Abstract
Lymphatic filariasis (LF) is a mosquito-transmitted parasitic disease that is a leading cause of disability globally. The island of Hispaniola, which the Dominican Republic shares with Haiti, accounts for approximately 90% of LF cases in the Americas region. In 1998, the Dominican Ministry of Public Health created the Program to Eliminate Lymphatic Filariasis (PELF) with the goal of eliminating LF transmission by 2020. Baseline mapping revealed 19 (12% of total) endemic municipalities clustered into three geographic foci (Southwest, La Ciénaga and East), with a total at-risk population of 262,395 people. Beginning in 2002, PELF sequentially implemented mass drug administration (MDA) in these foci using albendazole and diethylcarbamazine (DEC). In total, 1,174,050 treatments were given over three to five annual rounds of house-to-house MDA per focus with a median coverage of 81.7% (range 67.4%–92.2%). By 2018, LF antigen prevalence was less than 2% in all foci, thus meeting criteria to stop MDA and begin post-treatment surveillance (PTS). This success has been achieved against a shifting landscape of limited domestic funding, competing domestic public health priorities, and sporadic external donor support. Remaining steps include the need to scale-up morbidity management and disability prevention services for LF and to continue PTS until LF transmission is interrupted across Hispaniola.
Highlights
Lymphatic filariasis (LF) is a mosquito-transmitted neglected tropical disease with an estimated 858 million people at risk in 72 endemic countries [1]
Lymphatic filariasis (LF) is a neglected tropical disease caused by thin worms transmitted to humans by the bites of mosquitoes
This report describes the efforts to eliminate the disease in the country, including a review of disease mapping and implementation of mass drug administration (MDA) —the provision of safe and effective medicine to at-risk communities—to interrupt parasite transmission
Summary
Lymphatic filariasis (LF) is a mosquito-transmitted neglected tropical disease with an estimated 858 million people at risk in 72 endemic countries [1]. LF is caused by infection with one of three species of filarial nematodes that induce lymphatic dysfunction resulting in lymphedema, elephantiasis, and male genital swelling (hydrocele) [2]. These conditions lead to reduced mobility, impairment of daily activities, and social isolation for affected individuals [3,4] claiming at least 1.3 million disability-adjusted life years [5]. The global strategy consists of mass drug administration (MDA) to interrupt parasite transmission and supportive care to alleviate disability for those already affected by LF. Annual MDA for 4–6 years at effective coverage ( 65%) in at-risk populations is predicted to reduce infection prevalence to levels below which transmission is no longer sustainable [8]
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