National Nutrition Institute, General Organization for Teaching Hospitals and Institutes, Cairo, Egypt.
Ministry of Health and Population, Cairo, Egypt.
Acta Trop. 2019 Nov;199:105121. doi: 10.1016/j.actatropica.2019.105121. Epub 2019 Aug 7.
Lymphatic filariasis (LF) has been known in Egypt since ancient times. By 1930s it was recognized to be a major public health problem in the Nile Delta, and to be caused by Wuchereria bancrofti and transmitted by Culex pipiens. Remarkably, as a result of widespread DEC treatment and intensive vector control by the Ministry of Health and Population (MoHP), the infection rate of LF declined in the 1960s. However, relaxation of these efforts resulted in resurgence of filariasis in the 1980s and 1990s. In 2000, Egypt was among the first countries to join the WHO global efforts to eliminate LF as a public health problem by initiating a national LF elimination programme (NLFEP). This article reviews the history of LF control activities and summarizes the NLFEP extensive interventions to eliminate LF in Egypt. Based on MoHP data, mass drug administration (MDA) with DEC and ALB was started in 2000 in 161 implementation units (IUs). Additional IUs were included in subsequent MDA rounds, with the last IU included in 2007. MDA stopping surveys were conducted based on WHO guidelines (2005; 2011). Information about the presence of those suffering from lymphoedema/elephantiasis and hydrocele patients was collected, and care provided to those needing care in five rural health units (RHU) by primary health care system providers who were given training on LF morbidity management and disability prevention (MMDP). The NLFEP made excellent progress due to strong collaboration between different ministries, through intensive training and supervision, and the use of advocacy for mobilization of endemic communities. The epidemiological coverage for all MDA rounds was effectively ≥80%. Antigenemia levels found in schoolchildren during transmission assessment surveys (TAS) in 166 IUs approximately 10 years after stopping MDA was 0%. In 2017, TAS conducted in additional 29 IUs indicated 0.1% antigenemia and 0% microfilaremia. In 2015, the registration of chronic LF patients was updated to 1472 lymphoedema and 18 hydrocele patients. Lymphoedema patients were trained on self-management, and hydrocele patients were referred to local General Hospitals for surgery. Thus, after over a decade of sustained effort, Egypt met the WHO criteria for successful elimination of LF as a public health problem. In December 2017, WHO validated Egypt as the first country in the Eastern Mediterranean Region to successfully achieve elimination.
淋巴丝虫病（LF）在古埃及就已存在。到 20 世纪 30 年代，它被认为是尼罗河三角洲的一个主要公共卫生问题，由班氏吴策线虫引起，并通过库蚊传播。值得注意的是，由于卫生部广泛使用 DEC 治疗和强化病媒控制，LF 的感染率在 20 世纪 60 年代有所下降。然而，这些努力的放松导致丝虫病在 20 世纪 80 年代和 90 年代再次出现。2000 年，埃及是首批加入世界卫生组织全球消除 LF 作为公共卫生问题努力的国家之一，启动了国家 LF 消除规划（NLFEP）。本文回顾了 LF 控制活动的历史，并总结了 NLFEP 在埃及消除 LF 的广泛干预措施。根据卫生部的数据，2000 年，在 161 个实施单位（IU）开始用 DEC 和 ALB 进行大规模药物治疗（MDA）。在随后的 MDA 回合中增加了额外的 IU，最后一个 IU 于 2007 年包括在内。根据世界卫生组织的指导方针（2005 年；2011 年）进行 MDA 停止调查。收集了患有淋巴水肿/象皮病和鞘膜积液患者的信息，并在五个农村卫生单位（RHU）通过接受 LF 发病率管理和残疾预防培训的初级保健系统提供者提供护理。NLFEP 取得了出色的进展，这得益于不同部委之间的密切合作，通过密集培训和监督，以及利用宣传动员流行地区社区。所有 MDA 回合的流行病学覆盖面有效率均≥80%。在停止 MDA 大约 10 年后，在 166 个 IU 进行的传播评估调查（TAS）中，在学龄儿童中发现的抗原血症水平为 0%。2017 年，在另外 29 个 IU 进行的 TAS 表明抗原血症为 0.1%，微丝蚴血症为 0%。2015 年，对慢性 LF 患者的登记进行了更新，登记了 1472 名淋巴水肿患者和 18 名鞘膜积液患者。对淋巴水肿患者进行了自我管理培训，对鞘膜积液患者转介到当地综合医院进行手术。因此，经过十多年的持续努力，埃及达到了世界卫生组织成功消除 LF 作为公共卫生问题的标准。2017 年 12 月，世界卫生组织验证埃及是东地中海区域第一个成功消除 LF 的国家。
