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Efforts are being directed towards elimination of onchocerciasis transmission in endemic areas with community-directed treatment with ivermectin (CDTI) in Africa, which greatly reduces onchocerciasis-associated disease. However, onchocerciasis remains a major public health problem in areas of South Sudan, the Democratic Republic of the Congo, Cameroon, and the Central African Republic. Strengthening onchocerciasis elimination efforts in areas with high prevalence of disease burden is crucial to decrease transmission, morbidity, and mortality. We argue that clinical trials are needed to investigate the safety and efficacy of ivermectin treatment of Onchocerca volvulus-infected pregnant women and of children aged <5 years. Crucially, six-monthly administration of ivermectin in school-age children at risk of onchocerciasis-associated-epilepsy could be achieved by supplementing annual CDTI with an extra round of ivermectin treatment during Child Health Days in schools and/or other distribution sites every year. These strategies would help achieve elimination of onchocerciasis and its associated disease burden.

Original publication




Journal article


International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases

Publication Date



Global Health Institute, University of Antwerp, Antwerp, Belgium. Electronic address: