Gates Open Res. 2019 Sep 26;3:1545. doi: 10.12688/gatesopenres.13067.1. eCollection 2019.
The World Health Organization (WHO) has embarked on a consultation process to refine the 2030 goals for priority neglected tropical diseases (NTDs), onchocerciasis among them. Current goals include elimination of transmission (EOT) by 2020 in Latin America, Yemen and selected African countries. The new goals propose that, by 2030, EOT be verified in 10 countries; mass drug administration (MDA) with ivermectin be stopped in at least one focus in 34 countries; and that the proportion of the population no longer in need of MDA be equal or greater than 25%, 50%, 75% and 100% in at least 16, 14, 12, and 10 countries, respectively. The NTD Modelling Consortium onchocerciasis teams have used EPIONCHO and ONCHOSIM to provide modelling insights into these goals. EOT appears feasible in low-moderate endemic areas with long-term MDA at high coverage (≥75%), but uncertain in areas of higher endemicity, poor coverage and adherence, and where MDA has not yet, or only recently, started. Countries will have different proportions of their endemic areas classified according to these categories, and this distribution of pre-intervention prevalence and MDA duration and programmatic success will determine the feasibility of achieving the proposed MDA cessation goals. Highly endemic areas would benefit from switching to biannual or quarterly MDA and implementing vector control where possible (determining optimal frequency and duration of anti-vectorial interventions requires more research). Areas without loiasis that have not yet initiated MDA should implement biannual (preferably with moxidectin) or quarterly MDA from the start. Areas with loiasis not previously treated would benefit from implementing test-and(not)-treat-based interventions, vector control, and anti- therapies, but their success will depend on the levels of screening and coverage achieved and sustained. The diagnostic performance of IgG4 Ov16 serology for assessing EOT is currently uncertain. Verification of EOT requires novel diagnostics at the individual- and population-levels.
世界卫生组织（WHO）已启动一个协商进程，以完善2030年重点被忽视热带病（NTDs）的目标，其中包括盘尾丝虫病。当前目标包括到2020年在拉丁美洲、也门和部分非洲国家消除传播（EOT）。新目标提议，到2030年，在10个国家核实EOT；在34个国家至少一个流行区停止使用伊维菌素进行大规模药物治疗（MDA）；并且在至少16、14、12和10个国家，不再需要MDA的人口比例分别等于或大于25%、50%、75%和100%。NTD建模联盟盘尾丝虫病团队已使用EPIONCHO和ONCHOSIM对这些目标提供建模见解。在中低度流行地区，通过长期高覆盖率（≥75%）的MDA，EOT似乎可行，但在高流行地区、覆盖率和依从性差以及尚未开始或最近才开始MDA的地区，EOT尚不确定。各国按这些类别划分的流行区比例会有所不同，干预前患病率、MDA持续时间和项目成功情况的这种分布将决定实现提议的MDA停止目标的可行性。高流行地区将受益于改为每半年或每季度进行一次MDA，并在可能的情况下实施病媒控制（确定抗病媒干预的最佳频率和持续时间需要更多研究）。尚未开始MDA的无罗阿丝虫病地区应从一开始就每半年（最好使用莫西菌素）或每季度进行一次MDA。以前未接受治疗的有罗阿丝虫病地区将受益于实施基于检测和（不）治疗的干预措施、病媒控制和抗 治疗，但它们的成功将取决于所实现和维持的筛查水平和覆盖率。目前，IgG4 Ov16血清学评估EOT的诊断性能尚不确定。EOT的核实需要个体和人群层面的新型诊断方法。
