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Reassessment of areas with persistent Lymphatic Filariasis nine years after cessation of mass drug administration in Sri Lanka
PLOS Neglected Tropical Diseases ( IF 3.8 ) Pub Date : 2017-10-30 , DOI: 10.1371/journal.pntd.0006066
Ramakrishna U. Rao , Sandhya D. Samarasekera , Kumara C. Nagodavithana , Tharanga D. M. Dassanayaka , Manjula W. Punchihewa , Udaya S. B. Ranasinghe , Gary J. Weil

Background

Sri Lanka was one of the first countries to initiate a lymphatic filariasis (LF) elimination program based on WHO guidelines. The Anti-Filariasis Campaign provided 5 annual rounds of mass drug administration (MDA) with diethylcarbamazine plus albendazole in all 8 endemic districts from 2002–2006. Microfilaremia (Mf) prevalences have been consistently <1% in all sentinel and spot-check sites since 2006, and all evaluation units passed school-based transmission assessment surveys (TAS) in 2013. We previously reported results from comprehensive surveillance studies conducted in 2011–2013 that documented low-level persistence of Wuchereria bancrofti in 19 high risk areas in 8 endemic districts. We now present results from repeat surveys conducted 3 to 4 years later in 6 areas that had the strongest LF signals in the prior study.

Methodology and principal findings

The surveys assessed prevalence of filarial antigenemia (CFA) and Mf in communities, CFA and anti-filarial antibody in school children (ages 6–8), and filarial DNA in Culex mosquitoes (molecular xenomonitoring, MX). Three study areas had significantly improved infection parameters compared to the prior study, but three other areas had little change. MX was more sensitive for detecting W. bancrofti persistence, and it was a better predictor than other parameters. Adult males accounted for more than 80% of infections detected in the study.

Conclusions

These results suggest that W. bancrofti transmission was near the break point in some of the areas studied in 2011–13. LF is likely to decline to zero without further intervention in these areas, while other areas may require further intervention. Long term surveillance may be needed to verify W. bancrofti elimination in areas like Sri Lanka with efficient transmission by Culex. Test and treat or other programs targeting adult males plus bed net promotion may be more effective than MDA for clearing remaining hotspots of transmission in Sri Lanka.



中文翻译:

在斯里兰卡停止大规模药物管理后九年,对持续存在淋巴丝虫病的地区进行了重新评估

背景

斯里兰卡是根据世卫组织准则发起消除淋巴丝虫病(LF)计划的首批国家之一。从2002年至2006年,抗丝虫病运动在所有8个流行地区每年进行5轮大规模药物管理(MDA),包括二乙基卡巴嗪和阿苯达唑。自2006年以来,所有哨点和抽查地点的微丝虫病(Mf)患病率一直低于1%,并且所有评估单位均于2013年通过了基于学校的传播评估调查(TAS)。我们先前报告了2011年进行的全面监测研究的结果–2013年,该文件记录了班氏无节制的低水平持久性在8个流行地区的19个高风险地区中。现在,我们介​​绍3到4年后在先前研究中具有最强LF信号的6个区域进行的重复调查的结果。

方法和主要发现

调查评估了社区中丝虫抗原血症(CFA)和Mf的患病率,学龄儿童(6-8岁)中CFA和抗丝虫抗体的患病率以及蚊(Culex蚊子)中的丝虫DNA (分子异种监测,MX)的患病率。与先前的研究相比,三个研究区域的感染参数得到了显着改善,但其他三个区域的变化很小。MX对于检测W更为敏感。bancrofti持久性,它是比其他参数更好的预测指标。成年男性占研究中检测到的感染的80%以上。

结论

这些结果表明,w ^。在2011-13年研究的某些地区,班克罗夫蒂病毒传播已接近转折点。如果不对这些领域进行进一步干预,LF可能会降至零,而其他领域可能需要进一步干预。可能需要长期监测,以验证W¯¯库克斯Culex)有效地传播了斯里兰卡等地区的班克罗夫蒂消灭。针对斯里兰卡成年男性的测试和治疗或其他计划,加上蚊帐的推广,可能比MDA更有效,可以清除剩余的传播热点。

更新日期:2017-10-31
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