A survey of Brugia malayi infection on the Heugsan Islands, Korea

Prevention and Control Strategies for Parasitic Infections in the Korea Centers for Disease Control and Prevention

Korea is successfully controlled intestinal parasitic infections owing to economic development and high health consciousness. The Division of Vectors and Parasitic Diseases (formerly the Division of Malaria and Parasitology) is in the Center for Laboratory Control of Infectious Diseases of the Korea Centers for Disease Control and Prevention. It has been the governmental agency responsible for controlling and leading scientific research on parasitic diseases. The Division of Vectors and Parasitic Diseases has conducted and funded basic research and disseminated the research results to various medical fields, ultimately promoting public health in Korea. Among the noteworthy achievements of this division are the national surveillance of healthcare-associated parasitic infections, prevention and control for parasitic infections, and the elimination of lymphatic filariasis from Korea. On a broader scale, the division's research programs and academic supports were influential in preventing and treating infectious parasitic diseases through public policies and laws. In this review, we summarize the past and present role of the Division of Vectors and Parasitic Diseases in preventing and treating infectious parasitic diseases in Korea.

Follow-up Study of Patients Previously Diagnosed with Lymphatic Filariasis in Korea

Objectives

Korea was an endemic area for lymphatic filariasis (LF), caused by the nematode parasite Brugia malayi, until the 1970s. The World Health Organization recognized Korea as LF-free in June 2008. However, it is necessary to confirm that patients that have had LF in the past still test negative, to prevent the re-emergence of LF in Korea.

Methods

We followed up a total of 83 patients who had been diagnosed with LF between 2002 and 2010 in endemic LF areas.

Results

Fifty-two of the 83 subjects were negative for LF, whereas 31 subjects had re-located to a different city or province, were dead, or were unaccounted for. Most subjects with negative test results still exhibited edema in the legs or the arms, and some complained of redness and swelling in the legs or ankle joints. However, we found that these symptoms were due to diseases other than LF.

Conclusion

In this follow-up study, we did not find any evidence indicating the potential re-emergence of LF in Korea.

Surveillance and vector control of lymphatic filariasis in the republic of Korea

Objectives

Until the early 2000s, lymphatic filariasis would commonly break out in the coastal areas in Korea. Through steady efforts combining investigation and treatment, filariasis was officially declared eradicated in 2008. This study surveyed the density of vector species of filariasis in past endemic areas, and inspected filariasis DNA from collected mosquitoes for protection against the reemergence of filariasis.

Methods

Between May and October 2009, mosquitoes were caught using the black night trap in past endemic coastal areas: Gyeongsangnam-do, Jeollanamdo, and Jeju-do. The collected mosquitoes were identified, and the extracted DNA from the collected vector mosquitoes was tested by polymerase chain reaction for Brugia malayi filariasis.

Results

Ochletotatus togoi, Anophel es (Hyrcanus) group and Culex pipiens were most frequently caught in Jeollanam-do (Geomun Island, Bogil Island, Heuksan Island), Jeju-do (Namone-ri, Wimi-ri). and Gyeongsangnam-do (Maemul Island). DNA of B malayi was not found in Och Togoi and An (Hyrcanus) group as main vectors of filariasis.

Conclusion

Lymphatic filariasis was not found in the vector mosquitoes collected in past endemic areas. However, considering that the proportion of vector species is quite high, there is a potential risk that filariasis could be reemerging through overseas travel or trade. Thus, there is a need to continuously monitor vector mosquitoes of lymphatic filariasis.

Seasonal prevalence of mosquitoes, including vectors of Brugian filariasis, in southern islands of the Republic of Korea

A survey of mosquitoes, including the vector status of Brugia malayi filariasis and their relative larval density, was conducted from 2002 to 2005 at several southern remote islands of Jeollanam-do (province), Gyeongsangnam-do, and Jeju-do, Korea, where filariasis was previously endemic. Overall, a total of 9 species belonging to 7 genera were collected. Ochlerotatus togoi (formerly known as Aedes togoi), Anopheles (Hyrcanus) group, and Culex pipiens were the predominant species captured at all areas. Oc. togoi larvae were most frequently collected at salinity levels <0.5% during June and July, with densities decreasing sharply during the rainy season in August. The most likely explanation for the eradication of filariasis in these areas is suggested to be an aggressive treatment program executed during the 1970s and the 1990s. However, high prevalence of the vector mosquitoes may constitute a potential risk for reemerging of brugian filariasis in these areas.

Review of zoonotic parasites in medical and veterinary fields in the Republic of Korea

Zoonotic parasites are animal parasites that can infect humans. The major zoonotic protozoa in the Republic of Korea are Babesia bovis, Chilomastix mesnili, Cryptosporidium parvum, Endolimax nana, Entamoeba coli, Entamoeba hitolytica, Giardia lamblia, Iodamoeba bütschlii, Pneumocystis carinii, Sarcocystis cruzi, and Toxoplasma gondii. The major zoonotic helminths in Korea include trematodes, cestodes, and nematodes. Trematodes are Clonorchis sinensis, Echinostoma hortense, Echinostoma spp., Fasciola hepatica, Heterophyes nocens, Metagonimus yokogawai, and Paragonimus westermani. Cestodes are Diphyllobothrium latum, Dipylidium caninum, Echinococcus granulosus, Hymenolepis nana, Raillietina tetragona, sparganum (Spirometra spp.), Taenia saginata, T. solium, and T. asiatica. Nematodes are Ancylostoma caninum, Brugia malayi, Capillaria hepatica, Dirofilaria immitis, Gnathostoma dololesi, Gnathostoma spinigerum, Loa loa, Onchocerca gibsoni, Strongyloides stercoralis, Thelazia callipaeda, Trichinella spiralis, Trichostrongylus orientalis, Trichuris trichiura, and Trichuris vulpis. The one arthropod is Sarcoptes scabiei. Many of these parasites have disappeared or were in decline after the 1990's. Since the late 1990's, the important zoonotic protozoa have been C. parvum, E. nana, E. coli, E. hitolytica, G. lamblia, I. buetschlii, P. carinii and T. gondii. The important zoonotic helminths have been C. sinensis, H. nocens, M. yokogawai, P. westermani, D. latum, T. asiatica, sparganum, B. malayi, T. orientalis, T. callipaeda and T. spiralis. However, outbreaks of these parasites are only in a few endemic areas. The outbreaks of Enterobius vermicularis and head lice, human parasites, have recently increased in the kindergartens and primary schools in the Republic of Korea.

Successful control of lymphatic filariasis in the Republic of Korea

A successful experience of lymphatic filariasis control in the Republic of Korea is briefly reviewed. Filariasis in the Republic of Korea was exclusively caused by infection with Brugia malayi. Over the past several decades from the 1950s to 2006, many investigators exerted their efforts to detection, treatment, and follow-up of filariasis patients in endemic areas, and to control filariasis. Mass, combined with selective, treatments with diethylcarbamazine to microfilaria positive persons had been made them free from microfilaremia and contributed to significant decrease of the microfilarial density in previously endemic areas. Significant decrease of microfilaria positive cases in an area influenced eventually to the endemicity of filariasis in the relevant locality. Together with remarkable economic growth followed by improvement of environmental and personal hygiene and living standards, the factors stated above have contributed to blocking the transmission cycle of B. malayi and led to disappearance of this mosquito-borne ancient disease in the Republic of Korea.

Elimination of lymphatic filariasis in the Republic of Korea: an epidemiological survey of formerly endemic areas, 2002-2006

OBJECTIVES

To determine the current status of lymphatic filariasis (LF) in Korea.

METHODS

Epidemiological surveys between 2002 and 2006 in areas where LF was previously endemic: remote and coastal areas Jeollanam-do, Gyeongsangnam-do, and Jeju-do, and inland Gyeongsangbuk-do. We took night blood smears from 9426 people for microfilaria testing and assayed samples from 3049 children (10- to 13-year-olds) and 1526 adults for Brugia malayi antibodies.

RESULTS

We found two cases (0.01%) with low microfilaria density in their peripheral blood (1-2/20 mul) on the remote island of Jeollanam-do in the southern part of the Korean peninsula. These patients, males over 60-years old, were treated with diethylcarbamazine (DEC). None of the 4575 people surveyed tested positive for specific B. malayi antibodies.

CONCLUSION

Lymphatic filariasis appears to have been eliminated in Korea.