Prevalence Of Microfilaraemia Research Articles

Prevalence of diurnally subperiodic bancroftian filariasis among the Nicobarese in Andaman and Nicobar Islands, India: effect of age and gender.

We conducted a cross-sectional survey to assess the prevalence of disease and microfilaraemia caused by diurnally subperiodic strain of Wuchereria bancrofti transmitted by day biting Aedes niveus in Teressa Island, remotely located in the Nicobar district of Andaman and Nicobar Islands. Lymphatic filariasis is a considerable public health problem on this island with an overall endemicity rate of 16.2%. There was a gradual increase in microfilaraemia prevalence with age, reaching a plateau above 30 years. Both the microfilaraemia and disease rates were significantly higher in males (14.7% and 5.2%) than females (8.6% and 1.5%, P < 0.001). The age and gender specific distribution of chronic manifestations show a gradual increase with age, whereas acute disease started to occur from age 40 in males. Hydrocele (84.6%) was the commonest disease manifestation among males, whereas lymphoedema was the only manifestation encountered among females. As vector control measures are not practicable in this setting, chemotherapy using diethylcarbamazine (DEC) is the only potential option to control this disease.

Chrysops silacea biting densities and transmission potential in an endemic area of human loiasis in south-west Cameroon.

We studied the biting densities of Chrysops silacea and the transmission of loiasis over 1 year in a regenerated forest in the south-west province of Cameroon. A total of 3015 flies caught near a wood fire at ground level during rainy and dry seasons were identified morphologically and 1975 caught during the rainy season were dissected to determine their physiological age and infection rate. The prevalence of microfilaraemia in the human population in the study area was determined using the thick blood smear method. Chrysops silacea was the only species caught. The daily and seasonal biting cycle of C. silacea showed two peaks of activities, 9-11 a.m. and 2-4 p.m. The biting cycles of parous and nulliparous flies showed the same trends, but the density of nulliparous flies biting at all time of the day was 2-3 times higher. Chrysops silacea biting density was high during the rainy season (9.06 +/- 6.88 flies/man/h) and lowest during the dry season (0.44 +/- 0.75 flies/man/h). An infection rate of 1.72% and a monthly morning and afternoon transmission potentials of 120769.11 and 139016.64 infective head L3/man were observed, respectively, in the rainy season. Even though few Chrysops carried Loa loa infective larvae (0.7%), their parasite load was high, giving a high level of transmission of L. loa in the area. A total of 20.37% of the people examined for blood microfilariae were positive. These results suggest that the study area is an active focus of loiasis transmission.

Prevalence and intensity of Wuchereria bancrofti antigenaemia in Sri Lanka by Og4C3 ELISA using filter paper-absorbed whole blood

In Sri Lanka 2741 people from Matara, an endemic area for Wuchereria bancrofti, were examined in 1996/97 for microfilariae by 60-μL blood smear and for circulating filarial antigens by Og4C3 ELISA using filter paper-absorbed whole blood. The overall prevalence of microfilaraemia was 3 · 4%, and that of antigenaemia 14 · 4%. The prevalence of antigen-positive and microfilaria-negative people was 11 · 3%. Analysed by age-group, antigenaemia prevalence was similar in all groups, and the average number of antigen units was already very high in the age-group < 10 years, indicating that the infection started in early childhood. Among those who were antigen positive, the microfilaria prevalence was lower in females than in males. Diethylcarbamazine treatment eliminated microfilariae in 78% of the positives. However, 17 months after the treatment, antigenaemia was still positive in 76% of those who were parasitologically cured.

A community-based trial for the control of lymphatic filariasis and iodine deficiency using salt fortified with diethylcarbamazine and iodine.

To evaluate the effectiveness of salt fortified with diethylcarbamazine (DEC) and iodine for elimination of Bancroftian filariasis and iodine deficiency, all consenting residents of Miton, Haiti (n = 1,932) were given salt fortified with 0.25% diethylcarbamazine and 25 ppm of iodine for one year. Wuchereria bancrofti microfilaria prevalence and intensity, antigenemia, and urinary iodine were measured before and one year after salt distribution began. To measure the effect of DEC-fortified salt on adult worm motility, 15 microfilaria-positive men were examined by ultrasound of the scrotal area. Entomologic surveys were conducted to determine the proportion of W. bancrofti-infected Culex quinquefasciatus. After one year of treatment, the prevalence and intensity of microfilaremia were both reduced by more than 95%, while antigenemia levels were reduced by 60%. The motility of adult worms, as detected by ultrasound, was decreased, but not significantly, by DEC-fortified salt. The proportion of vector mosquitoes carrying infective stage larvae decreased significantly from 2.3% in the nine months before the intervention to 0.2% in the last three-month follow-up period. Iodine deficiency, which had been moderate to severe, was eliminated after one year of iodized salt consumption. The DEC-fortified salt was well accepted by the community and reduced microfilaremia and transmission to low levels in the absence of reported side effects. Based on these results, salt cofortified with DEC and iodine should be considered as a concurrent intervention for lymphatic filariasis and iodine deficiency elimination programs.

Immunochromatographic test (ICT) for estimation of true prevalence of bancroftian filariasis in an endemic area in southern India

Percentage prevalences of microfilaraemia (PPMF) and antigenaemia (PPCFA) were examined in 1999 in 3505 subjects from 3 villages in India. All microfilaraemics were positive for antigenaemia, and PPCFA was always higher than PPMF. Amicrofilaraemia among antigenaemic persons decreased steadily from 92% in the agegroup 2–5 years to 40% in the age-group 21–30 years.

Relationships between the prevalence and intensity of Loa loa infection in the Central province of Cameroon

Ivermectin treatment may induce marked adverse effects in those harbouring > 8000 Loa microfilariae (mff)/ml of blood, individuals with > 30 000 Loa mff/ml being at risk of developing serious neurological reactions. It is thus necessary to delineate the geographical areas where such responses may occur. To determine if the simple measure of prevalence of Loa microfilaraemia would be appropriate to identify the communities at risk, the relationships between prevalence and intensity of Loa microfilaraemia were investigated in 67 villages in Cameroon. The prevalence recorded in the adult population was found to be closely related to each of the indicators of infection intensity investigated. For example, when the prevalences of Loa microfilaraemia in adults were 20%, 30% and 40%, approximately 5%, 9% and 16% of the adults had microfilarial loads exceeding 8000 mff/ml, respectively; the corresponding percentages of adults with > 30 000 mff/ml were about 1%, 3% and 5%-6%. Thus it seems that, in areas where loiasis is co-endemic, the monitoring procedure during large-scale ivermectin treatments for the control of onchocerciasis only needs to be strengthened in those communities where the prevalence of Loa microfilaraemia in adults exceeds 20%.

Relationships between the prevalence and intensity ofLoa loainfection in the Central province of Cameroon

Ivermectin treatment may induce marked adverse effects in those harbouring > 8000 Loa microfilariae (mff)/ml of blood, individuals with > 30 000 Loa mff/ml being at risk of developing serious neurological reactions. It is thus necessary to delineate the geographical areas where such responses may occur. To determine if the simple measure of prevalence of Loa microfilaraemia would be appropriate to identify the communities at risk, the relationships between prevalence and intensity of Loa microfilaraemia were investigated in 67 villages in Cameroon. The prevalence recorded in the adult population was found to be closely related to each of the indicators of infection intensity investigated. For example, when the prevalences of Loa microfilaraemia in adults were 20%, 30% and 40%, approximately 5%, 9% and 16% of the adults had microfilarial loads exceeding 8000 mff/ml, respectively; the corresponding percentages of adults with > 30 000 mff/ml were about 1%, 3% and 5%–6%. Thus it seems that, in areas where loiasis is co-endemic, the monitoring procedure during large-scale ivermectin treatments for the control of onchocerciasis only needs to be strengthened in those communities where the prevalence of Loa microfilaraemia in adults exceeds 20%.

Annual single-dose diethylcarbamazine plus ivermectin for control of bancroftian filariasis: comparative efficacy with and without vector control

Two intervention strategies for the control of bancroftian filariasis were compared in rural villages of southern India: annual mass treatment with single-dose diethylcarbamazine plus ivermectin, either on its own or combined with vector control. Vector control, based on the use of polystyrene beads and larvivorous fishes in the major breeding sites of Culex quinquefasciatus, brought about a drastic and sustained reduction in vector density and man-biting rates. After the first round of treatment, chemotherapy alone brought about a 60% drop in the annual transmission potential (ATP) whereas the integrated strategy reduced ATP by 96% (P < 0.05). After two annual rounds of treatment, the reduction in ATP was similar for both strategies (91%–96%), with the prevalences of microfilaraemia reduced by 88%–92%. However, when drug pressure was removed in the third and final year of the study, transmission was resumed in the absence of vector control whereas no infective female mosquitoes were detected in the villages with vector control. Vector control, though obviously not cost-effective in the short term, could play an important role in an integrated programme, by preventing re-establishment of transmission after chemotherapy is completed.

Placebo-controlled community trial of four cycles of single-dose diethylcarbamazine or ivermectin against Wuchereria bancrofti infection and transmission in India

A double-blind placebo-controlled trial was carried out in 1994–1998 to compare the effects of 4 cycles of single-dose diethylcarbamazine (DEC) or ivermectin on prevalence and geometric mean intensity (GMI) of microfilaraemia in the human population, infection rates in the vector population, and transmission intensity of Culex-transmitted Wuchereria bancrofti in rural areas in Tamil Nadu state, south India. Fifteen villages (population 26 800) were included in the study: 5 villages each were randomly assigned to community-wide treatment with DEC or ivermectin or placebo. People over 14 kg bodyweight received DEC 6 mg/kg, ivermectin 400 gmg/kg or a placebo, all identically packaged. After 2 cycles of treatment at a 6-month interval, the code was broken and the study continued as an open trial, with third and fourth cycles of treatment at a 12-month interval; 54–77% of eligible people (20 872) received treatment during the 4 cycles. Microfilaraemia prevalence and GMI fell by 48% and 65% with DEC and 60% and 80% with ivermectin respectively after 4 cycles of treatment. There was no change in the incidence of acute adenolymphangitis. Infection in resting mosquitoes fell significantly in all arms: 82%, 78% and 42% in the ivermectin, DEC and placebo arm, respectively. Landing mosquitoes also showed the same trend. The decline in infectivity was significant for resting ( P < 0·05) and landing mosquitoes ( P < 0·05) with ivermectin and DEC ( P < 0·05), and for neither in the placebo group ( P > 0·05). Transmission intensity was reduced by 68% with ivermectin and 63% with DEC. Transmission was apparently interrupted in 1 village with ivermectin, but infected resting mosquitoes were consistently found in this village. Single-dose community-level treatment with DEC or ivermectin is effective in reducing W. bancrofti infection in humans and mosquitoes, and may result in total interruption of transmission after several years of control. There is an immediate need to define the role of vector, parasite and community factors that influence the elimination of lymphatic filariasis, particularly the duration of treatment vis-à-vis efficacy of drugs, treatment compliance and efficiency of vectors.

Epidemiology of bancroftian filariasis in three suburban areas of Matara, Sri Lanka.

The epidemiological parameters of bancroftian filariasis were investigated in three suburbs of Matara, within the south-western coastal belt of Sri Lanka where the disease is endemic. The overall prevalence of microfilaraemia and the geometric mean density of the microfilaraemias observed were 4.4% and 20.6 microfilariae/60 microl fingerprick blood, respectively. Prevalence was significantly lower in the female subjects than in the male, and in males aged < 20 years than in older males. Overall, 9.5% of the subjects had the clinical manifestations of bancroftian filariasis (6.4% had filarial fever, 3.0% had elephantiasis and/or oedema, and 6.2% had hydrocele). The prevalence of elephantiasis/oedema was generally higher among the female subjects (4.2%) than among the male (1.4%), and an age-prevalence plot for this manifestation showed a linear increase in prevalence after the age of 40 years. Hydrocele also became commoner with increasing age, but this increase in prevalence began at the lower age of 20 years. More than 60% of the cases of elephantiasis/oedema but only 26.3% of the subjects found to have hydroceles experienced filarial fever attacks. The cases of fever and elephantiasis/oedema (but not those of microfilaraemia or hydrocele) were aggregated within households. However, the children whose mothers were microfilaraemic were much more likely to be microfilaraemic themselves (8.7%) than the children who had amicrofilaraemic mothers (2.8%), microfilaraemic fathers (0.0%) or amicrofilaraemic fathers (2.7%). The results of entomological surveys indicated that transmission of Wuchereria bancrofti occurred throughout the year in the study community.

Epidemiology of bancroftian filariasis in three suburban areas of Matara, Sri Lanka

The epidemiological parameters of bancroftian filariasis were investigated in three suburbs of Matara, within the south-western coastal belt of Sri Lanka where the disease is endemic. The overall prevalence of microfilaraemia and the geometric mean density of the microfilaraemias observed were 4.4% and 20.6 microfilariae/60 µl fingerprick blood, respectively. Prevalence was significantly lower in the female subjects than in the male, and in males aged <20 years than in older males. Overall, 9.5% of the subjects had the clinical manifestations of bancroftian filariasis (6.4% had filarial fever, 3.0% had elephantiasis and/or oedema, and 6.2% had hydrocele). The prevalence of elephantiasis/oedema was generally higher among the female subjects (4.2%) than among the male (1.4%), and an age-prevalence plot for this manifestation showed a linear increase in prevalence after the age of 40 years. Hydrocele also became commoner with increasing age, but this increase in prevalence began at the lower age of 20 years. More than 60% of the cases of elephantiasis/oedema but only 26.3% of the subjects found to have hydroceles experienced filarial fever attacks. The cases of fever and elephantiasis/oedema (but not those of microfilaraemia or hydrocele) were aggregated within households. However, the children whose mothers were microfilaraemic were much more likely to be microfilaraemic themselves (8.7%) than the children who had amicrofilaraemic mothers (2.8%), microfilaraemic fathers (0.0%) or amicrofilaraemic fathers (2.7%). The results of entomological surveys indicated that transmission of Wuchereria bancrofti occurred throughout the year in the study community.

Impact of single-dose ivermectin on community microfilaria load in bancroftian filariasis infection: two years post treatment

The concept of annual single-dose treatment for the control and possible interruption of transmission of lymphatic filariasis has brought much hope to the previously hopeless disease. The logistics for implementing this enormous public health intervention have wide ramifications and will depend on the efficiency of drug delivery and distribution at various levels of the health system. In sub-Saharan Africa, where the public health services are inadequate, this becomes even more important. Six communities in southern Ghana known to be endemic for filariasis were treated with single-dose ivermectin in January/ February 1997 as part of pilot programme activities. The 1998 treatment could not take place because of unavailability of the drug. The 1999 community microfilaraemia prevalence and intensity were reduced by only 25·5% and 39·5% of pre-treatment levels, respectively. The implications of any shortfalls on the drug delivery system on the goal of elimination of lymphatic filariasis are discussed.

Bancroftian filariasis in the Varanasi region of north India: an epidemiological study.

The age- and sex-specific distributions of human infections with Wuchereria bancrofti were investigated at two sites in the Varanasi region of north India: one a rural, agricultural area (Chiraigaon) and the other an urban-slum area (Sunderpur). A random clinical and parasitological survey revealed that the prevalence of microfilaraemia and elephantiasis in the urban area (14% and 7.3%, respectively) were both higher than in the rural area (9% and 3.1%, respectively). In both areas, prevalence of microfilaraemia generally increased with age, to a maximum in those aged 20-29 years, and then declined. Within most age-groups, the prevalences of microfilaraemia and elephantiasis were higher in males than females. However, the prevalence of microfilaraemia in females from Chiraigaon who were aged > 30 years was higher than in their male counterparts. Though individual microfilarial intensities varied greatly, the geometric mean microfilarial intensity was higher in Sunderpur than in Chiraigaon (214 v. 196 microfilariae/ml). All 83 subjects with elephantiasis, except one in Sunderpur, were amicrofilaraemic. The present results indicate that bancroftian filariasis is one of the major public-health problems in the study area.

Bancroftian filariasis in an irrigation project community in southern Ghana.

An epidemiological study to document the endemicity and transmission characteristics of bancroftian filariasis was conducted in an irrigation project community in southern Ghana. In a 50% random sample of the population, the prevalence of microfilaraemia was 26.4% and the geometric mean microfilarial intensity among positives was 819 microfilariae/ml of blood. Hydrocoele was found in 13.8% of the males aged > or =18 years, and 1.4% of the residents examined, all females, had tymphoedema/elephantiasis. Detailed monitoring of the microfilarial intensity in 8 individuals over a 24-h period confirmed its nocturnal periodicity with a peak at approximately 0100 hours. The most important vector was Anopheles gambiae s.l., followed by An. funestus. The abundance of these mosquitoes and their relative importance as vectors varied considerably between the wet and the dry season. Opening of the irrigation canals late in the dry season resulted in a remarkable increase in the population of An. gambiae (8.3% of which carried infective filarial larvae) to levels comparable to those seen during the wet season, suggesting that the irrigation project is responsible for increased transmission of lymphatic filariasis in the community.

Lymphatic filariasis in a hyperendemic region: a ten-year, follow-up panel survey.

The present study is a long-term panel survey of a population living in a previously identified Wuchereria bancrofti-endemic area of Benin. Unexpectedly, a marked decrease in the prevalence of microfilaremia (from 9.4% to 0.48%; P < 0.001) occurred over a 10-year period in the absence of chemotherapy or vector control measures. The percentage of patients with chronic pathology remained stable during the study period. The decrease in the prevalence of parasitemia could not be explained by environmental or sociologic changes in the region, or by differences between the two study populations. These data suggest that the epidemiology of lymphatic filariasis in an endemic region may change independently of recognized modulating factors.

A review of the present status of lymphatic filariasis in Vietnam

Establishing the current status of an infectious disease forms the starting point of any attempt at parasite control. Although data on the prevalence and distribution of lymphatic filariasis exist for Vietnam from the early 1900s, the present situation regarding the disease is less well-known. Here, we review the results of recent surveys conducted by the Institute of Malariology, Parasitology and Entomology, Hanoi, to update the existing information on filariasis epidemiology and distribution for this country. The present results are from surveys carried out on some 135 000 individuals in 24 provinces of Vietnam. The highest prevalences of microfilaraemia (primarily Brugia malayi) are observed in lowland areas of the Red River Delta and in Quang-binh Province where the survey results show microfilaraemia (mf) prevalences in the range of 0.9–5.5%. The most common type of chronic clinical manifestation is shown to be leg elephantiasis. A significant finding is that an overall decrease in mf prevalence was observed to occur in five communities which were surveyed twice over an 11–21-year period, even though no interventions were carried out between the two surveys. The changes are probably caused by environmental changes, such as increased standards of housing and drainage. Studies on the effect of selective chemotherapy and mass chemotherapy using diethylcarbamazine showed reductions in community mf prevalences of 69 and 72–88%, respectively. Furthermore, cats do not appear to represent significant reservoirs of infection. These findings of geographical restriction of infection, effective and well-tolerated drug therapy, low significance of animal reservoirs, together with the existence of an effective national health network, suggest a good prognosis for the control of filariasis in this country.

Wuchereria bancrofti in Kwale District, Coastal Kenya: patterns of focal distribution of infection, clinical manifestations and anti-filarial IgG responsiveness.

A cross-sectional study of bancroftian filariasis was conducted in 2 adjacent communities, Mvumoni and Kilore in Muhaka, Kwale District. Wuchereria bancrofti infection, clinical manifestations and anti-filarial IgG responsiveness were determined before the long rains, a time coinciding with a low transmission season. The prevalence of microfilaraemia increased gradually with age and was significantly higher in Kilore (24%) than in Mvumoni (6.3%, P < 0.001). Similarly, the prevalence of antigenaemia increased with age and also was significantly higher in Kilore, 48.9% than in Mvumoni, 20.5% (P < 0.001). Hydrocele, funiculitis, lymphangitis and lymphadenitis were also significantly more common in Kilore than in Mvumoni. In comparing the 2 communities, levels of IgG4 responsiveness in antigen-positive persons were higher in Kilore than Mvumoni (P = 0.034), but this was related to higher antigen loads in persons in Kilore than in Mvumoni. In antigen-negative persons, anti-filarial antibodies of 3 IgG isotypes were significantly higher in Kilore than Mvumoni (P < 0.001, for IgG1, IgG2, IgG4). These results emphasize the highly focal nature of bancroftian filariasis in this setting and demonstrate that anti-filarial antibody levels are related to transmission intensity.

Prevalence of hydrocele as a rapid diagnostic index for lymphatic filariasis

The real burden of lymphatic filariasis in most endemic areas remains unknown even though it is a major public health problem in many tropical countries, particularly in sub-saharan Africa. The nocturnal periodicity of the parasite requires parasitological examinations to be done at night. The aim of this study was to develop and validate rapid epidemiological assessment tools for the community diagnosis of lymphatic filariasis, that may be used in the future to determine the distribution of the disease and identify high risk communities in Ghana. Twenty communities with varying endemicity of filariasis were sampled from 3 endemic districts. Community members were selected for the study using a modified Expanded Programme for Immunization (EPI) cluster sampling technique. The prevalence of hydrocele was high (range 4·5–40·75%, mean = 17·78%) and the community prevalence of microfilaraemia correlated well with that of hydrocele ( r = 0·84).The findings suggest that it is possible to obtain reliable and valid estimates of the community burden of lymphatic filariasis using the prevalence of hydrocele as a diagnostic index.

Bancroftian filariasis in south east Madhya Pradesh: Pre-control epidemilogical observations

Lymphatic filariasis caused byWuchereria bancrofti is a major health problem next only to malaria. A study had been conducted to estimate the prevalence of microfilaraemia in a rural endemic community near Raipur. The incidence of microfilaramia in the community was found to be about 14% when studied by night finger prick method. The incidence appears to be more in males as compared to females. The infection rate in vector population i.e.,Culex quinquefasciatus was recorded at a rate of 10%. No relationship could be drawn between the rates of vector and human filarial infections or between the density of vector population and the rate of vector/human infection(s). Prior health education is essential before taking up control and preventive measures in given endemic zone.

Wuchereria bancrofti microfilaraemia in children in relation to parental infection status

A total of 946 families with 2302 children was surveyed for microfilaraemia due to Wuchereria bancrofti. The prevalence of microfilaraemia among offspring born to microfilaraemic parents was significantly higher than in those born to amicrofilaraemic parents ( P = 0·0049; relative risk = 3·40). However, there was no statistically significant difference between the prevalence of microfilaraemia in children born to microfilaraemic mothers or microfilaraemic fathers, suggesting that parental (not only maternal) infection is the important risk factor, and it may be exposure within the household which is important. Logistic regression analyses also confirmed that the risk of infection for offspring born to either microfilaraemic mothers or microfilaraemic fathers was higher than that for offspring born to amicrofilaraemic parents and indicated that infection in children ≤20 years old was primarily dependent on parental infection status and minimally influenced by factors other than household exposure.