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Eliminating lymphatic filariasis
Ichimori, Kazuyo;Ottesen, Eric A.;
Boletín médico del Hospital Infantil de México , 2011,
Abstract: one of the oldest of the neglected tropical diseases, lymphatic filariasis, is caused by filarial worms transmitted by insect vectors that live in the lymphatic system and most commonly cause lymphedema, elephantiasis and hydrocele, which may lead to severe deformity, stigma and disability. similar to other neglected tropical diseases, lymphatic filariasis occurs mostly among the poor disenfranchised populations living in highly endemic settings perpetuating a cycle that traps people into further poverty and destitution. through the leadership of the world health organization, the global programme to eliminate lymphatic filariasis has reached substantial achievements in decreasing the transmission of lympahtic filariasis in multiple settings. the strategic plan for the next 10 years of the global programme, in addition to working within the new 'neglected tropical diseases environment,' lays out necessary mass drug administration implementation goals for the filariasis-endemic countries that have not yet started their elimination programs (principally in africa). the neglected tropical diseases programs-and the lymphatic filariasis program in particular-are among the very least expensive, most cost-effective tools to benefit needy populations of the developing world.
Pathology of lymphatic filariasis  [PDF]
Joon-Wah Mak
International e-Journal of Science, Medicine & Education , 2012,
Abstract: Developing and adult worms of the humanlymphatic filarial parasites (Wuchereria bancrofti,Brugia malayi, and Brugia timori) are located mainly inthe lymphatic system and occasionally in aberrant siteslike subcutaneous and conjunctival cysts. Lymphaticpathology ranging from dilatation of lymphatic channelsand lymphangiectasia are detected on ultrasonography inapparently healthy, amicrofilaraemic, but filarial antigenpositive individuals in endemic areas. Microfilariae aredistributed in various organs and may be associatedwith immune mediated pathology at these sites; tropicalpulmonary eosinophilia is characterized by intenseimmune mediated destruction of microfilariae in thelung parenchyma. In the spleen and other sites, nodulargranulomatous lesions can occur where microfilariaeare trapped and destroyed. The finding of Wolbachiaendosymbionts in all stages of lymphatic filarial parasiteshas provided new insight on the adverse reactionsassociated with anti-filarial chemotherapy. Inflammatorymolecules mainly lipopolysaccharide (LPS)-likemolecules released from endosymbionts on death of theparasites are largely responsible for the adverse reactionsencountered during anti-filarial chemotherapy. Prenataltolerance or sensitization to parasite derived moleculescan immune-modulate and contribute to both pathologyand susceptibility/resistance to infection. Pathologicalresponses thus depend not only on exposure tofilarial antigens/infection, but also on host-parasiteendosymbiontfactors and to intervention with antifilarialtreatment. Treatment induced or host mediateddeath of parasites are associated with various grades ofinflammatory response, in which eosinophils and LPSfrom endosymbionts play prominent roles, leadingto death of the parasite, granulomatous formation,organization and fibrosis.The non-human primate (Presbytis spp.) model ofBrugia malayi developed for the tertiary screeningof anti-filarial compounds has provided uniqueopportunities for the longitudinal study of the pathologyassociated with lymphatic filariasis. The pathology in thisnon-human primate model closely follows that seen in human lymphatic filarial infections and correlates withclinical evidence of lymphatic pathology as detectedwith ultrasonography. These studies also show thatsuccessful treatment as detected by loss of motility andcalcification of worms on ultrasonography is associatedwith reversal of early dilatations of lymphatic channels.
Elimination of Lymphatic Filariasis in Southern India  [PDF]
Sanjay Pattanshetty,Ashwini Kumar,Ravi Kumar,Chythra R Rao
Australasian Medical Journal , 2010,
Abstract: BackgroundLymphatic filariasis is an important public health problem in India. Inspite of National filarial control programme (NFCP) being in place for lymphatic filariasis (LF) elimination, several important issues need to be addressed. There is uncertainty about the coverage and compliance to treatment in order to achieve elimination. Method A community based cross-sectional study was conducted as per the National Vector Borne Disease Control Programme (NVBDCP) directions. The study included survey of 200 households of Dakshina Kannada District, South India where the Mass drug administration (MDA) program was conducted. The main objective of the study was to assess the coverage and compliance to MDA. ResultsOut of the total 1050 eligible people, 876 (83%) received the DEC tablets; so, the coverage was 83%. Among those who received the tablets, only 777 (88.7%) received the adequate dose and only 670 (76.8%) people actually consumed the tablets. Hence, compliance rate was only 76.8%.ConclusionThe planning and implementation of MDA programme needs to be strengthened by efficient micro planning, inter sectoral co-ordination and motivating the community to participate in the MDA programme.
Transmission Dynamics of Lymphatic Filariasis: A Mathematical Approach  [PDF]
C. P. Bhunu,S. Mushayabasa
ISRN Biomathematics , 2012, DOI: 10.5402/2012/930130
Abstract: An epidemiological model for the spread of lymphatic filariasis, a mosquito-borne infection, is developed and analysed. The epidemic thresholds known as the reproduction number and equilibria for the model are determined and stabilities analysed. Results from the analysis of the reproduction number suggest that treatment will somehow contribute to a reduction in lymphatic filariasis cases, but what it does not show is the magnitude of the reduction, a part answered by the numerical simulations. Numerical simulations show that even when all lymphatic filariasis cases displaying elephantiasis symptoms are put on treatment it will not be able to eradicate the disease. This result suggests that effective control of lymphatic filariasis may lie in treatment for those displaying symptoms as well as chemoprophylaxis for the exposed. 1. Introduction Lymphatic filariasis, a debilitating disease, is one of the most prevalent and yet one of the most neglected tropical diseases with serious economic and social consequences [1, 2]. Lymphatic filariasis affects women, men and children of all ages. It is a mosquito-borne disease caused by tissue-dwelling nematodes of Brugia malayi, Brugia timori, and Wuchereria bancrofti species [1, 3] and is estimated to affect about 120 million people worldwide [4–6]. Wuchereria bancrofti is responsible for 90% of the cases and is found throughout the tropical and subtropical areas of the world; Brugia malayi is confined to southeast and eastern Asia; Brugia timori is found only in Timor and its adjacent islands [7]. Infection leads to lymphedema, a buildup of fluid due to impaired function of the lymph vessels, in only a small proportion people, even in areas of intense transmission [8], as most people with long-term infections are clinically asymptomatic. Recurrent bacterial infections in some lymphedema patients lead to elephantiasis [9]. Filarial parasites are a major cause of morbidity and therefore hinder socioeconomic growth in parts of Asia, Africa, and the Western Pacific [1, 10]. Despite improved knowledge of pathology of lymphatic filariasis and existence of the drugs diethylcarbamazine and albendazole necessary to treat lymphatic filariasis, it continues to be a major public health problem in tropical and subtropical countries. Lymphatic filariasis is more common in regions that have a higher incidence of poverty [11] making it a disease of the poor and serves as an indicator of underdevelopment [1]. Surveys in Ghana have indicated that bancroftian filariasis is present in most parts of the country with considerable
Lymphatic filariasis in India: Epidemiology and control measures  [cached]
Sabesan S,Vanamail P,Raju KHK,Jambulingam P
Journal of Postgraduate Medicine , 2010,
Abstract: Lymphatic filariasis caused by Wuchereria bancrofti and Brugia malayi is an important public health problem in India. Both parasites produce essentially similar clinical presentations in man, related mainly to the pathology of the lymphatic system. Filariasis is endemic in 17 States and six Union Territories, with about 553 million people at risk of infection. The Government of India has accorded a high priority for elimination of this infection through mass chemotherapy programme (annual, single dose of Diethylcarbamazine citrate, i.e. DEC - 6 mg/kg of bodyweight, plus Albendazole repeated four to six times). This campaign has become a part of the National Vector-Borne Disease Control Programme in 2003 under the National Health Policy 2002 and aims to eliminate filariasis by 2015. We discuss here the epidemiology and current control strategy for filariasis; highlighting key issues, challenges and options in the implementation of the programme, and suggesting measures for mid-course corrections in the elimination strategy.
Lymphatic filariasis in Brazil: epidemiological situation and outlook for elimination  [cached]
Fontes Gilberto,Leite Anderson,Vasconcelos de Lima Ana Rachel,Freitas Helen
Parasites & Vectors , 2012, DOI: 10.1186/1756-3305-5-272
Abstract: Since the World Health Assembly’s (Resolution WHA 50.29, 1997) call for the elimination of lymphatic filariasis by the year 2020, most of the endemic countries identified have established programmes to meet this objective. In 1997, a National Lymphatic Filariasis Elimination Plan was drawn up by the Ministry of Health of Brazil, creating local programs for the elimination of Bancroftian filariasis in areas with active transmission. Based on a comprehensive bibliographic search for available studies and reports of filariasis epidemiology in Brazil, current status of this parasitic infection and the outlook for its elimination in the country were analysed. From 1951 to 1958 a nationwide epidemiological study conducted in Brazil confirmed autochthonous transmission of Bancroftian filariasis in 11 cities of the country. Control measures led to a decline in parasite rates, and in the 1980s only the cities of Belém in the Amazonian region (Northern region) and Recife (Northeastern region) were considered to be endemic. In the 1990s, foci of active transmission of LF were also described in the cities of Maceió, Olinda, Jaboat o dos Guararapes, and Paulista, all in the Northeastern coast of Brazil. Data provide evidence for the absence of microfilaremic subjects and infected mosquitoes in Belém, Salvador and Maceió in the past few years, attesting to the effectiveness of the measures adopted in these cities. Currently, lymphatic filariasis is a public health problem in Brazil only in four cities of the metropolitan Recife region (Northeastern coast). Efforts are being concentrated in these areas, with a view to eliminating the disease in the country.
Michael J. Bangs,David T. Dennis,Sri Oemijati,Liliana Kurniawan
Bulletin of Health Research , 2012,
Abstract: The accomplishments and progress that have occurred over the past 20 years in collaborative filariasis research between NAMRU-2 detachment staff, National Institute of Health, Research and Development (NIHRD), and Directorate General of Communicable Disease Control and Environmental Health (CDC&EH), University of Indonesia, and other health institutions have produced an impressive array of important contributions to the study of human lymphatic filarial disease. Over this time, no less than 62 publications specifically addressing filariasis studies have come about as a direct result of close cooperation between interorganizational investigators (Figs. 1,2). Beginning in 1972 with observations on diethylcarbamazine (DEC) provocation for diurnal diagnosis of W. bancrofti, publications have covered a wide range of different disciplines all with the common goal of understanding and ultimately controlling this disease. Numerous biomedical and filariasis surveys have been recorded over this period, adding greatly to our knowledge of the diverse epidemiology and disease distribution across the archipelago. The following is an attempt to highlight the major milestones among selected categories that have made significant contributions and have provided insights into filariasis research.
Community-directed treatment of lymphatic filariasis in Kenya and its role in the national programmes for elimination of lymphatic filariasis
N Wamae, S M Njenga, WM Kisingu, PW Muthigani, K Kiiru
African Journal of Health Sciences , 2006,
Abstract: We conducted a prospective, cross-sectional study to examine and compare treatment coverage of lymphatic filariasis by the health system (HST) and a health system implemented, community-directed treatment for the control of lymphatic filariasis (ComDT/HS) in 44 randomly selected villages in coastal Kenya. Demographic information on the villages and peripheral health facilities to guide design and implementation was obtained from a situation analysis phase of this study. A series of interactive training sessions on basic biology of lymphatic filariasis, concept and philosophy of ComDT/HS were given to members of the District Health Management Team (DHMT), peripheral health staff, community leaders and community drug distributors (CDDs) prior to ivermectin distribution. An intensive sensitization process of the community by the trained peripheral health staff and community leaders followed before selection of the CDDs. Quantitative and qualitative data for evaluation of the study were collected by coverage surveys of randomly selected households, focus group discussions and interviews, immediately after the drug distribution. Treatment coverage of all eligible persons was 46.5 and 88% in HST and ComDT/HS villages, respectively, P < 0.001. In comparing treatment coverage by the two study arms in relationship to the distance from a health facility, coverage among HST and not ComDT/HS villages was influenced by distance. In Kenya, ComDT/HS can effectively be implemented by the regular health system and can attain coverage levels compatible with the global filariasis elimination goal. African Journal of Health Sciences Vol. 13 (1-2) 2008: pp. 69-79
Unfulfilled potential: using diethylcarbamazine-fortified salt to eliminate lymphatic filariasis
Lammie,Patrick; Milner,Trevor; Houston,Robin;
Bulletin of the World Health Organization , 2007, DOI: 10.1590/S0042-96862007000700012
Abstract: fortifying salt with diethylcarbamazine (dec) is a safe, low-cost and effective strategy to eliminate transmission of lymphatic filariasis. dec-fortified salt has been used successfully in pilot projects in several countries and has been used operationally by china to eliminate lymphatic filariasis. the successful use of iodized salt to eliminate iodine-deficiency disorders is encouraging; similarly, fortified salt could be used as a vehicle to eliminate lymphatic filariasis. despite the potential programmatic advantages of fortifying salt with dec instead of undertaking mass administration of tablets, dec-fortified salt remains an underutilized intervention. we discuss the reasons for this and suggest settings in which the use of dec-fortified salt should be considered.
Population Migration: Implications for Lymphatic Filariasis Elimination Programmes  [PDF]
K. D. Ramaiah
PLOS Neglected Tropical Diseases , 2013, DOI: 10.1371/journal.pntd.0002079
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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