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Newest Victory in Onchocerciasis Elimination: Mexico!

29 September 2015

Please join The Mectizan Donation Program in congratulating the government of Mexico on the elimination of transmission of river blindness. Congratulations also to The Carter Center and its Onchocerciasis Elimination Program for the Americas for their support and dedication to help Mexico achieve this remarkable milestone as the 3rd country in the Americas to eliminate onchocerciasis.

Pictured right: Jimmy Carter, Brenda Colatrella (Merck), Adrian Hopkins (Mectizan Donation Program)

FOR IMMEDIATE RELEASE
Oct. 2, 2015
Contact: Emily Staub, The Carter Center, Tele: +1-404-420-5126;emily.staub@cartercenter.org

The Carter Center Congratulates Mexico on its Official Verification of Transmission Elimination

Atlanta, GA… Former U.S. President Jimmy Carter and The Carter Center congratulate President Enrique Peña Nieto and the people of Mexico for eliminating onchocerciasis (river blindness) within its borders, as verified recently by the World Health Organization (WHO). Mexico is the world’s third nation to receive official verification of elimination of the disease.

“Together with The Carter Center, Rosalynn and I recognize Mexico’s dedicated river blindness health workers for improving the lives of so many for generations to come,” said former U.S. President Jimmy Carter, founder of The Carter Center. “I am personally committed to wiping out this scourge in the Americas as soon as possible.” Watch President Carter’s video message accepting an award from Merck recognizing the Carter Center’s contributions to the campaign against river blindness in the Americas. A not-for-profit organization, The Carter Center coordinates the regional campaign to eliminate the river blindness through its Onchocerciasis Elimination Program for the Americas (OEPA).

Mexico’s Secretary of Health, Dr. Mercedes Juan Lopez, made the official announcement on Tuesday, Sept. 29, 2015, during a press conference held in Washington, D.C., while she and other ministry representatives were attending the Pan American Health Organization’s (PAHO) 54th annual Directing Council meeting.

Mexico is one of six countries in the Americas that have been affected by onchocerciasis and is the most recent country in the world, after Colombia (2013) and Ecuador (2014), to apply for and be granted verification of elimination of onchocerciasis by the WHO, for which PAHO serves as Regional Office for the Americas. The WHO is the only organization that can officially verify the elimination of a disease.

Guatemala, which has eliminated transmission of the disease and completed its post-treatment surveillance period, officially filed its request for verification of elimination in March of 2015. Today, river blindness transmission in the Americas, only occurs among the indigenous Yanomami people who live deep in the Amazon rainforest in an area that straddles the border of the Bolivarian Republic of Venezuela and Brazil. The two countries have pledged to eliminate the disease from their shared border as soon as possible.

Onchocerciasis is a parasitic disease that afflicts the rural poor. It is caused by a worm that is spread by the bites of Simulium black flies which breed in rapid-flowing rivers and streams. The disease can cause intense itching, eye damage, and irreversible blindness, reducing an individual’s ability to work and learn. Worldwide, an estimated 18 million people are infected and 270,000 blinded by the disease. Onchocerciasis affects countries in Africa and Latin America, as well as Yemen.

For more than two decades, elimination efforts undertaken by the endemic countries and coordinated by the Carter Center’s OEPA have reduced the incidence of transmission to about 25,000 people in the region. The other core partners who have supported the ministries of health of the affected countries include PAHO/WHO, the U.S. Centers for Disease Control and Prevention (CDC), Merck & Co. Inc.’s Mectizan Donation Program, and a host of international partners, foundations, universities, and individuals.

THE MEXICO EXPERIENCE

Mexico’s success against onchocerciasis is the culmination of a more than 80-year national effort to first control, and then eliminate, the debilitating disease. For this entire period of time, the Mexican government maintained a cadre of field workers devoted exclusively to fighting the disease, demonstrating strong national leadership and sustained commitment.

Mexico’s first case of river blindness was diagnosed by Dr. Friedrich Fülleborn in 1923. In 1930, a national program to combat the disease was launched, based on a strategy of surgical removal of the subcutaneous nodules that contained the adult worms. Mass distribution of the safe and effective oral medication ivermectin, donated by Merck as Mectizan®, began to be used by the program in 1988. Launching mass drug administration (MDA) programs that continually reached more than 85 percent of the population at risk for the infection heralded the demise of river blindness in Mexico. When OEPA joined the fight against river blindness in 1993, Mexican cases were located in three transmission zones (foci): Oaxaca, North Chiapas, and South Chiapas.

Through more than 25 consecutive rounds of semiannual distribution of Mectizan and health education, onchocerciasis was wiped out from the North Chiapas and Oaxaca foci by the late 2000s. After halting MDA, both foci completed a three-year period of post-treatment surveillance (PTS), during which time there was no evidence of renewed transmission for the infection by the vector black flies. Transmission was declared eliminated in North Chiapas in 2010, and Oaxaca in 2011.

Mectizan MDA was halted in South Chiapas in 2011 after 34 consecutive rounds were administered.  South Chiapas conducted PTS from 2012-2014, with final evaluations confirming that surveillance had been successful and that onchocerciasis remained absent from the focus area. In the Americas, the South Chiapas focus had the second largest number of people afflicted (after Guatemala’s Central focus).

Mexico filed a request for the WHO to verify nationwide elimination of onchocerciasis in November 2014.  An International Verification Team (IVT) made its country visit to confirm elimination in June of the following year. The IVT report confirmed that onchocerciasis had been successfully wiped out from all three focus areas in Mexico. As such, the WHO’s Director General Dr. Margaret Chan sent an official letter of verification to the Mexican government on July 29, 2015. Two months later, Dr. Juan made Mexico’s achievement public during a press conference.

STRONG PARTNERSHIPS

In the late 1990s, an estimated 660,000 people in the Americas were at risk of onchocerciasis in 13 foci in six countries: Brazil, Colombia, Ecuador, Guatemala, Mexico, and Venezuela. The donation of Mectizan beginning in 1987 stimulated new partnerships and opportunities to fight onchocerciasis. After PAHO declared elimination as the goal for the region using a strategy of mass drug administration, a regional partnership, OEPA, was established to focus on reaching that objective. OEPA was launched in 1993 with funding from the former River Blindness Foundation, which The Carter Center absorbed in 1996. Both The Carter Center’s OEPA and PAHO provide technical assistance to the affected national country programs. Additionally, the Center provides supplemental financial support.

Due to the dedication of the six ministries of health and thousands of community-based health workers, today transmission of onchocerciasis has been eliminated or interrupted in all but 2 of the Americas’ original 13 endemic foci. Progress in the Americas has provided lessons for pursuing elimination efforts in Africa, where more than 120 million people are at risk and hundreds of thousands have been blinded by the condition. The Carter Center assists governments in four countries in Africa in their efforts to eliminate onchocerciasis: Ethiopia, Nigeria, Sudan, and Uganda. Since 1986, The Carter Center has pioneered multiple disease elimination projects in Africa and Latin America.

Today, as a result of national leadership and strong partnerships, approximately 170,000 people in Mexico’s three formerly endemic areas are no longer at risk of contracting river blindness. The long struggle and ultimate victory against this disease belongs primarily to the people of Mexico and their Ministry of Health, in partnership with Merck and the Mectizan Donation Program, The Carter Center’s OEPA, PAHO/WHO, the U.S. Centers for Disease Control and Prevention (CDC), the Bill & Melinda Gates Foundation, the United States Agency for International Development (USAID), the Lions Clubs International Foundation, the Carlos Slim Foundation, Mr. John Moores and the River Blindness Foundation,  the Inter-American Development Bank, OPEC Fund for International Development, Alwaleed Philanthropies, several universities in Latin America and the U.S., and many generous individuals.