Human onchocerciasis: the essential partnership between research and disease control efforts

Twenty years ago onchocerciasis was a disease generally ignored by the medical world, except by those who actually worked with the affected people in Africa and Latin America. Now, largely as a result of the success of mass vector control and drug treatment programs, this is a disease management model for developing countries. The recent literature on onchocerciasis has, not surprisingly, mainly focused on various aspects of control. Investigation into the more basic questions is needed to ensure continued effective disease control. The present mass drug control program is based on a single pharmaceutical, ivermectin (Mectizan), which acts almost exclusively on the microfilarial stage of the infection. Efforts are being made to identify other useful drugs; however, no major candidates have yet appeared. The identification of potential biochemical targets for anti-filarial compounds through a better understanding of the biochemistry of these worms is being pursued. The Onchocerca volvulus endosymbiont Wolbachia may provide a target for therapeutic intervention. An improved understanding of the genomics of O. volvulus has made possible the identification of strain differences in the parasites, and an appreciation of the relevance of these strain differences to the clinical disease, onchocerciasis. There is a need for a better understanding of the clinical disease, and the various pathogenic mechanisms that underly the different syndromes. It is particularly important to understand the pathological basis and mechanisms underlying the adverse responses that can occur with chemotherapy. Present control programs now need to be carefully monitored for effectiveness using new assessment tools, such as antigen assays and the identification of organisms in pools of vectors. Current efforts to control onchocerciasis must be coordinated with new chemotherapy-based control programs for other worm diseases that are emerging. The results of laboratory studies are increasingly being applied to improve the effectiveness of field-based control programs and their assessment. Such research is essential for progress towards the goals of controlling and eliminating onchocerciasis.