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Human Onchocerciasis: Modelling the Potential Long-term Consequences of a Vaccination Programme

Publication Date: July 17, 2015
Journal: PLOS Neglected Tropical Diseases
Authors: Hugo C. Turner, Martin Walker, Sara Lustigman, David W. Taylor, et al
Volume: 9
Issue: 7
Pages: e0003938
DOI: https://dx.plos.org/10.1371/journal.pntd.0003938
Publisher URL: http://journals.plos.org/plosntds/article?id=10.1371%2Fjournal.pntd.0003938
PubMed: http://www.ncbi.nlm.nih.gov/pubmed/26186715
PubMed Central: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4506122
Europe PMC: http://europepmc.org/abstract/MED/26186715
Web of Science: 000359079700042
Scopus: 84938562675
Mendeley: http://www.mendeley.com/research/human-onchocerciasis-modelling-potential-longterm-consequences-vaccination-programme

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Mendeley 4417 Apr 22:14 UTC

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{"title"=>"Human onchocerciasis: Modelling the potential long-term consequences of a vaccination programme", "type"=>"journal", "authors"=>[{"first_name"=>"Hugo C.", "last_name"=>"Turner", "scopus_author_id"=>"55668409700"}, {"first_name"=>"Martin", "last_name"=>"Walker", "scopus_author_id"=>"55461484300"}, {"first_name"=>"Sara", "last_name"=>"Lustigman", "scopus_author_id"=>"7003666182"}, {"first_name"=>"David W.", "last_name"=>"Taylor", "scopus_author_id"=>"11238901800"}, {"first_name"=>"María Gloria", "last_name"=>"Basáñez", "scopus_author_id"=>"6701712698"}], "year"=>2015, "source"=>"PLoS Neglected Tropical Diseases", "identifiers"=>{"pmid"=>"26186715", "doi"=>"10.1371/journal.pntd.0003938", "sgr"=>"84938562675", "isbn"=>"0002-9637", "scopus"=>"2-s2.0-84938562675", "issn"=>"19352735", "pui"=>"605468720"}, "id"=>"1ffbca92-263d-3988-a649-25a8d3ca16fb", "abstract"=>"BACKGROUND: Currently, the predominant onchocerciasis control strategy in Africa is annual mass drug administration (MDA) with ivermectin. However, there is a consensus among the global health community, supported by mathematical modelling, that onchocerciasis in Africa will not be eliminated within proposed time frameworks in all endemic foci with only annual MDA, and novel and alternative strategies are urgently needed. Furthermore, use of MDA with ivermectin is already compromised in large areas of central Africa co-endemic with Loa loa, and there are areas where suboptimal or atypical responses to ivermectin have been documented. An onchocerciasis vaccine would be highly advantageous in these areas.\\n\\nMETHODOLOGY/PRINCIPAL FINDINGS: We used a previously developed onchocerciasis transmission model (EPIONCHO) to investigate the impact of vaccination in areas where loiasis and onchocerciasis are co-endemic and ivermectin is contraindicated. We also explore the potential influence of a vaccination programme on infection resurgence in areas where local elimination has been successfully achieved. Based on the age range included in the Expanded Programme on Immunization (EPI), the vaccine was assumed to target 1 to 5 year olds. Our modelling results indicate that the deployment of an onchocerciasis vaccine would have a beneficial impact in onchocerciasis-loiasis co-endemic areas, markedly reducing microfilarial load in the young (under 20 yr) age groups.\\n\\nCONCLUSIONS/SIGNIFICANCE: An onchocerciasis prophylactic vaccine would reduce the onchocerciasis disease burden in populations where ivermectin cannot be administered safely. Moreover, a vaccine could substantially decrease the chance of re-emergence of Onchocerca volvulus infection in areas where it is deemed that MDA with ivermectin can be stopped. Therefore, a vaccine would protect the substantial investments made by present and past onchocerciasis control programmes, decreasing the chance of disease recrudescence and offering an important additional tool to mitigate the potentially devastating impact of emerging ivermectin resistance.", "link"=>"http://www.mendeley.com/research/human-onchocerciasis-modelling-potential-longterm-consequences-vaccination-programme", "reader_count"=>41, "reader_count_by_academic_status"=>{"Unspecified"=>2, "Researcher"=>12, "Student > Doctoral Student"=>1, "Student > Ph. D. Student"=>9, "Student > Postgraduate"=>2, "Student > Master"=>8, "Other"=>3, "Student > Bachelor"=>2, "Lecturer"=>1, "Lecturer > Senior Lecturer"=>1}, "reader_count_by_user_role"=>{"Unspecified"=>2, "Researcher"=>12, "Student > Doctoral Student"=>1, "Student > Ph. D. Student"=>9, "Student > Postgraduate"=>2, "Student > Master"=>8, "Other"=>3, "Student > Bachelor"=>2, "Lecturer"=>1, "Lecturer > Senior Lecturer"=>1}, "reader_count_by_subject_area"=>{"Unspecified"=>3, "Environmental Science"=>2, "Nursing and Health Professions"=>2, "Medicine and Dentistry"=>11, "Agricultural and Biological Sciences"=>9, "Neuroscience"=>1, "Philosophy"=>1, "Pharmacology, Toxicology and Pharmaceutical Science"=>1, "Veterinary Science and Veterinary Medicine"=>1, "Chemistry"=>1, "Social Sciences"=>2, "Immunology and Microbiology"=>7}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>11}, "Neuroscience"=>{"Neuroscience"=>1}, "Chemistry"=>{"Chemistry"=>1}, "Social Sciences"=>{"Social Sciences"=>2}, "Immunology and Microbiology"=>{"Immunology and Microbiology"=>7}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>9}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>2}, "Unspecified"=>{"Unspecified"=>3}, "Environmental Science"=>{"Environmental Science"=>2}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>1}, "Philosophy"=>{"Philosophy"=>1}, "Veterinary Science and Veterinary Medicine"=>{"Veterinary Science and Veterinary Medicine"=>1}}, "reader_count_by_country"=>{"United Kingdom"=>2}, "group_count"=>3}

ORCID26 Feb 05:06 UTC

Scopus | Further Information

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Web of Science®24 Nov 17:15 UTC

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Journal Comments22 Oct 04:30 UTC

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Figshare 18127 Feb 08:18 UTC

Figshare

{"files"=>["https://ndownloader.figshare.com/files/2181306"], "description"=>"A: Model assumes an initial vaccine efficacy against the development of incoming worms of 50% and against skin microfilarial load of 90%. B: Model assumes a higher initial vaccine efficacy against the development of incoming worms of 70% and against skin microfilarial load of 95%. Results assume mean duration of prophylactic and therapeutic effects of 20 years (rate of decay = 0.05 per year) and an 80% coverage of vaccination. Annual transmission potential (ATP): the average number of L3 larvae potentially received per person per year.Long-term impact of vaccination on onchocerciasis annual transmission potential and microfilarial load in the absence of ivermectin treatment under different assumptions of initial vaccine efficacy.", "links"=>[], "tags"=>["Vaccination Programme BackgroundCurrently", "epi", "onchocerciasis control strategy", "onchocerciasis transmission model", "Onchocerciasis Vaccine", "Onchocerca volvulus infection", "ivermectin", "mda", "Mass Drug Administration", "onchocerciasis disease burden", "EPIONCHO", "5 year olds", "onchocerciasis control programmes"], "article_id"=>1487533, "categories"=>["Biological Sciences"], "users"=>["Hugo C. Turner", "Martin Walker", "Sara Lustigman", "David W. Taylor", "María-Gloria Basáñez"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0003938.t002", "stats"=>{"downloads"=>1, "page_views"=>11, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Long_term_impact_of_vaccination_on_onchocerciasis_annual_transmission_potential_and_microfilarial_load_in_the_absence_of_ivermectin_treatment_under_different_assumptions_of_initial_vaccine_efficacy_/1487533", "title"=>"Long-term impact of vaccination on onchocerciasis annual transmission potential and microfilarial load in the absence of ivermectin treatment under different assumptions of initial vaccine efficacy.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2015-07-17 04:08:06"}
{"files"=>["https://ndownloader.figshare.com/files/2181305"], "description"=>"Values adapted from [<a href=\"http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003938#pntd.0003938.ref072\" target=\"_blank\">72</a>].Endemicity categories as defined by microfilarial prevalence.", "links"=>[], "tags"=>["Vaccination Programme BackgroundCurrently", "epi", "onchocerciasis control strategy", "onchocerciasis transmission model", "Onchocerciasis Vaccine", "Onchocerca volvulus infection", "ivermectin", "mda", "Mass Drug Administration", "onchocerciasis disease burden", "EPIONCHO", "5 year olds", "onchocerciasis control programmes"], "article_id"=>1487532, "categories"=>["Biological Sciences"], "users"=>["Hugo C. Turner", "Martin Walker", "Sara Lustigman", "David W. Taylor", "María-Gloria Basáñez"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0003938.t001", "stats"=>{"downloads"=>0, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Endemicity_categories_as_defined_by_microfilarial_prevalence_/1487532", "title"=>"Endemicity categories as defined by microfilarial prevalence.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2015-07-17 04:08:06"}
{"files"=>["https://ndownloader.figshare.com/files/2181302"], "description"=>"The mean duration of vaccine prophylactic (against incoming L3 larvae) and therapeutic (against microfilariae) activity is 1/the rate of decay (i.e. 5, 10, 20 and 50 years). We illustrate with a pre-control endemicity of 40% microfilarial prevalence. The solid line indicates the baseline (pre-control) contribution of each group to the overall microfilarial load, which is the product of multiplying the age- and sex-specific microfilarial loads (<a href=\"http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003938#pntd.0003938.g003\" target=\"_blank\">Fig 3B</a>) times the proportion of the population within each corresponding demographic stratum (<a href=\"http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003938#pntd.0003938.g002\" target=\"_blank\">Fig 2</a>). The dotted lines correspond to these contributions after 15 years of vaccination for decreasing waning rates of the prophylactic and therapeutic effects of the vaccine; the lower the rate, the greater the reduction in microfilarial loads achieved by the vaccination programme. Other assumptions as in <a href=\"http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003938#pntd.0003938.g004\" target=\"_blank\">Fig 4</a>.", "links"=>[], "tags"=>["Vaccination Programme BackgroundCurrently", "epi", "onchocerciasis control strategy", "onchocerciasis transmission model", "Onchocerciasis Vaccine", "Onchocerca volvulus infection", "ivermectin", "mda", "Mass Drug Administration", "onchocerciasis disease burden", "EPIONCHO", "5 year olds", "onchocerciasis control programmes"], "article_id"=>1487529, "categories"=>["Biological Sciences"], "users"=>["Hugo C. Turner", "Martin Walker", "Sara Lustigman", "David W. Taylor", "María-Gloria Basáñez"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0003938.g006", "stats"=>{"downloads"=>0, "page_views"=>8, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Sensitivity_of_the_long_term_reduction_in_microfilarial_load_in_individuals_under_20_years_of_age_to_the_assumed_rate_of_decay_of_vaccine_efficacy_/1487529", "title"=>"Sensitivity of the long-term reduction in microfilarial load in individuals under 20 years of age to the assumed rate of decay of vaccine efficacy.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-07-17 04:08:06"}
{"files"=>["https://ndownloader.figshare.com/files/2181300"], "description"=>"The green (A), blue (B) and red (C) lines correspond to, respectively, a pre-control endemicity of 40%, 60%, and 80% microfilarial prevalence. The solid lines indicate the pre-control contribution of each group to the overall microfilarial load, which is the product of multiplying the microfilarial age- and sex specific profiles (<a href=\"http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003938#pntd.0003938.g003\" target=\"_blank\">Fig 3B</a>) times the proportion of hosts in each demographic stratum, i.e. the proportion of hosts in each age and sex group (<a href=\"http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003938#pntd.0003938.g002\" target=\"_blank\">Fig 2</a>). The sum total of the age- and sex-specific contributions yields the overall mean microfilarial load. The dotted lines correspond to the values after 15 years of vaccination. The shaded area illustrates the reduction in microfilarial load in those aged less than 20 years. Modelling assumptions are as follows: a vaccination programme targeting initially 1–5 year olds with continuous vaccination of one year olds after the first year of the programme; an initial prophylactic efficacy against the development of incoming worms of 50%; an initial therapeutic efficacy against skin microfilarial load of 90%; a mean duration of protective and therapeutic effects of 20 years (rate of decay = 0.05 per year) and an 80% coverage of vaccination.", "links"=>[], "tags"=>["Vaccination Programme BackgroundCurrently", "epi", "onchocerciasis control strategy", "onchocerciasis transmission model", "Onchocerciasis Vaccine", "Onchocerca volvulus infection", "ivermectin", "mda", "Mass Drug Administration", "onchocerciasis disease burden", "EPIONCHO", "5 year olds", "onchocerciasis control programmes"], "article_id"=>1487527, "categories"=>["Biological Sciences"], "users"=>["Hugo C. Turner", "Martin Walker", "Sara Lustigman", "David W. Taylor", "María-Gloria Basáñez"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0003938.g004", "stats"=>{"downloads"=>0, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Long_term_impact_of_vaccination_on_microfilarial_load_in_the_absence_of_ivermectin_treatment_/1487527", "title"=>"Long-term impact of vaccination on microfilarial load in the absence of ivermectin treatment.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-07-17 04:08:06"}
{"files"=>["https://ndownloader.figshare.com/files/2181301"], "description"=>"The green (A), blue (B) and red (C) lines correspond to, respectively, a pre-control endemicity of 40%, 60%, and 80% microfilarial prevalence. The solid line indicates the baseline age-specific contribution to the annual transmission potential (ATP, no. L3/person/year). This is obtained as the product of multiplying the following factors: age- and sex-specific microfilarial loads; proportion of the population within each corresponding demographic stratum; proportion of blackfly bites taken on each demographic stratum (<a href=\"http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003938#pntd.0003938.g003\" target=\"_blank\">Fig 3A</a>); annual biting rate; and the constraining (negative) density-dependent processes, acting on ingested microfilariae within the blackfly vector and on vector survival, that determine L3 output. The dotted lines correspond to the age-specific contributions to the ATP after 15 years of vaccination. The shaded area illustrates the reduction in contribution to transmission by those aged less than 20 years. Modelling assumptions on the initial vaccine efficacy and vaccine duration are as in <a href=\"http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003938#pntd.0003938.g004\" target=\"_blank\">Fig 4</a>. The increasing contribution to ATP by older age groups is mainly due to women for whom microfilarial load and exposure to blackfly bites increases with age (<a href=\"http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003938#pntd.0003938.g003\" target=\"_blank\">Fig 3</a>).", "links"=>[], "tags"=>["Vaccination Programme BackgroundCurrently", "epi", "onchocerciasis control strategy", "onchocerciasis transmission model", "Onchocerciasis Vaccine", "Onchocerca volvulus infection", "ivermectin", "mda", "Mass Drug Administration", "onchocerciasis disease burden", "EPIONCHO", "5 year olds", "onchocerciasis control programmes"], "article_id"=>1487528, "categories"=>["Biological Sciences"], "users"=>["Hugo C. Turner", "Martin Walker", "Sara Lustigman", "David W. Taylor", "María-Gloria Basáñez"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0003938.g005", "stats"=>{"downloads"=>0, "page_views"=>10, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Long_term_impact_of_vaccination_on_the_overall_contribution_to_onwards_transmission_by_age_groups_in_the_host_population_in_absence_of_ivermectin_treatment_/1487528", "title"=>"Long-term impact of vaccination on the overall contribution to onwards transmission by age groups in the host population in absence of ivermectin treatment.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-07-17 04:08:06"}
{"files"=>["https://ndownloader.figshare.com/files/2181299"], "description"=>"(A) The age- and sex-specific exposure profiles to blackfly bites calibrated to reproduce the observed pre-control age-dependent microfilarial loads. (B) The age- and sex-specific microfilarial loads in African savannah settings of northern Cameroon [<a href=\"http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003938#pntd.0003938.ref032\" target=\"_blank\">32</a>]. Note that the fitting was performed using the individual data, not the binned data shown in <a href=\"http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003938#pntd.0003938.g002\" target=\"_blank\">Fig 2B</a>. Note also that the legend on panel (B) applies to both panels (A) and (B).", "links"=>[], "tags"=>["Vaccination Programme BackgroundCurrently", "epi", "onchocerciasis control strategy", "onchocerciasis transmission model", "Onchocerciasis Vaccine", "Onchocerca volvulus infection", "ivermectin", "mda", "Mass Drug Administration", "onchocerciasis disease burden", "EPIONCHO", "5 year olds", "onchocerciasis control programmes"], "article_id"=>1487526, "categories"=>["Biological Sciences"], "users"=>["Hugo C. Turner", "Martin Walker", "Sara Lustigman", "David W. Taylor", "María-Gloria Basáñez"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0003938.g003", "stats"=>{"downloads"=>0, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_EPIONCHO_8217_s_underlying_age_and_sex_specific_exposure_and_baseline_microfilarial_load_profiles_/1487526", "title"=>"EPIONCHO’s underlying age- and sex-specific exposure and baseline microfilarial load profiles.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-07-17 04:08:06"}
{"files"=>["https://ndownloader.figshare.com/files/2181307"], "description"=>"<div>BackgroundCurrently, the predominant onchocerciasis control strategy in Africa is annual mass drug administration (MDA) with ivermectin. However, there is a consensus among the global health community, supported by mathematical modelling, that onchocerciasis in Africa will not be eliminated within proposed time frameworks in all endemic foci with only annual MDA, and novel and alternative strategies are urgently needed. Furthermore, use of MDA with ivermectin is already compromised in large areas of central Africa co-endemic with Loa loa, and there are areas where suboptimal or atypical responses to ivermectin have been documented. An onchocerciasis vaccine would be highly advantageous in these areas.Methodology/Principal FindingsWe used a previously developed onchocerciasis transmission model (EPIONCHO) to investigate the impact of vaccination in areas where loiasis and onchocerciasis are co-endemic and ivermectin is contraindicated. We also explore the potential influence of a vaccination programme on infection resurgence in areas where local elimination has been successfully achieved. Based on the age range included in the Expanded Programme on Immunization (EPI), the vaccine was assumed to target 1 to 5 year olds. Our modelling results indicate that the deployment of an onchocerciasis vaccine would have a beneficial impact in onchocerciasis–loiasis co-endemic areas, markedly reducing microfilarial load in the young (under 20 yr) age groups.Conclusions/SignificanceAn onchocerciasis prophylactic vaccine would reduce the onchocerciasis disease burden in populations where ivermectin cannot be administered safely. Moreover, a vaccine could substantially decrease the chance of re-emergence of Onchocerca volvulus infection in areas where it is deemed that MDA with ivermectin can be stopped. Therefore, a vaccine would protect the substantial investments made by present and past onchocerciasis control programmes, decreasing the chance of disease recrudescence and offering an important additional tool to mitigate the potentially devastating impact of emerging ivermectin resistance.</div>", "links"=>[], "tags"=>["Vaccination Programme BackgroundCurrently", "epi", "onchocerciasis control strategy", "onchocerciasis transmission model", "Onchocerciasis Vaccine", "Onchocerca volvulus infection", "ivermectin", "mda", "Mass Drug Administration", "onchocerciasis disease burden", "EPIONCHO", "5 year olds", "onchocerciasis control programmes"], "article_id"=>1487534, "categories"=>["Biological Sciences"], "users"=>["Hugo C. Turner", "Martin Walker", "Sara Lustigman", "David W. Taylor", "María-Gloria Basáñez"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0003938", "stats"=>{"downloads"=>0, "page_views"=>13, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Human_Onchocerciasis_Modelling_the_Potential_Long_term_Consequences_of_a_Vaccination_Programme_/1487534", "title"=>"Human Onchocerciasis: Modelling the Potential Long-term Consequences of a Vaccination Programme", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2015-07-17 04:08:06"}
{"files"=>["https://ndownloader.figshare.com/files/2181304"], "description"=>"The mean duration of vaccine prophylactic (against incoming L3 larvae) and therapeutic (against microfilariae) activity is 1/the decay rate (i.e. 5, 10, 20 and 50 years). The lower the waning rate, the greater the reduction in incoming worms achieved by the vaccination programme. Other assumptions as in <a href=\"http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003938#pntd.0003938.g004\" target=\"_blank\">Fig 4</a>.", "links"=>[], "tags"=>["Vaccination Programme BackgroundCurrently", "epi", "onchocerciasis control strategy", "onchocerciasis transmission model", "Onchocerciasis Vaccine", "Onchocerca volvulus infection", "ivermectin", "mda", "Mass Drug Administration", "onchocerciasis disease burden", "EPIONCHO", "5 year olds", "onchocerciasis control programmes"], "article_id"=>1487531, "categories"=>["Biological Sciences"], "users"=>["Hugo C. Turner", "Martin Walker", "Sara Lustigman", "David W. Taylor", "María-Gloria Basáñez"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0003938.g008", "stats"=>{"downloads"=>0, "page_views"=>8, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_The_profile_of_protection_against_incoming_worms_after_15_year_of_vaccination_for_different_rates_of_decay_of_vaccine_efficacy_/1487531", "title"=>"The profile of protection against incoming worms after 15 year of vaccination for different rates of decay of vaccine efficacy.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-07-17 04:08:06"}
{"files"=>["https://ndownloader.figshare.com/files/2181303"], "description"=>"The product of multiplying the age-and sex-specific exposure profiles to blackfly bites (<a href=\"http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003938#pntd.0003938.g003\" target=\"_blank\">Fig 3A</a>) times the proportion of hosts in each age and sex group according to the demographic characteristics of the population (<a href=\"http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003938#pntd.0003938.g002\" target=\"_blank\">Fig 2</a>).", "links"=>[], "tags"=>["Vaccination Programme BackgroundCurrently", "epi", "onchocerciasis control strategy", "onchocerciasis transmission model", "Onchocerciasis Vaccine", "Onchocerca volvulus infection", "ivermectin", "mda", "Mass Drug Administration", "onchocerciasis disease burden", "EPIONCHO", "5 year olds", "onchocerciasis control programmes"], "article_id"=>1487530, "categories"=>["Biological Sciences"], "users"=>["Hugo C. Turner", "Martin Walker", "Sara Lustigman", "David W. Taylor", "María-Gloria Basáñez"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0003938.g007", "stats"=>{"downloads"=>1, "page_views"=>11, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Model_predicted_proportion_of_bites_taken_on_each_age_group_/1487530", "title"=>"Model-predicted proportion of bites taken on each age group.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-07-17 04:08:06"}
{"files"=>["https://ndownloader.figshare.com/files/2181298"], "description"=>"(A) Age distribution and (B) Human sex ratio parameterised for savannah settings of northern Cameroon [<a href=\"http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003938#pntd.0003938.ref032\" target=\"_blank\">32</a>,<a href=\"http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003938#pntd.0003938.ref035\" target=\"_blank\">35</a>,<a href=\"http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003938#pntd.0003938.ref036\" target=\"_blank\">36</a>].", "links"=>[], "tags"=>["Vaccination Programme BackgroundCurrently", "epi", "onchocerciasis control strategy", "onchocerciasis transmission model", "Onchocerciasis Vaccine", "Onchocerca volvulus infection", "ivermectin", "mda", "Mass Drug Administration", "onchocerciasis disease burden", "EPIONCHO", "5 year olds", "onchocerciasis control programmes"], "article_id"=>1487525, "categories"=>["Biological Sciences"], "users"=>["Hugo C. Turner", "Martin Walker", "Sara Lustigman", "David W. Taylor", "María-Gloria Basáñez"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0003938.g002", "stats"=>{"downloads"=>2, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_EPIONCHO_8217_s_underlying_demography_/1487525", "title"=>"EPIONCHO’s underlying demography.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-07-17 04:08:06"}
{"files"=>["https://ndownloader.figshare.com/files/2181297"], "description"=>"The red arrows indicate the points in the Onchocerca volvulus lifecycle on which a hypothetical vaccine is assumed to have an effect; namely on parasite establishment and microfilariae.", "links"=>[], "tags"=>["Vaccination Programme BackgroundCurrently", "epi", "onchocerciasis control strategy", "onchocerciasis transmission model", "Onchocerciasis Vaccine", "Onchocerca volvulus infection", "ivermectin", "mda", "Mass Drug Administration", "onchocerciasis disease burden", "EPIONCHO", "5 year olds", "onchocerciasis control programmes"], "article_id"=>1487524, "categories"=>["Biological Sciences"], "users"=>["Hugo C. Turner", "Martin Walker", "Sara Lustigman", "David W. Taylor", "María-Gloria Basáñez"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0003938.g001", "stats"=>{"downloads"=>4, "page_views"=>83, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Schematic_representation_of_EPIONCHO_/1487524", "title"=>"Schematic representation of EPIONCHO.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-07-17 04:08:06"}

PMC Usage Stats 64517 Nov 22:15 UTC

PMC Usage Stats | Further Information

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{"unique-ip"=>"8", "full-text"=>"7", "pdf"=>"2", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"8"}
{"unique-ip"=>"7", "full-text"=>"4", "pdf"=>"2", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"9"}
{"unique-ip"=>"8", "full-text"=>"9", "pdf"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"1", "cited-by"=>"0", "year"=>"2019", "month"=>"10"}

Relative Metric23 Feb 23:21 UTC

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{"start_date"=>"2015-01-01T00:00:00Z", "end_date"=>"2015-12-31T00:00:00Z", "subject_areas"=>[]}

F1000Prime11 Dec 13:07 UTC

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