Nodulectomies :
A Key Step in the EMINENCE Project to Eliminate Onchocerciasis
Understanding Nodulectomies within the EMINENCE Project
The EMINENCE project (Eliminating Onchocerciasis with Moxidectin in Endemic Hotspots of Central Africa) has an ambitious goal: to contribute to the elimination of onchocerciasis in persistent transmission hotspots of Central Africa through the introduction of new moxidectin-based treatment strategies.
Following a first phase of baseline data collection conducted in March 2026 in the health districts of Bafia, Monatélé, Ntui, and Ebebda, the project is entering a new major stage: the nodulectomy and blood sampling campaign, which will take place between April and May 2026.
Following a first phase of baseline data collection conducted in March 2026 in the health districts of Bafia, Monatélé, Ntui, and Ebebda, the project is entering a new major stage: the nodulectomy and blood sampling campaign, which will take place between April and May 2026.
What Is a Nodulectomy?
A nodulectomy is a simple surgical procedure that consists of removing a subcutaneous nodule containing adult Onchocerca volvulus worms, the parasite responsible for onchocerciasis, also known as river blindness.
In infected individuals, adult worms live clustered within these nodules located beneath the skin. They can survive for several years and produce millions of microfilariae that migrate throughout the body and cause the manifestations of the disease, including skin lesions and eye damage.
Performed under local anaesthesia by qualified medical personnel, nodulectomy allows for the safe removal of these adult worms while providing valuable information for scientific research.
In infected individuals, adult worms live clustered within these nodules located beneath the skin. They can survive for several years and produce millions of microfilariae that migrate throughout the body and cause the manifestations of the disease, including skin lesions and eye damage.
Performed under local anaesthesia by qualified medical personnel, nodulectomy allows for the safe removal of these adult worms while providing valuable information for scientific research.
Why Are Nodulectomies Conducted within the EMINENCE Project?
The primary objective of the EMINENCE project is to evaluate the effectiveness of moxidectin, administered once or twice a year, compared with the current standard strategy of Community-Directed Treatment with Ivermectin (CDTI).
While skin examinations allow researchers to measure the presence of microfilariae, nodulectomies provide a unique opportunity to directly study the adult worms contained within the nodules. They therefore constitute an essential parasitological endpoint for assessing the true impact of treatment on the parasite at different stages of its life cycle.
The excised nodules will be preserved according to strict biobanking protocols to enable in-depth laboratory analyses. These analyses will help improve our understanding of parasite biology, its response to treatment, and the mechanisms involved in disease transmission.
At the same time, blood samples will be collected from participants with detectable microfilariae to support immunological, serological, and molecular analyses that will strengthen the scientific foundation of the project.
While skin examinations allow researchers to measure the presence of microfilariae, nodulectomies provide a unique opportunity to directly study the adult worms contained within the nodules. They therefore constitute an essential parasitological endpoint for assessing the true impact of treatment on the parasite at different stages of its life cycle.
The excised nodules will be preserved according to strict biobanking protocols to enable in-depth laboratory analyses. These analyses will help improve our understanding of parasite biology, its response to treatment, and the mechanisms involved in disease transmission.
At the same time, blood samples will be collected from participants with detectable microfilariae to support immunological, serological, and molecular analyses that will strengthen the scientific foundation of the project.
How Are Nodulectomies Performed and Who Is Concerned?
During the baseline survey conducted in March 2026, project teams identified 1,169 individuals with palpable nodules and 927 individuals positive for O. volvulus microfilariae.
Among those carrying nodules, approximately 780 consenting volunteers will undergo nodulectomy procedures.
Each participant will follow a standardized pathway :
- Identification based on lists established during the baseline survey;
- Community information and sensitisation activities;
- Transportation organized by the project to the designated health facility;
- Confirmation of informed consent and pre-operative examination;
- Surgical excision of nodules under local anaesthesia;
- Post-operative care and monitoring; Safe return home;
- Community follow-up through local health facilities.
How Many Nodulectomies Will Be Performed and When?
Before the start of surgical activities, a large-scale community sensitisation campaign will be conducted from 13 to 15 April 2026 across the four participating health districts. This phase will inform communities, administrative and health authorities, and health facility personnel about the upcoming activities.
The nodulectomy and blood sampling campaign will then take place from 20 April to 4 May 2026, over a period of fifteen days. Overall, the project aims to achieve:
The nodulectomy and blood sampling campaign will then take place from 20 April to 4 May 2026, over a period of fifteen days. Overall, the project aims to achieve:
- At least 780 nodulectomies;
- Approximately 930 blood samples collected from microfilaria-positive participants;
- Full coverage of the health districts of Bafia, Monatélé, Ntui, and Ebebda.
What Results Are Expected?
The campaign seeks to achieve several key outcomes:
- The safe completion of at least 780 nodulectomies;
- The collection of approximately 930 blood samples;
- The preservation of all excised nodules in the project biobank;
- The documentation and management of any adverse events or surgical complications;
- The establishment of a valuable repository of biological samples for scientific research.
How Does This Activity Fit into the EMINENCE Project?
The nodulectomy campaign represents the second major field phase of the EMINENCE project, following the baseline survey conducted in March 2026.
It plays a central role in the scientific design of the study. Information obtained from nodules and blood samples will complement the clinical and parasitological data already collected, enabling a more comprehensive evaluation of the treatment strategies under investigation.
Beyond its scientific value, this activity also demonstrates the project's commitment to participating communities. It combines community engagement, medical care, strengthened collaboration with local health facilities, and the generation of scientific evidence that can support the elimination of onchocerciasis.
By generating robust data on the effectiveness of moxidectin in areas where transmission persists, the EMINENCE project will help inform future onchocerciasis control and elimination policies in Central Africa and bring affected countries closer to the goal of eliminating this neglected tropical disease.
It plays a central role in the scientific design of the study. Information obtained from nodules and blood samples will complement the clinical and parasitological data already collected, enabling a more comprehensive evaluation of the treatment strategies under investigation.
Beyond its scientific value, this activity also demonstrates the project's commitment to participating communities. It combines community engagement, medical care, strengthened collaboration with local health facilities, and the generation of scientific evidence that can support the elimination of onchocerciasis.
By generating robust data on the effectiveness of moxidectin in areas where transmission persists, the EMINENCE project will help inform future onchocerciasis control and elimination policies in Central Africa and bring affected countries closer to the goal of eliminating this neglected tropical disease.
About Us
The EMINENCE project is dedicated to eliminating onchocerciasis in Africa through innovative clinical research and the evaluation of moxidectin to enhance disease control and accelerate eradication efforts.
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