Abstract
BackgroundLymphatic filariasis (LF) is a mosquito-borne parasitic disease which is targeted for elimination as a public health problem worldwide. Niue is a small self-governing South Pacific island nation with approximately 1600 residents that was formerly LF endemic. Here, we review the progress made towards eliminating LF in Niue since 1999.MethodsThis study has reviewed all the available literature relating to LF in Niue to assess surveillance efforts and the elimination of transmission. Reviewed documentation included both published and unpublished works including historical reports of LF, WHO PacELF records, and Niue Country Reports of the national LF elimination program.FindingsNiue conducted mapping of baseline LF endemicity by testing the total present and consenting population for LF antigen with immunochromatographic test (ICT) in 1999, when circulating filarial antigen prevalence was 3.1% (n = 1794). Five nationwide annual mass drug administration (MDA) rounds with albendazole (400 mg) and diethylcarbamazine citrate (DEC) were undertaken from 2000 to 2004, with coverage reported from distribution records ranging from 78 to 99% of the eligible population, which excluded pregnant women and children under 2 years of age. A further whole population survey using ICT in 2001 found 1.3% positive (n = 1630). In 2004, antigen prevalence had reduced to 0.2% (n = 1285). A similar post-MDA survey in 2009 indicated antigen prevalence to be 0.5% (n = 1378). Seven positive cases were re-tested and re-treated every six months until negative.ConclusionsAfter five rounds of MDA, Niue had reduced the LF antigen population prevalence in all ages from 3.1% to below 1% and maintained this prevalence for a further five years. Due to Niue’s small population, surveillance was done by whole population surveys. Niue’s results support the WHO recommended strategy that five to six rounds of annual MDA with effective population coverage can successfully interrupt the transmission of LF. Niue received official acknowledgement of the validation of elimination of LF as a public health problem by the WHO Director-General and WHO Western Pacific Regional Office (WPRO) Regional Director at the 67th session of the Regional Committee for the Western Pacific held in Manila in October 2016.
Highlights
Lymphatic filariasis (LF) is a mosquito-borne parasitic disease which is targeted for elimination as a public health problem worldwide
In 2000, the first national mass drug administration (MDA) round was undertaken using a combined regimen of diethylcarbamazine citrate (DEC) (6 mg/kg) and albendazole (400 mg)
The main distribution method was people coming to the village community halls to obtain medicines from trained distributors who insisted upon directly observed therapy (DOT) [15]
Summary
Lymphatic filariasis (LF) is a mosquito-borne parasitic disease which is targeted for elimination as a public health problem worldwide. Niue is a small self-governing South Pacific island nation with approximately 1600 residents that was formerly LF endemic. Lymphatic filariasis (LF) is a mosquito-borne parasitic disease. The disease is caused by three species of parasitic worm, namely Wuchereria bancrofti, Brugia malayi, and Brugia timori [1]. In the South Pacific, W. bancrofti is the parasite responsible for LF [1]. Secondary bacterial infections and inflammation occur, and damage caused to the lymphatic system accumulates, resulting in some individuals in severely disabling and disfiguring manifestations of lymphoedema, elephantiasis, and hydrocele [1, 4]. LF is the second leading cause of chronic disability [5]. The disease imposes considerable economic and psychosocial hardship on sufferers, their carers, and families [6,7,8]
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