Ocular onchocerciasis and intensity of infection in the community. II. West African rainforest foci of the vector Simulium yahense.

A novel method of analysis was used to describe community patterns of ocular onchocerciasis in relation to the intensity of infection in West African forest villages where S. yahense is the sole vector. The pattern is completely different from that found in the savanna, even after correction for the intensity of infection as measured by the Community Microfilarial Load (CMFL). Lesions of the anterior segment of the eye as well as onchocercal blindness either do not occur or occur only sporadically with increasing CMFL in the Yahense forest whilst a steep linear relation exists between the prevalence of these lesions and the CMFL in the savanna. Lesions of the posterior segment of the eye are also less common in the Yahense forest. For a given skin microfilarial load, the ocular microfilarial load is lower in the Yahense forest. For a given ocular microfilarial load, a lower prevalence of eye lesions is found in the Yahense forest compared to the savanna. It is concluded that microfilariae of Onchocerca volvulus in the Yahense forest are less eye invasive than microfilariae from the savanna. Furthermore, they appear to be also less pathogenic to the eye. These findings explain why ocular onchocerciasis is relatively mild in the Yahense forest, in spite of the high intensities of O. volvulus infection in the community.