The risk and dynamics of onchocerciasis recrudescence after cessation of vector control

Using a computer simulation study, we have investigated the risk and dynamics of onchocerciasis recrudescence after stopping vector control, in order to provide guidelines for operational decision-making in the Onchocerciasis Control Programme in West Africa (OCP). For this purpose, we used the microsimulation model ONCHOSIM to predict for periods of 9-15 years of vector control the ensuing risk and dynamics of recrudescence in an onchocerciasis focus. The model was quantified and validated using OCP evaluation and field research data. A range of plausible values was determined for important confounding parameters, i.e., vector biting rate, variation in exposure between individuals, parasite life span, and the relation between skin microfilarial load and vector infection. Different model quantifications were used in order to take account of the possible confounding effect of these parameters on the prediction of recrudescence. In the absence of immigration of infected humans or invasion by infected flies, the model predicts that 14 years of full-scale vector control are required to reduce the risk of recrudescence to less than 1%. The risk depends, in particular, on the vector biting rate, and this has implications for the planning of post-larviciding surveillance. Recrudescence will be a relatively slow process, and its rate will depend on the duration of vector control. Even if vector control were stopped too early, i.e., after 12-13 years in a highly endemic area, it would take more than 20 years before the intensity of infection in the community would reach levels of public health importance.