Further Outpatient Care

Patients who are infected with larvae should receive close follow-up care with their primary care doctors, as well as their ophthalmologists and infectious disease physicians.

Once the acute stage has result, the follow-up depends on the severity of visual loss.

Further Inpatient Care

Inpatient care is generally unnecessary for onchocerciasis.

Inpatient & Outpatient Medications

See Medication section.

Transfer

If adequate healthcare is unavailable, patients with onchocerciasis should ideally be transferred to areas with qualified physicians who are able to promptly treat this disease. Unfortunately, many of the patients affected by onchocerciasis live in remote areas with little or no possibility of fast diagnosis and transfer.

Deterrence/Prevention

Associations such as the African Programme for Onchocerciasis Control (APOC), OCP, River Blindness Elimination Program from the Carter Center, and organizations such as Sightsavers are working on global prevention of onchocerciasis. They administer community-wide ivermectin and focus on vector control. These measures have been very successful. Approximately 35 million people are no longer at risk for infection, 2 million infected people have been appropriately treated, and blindness has been prevented in over 200,000 people. They also target individual prevention, which includes counseling people to avoid endemic areas, using insect repellent, and wearing protective clothing.

African Programme for Onchocerciasis Control (APOC)

Launched in 1995, this programme focuses on mass distribution of ivermectin through the Ivermectin Distribution Programme. It includes 19 participating countries and empowers communities to fight onchocerciasis in their own villages and aims to treat over 90 million annually, protect 115 million people at risk, and prevent over 40,000 cases of blindness every year.^[15]

Onchocerciasis Control Programme

This was launched by the WHO in 1974 in collaboration with the United Nations Development Programme, the World Bank, and the Food and Agriculture Organization to protect 30 million people from onchocerciasis in 11 countries.

Its focus was initially on spraying insecticides via helicopters and aircrafts over the endemic blackflies areas.

In 1987, Merck & Co., Inc. donated Mectizan (ivermectin) and the focus changed to treatment of the disease alone.

The OCP finished in 2002 after virtually eradicating the transmission of disease in all participating countries except Sierra Leone, where the program was interrupted by a civil war. They prevented 600,000 cases of blindness, 18 million children born in now disease-free areas were spared of the disease, and 25 million hectares of land are now safe for cultivation and settlement.^[15]

River Blindness Elimination Program of the Carter Center

This aims to eliminate river blindness from 11 countries in Latin America. They focus on health education and distribution of Mectizan, donated by Merck. This program works through the Onchocerciasis Elimination Program for the Americas (OEPA) to eliminate the disease in pockets of Brazil, Colombia, Ecuador, Guatemala, Mexico, and Venezuela.^[16]To date, they have distributed more than 170 million treatments of Mectizan in Africa and Latin America, interrupted transmission in 11 foci of the 13 endemic areas in Latin America, stopped transmission from 8 of 18 endemic areas in Uganda, and eradicated river blindness in Abu Hamad, Sudan. In 2013, Colombia became the first American country to eliminate onchocerciasis.^[17]

Vaccination

The prospect for the development of a vaccine against onchocerciasis is hindered by the fact that antigens of O volvulus are complex and show extensive cross-reactivity with other filaria parasites of humans and animals. Challenges to development of the vaccine include development of field-usable immunodiagnostic tests to enable quantification of worm burdens in infected patients and research using immunology and molecular biology to develop a vaccine against O volvulus.^[18]

Complications

Potential complications of onchocerciasis include the following:

Dermatitis, skin atrophy, depigmentation
Lymphadenitis and chronic lymphadenopathy
Blindness caused by keratitis, corneal pannus or fibrosis, chorioretinitis, glaucoma, or optic atrophy

Prognosis

The prognosis in individuals with onchocerciasis depends on the stage of infection. If it is identified and treated early, blindness can be effectively prevented.

Globally, multiple efforts are being made for the prevention and community-based treatment of onchocerciasis (see Prevention). After parts of Uganda and Sudan were officially announced as onchocerciasis-free, there has been a surge of hope that this can continue to the remaining endemic areas. At present, however, this devastating disease has significant socioeconomic and public health effects and is still an important world health problem.

Patient Education

Training local experts, who would assume responsibility for human and vector population surveillance, is important.

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Author

Debora E Garcia-Zalisnak, MD Resident Physician, Department of Ophthalmology, Eastern Virginia Medical School

Debora E Garcia-Zalisnak, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American College of Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

John D Sheppard, Jr, MD, MMSc Professor of Ophthalmology, Microbiology and Molecular Biology, Clinical Director, Thomas R Lee Center for Ocular Pharmacology, Ophthalmology Residency Research Program Director, Eastern Virginia Medical School; President, Virginia Eye Consultants

John D Sheppard, Jr, MD, MMSc is a member of the following medical societies: American Academy of Ophthalmology, American Society for Microbiology, American Society of Cataract and Refractive Surgery, American Uveitis Society, Association for Research in Vision and Ophthalmology

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: 1-800-DOCTORS; AbbVie; Alcon; Aldeyra; Allergan; Alphaeon; ArcScan; Baush+Lomb; Bio-Tissue; Clearside; EyeGate; Hovione; Mededicus; NovaBay; Omeros; Pentavision; Portage; Santen; Science Based Health; Senju; Shire; Sun Pharma; TearLab;TearScience;Topivert<br/>Serve(d) as a speaker or a member of a speakers bureau for: AbbVie; Alcon; Allergan; Bausch+Lomb; Bio-tissue; EyeGate;Hovione;LayerBio; NovaBay;Omeros;Portage; Santen; Shire; Stemnion; Sun Pharma;TearLab;TearScience; Topivert <br/>Received research grant from: Alcon; Aldeyra; allergan; Baush+ Lomb; EyeGate; Hovione; Kala; Ocular Therapeutix;Pfizer; RPS; Santen;Senju;Shire;Topcon; Xoma.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

R Christopher Walton, MD Adjunct Professor, Department of Ophthalmology, University of Texas Health Science Center at San Antonio

R Christopher Walton, MD is a member of the following medical societies: American Academy of Ophthalmology, American Uveitis Society

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD † Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Acknowledgements

Deborah R Eezzuduemhoi, MD Assistant Professor, Department of Ophthalmology and Visual Sciences, Texas Tech University, Health Sciences Center School of Medicine

Deborah R Eezzuduemhoi, MD is a member of the following medical societies: American Academy of Ophthalmology, American Academy of Pediatrics, and Women in Ophthalmology, Inc

Disclosure: Nothing to disclose.

Deborah Wilson, MD Director of Glaucoma Service, Assistant Professor, Department of Ophthalmology, Georgetown University Medical Center

Deborah Wilson, MD is a member of the following medical societies: American Academy of Ophthalmology and American College of Physicians

Disclosure: Nothing to disclose.