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PubMed1977

Sensitivity and specificity of skin reactivity to Brugia malayi and Dirofilaria immitis antigens in Bancroftian and Malayan filariasis in the Philippines.

Saline antigen extracts of microfilariae, adult worms and third-stage larvae of subperiodic Brugia malayi maintained in gerbils were prepared for use as skin test reagents. Patients were studied on three different islands in the Philippines, one endemic for Bancroftian filariasis (Sorsogon, Luzon), another endemic for Malayan filariasis (Palawan) and the third without endemic filariasis (Cebu). A dose-response curve was established initially in patients with Bancroftian filariasis: thereafter 1.0 microng of the B. malayi antigens and 0.05 microng of Dirofilaria immitis FST antigen (obtained from Dr. T. Sawada) were used. Sizes of reactions were measured by recording the diameters of wheals at 20 minutes, 24 and 48 hours. There was a very high correlation in immediate hypersensitivity reactions among the three B. malayi antigens. Reaction sizes followed a normal distribution. When an area of an antigen-induced wheal 3 X that of the saline control was considered a positive reaction, 99% of 150 patients with Bancroftian filariasis and 96% of 45 subjects with Malayan filariasis reacted to B. malayi larval antigen. Only 68% of patients with Bancroftian filariasis but 90% of those with Malayan filariasis reacted to D. immitis FST antigen. There was no relationship between skin reactivity and age, sex, microfilaremia or severity of clinical disease. Approximately half of 50 patients who lived in an endemic area for W. bancrofti but had neither patent infection nor clinical disease reacted to B. malayi antigens. A maximum of 7% of 120 age- and sex-matched controls from Cebu gave false positive reactions with any of the antigens. Only a small proportion of patients gave 24- and 48-hour reactions. It is concluded that the use of antigens prepared from a human parasite, subperiodic B. malayi, which is easily maintained in a laboratory animal host, improves the ability to diagnose filarial infections by immunological means.

Adult↗
PubMed1993

Current status of filariasis in Malaysia.

The Filariasis Control Program was established more than 30 years ago in the country and the disease is still a public health problem in some states. Since 1983, a total of 17 filariasis control teams were formed throughout the country to carry out filariasis control work. The teams conduct house and population censuses, nocturnal mass blood surveys and treatment of microscopically confirmed cases. Individual case follow-up is being carried out after 3-5 months while the locality is resurveyed after about 2-3 years. During the years 1988 to 1990, there appeared to be a decreasing trend in the number of filariasis cases detected countrywide. In 1991, brugian filariasis accounted for 92% of the cases detected. The microfilaria rate (MFR) also showed a decreasing trend countrywide for the years 1988 (0.57%) to 1990 (0.35%) but there was an increase in 1991 although it remained well below the 5% MFR targeted in the program objective, In 1991, the filariasis control teams and the district multi-purpose teams collected a total of 167, 151 blood slides out of which 871 were found to be positive for microfilaria. To determine the true endemicity of filariasis in the country, the malaria district multi-purpose teams are also utilized to assist in probe surveys in new areas of the district. Two species of filarial worms, namely Brugia malayi and Wuchereria bancrofti, and the mosquito vectors belonging to the Anopheles and Mansonia genera are involved in the transmission of filariasis in Malaysia. Monkeys and domestic cats are the reservoir hosts for the subperiodic strain of B. malayi.

Animals↗
PubMed1996

Lymphatic filariasis and the women of India.

Lymphatic filariasis is a disease of the poor and underprivileged and has received little attention in the past. In particular, there has been a lack of gender sensitive research on women and lymphatic filariasis. Women suffer from lymphatic filariasis to a great extent but embarrassment, shame, cultural constraints and social taboos are some of the reasons that refrain them from reporting problems and seeking help. Women are thus silently bearing the brunt of this disease. This study has tried to obtain basic information on women and lymphatic filariasis with a gender approach. To understand the consequence of lymphatic filariasis on women in India, a holistic framework was used for this study, which encompasses all issues in women's lives such as their perspective on the disease, their role as social and economic entities and their relationships with others; in addition to their reproductive role. A qualitative approach using the technique of informal interview was used for this research. Eighty-eight women and 39 children were interviewed, during home visits and at clinics, primary health care centers and schools in both urban and rural areas in India. The study has obtained the much needed information on the knowledge of lymphatic filariasis among women in India, the impact of the disease on the women which include the social and economic aspects, clinic attendance and the barriers to health care for women with the disease, and women's awareness regarding control programs for lymphatic filariasis. The study also found how women cope with the disabilities or other manifestations of the disease. This paper discusses lymphatic filariasis using a gender sensitive approach. It reviews the literature, describes the study, analyzes the results and suggests feasible disease control programs for women with a multisectoral approach.

Adolescent↗
PubMed2004

Assessment of disease and infection of lymphatic filariasis in Northeastern Cambodia.

We assessed the filariasis disease burden in four northeastern provinces of Cambodia by using and validating a key-informant questionnaire, consisting of four questions, with pictures of patients with leg elephantiasis and hydrocoele. The questionnaire was distributed and collected through the school, health and administrative systems. Validation surveys included clinical examination, a card test for W. bancrofti (ICT Filariasis card test, AMRAD) and night blood finger prick examination of patients reported with clinical elephantiasis. Only 48.0% of questionnaires were returned. A total of 220 patients were reported, mostly from Stung Treng (36.8%) and Rattanakiri provinces (35.0%). Key-informants reported patients with lymphatic filariasis with a sensitivity of 85.7% for leg and 97.0% for scrotum morbidity, and with a specificity of 95.6%. However, substantial over-reporting resulted in very low positive predictive values for elephantiasis of 19.4% for legs and of 23.7% for the scrotum. As 97.4% of patients with clinical lymphatic filariasis were older than 40 years, the diagnostic performance of the questionnaire would be improved by restricting its use to that age group. About 0.7% of 3490 W. bancrofti card tests were positive; the prevalence was 1.94% (12/618) in Rattanakiri, 0.38% (4/1055) in Stung Treng and 0.22% (2/919) in Preah Vihear. W. bancrofti microfilaria were identified in blood from two patients in Rattanakiri (0.32%) and from one patient in Stung Treng (0.09%). Brugia malayi microfilaria were identified in blood from five patients in Rattanakiri (0.81%) only. No patients with microfilariaemia were identified in Preah Vehear. In Mondulkiri province all investigations (card test, night blood examination, clinical examination) for lymphatic filariasis were negative. Our findings confirm the usefulness of key-informant questionnaire for the identification of filariasis patients provided that high adherence can be achieved. Lymphatic filariasis infection and disease is present in northern Cambodian provinces but the burdens of disease and infection are relatively low. These results are being used in the implementation of the national control programme for lymphatic filariasis.

Adolescent↗
PubMed1991

Filariasis and its control in Fujian, China.

Epidemiological survey of filariasis in Fujian Province, China showed that malayan filariasis, transmitted by Anopheles lesteri anthropophagus was mainly distributed in the northwest part and bancroftian filariasis with Culex quinquefasciatus as vector, in middle and south coastal regions. Both species of filariae showed typical nocturnal periodicity. Involvement of the extremities was not uncommon in malayan filariasis. In contrast, hydrocele was often present in bancroftian filariasis, in which limb impairment did not appear so frequently as in the former. Hetrazan treatment was administered to the microfilaremia cases identified during blood examination surveys, which were integrated with indoor residual spraying of insecticides in endemic areas of malayan filariasis when the vector mosquito was discovered and with mass treatment with hetrazan medicated salt in endemic areas of bancroftian filariasis. At the same time the habitation condition was improved. These factors facilitated the decrease in incidence. As a result malayan and bancroftian filariasis were proclaimed to have reached the criterion of basic elimination in 1985 and 1987 respectively. Surveillance was pursued thereafter and no signs of resurgence appeared.

Animals↗
PubMed1995

Filarial antibody detection in suspected occult filariasis in children in an endemic area.

A study was conducted in filarial endemic area for diagnosis of occult filariasis in various clinical conditions in children. Thirty-five age- and sex-matched controls (endemic-15, non-endemic-10, disease control-10), 16 classical lymphatic filariasis, and 92 occult filariasis (clinical conditions which fall in the spectrum of occult filariasis and suspected to be filarial), were subjected to peripheral night blood smear examination for microfilaria (mf) and stick ELISA test using mf ES antigen for filarial antibodies. In the control group none showed mf and only 3 per cent (1/35) among endemic control were positive for filarial antibodies. In classical filariasis 1 per cent (2/16) showed mf and 94 per cent (15/16) had filarial antibodies. In suspected occult filariasis 1 per cent (one case of arthritis) showed mf and 62 per cent (57/92) showed filarial antibodies. These consisted of tropical pulmonary eosinophilia 63 per cent (15/24), arthritis where no cause could be ascertained on investigation 64 per cent (27/42), nephrotic syndrome 69 per cent (11/16), acute glomerulonephritis with ASO < 200 units 38 per cent (3/8), and cardiomyopathy 50 per cent (1/2). Correlation with age showed that 80 per cent (4/5) of cases of arthritis seen in 0-4 years of age group and 82 per cent (11/9) of nephrotic syndrome in the 10-14 years of age group were positive for filarial antibody. Arthritis due to other causes and minimal change nephrotic syndrome are uncommon in these respective age groups. It is concluded that the role of filariasis in endemic areas in these disease states cannot be denied and needs to be studied further.

Adolescent↗
PubMed1998

[SurveilLance on filariasis after its basic elimination in Hunan Province].

AIM: To explore the fluctuation pattern of prevalence and to detect the residual infection in Hunan Province where filariasis had been basically eliminated since 1986. METHODS: Longitudinal surveillance and cross-sectional surveillance were extensively carried out by using parasitological, entomological and serological methods in areas previously endemic for filariasis. RESULTS: In 55 counties, cross-sectional surveillance on filariasis had been executed for 11-19 years. The results showed that microfilaria cases had not been found for 4 years, and filaria larvae had failed to be detected from mosquito vectors for 12 years. Serological surveillance in the population revealed that the mean positive rate of IFAT had dropped from 13.15% in 1987 to 1.06% in 1996, the latter rate being similar to that of the nonendemic area. 6 longitudinal surveillance spots in 5 counties (cities) had been observed for 10-17 years. Annual quantitative blood examination of 11 microfilariemia cases showed that 10 cases became negative in 1-10 years, and the remaining 1 case remained positive at the 14th year. A. sinensis were dissected with no filaria larvae found in 2 surveillance spots of malayan filariasis. Culex quinquefasciatus were dissected with filaria larvae found only in the first to third year, the natural infection rates were 0.38%-1.98% in 4 surveillance spots of bancroftian filariasis. CONCLUSION: Since the basic elimination of filariasis in Hunan Province in 1986, the number of residual microfilariemia cases decreased year after year, suggesting that the transmission of filariasis has been interrupted.

Animals↗
PubMed2002

Lymphatic filariasis in Papua New Guinea: prospects for elimination.

Lymphatic filariasis is a significant public health problem in several Pacific island countries. Papua New Guinea is one of the most populous countries in this region, and 39% of its residents are estimated to be infected with Wuchereria bancrofti. The Ministries of Health of the 22 islands and territories in the Pacific region are committed to taking action against lymphatic filariasis. Accordingly, a regional collaborative effort aimed at the control of filariasis has been organized under the auspices of a program referred to as PacELF. The main objective of PacELF is to eliminate filariasis as public health problem in the Pacific region by the year 2010, 10 years before global elimination of this infectious disease has been targeted. This contribution describes the epidemiology and ecological features of filariasis and prospects for its elimination in Papua New Guinea. The frequencies of microfilaremia, chronic lymphatic disease, and acute filarial morbidity in Papua New Guinea are higher than in many other endemic countries of the Pacific, Africa, and South America. All possible combinations of these three manifestations of filariasis exist. They occur independently of each other, and there is no association between chronic lymphatic disease and microfilarial status. Anopheles punctulatus mosquitoes are the main vectors throughout the country. Transmission intensity is heterogeneous and a major determinant of local patent infection and morbidity rates. Annual transmission potential and annual infective biting rates are positively associated with the village-specific microfilarial rate, mean intensity of microfilaremia, and prevalence of leg edema. Children and adults have similar worm burdens, assessed by circulating filarial antigen levels, in areas of high transmission, whereas worm burdens increase with age in areas of lower transmission. Intensity of exposure to infective third-stage larvae (L3) is significantly correlated with filarial antigen-specific lymphocyte proliferation and cytokine production, possibly by a mechanism that alters APC function. Historical evidence suggests that residual insecticide spraying conducted for malaria control in some parts of the country interrupted transmission of W. bancrofti as it did in the Solomon Islands. Prospects for eliminating lymphatic filariasis in Papua New Guinea are good and may be achieved by the end of the second decade of the twenty-first century if an integrated control approach using mass drug administration with vector control is adopted.

Animals↗
PubMed2006

Lymphatic filariasis: possible pathophysiological nexus with oxidative stress.

Wuchereria bancrofti-mediated lymphatic filariasis is widely prevalent. Diversity in immune response presumably may lead to myriad clinical presentations, such as overt chronic filariasis, occult filariasis with atypical systemic manifestation and asymptomatic microfilariae carrier state. Anticipated oxidative stress during inflammatory response to infective conditions might complicate the immune response and thus might alter the disease outcome. The present study was carried out to assess the status of oxidative stress in different clinical presentations of bancroftian filariasis. Twenty-five microfilariae carriers and 30 cases each of chronic filariasis and occult filariasis were compared to 30 endemic normal individuals. Serum malondialdehyde level and superoxide dismutase enzyme activity were measured by spectrophotometric methods and levels of filarial antigen were measured by ELISA. In the filarial cases, the levels of these parameters were assayed again after treatment with diethylcarbamazine citrate (DEC). Results showed significant (P<0.05) association of oxidative stress with chronic and occult filariasis but not with microfilarial carriers. DEC therapy in both clinical cases and carriers resulted in a significant reduction of oxidative stress associated with decreased antigen level (P<0.01). These findings suggest the possible involvement of oxidative stress in filarial disease pathology.

Adult↗
PubMed2003

Mapping of lymphatic filariasis in Nepal.

BACKGROUND: Human infection with Wuchereria bancrofti causes a disabling parasitic disease known as lymphatic filariasis, which is a major public health and socio-economic problem in many parts of the world. At the onset of the study, little was known of the distribution of filariasis and its current importance as a public health problem in Nepal. METHODS: Epidemiological mapping was undertaken to determine the prevalence of infection by Wuchereria bancrofti in 37 districts of Nepal between July to December 2001. The study population above 15 years of age was selected, and the immunochromatographic test (ICT Filariasis) was used to screen for circulating filarial antigen (CFA). RESULTS: The overall prevalence of lymphatic filariasis from a 4,488-sample population was 13% and 33/37 districts were found to be endemic. On the basis of geographical data, the highest number of cases was found at altitudes between 500-700 m; however, a substantial number of infected individuals were found in the highly populated Kathmandu valley, at altitudes between 900-1,500 metres where transmission appears to take place. Prevalence rates above 20% were found in 11 districts (with the highest rate of 40%), 6-19% were found in 15 districts, and 0.1-5% were in 7 districts.Information on people's knowledge, attitudes and behaviour towards filariasis was also collected by means of a structured questionnaire, which is presented and discussed in the study. CONCLUSIONS: This is the most extensive study of lymphatic filariasis undertaken to date in Nepal. The study indicates that the prevalence of infection is far greater that was previously reported and that lymphatic filariasis should be a much higher health priority than currently given.

Journal Article↗
PubMed2002

[Technical measures of filariasis elimination in Tengzhou City].

OBJECTIVE: To summarize the technical measures in achieving the elimination of lymphatic filariasis in Tengzhou city. METHODS: To collect and analyze the materials on research and control of lymphatic filariasis in Tengzhou city during the disease elimination program over the 40 years. RESULTS: Following to the national criteria for the control and elimination of filariasis, efforts were made for epidemiological investigation, mass blood examination, and mass drug administration by taking diethylcarbamazine (DEC) medicated salt for the whole population. After the criteria of transmission interruption (basic elimination) of filariasis were met in 1974, re-examination and treatment for the cases with microfilaremia, and parasitological and entomological surveillance were conducted. In 1995, filariasis elimination in the whole city was declared. CONCLUSION: Comprehensive measures focusing on the elimination of source of infection were proved effective for interrupting the transmission of filariasis. Unremitting surveillance was necessary for achieving the goal of elimination of filariasis.

Animals↗
PubMed1978

Serological diagnosis of bancroftian and malayan filariasis.

A study was undertaken to define the sensitivity and specificity of serological tests in bancroftian and malayan filariasis and correlate the findings with clinical disease. Sera were collected from subjects on three different islands in the Philippines: one endemic for bancroftian filariasis, another endemic for malayan filariasis and the third without endemic filariasis. Antibodies were measured, using rugia malayi as the source of antigen. Antibodies against adult worms measured by indirect immunofluorescence were found at a titer of 1:8 or greater in all patients with bancroftian or malayan filariasis but not in the control subjects. There was no relationship of antibody titer to clinical status. Antibodies against microfilariae were measured by indirect immunofluorescence and microfilarial agglutination. A high correlation was observed between the two methods. These antibodies were found in only one quarter, approximately, of patients with filariasis. Microfilarial antibodies were found more commonly in those patients with chronic lymphatic obstruction. It is concluded that measurement of antibodies to adult worms is a useful indicator of infection while microfilarial antibodies are correlated with disease.

Agglutination Tests↗
PubMed1977

Observation on the reduction of the prevalence of malayan filariasis in Chumphon Province of South Thailand.

Further studies on malayan filariasis were made at Bangluke canton of Chumphon province of South Thailand, where mass drug treatment was not applied. It was found after 9 years that there was a marked reduction in filariasis in the area. The filariasis infection rate being decreased from 14.1 to 1.9 per cent, the microfilarial rate from 10.8 to 0.9 per cent, and the elephantiasis rate from 3.3 to 1.0 per cent, and the mean microfilarial density among positive cases being decreased from 27.6 to 6.6 per 20 c.mm blood. Dissection of 1,893 Mansonia mosquitoes revealed the finding of only stage I and stage II larvae of B. malayi in seven M. annulifera and M. indiana. The reduction in the filariasis infection was assumed to be due to the interruption of transmission of filariasis cycle in the mosquitoes resulting from DDT spraying operation of the Malaria Eradication Programme of the Thai Government. There were also some positive cases moving out of the area. The rural development programme of the Thai Government also played another important role in the reduction in the prevalence of malayan filariasis in this area.

Blood↗
PubMed1986

Comparison of knowledge on filariasis and epidemiologic factors between infected and uninfected respondents in a Malay community.

A study to identify the knowledge of infected and uninfected respondents on filariasis and epidemiologic factors in one endemic community in Malaysia to determine their role in the transmission and control of filariasis was carried out. The data were collected by non-participant observations and interviews using semi-structured schedules. The majority of respondents in both groups had knowledge of filariasis. There was no marked difference between male and female respondents, and similarly, there was fair distributions of knowledgeable respondents with and without some years of schooling. On filarial transmission, 9.2% of the infected said that filariasis was contacted through mosquito bites, while among the uninfected it was 7.4%. Within the infected, 14.8% thought that filarial worms entered the human body through the consumption of unhygenically prepared foods and drinks while, among the uninfected it was 20.4%. Both groups were aware of the presence of mosquitoes in their village. However, the majority did not associate this factor with host's susceptibility to filarial infections. Rather, they were of the opinion that personal hygiene and proper meals had something to do with filariasis. The findings showed there was general awareness of filariasis in the community which might indicate that the health campaigns had reached various levels of the population. Yet, they still lacked knowledge on disease transmission. Also, they did not make direct association between environment and exposure to mosquitoes bites though they were aware of their presence but which they regarded as not directly harmful to their health.

Adult↗
PubMed1993

Recent advances in epidemiological field techniques in filariasis.

There have been very few advances in epidemiological field techniques for filariasis in recent years. Advances in other areas of study of filariasis have been published and a summary of some of those which have some application to field technology will be given. Studies on vectors involving host influences on the development of filariae and the use of DNA probes for vector speciation were reported as well as the development of techniques that yielded species-specific identification of larvae in mosquito vectors. Experiments on animal transmission potentials also have been described. Mathematical models are becoming popular for various biological systems. It is postulated that models will enable workers to make predictions on prevalence of diseases and effect of control measures. A model has been proposed for bancroftian filariasis transmission dynamics and frequency distribution of microfilariae in blood samples. Other statistical methodologies have been published relating to age and sex distribution and frequency distribution and one suggested that females have increased resistance to filariasis, especially in the reproductive years. Advances in diagnostic technologies are highly relevant to the epidemiology of filariasis. The development of antibody and especially antigen detection systems using monoclonal antibodies, DNA probes, and polymerase chain reactions, etc, will make a significant impact on the identification of infected persons. Findings along other lines may also have application to field epidemiology. The quantitative blood count (QBC) acridine orange hematocrit tube has also been found to be of value in diagnosis. Elevated levels of ecdysteroids found in other filarial infections should be tested in cases of lymphatic filariasis.

Animals↗
PubMed1993

[Comparison of the transmission dynamics and the control effects between malaria and filariasis by using mathematical model].

By dynamic modeling based on Ross & MacDonald's mathematical model, the characteristics of rapid transmission of malaria and slow transmission of filariasis was compared. The dynamic mechanism showed that the infection efficiency in filariasis, namely, the probability of becoming infected in man by one infective bite of mosquito, was much lower than that in malaria; hence the vectorial capacity or transmission velocity in filariasis was also markedly lower than that in malaria. Since the intensity of infection i.e. the microfilaria density can largely affect the infection efficiency in filariasis, drug treatment, especially using DEC-medicated salt can reduce the intensity of infection and the infection efficiency, thus interrupting transmission finally. However, for malaria, only when the measures for mosquito vector control (including mosquito proofing) are taken as a priority to reduce the vectorial capacity or transmission velocity, malaria can then be controlled subsequently. These theoretical analyses are being demonstrated by the practice for malaria and filariasis control in our country, which could also be used as a theoretical base for enlightening the successful filariasis control strategies in our country.

Animals↗
PubMed2000

Salt fortified with diethylcarbamazine (DEC) as an effective intervention for lymphatic filariasis, with lessons learned from salt iodization programmes.

DEC-fortified salt has been used successfully as a principal public health tool to eliminate lymphatic filariasis (LF) in China and, less extensively, in several other countries. Studies from 1967 to the present conducted in Brazil, Japan, Tanzania, India, China, and Taiwan involving administration of DEC salt for 18 days to 1 year, have shown this intervention to be effective for both bancroftian and brugian filariasis, as measured by reductions in both microfilarial density and positivity, and in some studies through reduction in mosquito positivity rates as well. Furthermore, studies suggest specific advantages from using DEC salt, including lack of side effects, particularly for bancroftian filariasis, and ability to reduce prevalence below 1% when used in conjunction with standard regimens of DEC tablets. However, use of DEC salt as a control tool suffers from a concern that health authorities might find it difficult to manage a programme involving a commodity such as salt. In the past decade, the very successful global efforts to eliminate iodine deficiency through universal salt iodization have demonstrated that partnership with the salt industry can be both successful and effective as a public health tool. Use of DEC salt can be most successfully implemented in areas in which (a) there is adequate governmental support for its use and for elimination of filariasis, (b) filariasis-endemic areas are clearly defined, (c) political leaders, health officials and the salt industry agree that DEC salt is an appropriate intervention, (d) the salt industry is well-organized and has known distribution patterns, (e) a successful national salt iodization effort exists, (f) a monitoring system exists that ensures adequacy of salt iodine content during production and that can also measure household coverage, and (g) measurement of impact on transmission of LF with the new antigen or filarial DNA detection methods can be established. There are advantages and disadvantages of using DEC-fortified salt compared with other interventions for LF elimination programmes, but rather than being considered as a 'competing' intervention, DEC salt should be seen as an additional option. Indeed, it is likely that many countries will derive maximal benefit from the synergistic effects of combining different intervention strategies in their national programmes to eliminate lymphatic filariasis.

Diethylcarbamazine↗
PubMed2003

Lymphatic Filariasis (Elephantiasis) Elimination: A public health success and development opportunity.

BACKGROUND: The Global Programme to Eliminate Lymphatic Filariasis, launched following World Health Assembly Resolution 50.29 (WHA 50.29), has been facilitated in its progress by new research findings, drug donations, the availability of diagnostic tools, disability management strategies to help those already suffering and the development of partnerships. The strategy recommended by the World Health Organization of annual treatment with a two-drug combination has proved safe. DISCUSSION: Using different approaches in several countries the elimination of lymphatic filariasis (LF) has been demonstrated to be feasible during earlier decades. These successes have been largely overlooked. However, the programme progress since 2000 has been remarkable - upscaling rapidly from 2 million treatments in 2000 to approximately 60 million in 2002. Around 34 countries had active programmes at the end of 2002. It is anticipated that there will be further expansion - but this will be dependent on additional resources becoming available. The programme also provides significant opportunities for other disease control programmes to deliver public health benefits on a large scale. Few public health programmes have upscaled so rapidly and so cost-effectively (<$0.03/treatment in some Asian settings) - one country treating 9-10 million people in a day (Sri Lanka). The LF programme is arguably the most effective pro-poor public health programme currently operating which is based on country commitment and partnerships supported by a global programme and alliance. Tables are provided to summarize programme characteristics, the benefits of LF elimination, opportunities for integration with other programmes and relevance to the Millennium Development Goals. SUMMARY: Lymphatic filariasis elimination is an "easy-to-do" inexpensive health intervention that provides considerable "beyond filariasis" benefits, exemplifies partnership and is easily evaluated. The success in global health action documented in this paper requires and deserves further support to bring to fruition elimination of lymphatic filariasis as a public health problem and health benefits to poor people. A future free of lymphatic filariasis will reduce poverty and bring better health to poor people, prevent disability, strengthen health systems and build partnerships.

Journal Article↗