Research for the Elimination of Lymphatic Filariasis

描述（由申请人提供）：大约有1亿人感染了班氏乌切里氏菌，这是一种蚊子传播的线虫寄生虫，在热带地区会导致淋巴丝虫病的变形。治疗和诊断方法的改进使人们对淋巴丝虫病（LF）有了新的认识，并认识到应该有可能通过反复的大规模给药周期来中断传播并消除这一重大公共卫生问题。埃及是世界上最早根据这一战略实施消除淋巴丝虫病国家规划的国家之一。我们目前的ICIDR致力于记录埃及PELF对哨村丝虫病流行和传播的影响，并对监测ELF项目进展的不同工具的价值进行了研究。这项新的ICIDR提案是这项工作的自然延伸。除了目前华盛顿大学、史密斯学院和艾因沙姆斯大学（开罗）RTC具有不同科学背景（医学流行病学、免疫学、分子生物学和昆虫学）的研究人员组成的凝聚力小组之外，新项目还在伊拉斯谟医学中心（鹿特丹）增加了一个强大的研究小组，具有模拟LF传播和评估控制措施影响的专业知识。新的ICIDR项目将在埃及PELF的第五轮和最后一轮MDA（2004年10月完成）大约一年后开始。该方案由两个相互关联的项目组成：项目1将在广泛的实地研究中使用现有的最佳诊断工具，以评估丝虫病在埃及是否已被消灭；在现场收集的资料和数据将用于项目2。项目2的重点是开发监测PELFs的新工具（促进项目1的目标）。我们已经组建了一个强大的核心包来支持这些项目，并加强RTC的研究能力。我们的人员、经验和热情使我们在开展研究方面处于有利地位，不仅在埃及，而且在世界上许多其他流行丝虫病的国家，这些研究应直接有利于消除丝虫病的努力。

DESCRIPTION (provided by applicant): Approximately 100 million people are infected with Wuchereria bancrofti, a mosquito-transmitted nematode parasite that causes deforming lymphatic filariasis in the tropics. Improved therapies and diagnostic methods have led to new thinking about lymphatic filariasis (LF) and the realization that it should be possible to interrupt transmission and eliminate this major public health problem by repeated cycles of mass drug administration (MDA). Egypt was one of the first countries in the world to implement a national program for elimination of lymphatic filariasis (PELF) based on this strategy. Our current ICIDR has worked to document the impact of the Egyptian PELF on filariasis prevalence and transmission in sentinel villages, and we have conducted research on the value of different tools for monitoring progress in ELF programs. This new ICIDR proposal is a natural extension of that work. In addition to the current cohesive group of researchers with different scientific backgrounds (medical epidemiology, immunology, molecular biology, and entomology) at Washington University, Smith College, and the RTC at Ain Shams University (Cairo), the new project adds a strong research group at Erasmus MC (Rotterdam) with expertise in modeling LF transmission and assessing the impact of control measures. The new ICIDR program will begin approximately one year after the 5th and final round of MDA in the Egyptian PELF (completed in October, 2004). The program is comprised of two interrelated projects: Project 1 will use the best available diagnostic tools in extensive field studies to assess whether filariasis has been eliminated in Egypt; materials and data collected in the field will be used in Project 2. Project 2 is focused on development of new tools for monitoring PELFs (promoting the objectives of Project 1). We have assembled a strong package of Cores to support these Projects and strengthen research capacity at RTC. Our personnel, experience, and enthusiasm place us in an excellent position to conduct research that should directly benefit efforts to eliminate filariasis, not only in Egypt, but also in many other endemic countries around the world. PROJECT 1: Research for the Elimination of Lymphatic Filariasis (Weil, G.) PROJECT 1 DESCRIPTION (provided by applicant): Improved therapies and diagnostic methods have led to new thinking about lymphatic filariasis and the realization that it should be possible to interrupt transmission and eliminate this major public health problem by repeated, annual cycles of mass drug administration (MDA) with new single dose combination drug regimens. Egypt was one of the first countries to implement a national program for elimination of lymphatic filariasis (PELF) based on MDA (annual distribution of diethylcarbamazine and albendazole, initiated in September 2000). The Egyptian Ministry of Health and Population (MOHP) completed its 5th and final round of MDA in October, 2004. Our detailed studies of sentinel villages during the current ICIDR project showed that the initial years of the MDA program had a major impact on LF prevalence (microfilaremia and circulating antigenemia) and transmission parameters (using antibody prevalence rates in primary school children as a marker for exposure to the parasite and PCR detection of parasite DMA in mosquito pools to estimate mosquito infection rates). Indeed, it is likely that LF was eliminated by MDA in these villages. The new project is a natural extension (and major expansion) of that work. The new project takes advantage of the strong, multidisciplinary filariasis research team at RTC, Ain Shams University in Cairo. ICIDR personnel will work closely with the Egyptian Ministry of Health and Population to carry out this ambitious project with extensive field studies. This will be the first attempt to rigorously assess a national PELF on this scale and also the first to use a national ELF program as a research laboratory. We will explore strategies for managing late stages of a PELF, test elimination indicators, and test the hypothesis that filariasis has been eliminated in Egypt by 5 rounds of MDA. We will also assess the value of advanced diagnostic methods for detecting foci of continued transmission and for early detection of resurgent transmission following suspension of MDA. Lessons learned in Egypt will benefit PELFs around the world.