Progress toward elimination of lymphatic filariasis--Togo, 2000--2009.

Lymphatic filariasis (LF) is a disabling, mosquito-borne disease of humans caused by the parasitic filarial nematodes Wuchereria bancrofti, Brugia malayi, and Brugia timori. In 2000, the Global Program to Eliminate LF (GPELF) was established with the objective of eliminating LF as a public health problem by 2020. At that time, 80 countries had ongoing transmission, with an estimated 1.34 billion persons at risk for infection and 120 million infected. This report describes the LF elimination program in Togo, one of the 39 LF-endemic countries in the World Health Organization (WHO) African Region. Togo's approach to interrupt LF transmission included screening for infection to identify LF-endemic districts and mass drug administration (MDA) of ivermectin and albendazole in LF-endemic districts. MDA coverage and the impact of MDAs on the prevalence of infection were monitored throughout the program. In 2000, seven of 35 districts were LF-endemic, with baseline prevalence rates ranging from 1% to 22%. By 2009, MDAs had been conducted at least six times in each LF-endemic district. At that time, the decision was made to stop MDAs because reported drug coverage in LF-endemic districts exceeded 80% and no microfilaremia was detected in persons tested to monitor impact of MDAs. Togo is the first sub-Saharan country to have stopped MDAs after prevalence data suggested that LF transmission had been interrupted. Post-MDA surveillance is continuing nationally; the next step will be to certify elimination. The successful Togo program demonstrates that LF elimination can be achieved in countries with limited resources.