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Examination of 1829 children from 6 primary schools in coastal Tanzania revealed overall Wuchereria bancrofti microfilaria (mf) and circulating filarial antigen (CFA) prevalences of 17.3% and 43.7%, respectively. A randomized double-blind field trial with a single dose of ivermectin (150-200 microg/kg body weight) alone or in combination with albendazole (400 mg) was subsequently carried out among these children. Both treatment regimens resulted in a considerable decrease in mean mf intensities, with overall reductions being slightly but statistically significantly higher for the combination than for ivermectin alone. The difference in effect between the two treatment regimens was most pronounced at 6 months, whereas it was minor at 12 months after treatment. The relative effect of treatment on mean CFA units was less pronounced than on mf. For both treatment regimens, reductions in CFA intensity appeared to be higher in children who were both CFA and mf positive before treatment, which may suggest that treatment mainly affected the survival and/or production of mf, rather than the survival of adult worms. New cases of infection appeared after treatment with both regimens among the pre-treatment mf and CFA negative children. Adverse reactions were few and mild in both groups, and mainly reported from pre-treatment mf and CFA positive children. The alarmingly high prevalence of W. bancrofti infection in primary school children highlights the importance of also determining the reversibility of already acquired early lesions, and the development of new measures and strategies to specifically protect children from later developing clinical disease.

Intensive monitoring of Wuchereria bancrofti vector abundance and transmission intensity was carried out in two communities, one with high-level endemicity for bancroftian filariasis (Masaika, Tanzania) and the other with low-level (Kingwede, Kenya), on the East African coast. Mosquitoes were collected in light traps, from 50 randomly selected households in each community, once weekly for 1 year. They were identified, dissected and checked for parity and filarial larvae. Anopheles gambiae s. l., An. funestus and Culex quinquefasciatus transmitted W. bancrofti in the two communities but the importance of each of these taxa differed between the communities and by season. The overall vector densities and transmission intensities were significantly higher in Masaika than in Kingwede (the annual biting rate by 3.7 times and the annual transmission potential by 14.6 times), primarily because of differences in the available breeding sites for the vectors and in the vectorial capacity of the predominant vector species. A marked seasonal variation in vector abundance and transmission potential contributed to the complex transmission pattern in the communities. Generally, these indices were higher during and shortly after the rainy seasons than at other times of the year. Considerable differences in W. bancrofti transmission were thus observed between communities within a relatively small geographical area (mainly because of environmentally-determined differences in vector habitats), and these were reflected in the marked differences in infection level in the human populations. The variation in vector abundance, vector composition and transmission intensity in the two communities is discussed in respect to its cause, its effects, and its significance to those attempting to control bancroftian filariasis.

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Floating layers of polystyrene beads suffocate mosquito larvae and pupae and inhibit egg laying. The layers are very durable in breeding sites with water contained within walls, as in wet pit latrines and soakage pits. In some areas such pits constitute an important breeding site for Culex quinquefasciatus. Trials have been conducted in communities in Zanzibar, Tanzania, and in Tamil Nadu, India, where such mosquito populations were the vectors of Wuchereria bancrofti. In each case, treatment of all the pits with polystyrene beads was integrated with mass treatment of the people with antifilarial drugs-in Zanzibar in 1988 with diethylcarbamazine (DEC) and in India in the 1990s with DEC plus ivermectin. The results were compared with those in communities with the mass drug treatment alone and with control communities with neither treatment. The polystyrene-bead treatments greatly and sustainably reduced the vector populations. Comparison of the communities after drug treatment ceased showed that this form of vector control contributed markedly to the prevention of a resurgence of filarial infection. Where Cx. quinquefasciatus breeding in pits form a major component of the vector population, use of polystyrene-bead layers could assist considerably in the process of eliminating lymphatic filariasis by mass drug administration.

The effect of host infection, chronic clinical disease, and transmission intensity on the patterns of specific antibody responses in Bancroftian filariasis was assessed by analyzing specific IgG1, IgG2, IgG3, IgG4, and IgE profiles among adults from two communities with high and low Wuchereria bancrofti endemicity. In the high endemicity community, intensities of the measured antibodies were significantly associated with infection status. IgG1, IgG2, and IgE were negatively associated with microfilaria (MF) status, IgG3 was negatively associated with circulating filarial antigen (CFA) status, and IgG4 was positively associated with CFA status. None of the associations were significantly influenced by chronic lymphatic disease status. In contrast, IgG1, IgG2, and IgG4 responses were less vigorous in the low endemicity community and, except for IgG4, did not show any significant associations with MF or CFA status. The IgG3 responses were considerably more vigorous in the low endemicity community than in the high endemicity one. Only IgG4 responses exhibited a rather similar pattern in the two communities, being significantly positively associated with CFA status in both communities. The IgG4:IgE ratios were higher in infection-positive individuals than in infection-negative ones, and higher in the high endemicity community than in the low endemicity one. Overall, these results indicate that specific antibody responses in Bancroftian filariasis are more related to infection status than to chronic lymphatic disease status. They also suggest that community transmission intensity play a dominant but subtle role in shaping the observed response patterns.