Elimination of lymphatic filariasis as a public health problem from the Arab Republic of Egypt

Abstract

Abstract Lymphatic filariasis (LF), caused by Wuchereria bancrofti infection, has probably occurred in Egypt since ancient times. In more recent years, LF was recognized as a major public health problem in the Nile delta since the early 1930s and Culex pipiens was identified as the major mosquito vector of transmission. Since then the Ministry of Health and Population (MoHP) took measures for control of the disease. During 1955-1965, a nationwide survey determined the size and extent of LF as a public health problem. The survey included all 20 governorates of the country, involved rural and urban areas. Over 0.5 million blood films were examined. The survey results indicated that LF was focally endemic in rural localities, concentrated in the eastern part of the Nile Delta mainly in Qalyubia, Sharqia, Dakahlia and Damietta governorates, and in Giza and Asyout in Upper Egypt. The LF prevalence was <1% in Behira, Cairo, Gharbia, Ismailia, Kafr El Sheikh, Menoufia, Port Said and Suez governorate. Six governorates In Upper Egypt were free of LF. In 1976, the National Filariasis Control Program was launched in Qalyubia governorate, and then gradually extended to cover 10 endemic governorates including: Asyout, Behira, Dakahlia, Damietta, Gharbia, Giza, Kafr El Sheikh, Menoufia, Qalyubia and Sharqia governorate. In 2000, Egypt was among the first countries to join the WHO global efforts and initiated a national LF elimination programme (NLFEP). The NLFEP programme adopted the WHO two objectives (1) elimination of LF as a public health problem based on annual mass drug distribution (MDA) of two drug regiments (DEC & albendazole) to the entire eligible population living in areas where the disease was endemic (≥1%); (2) alleviate the suffering caused by LF through increased morbidity management and disability prevention (MMDP) activities. Intervention for interruption of transmission included several programme components. These included mapping of eligible MDA implementation units (IUs; villages); training of drug distributers on drug distribution activities; social mobilization using a variety of formal and informal channels to reach people with clear messages; directly observed drug distribution; treatment of adverse reactions; and monitoring and evaluation of MDA rounds. In 2005, after five effective MDA rounds (MDA coverage rate ≥80%), MDA was stopped in 92.5% of IUs, and continued in other IUs. In 2013, the last MDA round was implemented. In the 2014-2015 scholastic year, 10 years after stopping MDA in 166 villages, and more than six months after the last MDA implemented in 29 IUs during 2013, transmission assessment survey (TAS) was carried out according to WHO guidelines. In 2017, the last TAS was implemented. All TAS data clearly indicated that LF has likely been eliminated from Egypt. MMDP: five health centers, part of the primary health care system, are actively working with lymphoedema and elephantiasis affected people by providing skin care, necessary health care aids and information booklets. Thus, after over a decade of continued efforts, Egypt has successfully eliminated LF as a public health problem. In December 2017 the Director General of WHO congratulated Egypt for this historical achievement.