Effectiveness of a triple-drug regimen for global elimination of lymphatic filariasis: a modelling study.


Background

Lymphatic filariasis is targeted for elimination as a public health problem by 2020. The principal approach used by current programmes is annual mass drug administration with two pairs of drugs with a good safety profile. However, one dose of a triple-drug regimen (ivermectin, diethylcarbamazine, and albendazole) has been shown to clear the transmissible stage of the helminth completely in treated individuals. The aim of this study was to use modelling to assess the potential value of mass drug administration with the triple-drug regimen for accelerating elimination of lymphatic filariasis in different epidemiological settings.

Methods

We used three different transmission models to compare the number of rounds of mass drug administration needed to achieve a prevalence of microfilaraemia less than 1% with the triple-drug regimen and with current two-drug regimens.

Findings

In settings with a low baseline prevalence of lymphatic filariasis (5%), the triple-drug regimen reduced the number of rounds of mass drug administration needed to reach the target prevalence by one or two rounds, compared with the two-drug regimen. For areas with higher baseline prevalence (10–40%), the triple-drug regimen strikingly reduced the number of rounds of mass drug administration needed, by about four or five, but only at moderate-to-high levels of population coverage (>65%) and if systematic non-adherence to mass drug administration was low.

Interpretation

Simulation modelling suggests that the triple-drug regimen has potential to accelerate the elimination of lymphatic filariasis if high population coverage of mass drug administration can be achieved and if systematic non-adherence with mass drug administration is low. Future work will reassess these estimates in light of more clinical trial data and to understand the effect on an individual country’s programme.

Table Salt Can Eliminate This Crippling Disease By 2020 .


Cargill fighting lymphatic filariasis with salt

To help Haiti eliminate lymphatic filariasis, a disease that affects nearly half of its population, Cargill teams up with the Reverend Thomas Streit C.S.C. and the University of Notre Dame’s Haiti Program.

When Jim Reimer retired, he did not anticipate the important role he and the company would play in helping millions of Haitians combat a terrible disease. In 2012, Reimer became involved in the University of Notre Dame’s Haiti Program, which works to rid Haiti of lymphatic filariasis (LF) by 2020.

LF is a disease spread by mosquitos that can lead to the extreme swelling of various body parts. It also carries a cultural stigma, which can result in victims being shunned and excluded from their communities. Despite its devastating effects, LF is one of only a few infectious diseases that have the potential to be completely eliminated. Knowing this, Reimer, a former Cargill executive, and a team of Cargill employees partnered with the Reverend Thomas Streit C.S.C., the founder of the University of Notre Dame Haiti Program, to work toward this goal.

The solution came in the form of a common food: salt. Everyone eats salt on a regular basis, so delivering medication by fortifying salt proved to be an effective way to fight the disease.

Because Haitians typically consume a type of salt that contains many impurities, it was difficult to add the medication successfully. To overcome the production challenges, Cargill worked with the University’s Haiti Program, providing technical expertise as well as US $150,000 in donations over a three-year period.

Current efforts to defeat LF have positioned the program to meet its goal of ending the disease in Haiti by 2020. A new salt processing plant located near the country’s capital is run by the Congregation of the Holy Cross to help with the large-scale production of fortified salt. The salt treatment method also offers the opportunity to address several other health issues in Haiti, including working to correct an endemic iodine deficiency, reducing other parasites like hookworm that can harm children and strengthening Haiti’s public health infrastructure.