Bureau of Vector Borne Diseases, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand.
Office of Disease Prevention and Control, Ministry of Public Health, Songkhla, Thailand.
Infect Dis Poverty. 2019 May 27;8(1):38. doi: 10.1186/s40249-019-0549-1.
Lymphatic filariasis is endemic in nine of the eleven Member States of the World Health Organization South East Asia Region. This article describes the intensive interventions with the National Programme for Elimination of Lymphatic Filariasis in Thailand since its launch in 2001 till the validation of its elimination in 2017.
A baseline epidemiological survey was initiated in 2001 to identify both brugian and bancroftian filarial areas and delineate its endemicity. Mass drug administration (MDA) with diethylcarbamazine citrate (DEC) and albendazole (ALB) was implemented in a total of 357 implementation units (IUs) in 11 lymphatic filariasis (LF) endemic provinces. The implementing unit (IU) was a sub-village. Stop-MDA surveys were conducted in 2006 in the 11 LF endemic provinces among population over 6 years of age and children of ≤6 years using immunochromatographic test (ICT) for Wuchereria bancrofti antigen and microfilariae (mf) detection for Brugia malayi. In Narathiwat province, Stop-MDA surveys were done in 2011 using ELISA. Transmission assessment surveys (TAS) were conducted in 2012-2013, 2015 and 2016-2017 among school students in the 6-7-year age-group. Surveillance of migrant populations through the national migrant health checkup were intensified in seven provinces over 2002-2017 for LF antigenaemia using ICT test cards. In four B. malayi endemic provinces, annual surveys to detect LF reservoir in domestic cats commenced in 1994. A 2001 survey of the chronic disease burden for LF established a register of the cumulative number of people with lymphedema/elephantiasis.
A total of five rounds of MDA annually were implemented over 2002-2006 in all IUs. Additional annual rounds of MDA were required in 87 IUs of Narathiwat province from 2007 to 2011 due to persistent infection. The annual national drug coverage with MDA over 2002-2012 was in the range of 68.0 to 95.4%. Stop-MDA surveys in 2006 in the 11 LF endemic provinces found nine mf positive cases in seven IUs in Narathiwat province with the highest prevalence of 0.8% (range: 0.1-0.8%). In Narathiwat TAS-1, TAS-2 and TAS-3 detected below transmission threshold rates for B. malayi mf among antibody positive children (0.3, 0.2 and 0.7% respectively). Contact tracing both all mf cases in all three TAS yielded no positive cases. Through the migrant health checkup, a total of 23 477 persons were tested, showing a positive rate of 0.7% (range: 0.1-2.7%) over years 2002-2017. In Narathiwat province, annual ivermectin treatment among cats commenced in 2003 resulting in a decline of mf prevalence among cats from 8.0% in 1995 to 0.8% in 2015. As of April 2017, a total of 99 lymphoedema/elephantiasis patients were registered and followed-up under 34 health facilities.
Thailand over the years 2002 to 2011 conducted extensive MDA with high coverage rates. Through periodic and regular monitoring surveys it delineated LF transmission areas at sub-village level and demonstrated through its evaluation surveys - the Stop-MDA surveys and TAS, below transmission threshold rates that enabled its validation of LF elimination. In September 2017, World Health Organization acknowledged the Ministry of Health Thailand had eliminated lymphatic filariasis as a public health problem.
世界卫生组织东南亚区域的 11 个会员国中有 9 个流行淋巴丝虫病。本文描述了自 2001 年国家消灭淋巴丝虫病计划启动以来，泰国在消除淋巴丝虫病方面所进行的密集干预措施，直至 2017 年获得验证。
2001 年开展了基线流行病学调查，以确定班氏和马来丝虫病流行区并划定其流行范围。在 11 个淋巴丝虫病流行省份的 357 个实施单位（IU）中实施了包括乙胺嗪和阿苯达唑在内的大规模药物治疗（MDA）。实施单位（IU）是一个小村庄。2006 年在 11 个淋巴丝虫病流行省份对 6 岁以上和≤6 岁的人群进行了停止 MDA 调查，使用免疫层析试验（ICT）检测班氏丝虫抗原和马来丝虫微丝蚴（mf）。在那拉提瓦省，2011 年使用 ELISA 进行了停止 MDA 调查。2012-2013 年、2015 年和 2016-2017 年在 6-7 岁学生中进行了传播评估调查（TAS）。2002-2017 年期间，在 7 个省份通过国家移民健康检查加强了对移民人群的监测，使用 ICT 测试卡检测 LF 抗原血症。在 4 个马来丝虫病流行省份，从 1994 年开始每年对家猫中的 LF 储存宿主进行调查。2001 年对淋巴丝虫病慢性疾病负担的调查建立了一个累计患有淋巴水肿/象皮病人数的登记册。
2002-2006 年期间，所有 IU 每年进行五轮 MDA。由于持续感染，2007-2011 年那拉提瓦省的 87 个 IU 需要额外的年度 MDA 轮次。2002-2012 年期间，全国 MDA 的年度药物覆盖率在 68.0%至 95.4%之间。2006 年在 11 个淋巴丝虫病流行省份进行的停止 MDA 调查发现，在那拉提瓦省的 7 个 IU 中发现了 9 例 mf 阳性病例，其中最高流行率为 0.8%（范围：0.1-0.8%）。在那拉提瓦 TAS-1、TAS-2 和 TAS-3 中，抗体阳性儿童的 B. malayi mf 传播阈值率均低于检测阈值（分别为 0.3%、0.2%和 0.7%）。对所有三个 TAS 中的所有 mf 病例进行接触者追踪均未发现阳性病例。通过移民健康检查，共检查了 23477 人，2002-2017 年期间的阳性率为 0.7%（范围：0.1-2.7%）。在那拉提瓦省，2003 年开始对猫进行伊维菌素治疗，导致猫中 mf 流行率从 1995 年的 8.0%下降到 2015 年的 0.8%。截至 2017 年 4 月，共有 99 名淋巴水肿/象皮病患者在 34 个卫生机构登记并接受随访。
泰国在 2002-2011 年期间进行了广泛的 MDA，覆盖率很高。通过定期和定期监测调查，在小村庄一级划定了淋巴丝虫病传播区，并通过停止 MDA 调查和 TAS 评估调查证明，传播阈值率低于该阈值，从而验证了淋巴丝虫病的消除。2017 年 9 月，世界卫生组织承认泰国卫生部已经将淋巴丝虫病作为一个公共卫生问题消除。
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