The impact of mass drug administration and long-lasting insecticidal net distribution on Wuchereria bancrofti infection in humans and mosquitoes: an observational study in northern Uganda

BACKGROUND

Lymphatic filariasis (LF) in Uganda is caused by Wuchereria bancrofti and transmitted by anopheline mosquitoes. The mainstay of elimination has been annual mass drug administration (MDA) with ivermectin and albendazole, targeted to endemic districts, but has been sporadic and incomplete in coverage. Vector control could potentially contribute to reducing W. bancrofti transmission, speeding up progress towards elimination. To establish whether the use of long-lasting insecticidal nets (LLINs) can contribute towards reducing transmission of W. bancrofti in a setting with ongoing MDA, a study was conducted in an area of Uganda highly endemic for both LF and malaria. Baseline parasitological and entomological assessments were conducted in 2007, followed by high-coverage LLIN distribution. Net use and entomological surveys were carried out after one year, and final parasitological and entomological evaluations were conducted in 2010. Three rounds of MDA had taken place before the study commenced, with a further three rounds completed during the course of the study.

RESULTS

In 2007, rapid mapping indicated 22.3% of schoolchildren were W. bancrofti antigen positive, and a baseline survey during the same year found age-adjusted microfilaraemia prevalence was 3.7% (95% confidence interval (CI): 2.6-5.3%). In 2010, age-adjusted microfilaraemia prevalence had fallen to 0.4%, while antigenaemia rates were 0.2% in children < 5 years and 6.0% in ≥ 5 years. In 2010, universal coverage of mosquito nets in a household was found to be protective against W. bancrofti antigen (odds ratio = 0.44, 95% CI: 0.22-0.89). Prevalence of W. bancrofti larvae in anopheline mosquitoes had decreased significantly between the 2007 and 2010 surveys, but there was an apparent increase in vector densities.

CONCLUSION

A marked reduction in W. bancrofti infection and infectivity in humans was observed in the study area, where both MDA and LLINs were used to reduce transmission. The extent to which LLINs contributed to this decline is equivocal, however. Further work investigating the impact of vector control on anopheline-transmitted LF in an endemic area not benefitting from MDA would be valuable to determine the effect of such interventions on their own.

Impact of polystyrene beads as a mosquito control measure to supplement lymphatic filariasis elimination activities in Socotra Island, Yemen

Lymphatic filariasis (LF) is targeted for worldwide elimination. In Yemen, all mainland implementation units met the WHO criteria for stopping mass drug administration (MDA) after 5 rounds. However, in Socotra Island these criteria were not met. Our study evaluated the efficacy of applying expanded polystyrene beads (EPBs) on the Culex population and the effect on LF transmission. Human and mosquito surveys were conducted in 40 randomly selected households in Hadibo (capital of Socotra) before and after application of EPBs. The EPBs intervention resulted in a reduction in mosquito density of 80% and a 64.3% reduction in microfilaria prevalence. The majority of interviewed households (98%) thought EPBs considerably reduced the mosquito population. After the intervention all collected pools tested negative. Application of EPBs is an effective supplement to MDA for achieving the goal of LF elimination.

Geographical distribution and relative abundance of culicine mosquitoes in relation to transmission of lymphatic filariasis in El Menoufia Governorate, Egypt

Culicine mosquito were surveyed in El Menoufia Governorate (October to November 2008 and April to May 2009) in villages representing eight districts. Six species were reported: Culex (Culex) pipiens Linnaeus, Cx. (Cx) perexiguus Theobald, Cx. (Cx.) antennatus (Becker), Aedes (Ochlerotatus) caspius (Pallas), Aedes (Ochlerotatus) detritus (Haliday) and Culiseta (Allotheobaldia) longiareolata (Macquart). Cx. pipiens, the main filariasis vector was the commonest or predominating species (ca. 47% adults & 92% larvae, P < 0.01). For the common species, the following were investigated: 1- temperature and pH of the breeding habitats and their relation to the larval density and 2- relation of adult indoor density with indoor- and outdoor- temperature and RH. Besides, parasitologically, Wuchereria bancrofti cases (33/631 blood samples, 5.23%) were detected in three districts (range = 1.96-14.12% infection). The cases were associated with the abundance of Cx. pipiens adults (ca. 45- 62% of the collected adults).

Lymphatic filariasis in a rural community in Nigeria: a challenge ahead

Lymphatic filariasis (LF) represents a major public health problem in tropical and subtropical regions of the world. Following the admission of a 65 year old man from Sowo village Abeokuta Ogun State with a case of LF at the Federal Medical Centre Abeokuta, a cross-sectional based survey was carried out to determine the occurrence and prevalence of LF in this village. Identification of the LF parasite was carried out with blood stained with Giemsa and examined under low power magnification for the presence of sheathed microfilaria. Out of 317 persons examined 54 (17%) were microfilaraemic and their ages varied from 10 to 70 years. The age group 40-49 has the highest prevalence of 36.5% and highest mean microfilaria count of 4.8mf/mL. In the age group 20-29, females (12.8%) were more infected than males (9.3%) and the difference was statistically significant (P=0.0042). In all more males (17.8%) were affected than females (16.9%) (P=0.9481) and the mean MF count in males (22.8mf/ML) was higher than females (21.7mf/ML). The prevalent rate of elephantiasis and hydrecoele observed in the community was 2.2% respectively. The result of this study confirms and observed a high prevalence rate of LF in this community. This finding establishes the need for Ministry of Health (MOH) and Global Alliance to Eliminate LF (GAELF) to carry out disease control activities through Annual Mass Drug Administration (MDA) in this community.

Lymphatic filariasis and onchocerciasis

Lymphatic filariasis and onchocerciasis are parasitic helminth diseases that constitute a serious public health issue in tropical regions. The filarial nematodes that cause these diseases are transmitted by blood-feeding insects and produce chronic and long-term infection through suppression of host immunity. Disease pathogenesis is linked to host inflammation invoked by the death of the parasite, causing hydrocoele, lymphoedema, and elephantiasis in lymphatic filariasis, and skin disease and blindness in onchocerciasis. Most filarial species that infect people co-exist in mutualistic symbiosis with Wolbachia bacteria, which are essential for growth, development, and survival of their nematode hosts. These endosymbionts contribute to inflammatory disease pathogenesis and are a target for doxycycline therapy, which delivers macrofilaricidal activity, improves pathological outcomes, and is effective as monotherapy. Drugs to treat filariasis include diethylcarbamazine, ivermectin, and albendazole, which are used mostly in combination to reduce microfilariae in blood (lymphatic filariasis) and skin (onchocerciasis). Global programmes for control and elimination have been developed to provide sustained delivery of drugs to affected communities to interrupt transmission of disease and ultimately eliminate this burden on public health.

Laboratory selection of carbofuran tolerant line of Culex quinquefasciatus Say, the filarial vector at Mysore

Carbofuran is a systemic insecticide/nematicide extensively employed in modern agriculture and public health to combat various insect pests and vectors. The development of insecticide resistance due to natural selection pressure by Anopheline and Culicine mosquitoes has created serious repercussions in mosquito control and disease eradication campaigns. In this regard Culex quinquefasciatus, a widely dispersed domestic mosquito and the only vector of lymphatic filariasis in India, was selected for the present experiment. In order to assess the resistance development in this species, it was subjected to carbofuran bioassay by employing WHO method for 10 generations. The results of larval selection test up to F10 revealed a significant increase in tolerance development in every generation compared to the susceptible F1. The results revealed up to 16.225 times tolerance after 10 generations. The LC50 observed in F10 is 1.298 ppm compared to 0.08 ppm in the F1. The implications of the observations will be discussed.

Environmental factors associated with the distribution of Anopheles gambiae s.s in Ghana; an important vector of lymphatic filariasis and malaria

Anopheles gambiae s.s mosquitoes are important vectors of lymphatic filariasis (LF) and malaria in Ghana. To better understand their ecological aspects and influence on disease transmission, we examined the spatial distribution of the An. gambiae (M and S) molecular forms and associated environmental factors, and determined their relationship with disease prevalence. Published and current data available on the An. gambiae species in Ghana were collected in a database for analysis, and the study sites were georeferenced and mapped. Using the An. gambiae s.s sites, environmental data were derived from climate, vegetation and remote-sensed satellite sources, and disease prevalence data from existing LF and malaria maps in the literature. The data showed that An. gambiae M and S forms were sympatric in most locations. However, the S form predominated in the central region, while the M form predominated in the northern and coastal savanna regions. Bivariate and multiple regression analyses identified temperature as a key factor distinguishing their distributions. An. gambiae M was significantly correlated with LF, and 2.5 to 3 times more prevalent in the high LF zone than low to medium zones. There were no significant associations between high prevalence An. gambiae s.s locations and malaria. The distribution of the An. gambiae M and S forms and the diseases they transmit in Ghana appear to be distinct, driven by different environmental factors. This study provides useful baseline information for disease control, and future work on the An. gambiae s.s in Ghana.

A community-based study of factors associated with continuing transmission of lymphatic filariasis in Leogane, Haiti

Seven rounds of mass drug administration (MDA) have been administered in Leogane, Haiti, an area hyperendemic for lymphatic filariasis (LF). Sentinel site surveys showed that the prevalence of microfilaremia was reduced to <1% from levels as high as 15.5%, suggesting that transmission had been reduced. A separate 30-cluster survey of 2- to 4-year-old children was conducted to determine if MDA interrupted transmission. Antigen and antifilarial antibody prevalence were 14.3% and 19.7%, respectively. Follow-up surveys were done in 6 villages, including those selected for the cluster survey, to assess risk factors related to continued LF transmission and to pinpoint hotspots of transmission. One hundred houses were mapped in each village using GPS-enabled PDAs, and then 30 houses and 10 alternates were chosen for testing. All individuals in selected houses were asked to participate in a short survey about participation in MDA, history of residence in Leogane and general knowledge of LF. Survey teams returned to the houses at night to collect blood for antigen testing, microfilaremia and Bm14 antibody testing and collected mosquitoes from these communities in parallel. Antigen prevalence was highly variable among the 6 villages, with the highest being 38.2% (Dampus) and the lowest being 2.9% (Corail Lemaire); overall antigen prevalence was 18.5%. Initial cluster surveys of 2- to 4-year-old children were not related to community antigen prevalence. Nearest neighbor analysis found evidence of clustering of infection suggesting that LF infection was focal in distribution. Antigen prevalence among individuals who were systematically noncompliant with the MDAs, i.e. they had never participated, was significantly higher than among compliant individuals (p<0.05). A logistic regression model found that of the factors examined for association with infection, only noncompliance was significantly associated with infection. Thus, continuing transmission of LF seems to be linked to rates of systematic noncompliance.

Lymphatic filariasis (LF) is a mosquito-borne parasitic disease that affects an estimated 120 million people worldwide with over 1 billion at risk for infection. LF is considered to be a leading cause of permanent disability worldwide due to the clinical manifestations of the disease. A global effort was established to eliminate LF by 2020 through interruption of transmission by annual mass administrations of anti-parasitic drugs. In Leogane, Haiti, seven rounds of drug administration have been administered and, though infection levels have dropped, transmission has not been interrupted. In this study the authors examined factors that could contribute to continuing transmission of LF in Haiti. Ongoing transmission was confirmed by high infection rates among young children. Infection was found to cluster at the household level within communities. The factor most associated with this transmission was systematic noncompliance with drug administration (i.e. never taking the medication). While increased health education and awareness campaigns may improve noncompliance, new tools and approaches may be needed to stop transmission of LF in Haiti. Understanding obstacles and solutions from the Haiti program could aid elimination programs in other countries.

Sentinel surveillance of lymphatic filariasis, schistosomiasis soil transmitted helminths and malaria in rural southern Malawi

BACKGROUND

Baseline prevalence and knowledge, attitude and perception (KAP) survey is a prerequisite for mass drug administration for the control of Lymphatic filariasis (LF) and other neglected tropical diseases.

METHODS

In preparation for the first mass drug administration for LF elimination, a baseline survey was conducted in six sentinel sites in the southern Malawi, amongst participants aged five years or more. A standard questionnaire was used to obtain data on socio-demographic factors, ownership and use of bed nets, previous ingestion of ivermectin and KAP toward hydrocele and lymphoedema. Finger prick blood samples were collected from 22:00 to 01:00 hours for LF microscopy, malaria and haemoglobin examination. Stool and urine samples were collected for internal helminths and schistosomiasis respectively.

RESULTS

A total of 1, 903 participants were enrolled. Knowledge on the cause of hydrocele and lymphoedema was low in all the sentinel sites (16%-42%, 10%-24% (respectively). Sexual intercourse with a menstruating woman, bad weather and HIV/AIDS were perceived causes of hydrocele. Microfilaraemia prevalence was 1.5% and varied little between sentinel sites (1.0%-2.1%). Childhood urinary schistosomiasis was common in Phalombe (94.9%) and Blantyre (26.9%).

CONCLUSION

Integrated approach and understanding of the community KAP is vital or successful implementation of LF elimination programme.

Mosquito infection responses to developing filarial worms

Human lymphatic filariasis is a mosquito-vectored disease caused by the nematode parasites Wuchereria bancrofti, Brugia malayi and Brugia timori. These are relatively large roundworms that can cause considerable damage in compatible mosquito vectors. In order to assess how mosquitoes respond to infection in compatible mosquito-filarial worm associations, microarray analysis was used to evaluate transcriptome changes in Aedes aegypti at various times during B. malayi development. Changes in transcript abundance in response to the different stages of B. malayi infection were diverse. At the early stages of midgut and thoracic muscle cell penetration, a greater number of genes were repressed compared to those that were induced (20 vs. 8). The non-feeding, intracellular first-stage larvae elicited few differences, with 4 transcripts showing an increased and 9 a decreased abundance relative to controls. Several cecropin transcripts increased in abundance after parasites molted to second-stage larvae. However, the greatest number of transcripts changed in abundance after larvae molted to third-stage larvae and migrated to the head and proboscis (120 induced, 38 repressed), including a large number of putative, immunity-related genes (∼13% of genes with predicted functions). To test whether the innate immune system of mosquitoes was capable of modulating permissiveness to the parasite, we activated the Toll and Imd pathway controlled rel family transcription factors Rel1 and Rel2 (by RNA interference knockdown of the pathway's negative regulators Cactus and Caspar) during the early stages of infection with B. malayi. The activation of either of these immune signaling pathways, or knockdown of the Toll pathway, did not affect B. malayi in Ae. aegypti. The possibility of LF parasites evading mosquito immune responses during successful development is discussed.

Filarial worms that cause human lymphatic filariasis (LF) are transmitted by many species of mosquitoes. Within susceptible mosquitoes, Brugia malayi develop from microfilariae (mf) to infective-stage larvae (L3s), in approximately eight days. These nematodes develop as intracellular parasites within mosquito flight muscle cells, in which they ingest cellular material and eventually cause cell death when L3s migrate to the mosquito's proboscis. We examined the effects of B. malayi parasitism on Aedes aegypti by analyzing changes in mosquito gene expression at different stages of parasite development. We found that a few genes were differentially expressed at the RNA level relative to non-infected controls. The majority of changes occurred at two time periods, when the filarial worms began feeding and when the L3s were in the head and proboscis. Many transcriptional changes in the later group concur with documented descriptions of tissue damage, clean-up and repair that occurs in mosquitoes infected with filarial worms. In addition, we activated two innate immunity signaling pathways and observed the effects on filarial worm development. B. malayi seems to be capable of evading these immune responses, because its development was not impeded by the activation of either the Toll or Imd signal pathways in Ae. aegypti.

Immune activation by life-shortening Wolbachia and reduced filarial competence in mosquitoes

Wolbachia strain wMelPop reduces the longevity of its Drosophila melanogaster host and, when introduced into the mosquito Aedes aegypti, halves its life span. We show that wMelPop induces up-regulation of the mosquito's innate immune system and that its presence inhibits the development of filarial nematodes in the mosquito. These data suggest that wMelPop could be used in the global effort to eliminate lymphatic filariasis and possibly for the control of other mosquito-borne parasites where immune preactivation inhibits their development. The cost of constitutive immune up-regulation may contribute to the life-shortening phenotype.

Ecological meta-analysis of density-dependent processes in the transmission of lymphatic filariasis: survival of infected vectors

The survival rate of infected vectors represents one of the fundamental components that influence the transmission dynamics of mosquito-borne diseases. Despite the occurrence of a number of studies investigating mosquito survival after infection with filarial worms, there remains conflicting evidence from both laboratory and field experiments as to the existence and mechanism for parasite-induced mortality among filarial mosquitoes. Here, we used a mixed effects meta-analytical framework to combine the data from all available vector-human host blood feeding experiments to evaluate the evidence for the impact of parasite load on the mortality rates of the three major lymphatic filariasis transmitting mosquito genera, Culex, Aedes, and Anopheles mosquitoes, over the extrinsic incubation period of parasitic infection. The results show that, despite the application of this approach, or in the case of Anopheles using a convention fixed effects logistic regression analysis supplemented with additional survival analysis of longitudinal data, no strong association between mortality rate and microfilariae (mf) uptake for either of the three mosquito genera is apparent in the combined data. Instead, a key finding is that study effects played a more crucial role in determining the levels of mortality observed in these experimental studies. This was most revealing in the case of Culex, given that the largest single study in terms of both the number of data points and range of mf intensities, in contrast to smaller studies, showed a significant positive association between mf intensity and mortality, indicating that in this genus at least, the detrimental effect of infection may be manifested only at the highest mf intakes. Although no density dependence in vector mortality was also observed for Aedes, possibly because of the use of restricted human mf intensity range in previous studies, an intriguing finding was that a significantly higher overall mortality was observed for this genus over mfintake ranges that produced much less corresponding mortality in Culex and Anopheles. The results also indicate that currently very little can be said about the survival rate of Anopheles mosquitoes infected with filarial worms because of the striking paucity of data for this genus. Further studies, using standardized methods and covering an appropriate range of mf uptake intensities and using study frameworks that allow the design and comparison of data from both experimental and field experiments, are clearly indicated if we are to reliably quantify the likely effect of filarial infection on vector survival.

Insecticide resistance and detoxifying enzyme activity in the principal bancroftian filariasis vector, Culex quinquefasciatus, in northeastern India

The insecticide resistance status of Culex quinquefasciatus Say (Diptera: Culicidae) to DDT and deltamethrin across army cantonments and neighbouring villages in northeastern India was investigated. In India, DDT is still the insecticide of choice for public health programmes. In military stations, pyrethroids, especially deltamethrins, are used for insecticide-treated nets (ITNs). Recent information on the levels of resistance to DDT and deltamethrin in mosquito populations of northeastern India is scare. Continued monitoring of insecticide resistance status, identification of the underlying mechanisms of resistance in local mosquito populations and the establishment of a baseline data bank of this information are of prime importance. Insecticide susceptibility assays were performed on wild-caught adult female Cx. quinquefasciatus mosquitoes to the discriminating doses recommended by the World Health Organisation (WHO) to DDT (4%) and deltamethrin (0.05%). Across all study sites, mortality as a result of DDT varied from 11.9 to 50.0%, as compared with 91.2% in the susceptible laboratory strain (S-Lab), indicating that Cx. quinquefasciatus is resistant to DDT. The species was found to be 100% susceptible to deltamethrin in all study sites except Benganajuli and Rikamari. Knock-down times (KDT) in response to deltamethrin varied significantly between study sites (P < 0.01) from 8.3 to 17.8 min for KDT(50) and 37.4 to 69.5 min for KDT(90). All populations exceeded the threshold level of alpha-esterase, beta-esterase and glutathion S-transferase (GST) established for the S-Lab susceptible strain, and all populations had 100% elevated esterase and GST activity, except Missamari and Solmara. Beta-esterase activity in Field Unit II (96.9%) was less than in any of the other populations. Benganajuli had the highest activity level for all the enzymes tested. There was a significant correlation between all enzyme activity levels and insecticide resistance phenotype by populations (P < 0.05). The results presented here provide the first report and baseline information of the insecticide resistance status of Cx. quinquefasciatus in northeastern India, and associated information about biochemical mechanisms that are essential for monitoring the development of insecticide resistance in the area.

Assessing transmission of lymphatic filariasis using parasitologic, serologic, and entomologic tools after mass drug administration in American Samoa

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.

Role of vector control in the global program to eliminate lymphatic filariasis

Lymphatic filariasis (LF) is a major cause of acute and chronic morbidity in the tropical and subtropical parts of the world. The availability of safe, single-dose, drug treatment regimens capable of suppressing microfilaremia to very low levels, along with improvements in techniques for diagnosing infection, has resulted in the targeting of this major mosquito-borne disease for global elimination. The Global Program to Eliminate Lymphatic Filariasis (GPELF) was launched in 2000 with the principal objective of breaking the cycles of transmission of Wuchereria bancrofti and Brugia spp. through the application of annual mass drug administrations (MDAs) to entire at-risk populations. Although significant progress in initiating MDA programs in endemic countries has been made, emerging challenges to this approach have raised questions regarding the effectiveness of using MDA alone to eliminate LF without the inclusion of supplementary vector control. Here, we review advances in knowledge of vector ecology, vector-parasite relationships, and both empirical and theoretical evidence regarding vector management to assess the feasibility and strategic value of including vector control in the GPELF initiative to achieve the global elimination of LF.

[Discovery of a residual focus of bancroftian filariasis after declaration of its transmission interruption in Guangxi]

OBJECTIVE

To describe the discovery of a residual foci of bancroftian filariasis in Fuchuan County where the disease was announced to have been eliminated, and reveal its epidemiologic feature.

METHODS

The investigation was carried out from August 2007 to March 2008 among residents in Changtang village where the first case of filariasis was found and the neighboring villages. They were screened with two thick blood smears. Immunochromatographic technology (ICT) was conducted for those going out but returned and those in surrounding areas. Vector mosquitoes were collected and dissected to find filaria larvae. Historical documents were reviewed and relevant people were interviewed.

RESULTS

In Changtang administrative village, 1052 residents were screened and 19 cases with microfilaremia were found in 2 natural villages, with a Mf-positive rate of 1.8% (5.1% in Gangshang and 1.4% in Yinshan respectively). No Mf-positive case was found in 4119 residents screened in other 3 villages. The average microfilaria density in the 19 cases was 17.37/60 +/- 1 blood. All the 19 cases belonged to 12 families, and 13 cases were relatives to each other, which showed a feature of spatial clustering and family clustering. More patients were identified in the age groups of 20-29 and 50-59, and 57.9% of them were older than 50 years. No larvae were found in 54 Culex pipiens fatigans dissected.

CONCLUSION

The Changtang village is identified as a residual focus of bancroftian filariasis with a low, limited endemicity. More cases have been among the elderly with a low average microfilaremia.

Global eradication of lymphatic filariasis: the value of chronic disease control in parasite elimination programmes

The ultimate goal of the global programme against lymphatic filariasis is eradication through irrevocable cessation of transmission using 4 to 6 years of annual single dose mass drug administration. The costs of eradication, managerial impediments to executing national control programmes, and scientific uncertainty about transmission endpoints, are challenges to the success of this effort, especially in areas of high endemicity where financial resources are limited. We used a combined analysis of empirical community data describing the association between infection and chronic disease prevalence, mathematical modelling, and economic analyses to identify and evaluate the feasibility of setting an infection target level at which the chronic pathology attributable to lymphatic filariasis--lymphoedema of the extremities and hydroceles--becomes negligible in the face of continuing transmission as a first stage option in achieving the elimination of this parasitic disease. The results show that microfilaria prevalences below a threshold of 3.55% at a blood sampling volume of 1 ml could constitute readily achievable and sustainable targets to control lymphatic filarial disease. They also show that as a result of the high marginal cost of curing the last few individuals to achieve elimination, maximal benefits can occur at this threshold. Indeed, a key finding from our coupled economic and epidemiological analysis is that when initial uncertainty regarding eradication occurs and prospects for resolving this uncertainty over time exist, it is economically beneficial to adopt a flexible, sequential, eradication strategy based on controlling chronic disease initially.

Complex ecological dynamics and eradicability of the vector borne macroparasitic disease, lymphatic filariasis

BACKGROUND

The current global efforts to control the morbidity and mortality caused by infectious diseases affecting developing countries--such as HIV/AIDS, polio, tuberculosis, malaria and the Neglected Tropical Diseases (NTDs)-have led to an increasing focus on the biological controllability or eradicability of disease transmission by management action. Here, we use an age-structured dynamical model of lymphatic filariasis transmission to show how a quantitative understanding of the dynamic processes underlying infection persistence and extinction is key to evaluating the eradicability of this macroparasitic disease.

METHODOLOGY/PRINCIPAL FINDINGS

We investigated the persistence and extinction dynamics of lymphatic filariasis by undertaking a numerical equilibrium analysis of a deterministic model of parasite transmission, based on varying values of the initial L3 larval density in the system. The results highlighted the likely occurrence of complex dynamics in parasite transmission with three major outcomes for the eradicability of filariasis. First, both vector biting and worm breakpoint thresholds are shown to be complex dynamic entities with values dependent on the nature and magnitude of vector-and host specific density-dependent processes and the degree of host infection aggregation prevailing in endemic communities. Second, these thresholds as well as the potential size of the attractor domains and hence system resilience are strongly dependent on peculiarities of infection dynamics in different vector species. Finally, the existence of multiple stable states indicates the presence of hysteresis nonlinearity in the filariasis system dynamics in which infection thresholds for infection invasion are lower but occur at higher biting rates than do the corresponding thresholds for parasite elimination.

CONCLUSIONS/SIGNIFICANCE

The variable dynamic nature of thresholds and parasite system resilience reflecting both initial conditions and vector species-infection specificities, and the existence of hysteresis loop phenomenon, suggests that eradication of filariasis may require taking a more flexible and locally relevant approach to designing elimination programmes compared to the current command and control approach advocated by the global programme.

Lymphatic filariasis

(1) Lymphatic filariasis is a set of parasitic diseases that are endemic in tropical and subtropical regions and can be disabling in the long term. (2) The standard antiparasitic drug for adults is oral diethylcarbamazine. Ivermectin is an alternative, especially for patients with intercurrent onchocercosis or loasis.

Interspecific hybridization yields strategy for South Pacific filariasis vector elimination

BACKGROUND

Lymphatic filariasis (LF) is a leading cause of disability in South Pacific regions, where >96% of the 1.7 million population are at risk of LF infection. As part of current global campaign, mass drug administration (MDA) has effectively reduced lymphatic filiariasis prevalence, but mosquito vector biology can complicate the MDA strategy. In some regions, there is evidence that the goal of LF elimination cannot be attained via MDA alone. Obligate vector mosquitoes provide additional targets for breaking the LF transmission cycle, but existing methods are ineffective for controlling the primary vector throughout much of the South Pacific, Aedes polynesiensis.

METHODOLOGY/PRINCIPAL FINDINGS

Here we demonstrate that interspecific hybridization and introgression results in an A. polynesiensis strain ('CP' strain) that is stably infected with the endosymbiotic Wolbachia bacteria from Aedes riversi. The CP strain is bi-directionally incompatible with naturally infected mosquitoes, resulting in female sterility. Laboratory assays demonstrate that CP males are equally competitive, resulting in population elimination when CP males are introduced into wild type A. polynesiensis populations.

CONCLUSIONS/SIGNIFICANCE

The findings demonstrate strategy feasibility and encourage field tests of the vector elimination strategy as a supplement to ongoing MDA efforts.

Transmission dynamics of diurnally subperiodic lymphatic filariasis transmitted by Ochlerotatus (Finlaya) niveus in the Andaman & Nicobar Islands

BACKGROUND & OBJECTIVE

In India diurnally subperiodic filariasis is prevalent only in the Nicobar district of Andaman and Nicobar Islands, with significant health problem. Sample surveys indicated that this form of filariasis is restricted to a small region of Nancowry group of islands with Ochlerotatus niveus as the vector. We therefore carried out a comprehensive study to assess the transmission dynamics of LF in Teressa island in Nicobar district in view of its control and evaluation of interventions.

METHODS

Entomological studies were carried out for a period of twelve months covering all the seasons in the year, by means of man landing catches in Teressa Island, an endemic island for this form of filariasis. Parameters viz., the annual biting rate (ABR), annual infective biting rate (AIBR), annual transmission index (ATI), risk of infection index (RII) and annual transmission potential (ATP), which reflect the dynamics and intensity of transmission of filariasis, were estimated. Host efficiency of Oc. niveus was also assessed.

RESULTS

The number of vectors biting a person in a year was estimated to be 21851, of which 107 were harbouring infective parasite. Risk of infection intensity was 0.02332. Every person in this study area was at the risk of receiving an estimated number of 22 infective stage larvae per year. The host efficiency index of Oc. niveus indicated that over 40 per cent of the microfilariae ingested were able to develop into infective stages. The ATP was 169 with evidence of year round transmission. The pattern of monthly transmission potential suggested that the intensity of transmission was high during summer months.

INTERPRETATION & CONCLUSION

Perennial transmission of subperiodic Wuchereria bancrofti in the typical forest ecosystem was evident in Teressa Island with transmission parameters suggesting that summer is a high risk season for transmission. Personal protection measure is the method of choice to protect from the risk of infection, because of day biting, exophilic and exophagic behaviour of the vector and larvae are not amenable to larvicidal measures. An alternative method to control the transmission would be to use selective or periodic mass chemotherapy to reduce the parasite load in this community.

A critical appraisal of molecular xenomonitoring as a tool for assessing progress toward elimination of Lymphatic Filariasis

We used molecular xenomonitoring (MX, detection of filarial DNA in mosquitoes) to evaluate the impact of mass drug administration (MDA) in sentinel locations in Egypt with high (11.5%) and low (4.1%) baseline microfilaria prevalence rates. Blood-fed Culex pipiens were pooled by household and tested for Wuchereria bancrofti DNA by PCR. There was no significant relationship between the infection status of household residents and parasite DNA status of mosquitoes from the same houses. After 5 MDA rounds, parasite DNA rates in mosquitoes in high- and low-prevalence areas were reduced by 93.8% and 100% to 0.19% (95% CI: 0.076-0.382%) and 0% (95% CI: 0-0.045%), respectively. These changes were consistent with decreases in microfilaria prevalence rates in these sites; they provide insight regarding the minimal mosquito DNA rates necessary for sustained transmission of filariasis in Egypt. We conclude that MX is a powerful tool for monitoring the impact of MDA on filariasis endemicity and transmission.

Epidemiology of lymphatic filariasis

Human lymphatic filariasis is caused mainly by Wuchereria bancrofti, Brugia malayi and Brugia timori. Of the estimated 90.2 million people infected, more than 90% have bancroftian and less than 10% brugian filariasis. The distribution and transmission of the disease are closely associated with socioeconomic and behavioural factors in endemic populations. Urban W. bancrofti infection, as seen in South-East Asia, is related to poor urban sanitation, which leads to intense breeding of Culex quiquefasciatus, the principal vector. Rural strains of W. bancrofti are transmitted primarily by Anopheles spp. and Aedes spp. mosquitoes. Brugian filariasis is mainly a rural disease transmitted by Mansonia, Anopheles and Aedes spp. mosquitoes. The periodic form of B. malayi is principally a human parasite, whereas the subperiodic form is zoonotically transmitted in some countries. The control of filariasis has relied on chemotherapy, vector control and reduction of human-vector contact. Although eradication of W. bancrofti and periodic B. malayi can be achieved, it is possible only to reduce transmission of zoonotic subperiodic B. malayi in some areas. A rational approach to control should consider ecological, socioeconomic and behavioural factors and, where feasible, integrate control programmes into the delivery system for primary health care.