Lymphatic Filariasis Transmission and Elimination in Papua New Guinea

描述(申请人提供)：在非洲、亚洲和太平洋地区的80个中低收入国家，超过10亿人面临淋巴丝虫病(LF)的风险，淋巴丝虫病是一种由蚊子传播的寄生虫“被忽视的热带疾病”(NTD)，它会导致象皮肿、男性生殖器毁容和四肢疼痛肿胀。在过去10年中，由于班克罗夫氏舞蹈菌(WB)的目标日期为2020年(世卫组织)，全球一直在加紧努力消除低频。该战略依赖于对捐赠的抗丝虫病药物进行重复的年度大规模用药(5-7年阿苯达唑加二乙基氨基马津或伊维菌素的丙二醛)，目的是将血液传播微丝虫(MF)的储存量降至当地蚊媒继续传播所需的水平以下。然而，最近的观察表明，在许多领域，消除低频的进展停滞不前，难以确定。这个应用程序将解决两个主要缺陷。第一个问题是缺乏可靠的监测和评估方法，以便就a)是否应该继续或停止丙二醛，以及b)媒介控制措施(如长效驱虫蚊帐；LLIN)将如何利用丙二醛加速消除作出知情决定。现有的国家低频消除计划是基于世卫组织推荐的Binax快速卡片测试，该测试检测血液中的成人WB抗原。虽然这种卡片检测快速方便，但与寄生虫学检测、更敏感的寄生虫抗原特异性血清学检测相比，它在丙二醛检测后往往会产生高的假阳性和假阴性率。第二个缺陷是缺乏可靠的量化数据来评估结合使用LLIN和MDA的病媒控制以减少低频传播的相对附加效益。在目前的应用中，我们结合了&gt；25年的经验和对大量样本的访问，这些样本是在研究巴布亚新几内亚(PNG)的LF传播时获得的，使用NIH的同事提供的新抗原，以及最近在PNG引入LLIN用于疟疾流行地区的疟疾控制，在那里疟疾和LF的媒介是相同的。这项研究a)描述了低频消除的关键变量和监测工具，b)使用MDA量化了LLIN对低频消除计划的影响，以及c)在低频消除监测期间将低频传播的昆虫学和人类标记联系起来。本研究测试的有效低频消除监测工具和战略对于实现和维持巴新的低频消除以及消除低频全球方案(GPELF)所述的2020年目标至关重要。

DESCRIPTION (provided by applicant): More than a billion people in 80 mid- and low-income countries of Africa, Asia and the Pacific are at risk for lymphatic filariasis (LF), a mosquito bore parasitic worm "Neglected Tropical Disease" (NTD) that causes elephantiasis, disfigurement of the male genitalia and painful swelling of the extremities. For the past 10 years there has been intense global effort to eliminate LF due to Wuchereria bancrofti (Wb) with a target date of 2020 (WHO). The strategy relies on repeated annual mass drug administration (MDA) of donated anti-filarial drugs (5-7 years of MDA with albendazole plus diethylcarbamazine or ivermectin) with the aim to reduce the reservoir of blood borne microfilaria (MF) below a level required for continuing transmission by local mosquito vectors. However, recent observations indicate that progress toward LF elimination is stalled and difficult to ascertain in many areas. This application will address two major deficiencies. The first is a lack of robust methods for monitoring and evaluation that allow for informed decision making with respect to a) whether MDA should be continued or stopped and b) how vector control measures (such as long lasting insecticide treated bednets; LLIN) will accelerate elimination using MDA. Existing national LF elimination programs are based on the WHO recommended Binax rapid card test, which detects adult Wb antigen in the blood. Although this card test is rapid and convenient, it often produces high false positive and false negative rates following MDA when compared to parasitological assays, more sensitive parasite-antigen specific serological assays. The second deficiency is lack of robust quantitative data assessing of the relative added benefit of combining vector control using LLIN with MDA to reduce LF transmission. In the current application we combine >25 years experience and access to a large archive of samples obtained in studying LF transmission in Papua New Guinea (PNG) using novel antigens provided by colleagues at NIH and the recent introduction of LLINs in PNG for malaria control in a endemic area where the vectors for malaria and LF are the same. This study a) characterizes the critical variables and monitoring tools for LF elimination, b) quantifies the impact of LLIN on LF elimination programs using MDA, and c) links entomological and human markers of LF transmission during LF elimination monitoring. Effective LF elimination monitoring tools and strategies as tested in this study are essential to achieving and maintaining LF elimination in PNG and the stated 2020 goals of the Global Program for the Elimination of LF (GPELF).