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Lymphatic Filariasis Elimination Program - Articles By Carter Center Experts

June 2018
Building Trust through Lymphatic Filariasis Elimination: A Platform to Address Social Exclusion and Human Rights in the Dominican Republic
Published by Health and Human Rights Journal, Volume 20, Issue 1, June 2018.
Authors: Hunter Keys, Manuel Gonzales, Madsen Beau de Rochars, Stephen Blount, and Gregory S. Noland.
Hispaniola, the Caribbean island that includes the countries of Haiti and the Dominican Republic (DR), accounts for 90% of lymphatic filariasis (LF) in the Americas. Both countries have committed to LF elimination by 2020. In the DR, LF occurs mainly in bateyes, or company towns that historically hosted migrant laborers from Haiti. A legacy of anti-Haitian discrimination as well as the 2013 Sentencia, which stripped generations of Haitian-descended Dominicans of their citizenship, ensure that this population remains legally, economically, and socially marginalized. Despite this context, the country’s LF elimination program (PELF) has worked in bateyes to eliminate LF through health education and annual drug treatment to interrupt parasite transmission.

June 2018
Emotional Difficulties and Experiences of Stigma among Persons with Lymphatic Filariasis in Plateau State, Nigeria
Published by Health and Human Rights Journal, Volume 20, Issue 1, June 2018.
Authors: Jibril Abdulmalik, Emeka Nwefoh, James Obindo, Samuel Dakwak, Motunrayo Ayobola, John Umaru, Elisha Samuel, Christopher Ogoshi, and Julian Eaton.
Lymphatic filariasis (LF) is a chronic and often disfiguring condition that predominantly affects the rural poor and leads to social exclusion, stigma, and discrimination. Little is currently known about the emotional difficulties and stigma experiences among persons living with LF in Nigeria. Our study evaluated the emotional difficulties and stigma experienced by persons with LF in Plateau State, Nigeria. We utilized a combination of qualitative data instruments comprising focus group discussions, McGill’s Illness Narrative Interviews, and key informant interviews. We transcribed and analyzed the data using a combination of inductive and deductive coding approaches. Sixtynine respondents were interviewed: 37 females and 32 males. The prevalent community perception of LF was the belief that it was a spiritual problem.

Nov. 23, 2017
Mass Administration of Ivermectin in Areas Where Loa loa Is Endemic
Published by New England Journal of Medicine, 377:2088-2090.
Author: Frank O. Richards Jr.
An innovative cell-phone–based device (the LoaScope) was used to rapidly identify persons with very high L. loa microfilariae counts (>20,000 mf per milliliter) and exclude them from ivermectin treatment. In a district in Cameroon where L. loa infection is highly endemic, more than 16,000 participants were tested with the LoaScope; testing led to the identification of 340 persons at high risk for serious adverse events and their exclusion from ivermectin treatment. Proper use of the LoaScope cell-phone device can help avoid adverse reactions to ivermectin in areas where Loa loa infection is known to exist.

Sept. 1, 2017
Criteria to Stop Mass Drug Administration for Lymphatic Filariasis Have Been Achieved Throughout Plateau and Nasarawa States, Nigeria
Published by American Journal of Tropical Medicine & Hygiene, 97(3), 2017, pp. 677–680 doi:10.4269/ajtmh.16-0843.
Authors: Abel Eigege, Darin S. Evans, Gregory S. Noland, Emmanuel Davies, John Umaru, Solomon E. Adelamo, Bulus Mancha, Jonathan D. King, Emmanuel S. Miri, Bridget Okoeguale, Emily P. Griswold, and Frank O. Richards Jr.
Nigeria has the largest population at risk for lymphatic filariasis (LF) in Africa. This study used a transmission assessment survey (TAS) to determine whether mass drug administration (MDA) for LF could stop in 21 districts, divided into four evaluation units (EUs), of Plateau and Nasarawa States, Nigeria, after 8–12 years of annual albendazole–ivermectin treatment.

Nov. 28, 2016
We Must Finish Fight Against Diseases We've Overlooked for Too Long
Published by CNN
Authors: Mary Ann Peters and Sue Desmond-Hellmann 
The first thing you notice about Jude is his playful spirit and insatiable curiosity. An inquisitive and talented 13-year-old boy in Nigeria, Jude loves going to school, practicing drums and playing soccer with his friends. He dreams of growing up to serve his community and nation. Last week, Ambassador Peters was with Jude as he received a handful of small pills: the 500 millionth treatment the Carter Center has given across Africa and Latin America to stop diseases that blind, stunt development and rob people of nutrients. The story behind treatments to stop tropical diseases like these, and how they come to improve the lives of so many, is a remarkable public health success that few people know anything about.

May 30, 2015 
Onchocerciasis and Lymphatic Filariasis Elimination in Africa: It's About Time
Published by The Lancet.
Authors: Darin S. Evans, Thomas R. Unnasch, Frank O. Richards Jr.
About 164 million Africans are at risk of onchocerciasis, and for more than two decades, mass drug administration with ivermectin has been the primary drug to control it.1 In 2010, WHO and the World Bank African Programme for Onchocerciasis Control (APOC) announced a strategic transition from onchocerciasis morbidity control to Onchocerca volvulus transmission elimination and set an elimination goal of 2025 for most of Africa.

Sept. 18, 2014
Status of Onchocerciasis Transmission after More Than a Decade of Mass Drug Administration for Onchocerciasis and Lymphatic Filariasis Elimination in Central Nigeria: Challenges in Coordinating the Stop MDA Decision
Published on Sept. 18, 2014, in PLoS Neglected Tropical Diseases. PLoS Negl Trop Dis 8(9): e3113. doi:10.1371/journal.pntd.0003113
Authors: Darin S. Evans, Kal Alphonsus, Jon Umaru, Abel Eigege, Emmanuel Miri, Hayward Mafuyai, Carlos Gonzales-Peralta, William Adamani, Elias Pede, Christopher Umbugadu, Yisa Saka, Bridget Okoeguale, Frank O. Richards.
Both lymphatic filariasis and onchocerciasis are treated with ivermectin-based mass drug administration (MDA) regimens in Africa. Where the infections are co-endemic, ivermectin treatments cannot be stopped until both infection transmission cycles are broken. This report follows a previous determination that the LF transmission cycle had been interrupted in five districts (LGAs in Nigeria) but evidence was needed on the status of the onchocerciasis transmission cycle prior to halting MDA.

Oct. 31, 2013
Long-Lasting Insecticidal Nets Are Synergistic with Mass Drug Administration for Interruption of Lymphatic Filariasis Transmission in Nigeria (PDF)
Published by PLoS Journal of Neglected Tropical Diseases. 7(10): e2508. doi:10.1371/journal.pntd.0002508. Reprinted with permission.
Authors: Eigege A, Kal A, Miri E, Sallau A, Umaru J, et al.
In Plateau and Nasarawa states in central Nigeria, 4 million persons are threatened by a mosquito-transmitted parasitic disease called lymphatic filariasis (LF). LF can lead to elephantiasis, a crippling condition in which the limbs and genitals often are grotesquely swollen or enlarged. Through health education and community-delivered mass drug administration (MDA) with donated medicines, the Nigerian Ministry of Health and its Carter Center partners have been trying to stop mosquitoes from transmitting LF.

Aug. 12, 2013
Community-Wide Distribution of Long-Lasting Insecticidal Nets Can Halt Transmission of Lymphatic Filariasis in Southeastern Nigeria (PDF)
Published by The American Journal of Tropical Medicine and Hygiene, 2013, 89(3): 578–587, doi: 10.4269/ajtmh.13-0775.
Authors: Frank O. Richards,* Emmanuel Emukah, Patricia M. Graves, Omeni Nkwocha, Lawrence Nwankwo, Lindsay Rakers, Aryc Mosher, Amy Patterson, Masayo Ozaki, Bertram E. B. Nwoke, Chinyere N. Ukaga, Chidiebere Njoku, Kenrick Nwodu, Andrew Obasi, and Emmanuel S. Miri
Lymphatic filariasis (LF) in rural southeastern Nigeria is transmitted mainly by Anopheles spp. mosquitoes. Potential coinfection with Loa loa in this area has prevented use of ivermectin in the mass drug administration (MDA) strategy for LF elimination because of potential severe adverse L. loa-related reactions. This study determined if long-lasting insecticidal net (LLIN) distribution programs for malaria would interrupt LF transmission in such areas, without need for MDA.

Jan. 3, 2013
Disease Eradication
New England Journal of Medicine, Vol 368 No. 1.pp. 53-64. Doi:10.1056/NEJMra1200391
Author: Donald R. Hopkins. 
Since the last case of naturally-occurring smallpox in 1977, there have been three major international conferences devoted to the concept of disease eradication. Several other diseases have been considered as potential candidates for eradication, but the World Health Organization (WHO) has targeted only two other diseases for global eradication after smallpox. In 1986, WHO's policy-making body, the World Health Assembly, adopted the elimination of dracunculiasis (Guinea worm disease) as a global goal, and it declared eradication of poliomyelitis a global goal in 1988. Although both diseases now appear to be close to eradication, the fact that neither goal has been achieved after more than two decades, and several years beyond the initial target dates for their eradication, underscores the daunting challenge of such efforts, as does the failure of previous attempts to eradicate malaria, hookworm, yaws and other diseases. "Disease Eradication" was published as part one of "A Global View of Health – An Unfolding Series."Read the overview of the series >

Aug. 1, 2012
Evidence for Stopping Mass Drug Administration for Lymphatic Filariasis in Some, But Not All Local Government Areas of Plateau and Nasarawa States, Nigeria
Published in the American Journal of Tropical Medicine and Hygiene, 87(2), 2012, pp. 272-280. (Login may be required for full text.)
Authors: Jonathan D. King, Abel Eigege, John Umaru, Nimzing Jip, Emmanuel Miri, Jonathan Jiya, Kal M. Alphonsus, Yohanna Sambo, Patricia Graves and Frank Richards Jr.
An average of six annual rounds of ivermectin and albendazole were distributed in Plateau and Nasarawa States, Nigeria, to eliminate lymphatic filariasis. From 2007 to 2008, population-based surveys were implemented in all 30 local government areas (LGAs) of the two states to determine the prevalence of Wuchereria bancrofti antigenemia to assess which LGA mass drug administration (MDA) could be halted.

April 19, 2012
Mosquito-borne Diseases Under Attack in Haiti, Dominican Republic
Published by the Emory Report.
Author: Emily Staub
Efforts to eliminate two mosquito-borne diseases – malaria and lymphatic filariasis – in Haiti and the Dominican Republic are ongoing, with the first of four meetings on the issue this year held in Santo Domingo in March.

Dec. 10, 2011
Lymphatic Filariasis in Western Ethiopia With Special Emphasis on Prevalence of Wuchereria Bancrofti Antigenaemia In and Around Onchocerciasis Endemic Areas
Published online, Dec. 10, 2011, in Transactions of the Royal Society of Tropical Medicine and Hygiene. Reprinted with permission.
Authors: Welelta Shiferaw,Tadesse Kebede,Patricia M. Graves,Lemu Golasa,Teshome Gebre,Aryc W. Mosher,Abiot Tadesse,Heven Sime,Tariku Lambiyo,K.N. Panicker,Frank O. Richards,Asrat Hailu
Lymphatic filariasis is known to be endemic in Gambella Region, western Ethiopia, but the full extent of its endemicity in other regions is unknown. A national mapping program for Ethiopia was initiated in 2008. This report summarizes initial data on the prevalence of Wuchereria bancrofti antigenaemia based on surveys carried out in a sampled population of 11 685 individuals living in 125 villages (112 districts) of western Ethiopia.

Oct. 11, 2011
Epidemiological and Entomological Evaluations after Six Years or More of Mass Drug Administration for Lymphatic Filariasis Elimination in Nigeria (PDF)
Published in the Oct. 11, 2011, issue of PLoS Journal of Neglected Tropical Diseases and is reprinted with permission.
Authors: Richards FO, Eigege A, Miri ES, Kal A, Umaru J, et al. 2011. PLoS Negl Trop Dis 5(10): e1346. doi:10.1371/journal.pntd.0001346.
The current strategy for interrupting transmission of lymphatic filariasis (LF) is annual mass drug administration (MDA), at good coverage, for 6 or more years. We describe our programmatic experience delivering the MDA combination of ivermectin and albendazole in Plateau and Nasarawa states in central Nigeria, where LF is caused by anopheline transmitted Wuchereria bancrofti.

March 30, 2010
A Project for Haiti: The Eradication of Two Diseases
Published by The New York Times
Author: Dr. Donald R. Hopkins
This letter to the editor of the New York Times by Carter Center Vice President for Health Programs, Dr. Donald Hopkins, was written in response to the March 28, 2010 editorial "Making Haiti Whole." Two projects that the donors conference on Haiti should consider this week are the binational plan that Haiti and the Dominican Republic announced last October to eliminate malaria by 2020, and the plan that Haiti announced simultaneously to eliminate lymphatic filariasis (elephantiasis) by 2020 (the Dominican Republic expects to eliminate lymphatic filariasis this year).

Nov. 7, 2008
A Pilot Program of Mass Surgery Weeks for Treatment of Hydrocele Due to Lymphatic Filariasis in Central The American Journal of Tropical Medicine and Hygiene, 2008 80(3), 2009, pp. 447–451
Authors: Gail Thomas, Frank O. Richards Jr., Abel Eigege, Nuhu K. Dakum, Martin P. Azzuwut, John Sarki, Ibrahim Gontor, Jacob Abimiku, Gladys Ogah, Munirah Y. Jindau, Jonathan Y. Jiya, and Emmanuel S. Miri.
In a pilot program of mass surgery weeks (MSW) to provide hydrocelectomy services to men with filarial scrotal hydrocele, local general practitioners performed 425 surgical repairs in 301 men in five MSW in three rural Nigerian community hospitals between 2002 and 2005. The most common (94%) procedure used was the eversion technique, which was most familiar to the practitioners. Postoperative complications included hematoma (3.7%) and infection (3%), and there was one death from infection in an elderly man with previously unrecognized diabetes. In 115 patients (38%) followed for 1 to 3 years, the hydrocele recurrence rate was 7%. The eversion technique gives an acceptable outcome, and MSW are safe and effective if strict attention is paid to preoperative screening of candidates and asepsis.

Jan. 1, 2008
Collecting Baseline Information for National Morbidity Alleviation Programs: Different Methods to Estimate Lymphatic Filariasis Morbidity Prevalence (PDF)
Published by Am. J. Trop. Med. Hyg., 78(1), 2008, pp. 153–158, Copyright © 2008 by The American Society of Tropical Medicine and Hygiene.
Authors: Els Mathieu,* Josef Amann, Abel Eigege, Frank Richards, and Yao Sodahlon.
The lymphatic filariasis elimination program aims not only to stop transmission, but also to alleviate morbidity. Although geographically limited morbidity projects exist, few have been implemented nationally. For advocacy and planning, the program coordinators need prevalence estimates that are currently rarely available. This article compares several approaches to estimate morbidity prevalence: (1) data routinely collected during mapping or sentinel site activities; (2) data collected during drug coverage surveys; and (3) alternative surveys. Data were collected in Plateau and Nasarawa States in Nigeria and in 6 districts in Togo.

March 1, 2006
Urban lymphatic filariasis in central Nigeria
Published by Ann Trop Med Parasitol. Mar 2006: 100(2): 163-172
Authors: Terranella A, Eigege A, Gontor I, Dagwa P, Damishi S, Miri E, Blackburn B, McFarland D, Zingeser J, Jinadu MY, Richards FO.
Wuchereria bancrofti and the other mosquito-borne parasites that cause human lymphatic filariasis (LF) infect over 120 million people world-wide. Global efforts are underway to stop transmission of the parasites, using annual, single-dose mass drug administrations (MDA) to all at-risk populations.

June 2003
Rapid assessment for lymphatic filariasis in central Nigeria: a comparison of the immunochromatographic card test and hydrocele rates in an area of high endemicity
Published in Am J Trop Med Hyg. Jun 2003: 68(6): 643-646
Authors: Eigege A, Richards F, Blaney D, Miri ES, Gontor I, Ogah G, Umaru J, Jinadu MY, Mathai W, Amadiegwu S, Hopkins DR
The rapid immunochromatographic card test (ICT) for Wuchereria bancrofti circulating filarial antigen is being used to map areas endemic for lymphatic filariasis. However, the ICT is expensive; thus, surveys based on this test must be relatively limited.

Jan. 1, 2002
Lymphatic Filariasis Elimination and Schistosomiasis Control in Combination with Onchocerciasis Control in Nigeria
Authors: Hopkins D.R., Eigege A., Miri E.S., Gontor, I., Ogah, G., Umaru, J., Gwomkudu, C.C., Mathai, W., Jinadu, M.Y., Amadiegwu, S., Oyenekan, O.K., Korve, K., Richards, F.O. Published in American Journal of Tropical Medicine and Hygiene. 2002; 67(3):266-72.
This paper describes a pilot initiative to incorporate lymphatic filariasis (LF) elimination and urinary schistosomiasis (SH) control into a mature onchocerciasis control program bsed on community-directed ivermectin treatment in central Nigeria. In the same districts having onchocerciasis we found LF (as determined by blood antigen testing in adult males) in 90% of 149 villages with a mean prevalence of 22.4% (range 0-67%). Similarly, SH, as a mean prevalence in school age children of 24.4% (range 0-87%). Health education and treatment interventions for SH resulted in 52,480 cumulative praziquantel treatments, and 159,555 combined onchocerciasis and LF treatments (with ivermectin and albendazole) as of the end of 2000. Treatments for onchocerciasis and LF were separated by at least 1 week from treatments for SH. There was no negative impact on the coverage of the onchocerciasis program by the addition of LF and SH activities.

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