{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T06:01:50Z","timestamp":1783490510967,"version":"3.55.0"},"update-to":[{"DOI":"10.1371\/journal.pcbi.1013026","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,5,5]],"date-time":"2025-05-05T00:00:00Z","timestamp":1746403200000}}],"reference-count":54,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T00:00:00Z","timestamp":1745193600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/S502388\/1"],"award-info":[{"award-number":["MR\/S502388\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/X020258\/1"],"award-info":[{"award-number":["MR\/X020258\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-030046"],"award-info":[{"award-number":["INV-030046"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.ploscompbiol.org"],"crossmark-restriction":false},"short-container-title":["PLoS Comput Biol"],"abstract":"<jats:p>The World Health Organization (WHO) has proposed elimination of onchocerciasis transmission (EOT) in a third of endemic countries by 2030. This requires country-wide verification of EOT. Prior to the shift from morbidity control to EOT, interventions in Africa were mostly targeted at moderate- to high-transmission settings, where morbidity was most severe. Consequently, there remain numerous low transmission (hypoendemic) settings which have hitherto not received mass drug administration (MDA) with ivermectin. The WHO has prioritised the delineation of hypoendemic settings to ascertain treatment needs. However, the stability of transmission at such low levels remains poorly understood. We use the stochastic EPIONCHO-IBM transmission model to characterise the stability of transmission dynamics in hypoendemic settings and identify a range of threshold biting rates (TBRs, the annual vector biting rates below which transmission cannot be sustained). We show how TBRs are dependent on population size, inter-individual exposure heterogeneity and simulation time. In contrast with deterministic expectations, there is no fixed TBR; instead, transmission can persist between 70 and 300 bites\/person\/year. Using survivorship models on data generated from model simulations, we find that multiple vector biting rates can sustain hypoendemic prevalence for several decades. These findings challenge the assumption that hypoendemic foci would naturally fade out following treatment in nearby higher-endemicity regions. Our modelling suggests that, to achieve EOT, treatment should be extended to all areas where endogenous infection is identified, emphasising the need for improved diagnostic tools suitable for detecting low-prevalence infection and for strategies that allow safe treatment of communities where MDA would not be suitable.<\/jats:p>","DOI":"10.1371\/journal.pcbi.1013026","type":"journal-article","created":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T17:48:37Z","timestamp":1745257717000},"page":"e1013026","update-policy":"https:\/\/doi.org\/10.1371\/journal.pcbi.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Modelling transmission thresholds and hypoendemic stability for onchocerciasis elimination"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0732-1600","authenticated-orcid":true,"given":"Jacob N.","family":"Stapley","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan I.D.","family":"Hamley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5031-3361","authenticated-orcid":true,"given":"Maria-Gloria","family":"Bas\u00e1\u00f1ez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8714-5365","authenticated-orcid":true,"given":"Martin","family":"Walker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,4,21]]},"reference":[{"issue":"10440","key":"pcbi.1013026.ref001","doi-asserted-by":"crossref","first-page":"2133","DOI":"10.1016\/S0140-6736(24)00757-8","article-title":"Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021","volume":"403","author":"GBD 2021 Diseases and Injuries Collaborators","year":"2024","journal-title":"Lancet"},{"issue":"9112","key":"pcbi.1013026.ref002","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1016\/S0140-6736(97)12450-3","article-title":"Onchocerciasis","volume":"351","author":"G Burnham","year":"1998","journal-title":"Lancet"},{"issue":"11","key":"pcbi.1013026.ref003","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.1016\/S1473-3099(18)30425-0","article-title":"The temporal relationship between onchocerciasis and epilepsy: a population-based cohort study","volume":"18","author":"CB Chesnais","year":"2018","journal-title":"Lancet Infect Dis"},{"issue":"9420","key":"pcbi.1013026.ref004","doi-asserted-by":"crossref","first-page":"1514","DOI":"10.1016\/S0140-6736(04)16151-5","article-title":"Association between microfilarial load and excess mortality in onchocerciasis: an epidemiological study","volume":"363","author":"MP Little","year":"2004","journal-title":"Lancet"},{"issue":"3","key":"pcbi.1013026.ref005","doi-asserted-by":"crossref","first-page":"e1578","DOI":"10.1371\/journal.pntd.0001578","article-title":"Density-dependent mortality of the human host in onchocerciasis: relationships between microfilarial load and excess mortality","volume":"6","author":"M Walker","year":"2012","journal-title":"PLoS Negl Trop Dis"},{"key":"pcbi.1013026.ref006","first-page":"572","article-title":"Elimination of human onchocerciasis: progress report, 2022\u20132023","volume":"98","author":"World Health Organization","year":"2023","journal-title":"Wkly Epidemiol Rec"},{"key":"pcbi.1013026.ref007","author":"World Health Organization","year":"2021"},{"key":"pcbi.1013026.ref008","first-page":"655","article-title":"Les niveaux d\u2019end\u00e9micit\u00e9 dans l\u2019onchocercose","volume":"57","author":"A Prost","year":"1979","journal-title":"Bull World Health Organ"},{"key":"pcbi.1013026.ref009","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1186\/1756-3305-7-325","article-title":"The geographic distribution of onchocerciasis in the 20 participating countries of the African Programme for Onchocerciasis Control: (1) priority areas for ivermectin treatment","volume":"7","author":"M Noma","year":"2014","journal-title":"Parasit Vectors"},{"key":"pcbi.1013026.ref010","author":"World Health Organization","year":"2012"},{"key":"pcbi.1013026.ref011","unstructured":"World Health Organization. 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