Modelling the elimination of river blindness using long-term epidemiological and programmatic data from Mali and Senegal

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1 Modelling the elimination of river blindness using long-term epidemiological and programmatic data from Mali and Senegal Martin Walker, Wilma A Stolk, Matthew A Dixon, Christian Bottomley, Lamine Diawara, Mamadou O Traoré, Sake J de Vlas, María-Gloria Basáñez London Centre for Neglected Tropical Disease Research Mathematical Modelling for NTDs Wednesday 26 th April 2017

2 Infection, transmission, disease & mortality Blindness Simulium damnosum Microfilariae Skin snips Relative risk of mortality Children & young adults Troublesome itching Adult worms Treatment Walker M, Little M, et al. PLoS Negl Trop Dis :e578

3 The 2012 World Health Organization Roadmap & London Declaration

4 The NTD Modelling Consortium Are we on track to reach the WHO 2020 goals with current strategies? (8 NTDs: onchocerciasis; leishmaniasis; leprosy; lymphatic filariasis; human Africa trypanosomiasis; schistosomiasis; soil-transmitted helminthiases; trachoma)

5 Onchocerciasis transmission models ONCHOSIM Stochastic worm-based small community model Age, sex and individual (host) variation in exposure Elimination explored by parasite extinction (including breakpoint effects plus stochastic fade-out ) & operational prevalence thresholds EPIONCHO Deterministic mean-based large population model Age and sex variation in exposure Elimination explored by parasite extinction (by population breakpoint) & operational prevalence thresholds Comparison of prevalence & intensity dynamics plus times to elimination using annual or biannual mass treatment with ivermectin Stolk WA*, Walker M*, et al. Parasit Vectors 2015, 8: 552

6 Relationship between blackfly biting rate (transmission intensity) & microfilarial prevalence EPIONCHO ONCHOSIM Microfilarial prevalence Microfilarial prevalence Annual biting rate Annual biting rate Data from Renz A, Wenk P, Ann Trop Med Parasitol 1987; 81: Walker M*, Stolk WA*, et al. Epidemics 2017; 18: 4-15

7 Elimination in Mali & Senegal 17 years bcdti 15 years acdti R. Gambia focus, Senegal 16 years acdti R. Bakoye focus, Mali R. Falame focus, Mali/Senegal Diaware, L, Traore M, et al. PLoS Negl Trop Dis 2009; 3:e497

8 Pre-intervention (baseline) microfilarial prevalence in 27 communities River Bakoye, Mali River Gambia, Senegal Microfilarial prevalence Microfilarial prevalence Community Community Walker M*, Stolk WA*, et al. Epidemics 2017; 18: 4-15

9 Longitudinal validation & projection to 2020 River Bakoye, Mali (annual treatment) River Gambia, Senegal (biannual treatment) Microfilarial prevalence EPIONCHO Year Year ONCHOSIM Year Year Walker M*, Stolk WA*, et al. Epidemics 2017; 18: 4-15

10 EPIONCHO elimination or recrudescence? River Bakoye, Mali River Gambia, Senegal Coverage Coverage Communities with projection of sustained elimination by focus More training data More training data Probability of elimination driven by estimated preintervention endemicity (& vector biting rate) % communities with elimination projection River Bakoye, Mali Increasing endemicity River Gambia, Senegal Increasing endemicity Walker M*, Stolk WA*, et al. Epidemics 2017; 18: 4-15

11 Conclusions Feasibility of elimination by 2020 or 2025 depends on start year of intervention; intensity of transmission, the frequency & coverage of treatment with ivermectin Elimination may not feasible in highly endemic transmission settings (high vector biting rate) using ivermectin alone Where elimination unlikely alternative treatment strategies should be considered vector control test & treat with antiwolbachial macrofilaricides new potential MDA drugs like moxidectin Post-treatment surveillance must be very sensitive to detect low-level (latent) infections & undertaken for at least 3-5 years Model outputs should be aligned to new serological and entomological indicators that define latest elimination thresholds & PTS protocols

12 Acknowledgments Prof Maria-Gloria Basáñez Mr Matthew Dixon Dr Lamine Diawara Dr Wilma Stolk Dr Sake de Vlas Dr Mamadou Traoré Dr Christian Bottomley Dr Hans Remme

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