Abstract
The global decline in prevalence of lymphatic filariasis has been one of the major successes of the WHO’s NTD programme. The recommended strategy of intensive, community-wide mass drug administration, aims to break localised transmission by either reducing the prevalence of microfilaria positive infections to below 1%, or antigen positive infections to below 2%. After the threshold is reached, and mass drug administration is stopped, geographically defined evaluation units must pass Transmission Assessment Surveys to demonstrate that transmission has been interrupted. In this study, we use an empirically parameterised stochastic transmission model to investigate the appropriateness of 1% microfilaria-positive prevalence as a stopping threshold, and statistically evaluate how well various monitoring prevalence-thresholds predict elimination or disease resurgence in the future by calculating their predictive value. Our results support the 1% filaremia prevalence target as appropriate stopping criteria. However, because at low prevalence-levels random events dominate the transmission dynamics, we find single prevalence measurements have poor predictive power for predicting resurgence, which suggests alternative criteria for restarting MDA may be beneficial.
Highlights
Lymphatic Filariasis (LF) is one of the most important neglected tropical diseases that persists in resource poor settings throughout Sub-Saharan Africa, Asia, South and Central America
The disease lymphatic filariasis is caused by parasitic worms that are spread by mosquito vectors, and is endemic across much of Sub-Saharan Africa, Asia, South and Central America, with over 893 million people in 49 countries considered to be at-risk
In 1997 the Global Programme to Eliminate Lymphatic Filariasis was established by the World Health Organization (WHO)
Summary
Lymphatic Filariasis (LF) is one of the most important neglected tropical diseases that persists in resource poor settings throughout Sub-Saharan Africa, Asia, South and Central America. An estimated 1.3 billion people are at risk for contracting LF, and prior to intensive control efforts in many countries, 120 million people were infected [1]. LF is a disease that occurs when infective larvae of the nematode parasite are transmitted to a human host via mosquito vector feeding. The insect vector is an intermediate host within which parasite development takes place before transmission to the definitive human host. Three types of filarial nematode worms cause LF; namely, Wuchereria bancrofti, Brugia malayi, and Brugia timori. W. bancrofti is the most prevalent filarial infection worldwide being responsible for about 90% of reported LF cases [2]
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