Abstract
BackgroundThe lymphatic filarial parasite Brugia timori occurs only in eastern Indonesia where it causes high morbidity. The absence of an animal reservoir, the inefficient transmission by Anopheles mosquitoes and the high sensitivity to DEC/albendazole treatment make this species a prime candidate for elimination by mass drug administration (MDA).Methodology/Principal FindingsWe evaluated the effect of MDA using DEC and albendazole on B. timori and soil transmitted helminths (STH) in a cross-sectional study of a sentinel village on Alor Island annually over a period of 10 years. Pre-MDA the microfilaria (MF) prevalence was 26% and 80% of the residents had filaria-specific IgG4 antibodies. In 2010, 34 months after the 6th round of MDA, MF and antibody rates were only 0.17% and 6.4%, respectively. The MDA campaign had also a beneficial effect on STH. Baseline prevalence rates for Ascaris, hookworm and Trichuris were 34%, 28%, and 11%, respectively; these rates were reduced to 27%, 4%, and 2% one year after the 5th round of MDA. Unfortunately, STH rates rebounded 34 months after cessation of MDA and approached pre-MDA rates. However, the intensity of STH infection in 2009 was still reduced, and no heavy infections were detected.Conclusions/SignificanceMDA with DEC/albendazole has had a major impact on B. timori MF and IgG4 antibody rates, providing a proof of principle that elimination is feasible. We also documented the value of annual DEC/albendazole as a mass de-worming intervention and the importance of continuing some form of STH control after cessation of MDA for filariasis.
Highlights
Lymphatic filariasis (LF) has been targeted by the World Health Organization for global elimination by the year 2020 [1]
The impact of six annual rounds of mass drug administration (MDA) using DEC combined with albendazole on brugian filariasis and soil-transmitted helminths (STH) was evaluated
Our study indicated that B. timori infection can be eliminated by DEC/albendazole MDA and that the antifilarial IgG4 rate in the community significantly declines over time
Summary
Lymphatic filariasis (LF) has been targeted by the World Health Organization for global elimination by the year 2020 [1]. During the years 2000 to 2009 the Global Program to Eliminate Lymphatic Filariasis (GPELF) has provided .2.8 billion treatments with anti-filarial drugs to a minimum of 885 million individuals living in 53 endemic countries [2,3]. We have previously published a preliminary report on the impact of two annual rounds of MDA on brugian filariasis in Alor Island in Eastern Indonesia [4]. Other studies have shown that BmR1 rapid antibody test [5,6] is a sensitive marker for detecting brugian filariasis in populations. The absence of an animal reservoir, the inefficient transmission by Anopheles mosquitoes and the high sensitivity to DEC/ albendazole treatment make this species a prime candidate for elimination by mass drug administration (MDA)
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