LF
This review summarizes the
progress towards control of lymphatic filariasis (LF) and onchocerciasis,
focussing on the impact of mass drug administration (MDA) programmes, in
particular those that have developed following the donation of ivermectin and
albendazole. The contrasting strategies and objectives of the different
programmes are compared, and the impact on transmission, clinical disease and
public health assessed. The constraints on programme success are: (i) the
absence of a macrofilaricide, which can be used in a public health context;
(ii) the sustainability of high coverage of ivermectin over many years in
onchocerciasis control; and (iii) the problem of treatment in areas where Loa
loa (tropical eye worm) is co-endemic with onchocerciasis because of the rare
severe adverse events. LF programmes are expanding rapidly in over 30
countries, where circa 60 million people received treatments in 2002. No serious
adverse events have been associated with MDAs for LF elimination. Research on
new approaches to treatment using antibiotics are showing promising results in
pilot settings because doxycyline has been shown to have long-term embryostatic
effects and sustained reductions of microfilaria loads in onchocerciasis and
bancroftian filariasis.