Control, Elimination, and Eradication of River Blindness: Scenarios, Timelines, and Ivermectin Treatment Needs in Africa

River blindness (onchocerciasis) causes severe itching, skin lesions, and vision impairment including blindness. More than 99% of all current cases are found in sub-Saharan Africa. Fortunately, vector control and community-directed treatment with ivermectin have significantly reduced morbidity. Studies in Mali and Senegal proved the feasibility of elimination with ivermectin administration. The treatment goal is shifting from control to elimination in endemic African regions. Given limited resources, national and global policymakers need a rigorous analysis comparing investment options. For this, we developed scenarios for alternative treatment goals and compared treatment timelines and drug needs between the scenarios. Control, elimination, and eradication scenarios were developed with reference to current standard practices, large-scale studies, and historical data. For each scenario, the timeline when treatment is expected to stop at country level was predicted using a dynamical transmission model, and ivermectin treatment needs were predicted based on population in endemic areas, treatment coverage data, and the frequency of community-directed treatment. The control scenario requires community-directed treatment with ivermectin beyond 2045 with around 2.63 billion treatments over 2013–2045; the elimination scenario, until 2028 in areas where feasible, but beyond 2045 in countries with operational challenges, around 1.15 billion treatments; and the eradication scenario, lasting until 2040, around 1.30 billion treatments. The eradication scenario is the most favorable in terms of the timeline of the intervention phase and treatment needs. For its realization, strong health systems and political will are required to overcome epidemiological and political challenges

Control, elimination, and eradication of river blindness: scenarios, timelines, and ivermectin treatment needs in Africa

River blindness (onchocerciasis) causes severe itching, skin lesions, and vision impairment including blindness. More than 99% of all current cases are found in sub-Saharan Africa. Fortunately, vector control and community-directed treatment with ivermectin have significantly reduced morbidity. Studies in Mali and Senegal proved the feasibility of elimination with ivermectin administration. The treatment goal is shifting from control to elimination in endemic African regions. Given limited resources, national and global policymakers need a rigorous analysis comparing investment options. For this, we developed scenarios for alternative treatment goals and compared treatment timelines and drug needs between the scenarios. Control, elimination, and eradication scenarios were developed with reference to current standard practices, large-scale studies, and historical data. For each scenario, the timeline when treatment is expected to stop at country level was predicted using a dynamical transmission model, and ivermectin treatment needs were predicted based on population in endemic areas, treatment coverage data, and the frequency of community-directed treatment. The control scenario requires community-directed treatment with ivermectin beyond 2045 with around 2.63 billion treatments over 2013-2045; the elimination scenario, until 2028 in areas where feasible, but beyond 2045 in countries with operational challenges, around 1.15 billion treatments; and the eradication scenario, lasting until 2040, around 1.30 billion treatments. The eradication scenario is the most favorable in terms of the timeline of the intervention phase and treatment needs. For its realization, strong health systems and political will are required to overcome epidemiological and political challenges

Τhe worship of Cybele in the northeastern Aegean: Lesbos, Chios, Lemnos

The study materials for the worship of Cybele in the northeastern Aegean region are twenty-five stone sculptures of the goddess, guarded in the Archaeological Museums of Lesbos, Chios and Limnos and dating from the Archaic to the Roman period, seven inscriptions and remains preserved in situ, such as the Sanctuary of Daskalopetra in Chios, the Sanctuary of the Great Goddess in Hephaestia in Lemnos and a vaulted archaic building in the town of Mytilene which was identified with Cybele Sanctuary.The Phd thesis is divided in two parts. The first part, which is the core of this work, is divided into seven chapters. The second part consists of two units: the descriptive catalogue with photographs of the sculptures and the inscriptions, and the images. In chapter I the history of past research is given shortly and sporadic references and illustrations are recorded by geographical regions. In chapter II the historical context of the three islands from the Prehistoric period to Late Antiquity is outlined. In chapter III the origin of the sculptures and the inscriptions is presented in two units with historical data topography. In chapter IV issues of typology and iconography are examined thoroughly in three main units: a. small temples, b. statuettes and c. reliefs. In first section the origin and the time for the creation of the Greek type chapel are examined shortly and its gradual spread to the Greek world. Then the characteristic features of the earlier archaic Asian Minor chapels are recorded, and the similarities and differences of the chapels from Chios and Lesbos are pointed out. The monument of Daskalopetra is also examined. In second section the statuettes are examined which all give female seated figure. Archaic statuettes depict the seated figure with hands on knees, and only one from Lesbos is attributed with lion on apron. From statuettes of the iconographic type of the classical era important is the Late Classical statue from Atsiki of Lemnos, in which characteristics from Agorakriteious devotional statue of Mitroo from Athenian Agora are recognized. In third section the reliefs of the goddess are examined in detail. Below are the chronology (Chapter V) and the attribution of the sculptures to laboratories according to stylistic comparisons, the problem of Chian laboratory is affected indirectly and an effort to approach the character of lesbian plastic is tried. In chapter VI Sanctuaries are considered together in a synthetic way, the dedicatory inscriptions and some clues that emerged from the study of sculptures. Chapter VII contains the conclusions. The main of them is that the last quarter of the 6th century B.C. the worship of Cybele, which was introduced in southeastern Aegean Sea from Minor Asia around 550 B.C., is set in Sanctuaries that were founded near the edge and the defensive walls of the ancient cities.Το υλικό για τη μελέτη της λατρείας της Κυβέλης στο βορειοανατολικό Αιγαίο αποτελούν εικοσιπέντε λίθινα γλυπτά της θεάς, φυλασσόμενα στα Αρχαιολογικά Μουσεία Λέσβου, Χίου και Λήμνου και χρονολογούμενα από τους Αρχαϊκούς έως τους Ρωμαϊκούς χρόνους, επτά επιγραφικές μαρτυρίες, καθώς και κατά χώραν σωζόμενα λείψανα, όπως το Ιερό στη Δασκαλόπετρα της Χίου, το Ιερό της Μεγάλης Θεάς στην Ηφαιστία της Λήμνου, και ένα αψιδωτό αρχαϊκό κτίριο στην πόλη της Μυτιλήνης, το οποίο ταυτίστηκε με Ιερό της Κυβέλης. Η διατριβή χωρίζεται σε δύο μέρη. Το Α΄ Μέρος, το οποίο αποτελεί τον πυρήνα αυτής της εργασίας, υποδιαιρείται σε επτά κεφάλαια. Το Β΄ Μέρος απαρτίζεται από δύο ενότητες: τον περιγραφικό κατάλογο των γλυπτών και των επιγραφών, και τις εικόνες. Στο κεφάλαιο Ι δίνεται σύντομα η ιστορία της παλαιότερης έρευνας και καταγράφονται κατά γεωγραφικές περιοχές οι σποραδικές βιβλιογραφικές αναφορές και απεικονίσεις. Στο κεφ. ΙΙ σκιαγραφείται το ιστορικό πλαίσιο των τριών νησιών από τους Προϊστορικούς χρόνους έως την Ύστερη Αρχαιότητα. Στο κεφ. ΙΙΙ παρουσιάζεται σε δύο ενότητες η προέλευση των γλυπτών και των επιγραφών με στοιχεία ιστορικής τοπογραφίας. Στο κεφ. ΙV εξετάζονται διεξοδικά θέματα τυπολογίας και εικονογραφίας των γλυπτών σε τρεις κύριες ενότητες: α. ναΐσκοι, β. αγαλμάτια και γ. ανάγλυφα. Στην α΄ ενότητα εξετάζεται σύντομα η προέλευση και τα χρόνια της δημιουργίας του ελληνικού τύπου ναΐσκου, καθώς και η σταδιακή διάδοσή του στον ελληνικό κόσμο. Κατόπιν, καταγράφονται τα χαρακτηριστικά γνωρίσματα των πρωΐμοτέρων μικρασιατικών ναΐσκων, και επισημαίνονται οι ομοιότητες και οι διαφορές με τους ναΐσκους από τη Χίο και τη Λέσβο. Εδώ συνεξετάζεται και το μνημείο στη Δασκαλόπετρα. Στην β΄ ενότητα εξετάζονται τα αγαλμάτια, τα οποία αποδίδουν όλα καθιστή γυναικεία μορφή. Τα αρχαϊκά αγαλμάτια εικονίζουν καθήμενη μορφή με τα χέρια στα γόνατα, και μόνον ένα από τη Λέσβο αποδίδεται με λιοντάρι στην ποδιά. Από τα αγαλμάτια του εικονογραφικού τύπου των κλασικών χρόνων, σημαντικό είναι το υστεροκλασικό γλυπτό από την Ατσική της Λήμνου, στο οποίο αναγνωρίζονται στοιχεία του Αγορακρίτειου λατρευτικού αγάλματος του Μητρώου στην αθηναϊκή Αγορά. Στην γ΄ ενότητα εξετάζονται διεξοδικά τα ανάγλυφα της θεάς. Ακολουθεί η χρονολόγηση (κεφ. V) και η απόδοση των γλυπτών σε εργαστήρια σύμφωνα με τεχνοτροπικές συγκρίσεις, θίγεται έμμεσα το πρόβλημα του χιακού εργαστηρίου και καταβάλλεται προσπάθεια για την προσέγγιση της φυσιογνωμίας της λεσβιακής πλαστικής. Στο κεφ. VI συνεξετάζονται συνθετικά τα Ιερά, οι αναθηματικές επιγραφές και ορισμένα στοιχεία, τα οποία προέκυψαν από τη μελέτη των γλυπτών. Το VII κεφ. περιέχει τα συμπεράσματα. Το κυριότερο από αυτά είναι ότι στο τελευταίο τέταρτο του 6ου αι. π.Χ. η λατρεία της Κυβέλης, η οποία εισήχθη στο βορειοανατολικό Αιγαίο από τα μικρασιατικά παράλια γύρω στο 550 π.Χ., στεγάζεται σε Ιερά, ιδρυμένα κοντά στις παρυφές και τα οχυρωματικά τείχη των αρχαίων πόλεων

Impact of repeated annual community directed treatment with ivermectin on loiasis parasitological indicators in Cameroon: Implications for onchocerciasis and lymphatic filariasis elimination in areas co-endemic with Loa loa in Africa.

BACKGROUND Loiasis is a filarial infection endemic in the rainforest zone of west and central Africa particularly in Cameroon, Gabon, Republic of Congo, and Democratic Republic of the Congo. Repeated treatments with ivermectin have been delivered using the annual community directed treatment with ivermectin (CDTI) approach for several years to control onchocerciasis in some Loa loa-Onchocerca volvulus co-endemic areas. The impact of CDTI on loiasis parasitological indicators is not known. We, therefore, designed this cross sectional study to explore the effects of several rounds of CDTI on parasitological indicators of loiasis. METHODOLOGY/PRINCIPAL FINDINGS The study was conducted in the East, Northwest and Southwest 2 CDTI projects of Cameroon. Individuals who consented to participate were interviewed for ivermectin treatment history and enrolled for parasitological screening using thick smears. Ivermectin treatment history was correlated with loiasis prevalence/intensity. A total of 3,684 individuals were recruited from 36 communities of the 3 CDTI projects and 900 individuals from 9 villages in a non-CDTI district. In the East, loiasis prevalence was 29.3% (range = 24.2%-34.6%) in the non-CDTI district but 16.0% (3.3%-26.6%) in the CDTI district with 10 ivermectin rounds (there were no baseline data for the latter). In the Northwest and Southwest 2 districts, reductions from 30.5% to 17.9% (after 9 ivermectin rounds) but from 8.1% to 7.8% (not significantly different after 14 rounds) were registered post CDTI, respectively. Similar trends in infection intensity were observed in all sites. There was a negative relationship between adherence to ivermectin treatment and prevalence/intensity of infection in all sites. None of the children (aged 10-14 years) examined in the East CDTI project harboured high (8,000-30,000 mf/ml) or very high (>30,000 mf/ml) microfilarial loads. Individuals who had taken >5 ivermectin treatments were 2.1 times more likely to present with no microfilaraemia than those with less treatments. CONCLUSION In areas where onchocerciasis and loiasis are co-endemic, CDTI reduces the number of, and microfilaraemia in L. loa-infected individuals, and this, in turn, will help to prevent non-neurological and neurological complications post-ivermectin treatment among CDTI adherents

Correction to: Control, Elimination, and Eradication of River Blindness: Scenarios, Timelines, and Ivermectin Treatment Needs in Africa (PLoS Negl Trop Dis, 9, 5)

Correcito

Tetanus toxoid coverage as an indicator of serological protection against neonatal tetanus

OBJECTIVE: A Multiple-Indicator Cluster Survey (MICS) was conducted at mid-decade in more than 60 developing countries to measure progress towards the year 2000 World Summit for Children goals. These goals included the protection of at least 90% of children against neonatal tetanus through the immunization of their mothers, as measured by tetanus toxoid (TT) coverage. In the Central African Republic (CAR), serological testing was added to the MICS to understand better the relationship between survey estimates of TT coverage and the prevalence of serological protection. METHODS: In the CAR MICS, mothers of children younger than one year of age gave verbal histories of the TT vaccinations they had received, using the MICS TT questionnaire. A subsample of mothers was tested for tetanus antitoxin, using a double-antigen enzyme-linked immunoadsorbent assay (ELISA). Seropositivity was defined as a titre of > or = 0.01 IU/ml, and TT coverage was defined as the proportion of mothers protected at delivery, according to their history of TT vaccinations. FINDINGS: Among the 222 mothers in the subsample, weighted TT coverage was 74.4% (95% Confidence Interval (CI); 67.0% - 81.7%) and tetanus antitoxin seroprevalence was 88.7% (95% CI; 83.2% - 94.2%). The weighted median antitoxin titre was 0.35 IU/ml. CONCLUSIONS: Tetanus toxoid coverage in the CAR was lower than the prevalence of serological protection against neonatal tetanus. If this relationship holds for other countries, TT coverage estimates from the MICS may underestimate the extent to which the year 2000 goal for protecting children against neonatal tetanus was reached. We also showed that a high level of serological protection had been achieved in a country facing major public health challenges and resource constraints