Mass drug administration trial to eliminate lymphatic filariasis in Papua New Guinea: changes in microfilaremia, filarial antigen, and Bm14 antibody after cessation (original) (raw)
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Tropical Medicine and Health, 2007
Background Samoa was formerly highly endemic for Wuchereria bancrofti filariasis transmitted by Aedes mosquitoes. Previous control efforts including sporadic mass drug administration (MDA) campaigns have reduced the prevalence to low levels but have not succeeded in eliminating the disease. To effectively plan, model and evaluate the worldwide elimination effort, the Global Programme to Eliminate Lymphatic Filariasis (GPFLF) needs data on filariasis epidemiology (including age and sex-specific prevalence and the density of microfilariae (Mf)) and estimates of the number of years of MDA required for elimination. The five-year nationwide MDA campaign carried out in Samoa before the start of the Pacific Programme to Eliminate Lymphatic Filariasis (PacELF) generated extensive data on these issues. Methodology/Principal Findings MDA campaigns were conducted in Samoa with diethylcarbamazine (DEC) in 1993 to 1995 and DEC plus ivermectin in 1996 to 1997 for all persons aged 2 years and above. Coverage of the MDA, as assessed from the campaign village register books, ranged from 62% to 97% depending on the year, and was over 80% in three out of five years. Village based surveys showed that prevalence of Mf declined from 4.3% in 1993 (N=10,256) to 1.1% in 1998 (N=4,054) (Pχ =94.4, p<0.001). Males had a three-to five-fold higher prevalence than females, and this difference remained consistent over the five-year period. Transmission was still occurring over the period as shown by the occurrence of new infections in 3 children less than 5 years old out of 5,691 tested (five-year cumulative incidence of 0.53 per thousand children for the period 1993 to 1998). There was a statistically significant reduction in the geometric mean number of Mf per 60 µl in positive cases between 1993 (11.8) and 1998 (6.9) (t=2.61; p<0.01). The proportion of people with a high density of Mf-over 60 Mf per 60 µl (1000 per ml)-declined from to 19.4% to 4.0% (Pχ =5.6, p=0.018). Conclusions/Significance Five years of sustained MDA with DEC (3 years) and DEC plus ivermectin (2 years) reduced the prevalence of Mf of W.bancrofti in Samoa by 74%. Density of Mf in infected individuals was also significantly reduced. Males had a three to five-fold higher prevalence than women. New infections in children less than five years old still occurred at a low level, suggesting that transmission was not completely interrupted. These findings helped to prepare a sound monitoring and evaluation plan for PacELF.
Iranian Journal of Public Health, 2018
Background: WHO initiated lymphatic filariasis (LF) elimination globally. Pekalongan District, as LF endemic area, started a program of mass drug administration (MDA) to combat LF in 2015. This study aimed to determine prevalence of Wuchereria bancrofti infection prior to the MDA. Methods: LF infection was detected by the existence of circulating filarial antigen (CFA) W. bancrofti using immunochromatographic card test (ICT). The study population consisted of 1404 elementary school (ES) students living in Pekalongan District. Overall, 1033 were selected as study subjects. Prevalence survey was also conducted on 436 general population in areas where infected students were found. Results: The subjects ranged from 7–17 yr old (mean 9.85±1.296) and equally distributed between both sexes. Prevalence of W. bancrofti infection was 1.98% in children. Infection was mostly found in older students (12 yr old), male, in 6th grade, but did not differ significantly (P=0.129, 0.376, and 0.212 resp...
Proceedings of the 5th Universitas Ahmad Dahlan Public Health Conference (UPHEC 2019), 2020
Background: The mass drug administration program (MDA) has been implemented since 2007 and the evaluation of the assessment survey (TAS) was carried out in elementary school children in 2014 and 2016 with negative results. The activity was to assess whether there was any transmission of lymphatic filariasis in the community so that it was free from the disease. In supporting the success of MDA, a survey of knowledge, attitudes, and behavior of the community was needed to be conducted by the head of health center and the health department in order to control the disease. Method: the design of this study was cross-sectional study which was conducted from January-November 2017 in Kamundu and Tanah Miring village. A simple random sampling was 622 people. The measurement of the community knowledge, attitudes, and behavior was done using a structured questionnaire. The microfilariae survey was conducted with a fast test (diagnostic rapid test), alere Wuchereria bancrofti. Then, microscopic confirmation was carried out to find out whether or not the respondents were positive. Meanwhile, the data were analyzed descriptively. Results: The results of a microfilariae survey using an antigen test were quickly obtained that 12 respondents were positive and then that 2 respondents were poisitive based on microscopic confirmation. The results of the respondents' knowledge survey on the mass drugs administration were that the respondents still lacked of knowledge, in particular, of the causes, transmission, and sources of information about lymphatic filariasis. The attitude of respondents to POPM was good according to the number of MDA coverage treatment for 5 years. The respondents' behavior towards MDA and prevention of lymphatic filariasis was still not particularly preventive. The positive findings of respondents indicated that respondents' knowledge, attitudes, and behavior, in general, were still insufficient. Conclusion: The survey of antigen microfilariae rated of 1.9% (12/622). Then, community knowledge and behavior were still low about MDA and the prevention of lymphatic filariasishis.
Lymphatic filariasis in Papua New Guinea: prospects for elimination
Medical Microbiology and Immunology, 2003
Lymphatic filariasis is a significant public health problem in several Pacific island countries. Papua New Guinea is one of the most populous countries in this region, and 39% of its residents are estimated to be infected with Wuchereria bancrofti. The Ministries of Health of the 22 islands and territories in the Pacific region are committed to taking action against lymphatic
2018
First and foremost, it gives me great pleasure to acknowledge my supervisors, Dr Louise Kelly-Hope (Primary), Prof. Moses J. Bockarie and Dr Lisa Reimer. Prof Bockarie for the initial planning stages of my PhD project and the entomology section planning, Dr Reimer for entomological planning stages while she was still in PNGIMR and then in LSTM where she assisted so greatly in securing bench space for me to complete laboratory analyses of my mosquito samples. However, I really think all this would never have been possible without Dr Louise Kelly-Hope. You have been that light in the darkest tunnel for me, I am forever indebted to you and your family, for stealing your family time and most of all giving you white hairs ☺ 1. To review LF research in PNG, with specific focus on entomology in Madang Province 2. To map W. bancrofti antigen (Ag) prevalence and risk factors associated with LF in Madang Province 3. To micro-map and spatially analysis MF prevalence in a highly endemic village in Madang Province 4. To examine the distribution and incrimination of Anopheles species in LF transmission in a highly endemic village in Madang Province
PLoS Neglected Tropical Diseases, 2011
Background: Acute painful swelling of the extremities and scrotum are debilitating clinical manifestations of Wuchereria bancrofti infection. The ongoing global program to eliminate filariasis using mass drug administration is expected to decrease this and other forms of filarial morbidity in the future by preventing establishment of new infections as a consequence of eliminating transmission by the mosquito vector. We examined whether mass treatment with anti-filarial drugs has a more immediate health benefit by monitoring acute filariasis morbidity in Papua New Guinean communities that participated in a 5-year mass drug administration trial.
PLOS Neglected Tropical Diseases
The Global Programme to Eliminate Lymphatic Filariasis (LF) aims to eliminate the disease as a public health problem by 2020 by conducting mass drug administration (MDA) and controlling morbidity. Once elimination targets have been reached, surveillance is critical for ensuring that programmatic gains are sustained, and challenges include timely identification of residual areas of transmission. WHO guidelines encourage cost-efficient surveillance, such as integration with other population-based surveys. In American Samoa, where LF is caused by Wuchereria bancrofti, and Aedes polynesiensis is the main vector, the LF elimination program has made significant progress. Seven rounds of MDA (albendazole and diethycarbamazine) were completed from 2000 to 2006, and Transmission Assessment Surveys were passed in 2010/2011 and 2015. However, a seroprevalence study using an adult serum bank collected in 2010 detected two potential residual foci of transmission, with Og4C3 antigen (Ag) prevalence of 30.8% and 15.6%. We conducted a follow up study in 2014 to verify if transmission was truly occurring by comparing seroprevalence between residents of suspected hotspots and residents of other villages. In adults from non-hotspot villages (N = 602), seroprevalence of Ag (ICT or Og4C3), Bm14 antibody (Ab) and Wb123 Ab were 1.2% (95% CI 0.6-2.6%), 9.6% (95% CI 7.5%-12.3%), and 10.5% (95% CI 7.6-14.3%), respectively. Comparatively, adult residents of Fagali'i (N = 38) had significantly higher seroprevalence of Ag (26.9%, 95% CI 17.3-39.4%), Bm14 Ab (43.4%, 95% CI 32.4-55.0%), and Wb123 Ab 55.2% (95% CI 39.6-69.8%). Adult residents of Ili'ili/Vaitogi/Futiga (N = 113) also had higher prevalence of Ag and Ab, but differences were not statistically significant. The presence of transmission was demonstrated by 1.1% Ag prevalence (95% CI 0.2% to 3.1%) in 283 children aged 7-13 years who lived in one of the suspected hotspots; and microfilaraemia in four individuals, all of whom lived in the suspected hotspots, including a 9 year old child. Our results provide field evidence that integrating LF surveillance with other surveys is effective and feasible for identifying
The American Journal of Tropical Medicine and Hygiene, 2009
Assessing the interruption of lymphatic filariasis transmission after annual mass drug administration (MDA) requires a better understanding of how to interpret results obtained with the available diagnostic tools. We conducted parasitologic, serologic, and entomologic surveys in three villages in American Samoa after sentinel site surveys suggested filarial antigen prevalence was < 1% after five annual MDAs with diethylcarbamazine and albendazole. Antigen and antifilarial antibody prevalence ranged from 3.7% to 4.6% and from 12.5% to 14.9%, respectively, by village. Only one person was microfilaria positive. Although no children less than 10 years of age were antigen positive, antifilarial antibody prevalence in this age group was 5.1% and antibody-positive children were detected in all three villages. Wuchereria bancrofti-infected mosquitoes were also detected in all three villages. Thus, monitoring of infections in mosquitoes and antifilarial antibody levels in children may serve as indicators of local transmission and be useful for making decisions about program endpoints.
PLoS neglected tropical diseases, 2017
Sri Lanka was one of the first countries to initiate a lymphatic filariasis (LF) elimination program based on WHO guidelines. The Anti-Filariasis Campaign provided 5 annual rounds of mass drug administration (MDA) with diethylcarbamazine plus albendazole in all 8 endemic districts from 2002-2006. Microfilaremia (Mf) prevalences have been consistently <1% in all sentinel and spot-check sites since 2006, and all evaluation units passed school-based transmission assessment surveys (TAS) in 2013. We previously reported results from comprehensive surveillance studies conducted in 2011-2013 that documented low-level persistence of Wuchereria bancrofti in 19 high risk areas in 8 endemic districts. We now present results from repeat surveys conducted 3 to 4 years later in 6 areas that had the strongest LF signals in the prior study. The surveys assessed prevalence of filarial antigenemia (CFA) and Mf in communities, CFA and anti-filarial antibody in school children (ages 6-8), and filari...