The Carter Center River Blindness (Onchocerciasis) Program

Onchocerciasis, or river blindness, is a parasitic disease transmitted by the bites of small black flies that breed in rapidly flowing streams and rivers. Since 1996, The Carter Center has been a leader in the fight against river blindness in Africa and the Americas by working in thousands of communities in 11 countries.
 
The Carter Center's River Blindness Program assists ministries of health to eradicate river blindness in the six countries in the Americas — Brazil, Colombia, Ecuador, Guatemala, Mexico, and Venezuela — through the special Onchocerciasis Elimination Program of the Americas and to control river blindness in five African countries: Cameroon, Ethiopia, Nigeria, Sudan, and Uganda.
 

River Blindness Attacks the Poor
To contract river blindness, a person typically must be bitten hundreds of times by infected black flies, since only a small percentage of the flies carry the infection. Therefore, the disease is not common among travelers or visitors to endemic countries. It is in fact the poorest of the poor who cannot protect themselves or escape from the black flies who are at greatest risk. It is estimated that in some river blindness areas of the world such as Ethiopia, men, women, and children are bitten by these flies as many as 20,000 times each year. Larvae enter the body through the fly bites and eventually mature into adult worms.
 
The offspring of the worms, called microfilariae, swarm under the skin where they can infect black flies when they bite. The microfilariae irritate the skin and cause intense itching, skin discoloration, and rashes. If the microfilariae enter the eyes, they cause inflammation and irritation, which can cause diminished vision and potential blindness. The disruption of family life and education resulting from the disease directly impacts local economies and long-term development.  
 
 
Drug Treatment Fights River Blindness
Studies in the 1980s showed that the drug Mectizan®, made by Merck & Co. Inc., could effectively and safely treat and prevent river blindness by killing the microfilariae in the human body. Merck decided in the late 1980s to donate the drug to all who needed it for as long as needed. This donation was an important stimulus for the current initiative to globally control onchocerciasis using a strategy of community-based treatment.
 
With the use of Mectizan and health education, experts have concluded that it is possible to completely eliminate river blindness from the Western Hemisphere where it occurs. The Carter Center is the leading organization in a coalition of partners dedicated to this cause, called the Onchocerciasis Elimination Program of the Americas (OEPA). In Africa, the strategy is to control river blindness with one treatment per year. However, in 2006, areas in Sudan and Uganda began a twice-per-year treatment elimination strategy modeled after the successful Onchocerciasis Elimination Program of the Americas approach. 

 
Center Partners Increase Program Reach
The Carter Center's River Blindness Program works through partnerships at all levels. The primary partners are the people in the afflicted communities, who organize themselves and volunteer their time to help distribute Mectizan.
 
The Lions Clubs International Foundation, a longtime partner in the fight against river blindness, has provided The Carter Center with grants since 1996 to prevent the disease in Africa and the Americas. The River Blindness Program supports the ministries of health and their national onchocerciasis control efforts executed within and through national primary public and community health care systems. The Carter Center also works closely with the Centers for Disease Control and Prevention and the Mectizan Donation Program.
 
The River Blindness Program partners in Africa include the ministries of health in the five endemic countries, the United Nations and affiliated organizations (the World Health Organization, the World Bank, and UNICEF), and other nongovernmental development organizations. Another important partner is the African Programme for Onchocerciasis Control, which is executed by WHO and funded through a World Bank trust fund.
 
In Latin America, OEPA's partnerships include the ministries of health in the six endemic countries, the Pan American Health Organization, the Centers for Disease Control and Prevention, academic institutions (such as The Scripps Research Institute), and independent organizations.