Some unsolved problems in the epidemiology of onchocerciasis.

The descriptive epidemiology of onchocerciasis is well understood in the major foci of infection; a great stimulus to epidemiological research has been the implementation of the first control programme, which led to the eradication of infection in Kenya and, more recently, the vast Onchocerciasis Control Programme in the Volta River Basin of West Africa. However, there are still significant gaps in epidemiological knowledge which hamper the planning of future control programmes and the evaluation of current programmes. The four most important unsolved problems are: the refinement of field diagnostic techniques to identify skin microfilariae at the ultra-low densities that will become common in the late stages of vector-control campaigns; the definitive identification of Onchocerca volvulus infective larvae in Simulium species; strain analysis in the field of microfilariae from humans and of developing stages from Simulium, to determine their potential for ocular pathogenicity; determination of the lifespan, or maximum fecundity span, of adult female O. volvulus after the interruption of transmission. Three other unsolved problems are of enormous interest epidemiologically, although less urgent in practical importance. They are the identification of factors causing severe disease as opposed to heavy infection; the effects of seasonal as opposed to perennial transmission; and the importance of transplacental transmission of microfilariae or soluble antigens.