Prevalence Of Microfilaraemia Research Articles

How Does the Proportion of Never Treatment Influence the Success of Mass Drug Administration Programs for the Elimination of Lymphatic Filariasis?

Mass drug administration (MDA) is the cornerstone for the elimination of lymphatic filariasis (LF). The proportion of the population that is never treated (NT) is a crucial determinant of whether this goal is achieved within reasonable time frames. Using 2 individual-based stochastic LF transmission models, we assess the maximum permissible level of NT for which the 1% microfilaremia (mf) prevalence threshold can be achieved (with 90% probability) within 10 years under different scenarios of annual MDA coverage, drug combination and transmission setting. For Anopheles-transmission settings, we find that treating 80% of the eligible population annually with ivermectin + albendazole (IA) can achieve the 1% mf prevalence threshold within 10 years of annual treatment when baseline mf prevalence is 10%, as long as NT <10%. Higher proportions of NT are acceptable when more efficacious treatment regimens are used. For Culex-transmission settings with a low (5%) baseline mf prevalence and diethylcarbamazine + albendazole (DA) or ivermectin + diethylcarbamazine + albendazole (IDA) treatment, elimination can be reached if treatment coverage among eligibles is 80% or higher. For 10% baseline mf prevalence, the target can be achieved when the annual coverage is 80% and NT ≤15%. Higher infection prevalence or levels of NT would make achieving the target more difficult. The proportion of people never treated in MDA programmes for LF can strongly influence the achievement of elimination and the impact of NT is greater in high transmission areas. This study provides a starting point for further development of criteria for the evaluation of NT.

Low diagnostic performance of thick blood smears of 50 µl in comparison with direct examination of 10 µl blood and the leukoconcentration technique of 5ml blood among loiasis-suspected patients with low microfilaremia in Gabon, Central Africa, using the STARD-BLCM guidelines

BackgroundThe aim of this study was to determine performance indicators of thick blood smears of 50 µl (TBS-50), following the Standards for the Reporting of Diagnostic Accuracy Studies–Bayesian Latent Class Model (STARD-BLCM) guidelines. TBS-50 was compared with two common parasitological techniques—direct examination of 10 µl blood and a leukoconcentration of 5 ml—for the diagnosis of microfilaremic loiasis.MethodsThe study population was recruited among patients of the Department of Parasitology-Mycology-Tropical Medicine over a period of 1 year. Age, sex, symptoms, and eosinophilia variables were recorded from laboratory registers and medical files. Direct examination of 10 µl of blood, TBS-50, and the leukoconcentration technique with 5 ml of blood were performed for each patient. The classical formula and BLCM were used to determine the diagnostic accuracy of the three techniques as well as the prevalence of microfilaremic loiasis. Three models were built within the framework of BLCM—the BLCM model I and alternative models II and III—for sensitivity analysis.ResultsIn total, 191 patients consented to be included. The direct blood examination and TBS-50 yielded comparable qualitative and quantitative results. Hence, they are reported together. The prevalence of Loa loa microfilaremia was 9.4% (95% CI 5.7–14.5; n = 18/191) with direct blood examination/TBS-50 and 12.6% [8.2–18.1] (n = 24/191) for leukoconcentration. Comparing TBS-50 with the leukoconcentration method using the classical formula, the sensitivity was 75.0% [53.3–90.2], specificity was 100.0% [97.8–100.0], the positive predictive value was 100.0% [81.5–100.0], and the negative predictive value was 96.5% [92.6–98.7]. The prevalence of microfilaremic loiasis was estimated at 9.7% [6.2–13.7] using BLCM model I. The outputs of BLCM model I showed sensitivity of 78.9% [65.3–90.3], specificity of 100.0% [99.3–100.0], a positive predictive value of 99.1% [87.2–100.0], and a negative predictive value of 93.0% [87.3–97.7] for direct blood examination/TBS-50.ConclusionsTBS-50 demonstrates low sensitivity relative to two other techniques. In one in five cases, the result will be falsely declared negative using these methods. However, this method can be deployed with limited funds.Graphical

New distribution patterns of Dirofilaria immitis in Italy.

In recent decades, the number of autochthonous cases and foci of Dirofilaria immitis in dogs from southern regions has increased considerably, suggesting that the distribution of the species is not limited to northern Italian regions. This epidemiological picture emerges from case reports or studies in specific locations where outbreaks of heartworm disease have occasionally been reported together with the presence of mosquito vectors. To obtain a more comprehensive picture of the current distribution of D. immitis in southern Italy, a multicenter cross-sectional survey of canine filariasis was conducted. Owned and sheltered dogs (n = 1,987) were included in the survey regardless their breed, attitude and/or sex. All included dogs were older than 1 year and had no history of chemoprophylactic treatment against filarioses. A blood sample was collected from enrolled dogs and screened by modified Knott's test and, when positive, tested using D. immitis specific ELISA rapid test (SNAP 4DX, IDEXX). The overall microfilaremia prevalence was 17% (n = 338) being single-species infection (92.6%) more common that mixed (7.4%). Remarkably, D. immitis was the most frequent species detected with an overall prevalence of 11.4% (n = 227), followed by Dirofilaria repens (n = 74; 3.7%), and Acanthocheilonema reconditum (n = 12; 0.6%). Sheltered dogs were significantly more infected by D. immitis, as well as mongrel dogs and animals housed in rural areas. Data here reported indicate that D. immitis is largely present in southern Italy, raising awareness about the necessity of proper screening and chemoprophylactic treatments in exposed animals.

Excess Mortality Associated With Loiasis: Confirmation by a New Retrospective Cohort Study Conducted in the Republic of Congo.

Loiasis (Loa loa filariasis) is considered a benign disease and is currently not included in the World Health Organization's (WHO's) list of Neglected Tropical Diseases, despite mounting evidence suggesting significant disease burden in endemic areas. We conducted a retrospective cohort study to assess the mortality associated with L. loa microfilaremia in the Southwestern Republic of Congo. The cohort included 3329 individuals from 53 villages screened for loiasis in 2004. We compared mortality rates in 2021 for individuals initially diagnosed as with or without L. loa microfilariae 17 years earlier. Data were analyzed at the community level to calculate crude mortality rates. Survival models were used to estimate the effect of L. loa microfilaremia on mortality in the population. At baseline, prevalence of microfilaremia was 16.2%. During 17.62 years of cohort follow-up, 751 deaths were recorded, representing a crude mortality rate of 15.36 (95% CI, 14.28-16.50) per 1000 person-years. Median survival time was 58.5 (95% CI, 49.7-67.3) years and 39.2 (95% CI, 32.6-45.8) years for amicrofilaremic and microfilaremic indiviudals, respectively. A significant reduction in life expectancy was associated with L. loa microfilaremia, confirming previous observations from Cameroon. This adds to the evidence that loiasis is not a benign disease and deserves to be included in the WHO's list of Neglected Tropical Diseases.

Lymphatic filariasis elimination endgame in an urban Indian setting: the roles of surveillance and residual microfilaremia after mass drug administration

BackgroundTo secure the gains of lymphatic filariasis (LF) elimination programs, attention is needed to the ‘residual microfilaremia phase’, in which high-risk populations may be crucial. The present study documents the impact of mass drug administration (MDA) in the urban Indian setting of Surat City, with high rates of in-migration.MethodsEpidemiological assessment included National Filaria Control Program (NFCP) and World Health Organization recommended routine and pre-MDA microfilaremia surveys respectively. Routine filaria surveys were conducted around the year in approximately 2000–4000 people per month, while pre-MDA surveys were carried out annually among approximately 4000 people from four fixed and four random sites. In 2016, Transmission Assessment Survey (TAS) was done in primary school children. The outcomes were microfilaremia (Mf) and antigen prevalence; more specifically, microfilaremia according to place of birth, in pre-MDA and routine night blood smears (NBS) collected from 2008 to 2015. Prevalence ratios and confidence intervals were calculated.ResultsA total of 25 480 pre-MDA and 306 198 routine NBS were examined during the study. In 2008, the Mf prevalence in the routine survey was 63/18 814 (0.33%), declining to 23/39 717 (0.06%) in 2016. Pre-MDA surveys showed a similar decrease from 47/4184 (1.1%) in 2008 to 12/4042 (0.3%) in 2015. In those born outside Surat, microfilaremia decreased below transmission thresholds, but remained more than treble that of the remainder of the population, in both the pre-MDA surveys [prevalence ratio: 3.17, 95% confidence interval (CI): 1.15–8.72], and the routine surveys (3.31, 95% CI: 1.47–7.48). Though the TAS results indicated that MDA endpoints had been reached, sub-group analysis identified that 90% of antigenemic children were from families of high-risk groups.ConclusionsExtensive long-term epidemiological monitoring suggests that all the urban population, including high-risk groups, have benefitted from the ELF program. To prevent re-establishment of infection in large urban areas with unsanitary conditions conducive to filarial vector breeding, there is need to identify residual microfilaremia by customized surveys in addition to pre-MDA monitoring and TAS. The present findings can be used to develop strategies to prioritize screening, surveillance and plan treatment of high-risk groups after achieving MDA endpoints.

Investigation on the Prevalence of Canine Microfilaremia in Thailand Using a Novel Microfluidic Device in Combination with Real-Time PCR.

We conducted a survey of canine microfilaraemia in 768 dogs in Chanthaburi, Samut Sakhon, and Narathiwat provinces of Thailand using a novel semi-automated, microfluidic device that is easy and rapid to perform. Microfilariae species were identified using High Resolution Melting real-time PCR (HRM real-time PCR). The prevalence of canine microfilaremia was 16.2% (45/278) in Chanthaburi and 5.5% (12/217) in Samut Sakhon. The prevalence of canine microfilaremia in Narathiwat was 22.7% (67/273). Brugia pahangi and Dirofilaria immitis were the predominant species of filariae found in the infected dogs from Chanthaburi and Narathiwat, respectively. The low prevalence of canine microfilaremia of Samut Sakhon may reflect the success of the Soi Dog foundation’s efforts and the establishment of veterinary control programs. An effective disease control and prevention strategies is needed in Chanthaburi and Narathiwat to reduce the risks of zoonotic transmission of the parasites. An appropriate drug treatment should be given to infected dogs and prophylactic drugs are suggested to be given to dogs age ≤1-year-old to prevent filarial infection. The novel microfluidic device could be implemented for surveillance of filariae infection in other animals.

Correlated prevalence of hydrocele and microfilaremia in Amazon (Belém, 1951-2005).

For decades, the city of Belém in Brazil's eastern Amazon was the second city in the country with highest prevalence of cases of filariasis due to Wuchereria bancrofti infection. However, this prevalence decreased over time until reaching null records, concomitantly with a decrease in frequency of recorded hydrocele cases. In this context, we analyzed cross-sectional data to evaluate the degree of correlation between prevalence of positive blood microfilariae results during surveillance screening occurred along 54 years (1951-2005) and prevalence of hydrocele cases recorded in the same time period. The dataset regarding hydrocele cases was obtained from two local hospitals. The Endemic Diseases Control Division of the Health Surveillance Department of the Municipal Health Department of Belém provided dataset regarding positive blood microfilariae cases. Prevalence calculus and linear correlation statistics were performed. Both positive blood microfilariae and hydrocele cases are well correlated statistically in absolute frequency (r = 0.871, 95%CI = 0.788 to 0.923, R2 = 0.759, p < 0.0001) and in prevalence (r = 0.835, 95%CI = 0.732 to 0.901, R2 = 0.698, p < 0.0001). We have concluded that blood microfilariae detection and hospitalized hydrocele cases are well correlated in our dataset. In addition, these results support the hypothesis that hydrocele prevalence can be useful to filariasis surveillance and control in endemic areas. However, limitations to hydrocele prevalence as an epidemiological indicator of filariasis are evidenced.

Prevalence of Dirofilaria immitis in shelter dogs in Bucaramanga metropolitan area, Colombia

The heartworm Dirofilaria immitis is the causative agent of cardiopulmonary dirofilariosis in dogs and cats and also infects humans. The current knowledge about this parasite in South America is scarce compared to North America and Europe. Nevertheless, this parasite has been reported in some regions of Colombia. The objective of this study was to determine the prevalence and risk factors associated with D. immitis infection in shelter dogs from Bucaramanga metropolitan area. We performed a cross-sectional study using blood samples from shelter dogs. Microfilariae testing of whole blood included a blood smear and modified Knott's test. Antigen testing of serum was performed using the Anigen Rapid HW Ag Test Kit 2.0 ®. A descriptive analysis and univariable logistic regression analysis were applied. A total of 207 whole blood samples, from 7 shelters dogs in the Bucaramanga metropolitan area, were utilized. The overall prevalence of D. immitis observed in shelter dogs in the Bucaramanga metropolitan area by blood smears and modified Knott's test was 6.3% (13/ 207) and 0.5% (1/207) by immunochromatography test kit. Regarding the prevalence by municipalities, there was a statistical association (P < .05), indicating that the prevalence was higher in dogs in Girón municipality. Likewise, there was a statistical association (P < .05) between the prevalence with respect to heartworm knowledge and mosquito control. For prevalence by gender, age group, dog breed, and hair length, there was no statistical association (P > .05). For Girón municipality there was a 7.1 times (OR = 7.1; CI95% 0.8-59.2; P < .05) increased infection risk. This study provides current data and the first known report of the prevalence of D. immitis microfilaremia and antigenemia in shelter dogs in the Bucaramanga metropolitan area, and these results could be useful for designing new control measures for this infection. We observed that the prevalence of both microfilaremia and antigenemia was significantly lower in these sampled dogs compared to previous reports.

The impact of four years of semiannual treatments with albendazole alone on lymphatic filariasis and soil-transmitted helminth infections: A community-based study in the Democratic Republic of the Congo.

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.

Standardisation of lymphatic filariasis microfilaraemia prevalence estimates based on different diagnostic methods: a systematic review and meta-analysis

BackgroundLymphatic filariasis (LF) infection is generally diagnosed through parasitological identification of microfilariae (mf) in the blood. Although historically the most commonly used technique for counting mf is the thick blood smear based on 20 µl blood (TBS20), various other techniques and blood volumes have been applied. It is therefore a challenge to compare mf prevalence estimates from different LF-survey data. Our objective was to standardise microfilaraemia (mf) prevalence estimates to TBS20 as the reference diagnostic technique.MethodsWe first performed a systematic review to identify studies reporting on comparative mf prevalence data as measured by more than one diagnostic test, including TBS20, on the same study population. Associations between mf prevalences based on different diagnostic techniques were quantified in terms of odds ratios (OR, with TBS20 blood as reference), using a meta-regression model.ResultsWe identified 606 articles matching our search strategy and included 14 in our analyses. The OR of the mf prevalences as measured by the more sensitive counting chamber technique (≥ 50 µl blood) was 2.90 (95% confidence interval (CI): 1.60–5.28). For membrane filtration (1 ml blood) the OR was 2.39 (95% CI: 1.62–3.53), Knott’s technique it was 1.54 (95% CI: 0.72–3.29), and for TBS in ≥ 40 µl blood it was 1.37 (95% CI: 0.81–2.30).ConclusionsWe provided transformation factors to standardise mf prevalence estimates as detected by different diagnostic techniques to mf prevalence estimates as measured by TBS20. This will facilitate the use and comparison of more datasets in meta-analyses and geographic mapping initiatives across countries and over time.

Assessment of transmission in areas of uncertain endemicity for lymphatic filariasis in Brazil.

BackgroundThe objective of the Global Program to Eliminate Lymphatic Filariasis (GPELF) is to phase out this endemic disease as a public health problem by 2020. Validation of elimination is obtained from the World Health Organization through evidence of non-transmission in countries that have already been subjected to mass drug administration (MDA) and in places adjoining these endemic areas. While three municipalities in Brazil have completed MDA, the epidemiological situation remains uncertain in nine adjoining municipalities. To determine the epidemiological status, this study was to perform a review of the literature and a school-based survey to describe the past and recent endemicity of lymphatic filariasis (LF) theses nine municipalities in Brazil.Methodology/Principle findingsFor review of the literature, both formal and informal literature sources were accessed since the first reports of filariasis in the Metropolitan Region of Recife, Brazil. We conducted a school-based survey in 2016 using immunochromatographic card tests (ICTs) among schoolchildren aged 6–10 years living in nine municipalities contiguous with the endemic areas in which MDA was conducted. Our review of the literature identified eight studies involving surveys demonstrating that microfilariae had been circulating in eight of the municipalities since 1967, with a low prevalence of microfilaremia, isolated autochthonous cases, and treatment of individual cases. The school-based survey included 17,222 children in 185 urban schools in the nine areas of Brazil with uncertain endemicity. One child affected by allochthonous transmission was antigen positive based on ICT and lived in a municipality adjacent to Recife; this child’s family came from Recife, but no other case was diagnosed within the family.Conclusions/SignificanceThe study results suggest that there is no transmission of LF in the municipalities investigated. However, these areas have population migration and socioenvironmental conditions favorable to mosquito breeding grounds; therefore, surveillance is strongly recommended in these areas.

Evaluation of the effect of mass drug administration against lymphatic filariasis in three health districts and public health implications: study of 12 epidemiological surveillance sites in Burkina Faso.

The implementation of mass drug administration (MDA) campaigns of albendazole (400mg) and ivermectin (150-200μm/kg) since 2001 has helped to change the epidemiological profile of lymphatic filariasis (LF) in many health districts in Burkina Faso. From 2002 to 2016, 14rounds of MDA have taken place in the Central East zone, with therapeutic coverage exceeding 65%. The objective of the current study was to evaluate the impact of MDA in the fight against LF at 12sentinel and spot-check sites. This descriptive cross-sectional study surveyed subjects aged 5 years and older between April and July 2017 at these 12sites. The blood smear performed on nocturnal samples was used to diagnose Wuchereria bancrofti infection. The study included 4364 subjects. Their mean age was 20.55years with a standard deviation of 14.22 and a range of 5to 96years. The overall prevalence of microfilaremia was 0.62% (27/4364), with rates exceeding 1% at three (3) sites. The average microfilaremia density was 106μf/mL. The overall prevalence of morbidity was low (0.91%), predominantly lymphedema (0.60%). The MDA strategy has helped to reduce the prevalence of LF significantly in Burkina Faso, but some outbreaks still have microfilarial prevalence greater than 1%. Continuation of the additional 2-year strategy with improved adherence to treatment and vector control would help break LF transmission.

GEOFIL: A spatially-explicit agent-based modelling framework for predicting the long-term transmission dynamics of lymphatic filariasis in American Samoa

In this study, a spatially-explicit agent-based modelling framework GEOFIL was developed to predict lymphatic filariasis (LF) transmission dynamics in American Samoa. GEOFIL included individual-level information on age, gender, disease status, household location, household members, workplace/school location and colleagues/schoolmates at each time step during the simulation. In American Samoa, annual mass drug administration from 2000 to 2006 successfully reduced LF prevalence dramatically. However, GEOFIL predicted continual increase in microfilaraemia prevalence in the absence of further intervention. Evidence from seroprevalence and transmission assessment surveys conducted from 2010 to 2016 indicated a resurgence of LF in American Samoa, corroborating GEOFIL’s predictions. The microfilaraemia and antigenaemia prevalence in 6-7-yo children were much lower than in the overall population. Mosquito biting rates were found to be a critical determinant of infection risk. Transmission hotspots are likely to disappear with lower biting rates. GEOFIL highlights current knowledge gaps, such as data on mosquito abundance, biting rates and within-host parasite dynamics, which are important for improving the accuracy of model predictions.

Combining different diagnostic studies of lymphatic filariasis for risk mapping in Papua New Guinea: a predictive model from microfilaraemia and antigenaemia prevalence surveys

BackgroundThe Global Programme to Eliminate Lymphatic Filariasis has encouraged countries to follow a set of guidelines to help them assess the need for mass drug administration and evaluate its progress. Papua New Guinea (PNG) is one of the highest priority countries in the Western Pacific for lymphatic filariasis and the site of extensive research on lymphatic filariasis and surveys of its prevalence. However, different diagnostic tests have been used and thresholds for each test are unclear.MethodsWe reviewed the prevalence of lymphatic filariasis reported in 295 surveys conducted in PNG between 1990 and 2014, of which 65 used more than one test. Results from different diagnostics were standardised using a set of criteria that included a model to predict antigen prevalence from microfilariae prevalence. We mapped the point location of each of these surveys and categorised their standardised prevalence estimates.ResultsSeveral predictive models were produced and investigated, including the effect of any mass drug administration and number of rounds prior to the surveys. One model was chosen based on goodness of fit parameters and used to predict antigen prevalence for surveys that tested only for microfilariae. Standardised prevalence values show that 72% of all surveys reported a prevalence above 0.05. High prevalence was situated on the coastal north, south and island regions, while the central highland area of Papua New Guinea shows low levels of prevalence.ConclusionsOur study is the first to provide an explicit predictive relationship between the prevalence values based on empirical results from antigen and microfilaria tests, taking into account the occurrence of mass drug administration. This is a crucial step to combine studies to develop risk maps of lymphatic filariasis for programme planning and evaluation, as shown in the case of Papua New Guinea.

A preliminary survey of filarial parasites in dogs and cats in Sri Lanka.

Human brugian filariasis has re-emerged in Sri Lanka after a quiescent period of four decades. This study investigated the prevalence of canine and feline filarial parasites in three localities with human sub-periodic brugian filariasis, in order to determine their potential reservoir status. All reachable dogs and cats, both stray and domestic, within a 350m radius of an index case of brugian filariasis in three locations (Madampe, Wattala and Weliweriya) were screened for microfilariae using Giemsa stained thick blood smears. A representative sample of canine and feline blood samples positive for Brugia spp. microfilariae by microscopy, from each of the three locations, were further analyzed by PCR with specific primers for internal transcribed spacer region 2 (ITS2) of the ribosomal DNA. A total of 250 dogs and 134 cats were screened. The overall microfilaraemia rates were high among both dogs (68.8%) and cats (47.8%). The prevalence of microfilaraemia was significantly higher among dogs than cats (p<0.05). Two filarial species were identified based on morphology of microfilariae: Dirofilaria (Nochtiella) repens (dogs, 54.4% and cats, 34.3%) and Brugia spp. (dogs, 51.6% and cats, 30.6%). PCR analysis of canine (n = 53) and feline (n = 24) samples elicited bands in the region of 615bp, which confirmed Brugia malayi infection. Co-infection with D.(N.) repens was detected by PCR with an additional band at 484bp, in 36 canine and 17 feline samples. Overall microfilaraemia rates of dogs (81.8%) and cats (75%) in Madampe (rural) were significantly higher than in urbanized Wattala (dogs, 62.4% and cats, 26.0%) (p<0.05). High rates of zoonotic filarial infections strongly implicate dogs and cats as potential reservoirs for human dirofilariasis and brugian filariasis in Sri Lanka.

Epizootiological observations on canine microfilaremia in Gujarat state, India.

Aim:The present investigation was conducted to study the prevalence of microfilaremia in dogs in Gujarat.Materials and Methods:A total of 418 adult dogs aged between 2 and 14 years with signs of weakness and non-specified complaints, presented at TVCC, Deesa (North Gujarat), Nandini Veterinary Hospital, Surat (South Gujarat), and Private Clinics, Ahmedabad (Central Gujarat), were included in the present investigation for studying the prevalence of microfilaremia from July 2016 to May 2017.Results:A total of 418 dogs were screened, of which 33 were found positive for circulating microfilariae with the prevalence rate of 7.89% in the population. Among microfilaremic dogs, the finding of microfilariae of Dipetalonema (Acanthocheilonema) reconditum was more common (23 cases; 69.69%) than Dirofilaria immitis (10 cases; 30.30%) making their prevalence in the population of 418 dogs as 5.50% and 2.39%, respectively. Breed-wise distribution of microfilaremic dogs revealed that 12 (36.36%), 8 (24.24%), 5 (15.15%), 4 (12.12%), 2 (6.06%), 1 (3.03%), and 1 (3.03%) cases were observed in Pomeranian, non-descript, German Shepherd, Labrador, Great Dane, Lhasa Apso, and Pug dogs, respectively. Of 10 cases of D. immitis, 5, 2, 2, and 1 were observed in Pomeranian, Labrador, non-descript, and Great Dane dogs, respectively. Cases of Dipetalonema reconditum were highest in Pomeranian (7), followed by non-descript (6), German Shepherd (5), Labrador (2), Great Dane (1), Lhasa Apso (1), and Pug (1). Age-wise distribution recorded significantly (p≤0.01) higher number of cases in adult dogs (4-14 years) for D. immitis (30.30%) and D. reconditum (39.39%). Sex-wise distribution of microfilaremic dogs showed that male (22/33, 66.66%) was more predisposed to microfilaremia rather than females (11/33, 33.34%). It is apparent from the study that the number of dogs with microfilaremia due to D. reconditum was significantly (p≤0.01) higher than that of D. immitis.Conclusion:The present study revealed that microfilaremia due to D. immitis and D. reconditum is prevalent in the state of Gujarat. The infection with D. immitis was associated with severe lung and cardiac pathological manifestations.

Prevalence of canine heartworm infection in Mississippi animal shelters

Understanding diagnosis of heartworm disease in the context of animal shelters’ needs and expectations is crucial for developing guidelines that specifically address the unique shelter population. Accurate and economical heartworm testing strategies are essential. However, current comprehensive guidelines for the management of heartworm disease in dogs are directed toward client-owned animals and do not address needs of animal shelters and other resource-scarce facilities. Additionally, testing recommendations do not take into account regional and local differences in heartworm prevalence across the United States that occur due to abiotic and biotic factors. The objective of this study was to determine the apparent prevalence of Dirofilaria immitis microfilaremia and antigenemia in dogs from Mississippi animal shelters. Further, we compare agreement between microfilaria and antigen testing in this population. We performed a cross-sectional study using canine serum and blood bank samples representative of the Mississippi shelter population. Microfilaria testing of whole blood included a blood smear and modified Knott test. Antigen testing of serum was performed using the DiroCHEK® antigen ELISA test. Analyses included descriptive and analytic statistics as well as Cohen’s kappa for test agreement. A total of 283 whole blood samples and 363 serum samples, representing 363 dogs from 18 shelters in 17 Mississippi counties, were utilized in this study. Sixty-four (22.6%) whole blood samples demonstrated D. immitis microfilariae on the modified Knott test and 125 (34.4%) serum samples had detectable D. immitis antigen. Increasing age and low body condition were associated with antigen-positive test results. Only age was associated with microfilaria-positive test results. There was moderate agreement between the antigen ELISA test and the modified Knott microfilaria test and poor agreement between the antigen ELISA and the blood smear. This study provides the first known report of the prevalence of D. immitis microfilaremia and antigenemia in Mississippi shelter dogs. We observed that prevalence of both microfilaremia and antigenemia was significantly higher in these sampled dogs compared to previous reports for the owned canine population in Mississippi. Heartworm infection presents unique management challenges for animal shelters. Knowledge of the expected prevalence in the area can be utilized for management decisions related to prevention, testing, and treatment of dogs in shelter populations.

Progress on elimination of lymphatic filariasis in Sierra Leone

BackgroundA baseline survey in 2007–2008 found lymphatic filariasis (LF) to be endemic in Sierra Leone in all 14 districts and co-endemic with onchocerciasis in 12 districts. Mass drug administration (MDA) with ivermectin started in 2006 for onchocerciasis and was modified to add albendazole in 2008 to include LF treatment. In 2011, after three effective MDAs, a significant reduction in microfilaraemia (mf) prevalence and density was reported at the midterm assessment. After five MDAs, in 2013, mf prevalence and density were again measured as part of a pre-transmission assessment survey (pre-TAS) conducted per WHO guidelines.MethodsFor the pre-TAS survey, districts were paired to represent populations of one million for impact assessment. One sentinel site selected from baseline and one spot check site purposefully selected based upon local knowledge of patients with LF were surveyed per pair (two districts). At each site, 300 people over five years of age provided mid-night blood samples and mf prevalence and density were determined using thick blood film microscopy. Results are compared with baseline and midterm data.ResultsAt pre-TAS the overall mf prevalence was 0.54% (95% CI: 0.36–0.81%), compared to 0.30% (95% CI: 0.19–0.47) at midterm and 2.6% (95% CI: 2.3–3.0%) at baseline. There was a higher, but non-significant, mf prevalence among males vs females. Eight districts (four pairs) had a prevalence of mf < 1% at all sites. Two pairs (four districts) had a prevalence of mf > 1% at one of the two sites: Koinadugu 0.98% (95% CI: 0.34–2.85%) and Bombali 2.67% (95% CI: 1.41–5.00%), and Kailahun 1.56% (95% CI: 0.72–3.36%) and Kenema 0% (95% CI: 0.00–1.21%).ConclusionsCompared to baseline, there was a significant reduction of LF mf prevalence and density in the 12 districts co-endemic for LF and onchocerciasis after five annual LF MDAs. No statistically significant difference was seen in either measure compared to midterm. Eight of the 12 districts qualified for TAS. The other four districts that failed to qualify for TAS had historically high LF baseline prevalence and density and had regular cross-border movement of populations. These four districts needed to conduct two additional rounds of LF MDA before repeating the pre-TAS. The results showed that Sierra Leone continued to make progress towards the elimination of LF as a public health problem.

Factors Associated with Wuchereria bancrofti Microfilaremia in an Endemic Area of Mali.

Although Wuchereria bancrofti (Wb), the causative agent of lymphatic filariasis, is endemic throughout Mali, the prevalence of Wb microfilaremia (Mf) can vary widely between villages despite similar prevalence of infection as assessed by circulating antigen. To examine this variation, cross-sectional data obtained during screening prior to an interventional study in two neighboring villages in Mali were analyzed. The overall prevalence of Wb, as assessed by Wb CAg (circulating antigen), was 50.3% among 373 participants, aged 14-65. Wuchereria bancrofti Mf-positive and negative individuals appeared randomly distributed across the two villages (Moran's I spatial statistic = -0.01, Z score =0.1, P>0.05). Among the 187 subjects positive for Wb CAg, 117 (62.5%) had detectable Mansonella perstans microfilaremia (Mp Mf) and 64 (34.2%) had detectable Wb microfilaremia. The prevalence of Mp microfilaremia was 73.4% in the Wb Mf-positive group (as compared to 56.9% in the Wb Mf-negative group; p=0.01), and median Wb Mf load was increased in co-infected subjects (267Mf/ml vs 100 Mf/ml; p<0.001). In multivariate analysis, village of residence, Mp Mf positivity and gender were significantly associated with Wb Mf positivity. After controlling for age, gender, and village of residence, the odds of being Wb Mf positive was 2.67 times higher in Mp positive individuals (95% confidence interval [1.42-5.01]). Given the geographical overlap between Mp and Wb in Africa, a better understanding of the distribution and prevalence of Mp could assist national lymphatic filariasis control programs in predicting areas of high Wb Mf prevalence that may require closer surveillance.

Continental-Scale, Data-Driven Predictive Assessment of Eliminating the Vector-Borne Disease, Lymphatic Filariasis, in Sub-Saharan Africa by 2020

There are growing demands for predicting the prospects of achieving the global elimination of neglected tropical diseases as a result of the institution of large-scale nation-wide intervention programs by the WHO-set target year of 2020. Such predictions will be uncertain due to the impacts that spatial heterogeneity and scaling effects will have on parasite transmission processes, which will introduce significant aggregation errors into any attempt aiming to predict the outcomes of interventions at the broader spatial levels relevant to policy making. We describe a modeling platform that addresses this problem of upscaling from local settings to facilitate predictions at regional levels by the discovery and use of locality-specific transmission models, and we illustrate the utility of using this approach to evaluate the prospects for eliminating the vector-borne disease, lymphatic filariasis (LF), in sub-Saharan Africa by the WHO target year of 2020 using currently applied or newly proposed intervention strategies. We show how a computational platform that couples site-specific data discovery with model fitting and calibration can allow both learning of local LF transmission models and simulations of the impact of interventions that take a fuller account of the fine-scale heterogeneous transmission of this parasitic disease within endemic countries. We highlight how such a spatially hierarchical modeling tool that incorporates actual data regarding the roll-out of national drug treatment programs and spatial variability in infection patterns into the modeling process can produce more realistic predictions of timelines to LF elimination at coarse spatial scales, ranging from district to country to continental levels. Our results show that when locally applicable extinction thresholds are used, only three countries are likely to meet the goal of LF elimination by 2020 using currently applied mass drug treatments, and that switching to more intensive drug regimens, increasing the frequency of treatments, or switching to new triple drug regimens will be required if LF elimination is to be accelerated in Africa. The proportion of countries that would meet the goal of eliminating LF by 2020 may, however, reach up to 24/36 if the WHO 1% microfilaremia prevalence threshold is used and sequential mass drug deliveries are applied in countries. We have developed and applied a data-driven spatially hierarchical computational platform that uses the discovery of locally applicable transmission models in order to predict the prospects for eliminating the macroparasitic disease, LF, at the coarser country level in sub-Saharan Africa. We show that fine-scale spatial heterogeneity in local parasite transmission and extinction dynamics, as well as the exact nature of intervention roll-outs in countries, will impact the timelines to achieving national LF elimination on this continent.