Eliminating Lymphatic Filariasis in the Americas A Winnable Battle

1. Eliminating Lymphatic Filariasis in the AmericasA Winnable Battle Center for Global Health Division of Parasitic Diseases and Malaria

2. Lymphatic Filariasis (LF) • Caused by worms spread from person-to-person by the bite of infected mosquitoes • The worms live in the human lymphatic system and can cause: • Lymphedema (swelling) and elephantiasis in limbs and breasts • Hydrocele (severe fluid accumulation) affecting men’s genitalia Microfilaria of Wuchereriabancrofti (CDC photo, DPDx) Microfilaria of Brugiamalayi (CDC photo, DPDx)

3. Health and societal impacts of LF • Usually develop years after initial infection • Cause pain, severe and irreversible disfigurement, loss of productivity, and social stigmatization Lymphedema Elephantiasis CDC photos

4. LF: A costly and disabling NTD • One of the most disabling and economically costly neglected tropical diseases (NTDs) • NTDs are a group of poverty-associated parasitic and bacterial infections affecting more than 1 billion persons • NTDs are responsible for tremendous suffering and economic loss • More than 120 million persons are infected with LF, a disease that can be eliminated Photo courtesy Carter Center/Emily Staub

5. Worldwide distribution of LF 1.34 billion at risk in world

6. Global impact of LF • A leading cause of disability globally • Present in 73 countries • 44 million persons suffer from chronic manifestations Photos courtesy of CDC. Left: Dr. Susan Montgomery, Middle and Right: CDC PHIL

7. Global Programmeto Eliminate LF (GPELF) • Target elimination date of 2020 • Launched by World Health Organization (WHO) in 2000 • Two-pronged strategy to: • Interrupt the spread of infection • Reduce the suffering of persons already infected • To interrupt infection, medication is distributed to entire at-risk population through mass drug administration (MDA) • At least 5 rounds on MDA are needed to interrupt transmission • Treatment kills worms circulating in the blood

8. GPELF: Progress and successes • 53 countries have ongoing MDA campaigns • 37 countries have administered 5 or more rounds of MDA in many target areas • 2.8 billion doses of medicine delivered in first 9 years • Treatment cost typically less than US $0.50 per person and often less than $0.10 • Transmission interruption has protected 6.6 million newborns from becoming infected with the disease • Economic benefit of first 7 years of program estimated at $24 billion • Full economic benefit could exceed US $55 billion

9. The economic impact of GPELF, 2000-2007 Table courtesy of WHO GPELF

10. WHO Guidelines for LF Elimination Programs Rounds annual mass drug administration (MDA) Post-MDA Period 1 2 3 4 5 n Monitoring & Evaluation Passive Surveillance ( > 5 years) Coverage Impact Assessment TAS TAS TAS “Mapping” TAS = transmission assessment survey

11. LF elimination in the Americas • The Americas is the first region targeted for elimination of LF • Improvements in standard of living have reduced disease prevalence in continental Americas and Caribbean Islands • In areas where disease remained (Costa Rica, Suriname, and Trinidad and Tobago), transmission was interrupted through selective and community treatment • Transmission still occurs in Guyana, Haiti, and parts of Brazil and the Dominican Republic

12. Notable achievements in the Americas • Surveys carried out in the Dominican Republic suggest transmission interruption • MDA treatment scaling up in Haiti • 3 rounds of MDA have been completed in Haiti, including the urban capital of Port-au-Prince • Many departments of Haiti are ready to begin transmission assessment surveys (TAS) to determine if MDA can be stopped • Disease management programs operating in all four endemic countries CDC photo

13. Notable achievements in the Americas • Although there is still active transmission in Guyana, Haiti, and parts of Brazil and the Dominican Republic, each country has achieved notable success in the fight against LF • As of late 2012, nearly 9 million persons living in Americas had received MDA • Elimination in the Americas is within reach

14. Graph courtesy of WHO GPELF

15. CDC and partner support • CDC and its partners: • Work with each country’s ministry of health to offer advice and expert consultation • Develop monitoring and evaluation strategies • Provide technical support • Carry out operational research including working to understand: • Adherence to medication • Optimal surveillance methods • Strategies to accelerate elimination

16. Winning the battle against LF:What more can be done to eliminate LF by 2020? • Continue and scale-up MDA programs to interrupt transmission • Use operational research to develop strategies to accelerate the elimination of LF • Increase each country’s efforts to provide appropriate care for persons with filarial disease • Expand the reach of LF programs to include service delivery for other NTDs and health priorities

17. CDC partners • We would like to acknowledge and thank our partners working to eliminate lymphatic filariasis: • The Bill & Melinda Gates Foundation • CBM International • Eisai • GlaxoSmithKline • IMA World Health • Inter-American Development Bank • Merck • Pan American Health Organization • RTI International • The Task Force for Global Health • University of Notre Dame • United States Agency for International Development (USAID)

18. Thank you www.cdc.gov/winnablebattles/lymphaticfilariasis Center for Global Health Division of Parasitic Diseases and Malaria