Embed Size (px)
Citation preview
Eliminating Lymphatic Filariasis in the Americas
A Winnable Battle
Center for Global Health
Division of Parasitic Diseases and Malaria
Lymphatic Filariasis (LF)
Caused by worms spread from person-to-person by the bite of infected mosquitoes
The worms live in the human lymphatic system and can cause: Lymphedema (swelling) and elephantiasis in limbs and
breasts Hydrocele (severe fluid accumulation) affecting men’s
genitalia
Microfilaria of Wuchereria bancrofti (CDC photo, DPDx)
Microfilaria of Brugia malayi (CDC photo, DPDx)
Health and societal impacts of LF
CDC photos
Lymphedema
Elephantiasis
Usually develop years after initial infection Cause pain, severe and irreversible
disfigurement, loss of productivity, and social stigmatization
LF: A costly and disabling NTD
One of the most disabling and economically costly neglected tropical diseases (NTDs) NTDs are a group of poverty-associated parasitic and
bacterial infections affecting more than 1 billion persons NTDs are responsible for tremendous suffering and
economic loss More than 120 million persons are infected
with LF, a disease that can be eliminated
Photo courtesy Carter Center/Emily Staub
Worldwide distribution of LF
1.34 billion at risk in world
Global impact of LF
A leading cause of disability globally Present in 73 countries 44 million persons suffer from chronic
manifestations
Photos courtesy of CDC. Left: Dr. Susan Montgomery, Middle and Right: CDC PHIL
Global Programme to Eliminate LF (GPELF)
Target elimination date of 2020 Launched by World Health Organization
(WHO) in 2000 Two-pronged strategy to:
1. Interrupt the spread of infection 2. Reduce the suffering of persons already infected
To interrupt infection, medication is distributed to entire at-risk population through mass drug administration (MDA) At least 5 rounds on MDA are needed to interrupt
transmission Treatment kills worms circulating in the blood
GPELF: Progress and successes
53 countries have ongoing MDA campaigns 37 countries have administered 5 or more rounds of
MDA in many target areas 2.8 billion doses of medicine delivered in first 9 years
Treatment cost typically less than US $0.50 per person and often less than $0.10
Transmission interruption has protected 6.6 million newborns from becoming infected with the disease
Economic benefit of first 7 years of program estimated at $24 billion
Full economic benefit could exceed US $55 billion
The economic impact of GPELF, 2000-2007
Table courtesy of WHO GPELF
Passive Surveillance ( > 5 years)
“Mapping”TAS TAS TAS
n
Monitoring & Evaluation
1
Rounds annual mass drug administration (MDA)
2 3 4 5
Coverage
Impact Assessment
WHO Guidelines for LF Elimination Programs
Post-MDA Period
TAS = transmission assessment survey
LF elimination in the Americas
The Americas is the first region targeted for elimination of LF Improvements in standard of living have reduced
disease prevalence in continental Americas and Caribbean Islands
In areas where disease remained (Costa Rica, Suriname, and Trinidad and Tobago), transmission was interrupted through selective and community treatment
Transmission still occurs in Guyana, Haiti, and parts of Brazil and the Dominican Republic
Notable achievements in the Americas
Surveys carried out in the Dominican Republic suggest transmission interruption
MDA treatment scaling up in Haiti 3 rounds of MDA have been completed in Haiti, including
the urban capital of Port-au-Prince Many departments of Haiti are ready to begin
transmission assessment surveys (TAS) to determine if MDA can be stopped
Disease management programs operating in all four endemic countries
CDC photo
Notable achievements in the Americas
Although there is still active transmission in Guyana, Haiti, and parts of Brazil and the Dominican Republic, each country has achieved notable success in the fight against LF
As of late 2012, nearly 9 million persons living in Americas had received MDA
Elimination in the Americas is within reach
Graph courtesy of WHO GPELF
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20120
2,000,000
4,000,000
6,000,000
8,000,000
10,000,000
12,000,000
0
1
2
3
4
5
Progress in mass drug administration (MDA) for lymphatic filariasis,
WHO's Region of the Americas, by year, 2000-2012No. people targetedNo. people treatedNo. of countries delivering MDA
Year
Nu
mb
er
of
pe
op
le
Nu
mb
er
of
cou
ntr
ies
CDC and partner support
CDC and its partners: Work with each country’s ministry of health to
offer advice and expert consultation Develop monitoring and evaluation strategies Provide technical support Carry out operational research including
working to understand:• Adherence to medication• Optimal surveillance methods• Strategies to accelerate elimination
Winning the battle against LF:What more can be done to eliminate LF by
2020?
Continue and scale-up MDA programs to interrupt transmission
Use operational research to develop strategies to accelerate the elimination of LF
Increase each country’s efforts to provide appropriate care for persons with filarial disease
Expand the reach of LF programs to include service delivery for other NTDs and health priorities
CDC partners We would like to acknowledge and thank
our partners working to eliminate lymphatic filariasis: The Bill & Melinda Gates Foundation CBM International Eisai GlaxoSmithKline IMA World Health Inter-American Development Bank Merck Pan American Health Organization RTI International The Task Force for Global Health University of Notre Dame United States Agency for International Development (USAID)
For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: [email protected] Web: www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Thank you
www.cdc.gov/winnablebattles/lymphaticfilariasis
Center for Global HealthDivision of Parasitic Diseases and Malaria
