Elimination of lymphatic filariasis in Southeast Asia

Abstract

Approximately 15 million people with lymphatic filariasis (LF) live in Southeast Asia. Wuchereria bancrofti (transmitted by the Mansonia and Anopheles vectors), Brugia malayi and Brugia timori (both transmitted by Culex quinquefasciatus) are the filarial species in this region. The endemic countries are: Cambodia, Lao People's Democratic Republic, the Philippines, Indonesia, Thailand and Timor-Leste, which have all agreed to eliminate transmission of the disease by 2020. The public health interventions with respect to LF are based on the 1997 World Health Assembly resolution (WHA 50.29) which recommends elimination of the disease through mass drug administration (MDA) using diethylcarbamazine (DEC) and albendazole. The drugs are generally donated and as governments contribute 60-90% of the operational costs, MDA is deemed to be comparatively inexpensive for local administrations in relation to other public health programmes. So far, elimination has been accomplished only in the People's Republic of China (P.R. China) and this achievement is therefore described here in some detail. Resurgences have occurred but they have been successfully dealt with. Historically, the endemic areas in P.R. China covered 16,514 townships (or urban sub-districts), situated in 864 counties (or cities) in 14 provinces (or autonomous regions or municipalities). The total population at risk of infection in all endemic areas of P.R. China was originally 342 million.