Ojha Chet Raj, Joshi Basant, Kc Khagendra Prakash, Dumre Shyam Prakash, Yogi Keshav Kumar, Bhatta Bandana, Adhikari Tulasi, Crowley Kathryn, Marasini Babu Ram
Department of Immunology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America.
Leadership for Environment and Development Nepal, Kathmandu, Nepal.
PLoS Negl Trop Dis. 2017 Jul 19;11(7):e0005788. doi: 10.1371/journal.pntd.0005788. eCollection 2017 Jul.
Lymphatic filariasis (LF) is a neglected tropical disease transmitted by mosquitoes. Nepal has implemented a national effort to eliminate LF by 2020 through mass drug administration (MDA) using diethylcarbamazine (DEC) and albendazole (ALB). We assessed the impact of MDAs on LF in selected districts of Nepal after the recommended six MDA rounds had been completed.
Baseline surveys were conducted in seven districts and mapping data were used as baseline in the other three districts before starting MDA in 2009. LF antigen (Ag) prevalence ranged from 1.06% to 20% among districts included in the baseline and mapping study. The number of people who received DEC and ALB were recorded during each MDA round and population-based cluster surveys were conducted at least once in each district during the life of the program. The reported MDA coverage in five districts was consistently at least 65%. Two districts achieved the targeted coverage in four out of five rounds and the rest three districts achieved the target only in the first round. A pre-transmission assessment survey (pre-TAS) was conducted in one sentinel site and at least one spot check site in each of the districts after five MDA rounds. In pre-TAS, all the sites of five districts (Pyuthan, Arghakhanchi, Kaski, Bhaktapur, and Kathmandu) and all but one spot check site of Lalitpur district had LF Ag < 2% (ranging from 0.0% to 1.99%). Transmission assessment survey (TAS) was conducted in six evaluation units (EUs) consisting of six districts qualified on pre-TAS. Though MDA coverage of 65% was not achieved in three districts (Kathmandu, Lalitpur and Bhaktapur), Nepal government in consultation with World Health Organization (WHO) decided to conduct TAS. All six EUs achieved the LF Ag threshold required to stop MDA in TAS, despite the low reported MDA coverage in those three districts.
Although Nepal has achieved significant progress towards LF elimination, five rounds of MDA were not sufficient to disrupt the transmission cycle in all districts, probably because of high baseline prevalence.
淋巴丝虫病（LF）是一种由蚊子传播的被忽视的热带病。尼泊尔已开展全国性工作，计划到2020年通过使用乙胺嗪（DEC）和阿苯达唑（ALB）进行大规模药物给药（MDA）来消除淋巴丝虫病。在完成推荐的六轮MDA后，我们评估了MDA在尼泊尔选定地区对淋巴丝虫病的影响。
2009年开始MDA之前，在七个地区进行了基线调查，并将测绘数据用作其他三个地区的基线。在纳入基线和测绘研究的地区中，LF抗原（Ag）患病率在1.06%至20%之间。在每轮MDA期间记录接受DEC和ALB的人数，并在该项目实施期间在每个地区至少进行一次基于人群的整群调查。五个地区报告的MDA覆盖率始终至少为65%。两个地区在五轮中的四轮达到了目标覆盖率，其余三个地区仅在第一轮达到了目标。在五轮MDA后，在一个哨点和每个地区至少一个抽查点进行了传播前评估调查（pre-TAS）。在pre-TAS中，五个地区（皮乌坦、阿尔加坎奇、卡斯凯、巴克塔普尔和加德满都）的所有地点以及勒利德布尔区除一个抽查点外的所有地点的LF Ag < 2%（范围为0.0%至1.99%）。在由六个在pre-TAS中合格的地区组成的六个评估单位（EU）中进行了传播评估调查（TAS）。尽管加德满都、勒利德布尔和巴克塔普尔三个地区未达到65%的MDA覆盖率，但尼泊尔政府与世界卫生组织（WHO）协商后决定进行TAS。尽管这三个地区报告的MDA覆盖率较低，但所有六个EU在TAS中都达到了停止MDA所需的LF Ag阈值。
尽管尼泊尔在消除淋巴丝虫病方面取得了重大进展，但五轮MDA不足以在所有地区打破传播循环，可能是因为基线患病率较高。
