In 1975 the World Health Organization, supported by a number of donor and afflicted countries, began the Onchocerciasis Control Programme, an ambitious and expensive 20-year effort to eliminate onchocerciasis in the entire Volta Basin. The basic strategy was to kill fly larvae by aerial spraying of an organophosphate called Abate (generic name: temephos) over breeding sites scattered over a huge and repeatedly extended portion of West Africa. The absence of an effective agent to kill adult flies has not prevented tremendous success in reducing and sometimes eliminating Simulium populations. Although treatment of victims was less successful until very recently because existing drugs were too dangerous for mass use, the vector control program, though costly and constantly faced with the problem of reintroduction of adult flies from places beyond the limits of the control program, has resulted in dramatic declines in biting rates, infection, and blindness in most of the region. Recently, treatment of thousands of victims with ivermectin, a safe and effective microfilaricide, has helped to reduce blindness among infected persons and has reduced the chances that a feeding fly would ingest infective microfilariae. The absence of an agent to kill adult worms and the logistical and financial difficulties of the massive larviciding campaign make total eradication unlikely, but vector control and microfilarici-dal treatment can reduce the number of infected persons and lessen or eliminate severe clinical symptoms. Success at this level could help make thousands of square kilometers of valuable farmland safe for use in many regions of Africa. It is, however, clear that there must be a long-term commitment to the campaign for many years into the future, or river blindness will reconquer its old haunts.

K. David Patterson

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