Chronic manifestations of LF include lyphedema and hydrocele. Image: Left: Children in western Kenya, courtesy Dr. Susan Montgomery, DVM, MPH Right: Elephantiasis of leg due to filariasis. Luzon, Philippines, CDC Public Health Image Library. Center: Photograph of a female Aedesaegypti mosquito as she was in the process of obtaining a "blood meal." Laboratory strains of Aedesaegypti can be infected with Brugia.
Treatment consists of one or more the following medications: albendazole, ivermectin and/or diethylcarbamazine (DEC). These medications are readily available through pharmaceutical donations. Within the first 8 years of the worldwide elimination program, 1.9 billion treatments for lymphatic filariasis (LF) were delivered to more than 570 million people in 48 countries.
The full potential economic benefit could be in excess of US$ 55 billion whenGPELF is extended to all endemic populations.
This timeline illustrates the components of the WHO guidelines for LF elimination, and illustrates the various M and E components, from mapping to measuring coverage to sentinel sites to stopping MDA to post MDA surveillance Mapping determines which areas of the country are endemic for LF. The endemic areas are treated with at least 5 rounds of annual mass drug administration (or MDA), a stopping MDA survey determines whether further rounds of MDA are necessary, then the program moves into the post-MDA period. The main activity of this period is “passive surveillance”.Current guidelines also recommend repeating “stopping MDA” surveys at least twice in evaluation areas within the endemic districts.
Winnable Battle Lymphatic Filariasis presentation
Eliminating Lymphatic Filariasis in the Americas A Winnable Battle Center for Global Health Division of Parasitic Diseases and Malaria
Lymphatic Filariasis (LF) Caused by worms spread from person-to-person by the bite of infected mosquitoes The worms live in the human lymphatic system and can cause: lymphedema (swelling) and elephantiasis in limbs and breasts hydrocele (severe fluid accumulation) affecting men’s genitalia Microfilaria of Wuchereria Microfilaria of Brugia malayi bancrofti (CDC photo, DPDx) (CDC photo, DPDx)
Health and societal impacts of LF Usually develop years after initial infection Cause pain, severe and irreversible disfigurement, loss of productivity, and social stigmatization lymphedema elephantiasis CDC photos
LF: A costly and disabling NTD One of the most disabling and economically costly neglected tropical diseases (NTDs) NTDs are a group of poverty-associated parasitic and bacterial infections affecting more than 1 billion persons NTDs are responsible for tremendous suffering and economic loss More than 120 million persons are infected with LF, a disease that can be eliminated Photo courtesy Carter Center/Emily Staub
Worldwide distribution of LF1.34 billion at risk in world
Global impact of LF A leading cause of disability globally Endemic in 81 countries 44 million persons suffer from chronic manifestations Photos courtesy of CDC. Left: Dr. Susan Montgomery, Middle and Right: CDC PHIL
Global Programme to Eliminate LF (GPELF) Target elimination date of 2020 Launched by World Health Organization (WHO) in 2000 Two-pronged strategy to: 1. Interrupt the spread of infection 2. Reduce the suffering of persons already infected To interrupt infection, medication is distributed to entire at-risk population through mass drug administration (MDA) At least 5 rounds on MDA are needed to interrupt transmission Treatment kills worms circulating in the blood
GPELF: Progress and successes 53 countries have ongoing MDA campaigns 37 countries have administered 5 or more rounds of MDA in many target areas 2.8 billion doses of medicine delivered in first 9 years Treatment cost typically less than US $0.50 per person and often less than $0.10 Transmission interruption has protected 6.6 million newborns from becoming infected with the disease Economic benefit of first 7 years of program estimated at $24 billion Full economic benefit could exceed US $55 billion
The economic impact of GPELF, 2000-2007 Table courtesy of WHO GPELF
WHO Guidelines for LF Elimination ProgramsRounds annualmass drug administration (MDA) Post-MDA Period 1 2 3 4 5 n Monitoring & Evaluation Passive Surveillance ( > 5 years) Coverage Impact Assessment “Mapping” TAS TAS TAS TAS = transmission assessment survey
LF elimination in the Americas The Americas is the first region targeted for elimination of LF Improvements in standard of living have reduced disease prevalence in continental Americas and Caribbean Islands In areas where disease remained (Costa Rica, Suriname, and Trinidad and Tobago), transmission was interrupted through selective and community treatment Transmission still occurs in Guyana, Haiti, and parts of Brazil and the Dominican Republic
Notable achievements in the Americas Surveys carried out in the Dominican Republic suggest transmission interruption MDA treatment scaling up in Guyana and Haiti 4.5 million of 8.6 million at-risk Haitians received MDA 3 million Haitians treated since January 2010 earthquake Disease management programs operating in all four endemic countries CDC photo
Notable achievements in the Americas Although there is still active transmission in Guyana, Haiti, and parts of Brazil and the Dominican Republic, each country has achieved notable success in the fight against LF As of late 2009, nearly 5 million persons living in Americas had received MDA Elimination in the Americas is within reach
Progress in MDA for LF, WHO’s Region of the Americas, 2000-2009 Graph courtesy of WHO GPELF
CDC and partner support CDC and its partners: Work with each country’s ministry of health to offer advice and expert consultation Develop monitoring and evaluation strategies Provide technical support Carry out operational research including working to understand: • Adherence to medication • Optimal surveillance methods • Strategies to accelerate elimination
Winning the battle against LF: What more can be done to eliminate LF by 2020? Continue and scale-up MDA programs to interrupt transmission Use operational research to develop strategies to accelerate the elimination of LF Increase each country’s efforts to provide appropriate care for persons with filarial disease Expand the reach of LF programs to include service delivery for other NTDs and health priorities
CDC partners We would like to acknowledge and thank our partners working to eliminate lymphatic filariasis: The Bill & Melinda Gates Foundation CBM International Eisai GlaxoSmithKline IMA World Health Inter-American Development Bank Merck Pan American Health Organization RTI International The Task Force for Global Health University of Notre Dame United States Agency for International Development (USAID)
Thank you www.cdc.gov/winnablebattlesFor more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: firstname.lastname@example.org Web: www.cdc.govThe findings and conclusions in this report are those of the authors and do not necessarily represent the officialposition of the Centers for Disease Control and Prevention. Center for Global Health Division of Parasitic Diseases and Malaria