An investigation of the disparity in estimates of microfilaraemia and antigenaemia in lymphatic filariasis surveys

Community-based trial assessing the impact of annual versus semiannual mass drug administration with ivermectin plus albendazole and praziquantel on helminth infections in northwestern Liberia

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Mass drug administration (MDA) with ivermectin plus albendazole was more effective for clearing bancroftian filariasis than it was for onchocerciasis or hookworm.

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Semiannual MDA was no more effective than annual MDA for reducing prevalences of W. bancrofti, O. volvulus, or hookworm infections.

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Decreases in bancroftian filariasis prevalence were achieved despite unavoidable interruptions in our study related to the 2014 West Africa Ebola epidemic and the 2020 SARS-CoV-2 pandemic.

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Neglected Tropical Disease elimination programs in areas coendemic for lymphatic filariasis and onchocerciasis should focus on delivering high quality annual MDA with high coverage and compliance and not try to stretch limited resources to deliver semiannual MDA.

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MDA with praziquantel had little impact on Schistosoma mansoni infection in the heavily infected area.

We assessed the impact of three annual vs five semiannual rounds of mass drug administration (MDA) with ivermectin plus albendazole followed by praziquantel for the control or elimination of lymphatic filariasis (LF), onchocerciasis, soil-transmitted helminth (STH) infections and schistosomiasis in Lofa County, Liberia. The study started in 2012 and was interrupted in 2014 during the Ebola virus outbreak. Repeated cross-sectional surveys were conducted in individuals 5 years and older to measure infection markers. Wuchereria bancrofti antigenemia prevalences decreased from 12.5 to 1.2% (90% reduction) and from 13.6 to 4.2% (69% reduction) one year after three rounds of annual or five rounds of semiannual MDA, respectively. Mixed effects logistic regression models showed decreases in odds of antigenemia positivity were 91 and 74% at that time in the annual and semiannual treatment zones, respectively (p < 0.001). Semiannual MDA was slightly more effective for reducing Onchocerca volvulus microfiladermia prevalence and at follow-up 3 were 74% (from 14.4 to 3.7%) and 83% (from 23.6 to 4.5%) in the annual and semiannual treatment zones, respectively. Both treatment schedules had similar beneficial effects on hookworm prevalence. Thus, annual and semiannual MDA with ivermectin and albendazole had similar beneficial impacts on LF, onchocerciasis, and STH in this setting. In contrast, MDA with praziquantel had little impact on hyperendemic Schistosoma mansoni in the study area. Results from a long-term follow-up survey showed that improvements in infection parameters were sustained by routine annual MDA provided by the Liberian Ministry of Health after our study endpoint.

Geographic Spatial Distribution Patterns of Dirofilaria immitis and Brugia pahangi Infection in Community Dogs in Chiang Mai, Thailand

Simple Summary

Filariasis is emerging as a public health concern for humans, dogs, cats, and other wildlife species, and is frequently found in southeast Asian countries. The present study confirmed the species of filarial nematodes in free-roaming dogs from temple communities. Two species were found: Dirofilaria immitis infection and, for the first time, Brugia pahangi. The occurrence of the two species was comparable. Geographic spatial distribution revealed the abundance of D. immitis and B. pahangi in the central areas at altitudes less than 400 m. However, at higher altitudes between 400 and 800 m, we found a significantly higher number of B. pahangi infections than D. immitis infections. In conclusion, D. immitis and B. pahangi were the most common filarial infections found in community dogs in Northern Thailand. Dogs might be an important reservoir for B. pahangi in that region. The population dynamics of the mosquito vector of B. pahangi across altitudinal gradients merits further study.

Abstract

Filariasis is emerging as a public health concern in tropical and subtropical areas. Filariasis is an endemic problem commonly found in southeast Asian countries. Using the PCR-restriction fragment length polymorphism (PCR-RFLP) of the ITS1 region with Vsp I, the overall prevalence rates of Dirofilaria immitis (12.2% (41/337); 95% confidence interval: 9.1–16.1%) and Brugia pahangi (8.3% (28/337); 95% confidence interval: 5.8–11.8%) were determined based on 337 free-roaming community dogs from 20 districts in Northern Thailand. Microfilaremia was found in only 6.2% of dogs (21/337). Co-infection with D. immitis and B. pahangi was observed in two dogs. Of the 215 blood samples examined using a Canine Heartworm Ag Kit, only 3.72% (eight dogs) were D. immitis antigen positive. Among these eight, six dogs had occult D. immitis infections. In terms of geographic distribution, we found the abundance of D. immitis and B. pahangi in the central areas at altitudes less than 400 m to be 12.1% and 10.3%, respectively. In contrast, at higher altitudes between 400 and 800 m, a significantly higher number of B. pahangi compared with D. immitis infected individuals were observed at 14.29% and 4.1%, respectively. In conclusion, D. immitis and B. pahangi were the most common filarial infections found in community dogs in Northern Thailand. Dogs might be an important reservoir of B. pahangi in that region. Increasing awareness and concern and including proper deworming programs for community dogs should be endorsed to reduce the transmission risk. Additionally, the population dynamics of the mosquito vector of B. pahangi across altitudinal gradients deserved further investigation.

Mapping the baseline prevalence of lymphatic filariasis across Nigeria

Introduction

The baseline endemicity profile of lymphatic filariasis (LF) is a key benchmark for planning control programmes, monitoring their impact on transmission and assessing the feasibility of achieving elimination. Presented in this work is the modelled serological and parasitological prevalence of LF prior to the scale-up of mass drug administration (MDA) in Nigeria using a machine learning based approach.

Methods

LF prevalence data generated by the Nigeria Lymphatic Filariasis Control Programme during country-wide mapping surveys conducted between 2000 and 2013 were used to build the models. The dataset comprised of 1103 community-level surveys based on the detection of filarial antigenemia using rapid immunochromatographic card tests (ICT) and 184 prevalence surveys testing for the presence of microfilaria (Mf) in blood. Using a suite of climate and environmental continuous gridded variables and compiled site-level prevalence data, a quantile regression forest (QRF) model was fitted for both antigenemia and microfilaraemia LF prevalence. Model predictions were projected across a continuous 5 × 5 km gridded map of Nigeria. The number of individuals potentially infected by LF prior to MDA interventions was subsequently estimated.

Results

Maps presented predict a heterogeneous distribution of LF antigenemia and microfilaraemia in Nigeria. The North-Central, North-West, and South-East regions displayed the highest predicted LF seroprevalence, whereas predicted Mf prevalence was highest in the southern regions. Overall, 8.7 million and 3.3 million infections were predicted for ICT and Mf, respectively.

Conclusions

QRF is a machine learning-based algorithm capable of handling high-dimensional data and fitting complex relationships between response and predictor variables. Our models provide a benchmark through which the progress of ongoing LF control efforts can be monitored.

Combining different diagnostic studies of lymphatic filariasis for risk mapping in Papua New Guinea: a predictive model from microfilaraemia and antigenaemia prevalence surveys

Background

The Global Programme to Eliminate Lymphatic Filariasis has encouraged countries to follow a set of guidelines to help them assess the need for mass drug administration and evaluate its progress. Papua New Guinea (PNG) is one of the highest priority countries in the Western Pacific for lymphatic filariasis and the site of extensive research on lymphatic filariasis and surveys of its prevalence. However, different diagnostic tests have been used and thresholds for each test are unclear.

Methods

We reviewed the prevalence of lymphatic filariasis reported in 295 surveys conducted in PNG between 1990 and 2014, of which 65 used more than one test. Results from different diagnostics were standardised using a set of criteria that included a model to predict antigen prevalence from microfilariae prevalence. We mapped the point location of each of these surveys and categorised their standardised prevalence estimates.

Results

Several predictive models were produced and investigated, including the effect of any mass drug administration and number of rounds prior to the surveys. One model was chosen based on goodness of fit parameters and used to predict antigen prevalence for surveys that tested only for microfilariae. Standardised prevalence values show that 72% of all surveys reported a prevalence above 0.05. High prevalence was situated on the coastal north, south and island regions, while the central highland area of Papua New Guinea shows low levels of prevalence.

Conclusions

Our study is the first to provide an explicit predictive relationship between the prevalence values based on empirical results from antigen and microfilaria tests, taking into account the occurrence of mass drug administration. This is a crucial step to combine studies to develop risk maps of lymphatic filariasis for programme planning and evaluation, as shown in the case of Papua New Guinea.

Electronic supplementary material

The online version of this article (10.1186/s41182-018-0123-8) contains supplementary material, which is available to authorized users.

Understanding the relationship between prevalence of microfilariae and antigenaemia using a model of lymphatic filariasis infection

Background

Lymphatic filariasis is a debilitating neglected tropical disease that affects impoverished communities. Rapid diagnostic tests of antigenaemia are a practical alternative to parasitological tests of microfilaraemia for mapping and surveillance. However the relationship between these two methods of measuring burden has previously been difficult to interpret.

Methods

A statistical model of the distribution of worm burden and microfilariae (mf) and resulting antigenaemic and mf prevalence was developed and fitted to surveys of two contrasting sentinel sites undergoing interventions. The fitted model was then used to explore the relationship in various pre- and post-intervention scenarios.

Results

The model had good quantitative agreement with the data and provided estimates of the reduction in mf output due to treatment. When extrapolating the results to a range of prevalences there was good qualitative agreement with published data.

Conclusions

The observed relationship between antigenamic and mf prevalence is a natural consequence of the relationship between prevalence and intensity of adult worms and mf production. The method described here allows the estimation of key epidemiological parameters and consequently gives insight into the efficacy of an intervention programme.

Modelling the distribution and transmission intensity of lymphatic filariasis in sub-Saharan Africa prior to scaling up interventions: integrated use of geostatistical and mathematical modelling

BACKGROUND

Lymphatic filariasis (LF) is one of the neglected tropical diseases targeted for global elimination. The ability to interrupt transmission is, partly, influenced by the underlying intensity of transmission and its geographical variation. This information can also help guide the design of targeted surveillance activities. The present study uses a combination of geostatistical and mathematical modelling to predict the prevalence and transmission intensity of LF prior to the implementation of large-scale control in sub-Saharan Africa.

METHODS

A systematic search of the literature was undertaken to identify surveys on the prevalence of Wuchereria bancrofti microfilaraemia (mf), based on blood smears, and on the prevalence of antigenaemia, based on the use of an immuno-chromatographic card test (ICT). Using a suite of environmental and demographic data, spatiotemporal multivariate models were fitted separately for mf prevalence and ICT-based prevalence within a Bayesian framework and used to make predictions for non-sampled areas. Maps of the dominant vector species of LF were also developed. The maps of predicted prevalence and vector distribution were linked to mathematical models of the transmission dynamics of LF to infer the intensity of transmission, quantified by the basic reproductive number (R0).

RESULTS

The literature search identified 1267 surveys that provide suitable data on the prevalence of mf and 2817 surveys that report the prevalence of antigenaemia. Distinct spatial predictions arose from the models for mf prevalence and ICT-based prevalence, with a wider geographical distribution when using ICT-based data. The vector distribution maps demonstrated the spatial variation of LF vector species. Mathematical modelling showed that the reproduction number (R0) estimates vary from 2.7 to 30, with large variations between and within regions.

CONCLUSIONS

LF transmission is highly heterogeneous, and the developed maps can help guide intervention, monitoring and surveillance strategies as countries progress towards LF elimination.

Modelling strategies to break transmission of lymphatic filariasis--aggregation, adherence and vector competence greatly alter elimination

BACKGROUND

With ambitious targets to eliminate lymphatic filariasis over the coming years, there is a need to identify optimal strategies to achieve them in areas with different baseline prevalence and stages of control. Modelling can assist in identifying what data should be collected and what strategies are best for which scenarios.

METHODS

We develop a new individual-based, stochastic mathematical model of the transmission of lymphatic filariasis. We validate the model by fitting to a first time point and predicting future timepoints from surveillance data in Kenya and Sri Lanka, which have different vectors and different stages of the control programme. We then simulate different treatment scenarios in low, medium and high transmission settings, comparing once yearly mass drug administration (MDA) with more frequent MDA and higher coverage. We investigate the potential impact that vector control, systematic non-compliance and different levels of aggregation have on the dynamics of transmission and control.

RESULTS

In all settings, increasing coverage from 65 to 80 % has a similar impact on control to treating twice a year at 65 % coverage, for fewer drug treatments being distributed. Vector control has a large impact, even at moderate levels. The extent of aggregation of parasite loads amongst a small portion of the population, which has been estimated to be highly variable in different settings, can undermine the success of a programme, particularly if high risk sub-communities are not accessing interventions.

CONCLUSION

Even moderate levels of vector control have a large impact both on the reduction in prevalence and the maintenance of gains made during MDA, even when parasite loads are highly aggregated, and use of vector control is at moderate levels. For the same prevalence, differences in aggregation and adherence can result in very different dynamics. The novel analysis of a small amount of surveillance data and resulting simulations highlight the need for more individual level data to be analysed to effectively tailor programmes in the drive for elimination.