Impact of Mass Drug Administration with or Without Insecticide Impregnated Nets

全球消除淋巴丝虫病计划(GPELF)是基于这样的预期，即每年4至6次的大规模药物管理(MDA)将把淋巴丝虫病的发病率降低到可接受的水平，并阻断传播，从而导致淋巴丝虫病的灭绝。这一战略的基础是来自LF感染负担和发病率高的现场环境的有限数据。我们的长期目标是评估被禁的GPELF战略在巴布亚新几内亚的一个地区得到了持续，我们之前在该地区几乎完成了四个年度周期的丙二醛消除低频感染和传播，评估在新人口中，将丙二醛与病媒控制相结合是否加强了发病率控制和传播消除，以及在什么低频地方性水平下，这些补充干预措施最有效。具体目标是：1.确定目前推荐的GPELF MDA策略在减少LF发病率和感染方面的长期影响。我们将确定在停止任何系统干预后7至8年，连续4轮丙二醛导致的低频相关疾病和人类感染指标的减少/消除是否持续。2.量化媒介控制(浸药蚊帐)对丙二醛(每年单剂DEC加阿苯达唑)对班氏按蚊传播的吴氏按蚊的附加效益。本研究的目的是比较高传播区和中传播区未经治疗的居民在接受ITN加丙二醛治疗或单独使用丙二醛治疗后LF发病率和感染的变化。3.评估丙二醛和ITN对土壤传播蠕虫和相关共生疾病的感染水平和传播的影响。这一目的决定了包括阿苯达唑在内的丙二醛是否增加了学龄儿童的幸福感，以及在丙二醛处理的人群中可能出现的对苯并咪唑的寄生虫耐药性。 这项工作补充了对蚊媒的平行研究，并为低频生态学和根除的数学建模提供了经验数据。这些相互关联的项目的结果不仅将为巴布亚新几内亚的公共卫生政策提供信息，也将为世界上其他通过按蚊传播低频和疟疾的地区，如撒哈拉以南非洲地区提供信息。

The global program to eliminate lymphatic filariasis (GPELF) is based on the expectation that 4 to 6 annual mass drug administrations (MDA) will reduce LF morbidity to an acceptable level and interrupt transmission, thereby leading to extinction of LF. This strategy is based on as yet limited data from field settings where the burden of LF infection and morbidity are high. Our long terms goals are to assess the proscribed GPELF strategy has been sustained in an area of Papua New Guinea where we have previously nearly completed eliminated LF infection and transmission with four annual cycles of MDA, evaluate in new populations whether integration of MDA with vector control enhances morbidity control and transmission elimination, and under what levels of LF endemicity these complementary interventions are most effective. The specific aims are: 1.To determine the long-term impact of the currently recommended GPELF MDA strategy on reduction of LF morbidity and infection. We will determine whether reduction/elimination of LF-related disease and human infection indicators resulting from 4 consecutive rounds of MDA are sustained 7 to 8 years after cessation of any systematic intervention. 2.To quantify the added benefit of vector control (insecticide impregnated mosquito nets, ITN) to MDA (annual single dose DEC plus albendazole) on Anopheles mosquito-transmitted Wuchereria bancrofti. This aim compares changes in LF morbidity and infection following institution of ITN plus MDA or MDA alone in previously untreated residents of high transmission and moderate transmission areas. 3. To estimate the impact of MDA and ITN on infection levels and transmission of soil transmitted helminths and associated co-morbidities. This aim determines whether MDA that includes albendazole increases the well being of school children, and the possible emergence of parasite resistance against benzimidazole in MDA-treated populations. This work complements parallel studies of the mosquito vector and provides empirical data for mathematical modeling of LF ecology and eradication. Results of these inter-related projects will inform public health policy not only in Papua New Guinea but also other areas of the world where both LF and malaria are transmitted by Anopheles mosquitoes, such as sub-Saharan Africa.