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reporting on continuous progress towards removal as a public health problem
In 2019, 538.1 million people were treated for lymphatic filariasis (LF) in 38 countries that conducted mass drug delivery (MDA) to populations at risk for the disease, as recommended by the World Health Organization (WHO). Seventeen countries met the criteria for eliminating NN as a public health problem; Kiribati, Malawi and Yemen were the last to be recognized by the WHO.
The Global Lymph Filariasis Removal Program (GPELF) has provided over 8.2 billion cumulative treatments to more than 923 million people since 2000. The treatments target parasites in the blood of infected people and prevent the risk of transmission in the community. Infections have been brought to such low levels in some areas that 649.1 million people no longer need MDA for this debilitating parasitic disease.
Sightseeing at 2030
The goal set by GPELF in 2000 to globally eliminate LF as a public health problem will not be achieved by then. Despite delays due to COVID-19, the WHO will accelerate work to achieve this goal by 2030. New global estimates suggest a 74% reduction in the number of those infected since the start of GPELF.2 The new ambitious targets for 2030 are that 80% of endemic countries have met the criteria for confirming elimination as a public health problem, and the remaining 20% under post-treatment surveillance, meaning the MDA will no longer be needed.
The goal of GPELF is to reduce the prevalence of infection below the target thresholds and alleviate the suffering of people affected by lymphedema and hydrocele, chronic manifestations of the disease. The recommended basic care package for the treatment of lymphedema and hydrocele should be available in 100% of the districts where people live with these manifestations. This goal is in line with the goals of universal health coverage so that no one is left until 2030. LF mortality reporting improved again in 2019, showing that countries are addressing this goal and planning services for people affected by the disease.
Accelerate with a better combination of medications
In 2017, the WHO published a new guideline on alternative MDA regimens for LF removal and recommended a combined regimen of ivermectin, diethylcarbamazine citrate, and albendazole (IDA) to accelerate the impact of MDA on parasite transmission.2 In 2019, IDA was used to treat 45.2 million people in 11 countries. In India, the IDA has been expanded from four to 16 districts to treat more than 41 million people.
Risks to success
Currently, only six of the 17 countries have confirmed that they have eliminated LF as public reporting oversight activities. Without vigorous activity after validation, transmission may remain undetected and the number of infections may return to previous levels. Countries are willing to monitor and be vigilant, but programs require clear guidance and resources. Additional research and better diagnostics are needed to develop more detailed, standardized monitoring methods.
Further details of the progress GPELF made in 2019 are published in Weekly epidemiological record.3
1 Cromwell EA, Schmidt CA, Kwong KT, Pigott DM, Mupfasoni D, Biswas G, etc. 2020. Global distribution of lymphatic filariasis, 2000–18: geospatial analysis. Lancet Glob Health. 2020; 8: e1186–94.
2Guideline. Alternative regimens of mass administration of drugs to remove lymphatic filariasis. Geneva: World Health Organization: 2017
3Global Lymphatic Filariasis Removal Program: Progress Report, 2019. Wkly Epidemiol Rec. 2000; 95: 509-524.
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