Persistent Worms, Cumulative Injury: A Digital Twin Approach to Onchocerciasis

Abstract

Onchocerciasis is a chronic helminth disease in which morbidity accumulates slowly over years through repeated cycles of microfilarial production, immune activation, and tissue injury. Adult worms of Onchocerca volvulus can survive for more than a decade within the human host, while pathology arises primarily from inflammatory responses to dying microfilariae rather than parasite mass itself. Although large-scale ivermectin programmes have reduced transmission and blindness, individual disease trajectories remain highly variable, and cumulative skin, ocular, and neurological damage may persist despite treatment. A digital twin framework for onchocerciasis, defined as a continuously updated virtual representation integrating parasite longevity, treatment cycles, immune responses, and tissue damage, offers a novel approach to modelling lifelong disease burden. By combining longitudinal clinical data, treatment history, immunological markers, and exposure context, such a system could predict disability trajectories, optimise treatment timing, and support precision strategies for morbidity prevention. Here, we describe the conceptual basis, biological architecture, and translational potential of an onchocerciasis digital twin.