Research for the Elimination of Lymphatic Filariasis

描述（由申请方提供）：约有1亿人感染班氏吴策线虫，这是一种蚊子传播的线虫寄生虫，可在热带地区引起变形性淋巴丝虫病。改进的治疗和诊断方法导致了对淋巴丝虫病（LF）的新思考，并认识到应该可以通过重复的大规模药物管理（MDA）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执行消除淋巴丝虫病国家方案的国家之一。我们目前的ICIDR致力于记录埃及PELF对哨点村庄丝虫病流行和传播的影响，我们还研究了不同工具对监测ELF项目进展的价值。这一新的ICIDR提案是这项工作的自然延伸。除了目前在华盛顿大学、史密斯学院和艾因夏姆斯大学（开罗）的RTC拥有不同科学背景（医学流行病学、免疫学、分子生物学和昆虫学）的研究人员组成的有凝聚力的研究小组外，新项目还在伊拉斯谟MC（鹿特丹）增加了一个强大的研究小组，该研究小组在LF传播建模和评估控制措施的影响方面具有专业知识。新的ICIDR方案将在埃及PELF第五轮也是最后一轮MDA（2004年10月完成）后大约一年开始开始。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，以评估埃及是否已消除丝虫病;在实地收集的材料和数据将用于项目2。项目2的重点是开发新的工具，用于监测环境紧急情况基金（促进项目1的目标）。我们已经组装了一个强大的核心包，以支持这些项目，并加强在RTC的研究能力。我们的人员、经验和热情使我们处于一个非常有利的位置，可以开展研究，不仅在埃及，而且在世界上许多其他流行国家，这些研究应该直接有利于消除丝虫病的努力。 项目1：消除淋巴丝虫病的研究（Weil，G.） 项目1描述（由申请人提供）：改进的治疗和诊断方法导致了对淋巴丝虫病的新思考，并认识到应该可以通过新的单剂量组合药物方案的重复年度大规模药物给药（MDA）周期来中断传播并消除这一重大公共卫生问题。埃及是第一批执行以MDA（2000年9月开始的乙胺嗪和阿苯达唑年度分发）为基础的消除淋巴丝虫病国家方案的国家之一。埃及卫生和人口部于2004年10月完成了第五轮，也是最后一轮千年发展目标评估。我们在当前ICIDR项目期间对哨点村庄进行的详细研究表明，MDA项目的最初几年对LF流行率（微丝蚴血症和循环抗原血症）和传播参数（使用小学儿童的抗体流行率作为接触寄生虫的标志物，并对蚊池中的寄生虫DMA进行PCR检测以估计蚊子感染率）产生了重大影响。事实上，黎巴嫩阵线很可能已被MDA在这些村庄消灭。新项目是这项工作的自然延伸（和重大扩展）。新项目利用了开罗艾因夏姆斯大学RTC强大的多学科丝虫病研究团队。ICIDR工作人员将与埃及卫生和人口部密切合作，开展这一雄心勃勃的项目，进行广泛的实地研究。这将是第一次尝试严格评估这种规模的国家PELF，也是第一次使用国家ELF计划作为研究实验室。我们将探讨PELF晚期的管理策略，测试消除指标，并检验埃及通过5轮MDA消除丝虫病的假设。我们还将评估先进诊断方法在检测持续传播病灶和早期发现暂停MDA后传播死灰复燃方面的价值。埃及的经验教训将使世界各地的PELF受益。

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.