Abstract
BackgroundThe World Health Organization now recommends semiannual mass drug administration (MDA) of albendazole with integrated vector management as an option for eliminating lymphatic filariasis (LF) in areas of loiasis-endemic countries where it may not be safe to use diethylcarbamazine or ivermectin in MDA programs. However, the published evidence base to support this policy is thin, and uptake by national programs has been slow.Methodology/Principal findingsWe conducted a community trial to assess the impact of semiannual MDA on lymphatic filariasis and soil-transmitted helminth infections (STH) in two villages in the Bandundu province of the Democratic Republic of the Congo with moderately high prevalences for LF and hookworm infections. MDA with albendazole was provided every six months from June 2014 to December 2017 with treatment coverages of the eligible population (all ≥ 2 year of age) that ranged between 56% and 88%. No adverse effects were reported during the trial. Evaluation at 48 months, (i.e. 6 months after the 8th round of MDA), showed that W. bancrofti microfilaremia (Mf) prevalence in the study communities had decreased between 2014 to 2018 from 12% to 0.9% (p<0.001). The prevalence of W. bancrofti antigenemia was also significantly reduced from 31.6% to 8.5% (p<0.001). MDA with albendazole also reduced hookworm, Ascaris lumbricoides and Trichuris trichiura infection prevalences in the community from 58.6% to 21.2% (p<0.001), from 14.0% to 1.6% and 4.1% to 2.9%, respectively. Hookworm and Ascaris infection intensities were reduced by 93% (p = 0.02) and 57% (p = 0.03), respectively. In contrast, Trichuris infection intensity was not significantly reduced by MDA (p = 0.61) over this time period.Conclusion/SignificanceThese results provide strong evidence that semiannual MDA with albendazole alone is a safe and effective strategy for LF elimination in Central Africa. Community MDA also had a major impact on STH infections.
Highlights
Lymphatic filariasis (LF) in Africa is caused by Wuchereria bancrofti and is transmitted mainly by Anopheles or Culex mosquitoes
Together with the use of the night bed nets distributed as part of malaria programs, it was expected that this strategy could interrupt the transmission and eliminate lymphatic filariasis locally within period of 4 to 7 years
Our results suggest that semiannual mass drug administration (MDA) with albendazole is effective for lymphatic filariasis (LF) elimination in Central Africa, but they indicate that drug-based only intervention is not enough to eliminate gastrointestinal worm infections in areas with high transmission
Summary
Lymphatic filariasis (LF) in Africa is caused by Wuchereria bancrofti and is transmitted mainly by Anopheles or Culex mosquitoes. The presence of Loa loa in Central Africa prevents the widespread use of ivermectin for LF elimination in areas that are not already receiving ivermectin for onchocerciasis control, because ivermectin sometimes causes serious adverse events that can include coma and death in individuals with high L. loa microfilaremia [2]. WHO proposed a provisional strategy for controlling LF in areas with coendemic loiasis but where onchocerciasis is absent in 2012 This consists of MDA using ALB (preferably with semiannual delivery) together with integrated vector management [3]. The World Health Organization recommends semiannual mass drug administration (MDA) of albendazole with integrated vector management as an option for eliminating lymphatic filariasis (LF) in areas of loiasis-endemic countries where it may not be safe to use diethylcarbamazine or ivermectin in MDA programs. The published evidence base to support this policy is thin, and uptake by national programs has been slow
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
