Nodding syndrome-a new hypothesis and new direction for research

Robert Colebunders, Adam Hendy, Miriam Nanyunja, Joseph Francis Wamala, Marieke van Oijen

Research output: Contribution to journalShort surveypeer-review

31 Scopus citations


Nodding syndrome (NS) is an unexplained neurological illness that mainly affects children aged between 5 and 15 years. NS has so far been reported from South Sudan, northern Uganda, and Tanzania, but in spite of extensive investigations, the aetiology remains unknown. We hypothesize that blackflies (Diptera: Simuliidae) infected with Onchocerca volvulus microfilariae may also transmit another pathogen. This may be a novel neurotropic virus or an endosymbiont of the microfilariae, which causes not only NS, but also epilepsy without nodding. This hypothesis addresses many of the questions about NS that researchers have previously been unable to answer. An argument in favour of the hypothesis is the fact that in Uganda, the number of new NS cases decreased (with no new cases reported since 2013) after ivermectin coverage was increased and with the implementation of a programme of aerial spraying and larviciding of the large rivers where blackflies were breeding. If confirmed, our hypothesis will enable new strategies to control NS outbreaks.

Original languageEnglish (US)
Pages (from-to)74-77
Number of pages4
JournalInternational Journal of Infectious Diseases
StatePublished - Oct 1 2014
Externally publishedYes


  • Blackflies
  • Epilepsy
  • Nodding syndrome
  • Onchocerca volvulus
  • Onchocerciasis
  • South Sudan
  • Tanzania
  • Uganda

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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