Mass Treatment to Eliminate Filariasis in Papua New Guinea
Moses J. Bockarie, Ph.D., Daniel J. Tisch, M.P.H., Will Kastens, B.Sc., Neal D.E. Alexander, Ph.D., Zachary Dimber, Florence Bockarie, Ervin Ibam, Michael P. Alpers, M.D., and James W. Kazura, M.D.
Background The global initiative to eradicate bancroftian filariasiscurrently relies on mass treatment with four to six annual dosesof antifilarial drugs. The goal is to reduce the reservoir ofmicrofilariae in the blood to a level that is insufficient tomaintain transmission by the mosquito vector.
Methods In nearly 2500 residents of Papua New Guinea, we prospectivelyassessed the effects of four annual treatments with a singledose of diethylcarbamazine plus ivermectin or diethylcarbamazinealone on the incidence of microfilariae-positive infections,the severity of lymphatic disease, and the rate of transmissionof Wuchereria bancrofti by mosquitoes. Random assignment totreatment regimens was carried out according to the villageof residence, and villages were categorized as having moderateor high rates of transmission.
Results The four annual treatments with either drug regimenwere taken by 77 to 86 percent of the members of the populationwho were at least five years old; treatments were well tolerated.The proportion with microfilariae-positive infections decreasedby 86 to 98 percent, with a greater reduction in areas witha moderate rate of transmission than in those with a high rate.The respective aggregate frequencies of hydrocele and leg lymphedemawere 15 percent and 5 percent before the trial began, and 5percent (P<0.001) and 4 percent (P=0.04) after five years.Hydrocele and leg lymphedema were eliminated in 87 percent and69 percent, respectively, of those who had these conditionsat the outset. The rate of transmission by mosquitoes decreasedsubstantially, and new microfilariae-positive infections inchildren were almost completely prevented over the five-yearstudy period.
Conclusions Annual mass treatment with drugs such as diethylcarbamazinecan virtually eliminate the reservoir of microfilariae and greatlyreduce the frequency of clinical lymphatic abnormalities dueto bancroftian filariasis. Eradication may be possible in areaswith moderate rates of transmission, but longer periods of treatmentor additional control measures may be necessary in areas withhigh rates of transmission.
Source Information
From the Papua New Guinea Institute of Medical Research, Goroka, Madang, and Maprik, Papua New Guinea (M.J.B., W.K., Z.D., F.B., E.I., M.P.A.); the Division of Geographic Medicine and Center for International Health, Case Western Reserve University School of Medicine and University Hospitals of Cleveland, Cleveland (D.J.T., W.K., J.W.K.); the London School of Hygiene and Tropical Medicine, London (N.D.E.A.); and the Center for International Health, Curtin University, Perth, Australia (M.P.A.).
Address reprint requests to Dr. Kazura at the Division of Geographic Medicine and Center for International Health, Case Western Reserve University School of Medicine and University Hospitals of Cleveland, 2109 Adelbert Rd., W137 Harlan Wood Bldg., Cleveland, OH 44106, or at jxk14{at}po.cwru.edu.
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