A Filariasis-Control Program in American Samoa *

Ciferri, Flavio; Siliga, Nofo; Long, Gary W.; Kessel, John F.

doi:10.4269/ajtmh.1969.18.369

Cited by 32 publications

(13 citation statements)

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“…Estimates range from no regression at all to complete reversal of 87% of hydrocele cases and 69% of leg lymphedema cases after 5 annual rounds of DEC with ivermectin or DEC alone [24]. Other estimates from related studies also lie within this range [25], [26], [27], [28], [31], [55], which is therefore used as the lower and upper boundaries for the sensitivity analysis. A linear relationship will also be assumed – i.e.…”

Section: Resultsmentioning

confidence: 99%

“…A study in Papua New Guinea resulted in complete reversal of 87% of hydrocele and 69% of leg lymphedema cases after 5 annual rounds of DEC+ivermectin or DEC alone [24], and studies in Indonesia [25], [26] and Tanzania [27] using DEC, provide evidence of an improvement or complete disappearance of clinical manifestations by 62–90% after 2–4 rounds of annual MDA. However, other studies have failed to show such significant clinical benefits from MDA [28], [29], [30]. While evidence of acute and chronic disease regression using a combination of ivermectin+albendazole or ivermectin alone is even less well documented, a recent report from Tanzania indicates that MDA (using albendazole+ivermectin) lessens the frequency and severity of ADL episodes by a significant degree.…”

Section: Methodsmentioning

confidence: 99%

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The Economic Benefits Resulting from the First 8 Years of the Global Programme to Eliminate Lymphatic Filariasis (2000–2007)

et al. 2010

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BackgroundBetween 2000–2007, the Global Programme to Eliminate Lymphatic Filariasis (GPELF) delivered more than 1.9 billion treatments to nearly 600 million individuals via annual mass drug administration (MDA) of anti-filarial drugs (albendazole, ivermectin, diethylcarbamazine) to all at-risk for 4–6 years. Quantifying the resulting economic benefits of this significant achievement is important not only to justify the resources invested in the GPELF but also to more fully understand the Programme's overall impact on some of the poorest endemic populations.MethodologyTo calculate the economic benefits, the number of clinical manifestations averted was first quantified and the savings associated with this disease prevention then analyzed in the context of direct treatment costs, indirect costs of lost-labor, and costs to the health system to care for affected individuals. Multiple data sources were reviewed, including published literature and databases from the World Health Organization, International Monetary Fund, and International Labour OrganizationPrincipal FindingsAn estimated US$21.8 billion of direct economic benefits will be gained over the lifetime of 31.4 million individuals treated during the first 8 years of the GPELF. Of this total, over US$2.3 billion is realized by the protection of nearly 3 million newborns and other individuals from acquiring lymphatic filariasis as a result of their being born into areas freed of LF transmission. Similarly, more than 28 million individuals already infected with LF benefit from GPELF's halting the progression of their disease, which results in an associated lifetime economic benefit of approximately US$19.5 billion. In addition to these economic benefits to at-risk individuals, decreased patient services associated with reduced LF morbidity saves the health systems of endemic countries approximately US$2.2 billion.Conclusions/SignificanceMDA for LF offers significant economic benefits. Moreover, with favorable program implementation costs (largely a result of the sustained commitments of donated drugs from the pharmaceutical industry) it is clear that the economic rate of return of the GPELF is extremely high and that this Programme continues to prove itself an excellent investment in global health.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

The Economic Benefits Resulting from the First 8 Years of the Global Programme to Eliminate Lymphatic Filariasis (2000–2007)

et al. 2010

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“…Before the availability of these assays, assessments based on microfilaria detection by nocturnal blood samples or by prevalence of clinically apparent disease [1][2][3][4][5][6][7][8][9] seriously underestimated the true prevalence of lymphatic filarial infection. Indeed, mathematical models based on microfilarial counts have suggested that prevalence may be underestimated by as much as 25-100%.…”

Section: Introductionmentioning

confidence: 99%

Worm burden and host responsiveness in Wuchereria bancrofti infection: use of antigen detection to refine earlier assessments from the South Pacific.

Steel¹,

Ottesen²,

Weller³

et al. 2001

The American Journal of Tropical Medicine and Hygiene

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Abstract. A population from the Wuchereria bancrofti-endemic island of Mauke was reevaluated retrospectively by use of the Og4C3 circulating antigen (CAg) enzyme-linked immunosorbent assay to assess active infection in relation to host responses by age and gender. Use of microfilaremia (Mf) alone misclassified ϳ 50% of infected people, although CAg and Mf levels were positively correlated. Levels of CAg peaked between those aged 31-60 years; men aged Ͼ 60 years had a significantly higher CAg prevalence (Ͼ 90%) than women. Filaria-specific immunoglobulin (Ig) G4 reached maximum levels in both genders at age 51-60 years. By analysis of variance, both age and gender significantly influenced CAg and IgG4, with men having higher levels of both in the total population. Individuals positive for CAg had significantly lower lymphocyte proliferation responses to parasite antigen than did CAg-negative people, regardless of clinical status. This study reemphasizes the importance of CAg measurements for accurately assessing filarial prevalence and clinical status and demonstrates the relationship between active infection and immune responsiveness.

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“…The failure to find an impact of DEC on ADL episodes is consistent with the findings of Beye and others, 33 but is inconsistent with other studies assessing DEC. 14,20,[24][25][26]28,32,36 Similarly, the failure to find an improvement in lymphedema after receiving DEC is consistent with some studies, [32][33][34] but inconsistent with several reports examining this question; although these studies used varied DEC dosages over varied treatment schedules. 20,[24][25][26][27][28][29][30]50 However, because of numerous differences in methods between studies, comparison with this study is difficult.…”

Section: Discussionmentioning

confidence: 78%

“…22,23 Of the 13 published studies assessing the effect of DEC on lymphedema-specific filarial morbidity, nine found a beneficial effect of DEC on lymphedema 20,24 -31 and the other studies demonstrated no effect. [32][33][34][35] In addition, seven of eight studies demonstrated that DEC decreased the incidence of ADL episodes in patients with lymphedema 14,20,24 -26,32,36 and one study showed no effect. 33 It is important to note that these studies differ with regard to study design, evaluation criteria, frequency and dosage of drug treatment, case definitions, and clinical follow-up, thus making direct comparisons difficult.…”

Section: Introductionmentioning

confidence: 99%

A Longitudinal Analysis of the Effect of Mass Drug Administration on Acute Inflammatory Episodes and Disease Progression in Lymphedema Patients in Léogane, Haiti

Eddy

Blackstock

Williamson

et al. 2014

The American Society of Tropical Medicine and Hygiene

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Abstract. We conducted a longitudinal analysis of 117 lymphedema patients in a filariasis-endemic area of Haiti during [1995][1996][1997][1998][1999][2000][2001][2002][2003][2004][2005][2006][2007][2008]. No difference in lymphedema progression between those who received or did not receive mass drug administration (MDA) was found on measures of foot (P = 0.24), ankle (P = 0.87), or leg (P = 0.46) circumference; leg volume displacement (P = 0.09), lymphedema stage (P = 0.93), or frequency of adenolymphangitis (ADL) episodes (P = 0.57). Rates of ADL per year were greater after initiation of MDA among both groups (P 0.01). Nevertheless, patients who received MDA reported improvement in four areas of lymphedema-related quality of life (P 0.01). Decreases in foot and ankle circumference and ADL episodes were observed during the 1995-1998 lymphedema management study (P 0.01). This study represents the first longitudinal, quantitative, leg-specific analysis examining the clinical effect of diethylcarbamazine on lymphedema progression and ADL episodes.

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A Filariasis-Control Program in American Samoa *

Cited by 32 publications

References 0 publications

The Economic Benefits Resulting from the First 8 Years of the Global Programme to Eliminate Lymphatic Filariasis (2000–2007)

The Economic Benefits Resulting from the First 8 Years of the Global Programme to Eliminate Lymphatic Filariasis (2000–2007)

Worm burden and host responsiveness in Wuchereria bancrofti infection: use of antigen detection to refine earlier assessments from the South Pacific.

A Longitudinal Analysis of the Effect of Mass Drug Administration on Acute Inflammatory Episodes and Disease Progression in Lymphedema Patients in Léogane, Haiti

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