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Text Latian Meeting 12
Text Latian Meeting 12
Treatment
Elimination of lymphatic filariasis is possible by stopping the spread of the infection through
preventive chemotherapy. The WHO-recommended preventive chemotherapy strategy for
lymphatic filariasis elimination is mass drug administration (MDA).
The MDA regimen recommended depends on the co-endemicity of lymphatic filariasis with
other filarial diseases. WHO recommends the following MDA regimens:
albendazole (400 mg) alone twice per year for areas co-endemic with loiasis;
ivermectin (200 mcg/kg) with albendazole (400 mg) in countries with onchocerciasis;
diethylcarbamazine citrate (DEC) (6 mg/kg) and albendazole (400 mg) in countries without
onchocerciasis; and
ivermectin (200 mcg/kg) together with diethylcarbamazine citrate (DEC) (6 mg/kg) and
albendazole (400 mg) in countries without onchocerciasis and where other programmatic
conditions are met.
The impact of MDA depends on the efficacy of the regimen and the coverage (proportion of total
population ingesting the medicines). MDA with the 2-medicine regimens have interrupted the
transmission cycle when conducted annually for at least 4–6 years with effective coverage of
the total population at risk. Salt fortified with DEC has also been used in a few unique settings to
interrupt the transmission cycle.
At the start of GPELF, 81 countries were considered endemic for lymphatic filariasis. Further
epidemiological data reviewed since, indicate that preventive chemotherapy was not required in
10 countries. From 2000 to 2021, 9 billion cumulative treatments were delivered to more than
935 million people at least once in 70 countries, considerably reducing transmission in many
places. The population requiring MDA has declined by 52% (740 million) where infection
prevalence has been reduced below elimination thresholds. The overall economic benefit of the
programme during 2000–2007 is conservatively estimated at US$ 24 billion. Treatments until
2015 are estimated to have averted at least US$ 100.5 billion of economic loss expected to
have occurred over the lifetime of cohorts who have benefited from treatment.
Seventeen countries and territories (Cambodia, the Cook Islands, Egypt, Kiribati, Maldives,
Malawi, Marshall Islands, Niue, Palau, Sri Lanka, Thailand, Togo, Tonga, Vanuatu, Viet Nam,
Wallis and Futuna, and Yemen) are now acknowledged as achieving elimination of lymphatic
filariasis as a public health problem. By 2021, 11 countries had successfully implemented
recommended strategies, stopped large-scale treatment and are under surveillance to
demonstrate that elimination has been achieved. Preventive chemotherapy is still required in 44
countries and within 9 of these countries MDA has not yet been delivered to all endemic areas
as of the end of 2021.