Abstract
BackgroundLymphatic filariasis (LF) is targeted for elimination through annual mass drug administration (MDA) for 4–6 years. In 2006, Zanzibar stopped MDA against LF after five rounds of MDA revealed no microfilaraemic individuals during surveys at selected sentinel sites. We asked the question if LF transmission was truly interrupted in 2006 when MDA was stopped.Methodology/Principal FindingsIn line with ongoing efforts to shrink the LF map, we performed the WHO recommended transmission assessment surveys (TAS) in January 2012 to verify the absence of LF transmission on the main Zanzibar islands of Unguja and Pemba. Altogether, 3275 children were tested on both islands and 89 were found to be CFA positive; 70 in Pemba and 19 in Unguja. The distribution of schools with positive children was heterogeneous with pronounced spatial variation on both islands. Based on the calculated TAS cut-offs of 18 and 20 CFA positive children for Pemba and Unguja respectively, we demonstrated that transmission was still ongoing in Pemba where the cut-off was exceeded.ConclusionsOur findings indicated ongoing transmission of LF on Pemba in 2012. Moreover, we presented evidence from previous studies that LF transmission was also active on Unguja shortly after stopping MDA in 2006. Based on these observations the government of Zanzibar decided to resume MDA against LF on both islands in 2013.
Highlights
Lymphatic filariasis (LF) is a major cause of acute and chronic morbidity and a significant impediment to socioeconomic development in 73 countries in Africa, Southeast Asia, the Americas, and the Pacific region
We presented evidence from previous studies that LF transmission was active on Unguja shortly after stopping mass drug administration (MDA) in 2006
We presented evidence from previous entomological studies that LF transmission was active on Unguja shortly after stopping MDA in 2006
Summary
Lymphatic filariasis (LF) is a major cause of acute and chronic morbidity and a significant impediment to socioeconomic development in 73 countries in Africa, Southeast Asia, the Americas, and the Pacific region. The Global Programme to Eliminate Lymphatic Filariasis (GPELF) recommends annual mass drug administration (MDA) using albendazole in combination with either diethylcarbamazine (DEC) or ivermectin for 4–6 years as the main strategy to interrupt transmission of the disease [2]. In 2006, Zanzibar, in the United Republic of Tanzania, which started MDA in October 2001 [4], was the first country in Africa to complete five rounds of treatment using a combination of albendazole and ivermectin at 100% geographic coverage and achieving effective treatment coverage rate of over 65% during each round [3, 5]. Lymphatic filariasis (LF) is targeted for elimination through annual mass drug administration (MDA) for 4–6 years. We asked the question if LF transmission was truly interrupted in 2006 when MDA was stopped.
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