Mass Drug Administration with or Without Insecticide

消除淋巴丝虫病的全球规划（GPELF）是基于这样一种预期，即每年4至6次大规模给药（MDA）将使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。这一战略是根据目前有限的实地数据制定的，在这些地方，LF感染负担和发病率很高。我们的长期目标是评估被禁止的GPELF战略在巴布亚新几内亚的一个地区是否持续，在那里我们以前几乎完全消除了LF感染和传播，每年有四个周期的MDA，评估在新的人群中，MDA与媒介控制的结合是否能提高发病率控制和消除传播，以及在什么水平的LF流行下，这些补充干预措施是最有效的。具体目标是：1。确定目前推荐的GPELF MDA策略对降低LF发病率和感染的长期影响。我们将确定连续4轮MDA所导致的lf相关疾病和人类感染指标的减少/消除是否在停止任何系统干预后持续7至8年。2.量化媒介控制（杀虫剂浸渍蚊帐，ITN）与MDA（年单剂量DEC加阿苯达唑）对按蚊传播的班氏乌氏菌的附加效益。本研究的目的是比较高传播区和中度传播区以前未经治疗的居民在使用ITN加MDA或单独使用MDA后LF发病率和感染的变化。3. 评估丙二醛和ITN对土壤传播蠕虫感染水平和传播及相关合并症的影响。这一目的是确定含有阿苯达唑的丙二醛是否能提高学龄儿童的健康水平，以及在经丙二醛处理的人群中是否可能出现对苯并咪唑的寄生虫耐药性。

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.