Abstract
Lymphatic filariasis (LF) and soil-transmitted-helminths (STH) are co-endemic in 58 countries which are mostly in Africa and Asia. Worldwide, 486 million school-age children are considered at risk of both diseases. In 2000, the World Health Organization (WHO) established the global programme to eliminate LF by 2020. Since then, the LF elimination programme has distributed ivermectin or diethylcarbamazine citrate (DEC) in combination with albendazole, thereby also treating STH. Consequently, many school-age children have been treated for STH through the LF programme. As treatment targets towards the 2020 LF elimination goal are achieved, many countries are implementing the transmission assessment survey (TAS) and, if the LF prevalence is estimated to be less than 1%, scaling down mass drug administration (MDA). We analysed the 2014 data on preventive chemotherapy (PC) reported from LF STH co-endemic countries and projected the year and location of TAS expected to be conducted between 2016 and 2020 to assess the impact of this scaling down on STH PC. Eighty percent of all co-endemic countries that have already stopped LF MDA nationally were able to establish STH PC through schools. It is estimated that 14% of the total number of children presently covered by the LF programme is at risk of not continuing to receive PC for STH. In order to achieve and maintain the WHO 2020 goal for STH control, there is an urgent need to establish and reinforce school-based deworming programmes in countries scaling-down national LF elimination programmes.
Highlights
Lymphatic filariasis (LF) and soil-transmitted helminth (STH) infections are co-endemic in 58 countries worldwide: 34 in Africa region, 12 in Western Pacific region, six in South-East Asia region, four in America region and two in Eastern Mediterranean region (Fig 1)
School-age children are most affected by intestinal worms, albendazole, one of the two drugs used for LF, treats STH
The results show that 80% of countries that have already stopped LF treatment were able to administer deworming drugs for STH to school-age children within school-based treatment programmes
Summary
Lymphatic filariasis (LF) and soil-transmitted helminth (STH) infections are co-endemic in 58 countries worldwide: 34 in Africa region, 12 in Western Pacific region, six in South-East Asia region, four in America region and two in Eastern Mediterranean region (Fig 1). Since albendazole treats STH infections [1], MDA for LF has often replaced specific interventions targeting STH in co-endemic areas. In 2014, it was estimated that 46% of those school-age children (SAC) who received PC for STH received anthelminthics through MDA targeting LF while 54% were dewormed through school-based interventions (Fig 2). At least 5 years of MDA with effective coverage is expected to have reduced LF infection to a level at which doi:10.1371/journal.pntd.0005202.g002 transmission can no longer be sustained and MDA can stop. WHO recommends the transmission assessment survey (TAS) as the decision-making tool to determine when to stop MDA [3]. After stopping MDA, countries are expected to conduct TAS twice over a 4–5 year period to confirm whether LF elimination has been achieved and sustained [4]
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