Cessation of Mass Drug Administration for Lymphatic Filariasis in Zanzibar in 2006: Was Transmission Interrupted?

Abstract

BackgroundLymphatic filariasis (LF) is targeted for elimination through annual mass drug administration (MDA) for 4–6 years. In 2006, Zanzibar stopped MDA against LF after five rounds of MDA revealed no microfilaraemic individuals during surveys at selected sentinel sites. We asked the question if LF transmission was truly interrupted in 2006 when MDA was stopped.Methodology/Principal FindingsIn line with ongoing efforts to shrink the LF map, we performed the WHO recommended transmission assessment surveys (TAS) in January 2012 to verify the absence of LF transmission on the main Zanzibar islands of Unguja and Pemba. Altogether, 3275 children were tested on both islands and 89 were found to be CFA positive; 70 in Pemba and 19 in Unguja. The distribution of schools with positive children was heterogeneous with pronounced spatial variation on both islands. Based on the calculated TAS cut-offs of 18 and 20 CFA positive children for Pemba and Unguja respectively, we demonstrated that transmission was still ongoing in Pemba where the cut-off was exceeded.ConclusionsOur findings indicated ongoing transmission of LF on Pemba in 2012. Moreover, we presented evidence from previous studies that LF transmission was also active on Unguja shortly after stopping MDA in 2006. Based on these observations the government of Zanzibar decided to resume MDA against LF on both islands in 2013.

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“…The high variation in mf prevalence after a given number of treatment rounds within districts, as observed in Ghana (this study) and elsewhere [5-7] complicates decision making. If communities with high residual mf prevalence are by chance not included in surveys, MDA may be stopped prematurely with danger of resurgence [5]. This could be prevented by targeting pre-TAS surveys to communities at high risk of residual transmission.…”

“…Additional 30 countries have delivered MDA at least once in all endemic areas and are also on track to achieve elimination [4]. While many have passed the TAS, there are also reports of failure [5] and of ongoing transmission in spite of passing the TAS [5-7].…”

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