Abstract
.We compared the impact of annual and semiannual mass drug administration (MDA) on the prevalence of Brugia timori and Wuchereria bancrofti in Flores Island. Two villages (Paga, B. timori only; Lewomada, co-endemic) received annual MDA with diethylcarbamazine/albendazole and a larger village (Pruda, co-endemic) received semiannual MDA. Infection parameters (microfilariae [Mf], antibodies to recombinant filarial antigen BmR1 [Brugia Rapid (BR)], and a test for W. bancrofti antigenemia [immunochromatographic test (ICT)]) were assessed before and after treatment. The crude Mf prevalence in Pruda decreased after five semiannual treatments from 14.2% to 1.2%, whereas the Mf prevalence in the other two villages decreased after three annual treatments from 3.9% to 0% and from 5% to 0.3%, respectively. ICT positivity prevalence in Pruda and Lewomada decreased from 22.9% and 6.5% to 7% and 0.8%, respectively, whereas BR antibody prevalence in Pruda, Lewomada, and Paga decreased from 28.9%, 31.7%, and 12.5% to 3.6%, 4.1%, and 1.8%, respectively. Logistic regression analysis indicated that that Mf, BR, and ICT prevalence decreased significantly over time and that for the Mf and ICT outcomes the semiannual treatment had higher odds of positivity. Model-adjusted prevalence estimates revealed that apparent differences in treatment effectiveness were driven by differences in baseline prevalence and that adjusted prevalence declined more rapidly in the semiannual treatment group. We conclude that in this setting, annual MDA was sufficient to reduce Mf prevalence to less than 1% in areas with low to moderate baseline prevalence. Semiannual MDA was useful for rapidly reducing Mf prevalence in an area with higher baseline endemicity.
Highlights
Lymphatic filariasis (LF) is a common neglected tropical disease in Indonesia that may hinder economic development.[1]
The national LF elimination program is based on annual mass drug administration (MDA) using a single dose of diethylcarbamazine (DEC) combined with albendazole (ALB) in all areas with microfilaremia (Mf) or antigen (Wuchereria bancrofti) prevalence of 1% or higher
Previous studies by our group have shown that annual MDA can be efficiently performed in eastern Indonesia and provided evidence that LF caused by B. timori and W. bancrofti can be locally eliminated.[4,5]
Summary
Lymphatic filariasis (LF) is a common neglected tropical disease in Indonesia that may hinder economic development.[1]. W. bancrofti and B. malayi each have several distinct ecotypes with different vector species and ecology. This variability leads to varied transmission dynamics and responses to intervention.[3] Brugia timori is endemic in eastern Indonesia (east of the Wallace line). Previous studies by our group have shown that annual MDA can be efficiently performed in eastern Indonesia and provided evidence that LF caused by B. timori and W. bancrofti can be locally eliminated.[4,5] only 48 of the 235 evaluation units in Indonesia have passed transmission assessment surveys (TAS) and stopped MDA, whereas 80% of the implementation units still require MDA.[2] costeffective strategies to accelerate LF elimination are highly desirable
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More From: The American Journal of Tropical Medicine and Hygiene
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