Selective primary health care: strategies for control of disease in the developing world. VI. Onchocerciasis.

Onchocerca volvulus, a major filarial parasite of humans, infects tens of millions of people and is a leading cause of blindness. It also causes disabling or disfiguring dermatitis and lymph node involvement. The infection is transmitted by the bite of female blackflies of Simulium species, which breed around freely flowing waterways. Vector control by aerial spraying of rivers and streams with larvicide has achieved some success in the Volta River Basin, but other areas are less well-suited for such an approach. Efforts to control onchocerciasis are plagued by emerging resistance of blackflies, excessive costs of spraying, and the lack of suitable chemotherapy for existing cases. Mass chemotherapy for infected persons as a means to limit the disease and its impact is not feasible because existing drug regiments are too complex, too toxic, or not effective enough. Selective chemotherapy directed at persons at high risk of complications may be a more effective means of minimizing the impact of the disease.