Eliminating Lymphatic Filariasis in the Americas

A Winnable Battle

Center for Global HealthDivision 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

CoverageImpact 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

Num

ber

of p

eopl

e

Num

ber

of c

ount

ries

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: cdcinfo@cdc.gov Web: www.cdc.govThe 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