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Ramesh A, Oliveira P, Cameron M, Castanha PMS, Walker T, Lenhart A, Impoinvil L, Alexander N, Medeiros Z, Sá A, Rocha A, Souza WV, Maciel A, Braga C. Postintervention Immunological and Entomological Survey of Lymphatic Filariasis in the City of Olinda, Brazil, 2015-2016. Am J Trop Med Hyg 2024; 110:470-482. [PMID: 38350158 PMCID: PMC10919178 DOI: 10.4269/ajtmh.23-0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 11/05/2023] [Indexed: 02/15/2024] Open
Abstract
Lymphatic filariasis (LF) is a leading cause of disability due to infectious disease worldwide. The Recife Metropolitan Region (RMR) is the only remaining focus of LF in Brazil, where the parasite Wuchereria bancrofti is transmitted solely by the mosquito Culex quinquefasciatus. This study reports the results of transmission assessment surveys and molecular xenomonitoring in the city of Olinda, RMR, after nearly 15 years (2015-2016) of interventions for LF elimination. Participants were screened for W. bancrofti antigen via immunochromatographic card tests (ICT) in: 1) door-to-door surveys conducted for all children aged 5-7 years from 4 out of 17 intervention areas treated with at least five annual doses of mass drug administration (MDA), and 2) a two-stage cluster sampling survey of residents aged 5 years and older in non-MDA areas. Mosquitoes were collected via handheld aspirators in four MDA areas, differentiated by species, sex, and physiological status, pooled into groups of up to 10 blood-fed, semigravid, and gravid mosquitoes, and screened for W. bancrofti infection by real-time quantitative polymerase chain reaction (RT-qPCR). All 1,170 children from MDA areas and the entire population sample of 990 residents in non-MDA areas were ICT negative. In MDA areas, a total of 3,152 female Cx. quinquefasciatus mosquitoes in 277 households (range, 0-296 mosquitoes per house) were collected via aspiration. RT-qPCR of 233 pools of mosquitos were negative for W. bancrofti RNA; an independent reference laboratory confirmed these results. These results provide evidence that LF transmission has been halted in this setting.
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Affiliation(s)
- Anita Ramesh
- Department of Parasitology, Instituto Aggeu Magalhães/Fundação Oswaldo Cruz (FIOCRUZ), Recife, Brazil
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Paula Oliveira
- National Reference Service for Lymphatic Filariasis, Department of Parasitology, Instituto Aggeu Magalhães/FIOCRUZ, Recife, Brazil
| | - Mary Cameron
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Priscila M. S. Castanha
- Faculty of Medical Science, University of Pernambuco, Recife, Brazil
- School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Thomas Walker
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
- School of Life Sciences, The University of Warwick, Coventry, United Kingdom
| | - Audrey Lenhart
- Entomology Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lucy Impoinvil
- Entomology Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Neal Alexander
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Zulma Medeiros
- Department of Parasitology, Instituto Aggeu Magalhães/Fundação Oswaldo Cruz (FIOCRUZ), Recife, Brazil
| | - André Sá
- Collective Health Department, Instituto Aggeu Magalhães/FIOCRUZ
| | - Abraham Rocha
- National Reference Service for Lymphatic Filariasis, Department of Parasitology, Instituto Aggeu Magalhães/FIOCRUZ, Recife, Brazil
| | - Wayner V. Souza
- Collective Health Department, Instituto Aggeu Magalhães/FIOCRUZ
| | - Amélia Maciel
- Department of Tropical Medicine, Federal University of Pernambuco, Recife, Brazil
| | - Cynthia Braga
- Department of Parasitology, Instituto Aggeu Magalhães/Fundação Oswaldo Cruz (FIOCRUZ), Recife, Brazil
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Williams T, Karim MJ, Uddin S, Jahan S, Asm SM, Forbes SP, Hooper A, Taylor MJ, Kelly-Hope LA. Socio-economic and environmental factors associated with high lymphatic filariasis morbidity prevalence distribution in Bangladesh. PLoS Negl Trop Dis 2023; 17:e0011457. [PMID: 37432968 DOI: 10.1371/journal.pntd.0011457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 06/12/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Lymphatic filariasis (LF) is a vector-borne parasitic disease which affects 70 million people worldwide and causes life-long disabilities. In Bangladesh, there are an estimated 44,000 people suffering from clinical conditions such as lymphoedema and hydrocoele, with the greatest burden in the northern Rangpur division. To better understand the factors associated with this distribution, this study examined socio-economic and environmental factors at division, district, and sub-district levels. METHODOLOGY A retrospective ecological study was conducted using key socio-economic (nutrition, poverty, employment, education, house infrastructure) and environmental (temperature, precipitation, elevation, waterway) factors. Characteristics at division level were summarised. Bivariate analysis using Spearman's rank correlation coefficient was conducted at district and sub-district levels, and negative binomial regression analyses were conducted across high endemic sub-districts (n = 132). Maps were produced of high endemic sub-districts to visually illustrate the socio-economic and environmental factors found to be significant. RESULTS The highest proportion of rural population (86.8%), poverty (42.0%), tube well water (85.4%), and primary employment in agriculture (67.7%) was found in Rangpur division. Spearman's rank correlation coefficient at district and sub-district level show that LF morbidity prevalence was significantly (p<0.05) positively correlated with households without electricity (district rs = 0.818; sub-district rs = 0.559), households with tube well water (sub-district rs = 0.291), households without toilet (district rs = 0.504; sub-district rs = 0.40), mean annual precipitation (district rs = 0.695; sub-district rs = 0.503), mean precipitation of wettest quarter (district rs = 0.707; sub-district rs = 0.528), and significantly negatively correlated with severely stunted children (district rs = -0.723; sub-district rs = -0.370), mean annual temperature (district rs = -0.633.; sub-district rs = 0.353) and mean temperature (wettest quarter) ((district rs = -0.598; sub-district rs = 0.316) Negative binomial regression analyses at sub-district level found severely stunted children (p = <0.001), rural population (p = 0.002), poverty headcount (p = 0.001), primary employment in agriculture (p = 0.018), households without toilet (p = <0.001), households without electricity (p = 0.002) and mean temperature (wettest quarter) (p = 0.045) to be significant. CONCLUSIONS This study highlights the value of using available data to identify key drivers associated with high LF morbidity prevalence, which may help national LF programmes better identify populations at risk and implement timely and targeted public health messages and intervention strategies.
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Affiliation(s)
- Tijana Williams
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Mohammad Jahirul Karim
- Filariasis Elimination and STH Control Programme, Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Shihab Uddin
- Pedodontics Department, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Sharmin Jahan
- Centre for Injury Prevention and Research, Dhaka, Bangladesh (CIPRB)
| | - Sultan Mahmood Asm
- Filariasis Elimination and STH Control Programme, Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Shaun P Forbes
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island, United States of America
| | - Anna Hooper
- University of Nottingham, Nottingham, United Kingdom
| | - Mark J Taylor
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Louise A Kelly-Hope
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
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Badia-Rius X, Adamou S, Taylor MJ, Kelly-Hope LA. Morbidity hotspot surveillance: A novel approach to detect lymphatic filariasis transmission in non-endemic areas of the Tillabéry region of Niger. Parasite Epidemiol Control 2023; 21:e00300. [PMID: 37138586 PMCID: PMC10149363 DOI: 10.1016/j.parepi.2023.e00300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/24/2023] [Accepted: 04/17/2023] [Indexed: 05/05/2023] Open
Abstract
The Niger Lymphatic Filariasis (LF) Programme is making good progress towards the elimination goal and scaling up morbidity management and disability prevention (MMDP) activities. Clinical case mapping and the increased availability of services has prompted patients to come forward in both endemic and non-endemic districts. The latter included Filingué, Baleyara and Abala districts of the Tillabéry region, and in 2019, 315 patients were found during a follow-up active case finding activity, suggesting it may have low transmission. The aim of this study was to assess the endemicity status in areas reporting clinical cases, 'morbidity hotspots', in three non-endemic districts of the Tillabéry region. A cross-sectional survey was conducted in 12 villages in June 2021. Filarial antigen was detected using the rapid Filariasis Test Strip (FTS) diagnostic, and information obtained on gender, age, residency length, bed net ownership and usage, and presence of hydrocoele and/or lymphoedema. Data were summarised and mapped using QGIS software. A total of 4058 participants between 5 and 105 years old were surveyed, with 29 (0.7%) participants found to be FTS positive. Baleyara district had significantly higher FTS positive rates than the other districts. No significant differences were found by gender (male 0.8%; female 0.6%), age group (<26 years 0.7%; ≥26 years 0. 7%), and residency length (<5 years 0.7%; ≥5 years 0.7%). Three villages reported no infections; seven villages <1%, one village 1.1% and one village 4.1%, which was on the border of an endemic district. Bed net ownership (99.2%) and usage (92.6%) was very high and there was no significant difference between FTS infection rates. The results indicate that there are low levels of transmission in populations, including children, living in districts previously classified as non-endemic. This has implications for the Niger LF programme in terms of delivering targeted mass drug administration (MDA) in transmission hotspots, and MMDP services, including hydrocoele surgery to patients. The use of morbidity data may be a practical proxy to trigger mapping of ongoing transmission in low endemic areas. Continued efforts to study morbidity hotspots, post-validation transmission, cross-border and cross-district endemicity are needed to meet the WHO NTD 2030 roadmap targets.
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Affiliation(s)
- Xavier Badia-Rius
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, UK
- Corresponding author.
| | - Salissou Adamou
- Programme National de Dévolution de l'Onchocercose et Élimination de la Filariose Lymphatique, Ministère de la Santé Publique, de la Population et des Affaires Sociales, Niger
| | - Mark J. Taylor
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, UK
| | - Louise A. Kelly-Hope
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, UK
- Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, UK
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Assessing the effects of disease-specific programs on health systems: An analysis of the Bangladesh Lymphatic Filariasis Elimination Program's impacts on health service coverage and catastrophic health expenditure. PLoS Negl Trop Dis 2021; 15:e0009894. [PMID: 34813600 PMCID: PMC8651132 DOI: 10.1371/journal.pntd.0009894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/07/2021] [Accepted: 10/10/2021] [Indexed: 11/19/2022] Open
Abstract
This study presents a methodology for using tracer indicators to measure the effects of disease-specific programs on national health systems. The methodology is then used to analyze the effects of Bangladesh’s Lymphatic Filariasis Elimination Program, a disease-specific program, on the health system. Using difference-in-differences models and secondary data from population-based household surveys, this study compares changes over time in the utilization rates of eight essential health services and incidences of catastrophic health expenditures between individuals and households, respectively, of lymphatic filariasis hyper-endemic districts (treatment districts) and of hypo- and non-endemic districts (control districts). Utilization of all health services increased from year 2000 to year 2014 for the entire population but more so for the population living in treatment districts. However, when the services were analyzed individually, the difference-in-differences between the two populations was insignificant. Disadvantaged populations (i.e., populations that lived in rural areas, belonged to lower wealth quintiles, or did not attend school) were less likely to access essential health services. After five years of program interventions, households in control districts had a lower incidence of catastrophic health expenditures at several thresholds measured using total household expenditures and total non-food expenditures as denominators. Using essential health service coverage rates as outcome measures, the Lymphatic Filariasis Elimination Program cannot be said to have strengthened or weakened the health system. We can also say that there is a positive association between the Lymphatic Filariasis Elimination Program’s interventions and lowered incidence of catastrophic health expenditures. Evidence to understand the interactions between disease specific programs and the health system is insufficient and largely based on opinion. This study presents a methodology for using tracer indicators to measure the effect of a disease-specific program, the Bangladesh Lymphatic Filariasis Elimination Program, on its health system. The Composite Coverage Index and incidence of catastrophic health expenditures are well-established tracer indicators for measuring the strength of a health system. In this study, they were calculated, before the program started in 2000 and after it ended in 2015, using data from Demographic and Health Surveys and Household Income and Expenditure Surveys, respectively. Using the Composite Coverage Index to measure the effects of the Lymphatic Filariasis Elimination Program revealed that it did not negatively or positively affect health service coverage rates. We can also say that there is a positive association between the program interventions and lowered incidence of catastrophic health expenditures.
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Douglass J, Martindale S, Mableson H, Jhara ST, Karim MJ, Rahman MM, Kawsar AA, Khair A, Mahmood ASMS, Rahman AKMF, Chowdhury SM, Hailekiros F, Tamiru M, Seife F, Bishaw T, Nigussie M, Meribo K, Agidew G, Betts H, Taylor MJ, Kelly-Hope LA. Insights on Lymphedema Self-Care Knowledge and Practice in Filariasis and Podoconiosis-Endemic Communities in Bangladesh and Ethiopia. FRONTIERS IN TROPICAL DISEASES 2021. [DOI: 10.3389/fitd.2021.767045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Lymphedema is a life-long sequelae to several neglected tropical diseases (NTD). In Bangladesh the main cause is lymphatic filariasis (LF) and Ethiopia is endemic for both LF and podoconiosis. The World Health Organization (WHO) recommends daily self-care including meticulous washing and drying of affected skin and attention to entry lesions, limb exercises and elevation. Adherence to this regime reduces secondary infections which cause disabling episodes of acute dermato-lymphangitis (ADL). Self-care practices must be integrated into family life, supported by community and monitored by health staff; however, little is known about the influence of personal and socio-demographic factors on adherence. People affected by lymphedema (n=272), adult caregivers (n=272), and health workers (n=68) in Bangladesh and Ethiopia were trained in lymphedema management according to WHO recommendations. Surveys on the causes and management of lymphedema were collected at baseline and 24-weeks, and patients completed a daily journal of self-care activities and symptoms. At baseline knowledge on causes and management of lymphedema was greater among health workers (>70%) than patients and caregivers (<20%) in both countries, and there were significant between-country differences in patient reported use of limb washing (Bangladesh = 7.7%. Ethiopia = 51.1%, p = 0.001). At 24-weeks knowledge on lymphedema causes and management had increased significantly among patients and caregivers, there was <70% adherence to limb washing and exercises, but lesser use of limb elevation in both countries. A range of patient characteristics were associated with significant variation in self-care, except for limb washing. Performance of fewer leg exercises was significantly associated with increased age or severe lymphedema in Bangladesh, and with being female or in paid work in Ethiopia. Patient journals recorded ADL symptoms and working days lost due to lymphedema more frequently than were reported by recall during the 24-week survey. Core elements of lymphedema self-care education, training and monitoring are the same for multiple etiologies. This creates opportunities for cross-cutting implementation of integrated service delivery across several skin NTDs. Sustainability will depend on community level ownership and research on factors affecting adherence to lymphedema self-care are urgently needed.
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Kapa DR, Mohamed AJ. Progress and impact of 20 years of a lymphatic filariasis elimination programme in South-East Asia. Int Health 2021; 13:S17-S21. [PMID: 33349881 PMCID: PMC7753165 DOI: 10.1093/inthealth/ihaa056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/21/2020] [Accepted: 09/04/2020] [Indexed: 02/07/2023] Open
Abstract
Background The South-East Asia regional programme to eliminate lymphatic filariasis (LF) was launched in 2000. This study presents the progress and impact of the programme in the region. Methods Mass drug administration (MDA) and morbidity management data were accessed from the WHO preventive chemotherapy databank. The status of the programme in the nine South-East Asia countries was reviewed and progress was assessed. The impact of the programme on LF disease burden was estimated on the basis of the effectiveness of the MDA drugs against microfilaraemia and chronic disease. Results Under the MDA programme, 8.1 billion treatments were delivered in nine countries and 5.7 billion treatments were consumed by the target population during 2001–2018. Three of nine countries eliminated LF. Bangladesh is poised to reach its elimination goal by 2021. In the other five countries, 38–76% of intervention units completed intervention and surveillance is in progress. The MDA programme prevented or cured 74.9 million infections, equivalent to an 84.2% reduction. Close to 1 million lymphoedema patients and 0.5 million hydrocele patients were reported and are being provided with the minimum package of care. Conclusions The South-East Asia region's LF elimination programme reduced the burden of LF appreciably and is moving towards achieving the elimination goal in the next 8–10 y.
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Affiliation(s)
| | - Ahmed Jamsheed Mohamed
- Depa rtment of Communicable Diseases, WHO Regional Office for South-East Asia, New Delhi 110002, India
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Bizhani N, Hashemi Hafshejani S, Mohammadi N, Rezaei M, Rokni MB. Lymphatic filariasis in Asia: a systematic review and meta-analysis. Parasitol Res 2021; 120:411-422. [PMID: 33415391 PMCID: PMC7790732 DOI: 10.1007/s00436-020-06991-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/25/2020] [Indexed: 12/02/2022]
Abstract
Lymphatic filariasis (LF) is an important neglected parasitic disease according to the World Health Organization. In this study, we aimed to determine the prevalence of human LF in Asia using a systematic review and meta-analysis approach. Records from 1990 to 2018 in reputable databases including PubMed, Science Direct, Embase, and Cochrane Library were searched using a panel of related keywords. All 48 countries of Asia were searched one by one in combination with the keywords. In all, 41,742 cases identified in this study were included in the analysis. According to our findings, the pooled prevalence of LF in Asia was estimated at 3% (95% CI: [1.7, 5.2]). There was no major trend in the cumulative prevalence of LF over time. Some countries in Asia including China, Japan, Vietnam, and South Korea succeeded in eliminating LF as a public health problem, but others still need to monitor the disease. Based on the initiative of the WHO starting in 2000, some countries in Asia succeeded in eliminating LF as a public health problem. Other countries have taken steps to eliminate the disease with variable degrees of success. These efforts might be affected by issues such as climate change.
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Affiliation(s)
- Negar Bizhani
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeideh Hashemi Hafshejani
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Mohammadi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Rezaei
- Department of Forestry and Landscape Architecture, Konkuk University, Seoul, Republic of Korea
| | - Mohammad Bagher Rokni
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Douglass J, Mableson H, Martindale S, Jhara ST, Karim MJ, Rahman MM, Kawsar AA, Khair A, Mahmood ASMS, Rahman AKMF, Chowdhury SM, Kim S, Betts H, Taylor M, Kelly-Hope L. Effect of an Enhanced Self-Care Protocol on Lymphedema Status among People Affected by Moderate to Severe Lower-Limb Lymphedema in Bangladesh, a Cluster Randomized Controlled Trial. J Clin Med 2020; 9:jcm9082444. [PMID: 32751676 PMCID: PMC7464742 DOI: 10.3390/jcm9082444] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Lymphatic filariasis (LF) is a major cause of lymphedema, affecting over 16 million people globally. A daily, hygiene-centered self-care protocol is recommended and effective in reducing acute attacks caused by secondary infections. It may also reverse lymphedema status in early stages, but less so as lymphedema advances. Lymphatic stimulating activities such as self-massage and deep-breathing have proven beneficial for cancer-related lymphedema, but have not been tested in LF-settings. Therefore, an enhanced self-care protocol was trialed among people affected by moderate to severe LF-related lymphedema in northern Bangladesh. Methods: Cluster randomization was used to allocate participants to either standard- or enhanced-self-care groups. Lymphedema status was determined by lymphedema stage, mid-calf circumference, and mid-calf tissue compressibility. Results: There were 71 patients in each group and at 24 weeks, both groups had experienced significant improvement in lymphedema status and reduction in acute attacks. There was a significant and clinically relevant between-group difference in mid-calf tissue compressibility with the biggest change observed on legs affected by severe lymphedema in the enhanced self-care group (∆ 21.5%, −0.68 (−0.91, −0.45), p < 0.001). Conclusion: This study offers the first evidence for including lymphatic stimulating activities in recommended self-care for people affected by moderate and severe LF-related lymphedema.
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Affiliation(s)
- Janet Douglass
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; (H.M.); (S.M.); (H.B.); (M.T.); (L.K.-H.)
- Correspondence:
| | - Hayley Mableson
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; (H.M.); (S.M.); (H.B.); (M.T.); (L.K.-H.)
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool L69 3BX, UK
| | - Sarah Martindale
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; (H.M.); (S.M.); (H.B.); (M.T.); (L.K.-H.)
| | - Sanya Tahmina Jhara
- Filariasis Elimination and STH Control Program, Ministry of Health and Family Welfare, Dhaka 1000, Bangladesh; (S.T.J.); (M.J.K.); (M.M.R.); (A.A.K.); (A.K.); (A.S.M.)
| | - Mohammad Jahirul Karim
- Filariasis Elimination and STH Control Program, Ministry of Health and Family Welfare, Dhaka 1000, Bangladesh; (S.T.J.); (M.J.K.); (M.M.R.); (A.A.K.); (A.K.); (A.S.M.)
| | - Muhammad Mujibur Rahman
- Filariasis Elimination and STH Control Program, Ministry of Health and Family Welfare, Dhaka 1000, Bangladesh; (S.T.J.); (M.J.K.); (M.M.R.); (A.A.K.); (A.K.); (A.S.M.)
| | - Abdullah Al Kawsar
- Filariasis Elimination and STH Control Program, Ministry of Health and Family Welfare, Dhaka 1000, Bangladesh; (S.T.J.); (M.J.K.); (M.M.R.); (A.A.K.); (A.K.); (A.S.M.)
| | - Abul Khair
- Filariasis Elimination and STH Control Program, Ministry of Health and Family Welfare, Dhaka 1000, Bangladesh; (S.T.J.); (M.J.K.); (M.M.R.); (A.A.K.); (A.K.); (A.S.M.)
| | - ASM Sultan Mahmood
- Filariasis Elimination and STH Control Program, Ministry of Health and Family Welfare, Dhaka 1000, Bangladesh; (S.T.J.); (M.J.K.); (M.M.R.); (A.A.K.); (A.K.); (A.S.M.)
| | - AKM Fazlur Rahman
- Centre for Injury Prevention and Research Bangladesh, Dhaka 1206, Bangladesh; (A.F.R.); (S.M.C.)
| | - Salim Mahmud Chowdhury
- Centre for Injury Prevention and Research Bangladesh, Dhaka 1206, Bangladesh; (A.F.R.); (S.M.C.)
| | - Susan Kim
- College of Medicine and Public Health, Flinders University, Bedford Park SA 5042, Australia;
| | - Hannah Betts
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; (H.M.); (S.M.); (H.B.); (M.T.); (L.K.-H.)
| | - Mark Taylor
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; (H.M.); (S.M.); (H.B.); (M.T.); (L.K.-H.)
| | - Louise Kelly-Hope
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; (H.M.); (S.M.); (H.B.); (M.T.); (L.K.-H.)
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Pilotte N, Cook DA, Pryce J, Zulch MF, Minetti C, Reimer LJ, Williams SA. Laboratory evaluation of molecular xenomonitoring using mosquito and tsetse fly excreta/feces to amplify Plasmodium, Brugia, and Trypanosoma DNA. Gates Open Res 2020; 3:1734. [PMID: 32596646 PMCID: PMC7308644 DOI: 10.12688/gatesopenres.13093.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Results from an increasing number of studies suggest that mosquito excreta/feces (E/F) testing has considerable potential to serve as a supplement for traditional molecular xenomonitoring techniques. However, as the catalogue of possible use-cases for this methodology expands, and the list of amenable pathogens grows, a number of fundamental methods-based questions remain. Answering these questions is critical to maximizing the utility of this approach and to facilitating its successful implementation as an effective tool for molecular xenomonitoring. Methods: Utilizing E/F produced by mosquitoes or tsetse flies experimentally exposed to Brugia malayi, Plasmodium falciparum, or Trypanosoma brucei brucei, factors such as limits of detection, throughput of testing, adaptability to use with competent and incompetent vector species, and effects of additional blood feedings post parasite-exposure were evaluated. Two platforms for the detection of pathogen signal (quantitative real-time PCR and digital PCR (dPCR)) were also compared, with strengths and weaknesses examined for each. Results: Experimental results indicated that high throughput testing is possible when evaluating mosquito E/F for the presence of either B. malayi or P. falciparum from both competent and incompetent vector mosquito species. Furthermore, following exposure to pathogen, providing mosquitoes with a second, uninfected bloodmeal did not expand the temporal window for E/F collection during which pathogen detection was possible. However, this collection window did appear longer in E/F collected from tsetse flies following exposure to T. b. brucei. Testing also suggested that dPCR may facilitate detection through its increased sensitivity. Unfortunately, logistical obstacles will likely make the large-scale use of dPCR impractical for this purpose. Conclusions: By examining many E/F testing variables, expansion of this technology to a field-ready platform has become increasingly feasible. However, translation of this methodology from the lab to the field will first require field-based pilot studies aimed at assessing the efficacy of E/F screening.
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Affiliation(s)
- Nils Pilotte
- Department of Biological Sciences, Smith College, Northampton, Massachusetts, 01063, USA
- Molecular and Cellular Biology Program, University of Massachusetts, Amherst, Massachusetts, 01003, USA
| | - Darren A.N. Cook
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Joseph Pryce
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Michael F. Zulch
- Department of Biological Sciences, Smith College, Northampton, Massachusetts, 01063, USA
| | - Corrado Minetti
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Lisa J. Reimer
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Steven A. Williams
- Department of Biological Sciences, Smith College, Northampton, Massachusetts, 01063, USA
- Molecular and Cellular Biology Program, University of Massachusetts, Amherst, Massachusetts, 01003, USA
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10
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Davlin SL, Jones AH, Tahmina S, Kawsar AA, Joshi A, Zaman SI, Rahman MM, Morawski BM, Deming MS, Imtiaz R, Karim MJ. Soil-transmitted helminthiasis in four districts in Bangladesh: household cluster surveys of prevalence and intervention status. BMC Public Health 2020; 20:672. [PMID: 32397986 PMCID: PMC7218586 DOI: 10.1186/s12889-020-08755-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 04/22/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND In 2016, after 8 years of twice-annual nationwide preventive chemotherapy (PC) administration to school-age children (SAC), the Bangladesh Ministry of Health & Family Welfare (MOHFW) sought improved impact and intervention monitoring data to assess progress toward the newly adopted goal of eliminating soil-transmitted helminthiasis (STH) as a public health problem. METHODS We surveyed four Bangladeshi districts between August and October 2017. We conducted a multi-stage, cluster-sample, household survey which produced equal-probability samples for preschool-age children (PSAC; 1-4 years), SAC (5-14 years), and adults (≥ 15 years). Standardized questionnaires were administered, using Android-based smart phones running an Open Data Kit application. Stool samples were collected and testing for STH prevalence and infection intensity used the Kato-Katz technique. RESULTS In all, 4318 stool samples were collected from 7164 participants. Estimates of STH prevalence by risk group in three of the four surveyed districts ranged from 3.4 to 5.0%, all with upper, 1-sided 95% confidence limits < 10%. However, STH prevalence estimates in Sirajganj District ranged from 23.4 to 29.1%. Infections in that district were spatially focal; four of the 30 survey clusters had > 50% prevalence in at least one risk group. Among all tested specimens, Ascaris lumbricoides was the most common STH parasite [8.2% (n = 352)], followed by Trichuris trichiura [0.9% (n = 37)], and hookworm [0.6% (n = 27)]. In each district, PC coverage among SAC was above the 75% program target but did not exceed 45% among PSAC in any district. Improved sanitation at home, school, or work was over 90% in all districts. CONCLUSIONS In the three low-prevalence districts, the MOHFW is considering decreasing the frequency of mass drug administration, per World Health Organization (WHO) guidelines. Also, the MOHFW will focus programmatic resources and supervisory efforts on Sirajganj District. Despite considering WHO guidance, the MOHFW will not expand PC administration to women of reproductive age partly due to the low prevalence of hookworm and T. trichiura, the STH parasites that contribute most to morbidity in that risk group. Data collected from surveys such as ours would help effectively guide future STH control efforts in Bangladesh and elsewhere.
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Affiliation(s)
- Stacy L. Davlin
- Children Without Worms, The Task Force for Global Health, 325 Swanton Way, Decatur, GA USA
| | - Alexander H. Jones
- Children Without Worms, The Task Force for Global Health, 325 Swanton Way, Decatur, GA USA
| | - Sanya Tahmina
- Communicable Disease Control Department, Directorate General of Health Services, Ministry of Health and Family Welfare, Road # 29, New DOHS, Mohakhali, Dhaka, Bangladesh
| | - Abdullah Al Kawsar
- Elimination of Lymphatic Filariasis & STH Control Program, Directorate General of Health Services, Ministry of Health & Family Welfare, Road # 29, New DOHS, Mohakhali, Dhaka, Bangladesh
| | - Anand Joshi
- Children Without Worms, The Task Force for Global Health, 325 Swanton Way, Decatur, GA USA
| | - Sazid I. Zaman
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, C/O DOHS, Road # 29, New DOHS, Mohakhali, Dhaka, Bangladesh
| | - Muhammad M. Rahman
- Elimination of Lymphatic Filariasis & STH Control Program, Directorate General of Health Services, Ministry of Health & Family Welfare, Road # 29, New DOHS, Mohakhali, Dhaka, Bangladesh
| | - Bozena M. Morawski
- Children Without Worms, The Task Force for Global Health, 325 Swanton Way, Decatur, GA USA
| | - Michael S. Deming
- Children Without Worms, The Task Force for Global Health, 325 Swanton Way, Decatur, GA USA
| | - Rubina Imtiaz
- Children Without Worms, The Task Force for Global Health, 325 Swanton Way, Decatur, GA USA
| | - Mohammad J. Karim
- Elimination of Lymphatic Filariasis & STH Control Program, Directorate General of Health Services, Ministry of Health & Family Welfare, Road # 29, New DOHS, Mohakhali, Dhaka, Bangladesh
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11
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Goldberg EM, King JD, Mupfasoni D, Kwong K, Hay SI, Pigott DM, Cromwell EA. Ecological and Socioeconomic Predictors of Transmission Assessment Survey Failure for Lymphatic Filariasis. Am J Trop Med Hyg 2020; 101:271-278. [PMID: 31115301 PMCID: PMC6609191 DOI: 10.4269/ajtmh.18-0721] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The transmission assessment survey (TAS) is recommended to determine whether cessation of mass drug administration (MDA) for lymphatic filariasis (LF) is warranted. Ministries of health typically implement TASs in evaluation units (EUs) that have had more than five rounds of annual MDA. Under TAS guidelines, sample size calculations determine a decision value: if the number of individuals testing positive exceeds this threshold, then MDA continues in the EU. The objective of this study was to determine whether fine scale geospatial covariates could be used to identify predictors of TAS failure. We geo-referenced 746 TAS EUs, of which 65 failed and extracted geospatial covariates using R to estimate odds of failure. We implemented stepwise backward elimination to select covariates for inclusion in a logistic regression to estimate the odds of TAS failure. Covariates included environmental predictors (aridity, distance to fresh water, elevation, and enhanced vegetation index), cumulative rounds of MDA, measures of urbanicity and access, LF species, and baseline prevalence. Presence of Brugia was significantly associated with TAS failure (odds ratio [OR]: 4.79, 95% CI: 2.52–9.07), as was population density (OR: 2.91, 95% CI: 1.06–7.98). The presence of nighttime lights was highly protective against failure (OR: 0.22, 95% CI: 0.10–0.50), as was an increase in elevation (OR: 0.36, 95% CI: 0.18–0.732). This work identifies predictors associated with TAS failure at the EU areal level, given the data presently available, and also identifies the need for more granular data to conduct a more robust assessment of these predictors.
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Affiliation(s)
- Ellen M Goldberg
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | | | | | - Kevin Kwong
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - David M Pigott
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Elizabeth A Cromwell
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
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12
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Pilotte N, Cook DA, Pryce J, Zulch MF, Minetti C, Reimer LJ, Williams SA. Laboratory evaluation of molecular xenomonitoring using mosquito excreta/feces to amplify Plasmodium, Brugia, and Trypanosoma DNA. Gates Open Res 2019; 3:1734. [PMID: 32596646 PMCID: PMC7308644 DOI: 10.12688/gatesopenres.13093.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2019] [Indexed: 03/30/2024] Open
Abstract
Background: Results from an increasing number of studies suggest that mosquito excreta/feces (E/F) testing has considerable potential to serve as a supplement for traditional molecular xenomonitoring techniques. However, as the catalogue of possible use-cases for this methodology expands, and the list of amenable pathogens grows, a number of fundamental methods-based questions remain. Answering these questions is critical to maximizing the utility of this approach and to facilitating its successful implementation as an effective tool for molecular xenomonitoring. Methods: Utilizing E/F produced by mosquitoes or tsetse flies experimentally exposed to Brugia malayi, Plasmodium falciparum, or Trypanosoma brucei brucei, factors such as limits of detection, throughput of testing, adaptability to use with competent- and incompetent-vector species, and effects of additional blood feedings post parasite-exposure were evaluated. Two platforms for the detection of pathogen signal (quantitative real-time PCR and digital PCR [dPCR]) were also compared, with strengths and weaknesses examined for each. Results: Experimental results indicated that high throughput testing is possible when evaluating mosquito E/F for the presence of either B. malayi or P. falciparum from both competent- and incompetent-vector mosquito species. Furthermore, following exposure to pathogen, providing mosquitoes with a second, uninfected bloodmeal did not expand the temporal window for E/F collection during which pathogen detection was possible. However, this collection window did appear longer in E/F collected from tsetse flies following exposure to T. b. brucei. Testing also suggested that dPCR may facilitate detection through its increased sensitivity. Unfortunately, logistical obstacles will likely make the large-scale use of dPCR impractical for this purpose. Conclusions: By examining many E/F testing variables, expansion of this technology to a field-ready platform has become increasingly feasible. However, translation of this methodology from the lab to the field will first require the completion of field-based pilot studies aimed at assessing the efficacy of E/F screening.
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Affiliation(s)
- Nils Pilotte
- Department of Biological Sciences, Smith College, Northampton, Massachusetts, 01063, USA
- Molecular and Cellular Biology Program, University of Massachusetts, Amherst, Massachusetts, 01003, USA
| | - Darren A.N. Cook
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Joseph Pryce
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Michael F. Zulch
- Department of Biological Sciences, Smith College, Northampton, Massachusetts, 01063, USA
| | - Corrado Minetti
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Lisa J. Reimer
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Steven A. Williams
- Department of Biological Sciences, Smith College, Northampton, Massachusetts, 01063, USA
- Molecular and Cellular Biology Program, University of Massachusetts, Amherst, Massachusetts, 01003, USA
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13
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Xavier A, Oliveira H, Aguiar-Santos A, Barbosa Júnior W, da Silva E, Braga C, Bonfim C, Medeiros Z. Assessment of transmission in areas of uncertain endemicity for lymphatic filariasis in Brazil. PLoS Negl Trop Dis 2019; 13:e0007836. [PMID: 31765388 PMCID: PMC6917295 DOI: 10.1371/journal.pntd.0007836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 12/17/2019] [Accepted: 10/09/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The objective of the Global Program to Eliminate Lymphatic Filariasis (GPELF) is to phase out this endemic disease as a public health problem by 2020. Validation of elimination is obtained from the World Health Organization through evidence of non-transmission in countries that have already been subjected to mass drug administration (MDA) and in places adjoining these endemic areas. While three municipalities in Brazil have completed MDA, the epidemiological situation remains uncertain in nine adjoining municipalities. To determine the epidemiological status, this study was to perform a review of the literature and a school-based survey to describe the past and recent endemicity of lymphatic filariasis (LF) theses nine municipalities in Brazil. METHODOLOGY/PRINCIPLE FINDINGS For review of the literature, both formal and informal literature sources were accessed since the first reports of filariasis in the Metropolitan Region of Recife, Brazil. We conducted a school-based survey in 2016 using immunochromatographic card tests (ICTs) among schoolchildren aged 6-10 years living in nine municipalities contiguous with the endemic areas in which MDA was conducted. Our review of the literature identified eight studies involving surveys demonstrating that microfilariae had been circulating in eight of the municipalities since 1967, with a low prevalence of microfilaremia, isolated autochthonous cases, and treatment of individual cases. The school-based survey included 17,222 children in 185 urban schools in the nine areas of Brazil with uncertain endemicity. One child affected by allochthonous transmission was antigen positive based on ICT and lived in a municipality adjacent to Recife; this child's family came from Recife, but no other case was diagnosed within the family. CONCLUSIONS/SIGNIFICANCE The study results suggest that there is no transmission of LF in the municipalities investigated. However, these areas have population migration and socioenvironmental conditions favorable to mosquito breeding grounds; therefore, surveillance is strongly recommended in these areas.
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Affiliation(s)
- Amanda Xavier
- Programa de Pós-graduação em Ciências da Saúde, Universidade de Pernambuco, Recife, Brazil
- * E-mail:
| | - Heloize Oliveira
- Programa de Pós-graduação em Ciências da Saúde, Universidade de Pernambuco, Recife, Brazil
- Agência Pernambucana de Vigilância Sanitária, Secretaria de Saúde do Estado de Pernambuco, Recife, Brazil
| | - Ana Aguiar-Santos
- Departamento de Parasitologia, Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brazil
| | - Walter Barbosa Júnior
- Departamento de Parasitologia, Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brazil
| | - Ellyda da Silva
- Departamento de Parasitologia, Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brazil
| | - Cynthia Braga
- Departamento de Parasitologia, Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brazil
| | - Cristine Bonfim
- Diretoria de Pesquisas Sociais, Fundação Joaquim Nabuco, Ministério da Educação, Recife, Brazil
- Programa de Pós-graduação em Saúde Coletiva, Universidade Federal de Pernambuco, Recife, Brazil
| | - Zulma Medeiros
- Programa de Pós-graduação em Ciências da Saúde, Universidade de Pernambuco, Recife, Brazil
- Departamento de Parasitologia, Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brazil
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14
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Karim MJ, Haq R, Mableson HE, Sultan Mahmood ASM, Rahman M, Chowdhury SM, Rahman AKMF, Hafiz I, Betts H, Mackenzie C, Taylor MJ, Kelly-Hope LA. Developing the first national database and map of lymphatic filariasis clinical cases in Bangladesh: Another step closer to the elimination goals. PLoS Negl Trop Dis 2019; 13:e0007542. [PMID: 31306409 PMCID: PMC6658114 DOI: 10.1371/journal.pntd.0007542] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 07/25/2019] [Accepted: 06/11/2019] [Indexed: 11/18/2022] Open
Abstract
Background The Bangladesh Lymphatic Filariasis (LF) Elimination Programme has made significant progress in interrupting transmission through mass drug administration (MDA) and has now focussed its efforts on scaling up managing morbidity and preventing disability (MMDP) activities to deliver the minimum package of care to people affected by LF clinical conditions. This paper highlights the Bangladesh LF Programme’s success in conducting a large-scale cross-sectional survey to determine the number of people affected by lymphoedema and hydrocoele, which enabled clinical risk maps to be developed for targeted interventions across the 34 endemic districts (19 high endemic; 15 low endemic). Methodology/Principal findings In the 19 high endemic districts, 8,145 community clinic staff were trained to identify and report patients in their catchment area. In the 15 low endemic districts, a team of 10 trained field assistants conducted active case finding with cases reported via a SMS mHealth tool. Disease burden and prevalence maps were developed, with morbidity hotspots identified at sub-district level based on a combination of the highest prevalence rates per 100,000 and case-density rates per square kilometre (km2). The relationship between morbidity and baseline microfilaria (mf) prevalence was also examined. In total 43,678 cases were identified in the 19 high endemic districts; 30,616 limb lymphoedema (70.1%; female 55.3%), 12,824 hydrocoele (29.4%), and 238 breast/female genital swelling (0.5%). Rangpur Division reported the highest cases numbers and prevalence of lymphoedema (26,781 cases, 195 per 100,000) and hydrocoele (11661 cases, 169.6 per 100,000), with lymphoedema predominately affecting females (n = 21,652). Rangpur and Lalmonirhat Districts reported the highest case numbers (n = 11,199), and prevalence (569 per 100,000) respectively, with five overlapping lymphoedema and hydrocoele sub-district hotspots. In the 15 low endemic districts, 732 cases were identified; 661 lymphoedema (90.2%; female 39.6%), 56 hydrocoele (7.8%), and 15 both conditions (2.0%). Spearman’s correlation analysis found morbidity and mf prevalence significantly positively correlated (r = 0.904; p<0.01). Conclusions/Significance The Bangladesh LF Programme has developed one of the largest, most comprehensive country databases on LF clinical conditions in the world. It provides an essential database for health workers to identify local morbidity hotspots, deliver the minimum package of care, and address the dossier elimination requirements. The Global Programme to Eliminate Lymphatic Filariasis (GPELF) requires lymphatic filariasis (LF) endemic countries, such as Bangladesh, to estimate the number of lymphoedema and hydrocoele cases in order to deliver the minimum package of care required to control morbidity and reduce patient suffering. This paper highlights the Bangladesh LF Elimination Programme’s progress in training more than 8000 community health workers to identify more than 44,000 cases across 34 endemic districts where approximately 70 million people are at risk. The morbidity data collected enabled the creation of a national database and a series of risk maps of lymphoedema and hydrocoele to be developed, which highlighted the significant burden in northern Rangpur Division, especially of lymphoedema among female patients. The Bangladesh LF Elimination Programme’s efforts to identify LF cases across all endemic districts represents one of the most comprehensive national databases on LF clinical cases in the world. It provides an informative database for health workers to use in the delivery of the minimum package of care and a template for other countries to adopt and develop national strategies to manage morbidity and prevent disability as recommended by GPELF.
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Affiliation(s)
- Mohammad J. Karim
- Filariasis Elimination and STH Control Programme, Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
- * E-mail: (MJK); (LAK)
| | - Rouseli Haq
- Filariasis Elimination and STH Control Programme, Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Hayley E. Mableson
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - A. S. M. Sultan Mahmood
- Filariasis Elimination and STH Control Programme, Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Mujibur Rahman
- Filariasis Elimination and STH Control Programme, Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | | | | | - Israt Hafiz
- Filariasis Elimination and STH Control Programme, Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Hannah Betts
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Charles Mackenzie
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Mark J. Taylor
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Louise A. Kelly-Hope
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail: (MJK); (LAK)
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15
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Srividya A, Subramanian S, Jambulingam P, Vijayakumar B, Dinesh Raja J. Mapping and monitoring for a lymphatic filariasis elimination program: a systematic review. Res Rep Trop Med 2019; 10:43-90. [PMID: 31239804 PMCID: PMC6554002 DOI: 10.2147/rrtm.s134186] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 04/02/2019] [Indexed: 11/23/2022] Open
Abstract
Lymphatic filariasis (LF) is targeted for elimination by the year 2020. The Global Programme for Elimination of LF (GPELF) aims to achieve elimination by interrupting transmission through annual mass drug administration (MDA) of albendazole with ivermectin or diethylcarbamazine. The program has successfully eliminated the disease in 11 of the 72 endemic countries, putting in enormous efforts on systematic planning and implementation of the strategy. Mapping areas endemic for LF is a pre-requisite for implementing MDA, monitoring and evaluation are the components of programme implementation. This review was undertaken to assess how the mapping and impact monitoring activities have evolved to become more robust over the years and steered the LF elimination programme towards its goal. The findings showed that the WHO recommended mapping strategy aided 17 countries to delimit, plan and implement MDA in only those areas endemic for LF thereby saving resources. Availability of serological tools for detecting infection in humans (antigen/antibody assays) and molecular xenomonitoring (MX) in vectors greatly facilitated programme monitoring and evaluation in endemic countries. Results of this review are discussed on how these existing mapping and monitoring procedures can be used for re-mapping of unsurveyed and uncertain areas to ensure there is no resurgence during post-MDA surveillance. Further the appropriateness of the tests (Microfilaria (Mf)/antigenemia (Ag)/antibody(Ab) surveys in humans or MX of vectors for infection) used currently for post-MDA surveillance and their role in the development of a monitoring and evaluation strategy for the recently WHO recommended triple drug regimen in MDA for accelerated LF elimination are discussed.
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Affiliation(s)
- Adinarayanan Srividya
- Division of Epidemiology, Biostatistics and Operations Research, ICMR - Vector Control Research Centre, Puducherry, India
| | - Swaminathan Subramanian
- Division of Epidemiology, Biostatistics and Operations Research, ICMR - Vector Control Research Centre, Puducherry, India
| | - Purushothaman Jambulingam
- Division of Epidemiology, Biostatistics and Operations Research, ICMR - Vector Control Research Centre, Puducherry, India
| | - Balakrishnan Vijayakumar
- Division of Epidemiology, Biostatistics and Operations Research, ICMR - Vector Control Research Centre, Puducherry, India
| | - Jeyapal Dinesh Raja
- Division of Epidemiology, Biostatistics and Operations Research, ICMR - Vector Control Research Centre, Puducherry, India
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16
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Greenhouse B, Daily J, Guinovart C, Goncalves B, Beeson J, Bell D, Chang MA, Cohen JM, Ding X, Domingo G, Eisele TP, Lammie PJ, Mayor A, Merienne N, Monteiro W, Painter J, Rodriguez I, White M, Drakeley C, Mueller I. Priority use cases for antibody-detecting assays of recent malaria exposure as tools to achieve and sustain malaria elimination. Gates Open Res 2019; 3:131. [PMID: 31172051 PMCID: PMC6545519 DOI: 10.12688/gatesopenres.12897.1] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2019] [Indexed: 01/12/2023] Open
Abstract
Measurement of malaria specific antibody responses represents a practical and informative method for malaria control programs to assess recent exposure to infection. Technical advances in recombinant antigen production, serological screening platforms, and analytical methods have enabled the identification of several target antigens for laboratory based and point-of-contact tests. Questions remain as to how these serological assays can best be integrated into malaria surveillance activities to inform programmatic decision-making. This report synthesizes discussions from a convening at Institut Pasteur in Paris in June 2017 aimed at defining practical and informative use cases for serology applications and highlights five programmatic uses for serological assays including: documenting the absence of transmission; stratification of transmission; measuring the effect of interventions; informing a decentralized immediate response; and testing and treating P. vivax hypnozoite carriers.
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Affiliation(s)
- Bryan Greenhouse
- Department of Medicine,, University of California San Francisco, San Francisco, CA, USA
| | | | - Caterina Guinovart
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- PATH, Seattle, WA, USA
| | | | | | - David Bell
- Intellectual Ventures, Bellevue, WA, USA
| | | | | | | | | | - Thomas P. Eisele
- Center for Applied Malaria Research and Evaluation, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | | | - Alfredo Mayor
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | - Wuelto Monteiro
- Tropical Medicine Foundation Dr. Heitor Viera Dourado, Manaus, Amazonas, Brazil
| | - John Painter
- Centers of Disease Control and Prevention, Atlanta, GA, USA
| | - Isabel Rodriguez
- Department of Medicine,, University of California San Francisco, San Francisco, CA, USA
| | | | - Chris Drakeley
- London School of Tropical Medicine & Hygiene, London, UK
| | - Ivo Mueller
- Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - The Malaria Serology Convening
- Department of Medicine,, University of California San Francisco, San Francisco, CA, USA
- Consultant to UNITAID, Denver, CO, USA
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- PATH, Seattle, WA, USA
- London School of Tropical Medicine & Hygiene, London, UK
- The Burnet Institute, Melbourne, Australia
- Intellectual Ventures, Bellevue, WA, USA
- Centers of Disease Control and Prevention, Atlanta, GA, USA
- Clinton Health Access Initiative (CHAI), Boston, MA, USA
- FIND, Geneva, Switzerland
- Center for Applied Malaria Research and Evaluation, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
- Institut Pasteur, Paris, France
- Tropical Medicine Foundation Dr. Heitor Viera Dourado, Manaus, Amazonas, Brazil
- Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
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17
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Zaky WI, Tomaino FR, Pilotte N, Laney SJ, Williams SA. Backpack PCR: A point-of-collection diagnostic platform for the rapid detection of Brugia parasites in mosquitoes. PLoS Negl Trop Dis 2018; 12:e0006962. [PMID: 30462640 PMCID: PMC6281274 DOI: 10.1371/journal.pntd.0006962] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 12/05/2018] [Accepted: 10/30/2018] [Indexed: 11/25/2022] Open
Abstract
Background Currently, molecular xenomonitoring efforts for lymphatic filariasis rely on PCR or real-time PCR-based detection of Brugia malayi, Brugia timori and Wuchereria bancrofti in mosquito vectors. Most commonly, extraction of DNA from mosquitoes is performed using silica column-based technologies. However, such extractions are both time consuming and costly, and the diagnostic testing which follows typically requires expensive thermal cyclers or real-time PCR instruments. These expenses present significant challenges for laboratories in many endemic areas. Accordingly, in such locations, there exists a need for inexpensive, equipment-minimizing diagnostic options that can be transported to the field and implemented in minimal resource settings. Here we present a novel diagnostic approach for molecular xenomonitoring of filarial parasites in mosquitoes that uses a rapid, NaOH-based DNA extraction methodology coupled with a portable, battery powered PCR platform and a test strip-based DNA detection assay. While the research reported here serves as a proof-of-concept for the backpack PCR methodology for the detection of filarial parasites in mosquitoes, the platform should be easily adaptable to the detection of W. bancrofti and other mosquito-transmitted pathogens. Methodology/Principal findings Through comparisons with standard silica column-based DNA extraction techniques, we evaluated the performance of a rapid, NaOH-based methodology for the extraction of total DNA from pools of parasite-spiked vector mosquitoes. We also compared our novel test strip-based detection assay to real-time PCR and conventional PCR coupled with gel electrophoresis, and demonstrated that this method provides sensitive and genus-specific detection of parasite DNA from extracted mosquito pools. Finally, by comparing laboratory-based thermal cycling with a field-friendly miniaturized PCR approach, we have demonstrated the potential for the point-of-collection-based use of this entire diagnostic platform that is compact enough to fit into a small backpack. Conclusions/Significance Because this point-of-collection diagnostic platform eliminates reliance on expensive and bulky instrumentation without compromising sensitivity or specificity of detection, it provides an alternative to cost-prohibitive column-dependent DNA extractions that are typically coupled to detection methodologies requiring advanced laboratory infrastructure. In doing so, this field-ready system should increase the feasibility of molecular xenomonitoring within B. malayi-endemic locations. Of greater importance, this backpack PCR system also provides the proof-of-concept framework for the development of a parallel assay for the detection of W. bancrofti. Molecular xenomonitoring has demonstrated significant potential as a non-invasive means of providing reliable surveillance for the presence of lymphatic filariasis (LF)-causing parasites. Given the continuing successes of global mass drug administration efforts, the need for such non-invasive surveillance techniques is expanding. However, considering the significant infrastructural demands which such surveillance requires, the development of simplified surveillance methodologies will be fundamental to future programmatic implementation efforts. Accordingly, we have developed a novel, simplified diagnostic platform for point-of-collection-based detection of the LF-causing parasite, Brugia malayi in pools of mosquitoes. By coupling a rapid and inexpensive DNA extraction methodology with a field-friendly amplification platform and test strip-based detection assay, this backpack PCR system eliminates the need for expensive instrumentation and laboratory-based infrastructure. Furthermore, adaptation of the platform described here will allow for the straightforward and rapid development of a parallel assay for the detection of Wuchereria bancrofti, facilitating the increased use of xenomonitoring and enabling mosquito surveillance efforts in regions lacking sophisticated laboratory infrastructure.
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Affiliation(s)
- Weam I Zaky
- Department of Biological Sciences, Smith College, Northampton, Massachusetts, United States of America
| | - Francesca R Tomaino
- Department of Biological Sciences, Smith College, Northampton, Massachusetts, United States of America
| | - Nils Pilotte
- Department of Biological Sciences, Smith College, Northampton, Massachusetts, United States of America.,Molecular and Cellular Biology Program, University of Massachusetts, Amherst, Massachusetts, United States of America
| | - Sandra J Laney
- The Bill and Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Steven A Williams
- Department of Biological Sciences, Smith College, Northampton, Massachusetts, United States of America.,Molecular and Cellular Biology Program, University of Massachusetts, Amherst, Massachusetts, United States of America
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Garchitorena A, Raza-Fanomezanjanahary EM, Mioramalala SA, Chesnais CB, Ratsimbasoa CA, Ramarosata H, Bonds MH, Rabenantoandro H. Towards elimination of lymphatic filariasis in southeastern Madagascar: Successes and challenges for interrupting transmission. PLoS Negl Trop Dis 2018; 12:e0006780. [PMID: 30222758 PMCID: PMC6160210 DOI: 10.1371/journal.pntd.0006780] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 09/27/2018] [Accepted: 08/23/2018] [Indexed: 11/21/2022] Open
Abstract
Introduction A global strategy of mass drug administration (MDA) has greatly reduced the burden of lymphatic filariasis (LF) in endemic countries. In Madagascar, the National Programme to eliminate LF has scaled-up annual MDA of albendazole and diethylcarbamazine across the country in the last decade, but its impact on LF transmission has never been reported. The objective of this study was to evaluate progress towards LF elimination in southeastern Madagascar. Methods Three different surveys were carried out in parallel in four health districts of the Vatovavy Fitovinany region in 2016: i) a school-based transmission assessment survey (TAS) in the districts of Manakara Atsimo, Mananjary, and Vohipeno (following a successful pre-TAS in 2013); ii) a district-representative community prevalence survey in Ifanadiana district; and iii) a community prevalence survey in sentinel and spot-check sites of these four districts. LF infection was assessed using the Alere Filariasis Test Strips, which detect circulating filarial antigens (CFA) of adult worms. A brief knowledge, attitudes and practices questionnaire was included in the community surveys. Principal findings None of the 1,825 children sampled in the TAS, and only one in 1,306 children from sentinel and spot-check sites, tested positive to CFA. However, CFA prevalence rate in individuals older than 15 years was still high in two of these three districts, at 3.5 and 9.7% in Mananjary and Vohipeno, respectively. Overall CFA prevalence in sentinel and spot-check sites of these three districts was 2.80% (N = 2,707), but only two individuals had detectable levels of microfilaraemia (0.06%). Prevalence rate estimates for Ifanadiana were substantially higher in the district-representative survey (15.8%; N = 545) than in sentinel and spot-check sites (0.8%; N = 618). Only 51.2% of individuals surveyed in these four districts reported taking MDA in the last year, and 42.2% reported knowing about LF. Conclusions Although TAS results suggest that MDA can be stopped in three districts of southeastern Madagascar, the adult population still presents high CFA prevalence levels. This discordance raises important questions about the TAS procedures and the interpretation of their results. Lymphatic filariasis is a neglected disease with chronic disabling consequences. Endemic countries have reduced lymphatic filariasis transmission through a strategy of annual rounds of mass drug administration (MDA), but the impact of such strategy has not yet been reported for Madagascar. In this study we conducted three different surveys and used rapid diagnostic tests to evaluate lymphatic filariasis transmission in four health districts of southeastern Madagascar. This included a school-based transmission assessment survey (TAS), the international gold standard to help national programmes confirm that they have interrupted lymphatic filariasis transmission, and two complementary community-based surveys. Our TAS results suggested that MDA could be stopped in three districts, confirming the consistent decline in lymphatic filariasis observed in recent years. However, the other two surveys revealed that the adult population still had high prevalence levels. This discordance raises questions about the TAS procedures and the interpretation of their results in contexts where, like in Madagascar, implementation of MDA is different for school age children than for the rest of the population.
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Affiliation(s)
- Andres Garchitorena
- UMR 224 MIVEGEC, Institut de Recherche pour le Développement, Montpellier, France
- PIVOT, Ifanadiana, Madagascar
- * E-mail:
| | - Estelle M. Raza-Fanomezanjanahary
- Institut National de la Sante Publique et Communautaire, – Ministère de la Santé Publique, Ministère de l’Enseignement Supérieur et de la Recherche Scientifique, Antananarivo, Madagascar
| | - Sedera A. Mioramalala
- Direction de lutte contre le paludisme, – Ministère de la Santé Publique, Antananarivo, Madagascar
| | - Cédric B. Chesnais
- UMI 233, Institut de Recherche pour le Développement (IRD), Université Montpellier, INSERM Unité 1175, Montpellier, France
| | - Claude A. Ratsimbasoa
- Direction de lutte contre le paludisme, – Ministère de la Santé Publique, Antananarivo, Madagascar
| | - Herinirina Ramarosata
- Institut National de la Sante Publique et Communautaire, – Ministère de la Santé Publique, Ministère de l’Enseignement Supérieur et de la Recherche Scientifique, Antananarivo, Madagascar
| | - Matthew H. Bonds
- PIVOT, Ifanadiana, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Holivololona Rabenantoandro
- Service de Lutte contre les Maladies Epidémiques et Négligées – Ministère de la Santé Publique, Antananarivo, Madagascar
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Irish SR, Al-Amin HM, Paulin HN, Mahmood ASMS, Khan RK, Muraduzzaman AKM, Worrell CM, Flora MS, Karim MJ, Shirin T, Shamsuzzaman AKM, Tahmina S, Lenhart A, Dubray C. Molecular xenomonitoring for Wuchereria bancrofti in Culex quinquefasciatus in two districts in Bangladesh supports transmission assessment survey findings. PLoS Negl Trop Dis 2018; 12:e0006574. [PMID: 30048460 PMCID: PMC6062013 DOI: 10.1371/journal.pntd.0006574] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 06/01/2018] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Careful monitoring for recrudescence of Wuchereria bancrofti infection is necessary in communities where mass drug administration (MDA) for the elimination of lymphatic filariasis (LF) as a public health problem has been stopped. During the post-MDA period, transmission assessment surveys (TAS) are recommended by the World Health Organization to monitor the presence of the parasite in humans. Molecular xenomonitoring (MX), a method by which parasite infection in the mosquito population is monitored, has also been proposed as a sensitive method to determine whether the parasite is still present in the human population. The aim of this study was to conduct an MX evaluation in two areas of Bangladesh, one previously endemic district that had stopped MDA (Panchagarh), and part of a non-endemic district (Gaibandha) that borders the district where transmission was most recently recorded. METHODOLOGY/PRINCIPAL FINDINGS Mosquitoes were systematically collected from 180 trap sites per district and mosquito pools were tested for W. bancrofti using real-time PCR. A total of 23,436 intact mosquitoes, representing 31 species, were collected from the two districts, of which 10,344 (41%) were Culex quinquefasciatus, the vector of W. bancrofti in Bangladesh. All of the 594 pools of Cx. quinquefasciatus tested by real-time PCR were negative for the presence of W. bancrofti DNA. CONCLUSIONS/SIGNIFICANCE This study suggested the absence of W. bancrofti in these districts. MX could be a sensitive tool to confirm interruption of LF transmission in areas considered at higher risk of recrudescence, particularly in countries like Bangladesh where entomological and laboratory capacity to perform MX is available.
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Affiliation(s)
- Seth R. Irish
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- President’s Malaria Initiative, Bureau for Global Health, Office of Infectious Disease, United States Agency for International Development, Washington, DC, United States of America
| | | | - Heather N. Paulin
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - A. S. M. Sultan Mahmood
- Ministry of Health and Family Welfare, Communicable Disease Control, Directorate General of Health Services, Dhaka, Bangladesh
| | - Rajaul K. Khan
- Ministry of Health and Family Welfare, Communicable Disease Control, Directorate General of Health Services, Dhaka, Bangladesh
| | | | - Caitlin M. Worrell
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Meerjady S. Flora
- Institute of Epidemiology Disease Control & Research, Dhaka, Bangladesh
| | - Mohammed J. Karim
- Ministry of Health and Family Welfare, Communicable Disease Control, Directorate General of Health Services, Dhaka, Bangladesh
| | - Tahmina Shirin
- Institute of Epidemiology Disease Control & Research, Dhaka, Bangladesh
| | - A. K. M. Shamsuzzaman
- Ministry of Health and Family Welfare, Communicable Disease Control, Directorate General of Health Services, Dhaka, Bangladesh
| | - Sanya Tahmina
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
- Ministry of Health and Family Welfare, Communicable Disease Control, Directorate General of Health Services, Dhaka, Bangladesh
| | - Audrey Lenhart
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Christine Dubray
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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20
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Aye NN, Lin Z, Lon KN, Linn NYY, Nwe TW, Mon KM, Ramaiah K, Betts H, Kelly-Hope LA. Mapping and modelling the impact of mass drug adminstration on filariasis prevalence in Myanmar. Infect Dis Poverty 2018; 7:56. [PMID: 29855355 PMCID: PMC5984392 DOI: 10.1186/s40249-018-0420-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 04/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lymphatic filariasis (LF) is endemic in Myanmar and targeted for elimination. To highlight the National Programme to Eliminate Lymphatic Filariasis (NPELF) progress between 2000 and 2014, this paper describes the geographical distribution of LF, the scale-up and impact of mass drug administration (MDA) implementation, and the first evidence of the decline in transmission in five districts. METHODS The LF distribution was determined by mapping historical and baseline prevalence data collected by NPELF. Data on the MDA implementation, reported coverage rates and sentinel site surveillance were summarized. A statistical model was developed from the available prevalence data to predict prevalence at township level by year of measurement. Transmission assessment survey (TAS) methods, measuring antigenemia (Ag) prevalence in children, were used to determine whether prevalence was below a level where recrudescence is unlikely to occur. RESULTS The highest baseline LF prevalence was found in the Central Valley region. The MDA implementation activities scaled up to cover 45 districts, representing the majority of the endemic population, with drug coverage rates ranging from 60.0% to 98.5%. Challenges related to drug supply and local conflict were reported, and interrupted MDA in some districts. Overall, significant reductions in LF prevalence were found, especially after the first 2 to 3 rounds of MDA, which was supported by the corresponding model. The TAS activities in five districts found only two Ag positive children, resulting in all districts passing the critical threshold. CONCLUSION Overall, the Myanmar NPELF has made positive steps forward in the elimination of LF despite several challenges, however, it needs to maintain momentum, drawing on international stakeholder support, to aim towards the national and global goals of elimination.
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Affiliation(s)
- Ni Ni Aye
- Ministry of Health and Sports, Department of Public Health, Nay Pyi Taw, Myanmar
| | - Zaw Lin
- Ministry of Health and Sports, Department of Public Health, Nay Pyi Taw, Myanmar
| | - Khin Nan Lon
- Ministry of Health and Sports, Department of Public Health, Nay Pyi Taw, Myanmar
| | - Nay Yi Yi Linn
- Ministry of Health and Sports, Department of Public Health, Nay Pyi Taw, Myanmar
| | - Thet Wai Nwe
- Ministry of Health and Sports, Department of Public Health, Nay Pyi Taw, Myanmar
| | - Khin Mon Mon
- Ministry of Health and Sports, Department of Public Health, Nay Pyi Taw, Myanmar
| | | | - Hannah Betts
- Department of Parasitology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Louise A. Kelly-Hope
- Department of Parasitology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, UK
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