Contact: Emily Staub, [email protected]
Atlanta, GA… Former U.S. President Jimmy Carter and The Carter Center congratulate President Jimmy Morales and the people of Guatemala for eliminating onchocerciasis (river blindness) in the nation, as verified recently by the World Health Organization (WHO). Guatemala is the world's fourth nation to receive official verification of elimination of the disease.
"Guatemala deserves enormous credit for its 100-year struggle against river blindness. It was the great Guatemalan researcher Dr. Rodolfo Robles, who discovered onchocerciasis in the Americas in 1915,” said President Carter, founder of The Carter Center. "Health workers, community educators and program leaders in Guatemala deserve the credit for their unrelenting work and determination to improve the health of future generations.”
The Carter Center’s Onchocerciasis Elimination Program for the Americas (OEPA) coordinates the regional initiative to eliminate river blindness from the Americas. The OEPA office was established in Guatemala because it had been the most endemic nation in the Americas, accounting for over 40 percent of people at risk for onchocerciasis in the region.
Guatemala’s minister of health, Dr. Lucrecia Hernandez Mack, made the official announcement on Sept. 29, 2016 at the Pan American Health Organization’s 55th Directing Council meeting in Washington, D.C.
Guatemala 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), Ecuador (2014), and Mexico (2015), to apply for and be granted verification of elimination of onchocerciasis by WHO, the only organization that can officially verify the elimination of a disease.
Today, river blindness transmission in the Americas occurs only among the indigenous Yanomami people, who live deep in the Amazon rainforest in an area that straddles the border 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 from person to person by the bites of Simulium black flies that 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 120 million are at risk of being infected and 270,000 have been blinded by the disease, mostly in Africa. In addition to Africa and Latin America, onchocerciasis also affects Yemen.
For more than two decades, elimination efforts undertaken by the endemic Latin American countries and coordinated by the Carter Center's OEPA and the Pan American Health Organization (PAHO/WHO) have reduced the overall population needing treatment for onchocerciasis by 95 percent, to about 29,000 people in the Americas.
Partners in the effort to wipe out river blindness from the Americas include the ministries of health of the six endemic countries, thousands of community-based volunteers, The Carter Center, PAHO/WHO, Merck and its Mectizan® Donation Program, the United States Agency for International Development (USAID), the Carlos Slim Foundation, the Bill & Melinda Gates Foundation, the Lions Clubs International Foundation and local Lions Clubs from the six countries, the U.S. Centers for Disease Control and Prevention (CDC), and formerly the Inter-American Development Bank and River Blindness Foundation, as well as several universities in Latin America and the United States, and many others.
Guatemala’s success against onchocerciasis began in 1915 when Dr. Rodolfo Robles Valverde, a renowned Guatemalan researcher, discovered in the Americas the association between infection with the parasite Onchocerca volvulus and the ocular disease. Onchocerciasis was known as “Robles’ disease” in Guatemala.
In 1935 the Guatemalan Ministry of Health launched a national River Blindness Control Program, with a widespread campaign to surgically remove subcutaneous nodules (containing the worm parasites) in the country’s four endemic areas: Central (which includes Suchitepequez, Sololá and Chimaltenango Departments), Escuintla-Guatemala, Huehuetenango, and Santa Rosa. The disease threatened more than 500 of Guatemala’s poorest communities. Nodule removal remained the national program’s main strategy until 1987, when Merck pledged to make a new oral medicine for onchocerciasis (ivermectin, brand name Mectizan®) available to “all who need it, for as long as needed.” Mectizan distribution began on a pilot basis in Guatemala the following year. When pilot studies were found to be successful, Guatemala’s national program adopted Mectizan mass drug administration (MDA) twice per year as its primary elimination strategy in 1991.
By 2009, the MDA program had eliminated onchocerciasis from the Santa Rosa focus, the first of the 13 onchocerciasis foci in the Americas to do so. The Escuintla-Guatemala focus followed in 2010, and Huehuetenango in 2011. The largest and final Guatemalan focus, Central, completed its elimination activities in 2014. In 2015, 100 years after Robles first discovered the disease, Guatemala submitted a request to WHO for verification of elimination.
A WHO International Verification Team made its country visit to confirm elimination in June 2016. The team’s report confirmed that transmission of the onchocerciasis parasite had been successfully wiped out from all four focus areas in Guatemala, and WHO Director General Dr. Margaret Chan sent an official letter of verification to the Guatemalan government.
Today, as a result of national leadership and strong partnerships, approximately 230,000 people in Guatemala’s four 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 Guatemala, the nation’s Ministry of Health, and their partners.
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, the Onchocerciasis Elimination Program of the Americas (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. Most financing for the programs comes from the countries themselves, with supplemental financial support to the programs from other donors through The Carter Center. Elimination would not have been possible without the generous donation of Mectizan by Merck.
Thanks 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 two 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, while assisting in nearly 28 million Mectizan treatments to prevent river blindness in 2015.
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