Abstract
BackgroundIn March 2017, Togo was declared the first country in sub-Saharan Africa to eliminate lymphatic filariasis as a public health problem, but post-validation surveillance has been lacking. In some areas of the country, migrant groups from neighboring countries that are still endemic for LF pose a risk of reintroduction of LF to Togo. The objective of this study was to identify the risk posed by migrant groups by measuring their prevalence of LF infection and investigating any positive case using Togo’s case investigation algorithm to prevent resurgence of LF and sustain Togo’s elimination success.MethodA cross-sectional study was conducted in 2018 in the northernmost region of the country. Three migrant populations were identified: (i) nomadic Peuhls, (ii) Togolese members of local communities who migrate annually to neighboring countries for seasonal labor, and (iii) refugees from Ghana who came to Togo because of a communal conflict in Ghana. A questionnaire was designed to collect data on demographics and history of LF and MDA; all participants were tested for circulating filariasis antigen (CFA) using the filariasis test strip (FTS). Any CFA-positive case was confirmed with nocturnal microfilaremia.ResultsRefugees, seasonal economic migrants and nomadic Peuhls represented 42.1%, 31.4% and 26.5% of the study participants, respectively. The overall prevalence of CFA was 4.2% (58/1391) with the highest prevalence in the nomadic Peuhl group (11.9%), but only one of them (0.07%) was confirmed positive with nocturnal microfilaremia. Using the case investigation algorithm, no other positive case was identified in the positive case’s surroundings.ConclusionThis study demonstrates that nomadic Peuhls, with a CFA prevalence of 11.9%, pose a potential risk for reintroduction of LF into Togo while Ghanaian refugees and seasonal economic migrants do not appear to pose a significant risk. Periodic monitoring of migrants, especially the nomadic Peuhl population, is a potential post-validation surveillance approach that could be used to promptly detect any LF cluster that may arise.Graphical
Highlights
Lymphatic filariasis (LF) is a parasitic infection that is spread by mosquitos infected with worm larvae
This study demonstrates that nomadic Peuhls, with a circulating filariasis antigen (CFA) prevalence of 11.9%, pose a potential risk for reintroduction of LF into Togo while Ghanaian refugees and seasonal economic migrants do not appear to pose a significant risk
The study period was determined based on (i) the migratory calendar of the migrant groups: the Peuhls, who cross the territory between December and May coming from Burkina Faso to Ghana, and the Togolese migrating to neighboring countries for seasonal labor, who return to Togo between December and May, and (ii) the reliability of biological results; the assessment should be conducted at least 6 months after the end of the integrated mass drug administration (MDA) with albendazole, ivermectin, and praziquantel for soil-transmitted helminths (STH), onchocerciasis, and schistosomiasis, conducted from August 19 to September 7, 2017
Summary
Lymphatic filariasis (LF) is a parasitic infection that is spread by mosquitos infected with worm larvae. The World Health Organization (WHO) has formally validated the elimination of LF as a public health problem in 16 countries and territories in the world, including Togo [4, 5]. In March 2017, Togo was declared the first country in sub-Saharan Africa to eliminate lymphatic filariasis as a public health problem, but post-validation surveillance has been lacking. In some areas of the country, migrant groups from neighboring countries that are still endemic for LF pose a risk of reintroduction of LF to Togo. The objective of this study was to identify the risk posed by migrant groups by measuring their prevalence of LF infection and investigating any positive case using Togo’s case investigation algorithm to prevent resurgence of LF and sustain Togo’s elimination success
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