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Sankari T, Subramanian S, Hoti SL, Pani SP, Jambulingam P, Das PK. Heterogeneous response of Wuchereria bancrofti-infected persons to diethylcarbamazine (DEC) and its implications for the Global Programme to Eliminate Lymphatic Filariasis (GPELF). Parasitol Res 2020; 120:311-319. [PMID: 33146778 DOI: 10.1007/s00436-020-06950-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Abstract
DEC or ivermectin (IVM) in combination with albendazole (ALB) has been the recommended strategy of the Global Programme to Eliminate Lymphatic Filariasis (GPELF) since 2000. Despite effective population coverage (> 65%) with several rounds of MDA with DEC or combination of DEC plus ALB, microfilariae persist in few individuals and they continue to be the source of infection for transmitting LF. We report an individual's variability in response to DEC by defining the response as complete absence of microfilaria (mf) (post-treatment mf count = 0) and non-response as presence of mf (post-treatment mf count ≥ 1). We analyzed follow-up data on individual's response to treatment from two randomized clinical trials in which 46 microfilaremic individuals were treated with single-dose DEC (6 mg/kg body weight). They were classified into low, medium, and high mf density categories based on their pre-treatment mf counts. Of the 46 individuals, 65.2% have not responded throughout the 12-month post-treatment period. Application of a logistic regression model with fixed (age, gender, mf density, post-treatment time, and their interactions) and random (individual's response over time) effects indicated that treatment response is independent of age, gender, and time. The overall treatment response increases in low and decreases in high mf density categories. Furthermore, the estimates for the random coefficients model showed that there is a greater variability in response between individuals over post-treatment time. The results substantiate that individual variation in response to DEC exists which indicate the importance of studying the parasite as well as host genetic factors associated with DEC action.
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Affiliation(s)
- Thirumal Sankari
- ICMR-Vector Control Research Centre, Medical Complex, Indira Nagar, Pondicherry, 605006, India
| | - Swaminathan Subramanian
- ICMR-Vector Control Research Centre, Medical Complex, Indira Nagar, Pondicherry, 605006, India.
| | - Subhash L Hoti
- ICMR-National Institute of Traditional Medicine, Nehru Nagar, National Highway No. 4, Belagavi, Karnataka, 590010, India
| | - Subhada P Pani
- Faculty of Medicine, Quest International University Perak, Ipoh, Malaysia
| | | | - Pradeep K Das
- ICMR-Vector Control Research Centre, Medical Complex, Indira Nagar, Pondicherry, 605006, India
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da Silva JSF, Braga C, Duarte FM, Oliveira P, Feitosa Luna C, Marcondes M, Araújo J, Grilis MR, de Souza Melo PFA, Brandão E, Rocha A. Effectiveness of annual single doses of diethylcarbamazine citrate among bancroftian filariasis infected individuals in an endemic area under mass drug administration in Brazil. Pathog Glob Health 2018; 112:274-280. [PMID: 30111259 PMCID: PMC6225505 DOI: 10.1080/20477724.2018.1498821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
The Global Program to Eliminate Lymphatic Filariasis has achieved extraordinary success in reducing transmission and preventing morbidity through mass drug administration (MDA) to the population at-risk. Brazil is the only currently using diethylcarbamazine citrate (DEC) alone for MDA, so an assessment of its effectiveness is needed. We report the trends of filarial markers in a cohort of 175 individuals infected with Wuchereria bancrofti in areas that underwent MDA in the city of Olinda, Northeastern Brazil. The prospective study was conducted between 2007 and 2012 (corresponding to five annual MDA rounds). The quantification of microfilaraemia (QMFF) was assessed by filtration. Circulating filarial antigen (CFA) was detected through immunochromatographic point-of-care test (POCT-ICT) and Og4C3-ELISA whereas antifilarial antibody titres (IgG4) were assessed through Bm14 assay. The CFA and IgG4 titres were measured by Optical Density (OD). The main characteristics at baseline, MDA coverage and the trend of filarial infection markers during follow up were described. The trend of filarial markers in relation to time (years of MDA), sex and age were analysed through Generalized Estimating Equations (GEE) models. The models demonstrated a significant decrease in all markers during MDA. The probability of remaining positive by QMFF and POCT-ICT diminished 70% and 46%, respectively, after each MDA round. There was a significant annual drop in CFA (-0.290 OD) and IgG4 antibodies titres (-0.303 OD). This study provides evidence that MDA with DEC alone can be effective in the elimination of LF in Brazil.
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Affiliation(s)
- Jennifer S. F. da Silva
- Oswaldo Cruz Fundation, Aggeu Magalhães Institute, National Center of Lymphatic Filariasis, Recife, Pernambuco, Brazil
| | - Cynthia Braga
- Oswaldo Cruz Fundation, Aggeu Magalhães Institute, National Center of Lymphatic Filariasis, Recife, Pernambuco, Brazil
| | | | - Paula Oliveira
- Oswaldo Cruz Fundation, Aggeu Magalhães Institute, National Center of Lymphatic Filariasis, Recife, Pernambuco, Brazil
| | - Carlos Feitosa Luna
- Oswaldo Cruz Fundation, Aggeu Magalhães Institute, National Center of Lymphatic Filariasis, Recife, Pernambuco, Brazil
| | - Márcia Marcondes
- Municipal Health Secretariat of Recife, Recife, Pernambuco, Brazil
| | - Josué Araújo
- Oswaldo Cruz Fundation, Aggeu Magalhães Institute, National Center of Lymphatic Filariasis, Recife, Pernambuco, Brazil
| | - Maria Rosangela Grilis
- Oswaldo Cruz Fundation, Aggeu Magalhães Institute, National Center of Lymphatic Filariasis, Recife, Pernambuco, Brazil
| | | | - Eduardo Brandão
- Oswaldo Cruz Fundation, Aggeu Magalhães Institute, National Center of Lymphatic Filariasis, Recife, Pernambuco, Brazil
| | - Abraham Rocha
- Oswaldo Cruz Fundation, Aggeu Magalhães Institute, National Center of Lymphatic Filariasis, Recife, Pernambuco, Brazil
- Laboratory of the Hospital Otávio de Freitas, Recife, Pernambuco, Brazil
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Win KM, Tripathy JP, Maung TM, Oo T, Thi A, Lon KN, Lin Z. Rapid progress towards elimination of lymphatic filariasis in endemic regions of Myanmar as a result of 16 years of anti-filarial activities (2001-2016). Trop Med Health 2018; 46:14. [PMID: 29720887 PMCID: PMC5916724 DOI: 10.1186/s41182-018-0093-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/22/2018] [Indexed: 11/10/2022] Open
Abstract
Background As Myanmar progresses towards lymphatic filariasis (LF) elimination, it is important to know how well the anti-filarial activities have performed. The present study was conducted to study the implementation of the key anti-filarial activities and their impact on key indicators of LF transmission. Methods A secondary analysis of aggregate program data on the anti-filarial activities was conducted in four endemic state/regions of Myanmar receiving at least six mass drug administration (MDA) rounds during 2001-2016. Results MDA coverage has been expanded to cover all the endemic implementation units (IUs), i.e., 45 by 2015 and 6 IUs out of them have already stopped MDA. The reported coverage of MDA ranges from 87 to 100% whereas surveyed coverage ranges from 78 to 100% among the eligible population. The prevalence of microfilaria has significantly declined especially in Magway from 4.7 to 0.2% and Sagaing region from 7.9 to 1.3% during 2001-2016. Around 2.5% of estimated cases of hydrocele were reported to the program during 2009-2014. Conclusion Myanmar has achieved significant success in interrupting LF transmission through several MDA rounds with high coverage. However, morbidity reporting and management, being in its initial phase requires an active surveillance system for identifying and managing people with LF-associated morbidities under the program.
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Affiliation(s)
- Kyawt Mon Win
- Vector Borne Diseases Control Program, Ministry of Health and Sports, Naypyitaw, Myanmar
| | - Jaya Prasad Tripathy
- 2International Union Against Tuberculosis and Lung Disease, The Union South-East Asia Regional Office, New Delhi, India
| | - Thae Maung Maung
- 3Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Tin Oo
- 3Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Aung Thi
- Vector Borne Diseases Control Program, Ministry of Health and Sports, Naypyitaw, Myanmar
| | - Khin Nan Lon
- 4Yangon Regional Public Health Department, Department of Public Health, Ministry of Health and Sports, Yangon, Myanmar
| | - Zaw Lin
- Vector Borne Diseases Control Program, Ministry of Health and Sports, Naypyitaw, Myanmar
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Chand G, Kaushal LS, Choudhari NK, Singh N. Mapping is a prerequisite for elimination of filariasis and effective targeting of filarial 'hot spots'. Pathog Glob Health 2016; 110:157-63. [PMID: 27413817 DOI: 10.1080/20477724.2016.1205302] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE This study was undertaken to determine the prevalence of filarial infection in the districts of Madhya Pradesh, which were classified as non-endemic by the national program for control of filariasis. These districts showed evidence of clinical symptoms related to filariasis. To confirm the presence of filariasis, night blood surveys and entomological surveys were carried out to detect microfilaria in humans and filarial infection in vectors. MATERIALS AND METHODS For microfilaria surveys, thick blood smears were prepared by taking 60 μL of blood between 8.00 and 11.00 pm and examined under a microscope. Vectors Culex quinquefasciatus were dissected for the filarial infection from the affected villages of four non-endemic districts. RESULTS Prevalence of microfilaria in the four districts ranged from 3.8% in district Shivpuri to 11.2% in district Bhind (overall mf rate 6.9%, 95% CI = 6.2-7.7). Infection and infectivity rates among vectors were recorded from three districts which varied from 2 to 13% and from 1.3 to 3.6%. CONCLUSION The study confirmed the presence of circulating microfilaria in non-endemic population of four districts, which has significant public health implications. To assess filarial endemicity and hot spots, precise filarial risk mapping using new efficient diagnostic tools is needed to reinforce and extend the strategy in other areas to achieve elimination of lymphatic filariasis.
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Affiliation(s)
- Gyan Chand
- a Department of Public Health Entomology , National Institute for Research in Tribal Health (ICMR) , Jabalpur , India
| | - Laxman Singh Kaushal
- a Department of Public Health Entomology , National Institute for Research in Tribal Health (ICMR) , Jabalpur , India
| | - Narendra Kumar Choudhari
- a Department of Public Health Entomology , National Institute for Research in Tribal Health (ICMR) , Jabalpur , India
| | - Neeru Singh
- b Department of Epidemiology and Vector Control , National Institute for Research in Tribal Health (ICMR) , Jabalpur , India
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Zakai HA, Khan W. Effects of filaricidal drugs on longevity and enzyme activities of the microfilariae of Setaria cervi in white rats. Asian Pac J Trop Biomed 2015. [DOI: 10.1016/j.apjtb.2015.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Coulibaly YI, Dembele B, Diallo AA, Konaté S, Dolo H, Coulibaly SY, Doumbia SS, Soumaoro L, Coulibaly ME, Bockarie MJ, Molyneux D, Nutman TB, Klion AD, Toure YT, Traore SF. The Impact of Six Annual Rounds of Mass Drug Administration on Wuchereria bancrofti Infections in Humans and in Mosquitoes in Mali. Am J Trop Med Hyg 2015; 93:356-60. [PMID: 26033027 PMCID: PMC4530761 DOI: 10.4269/ajtmh.14-0516] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 02/16/2015] [Indexed: 11/07/2022] Open
Abstract
Wuchereria bancrofti prevalence and transmission were assessed in six endemic villages in Sikasso, Mali prior to and yearly during mass drug administration (MDA) with albendazole and ivermectin from 2002 to 2007. Microfilaremia was determined by calibrated thick smear of night blood in adult volunteers and circulating filarial antigen was measured using immunochromatographic card test in children < 5 years of age. Mosquitoes were collected by human landing catch from July to December. None of the 686 subjects tested were microfilaremic 12 months after the sixth MDA round. More importantly, circulating antigen was not detected in any of the 120 children tested, as compared with 53% (103/194) before the institution of MDA. The number of infective bites/human/year decreased from 4.8 in 2002 to 0.04 in 2007, and only one mosquito containing a single infective larva was observed 12 months after the final MDA round. Whether this dramatic reduction in transmission will be sustained following cessation of MDA remains to be seen.
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Affiliation(s)
- Yaya I Coulibaly
- International Center of Excellence in Research (ICER-Mali), Filariasis Research and Training Unit, Bamako, Mali; University of Liverpool, Liverpool Liverpool School of Tropical Medicine, Centre for Neglected Tropical Diseases, Liverpool, United Kingdom; University of Liverpool, Liverpool Liverpool School of Tropical Medicine, Centre for Neglected Tropical Diseases, Liverpool, United Kingdom; National Institutes of Health, Laboratory of Parasitic Diseases, Helminth Immunology Section, Bethesda, Maryland; National Institutes of Health, Laboratory of Parasitic Diseases, Eosinophil Pathology Section, Bethesda, Maryland; World Health Organization, Vectors, Environment and Society Research, Geneva, Switzerland
| | - Benoit Dembele
- International Center of Excellence in Research (ICER-Mali), Filariasis Research and Training Unit, Bamako, Mali; University of Liverpool, Liverpool Liverpool School of Tropical Medicine, Centre for Neglected Tropical Diseases, Liverpool, United Kingdom; University of Liverpool, Liverpool Liverpool School of Tropical Medicine, Centre for Neglected Tropical Diseases, Liverpool, United Kingdom; National Institutes of Health, Laboratory of Parasitic Diseases, Helminth Immunology Section, Bethesda, Maryland; National Institutes of Health, Laboratory of Parasitic Diseases, Eosinophil Pathology Section, Bethesda, Maryland; World Health Organization, Vectors, Environment and Society Research, Geneva, Switzerland
| | - Abdallah Amadou Diallo
- International Center of Excellence in Research (ICER-Mali), Filariasis Research and Training Unit, Bamako, Mali; University of Liverpool, Liverpool Liverpool School of Tropical Medicine, Centre for Neglected Tropical Diseases, Liverpool, United Kingdom; University of Liverpool, Liverpool Liverpool School of Tropical Medicine, Centre for Neglected Tropical Diseases, Liverpool, United Kingdom; National Institutes of Health, Laboratory of Parasitic Diseases, Helminth Immunology Section, Bethesda, Maryland; National Institutes of Health, Laboratory of Parasitic Diseases, Eosinophil Pathology Section, Bethesda, Maryland; World Health Organization, Vectors, Environment and Society Research, Geneva, Switzerland
| | - Siaka Konaté
- International Center of Excellence in Research (ICER-Mali), Filariasis Research and Training Unit, Bamako, Mali; University of Liverpool, Liverpool Liverpool School of Tropical Medicine, Centre for Neglected Tropical Diseases, Liverpool, United Kingdom; University of Liverpool, Liverpool Liverpool School of Tropical Medicine, Centre for Neglected Tropical Diseases, Liverpool, United Kingdom; National Institutes of Health, Laboratory of Parasitic Diseases, Helminth Immunology Section, Bethesda, Maryland; National Institutes of Health, Laboratory of Parasitic Diseases, Eosinophil Pathology Section, Bethesda, Maryland; World Health Organization, Vectors, Environment and Society Research, Geneva, Switzerland
| | - Houseini Dolo
- International Center of Excellence in Research (ICER-Mali), Filariasis Research and Training Unit, Bamako, Mali; University of Liverpool, Liverpool Liverpool School of Tropical Medicine, Centre for Neglected Tropical Diseases, Liverpool, United Kingdom; University of Liverpool, Liverpool Liverpool School of Tropical Medicine, Centre for Neglected Tropical Diseases, Liverpool, United Kingdom; National Institutes of Health, Laboratory of Parasitic Diseases, Helminth Immunology Section, Bethesda, Maryland; National Institutes of Health, Laboratory of Parasitic Diseases, Eosinophil Pathology Section, Bethesda, Maryland; World Health Organization, Vectors, Environment and Society Research, Geneva, Switzerland
| | - Siaka Yamoussa Coulibaly
- International Center of Excellence in Research (ICER-Mali), Filariasis Research and Training Unit, Bamako, Mali; University of Liverpool, Liverpool Liverpool School of Tropical Medicine, Centre for Neglected Tropical Diseases, Liverpool, United Kingdom; University of Liverpool, Liverpool Liverpool School of Tropical Medicine, Centre for Neglected Tropical Diseases, Liverpool, United Kingdom; National Institutes of Health, Laboratory of Parasitic Diseases, Helminth Immunology Section, Bethesda, Maryland; National Institutes of Health, Laboratory of Parasitic Diseases, Eosinophil Pathology Section, Bethesda, Maryland; World Health Organization, Vectors, Environment and Society Research, Geneva, Switzerland
| | - Salif Seriba Doumbia
- International Center of Excellence in Research (ICER-Mali), Filariasis Research and Training Unit, Bamako, Mali; University of Liverpool, Liverpool Liverpool School of Tropical Medicine, Centre for Neglected Tropical Diseases, Liverpool, United Kingdom; University of Liverpool, Liverpool Liverpool School of Tropical Medicine, Centre for Neglected Tropical Diseases, Liverpool, United Kingdom; National Institutes of Health, Laboratory of Parasitic Diseases, Helminth Immunology Section, Bethesda, Maryland; National Institutes of Health, Laboratory of Parasitic Diseases, Eosinophil Pathology Section, Bethesda, Maryland; World Health Organization, Vectors, Environment and Society Research, Geneva, Switzerland
| | - Lamine Soumaoro
- International Center of Excellence in Research (ICER-Mali), Filariasis Research and Training Unit, Bamako, Mali; University of Liverpool, Liverpool Liverpool School of Tropical Medicine, Centre for Neglected Tropical Diseases, Liverpool, United Kingdom; University of Liverpool, Liverpool Liverpool School of Tropical Medicine, Centre for Neglected Tropical Diseases, Liverpool, United Kingdom; National Institutes of Health, Laboratory of Parasitic Diseases, Helminth Immunology Section, Bethesda, Maryland; National Institutes of Health, Laboratory of Parasitic Diseases, Eosinophil Pathology Section, Bethesda, Maryland; World Health Organization, Vectors, Environment and Society Research, Geneva, Switzerland
| | - Michel Emmanuel Coulibaly
- International Center of Excellence in Research (ICER-Mali), Filariasis Research and Training Unit, Bamako, Mali; University of Liverpool, Liverpool Liverpool School of Tropical Medicine, Centre for Neglected Tropical Diseases, Liverpool, United Kingdom; University of Liverpool, Liverpool Liverpool School of Tropical Medicine, Centre for Neglected Tropical Diseases, Liverpool, United Kingdom; National Institutes of Health, Laboratory of Parasitic Diseases, Helminth Immunology Section, Bethesda, Maryland; National Institutes of Health, Laboratory of Parasitic Diseases, Eosinophil Pathology Section, Bethesda, Maryland; World Health Organization, Vectors, Environment and Society Research, Geneva, Switzerland
| | - Moses J Bockarie
- International Center of Excellence in Research (ICER-Mali), Filariasis Research and Training Unit, Bamako, Mali; University of Liverpool, Liverpool Liverpool School of Tropical Medicine, Centre for Neglected Tropical Diseases, Liverpool, United Kingdom; University of Liverpool, Liverpool Liverpool School of Tropical Medicine, Centre for Neglected Tropical Diseases, Liverpool, United Kingdom; National Institutes of Health, Laboratory of Parasitic Diseases, Helminth Immunology Section, Bethesda, Maryland; National Institutes of Health, Laboratory of Parasitic Diseases, Eosinophil Pathology Section, Bethesda, Maryland; World Health Organization, Vectors, Environment and Society Research, Geneva, Switzerland
| | - David Molyneux
- International Center of Excellence in Research (ICER-Mali), Filariasis Research and Training Unit, Bamako, Mali; University of Liverpool, Liverpool Liverpool School of Tropical Medicine, Centre for Neglected Tropical Diseases, Liverpool, United Kingdom; University of Liverpool, Liverpool Liverpool School of Tropical Medicine, Centre for Neglected Tropical Diseases, Liverpool, United Kingdom; National Institutes of Health, Laboratory of Parasitic Diseases, Helminth Immunology Section, Bethesda, Maryland; National Institutes of Health, Laboratory of Parasitic Diseases, Eosinophil Pathology Section, Bethesda, Maryland; World Health Organization, Vectors, Environment and Society Research, Geneva, Switzerland
| | - Thomas B Nutman
- International Center of Excellence in Research (ICER-Mali), Filariasis Research and Training Unit, Bamako, Mali; University of Liverpool, Liverpool Liverpool School of Tropical Medicine, Centre for Neglected Tropical Diseases, Liverpool, United Kingdom; University of Liverpool, Liverpool Liverpool School of Tropical Medicine, Centre for Neglected Tropical Diseases, Liverpool, United Kingdom; National Institutes of Health, Laboratory of Parasitic Diseases, Helminth Immunology Section, Bethesda, Maryland; National Institutes of Health, Laboratory of Parasitic Diseases, Eosinophil Pathology Section, Bethesda, Maryland; World Health Organization, Vectors, Environment and Society Research, Geneva, Switzerland
| | - Amy D Klion
- International Center of Excellence in Research (ICER-Mali), Filariasis Research and Training Unit, Bamako, Mali; University of Liverpool, Liverpool Liverpool School of Tropical Medicine, Centre for Neglected Tropical Diseases, Liverpool, United Kingdom; University of Liverpool, Liverpool Liverpool School of Tropical Medicine, Centre for Neglected Tropical Diseases, Liverpool, United Kingdom; National Institutes of Health, Laboratory of Parasitic Diseases, Helminth Immunology Section, Bethesda, Maryland; National Institutes of Health, Laboratory of Parasitic Diseases, Eosinophil Pathology Section, Bethesda, Maryland; World Health Organization, Vectors, Environment and Society Research, Geneva, Switzerland
| | - Yeya T Toure
- International Center of Excellence in Research (ICER-Mali), Filariasis Research and Training Unit, Bamako, Mali; University of Liverpool, Liverpool Liverpool School of Tropical Medicine, Centre for Neglected Tropical Diseases, Liverpool, United Kingdom; University of Liverpool, Liverpool Liverpool School of Tropical Medicine, Centre for Neglected Tropical Diseases, Liverpool, United Kingdom; National Institutes of Health, Laboratory of Parasitic Diseases, Helminth Immunology Section, Bethesda, Maryland; National Institutes of Health, Laboratory of Parasitic Diseases, Eosinophil Pathology Section, Bethesda, Maryland; World Health Organization, Vectors, Environment and Society Research, Geneva, Switzerland
| | - Sekou F Traore
- International Center of Excellence in Research (ICER-Mali), Filariasis Research and Training Unit, Bamako, Mali; University of Liverpool, Liverpool Liverpool School of Tropical Medicine, Centre for Neglected Tropical Diseases, Liverpool, United Kingdom; University of Liverpool, Liverpool Liverpool School of Tropical Medicine, Centre for Neglected Tropical Diseases, Liverpool, United Kingdom; National Institutes of Health, Laboratory of Parasitic Diseases, Helminth Immunology Section, Bethesda, Maryland; National Institutes of Health, Laboratory of Parasitic Diseases, Eosinophil Pathology Section, Bethesda, Maryland; World Health Organization, Vectors, Environment and Society Research, Geneva, Switzerland
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Simonsen PE, Derua YA, Magesa SM, Pedersen EM, Stensgaard AS, Malecela MN, Kisinza WN. Lymphatic filariasis control in Tanga Region, Tanzania: status after eight rounds of mass drug administration. Parasit Vectors 2014; 7:507. [PMID: 25387483 PMCID: PMC4233105 DOI: 10.1186/s13071-014-0507-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 10/28/2014] [Indexed: 11/13/2022] Open
Abstract
Background Lymphatic filariasis (LF) control started in Tanga Region of Tanzania in 2004, with annual ivermectin/albendazole mass drug administration (MDA). Since then, the current project has monitored the effect in communities and schools in rural areas of Tanga District. In 2013, after 8 rounds of MDA, spot check surveys were added in the other 7 districts of Tanga Region, to assess the regional LF status. Methods LF vector and transmission surveillance, and human cross sectional surveys in communities and schools, continued in Tanga District as previously reported. In each of the other 7 districts, 2–3 spot check sites were selected and about 200 schoolchildren were examined for circulating filarial antigens (CFA). At 1–2 of the sites in each district, additional about 200 community volunteers were examined for CFA and chronic LF disease, and the CFA positives were re-examined for microfilariae (mf). Results The downward trend in LF transmission and human infection previously reported for Tanga District continued, with prevalences after MDA 8 reaching 15.5% and 3.5% for CFA and mf in communities (decrease by 75.5% and 89.6% from baseline) and 2.3% for CFA in schoolchildren (decrease by 90.9% from baseline). Surprisingly, the prevalence of chronic LF morbidity after MDA 8 was less than half of baseline records. No infective vector mosquitoes were detected after MDA 7. Spot checks in the other districts after MDA 8 showed relatively high LF burdens in the coastal districts. LF burdens gradually decreased when moving to districts further inland and with higher altitudes. Conclusion LF was still widespread in many parts of Tanga Region after MDA 8, in particular in the coastal areas. This calls for intensified control, which should include increased MDA treatment coverage, strengthening of bed net usage, and more male focus in LF health information dissemination. The low LF burdens observed in some inland districts suggest that MDA in these could be stepped down to provide more resources for upscale of control in the coastal areas. Monitoring should continue to guide the programme to ensure that the current major achievements will ultimately lead to successful LF elimination.
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Affiliation(s)
- Paul E Simonsen
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlægevej 100, 1870, Frederiksberg C, Denmark.
| | - Yahya A Derua
- National Institute for Medical Research, Amani Medical Research Centre, P.O. Box 81, Muheza, Tanzania.
| | - Stephen M Magesa
- RTI International, Global Health Division, Dar es Salaam, Tanzania.
| | - Erling M Pedersen
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlægevej 100, 1870, Frederiksberg C, Denmark.
| | - Anna-Sofie Stensgaard
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlægevej 100, 1870, Frederiksberg C, Denmark. .,Center for Macroecology, Evolution and Climate, Natural History Museum of Denmark, University of Copenhagen, Universitetsparken 15, 2100, Copenhagen Ø, Denmark.
| | - Mwelecele N Malecela
- National Institute for Medical Research, P.O. Box 9653, Dar es Salaam, Tanzania.
| | - William N Kisinza
- National Institute for Medical Research, Amani Medical Research Centre, P.O. Box 81, Muheza, Tanzania.
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Ramaiah KD, Ottesen EA. Progress and impact of 13 years of the global programme to eliminate lymphatic filariasis on reducing the burden of filarial disease. PLoS Negl Trop Dis 2014; 8:e3319. [PMID: 25412180 PMCID: PMC4239120 DOI: 10.1371/journal.pntd.0003319] [Citation(s) in RCA: 204] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 10/06/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A Global Programme to Eliminate Lymphatic Filariasis was launched in 2000, with mass drug administration (MDA) as the core strategy of the programme. After completing 13 years of operations through 2012 and with MDA in place in 55 of 73 endemic countries, the impact of the MDA programme on microfilaraemia, hydrocele and lymphedema is in need of being assessed. METHODOLOGY/PRINCIPAL FINDINGS During 2000-2012, the MDA programme made remarkable achievements - a total of 6.37 billion treatments were offered and an estimated 4.45 billion treatments were consumed by the population living in endemic areas. Using a model based on empirical observations of the effects of treatment on clinical manifestations, it is estimated that 96.71 million LF cases, including 79.20 million microfilaria carriers, 18.73 million hydrocele cases and a minimum of 5.49 million lymphedema cases have been prevented or cured during this period. Consequently, the global prevalence of LF is calculated to have fallen by 59%, from 3.55% to 1.47%. The fall was highest for microfilaraemia prevalence (68%), followed by 49% in hydrocele prevalence and 25% in lymphedema prevalence. It is estimated that, currently, i.e. after 13 years of the MDA programme, there are still an estimated 67.88 million LF cases that include 36.45 million microfilaria carriers, 19.43 million hydrocele cases and 16.68 million lymphedema cases. CONCLUSIONS/SIGNIFICANCE The MDA programme has resulted in significant reduction of the LF burden. Extension of MDA to all at-risk countries and to all regions within those countries where MDA has not yet reached 100% geographic coverage is imperative to further reduce the number of microfilaraemia and chronic disease cases and to reach the global target of interrupting transmission of LF by 2020.
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Affiliation(s)
- K. D. Ramaiah
- Consultant on Lymphatic Filariasis, Tagore Nagar, Pondicherry, India
| | - Eric A. Ottesen
- Neglected Tropical Disease Support Center, The Task Force for Global Health, Decatur, Georgia, United States of America
- ENVISION Project, RTI International, Washington, D.C., United States of America
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Simonsen PE, Derua YA, Kisinza WN, Magesa SM, Malecela MN, Pedersen EM. Lymphatic filariasis control in Tanzania: effect of six rounds of mass drug administration with ivermectin and albendazole on infection and transmission. BMC Infect Dis 2013; 13:335. [PMID: 23870103 PMCID: PMC3723586 DOI: 10.1186/1471-2334-13-335] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 07/17/2013] [Indexed: 12/03/2022] Open
Abstract
Background Control of lymphatic filariasis (LF) in most countries of sub-Saharan Africa is based on annual mass drug administration (MDA) with a combination of ivermectin and albendazole, in order to interrupt transmission. We present findings from a detailed study on the effect of six rounds of MDA with this drug combination as implemented by the National Lymphatic Filariasis Elimination Programme (NLFEP) in a highly endemic rural area of north-eastern Tanzania. Methods The effect of treatment on transmission and human infection was monitored in a community- and a school-based study during an 8-year period (one pre-intervention and 7 post-intervention years) from 2003 to 2011. Results Before intervention, 24.5% of the community population had microfilariae (mf) in the blood, 53.3% had circulating filarial antigens (CFA) and 78.9% had specific antibodies to the recombinant filarial antigen Bm14. One year after the sixth MDA, these values had decreased considerably to 2.7%, 19.6% and 27.5%, respectively. During the same period, the CFA prevalence among new intakes of Standard 1 pupils in 10 primary schools decreased from 25.2% to 5.6%. In line with this, transmission by the three vectors (Anopheles gambiae, An. funestus and Culex quinquefasciatus) as determined by dissection declined sharply (overall vector infectivity rate by 99.3% and mean monthly transmission potential by 99.2% between pre-intervention and fifth post-intervention period). A major shift in vector species composition, from predominantly anopheline to almost exclusively culicine was observed over the years. This may be largely unrelated to the MDAs but may have important implications for the epidemiology of LF in the area. Conclusions Six MDAs caused considerable decrease in all the measured indices for transmission and human infection. In spite of this, indices were still relatively high in the late period of the study, and it may take a long time to reach the recommended cut-off levels for interruption of transmission unless extra efforts are made. These should include increased engagement of the target population in the control activities, to ensure higher treatment coverage. It is expected that the recent initiative to distribute insecticide impregnated bed nets to every household in the area will also contribute towards reaching the goal of successful LF elimination.
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Affiliation(s)
- Paul E Simonsen
- DBL - Centre for Health Research and Development, Faculty of Health and Medical Sciences, University of Copenhagen, Thorvaldsensvej 57, 1871 Frederiksberg C, Denmark.
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Chand G, Barde PV, Singh N. Emergence of new foci of filariasis in Madhya Pradesh, India. Trans R Soc Trop Med Hyg 2013; 107:462-4. [PMID: 23687107 DOI: 10.1093/trstmh/trt040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Lymphatic filariasis is a major vector-borne disease and India bears 81% of the filariasis burden in South East Asia. Screening and mass drug administration is carried out in 11 known endemic districts of Madhya Pradesh. However, regular monitoring is not carried out in non-endemic areas. METHODS Cross sectional surveys were carried out to examine blood samples for filariasis. Entomological surveys were conducted for infective mosquitoes. RESULTS Altogether, 24 of 252 samples were positive for filariasis with a mean microfilaria count of 0.8. The entomological investigations showed 7.4% infection and 1.4 % infectivity rates in vectors. CONCLUSION This study reveals the emergence of new foci of lymphatic filariasis in Madhya Pradesh. We conclude that filariasis surveys should be carried out in non-endemic areas of India to achieve the goal of elimination.
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Affiliation(s)
- Gyan Chand
- Regional Medical Research Centre for Tribals, ICMR, Nagpur Road, Jabalpur 482003, Madhya Pradesh, India
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Abstract
Human population migration is a common phenomenon in developing countries. Four categories of migration—endemic to nonendemic areas, rural to urban areas, non-MDA areas to areas that achieved lymphatic filariasis (LF) control/elimination, and across borders—are relevant to LF elimination efforts. In many situations, migrants from endemic areas may not be able to establish active transmission foci and cause infection in local people in known nonendemic areas or countries. Urban areas are at risk of a steady inflow of LF-infected people from rural areas, necessitating prolonged intervention measures or leading to a prolonged “residual microfilaraemia phase.” Migration-facilitated reestablishment of transmission in areas that achieved significant control or elimination of LF appears to be difficult, but such risk can not be excluded, particularly in areas with efficient vector-parasite combination. Transborder migration poses significant problems in some countries. Listing of destinations, in endemic and nonendemic regions/countries, and formulation of guidelines for monitoring the settlements and the infection status of migrants can strengthen the LF elimination efforts.
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Affiliation(s)
- K D Ramaiah
- Vector Control Research Centre (ICMR), Medical Complex, Indira Nagar, Pondicherry, India.
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Ramaiah KD, Vanamail P. Surveillance of lymphatic filariasis after stopping ten years of mass drug administration in rural communities in south India. Trans R Soc Trop Med Hyg 2013; 107:293-300. [PMID: 23442572 DOI: 10.1093/trstmh/trt011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND While various studies provided insight into the impact of mass drug administration (MDA), information on the dynamics of the post-MDA threshold level lymphatic filariasis (LF) infection facilitates understanding its disappearance pattern and determining the duration of post-MDA monitoring and evaluation. METHODS The changes in microfilaraemia (Mf) prevalence and vector infection rates were monitored for four (2005-2008) and six years (2005-2010) respectively after stopping ten rounds of annual mass diethylcarbamazine (DEC) administration in a group of five villages located in South India. Four years after stopping MDA, circulating filarial antigenaemia (Ag) status among children and adults was also assessed in two villages. RESULTS Overall Mf prevalence (n = 700) and vector infection rates (n=803-3520) showed a declining trend. Two villages maintained zero Mf status in each of the four years, vector infection rate was zero from the third year onwards and Ag prevalence in adults was 0.4% (n = 226). In two other villages despite persistence of Mf and vector infection there was zero vector infectivity rate during the third to sixth year and Ag prevalence among children (n = 50) was nil. In the fifth village Mf prevailed at <1.0% and Ag prevalence among 1-7 year old children was 4.6% (n = 44) and vector infectivity rate during the sixth year was 0.1% (n = 852). CONCLUSION The incidence of sporadic new infections is evident in highly endemic communities such as the fifth village. However, there is uncertainty on the potential of the Ag positive children to reestablish infection. Six years of post-MDA monitoring and evaluation appears to be adequate to discern the status of transmission interruption and appropriate decision making.
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Affiliation(s)
- K D Ramaiah
- Vector Control Research Centre, Indian Council of Medical Research, Medical Complex, Indira Nagar, Pondicherry 605006, India
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Swaminathan S, Perumal V, Adinarayanan S, Kaliannagounder K, Rengachari R, Purushothaman J. Epidemiological assessment of eight rounds of mass drug administration for lymphatic filariasis in India: implications for monitoring and evaluation. PLoS Negl Trop Dis 2012; 6:e1926. [PMID: 23209865 PMCID: PMC3510097 DOI: 10.1371/journal.pntd.0001926] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 10/14/2012] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Monitoring and evaluation guidelines of the programme to eliminate lymphatic filariasis require impact assessments in at least one sentinel and one spot-check site in each implementation unit (IU). Transmission assessment surveys (TAS) that assess antigenaemia (Ag) in children in IUs that have completed at least five rounds of mass drug administration (MDA) each with >65% coverage and with microfilaria (Mf) levels <1% in the monitored sites form the basis for stopping the MDA. Despite its rigour, this multi-step process is likely to miss sites with transmission potential ('hotspots') and its statistical assumptions for sampling and threshold levels for decision-making have not been validated. We addressed these issues in a large-scale epidemiological study in two primary health centres in Thanjavur district, India, endemic for bancroftian filariasis that had undergone eight rounds of MDA. METHODOLOGY/PRINCIPAL FINDINGS The prevalence and intensity of Mf (per 60 µl blood) were 0.2% and 0.004 respectively in the survey that covered >70% of 50,363 population. The corresponding values for Ag were 2.3% and 17.3 Ag-units respectively. Ag-prevalence ranged from 0.7 to 0.9%, in children (2-10 years) and 2.7 to 3.0% in adults. Although the Mf-levels in the survey and the sentinel/spot check sites were <1% and Ag-level was <2% in children, we identified 7 "residual" (Mf-prevalence ≥ 1%, irrespective of Ag-status in children) and 17 "transmission" (at least one Ag-positive child born during the MDA period) hotspots. Antigenaemic persons were clustered both at household and site levels. We identified an Ag-prevalence of ~1% in children (equivalent to 0.4% community Mf-prevalence) as a possible threshold value for stopping MDA. CONCLUSIONS/SIGNIFICANCE Existence of 'hotspots' and spatial clustering of infections in the study area indicate the need for developing good surveillance strategies for detecting 'hotspots', adopting evidence-based sampling strategies and evaluation unit size for TAS.
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Affiliation(s)
- Subramanian Swaminathan
- Vector Control Research Centre, Indian Council of Medical Research, Indira Nagar, Pondicherry, India.
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Boatin BA, Basáñez MG, Prichard RK, Awadzi K, Barakat RM, García HH, Gazzinelli A, Grant WN, McCarthy JS, N'Goran EK, Osei-Atweneboana MY, Sripa B, Yang GJ, Lustigman S. A research agenda for helminth diseases of humans: towards control and elimination. PLoS Negl Trop Dis 2012; 6:e1547. [PMID: 22545161 PMCID: PMC3335858 DOI: 10.1371/journal.pntd.0001547] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Human helminthiases are of considerable public health importance in sub-Saharan Africa, Asia, and Latin America. The acknowledgement of the disease burden due to helminth infections, the availability of donated or affordable drugs that are mostly safe and moderately efficacious, and the implementation of viable mass drug administration (MDA) interventions have prompted the establishment of various large-scale control and elimination programmes. These programmes have benefited from improved epidemiological mapping of the infections, better understanding of the scope and limitations of currently available diagnostics and of the relationship between infection and morbidity, feasibility of community-directed or school-based interventions, and advances in the design of monitoring and evaluation (M&E) protocols. Considerable success has been achieved in reducing morbidity or suppressing transmission in a number of settings, whilst challenges remain in many others. Some of the obstacles include the lack of diagnostic tools appropriate to the changing requirements of ongoing interventions and elimination settings; the reliance on a handful of drugs about which not enough is known regarding modes of action, modes of resistance, and optimal dosage singly or in combination; the difficulties in sustaining adequate coverage and compliance in prolonged and/or integrated programmes; an incomplete understanding of the social, behavioural, and environmental determinants of infection; and last, but not least, very little investment in research and development (R&D). The Disease Reference Group on Helminth Infections (DRG4), established in 2009 by the Special Programme for Research and Training in Tropical Diseases (TDR), was given the mandate to undertake a comprehensive review of recent advances in helminthiases research, identify research gaps, and rank priorities for an R&D agenda for the control and elimination of these infections. This review presents the processes undertaken to identify and rank ten top research priorities; discusses the implications of realising these priorities in terms of their potential for improving global health and achieving the Millennium Development Goals (MDGs); outlines salient research funding needs; and introduces the series of reviews that follow in this PLoS Neglected Tropical Diseases collection, "A Research Agenda for Helminth Diseases of Humans."
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Affiliation(s)
- Boakye A. Boatin
- Lymphatic Filariasis Support Centre, Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
- Institute of Parasitology, McGill University, Montreal, Canada
| | - María-Gloria Basáñez
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | | | - Kwablah Awadzi
- Onchocerciasis Chemotherapy Research Centre, Hohoe Hospital, Hohoe, Ghana
| | - Rashida M. Barakat
- High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Héctor H. García
- Department of Microbiology, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Andrea Gazzinelli
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Warwick N. Grant
- The Nematode Functional Genomics Laboratory, La Trobe University, Victoria, Australia
| | - James S. McCarthy
- Queensland Institute of Medical Research, University of Queensland, Herston, Australia
| | - Eliézer K. N'Goran
- Laboratoire de Zoologie et de Biologie Animale, Université de Cocody, UFR Biosciences, Abidjan, Côte d'Ivoire
| | - Mike Y. Osei-Atweneboana
- Council for Scientific and Industrial Research (CSIR), Department of Environmental Biology and Health, Water Research Institute, Accra, Ghana
| | - Banchob Sripa
- Tropical Disease Research Laboratory, Division of Experimental Pathology, Department of Pathology, Khon Kaen University, Khon Kaen, Thailand
| | - Guo-Jing Yang
- Department of Schistosomiasis Control, Jiangsu Institute of Parasitic Diseases, Meiyuan Yangxiang, Wuxi, People's Republic of China
| | - Sara Lustigman
- Laboratory of Molecular Parasitology, Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, United States of America
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