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Thomas UnnaschDepartment of Global Health, College of Public Health, University of South Florida, Tampa, FL, USAPeople living in tropical regions account for a large percentage of the world’s population, and residents of the tropics face many challenges to their health. Populations living in tropical regions must deal with most of the same diseases that confront people inhabiting temperate regions, but face many other health problems as well. For example, it is estimated that the neglected tropical diseases (NTDs), including the parasitic helminths and apicoplast parasites, afflict roughly 40% of the world’s population, almost all of whom reside in tropical climates.

Nadia A Fernández-Santos,1 Francisco Gibert Prado-Velasco,2 Dey Carol Damián-González,2 Thomas R Unnasch,3 Mario A Rodríguez-Pérez1 1Instituto Politécnico Nacional, Centro de Biotecnología Genómica, Laboratorio de Biomedicina Molecular, Ciudad Reynosa, Tamaulipas, México; 2Instituto de Salud del Estado de Chiapas, Programas de Tracoma y Oncocercosis en Chiapas, Tuxtla Gutiérrez, Chiapas, México; 3Global Health Infectious Disease Research Program, College of Public Health, University of South Florida, Tampa, FL, USACorrespondence: Mario A Rodríguez-Pérez Email drmarodriguez@hotmail.comAbstract: We present a historical review of two neglected tropical diseases (NTD), namely, onchocerciasis and trachoma, both which were successfully eliminated in Mexico. In addition, we present a cost-effectiveness assessment (CEA) demonstrating that these were worthwhile health interventions. Historically, an estimate of $310.68 and $38.92 per person were spent during the period of time the onchocerciasis and trachoma elimination programs operated, respectively.Keywords: onchocerciasis, trachoma, assessments, Mexico, Chiapas, Oaxaca

Many blackfly species ( Diptera: Simuliidae) are economically important insect pests, both as nuisance biters and as vectors of pathogens of medical and veterinary relevance. Among the important blackfly pest species in North America is Simulium vittatum Zetterstedt sensu lato. The objective of this study was to identify compounds excreted by mammalian hosts that are attractive to host-seeking S. vittatum females. The attractiveness of putative compounds to colonized S. vittatum was tested through electrophysiological (electroantennography; n = 58 compounds) and behavioural ( Y-tube assays; n = 7 compounds in three concentrations) bioassays. Five compounds were significantly attractive to host-seeking S. vittatum females: 1-octen-3-ol; 2-heptanone; acetophenone; 1-octanol, and naphthalene. These candidate compounds might be useful as attractants in traps that could be developed for use in alternative or complementary management tactics in programmes to suppress nuisance blackfly populations, or for the collection of samples in which to study the transmission ecology of pathogens transmitted by blackflies of the S. vittatum complex. [ABSTRACT FROM AUTHOR]

The standard assay for onchocerciasis diagnosis is microscopic detection of parasites in skin snips. Skin snipping is painful and may potentially transmit bloodborne infections. Thus, an alternative method for the diagnosis of onchocerciasis that does not require skin snipping is needed. A polymerase chain reaction (PCR)-based assay was shown to detect the presence of parasite DNA in superficial skin scrapings. Detection of parasite DNA in both skin snips and skin scratches was found to be more sensitive for detecting low-density infections than was microscopic examination of skin snips. The skin scratch PCR assay is minimally invasive and painless and does not present the risk of transmitting bloodborne infections. These properties make the skin scratch an attractive alternative to the skin snip for detecting O. volvulus infection. [ABSTRACT FROM AUTHOR]

Ed W Cupp1, Charles D Mackenzie2, Thomas R Unnasch31Department of Entomology and Plant Pathology, Auburn University, Auburn, AL, USA; 2Department of Pathobiology, Michigan State University, East Lansing, MI, USA; 3Department of Global Health, University of South Florida, Tampa, FL, USAAbstract: Ivermectin (registered for human use as Mectizan®) was donated by Merck & Co Inc in 1987 for the treatment and control of human onchocerciasis ("river blindness"). This philanthropic gesture has had a remarkable effect in reducing the incidence and prevalence of this serious ocular and dermatological disease, while changing health system support for millions of people worldwide. Over 800 million doses have been given to more than 80 million people for onchocerciasis during the past 23 years. As a result, onchocerciasis has been significantly reduced in more than 25 countries, transmission has been interrupted in foci in at least 10 countries, and the disease is no longer seen in children in many formerly endemic foci. Recent communications have suggested that the drug's efficacy as the major therapeutic agent for these control and elimination programs may be threatened, but alternative interpretations for suboptimal response/resistance suggest otherwise. Current research needs and control methods by which the public health community in endemic countries may respond to resistance, should it occur in their area, are discussed, along with the continuing importance of this anthelmintic as the mainstay in onchocerciasis control programs.Keywords: Ivermectin, Onchocerca volvulus, river blindness, resistance, African Programme for Onchocerciasis Control, Onchocerciasis Elimination Program for the Americas

Abstract Background Eastern Equine Encephalitis virus (EEEV) is an alphavirus with high pathogenicity in both humans and horses. Florida continues to have the highest occurrence of human cases in the USA, with four fatalities recorded in 2010. Unlike other states, Florida supports year-round EEEV transmission. This research uses GIS to examine spatial patterns of documented horse cases during 2005–2010 in order to understand the relationships between habitat and transmission intensity of EEEV in Florida. Methods Cumulative incidence rates of EEE in horses were calculated for each county. Two cluster analyses were performed using density-based spatial clustering of applications with noise (DBSCAN). The first analysis was based on regional clustering while the second focused on local clustering. Ecological associations of EEEV were examined using compositional analysis and Euclidean distance analysis to determine if the proportion or proximity of certain habitats played a role in transmission. Results The DBSCAN algorithm identified five distinct regional spatial clusters that contained 360 of the 438 horse cases. The local clustering resulted in 18 separate clusters containing 105 of the 438 cases. Both the compositional analysis and Euclidean distance analysis indicated that the top five habitats positively associated with horse cases were rural residential areas, crop and pastureland, upland hardwood forests, vegetated non-forested wetlands, and tree plantations. Conclusions This study demonstrates that in Florida tree plantations are a focus for epizootic transmission of EEEV. It appears both the abundance and proximity of tree plantations are factors associated with increased risk of EEE in horses and therefore humans. This association helps to explain why there is are spatially distinct differences in the amount of EEE horse cases across Florida.

Abstract Background A site near Tuskegee, Alabama was examined for vector-host activities of eastern equine encephalomyelitis virus (EEEV). Land cover maps of the study site were created in ArcInfo 9.2® from QuickBird data encompassing visible and near-infrared (NIR) band information (0.45 to 0.72 μm) acquired July 15, 2008. Georeferenced mosquito and bird sampling sites, and their associated land cover attributes from the study site, were overlaid onto the satellite data. SAS 9.1.4® was used to explore univariate statistics and to generate regression models using the field and remote-sampled mosquito and bird data. Regression models indicated that Culex erracticus and Northern Cardinals were the most abundant mosquito and bird species, respectively. Spatial linear prediction models were then generated in Geostatistical Analyst Extension of ArcGIS 9.2®. Additionally, a model of the study site was generated, based on a Digital Elevation Model (DEM), using ArcScene extension of ArcGIS 9.2®. Results For total mosquito count data, a first-order trend ordinary kriging process was fitted to the semivariogram at a partial sill of 5.041 km, nugget of 6.325 km, lag size of 7.076 km, and range of 31.43 km, using 12 lags. For total adult Cx. erracticus count, a first-order trend ordinary kriging process was fitted to the semivariogram at a partial sill of 5.764 km, nugget of 6.114 km, lag size of 7.472 km, and range of 32.62 km, using 12 lags. For the total bird count data, a first-order trend ordinary kriging process was fitted to the semivariogram at a partial sill of 4.998 km, nugget of 5.413 km, lag size of 7.549 km and range of 35.27 km, using 12 lags. For the Northern Cardinal count data, a first-order trend ordinary kriging process was fitted to the semivariogram at a partial sill of 6.387 km, nugget of 5.935 km, lag size of 8.549 km and a range of 41.38 km, using 12 lags. Results of the DEM analyses indicated a statistically significant inverse linear relationship between total sampled mosquito data and elevation (R2 = -.4262; p < .0001), with a standard deviation (SD) of 10.46, and total sampled bird data and elevation (R2 = -.5111; p < .0001), with a SD of 22.97. DEM statistics also indicated a significant inverse linear relationship between total sampled Cx. erracticus data and elevation (R2 = -.4711; p < .0001), with a SD of 11.16, and the total sampled Northern Cardinal data and elevation (R2 = -.5831; p < .0001), SD of 11.42. Conclusion These data demonstrate that GIS/remote sensing models and spatial statistics can capture space-varying functional relationships between field-sampled mosquito and bird parameters for determining risk for EEEV transmission.

Background: Onchocerciasis transmission across international borders is not uncommon, yet a coordinated cross border stops mass drug administration (MDA) decision has not been documented., Methods/principle Findings: The Galabat-Metema focus involves neighboring districts on the border between Sudan and Ethiopia. Mass drug administration (MDA) was provided once and subsequently twice per year in this focus, with twice-per-year beginning in Ethiopia's Metema subfocus in 2016 and in the Sudan's Galabat subfocus in 2008. Ov16 ELISA-based serosurveys were conducted in 6072 children under 10 years of age in the Metema subfocus in 2014, and 3931 in the Galabat in 2015. Between 2014 and 2016, a total of 27,583 vector Simulium damnosum flies from Metema and 9,148 flies from Galabat were tested by pool screen PCR for Onchocerca volvulus O-150 DNA. Only 8 children were Ov16 seropositive (all in the Metema subfocus); all were negative by skin snip PCR. The upper limit of the 95% confidence interval (UCL) for Ov16 seropositive was <0.1% for the overall focus and 0.14 positive fly heads per 2000 (UCL = 0.39/2000). However, an entomological 'hotspot' was detected on the Wudi Gemzu river in Metema district. The hotspot was confirmed when 4 more positive fly pools were found on repeat testing in 2017 (1.04 L3/2000 flies (UCL = 2.26/2000). Information exchange between the two countries led to stopping MDA in a coordinated fashion in 2018, with the exception of the hotspot at Wudi Gemzu, where MDA with ivermectin was increased to every three months to hasten interruption of transmission., Conclusion: Coordinated stop MDA decisions were made by Sudan and Ethiopia based on data satisfying the World Health Organization's criteria for interruption of onchocerciasis transmission. Definitions of entomological 'hotspots' and buffer zones around the focus are proposed., Competing Interests: The authors have declared that no competing interests exist.

Eastern Equine Encephalitis Virus (EEEV) is the most pathogenic arbovirus endemic to the United States. EEEV primarily infects birds but can be fatal to humans, horses, and some other mammals. Although EEEV transmission occurs in the Northeastern, Southeastern, and Midwestern United States, the largest number of horse and human cases have been reported in Florida, the only state where transmission occurs year round. Currently, a GIS-based risk index (RI) model is used to map EEE transmission risk to horses in Florida. This study validates that RI model using a 5-yr dataset of horse cases in Florida. RI values were similar between summer (N = 152, x¯ = 0.59) and winter (N = 25, x¯ = 0.66) cases, suggesting the model is effective for mapping risk during both transmission seasons. These risk values were larger and remained similar when a 100-m buffer was applied to the case locations to account for modest spatial errors in case reporting (summer x¯ = 0.73, winter x¯ = 0.77). In both comparisons, RI values for summer and winter cases were higher than expected at random in the Panhandle, North, and Central regions of the state, although the analysis was inconclusive in the South, where only two cases were observed. This suggests the RI map could be used to target EEEV surveillance, prevention, and control efforts in both transmission seasons in Florida.

Background: The Esmeraldas focus of onchocerciasis in Ecuador expanded geographically during the 1980s and was associated with severe ocular and skin disease. Mass drug administration (MDA) with ivermectin started in 1991, initially once but later twice a year, in the principle endemic focus followed by all satellite foci. Treatment was stopped in 2009 when entomological assessments determined that transmission of Onchocerca volvulus had been interrupted., Methods: Three years after the cessation of ivermectin treatment in 2012, as defined by the WHO guidelines for onchocerciasis elimination, blackfly collections were done in four sentinel sites in former hyperendemic areas. The presence of infective larvae in local vectors, Simulium exiguum and Simulum quadrivittatum, was assessed by detection of O. volvulus DNA by PCR. Additional flies captured in four extra-sentinel sites located in former hyper- and mesoendemic dispersed isolated areas were also assessed., Results: The results from 68,310 captured blackflies, 40,114 from four sentinel villages in the previously hyperendemic areas (Corriente Grande, El Tigre, San Miguel on Río Cayapas and Naranjal on Río Canandé) and 28,197 from extra-sentinel locations, were all negative for the presence of O. volvulus. These extra-sentinel sites (Hualpí on Río Hoja Blanca, Capulí on Río Onzole, La Ceiba on Río Tululví and Medianía on Río Verde) were included to provide additional evidence of the impact of MDA on the transmission of O. volvulus in isolated endemic areas., Conclusions: Our data indicate that transmission of O. volvulus has been stopped in all endemic areas in Ecuador, including all satellite foci outside the main focus. These findings indicate that a strategy of ivermectin distribution twice a year to over 85% of the treatment-eligible population was effective in eliminating the infection from Ecuador in a focus with a highly competent primary vector, S. exiguum, and where the infection rates were equal to or greater than observed in many onchocerciasis foci in Africa.