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Lymphatic Filariasis Elimination Program - Articles By Carter Center Experts

Nov. 23, 2017
Mass Administration of Ivermectin in Areas Where Loa loa Is Endemic
Published by New England Journal of Medicine.
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. Abstract: 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.

May 30, 2015 
Onchocerciasis and Lymphatic Filariasis Elimination in Africa: It's About Time
Published by The Lancet.
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. Rreprinted with permission.
PLoS Negl Trop Dis 7(10): e2508.doi:10.1371/journal.pntd.0002508. 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 American Journal of Tropical Medicine and Hygiene, 2013 doi: 10.4269/ajtmh.13-0775.
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 >

2013
Community-Wide Distribution of Long-Lasting Insecticidal Nets Can Halt Transmission of Lymphatic Filariasis in Southeastern Nigeria
American Journal of Tropical Medicine and Hygiene, 2013 doi:10.4269/ajtmh.12-0775
Authors: Frank O. Richards Jr., Emmanuel Emukah, Patricia M. Graves, Omeni Nkwocha, Lawrence Nwanko, Lindsay J. 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. Monthly entomologic monitoring was conducted in sentinel villages before and after LLIN distribution to all households and all age groups (full coverage) in two districts, and to pregnant women and children less than five years of age in the other two districts.

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.

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.
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
This letter to the editor of the New York Times by Carter Center Vice President for Health Programs Dr. Donald R. Hopkins was published March 30, 2010, 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)
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. Abstract: 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.

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. Abstract: 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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