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Geneva, Switzerland, WHO, Department of Control of Neglected Tropical Diseases, 2006.  p. (WHO/CDS/NTD/2006.2)Neglected tropical diseases affect an estimated 1 billion people, primarily poor populations living in tropical and subtropical climates. They frequently cluster geographically and overlap; individuals are often afflicted with more than one parasite or infection. 100% of low-income countries are affected by at least five neglected tropical diseases simultaneously. More than 70% of countries and territories that report the presence of neglected tropical disease are low-income and lower middle-income economies. Infections are attributable to unsafe water, poor housing conditions and poor sanitation. Children are most vulnerable to infections of most neglected tropical diseases. Neglected tropical diseases kill, impair or permanently disable millions of people every year, often resulting in life-long physical pain, social stigmatization and abuse. Many can be prevented, eliminated or even eradicated with improved access to existing safe and costeffective tools. (excerpt)
Manila, Philippines, World Health Organization [WHO], Regional Office for the Western Pacific, Pacific Programme to Eliminate Lymphatic Filariasis [PacELF], 2006.  p.The Pacific Programme to Eliminate Lymphatic Filariasis (PacELF) is working with 22 Pacific Island countries and territories to rid the Pacific region of the disease. This book describes the work of PacELF since the programme was launched in 1999 up to the end of 2005. The book is divided into two main parts. Part 1 narrates the genesis of PacELF as a regional programme in the Pacific, its work of mass drug administration (MDA) and other activities, the encouraging successes achieved to date, and the challenges that remain. The contents of the chapters in Part 1 are described briefly below. Part 2 is arranged by country and gives detailed information on individual country programmes, based mainly on data from the annual reports and meeting presentations of the PacELF member countries. Part 2 also contains many photographs of the programme and its staff in action. (excerpt)
Vector-control synergies, between "roll back malaria" and the Global Programme to Eliminate Lymphatic Filariasis, in the African region.
Annals of Tropical Medicine and Parasitology. 2002; 96 Suppl 2:S129-S132.The perspectives and opportunities for controlling the mosquito vectors of Wuchereria bancrofti in tropical Africa are summarized and discussed. The countries covered by the World Health Organization’s African Region have about one third of the world’s burden of lymphatic filariasis (LF) as well as large shares of the planet’s malaria and of many other vector-borne diseases. African LF is entirely caused by nocturnally periodic W. bancrofti, a filarial nematode that is transmitted in urban East Africa by Culex quinquefasciatus, and in rural areas across tropical Africa by the same anopheline species that transmit the Plasmodium spp. causing human malaria. The standard practices for controlling the vectors of malarial parasites — house-spraying with residual insecticides and the use of bednets (preferably pre-treated with insecticide) for personal and community protection — can be simultaneously effective against both LF and malaria. Although mass drug administrations remain the mainstay of the current strategy for LF elimination, the vector-control activities of the ‘Roll Back Malaria’ campaign can be expected to reduce the transmission of W. bancrofti in co-endemic areas. The relevant issues of programme management and integrated vector control are briefly reviewed. (author's)
Annals of Tropical Medicine and Parasitology. 2002; 96 Suppl 2:S55-S59.Approximately 50 million people in Egypt and sub-Saharan Africa have bancroftian filariasis and together they represent about a third of all cases of lymphatic filariasis (LF) world-wide. Currently, the Global Programme to Eliminate Lymphatic Filariasis, which was launched by the World Health Organization (WHO) in 1998, is largely based on repeated annual cycles of mass drug administration (MDA) to endemic populations. Also, some countries, including Egypt, are taking steps to improve LF vector-control interventions, to break the transmission cycle more effectively than is achievable with MDA alone. New tools and strategies for monitoring and evaluating elimination campaigns are needed. The last 20 years have witnessed dramatic advances in the diagnosis of LF for epidemiological purposes. The recent introduction and development of molecular technologies have moved parasite-detection systems from traditional methods (that are labour-intensive, tedious and often impractical ) to improved PCR-based assays that have considerable potential for field use. The present article highlights the strengths and limitations of the PCR-based assays when used to detect filarial infections in mosquitoes ( particularly for the xenomonitoring of elimination campaigns). (excerpt)
Annals of Tropical Medicine and Parasitology. 2002; 96 Suppl 2:S3-S13.Human lymphatic filariasis (LF), the sequelae of which are commonly known as elephantiasis, results from infection with nematode filarial parasites, which are transmitted by certain species of vector mosquito. Transmission of these parasites to humans continues in more than 80 countries, with a combined population of well over 1000 million people at risk. In some situations, usually where economic progress has raised the standard of living, the disease has disappeared (Australia, South Korea, U.S.A). In other settings, specific public-health interventions, such as mass drug administrations (MDA) based on diethylcarbamazine (DEC) tablets (Suriname, Trinidad and Tobago) or the mass distribution of salt fortified with DEC (China), have led to the interruption of transmission. In most areas where LF remains endemic, the disease is an important health burden. Indeed, it probably causes the loss of more disability-adjusted life-years (DALY) than any other communicable parasitic disease except malaria. Lymphatic filariasis is a painful and profoundly disfiguring disease that has a major social and economic impact. Of the estimated 120 million people who are currently infected with the causative parasites, 40 million have the clinical manifestations of the disease. (excerpt)
Transmission intensity index to monitor filariasis infection pressure in vectors for the evaluation of filariasis elimination programmes.
Tropical Medicine and International Health. 2003 Sep; 8(9):812-819.We conducted longitudinal studies on filariasis control in Villupuram district of Tamil Nadu, south India, between 1995 and 2000. Overall, 23 entomological (yearly) data sets were available from seven villages, on indoor resting collections [per man hour (PMH) density and transmission intensity index (TII)] and landing collections on human volunteers [PMH and annual transmission potential (ATP)]. All four indices decreased or increased hand-in-hand with interventions or withdrawal of inputs and remained at high levels without interventions under varied circumstances of experimental design. The correlation coefficients between parameters [PMH: resting vs. landing (r = 0.77); and TII vs. ATP (r = 0.81)] were highly significant (P < 0.001). The former indices from resting collections stand a chance of replacing the latter from landing collections in the evaluation of global filariasis elimination efforts. The TII would appear to serve the purpose of a parameter that can measure infection pressure per unit time in the immediate household surroundings of human beings and can reflect the success or otherwise of control/elimination efforts along with human infection parameters. Moreover, it will not pose any additional risk of new infection(s) and avoids infringement of human rights concerns by the experimental procedures of investigators, unlike ATP that poses such a risk to volunteers. (author's)
Variation in incidence of serious adverse events after onchocerciasis treatment with ivermectin in areas of Cameroon co-endemic for loiasis.
Tropical Medicine and International Health. 2003 Sep; 8(9):820-831.Objective: To determine the incidence of serious adverse events (SAEs) after mass treatment with ivermectin in areas co-endemic for loiasis and onchocerciasis, and to identify potential risk factors associated with the development of these SAEs, in particular encephalopathic SAEs. Methods: We retrospectively analysed SAEs reported to have occurred between 1 December 1998 and 30 November 1999 in central-southern Cameroon by chart review, interview and examination of a subset of patients. Results: The overall incidence of SAEs for the three provinces studied was 6 per 100,000. However, for Central Province alone the incidence of SAEs was 2.7 per 10,000 overall, and 1.9 per 10,000 for encephalopathic SAEs associated with Loa loa microfilaremia (PLERM). The corresponding rates for the most severely affected district within Central Province (Okola) were 10.5 per 10,000 and 9.2 per 10,000 respectively. Symptoms began within the first 24–48 h of ivermectin administration but there was a delay of approximately 48–84 h in seeking help after the onset of symptoms. First-time exposure to ivermectin was associated with development of PLERM. Conclusion: In Cameroon, the incidence of SAEs following ivermectin administration in general, and PLERM cases in particular, varies substantially by district within the areas co-endemic for loiasis and onchocerciasis. More intense surveillance and monitoring in the first 2 days after mass distribution in ivermectin-naïve populations would assist in early recognition, referral and management of these cases. The increased reporting of SAEs from Okola is unexpected and warrants further investigation. Research is urgently needed to find a reliable screening tool to exclude individuals (rather than communities) at risk of PLERM from the mass treatment program. (author's)
TDR NEWS. 1996 Mar; (49):1-2.A UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases (TDR) expert meeting has concluded that the means already exist with which to eliminate 4 of the 8 diseases which TDR originally identified as public health problems. Elimination in this case refers to reducing the number of cases of disease to a small and routinely manageable number. The diseases capable of being eliminated with existing tools are leprosy, onchocerciasis, lymphatic filariasis, and Chagas disease. Leprosy can be eliminated through the use of multidrug therapy, onchocerciasis through the administration of ivermectin, lymphatic filariasis through the use of DEC and ivermectin, and Chagas disease through the rational use of insecticides and the control of blood banks. Malaria, schistosomiasis, leishmaniasis, and African trypanosomiasis, however, must await better tools before their elimination can be attempted. TDR's role in identifying how to eliminate each of these diseases is described. Meeting attendees identified additional avenues of operational research upon which TDR should embark.
The application of modelling to control strategies in lymphatic filariasis. Report of a consultative meeting, Geneva, 14-16 February, 1996.
[Unpublished] 1996. 23 p. (TDR/AFR/FIL/97.1)An informal meeting was held in Geneva during February 14-16, 1996, under the auspices of the Filariasis Operational Research Task Force of the World Health Organization's (WHO) Special Program for Research and Training in Tropical Diseases (TDR) and the Filariasis Unit of the Division of Control of Tropical Diseases (CTD) to critically review recent advances and the current status of approaches to the epidemiologic modelling of lymphatic filariasis, and to recommend further steps needed to improve the field use of epidemiologic models in the control of lymphatic filariasis in endemic countries. Participants included experts in epidemiologic modelling, clinicians, parasitologists, entomologists, epidemiologists, public health planners, and members of the WHO secretariat. Modelling is a way of organizing information so that the interrelationships of components can be readily understood, and so that data lacking for the complete understanding of a problem can be identified. Progress in modelling and optimizing models for field applications are discussed. A work plan and recommendations are also presented. Meeting participants concluded that both the EPIFIL and LYMFASIM epidemiologic modelling packages have good potential to contribute to lymphatic filariasis control efforts. Although simple models of transmission are most urgently needed by control programs, complex models of pathogenesis are also needed.
TDR NEWS. 1998 Feb; (55):5.Following the demonstration of onchocercal skin disease's (OSD) public health and social importance in 1994, the UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases (TDR) Task Force on Onchocerciasis Operational Research was asked to assess its economic impact. A multi-country study was subsequently undertaken in Ethiopia, Sudan, and Nigeria to measure the effect of OSD upon labor input and the effect of severe reactive skin disease in the household upon school attendance by children. Where the head-of-household had OSD, children were twice as likely to drop out of school compared to other children of the same age from the same community. The relationship was especially strong among girls, who were 2.6 times as likely to drop out of school if the head-of-household had OSD than if the head did not. It follows that onchocerciasis impedes educational development where OSD is highly prevalent. People with OSD spend US$20 more annually on health-related expenditures, 15% of their annual income, than do people without OSD. There are also significant time costs to having OSD. Another study was conducted in Uganda, Ghana, and Nigeria to assess the effect of ivermectin treatment upon OSD. Treatment led to a 40-50% decline in severe itching compared to placebo, sustained for up to 12 months after the first treatment. There was also a significant decline in the prevalence of reactive skin lesions following treatment compared to placebo.
In sickness or in health: TDR's parners. 7. Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
TDR NEWS. 1998 Feb; (55):8, 10.Mahidol University's Faculty of Tropical Medicine, Bangkok, Thailand, established in 1960, is one of 14 faculties, 5 institutions, 5 centers, and 2 colleges within Mahidol University. It consists of the following departments: Helminthology, Medical Entomology, Microbiology and Immunology, Protozoology, Social and Environmental Medicine, Tropical Hygiene, Tropical Medicine, Tropical Nutrition and Food Science, Tropical Pediatrics, Tropical Pathology, and Tropical Radioisotopes. The UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases (TDR) has been associated with the Faculty since 1977, collaborating mainly upon malaria research, but also in filariasis, leprosy, and schistosomiasis research. Early TDR support was directed at research training and institutional strengthening, although by the early 1980s, the Faculty played an increasingly important role in TDR's research and development program. In recent years, the Faculty has focused upon researching malaria, parasitic and bacterial diseases, nutrition and food sciences, and environmental health. The Faculty's malaria-related research is described. The Faculty also conducts research in many other areas of tropical medicine outside of those of interest to TDR.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1997; 75(6):491-503.Lymphatic filariasis, which infects 120 million people in 73 countries each year, is a serious public health problem in Africa and the Indian subcontinent. Elephantiasis, lymphoedema, and genital pathology afflict 44 million people, while another 76 million have parasites in their blood and hidden internal damage to their lymphatic and renal systems. New parasitic disease strategies combine transmission control through mass treatment programs and disease control through individual patient management. Annual single-dose administration of ivermectin plus diethylcarbamazine or albendazole reduces blood microfilariae by 99% for a full year; even a single annual dose of just 1 drug can result in a 90% reduction and interrupt disease transmission. New approaches based on the prevention of bacterial superinfection have the potential to halt or even reverse lymphoedema and elephantiasis. Given these technical advances, the Fiftieth World Health Assembly urged the World Health Organization and its Member States to establish the global elimination of lymphatic filariasis as a priority public health problem.
In: Tropical disease research: progress 1991-92. Eleventh programme report of the UNDP / World Bank / WHO Special Programme for Research and Training in Tropical Diseases (TDR). Geneva, Switzerland, World Health Organization [WHO], 1993. 1-14.1991 and 1992 were good years for the UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases (TDR). Major advances were made in controlling leprosy, onchocerciasis, and Chagas disease, using TDR-supported products; significant advances were made in applied field research, operational research, and in the social sciences; arteether was brought into fully controlled clinical trials and a field trial of a malaria vaccine in African children was initiated; an initiative was launched to control malaria through the genetic engineering of the mosquito vector to interrupt transmission; TDR's research capability strengthening (RCS) component accelerated its move toward strengthening through research and increased its focus upon identifying individuals for training as a first step in the RCS process; and TDR increased the level of convergence among its internal components and between TDR and other health programs, and prepared to define its targets in terms of precise products and time frames.
In: Mectizan (Ivermectin) and the Control of Onchocerciasis: Strengthening the Global Impact. A symposium sponsored by Merck and Co., Inc. marking the fifth anniversary of the donation of Mectizan for the treatment of onchocerciasis and held with the technical cooperation of the World Health Organization at the Hudson Theater in New York on September 23, 1992. Summary proceedings of the symposium. Rahway, New Jersey, Merck and Company, 1992. 17-8.The World Health Organization (WHO) was selected as the Executing Agency for the Onchocerciasis Control Programme (OCP) in West Africa, and The World Bank agreed to mobilize funds from the donors and the beneficiary African governments. Because of the severity and spread of the disease and the flight range of the vector, Simulium damnosum, a large area was demarcated for vector control activities. Most of the vector breeding sites were inaccessible to land-based vehicles, and the only control tool available was aerial larviciding. Work started in 1975. By 1986, the original 7-country treatment area was expanded to include 11 countries with a total population of 30 million. Weekly larvicide treatments were continuing in 1987, when chemotherapy with Mectizan was added. As a result of intensive research, today there are 6 pesticides and Mectizan, a microfilaricide suitable for mass distribution. In the original program area, OCP has been ahead of schedule in removing the disease as a public health and socioeconomic development problem: a) None of the 30 million people living in the OCP area risk getting onchocerciasis; over 150,000 cases of blindness have been prevented. b) 25 million hectares of fertile land have been liberated and, in many areas, production of cereal, animals, and fish has increased. More than 400 indigenous scientists and health workers have been formally trained, and over 98% of OCP staff are Africans. Merck & Co. tested Mectizan in large-scale clinical trials that were conducted in association with OCP and WHO. By 1986, about 1200 patients had been treated and, of those, over 1000 were in the OCP region. In October 1987, Mectizan was registered for human use, and Merck & Co. donated the drug to all patients. Since then, OCP has used over 3 million tablets. Mectizan is well accepted by the patients; it controls the disease, and, in combination with larviciding, it dramatically affects transmission.