foundation, Merck and the Mectizan Donation Program, the U.S. Centers for Disease Control and Prevention (CDC), the United States Agency for International Development (USAID), The Carlos Slim Foundation, The Inter-American Development Bank, The River Blindness Foundation, the OPEC Fund for International Development (OFID), The Alwaleed Bin Talal Foundation, The Starr Foundation, Falconer Charitable Remainder Trust, The Carter Center, The Cartre UK Foundation, The Baxter International Foundation, Alcon Laboratories, John C. and Karyl Kay Hughes Foundation, The Osprey Foundation of Maryland, The UPS Foundation and many private individuals. Prior to OEPA, in the late 1980s and 1990s, key support to Guatemala for ivermectin distribution, in addition to that of the Government of Guatemala, was provided by the River Blindness Foundation, the Pan American Health Organization, the International Eye Foundation, the Japan International Cooperation Agency (JICA), and the Public Welfare Foundation. Ivermectin (Mectizan®) was provided by Merck.

Authors' addresses: Frank Richards Jr., River Blindness Program, The Carter Center, Atlanta, GA, E-mail: frank.richards@emory.edu. Nidia Rizzo, Renata Mendizabal de Cabrera, and Oscar de Leon, Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala, Guatemala, E-mails: nrizzo@ces.uvg.edu.gt, rmendizabal@ces.uvg.edu.gt, and odeleon@ces.uvg.edu.gt. Carlos Enrique Diaz Espinoza, Ministerio de Salud Pública y Asistencia Social, Guatemala, Guatemala, E-mail: carlosenriquediazespinoza@gmail.com. Zoraida Morales Monroy, Programa Nacional de Enfermedades Transmitidas por Vectores, Ministerio de Salud Pública y Asistencia Social de Guatemala, Ciudad de Guatemala, Guatemala, E-mail: zoraidamoralesmonroy@gmail.com. Carol Guillermina Crovella Valdez, Ministerio de Salud Pública y Asistencia Social de Guatemala, Ciudad de Guatemala, Guatemala, E-mail: ccrovellav@gmail.com. Guillermo Zea-Flores, Guatemala, E-mail: gzeaflores@hotmail.com. Mauricio Sauerbrey, Alba Lucia Morales, Dalila Rios, and Alfredo Domínguez, Onchocerciasis Elimination Program for the Americas, Edificio Murano Center, Guatemala City, Guatemala, E-mails: msauercar@gmail.com, almorales@oepa.net, drios@oepa.net, and adominguez59@hotmail.com. Thomas R. Unnasch and Hassan K. Hassan, Global Health Infectious Disease Program, Department of Global Health, University of South Florida, Tampa, FL, E-mails: tunnasch@health.usf.edu and hhassan@health.usf.edu. Robert Klein, Medical Entomology Research and Training Unit/Guatemala Miami, FL, E-mail: roeklein64@gmail.com. Mark Eberhard, Centers for Disease Control and Prevention, Atlanta, GA, E-mail: mle1@cdc.gov. Ed Cupp, Auburn University, Department of Entomology, Owensboro, KY, E-mail: cuppedd@auburn.edu.

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