Research for the Elimination of Lymphatic Filariasis: Egyptian Endgame

改进的治疗和诊断方法导致了对淋巴丝虫病的新思考， 认识到阻断传播和消除这一重大公共卫生问题应该是可能的 通过使用新的单剂量复方药物进行重复的年度大规模药物给药（MDA）周期 养生法埃及是最早实施国家消除淋巴结核计划的国家之一。 丝虫病（PELF）基于MDA（乙胺嗪和阿苯达唑的年度分布，始于2009年） 2000年9月）。埃及卫生和人口部（MOHP）完成了第五次也是最后一次 在2004年10月的一轮MDA。我们在当前ICIDR项目期间对哨点村庄的详细研究 表明MDA项目的最初几年对LF患病率（微丝蚴血症和 循环抗原血症）和传播参数（使用小学抗体流行率 儿童作为接触寄生虫的标志物，并在蚊池中进行寄生虫DMA的PCR检测， 估计蚊子感染率）。事实上，黎巴嫩阵线很可能已被MDA在这些村庄消灭。的 新项目是该工作的自然延伸（和主要扩展）。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小组。ICIDR人员 将与埃及卫生和人口部密切合作，实施这一雄心勃勃的项目， 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， 也是第一个使用国家ELF计划作为研究实验室的国家。我们将探讨战略， 管理PELF的后期阶段，测试消除指标，并测试丝虫病已被 在埃及被5轮MDA淘汰。我们还将评估先进的诊断方法的价值， 检测继续传播的疫源地，并及早发现 MDA的悬浮液。埃及的经验教训将使世界各地的PELF受益

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