Identifying sub-optimal responses to ivermectin in the treatment of River Blindness.

Identification of drug resistance before it becomes a public health concern requires a clear distinction between what constitutes a normal and a suboptimal treatment response. A novel method of analyzing drug efficacy studies in human helminthiases is proposed and used to investigate recent claims of atypical responses to ivermectin in the treatment of River Blindness. The variability in the rate at which Onchocerca volvulus microfilariae repopulate host's skin following ivermectin treatment is quantified using an individual-based onchocerciasis mathematical model.

Rates of microfilarial production by Onchocerca volvulus are not cumulatively reduced by multiple ivermectin treatments.

Regular distribution of ivermectin reduces onchocerciasis transmission and morbidity by killing, within humans, the microfilarial stage of the parasite (microfilaricidal effect). In addition, ivermectin exerts a so-called embryostatic effect by which microfilarial production by the adult female worm becomes suppressed during a number of weeks after treatment. To assess the overall effect of ivermectin on onchocerciasis transmission and evaluate the likelihood of local elimination of the infection it is important to estimate the magnitude of the anti-fertility effect over the course of a treatment programme.

Vector competence for Onchocerca volvulus in the Simulium (Notolepria) exiguum complex: cytoforms or density-dependence?

Although Simulium exiguum Roubaud s.l. is present in all South American onchocerciasis foci, it is a significant vector only in Colombia and Ecuador.

Human infection patterns and heterogeneous exposure in river blindness.

Here we analyze patterns of human infection with Onchocerca volvulus (the cause of river blindness) in different continents and ecologies. In contrast with some geohelminths and schistosome parasites whose worm burdens typically exhibit a humped pattern with host age, patterns of O. volvulus infection vary markedly with locality.

Transmission intensity and the patterns of Onchocerca volvulus infection in human communities.

We focus on possible constraints upon Onchocerca volvulus establishment in humans in relation to exposure rates to infective larvae (L3) as measured by the annual transmission potential (ATP). We use mathematical and statistical modeling of pre-control west African (savanna), Mexican, and Guatemalan data to explore two hypotheses relating human infection to transmission intensity: microfilarial (mf) loads either saturate with increasing ATP or become (asymptotically) proportional to the ATP. The estimated proportion of L3 developing into adult worms ranged from 7% to 0.