New data in Lancet confirm potential to eliminate Lymphatic Filariasis

Friday 24 March 2006 - Clear evidence that Lymphatic Filariasis (LF, commonly known as elephantiasis) can be eliminated is reported in the March 25 issue of The Lancet. LF is one of the world’s most disfiguring and disabling parasitic diseases, and the target of one of the largest global public health programmes using mass drug administration (MDA).

Commenting on the data Professor David Molyneux of the Liverpool School of Tropical Medicine says “In this landmark publication, new data from the national programme in Egyptshow that we can, using the World Health Organization (WHO) recommended strategy of an annual drug distribution, end the cycle of transmission of lymphatic filariasis by mosquitoes.”

LF has plagued Egypt since the time of the pharaohs; yet this simple strategy - to provide diethylcarbamazine (DEC) plus albendazole (donated by GlaxoSmithKline) once a year for five years to the majority of people in affected communities - reduces infection rates, leading to elimination of the disease.

The world has seen the successful elimination of only one disease — smallpox - and these promising data provide imminent hope for eliminating another. As part of the WHO led global effort to eliminate LF, Egyptwas among the first countries to implement a national programme.

Gary Weil, M.D. senior author and professor of medicine and molecular microbiology at WashingtonUniversityin St. Louis, Missouricommented “Our assessments suggest that the Egyptian campaign to eliminate LF, which was implemented by the Egyptian Ministry of Population and Health, has achieved its goals in most areas of the country.”

Using several tests, Egyptian scientists were able to assess infection and transmission parameters over the five years of the mass drug administration. All the tests revealed sharp declines. For example, community parasite loads (a broad measure of infection) declined by more than 90% after MDA; antibody tests in 5 year old school children showed that levels of exposure to infection declined by 99 -100%.

LF threatens over one billion people in 83 countries. Approximately 120 million people are infected with the parasites, 40 million of whom have clinical symptoms of the disease. The Global Alliance to Eliminate LF was formed with the support of the pharmaceutical companies GlaxoSmithKline and Merck to help countries with LF respond. GSK has donated over 440 million albendazole tablets to date, which serve as a cornerstone of the programme.

JP Garnier, CEO of GlaxoSmithKline added “The Egypt data show that we can now eliminate a disease that has plagued the world for centuries. We remain committed to donating as much albendazole as required to eliminate this disabling disease, but ultimate success will depend on continued long-term commitments by all partners across the globe.”

The Global Alliance to Eliminate LF will meet in Fijinext week where the future prospects and challenges for eliminating LF by the year 2020 will be discussed. The Alliancebrings together national Ministries of Health and more than 40 diverse public and private partners including the World Health Organization, private sector companies, international development agencies and foundations, non-governmental organisations, research institutions, and local communities.

Despite this promising scientific validation from Egyptand the building of the global partnership, many challenges lie ahead. As LF affects the world’s poorest countries, there is an urgent need for additional external resources to continue the momentum towards elimination. Several countries in Africaand Asiathat are poised to initiate an elimination programmes or scale-up activities cannot do so because of lack of funding. More help and support from existing and new donors is desperately needed.

Reaching the world’s entire at-risk population for at least five years presents a daunting task; but, as the data from Egyptconfirm, country by country, it is possible to defeat this disease and protect future generations.

About Lymphatic Filariasis (LF):

LF is caused by a microscopic, parasitic worm that invades the human lymphatic system. The disease is spread by mosquitoes that carry the filarial worms Wuchereria bancrofti, Brugia malayi, and Brugia timori. The disease can cause devastating symptoms such as grotesquely swollen legs, arm and genitals, as well as debilitating fevers and pain. The disease is usually contracted in childhood, often before the age of five. The disabling aspects of the disease exacerbate the cycle of poverty as those suffering from LF are often too incapacitated to provide adequately for their families. They also become ostracised from school and community life.

The LF programme is an ambitious global partnership to eliminate the disease over a 20-year period. Two medicines given once a year for at least five years can halt transmission of the disease — GlaxoSmithKline donates one of the two required drugs, albendazole, globally. For Africa, Mectizan®, donated by Merck & Co. Inc. is given with albendazole; outside Africa, DEC is used with albendazole.

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