The PacELF way: towards the elimination of lymphatic filariasis from the Pacific, 1999-2005 by Alexander Pascual

•

•• ....

II .

the elimination of lymphatic filariasis from the Pacific

1999-2005

.~, World Health ~ Organization

Prepared by PacELF

Western Pacific Region

WHO Library Cataloguing in Publication Data The PacELF Way: towards the: eUmlnation oftymphatk fit.Arla.sis from the PadOc, 1999- 2005.

1. Beph.antJasts..Fltarial- dlagnosl$,drug therapy, epidemiology,histry, prevatk>n and (Ontrol, transmission. 2. RlarlcidM-supply a.nd disuibution, therapeutic use. l. Program me development. 4. International cooperation. S. Paciflc 1.sland$. I. khimort, Kazuyo. II. World Health Organiz.atlon, Regional OffKe fe>r the Westem PCKffic.

IS8N9?906121SO

(NLM Classification: WC 880)

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Contents

Abbreviations Foreword ............................................................................................................................. iv Preface .................................................................................................................................... v Acknowledgements ...................................................................................................... vi Overview ............................................................................................................................ vii Part 1 Chapter 1: Background .................................................................................................... 1 Lymphatic Filariasis .................................................................................................... 1 Biology .......................................................................................... .......................... 1 Life Cycle ......•...•.•.................•..•...•...............................•....•...............•...................... 2 Pathogenesis ........................................................................................................... 2 Transmission ........................................................................................................... 4 Diagnostics •.........................•..............................•..............................•.................... 5 Control Measures .................. ............................... .................................................. 7 Vector Control ................... ... ........................................................ .......................... 9 Global Programme to Eliminate Lymphatic Filariasis .......................................... 1O Formation of the Global Programme ....................•......................•..•.........•....•...... 10 Organization and Function ........... ...... ............................... ................................... 11 The Global Alliance ............................................................................................... 11

Chapter 2:

Filariasis in the Pacific ................................................................................ 13

The Pacific Islands ......................•.................•..............................•.......•.........•.•......... 13 Filariasis Epidemiology in the Pacific ................... ... ............................ ... ................. 17 Types of Fitariasis .................................................................................................. 17 Mosquito Vectors .................................................................................................. 18 History of Filariasis Before PacELF ......................................................................... 19 Filariasis Control Programmes ...................... .. ... ........ ........ .......... .. ....................... 19 The PacELF Initiative ......•..............................•.......•.................•.................................. 25 Birth of PacELF ..•....................•......................•..•..............•..•...... ...•............•....•...... 25 Organization and Funding .................. ................................................. ................. 28 Policy. Strategy. and Plan •..•..............................•................................ .................... 29

Chapter 3: Approach and Activities ............................................................................. 34 Administration and Office Management ................................................................. 35 Sub-regional Stock and Supply System ................................................................. 35

Data Management and Communications ............................................................... 37 Advocacy and Publications ...................................................................................... 4.0 Training and Meetings ............................................................................................ 42 Technical Collaboration and Scientific Support ..................................................... 44 Coordination and Programme Review .................................................................... 45 Implementation of Country Activities ................................ ...................................... 48 Partnerships and External Relations ..................... ..... ............. ................................. 50

Chapter 4: Progress and Achievements

.................................................................... 52

Progress ........................................... ..................... ...................................... ............... 52 Baseline Prevalence ............................................................................................... 52 Mass Drug Administration ................................................................... .. ............... 54 Drugs and ICT Tests Distributed ............................................................................ 57 Drug Coverage Achieved ............................................................ .......................... 58 Health Promotion ................................................................................................. 59 Costs ..................................................................................................................... 61 Achievements ................... ............ .............................................................. ............... 62 Impact on Filariasis ..................................................................... .......................... 62 Impact on the Health System ............................................................................... 69 Social and Political Impact ...................................... ............................... ............... 71

Chapter 5: Success and Challenges

........................................................................... 74 Highlights ... ............................................................................................................ 74 Constraints ............................... .. ............................................................................. 76 The PacELF Way ....................................................................................................... 77 Regional Collaboration with a Common Goal .......................................................... 17 Programme Ownership .................................................................. ....................... 77 Operational Flexibility ........................................................................................... 17 A Simple Core Package or Activilles ....................... .............................................. 78 Effective Coordination ................................. ............................... .......................... 78 Focus on t he Positive Outcome ......................................... .................................... 78 What's Next? .............................. ............................................................................. 79 A Sustained, Expanded Programme ..................... ............................... ....................... 79 Technical Challenges ... ........................................................................... ........ ....... 80 Maintaining t he PacELF Way ................................................................................. 81

Part 2 Country Programmes........................................................................................................... 84 American Samoa ....................................................................................................... 87 Cook Islands .............................................................................................. ............... 95 Federated States of Micronesia ............................................................................. 102 Fiji ................................................... ..................................................................... ...... 108 French Polynesia .......................... ............................... ............................................ 118

Guam ...................................................................................................................... 125 Kiribati ... ....................................... ........ ............................................................. ...... 130 Marshall Islands ....................................................................................................... 137 Nauru ........................................ .. ........................................................................... 142 New Caledonia ......................................................................................................... 147 Niue ......................................................................................................................... 151 Northern Mariana Islands .................. ............................... .................................... 156

Palau ...................................................................................................................... 161 Papua New Guinea .....................•.......... .........................•.................. ....... ............... 166 Pitcairn Islands ....................................................................................................... 171 Samoa ................................................. .................................................................... 175 Solomon Isla nds ......................... ........ .................. ................................. ............... 183 Tokelau .............. ....................................................................................... ............... 188 Tonga ........................................................................................................................ 192 Tuvalu ..................... ............................... ............................... .................... ............... 200 Vanuatu ............... ... ........ .................... ... ........ .......................................................... 207 Wallis and Futuna .................................................................................................... 215

Photo Album Annual Meeting Group Photos ............................................................................. 221 Blood Survey .... ..... .. ............. .................. ............................... ............................... .... 222 MDA .......................................................................................................................... 225 Patients ................. ................................ .................................................................... 231 PacELF Home Office .................. ............................... ................................. ............... 233

Bibliography ................................................................................................................. 234

Abbreviations Ae. Ag ALB AM An. Au SAID CB CDC

Cx. DEC DDT DIS DOH ELISA GA GP ELF GSK HQ ICT IEC

Aedes antigen albendatole Annual PacELF Meeting Anopheles Austr alian Agency for International Development coodinating body Cen ters for Disease Control and Prevention (Atlanta, Georgia. United Statas of America) Cu/ex diethyfcarbamazine dichlorodlphenyltrichloroethane data information system Department of Health enzyme-linked lmmunosolbent assay Global Alliance Global Programme to Eliminate Lymphatic Fllariasis GlaxoSmithKline headquarters immunochromatographic test information, education, and communl·

cation lgG4

immunoglobulin type 4

JICA JOCV

Japan International Cooperation Agency Japan Overseas Cooperation Volunteer

KAP L1

L2 L3 L4 LF

knowledge, altitudes, and practices firsl-slage larvae second·stage (or sausage-stage} larvae third-stage (or infective-stage) larvae fourth·slage larvae lymphatic filariasis

LQAS MDA

lot quality assurance sampling

ME Mt MOH

midterm evaluation

NGO PacCARE PacELF PacMAN PCR PICTs PRG

mass drug administration m1crofilana Ministry of Health non -governmental organization PacELF Coordinaling and Review Group Pa cifi c Programme to El iminate Lymphatic Filarlasis PacELF Monitoring and Analysis Network

polymerase chain reaction

RAK

Pacific Island countries and territories Programme Review Group rapid assessment kits

SPC TAG UNV

Secretariat of the Pacific Community Technical Advisory Group United Na1tons Volunteer

vso

Voluntary Service Overseas W. bancrofti Wuch erens bancrofli WHA World Health Assembly WHO World Health Organitation

Foreword The Pacific Programme to Eliminate Lymphatic Fflanasis (PacELF) is leading the way i n the batUe to rid the world or tymphatic filariasis and the threat posed by the disease to 20% of the world's population. Since the launching of the programme in 1999 by the 22 Pacific Island countries and territories, WHO, and other partners, it has achieved great progress towards eliminating lymphatic filarlasls in lhe Pacific. setting an example for the rest of the world to follow. PacELF was the first regional network to set a date for the elimination of lymphatic filariasis. Its target date of 2010 is 10 years before the global target date.

The publication of the The PacELF Way: Towards the Elimination of Lymphatic Filariasis from the Pacific. 19992005 is timely. The programme Is at its halfway point. and its elimination target looks well within reach. The dramatic

reductions in the prevalence of lymphatic filariasis seen in several countries Jn the Pacific after mass drug administration show other countries in the Region and worldwide what they may achieve by coordinating and collaborating closely towards a common goal. Thi s book was produced by the PacELF Home Office team and edited by Kazuyo l chimori, WHO Scientist and PacELF Team Leader, with technical support from Patricia Graves. CDC. It traces the history of PacELF and describes its strategy. activities, and progress in lhe 22 Pacific Island countries and territories in lhe network. We trust this book will Inspire all those who are fighting to eliminate lymphatic filarlasis, to persevere in their efforts against this debilitating disease.

Shlgeru Oml, MD, Ph. D. Regional Director

Preface The PacELF Way: Towards the Elimination of Lymphatic Fi/ariasis from the Pacific, 1999- 2005 records the i ntense commitment and cooperation of the member countries of the Pacific Programme to Eliminate Lymphatic Filariasis (PacELF) In its first six years. It presents evidence of I.he noteworthy Impact and success achieved halfway through the programme, and points out the challenges that still remain. We hope that community leaders, field staff, programme managers, poticy-making and planning officers, health pfofessionals, scientists, and students interested in lymphatic filariasis elimination and disease control programmes

in general will find this book useful in programme implementation, strategic planningf and research . The world has much to learn from the lessons In International cooperation and management In the Pacific contained In this b<>ok.

The PacELF Way shows that the people involved, their motivation and active participation, are the key to eliminating lhis communicable disease. PacELF owes its success to collaboration between small island countries separated by a vast ocean, working tov1ards a common goal.

Kazuyo lchimori, Ph. 0. PacELF Team Leader Fiji March2006

Acknowledgments The book, The PacELF Way: Towards the Elimination of Lymphailc F//ariasis from the Pacific. 1999- 2005 was produced by PacELF and printed In Fiji The editorial team members are: Kazuya lchimori , WHO (Editor-in-Chief): Akiko Takamlya, JOCV: Yoshlo Furuya. Hiroko Watahashl, UNV; and Patricia Graves, CDC.

The work described in this book was done by the PacELF family members and friends 1n the Pacific: To the health workers, communities, and people in the Pacific Islands who were part of the PacELF activities. for

their brave Pacific spirit and smiles. Thank you, Meitakl, Kin1sou, Vinaka. Faiak.sia, Maururu. Merci, Si Tu'us Maese, Korabwa. Komo/. Tubwa. Oleti. Fakaaue Lahr, Si Yuu's Ma'ase. Mesufang, Ateu Owa. Fa'afetai, Tagio Tumas, Leana Ho/a, Malo Aupito, Fskafetai Lasi. Tankyu Tumas. Tsngio, Namesuk, Malo Le 'Alofa. This book was made possible

by the support and valuable contributions of many individuals and organizations.

Many thanks to the following: The country data are the property of the 22 countries and territories Iha! form PacELF and are presented with their

permission; Department of Health, American Samoa Ministry of Health, Cook Islands Department of Health, Education and Social Affairs. the Federated States of Micronesia Ministry of Health, FlP Direction de la Sanlll, French Polynesia Department of Public Health and Social Services, Guam Ministry of Health, Kiribati Ministry of Health and Environmenl, the Marshall Islands Department of Health, Nauru Direction des Aflaires Sanitaires el Sociales, New Caledonia Department of Health, Niue Department of Public Health, the Commonwealth of the NOC1hem Mariana Islands Ministry of Health, Palau Ministry of Health, Papua New Guinea

The Pilcalrn Islands Department of Health, Samoa Ministry of Heallh and Medical Services, Solomon Islands Department of Health. Tokelau Mlnislry of Health, Tonga Ministry of Health, Tuvalu Ministry of Health, vanuatu Agence de Sante, Wallls and Futuna PacCARE members and, i n particular, chair persons Josefa Koroivueta ( 2001-2004) and JeanÂˇ Francois Yvon (2005-present) for their voluntary and professional conlribullons lo PacELF; Maca Colata, Emma Gibbons, Kevin Palmer, Ruby De Vera or WHO; Eric Ollesen and Jeffrey Talbol of Emory University Fuatai Maiava of Samoa; Tom Burkot and Jonathan King of CDC. Tony Stewart of Macfarlane Burnet Centre. Austrafia: Margaret Fraser of VSO; the Atlanta Monitoring and Evaluation Group for the Global Lymphatic Filariasis Elimination Programme; for their advice and suggestions for lhe book;

Mary Ann Asico for editing and Alexander Pascual for design and layout; and Professor Manabu Sasa, author of the classic book Human Fifarias/s, whose comprehensive knowledge and

inspirational teaching were very influential In the formation of PacELF. Kl

Overview The Pacific Programme to Eliminate Lymphatic Filariasis (PacELF) is working with 22 Pacific Island coun1rles and territories to rid the Pacific region of the disease. This book describe.s the work al PacELF since the programme was launched in 1999 up to the end of 2005. The book is divtded into two main parts. Part 1 narrates the genesis of PacELF as a regional programme in the Pacific. its work of mass drug administration (MDA) and other activities. the encouraging successes achieved to date. and the challenges that remain. The contents of the chapters in Part 1 are described brieRy below.

Part 2 is arranged by country and gives detailed information on individual country programmes. based mainly on data from the annual reports and meeting presentations of the PacELF member countries. Part 2 also contains many photographs or the programme and its staff in action. The book closes with a bibliography or references cited in the book and relevant other references published in 1994 lo 2004. Chapter 1 gives some baci<ground on lymphatic filariasis wortdwide, as well as on its biol-Ogy. pathology, epidemiology. and vectors; methods of diagnosis: and available drugs to treat the disease. The Global Programme to Eliminate Lymphatic Fllariasis (GPELF) Is also described . PacELF and GPELF are using combi nation therapy with diethylcarbamazlne (DEC) or lvermectin and albendazole in sustained MDA campaigns with high coverage for at least ftve years to eliminate lymphatic filariasis. They are helped In this challengi ng task by new d iagnostic tests for filariasis antigen, which give lmmedia~e results and can be performed at any time of day. even al night, in areas with nocturnally periodic filarlasis. Chapter 2 gives specifics about the types of fi1arlasis in the Pacific region and how they are transmitted. Wuchereria bancrolll is the only species round here, but II occurs in at least two distinct types: nocturnally periodic and diurnally sub-periodic, according to the time of day when mfcrofilariae are present In the peripheral blood~ The nocturnally periodic rorm present in Micronesia and Melanesia is transmitted by Cule1< and Anopheles mosquitoes. respectively. whfle the sub-periodic rorm in Polynesia is transmitted by the highly efficient vector Aedes po/ynesiensls and other Aedes species.

Chapter 2 also reviews the filariasis control programmes before PacELF. Because the disease used to be very highly prevalent in the region, mass drug distribution campaigns using DEC alone have been extensive and long-lasting in several countries including American Samoa, Fiji, French Polynesi a. and Samoa, and have been waged as well. but

on a more limited scale. in other countries l!ke Papua New Guinea. These earlier campaigns informed later activities. A summary of their results leads into an account of how and why the PacELF programme started, and how It is different from the earlier efforts. PacELF"s goals for elimination in the Pacific. its strategy ror reaching those goals, the operational planning needed to carry out the strategy, and the time line or activities are all spelled out as well in Chapter 2. A detailed monitoring and evaluation plan and a description of the types of blood survey carried out are included here. The plan calls for blood surveys to be done at baseline, after two or three MDAs. and after five MDAs, to assess the prevalence or the filariasis antigen. Further surveys among young children will uncover new lnrections.

Chapter 3 describes PacELF activities in detail. The PacELF home office has many roles: it is a channel of

communication. a global advocate, a stock and supply agent, a meeting organizer, a data manager. and a general encourager and supporter or all the country programmes. PacELF also helps countries produce appropriate health promotion materials. examples of which are shown In this chapter. The progress and i mpact or PacELF's activities to date are described i n Chapter 4 . The section on progress addresses how well activities have been delivered. and lhe seC!ion on impact assesses how PacELF has affected the prevalence of filariasis. The economic costs of MOA treatment in the years 2001 to 2004 are estimated at S.58 per person. The impact of PacELF on knowledge or lhe disease and on health is also examined, as are the more

intangible effects on health, society, and politics in the member countries. The first thing that PacELF d id was to present a clear picture or the endemicity of filariasis in the Pacific at the start

of the programme. Ninety~two percent of the 8.6 million or so people in the Pacific were at risk, and 6.5o/o. or about 500,000. were infected with lymphatic filariasis. Of the 22 Pacific Island countries and territories. six no tonger had filariasls and in five others the disease was only partially endemic (transmission occurred only in limited areas or the country). The 11 countries where filariasis was still endemic became the focus of MDA programmes., starting w llh Samoa fn 1999. Mosl of these 11 countries are fn Polynesia and Melanesia.

Summary: Counlries participating In PacELF ............................................................................................. 22

•

Number of endemic countries ... ......... ...................... ................................................. ................ 11 Number of partially endemic countries ....................................................................................... 5 Number of non· endemic countries ............................................................................................. 6 Total population 1n countries participating in PacELF ........................................... ....... 8.6 million Tola! population at risk (all endemic and partially endemic counules) ........................ 7.9 million Tola! population targeted for MDA ................. ............... ................................................ 6.2 million (79% of people of PNG and 100% of all other endemic countries and Wallis and Fuluna) Estimated number of people Infected .................................................. ............................ 500,000

All of the 11 countrfes and one country where filariasls is parllally endemic have started MOA programmes: five

had completed five rounds by 2004. By the end of the programme, 6.2 million people will have received five rounds of MDA. MDAcoverage in the lasl five years has ranged between 69% and 75%. More lhan 80 million DEC tablels and 6 million atbendazole tablets have been d istributed through PacELF to member countries. In addition, more than 200,000 ICT cards have been used In blood surveys In the region.

The prevalence of filarias1s antigen was dramatically reduced after five rounds of MDA, by an average of 85%, in two PacELF countries, Niue (from 3.1% lo0.2%) and Samoa (from 4.5% to 1.1%). The antigen lest overeslimales by two- 10 fourfold the number of mlerofilaria carriers, which went down from 1. 1% to 0.4% in Samoa. Six other countries had their antigen prevalence reduced between the Initial survey and the lollow·up survey after MDA In

sentinel sites. Chapter 5 reviews the hfghlights and constraints of the PacELF programme so far, suggests reasons for lhe successes achieved lhrough the ' PacELF way', and discusses the next steps in the programme. Even though MDA programmes are not complete, the prevalence of filariasis has been slgnlficanUy reduced in mosl PacELF

countries. But several challenges remain. MDA programmes that are still In progress, especially In Papua N ew Guinea, must be suslained and grealer efforts must be made to control morbidity, treallymphoedema and hydrocoele, and con1rol mosquito vectors.especially the highly efficient vector Aedes po/ynesiensls. All the remaining ·hot spots' of filariasis in remote island communities must be found. The.se and other hurdles must be overcome before the disease can be truly considered eradicated.

CHAPTER

Background

LYMPHATIC FILARIASIS

BIOLOGY

worms live In ·nesls" in lhe lymphatic vessels and nodes. Male and female

Lymphallc lilariasis Is a disease caused by parasitic infection with a nematode worm that hves in the human

body. The parasi1e Is lransmilled from one person to another by an Inter· mediate mosquito host. About 20o/o of the world's population In lhe tropics and subtropics is at risk of infection with

lymphalic filariasis. Wuchereria bancrofli, Brug/a

worms sharing a nest reproduce sexually and release millions of mlcrofilariae (Mf) lnlo lhe blood. The Mf

of W. bancroftl are 0.2-0.3 mm long. snake-like, and enclosed In a sheath

(Figure 1·2). W. bancrofli worms have differenl physiologic lypes. The lwo main types can

distinguished from each other

oommon Brugia species or filariasis are distribuled over parts of South and East Asia. W. bancrofti Is the only species found in the Pacific and is the focus of

by lhe periodicity of Mf In 1he blood. Each type Is transmilled by a different group or inlermediale mosquito hosts, and 1he periodicity of Mf coincides wilh lhe biling paltems of lhe disease· 1ransmitling mosquitoes. Ml of the periodic 1ype appear and disappear from the peripheral blood on a dally cycle. In the nocturnally periodic type of w. bsncrofti, Mt are in their highest numbers in lhe blood be1ween 22:00

this book. Humans are the only reservoir

hours and 02:00 hours. When not

for Bancroftian and mos I Brugian fllarlasis, !hough cals and cerlaln

circulaling in lhe peripheral blood, Ml are found in blood nearer to lhe lungs.

malayf, and Brugia limori are three

species of nemalodes lhal live In lhe lymphatic vessels of humans and caus·e lymphallc filariasis. Of lhe lhree, W. bancrof11 is lhe mosl widely dislributed and is responsible for 90% of lymphalic filanasis infections worldwide. The less

monkeys can also be infected with some

The sub·periodic type also has a daily

Brugian parasitic worms. Adult W. bancrofti worms (macro·

cycle, bul nol as well delined as tha1 of the periodic lype. Microfilariae of

W. bancrohi

filarfae} are about the thickness of a

diurnally sub·periodic

human hair and average 25-100 mm

circulale in the peripheral blood at all times. but more are present in the blood during lhe daylime than al night

long, with male worms being shorter

than females (Figure 1-1). The adult

Adull of W.bancrofti

W.bancrohi mlcrofllari• In human

blood

The PacELF Way Towards !he Elimlnalion ol Lympllaijc Filariasis In lhe Pacilic

Adult worms hve 1n lymphatic ducts for 4 6

L..Years and cause Lympha1.ic Fllariasl.s

Adult wor m (25-100 mm)

....

·-"' :I "' CT...,

"'0 ·.tl

HUMAN BODY

CT 0

+- -----------------1· ;:;:~ 1i!:.

::E

...

MOSQUITO BODY

Infective larva L3 (1.0-2.0 mm)

larva L2

larva l 1 (0.1-0.4 m m)

(0.3-1.4 mm)

Section of the thoracic muscfes of a mosquito w11h L2 worms

.... p;;.111111• ~

-·

Life cycle of W bancrofti fllariasis

LIFE CYCLE

body oflhe mosquito. When the infected Adull W. bancroffl worms start 10 release Mf into the blood about a year after Infecting the human hos!. A pair or adull worms can produce millions of Ml in their lifetime. Mlcrofitariae may be

L3 worms emerging from the ptoboscis of the moMtUtto

hurnan slon at the bite wound

mosquito next bites a person, these L3 worms emerge from !he moulhparls

(Figure 1·5) and drop onto !he person's skin. The worms !hen crawl lhrough the

found in olher areas of !he body such as hydrocoele fluid , chylous urine.

bite \Yound, Inside the skin of the new human host (Figure 1- 6). The L3 worms develop through a

lungs, and lymph nodes, bul ii is In the circulating peripheral blood where !hey can be ingested by feeding mosquitoes.

fourth stage (L4 ) while they migrate through !he human body 10 the lymphatic vessels and lymph nodes,

Microfilariae lhal are not ingested by mosquitoes usually die after about six to nine months.

where they develop into adult worms. L4 worms may take up to a year to

Figure 1-3 shows lhe life cycle of W bancrofri. Once 1a ken up by a

able to release Ml lnlo the blood , complellng the life cycle. Adull W

mosquito in its blood meal, the Mf penetrate the mosquito's midgul wall and migrate to !he 1horacic muscles,

bancrofli are thought to live for an average of four to six years In the human

where the larvae develop (Figure 1·4). Wuchereria bancrofli Ml pass through lhree larval slages-the firsl slage (L 1),

Diagram of L3 worms crawling into

n1ove from the thoracic muscle into the

second (or sausage) stage (L2), and third (or Infective) stage (l3)-over a period or about two weeks.The L3 worms

mature into adults, after which they are

hosL bu! lhe actual lifespan ol lhe adull worm is not completely known.

PATHOGENESIS Clinical presentations of lymphatic filarlasis Infections can be asymp-

PART I

Infective larvae from

a mosquito enter human

./"" body through a mosquito ~

bite \vound

•,/·

.__ ·

Larvae move to lymph

vesse:l.s and nodes.

€)

The adult worms

mate and stan producing mitrofilariae

Adult worms cause dilation

of lymphatic system, preventing normal flow of lymph. This damage caused by the adult worm, plus frequent bacterial Infections. causes swelling (lymphoedema), which

may somet.imes develop lo elephantiasis

Adult filariasis worms 1n the human body

•

t•

tomatic, acute, or chronic. At least half

Chronic manHestatio ns of the

of all persons Infected wtth lymphatic filariasis show no signs of the disease, although they may have circulating Mf.

disease ari sing from adult worm

These Infected individuals may or may not eventually develop overt manifestations. Asymptomatic infections are

elephantiasis (Figure 1-7). In W. bancrofli i nfections . the scrotal lymphatics are the preferred site for

associated with an altered immune system and hidden damage lo lymphatic

adult worm nesls, but the nests may be round elsewhere In the lymphalic

vessels. Many asymptomatic cases of

system as well Hydrocoele, a swelling

lymphatic filariasis have damage to lhe kidneys that shows up as microscopic

caused by accumulation of fluid in the tunica vagina/is of the scrotum, is the

blood or abnormal quantities of protein In the urine. Acute presentations include "filarial

most common clinical manifestation of lymphallc rnarlasis (Figure 1-8) .

fevers" or acute attacks associated with inflammation of the glands or lymph

damage to the lymphatic system Include hydrocoele, lymphoedema, chyluria,and

lymphoedema 1n arm

Lymphoedema. or swelling due to lhe bulld· up of fluid in the tissues, is lllusttated in Figures 1-9 and 1-10.

nodes. lymphatic vessels, or connective tissue under the skin. The inftammatory

D ilation of the lymphatics in the bladder

episodes are caused by dead or dying adult worms or, more commonly, by

chyluria (milky urine).

and kidney can cause rupture leading to

secondary bacterial or fungal Infections of tissues damaged by filariasis. These

Secondary infections and repeated lnflammalion during acute allacks continue to damage the lymphatic

organisms get into the tissues through euts or small breaks In the skin.

system and thicken and harden the skin. In some cases leading lo elephantiasis

lymphoedema In leg

'' Chaplet I •

[TI

The PacELF Way Towards !heElimlnalloo ol lympllaijc Filariasis In lhePa<~ic lablt? 1·1 : Geographical dlsuibullon of W bancrofr1 and its pfin6pal voctots Spetcles <1nd rtlce

Principal Vectors

Endemic Area

Anopheles. Culex

Africa. Noctumally pe:rtodi< W. bancrohi

Oturnally ,:ub·peoriod1c

W. bancroln

Amefica

Cu/ex

Egypt

Culex

Asia

Cu/ex, Anophe~s, Aedes

South ·~St Asia

Cul~

Western P<1dftc:

Anopheles. Culex

Asla·Western Padflc

Aedes. Ochlerotarvs

(Figures 1·9, 1· 10, 1-11, 1· 12, and 1· 13). Mi ni mizing acute attacks by preventing seeondaiy bacterial or fungal infections-one of lhe main goals of managing lymphatic filariasis--prevents these disfiguring consequences. Sometimes the host immune response to Mf is so strong that severe inflammation destroys tissue in the lungs and leads to permanent lung disease. This condition is oalloo tropical pulmonary eosinophilia. Patients with

this condition have symptoms of asthma and cough, and have high levels of eosinophils and filarial antibodies in the blood.

TRANSMISSION lymphatic filariasis is transmitted from one human to another by mosquitoes. The parasite requires an

Intermediate host, where microfilariae develop through the larval stages. The type of vector mosquito depends on geography, the periodici ty of the parasite. and mosquito biting patterns. The periodicity may be a selecti ve adaptation to the mosquito biting cycle.

Elephantiasis

Table 1-1 shows the main vectors associated w ith W. bancrofli by geographic area. The most important vectors in the Pacific are Anopheles species in Papua New Guinea and Vanuatu, Cu/ex quinquefasciatus in Micronesia, and Aedes (Ae.) poly· nesiensis' from Fiji through Polynesia. Ae. tabu and Ae. cooki are the vectors of filariasi s In Tonga and Niue , respectively.

The Ml mai ntain a delicate relationship with the mosquito vector.

The size, location, and movements of the filarial larvae affect vector performance, and too many Mf ingested at

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one time can kill the vector. Characteristics or lhe mosquitoes can also affect the farvae. While up to 20 Ml may mature to the infective L3 stage in the mosquito. larvae can be destroyed

PART I Rgute 1·14: Diagrammatic represe11tatJon of flmltatlon (l) and facilitatton {F)

:s.. ~

..,"'.

J!i

i; 20

0 c

~ 10

:i;

0 0

20 30 Mean no. of ingested ml<rofilorioe (,It')

Souru: G ~11onuoon

In the mouthparts of the mosquito or by Its immune system. In Aedes vectors of f1lariasis. ingested Ml that reach the hemocoel make the stomach wall less permeable to other Mf. Therefore, by a process

known as "limitation", the proportion or Mf that successfully develop to the L3 stage Increases if the mosquito Ingests fewer Ml (Figure 1-14). In contrast. in lhe Anopheles mosquito the proportion of Ml that reach the L3 stage decreases as the mosqui to Ingests fewer Ml (process of •facilitation"), making It easier to interrupt transmission of lymphatic filari asi s by Anopheles mosquitoes than transmission by Aedes mosquitoes. Because or facilitation, reducing Mr density (through mass drug administration with diethylcarbamazine and albendazole. for example) below a critical equilibrium between adult worms and Ml wi ll eliminate the parasite population. But In areas with limitation, it would be much harder lo eliminate the 11ansmlssion by reducing Ml density through MDA. For this reason Ae. polynesiensls presents a challenge to the elimination efforts or areas In the Pacific with diurnally sub-periodic W bancrofli. Areas where there is transmission of lymphatic filarias1s can be determined either by diagnosing infections in the human population (see next section)

or by collecting mosquitoes and testing

tor the presence or lymphatic filariasis worms. The presence of L3s in the mosquito population Indicates that the mosquitoes are transmitting the parasite to the human population. Using the mosquito population to determine if

people are still Infected with Ml i s called · xenomonitoring·, Instead of testing individuals for evidence or Ml infection , xenodiag nosis Involves sampllng the mosquito population. usua lly by collecting mosquitoes Inside houses. and then assaying for lymphatic filariasis worms through di ssectio n o r polymerase chain react ion (PCR) tests. tr mosquitoes are found positive for lymphatic ftleriasis, some humans In the area are still infected with Ml

DIAGNOSTICS W bancrofti is most commonly

diagnosed when Mf or parasite antigen is detected In the blood. Fllarial antibody and DNA could also be det.ected. A small amount of blood is collected for all of these diagnostic tests.

Blood slides Microfilariae are detected through microscopy of a finger-prick sample of blood on a slide that is then stained with Giemsa. The presence of Ml is direct evidence of Infection, but the absence

The PacELF Way Towards !heElimlnalloo ol l ympllaijc Filariasis In !hePa<llic of Mf does not rule out infection .

for example). This method is highly

Microscopy does not detect the presence of W. bancroffi adull worms that are not producing Mf. This method

sensitive, but again does not detect adult parasites that are no! producing Mf; and Jn areas where nocturnal

is most sensitive when Mf are circuJating In !he peripheral blood. Therefore, in

periodic W. bancrofli is endemic, blood mus! be taken al night.

areas with nocturnally periodic lymphatic filariasis, blood must be taken In the middle of the nighl The intensity

Antigen detection t ests

of Infection can be estimated by counting lhe Mf in a measured amount

= • •

Blood slides ready for sta1n1ng

..........

of blood. In Figure 1-15 two standard amounts of blood have been used: 20µ1 of a finger·prick sample in a round drop on a glass slide. and 60 µI of a finger-prick sample In three lines on a

Circulating fllarial antigen from W. bancrofli worms can be detected in the blood. Two tests can detect the antigen: enzyme~linked immunosorbent assay {ELI SA) and lhe i mmunochroma tographic test {ICT). Both teslS detect

glass slide. Figure 1-16 shows how Mf

circulating adult worm antigen and are highly sensitive and specific. Antigen tests do not depend on the periodicity of the parasite, so blood can be sampled

look on a blood sl ide stained with Giemsa. A third way oflesling forMf in blood

anytime in the day. In addition, these tests detect infections even if adult worms are not producing Mf.

is by filteri ng 1 ml b lood samples through a membrane {Nucleopore filler,

The ELISA test detects a specific antigen called Og4C3. This can be done only in the laboratory, but large batches can be tested al once. Blood for this test can be collected in dried spots on filter paper and kept for later testing. The !CT test, on the other hand, is a rapid card test (Figure 1· 16) that requires no laboratory equipment and provides results In about 10 minutes, making

it ideal for

field surveys. Rapid assessment ki ts {RAK) are available for field survey Mlcros<:opic image of ml«<>filaria in Giem~S1ained blood ~ide

Filar1asis JCT rapid ass(.l'Ssmoot kil Joiorct

~·1-1u

l'kl 11

use; each kit contains 50 JCT cards {Fi gure 1-17) and the necessary supplies to do the tests including latex gloves , alcohol wipes. lancets , capillary tubes, and a sharp container.

The percentage of positive samples detected through these antigen tests gives the prevalence of anti genaemi a , A d isadvan tage of antigen tests is that patients may

continu e to be positive even after effective treatment. since antigen may still be detected In the blood for months Atariasis ICT test urds showing nega!Ne and p0si1lve results $ol.rtt-

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r 'I I I

to years after adult worms and Mf have

died. The exact length of time ror Which antigen persists after treatment is not

known.

PART I

Antibody detection tests

Table 1-2: Characteristics of d1agnost>c tests for W. bancroftl

Antibody levels in the host rise after infection with or exposure to lymphatic

filariasis. The lgG4 sub-type of antibody specificalty increases. However, the test

c annot d istinguish between a current and a past Infection. Nevenheless, a

high level of antibodies detected in children may Indicate recenl exposure and infection. For this reason antibody

Blood slide, 20 µI

(-)

Med11.tm

High

Blood •Nlo, 6() µ)

(- )

>.1fdium

High

Blood. I ml. filtettd

(-)

High

testing may be an effective tool for determining iffilariasis transmission has

0940

been i nterrupted.

AnUbody (lgG4)

Polymerase chain reaction tests The PCR test detects parasite nucleic acid, but it requires complicated

and expensive laboratory equipment. A test result is positive when nucleic acid of Ml is detected in the blood. The PCR test Is highly sensitive and specific. It can also be used to detect the L3 infective stage in the mosquito. The features of the foregoing

d iagnostic tests are compared in Table 1-2.

CONTROL MEASURES

Adult worm

ICT

VMon1hs

V'tfy high VOJY hf9h

antigen

./Months

Very l'l1gh Vtryh1gh

Antibod)' lndl""'"'l

./Months or High

41n1igen Adult WO<m

pasi Of current

POl

v..y•1gn

DEC is the oldest or the drugs and has been used to

Figure 1 19: Recfudions 1n Mf prevalence with 4

d1ffNent DEC treatment schedules (a} f~ rounth of onnual \mg~ DEC tt1>1tmcnt

The exact effec1 of th is piperazioe derivative on the

Yoill\ a IOtal ~ ol 30 mgl\O - - - - - - - - - - - ---,

10 ,

adult parasite is not clear. However. Ml are effectively cleared and some evidence

suggests that adult worms die as well. DEC may Inhibit parasite function, making the host immune system better able to destroy lymphatic

0 85/ 86

Previously. the

Fllari asis control has a twofold objective: to reduce the number of

Infected individual was 12

infections, and to stop further tr ansmission. The control measures ava ilable are d rugs (ei ther u sed

doses of 6 mg DEC per kg of body weight. However. a study In FijP (see Figure 1-

individually or for mass treatment) and vector control . Drug tr eatment o f Infections will achieve both objectives,

19) showed that a si ngle annual dose of 6 mg/kg repeated for five years also

while vector contr ol will reduce the

effectively cleared Mf. Other

number of new infections.

studies have confirmed the

standard treatment for an

,. t

90 / 9 1

•

~ a.

Wl\l\ •101.aldowgeo! 1 40~

++HUH WUl-kU

10 $

~UhlHH

• 4

yearty doses. Al bendatole, a ben-

tre atment and control of filariasi s:

zimidazote carbamate, was

d l ethylcarbamazine (DEC), a lbendazole, and ivermectin. AJI three have

originally developed for use against soiltransmitted intestinal parasites, and has

been used for many years and have

been used for this purpose for more than

well-established safety records. DEC i s

20 years. It Is also effective against lymphatic filariasis. Albendazole inhibits

and fvermectin affordable.

1990

(b) .ll'l In~ 28-d~ ltHtmtnl &Id tW'O ye.'111

Three drugs are available for the

inexpensive, and donations from drug

..., .... .... Year

effectiveness of these once-

manufacturers have made albendazole

Vcoy hf9h

treat filariasis since 1947.

worms.

Drugs

Low

>"'"

1nfeci1on

the polymerization of tubulln, whieh is required for parasite development.

85/86

15181

1988 Y~ar

1999

1990

90/91

The PacELF Way Towards !he Eliminalloo ol lympllaijc Filariasis In lhePa<~ic intestinal worms like hookworm,

DEC 1able1S, SO mg

Albenllazole tablets, 400 mg

Another drug , ivenmectin, causes long-term reduction of Mf with one dose. It is a macrocyclic lactone. The direct toxic effects or ivermectln on lllarial worms are not fully clear. but it probably reduces membrane permeability. lvermectin is very effective aga inst onchocerciasis, another filarial disease. Combination therapy with DEC and albendazole (Figure 1-20), or ivenmectin and albendazole, is more effective in

clearing Ml from the blood than therapy with just one of the three drugs (Figure 1·21). Research has also shown that combination therapy suppresses the production of Mf for a longer period than DEC alone. Furthenmore. Ml that are not affected by one drug may be cleared by another drug given In comblnation .

Although resistance h as not been documented , treatment with multiple drugs that work differently may give the parasite less opportunity to develop resistance. The drugs also kill olher Figul'e 1·21: Comparative effects of treatment with DEC and with DEC plus a!bendazole on Mf prevalence and det1s11y, at sax months after utatment

I•OK • DK. Al.I I

l•e« • OEC•Al.I I

... - ---....., .... §. I

i 'S '

i ~

50 ~ 40 30 20 10

••#

,__

-.......... "'lndi.-1 ,

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>---

...

l111hl

'•" "''... •

•o

•: flJI .... 11 lr'ocll•· 1

"""

n. Kelty• Sl4 l.Mlb

......,Gy,,,.,,..,,. mosi Backgroond

Ascaris, Trichuris , and Enterobius. These factors make combination therapy sullable for mass treatment programs. As with any other drug, treatment may have adverse effects. These can be classifie<l into two categories: those caused by lhe drugs themselves and those resulting from the destruction of Ml and adult parasites. Most adverse effects associa1ed with the chemical effects of the drugs are mild general reactions, such as nausea and vomiting shortly after fngestion , a nd are independent of infection status. In i nfected people, antigen is released when the drugs destroy Ml . Cytokines are then produced and Immune complexes are formed, resulting in fever, headache , and myalgia. These effects may start hours affer ingestion and may last from only a few hours to a few days. Mass treatment may also cause lhe death of adult worms. Adverse reactions that can result from this include silent or painful nodules in the lymph nodes where adult worms were living. In men this most often results in scrotal nodules. Nodules usually resolve in seven to 10 days. In addition, fever may be provoked by antigen rrom end osymbiotic gramnegalive Wolbach/a released from dying adult parasites.

Mass treatment Filariasis cou ld be effectively controlle<l ii all infected persons were identifie<l and treate<l. Although ideal, this method cannot be applied in large populations. Over hall or W. bancrofli infections are asymptomatic, so every individual in an endemic area would need diagnostic testing. This strategy is too costly to be feasible. Therefore, to control filarlasls on a targe scale, mass treatment strategies are needed. Mass drug administration (MDA) for lilariasis means ireating all individuals in an endemic area once a year wilh DEC and albendazole (or

PART I ivermectin and albendazole). Sucl1 MDA rapidly clears Mf in infected individuals, thus interrupting transmission. However, some adult parasites may survive and continue to produce Mf after the effects or the drugs wear orr. The aim or repeated annua l MDA is to stop production of Ml unlit all adult parasites die (Figure 1-22). Adult W. bancrom have been estimated to live for an average olfive years. Thus, annual MDA must be repeated for about five years to suppress Ml production throughout the lile of the adult parasite (Figure 1-23).

Figure 1-22: Predicted effect on Mf prcvalooce of single-dose OEC administered fo1 five years

DEC salt

night-biting species. Long-lasting

Adding DEC to salt is another possible method of mass treatment for the control of lymphatic filariasis. DEC, just like iodine, can be added to cooking sail to lortify It. China . India, and Tanzania have used DEC salt to ellectively reduce community prevalence levels of W. bancrofti. The effective concentration should be 0.2'¥.-0.3% by weight or the salt the aclual dose an Individual receives cannot be tightly controlled. local patterns ol use of salt must first be determined. Ideally, only DEC salt should be available for use.

inseciicide·treated materials have great

I :-t-'<J-~--'r--;:: : :~~~~~~~~~ li.

~ 40-l-~~~lL..~-\.-;<~~~~~~~

]

20-f-~~~~~~~~~.!....~~,,c~

SOI.Ir<•: ao e1•l(1991}

nets are effective in prevent.Ing bites by

VECTOR CONTROL

potential for stopping transmission ,

even perhaps for day-biting species (Figure 1-25). Over 100 species of mosquitoes

are potential vectors of filariasis. Adult mosquitoes or the different filariasis vectors have drtferences in biology and

behaviour lhat determine appropriate control measures. Some of these

differences are : locat i on of oviposition, biting pattems. and flight range . For exa1nple. the night·biting Anopheles mosquitoes can be prevented from transmitting filariasis if all individuals in the endemic area were 10 sleep under mosquito nets. local

Vector control may increase the

vector breeding and biting habits must

impact of other interventions to interrupt lllarlasis transmission. Appropriate

be understood before effective control

vector contro l strategies may a lso continue

suppressing

transmission

filariasis

Many of the mosquito con trol measures used to slop filariasi s

areas where some

transmissionv1ill also help reduce other diseases such as malaria or dengue

interventi ons such as MDA have stopped.

fever. In areas with noctumally periodic filariasis as well as malaria, impreg·

The main purpose of vector control

nated mosquito nets and indoor house

Is to reduce the number of adult

spraying can protect against both diseases. This is because the same type

humans and mosquitoes. Vector control

of mosquito, Anopheles, transmits

can be directed at either the larval or

malaria and f'i larlasis. In Polynesian

the adult stage. Source reduction and

countries, Aedes polynesiensis may

larvici<le with Insecticides can be used against the larvae , wh ile space or

transmit dengue as well as filariasis, so reducing the numbers of this mosquito

residual

will help control both diseases.

spraying

con tro l s adult

mosquitoes (Figure 1-24). Mosquito

kr.irc•

methods can be developed.

infections still remain after other

mosquitoes and lessen contact between

Mass drug admlflistratlon in Samoa

Photograph of residual insecticide spraying

lnsect1c1de--impregnated mosquito nets

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The PacELF Way Towards !he Elimlnalloo ol lympllaijc Filariasis In lhe Pa<~ic

GLOBAL PROGRAMME TO ELIMINATE LYMPHATIC FILARIASIS Lymphatic filariasis is endemic in al least 80 countries (Figure 1-26). The disabling clinical manifestations of the di sease i nclude lymphoedema. hydrocoele. and elephantiasis.

repeated annual doses of DEC were

Lymphatic filari asis is the second leading cause of disability worldwide. II

studies also provided evidence that the combination of DEC or ivermeclin with

causes enormous physical. soci al .

albendazole was safe and more effective in lowering parasite density than either drug when used alone.

psychological, and economic suffering to those affected. Fortunately, a global

Figure 1·26: Countcies and

ID '~ ~

t~rtitor1es where

Endemic countrle\

determination of endemic areas . Second. research studies showed that

almost as effective as the previous regi men of multiple doses. Finally,

lymphabc filariasis is endemic

-----

.,,.,.._._

...,_

::*"":i~l«lw

... llot_ _ a,...-

--...¥_.,..,_.,.....,.*"'.,, ______ _..,.it-.._.... _ .. _ ....._ . _... _ _ _ , _ _ .... _ , , ..._ _ . . . ._

·--~-*'

effort i s under way 10 ellmlnale this terrible disease.

FORMATION OF THE GLOBAL PROGRAMM E In 1993 the Internationa l Task Force for Disease Eradication declared lymphatic filariasis to be one of only six eradicable or potentially eradicable diseases. This optimism was based on three developments. First, diagnostic methods for i dentifyi ng fllarlasis infeclion had i mproved g really and

opened the way

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The

G lobal

Programme

Eliminate Lymphatic Filariasis (GPELF) started after !he fiftieth World Heallh

for the rapi d

Assembly in May 1997. The world Health Assembly, concerned about the continued prevalence of !he disease and the human suffering associated with it, called for the elimination of lymphatic fitariasis as a public health problem. In

resolution 50 .29 the World Health Assembly: Urges Member States to:

Take advantage of recent advances in the understanding of

PART I lymphatic filariasis and the new opportunities for its elin1ination by developing national plans leading to Its elimination, as well as for the monitoring and evaluation of programme activities .

After the World Health Assembly resolution. two major drug companies further boosted the momentum of the

programme. Merck & Co. Inc. and GlaxoSmlthKllne (GSK) agreed to donate 1vermectin and albendazole,

respectively, for use in the rilariasis elimination campaign. The GPELF first directed its efforts towards building a large network of partners and setting programme guidelines. By lhe end of 1999, the GPELF had developed a global strategic plan with the goal of el iminating lymphatic filariasis as a public health problem by the year 2020. This GPELF goal rests on these two pillars:

Interruption of transmission, in most cases through mass treatment of the population;

and Morbidity control lo relieve the suffering of those who already

have the disease. The plan is focused on:

Slopping the spread of infection (interrupting transmission): Relieving and preventing suffering and disability; Providing es.sential technical

support; and Carryi ng oul strategic operational research. The GPELF strategic plan sets oul a rationale. a timeline. and the resources needed lo reach its goal by 2020.

ORGANIZATION AND FUNCTION The GPELF consi sts of lhe national programmes of all the filarl asis-endemlc countries . co-

ord inated by the World Health Organization (WHO). The Global Alliance. formally established in 2000 at the nrsl annual GPELF meeting in Sanllago de Compostela, Spain, is a forum for information shari ng and advocacy for lhe GPELF. The GPELF Technica l Advisory Group (TAG) consists of lymphallc fllariasls experts and specialists In programme management. The TAG gives advice on technical issues. and suggests research priorities lo the GPELF. There are also regional Programme Revi ew Groups (RPRGs), which review all aspects of country programmes and make recommendations lo WHO, GSK, and Merck & Co. Inc. for the provision of drugs and support to the countries. There are six endemic regions: Africa, America, Eastern Mediterranean, Indian subcontinent, Mekong-Plus.' and the Pacific Programme to Eliminate

Lymphatic Filariasis (PacELF). Table 13 gives a brief description of the burden of lymphatic filariasis In each region.

India accounts for about one third of the total esHmaled infections.

THE GLOBAL ALLIANCE The G lobal Alliance (GA) to Eliminate Lymphatic Filariasis is a free,

non-restrictive partnership forum for the Table 1·3: Regional programmes to eliminat~ lymphatic fflariasis. as o1 2003

Region

Endemic countries

Population at risk (millions)

Percentage of at · risk population

covered

477

Amenc:a

14.4

Eastern MedlteJranean

17.3

Indian Subcon1inenl

5 14

5.4

Melcong-Plus

214

9.6

PacELF

30.0

Africa

3.S

' The MtkOf"IO·Plirt ftg~ Otig1Nl!y C01"1'1$)11~ CIMl>Od..a, LIO~. c,_,..., ll'ldOM'S•I, Ma ys.a, My•t1rt\;M,, PfldipplMS, Tlt.a1l1fld, •nd Vlett\1111. In 2005 h t>K.lrne 1he "N'°"" Mtl:otig P'us~. whim ii~ up of 011T1boch.I., u.os, Ch1t11, Ma&lysl,., Phlllf)9ines, and Vi~tntM. tndonHia. Myanm.t, and ThWf'ld we-re g1oul)Nt tt1ge1tl~ w1ih ttlt' lndlan .SUbcOf'ltinML

The PacELF Way Towards !heEliminalloo ol lympllaijc Filariasis In !hePa<llic

AFUTUfl.Ef

OFU:

Global Logo of 1he Global Alliance

exchange of ideas and coordination of

guiding, implementing. and sustaining

activities to eliminate lymphatic filariasis (Figure 1-27), Membership In !he GA Is open to all interested parties. The main

activities to meet the goal of elimination.

functions of the GA are sharing i nformation on 1he progress and challenges of eliminating lymphatic filariasis. and coordinating fund-raising and advocacy efforts. Soon after the World Health Assembly resolution in 1997, SmithKtine Beecham (now GlaxoSmi thKl i ne) pledged to support the global effort by donating albendazole for as long as needed to eliminate lymphatic filariasis. Merck & Co. Inc. made a similar agreement to donate ivermectin, for use

funds to support the activities within the

countries. WHO supports the activities of the ministries of health by providing assistance in all programmatic areas

such as action p la n development, endemicity mapping. training, social mobilization,

and

evaluation .

Nongovenmental organizations work with national programmes to implement activities and p rovide local funding.

Academic and research organizations provide scientific guidance and conduct

endemic. These two generous donations pushed the global effort forward by dramatically reducing the costs of mass treatment. The Bill and Melinda Gates Foundation added a substantial donation to the GPELF for 2000-2004, in addition to the early support of the Arab Fund for Economic

operational research.

The Global Alliance maintains an

active partnership with nationa l ministries of health of endemic countries, international organizations,

the private sector, International development agencies , nongovernÂˇ

mental organizations (NGOs). and academjc and research organizations. These partners provide the means for

ttlatiasis Ill Ille Paalic

evaluate the Impact of these activities.

Private donor organiz.ations provide

in areas where onchocerciasis is coÂˇ

and Social Development and the Governments of the United Kingdom and Japan.

QI] @

The endemic countries implement the elimination acUvities, and monitor and

After its first annual meeting In Santiago de Compostela, Spain, in May 2000. the Global Alliance has met lwo more times. Discussions first focused on how to support effecUve country

activities. The theme of the second meeting in India In 2002 was empowering the countries to pursue

public health development and poverty alleviation by elimi nating l ymphatic filarlasis. At the meeting in Egypt in 2004, members were encouraged by the current progress and challenged

to be more active. The next Global Alliance meeting will be held in Fiji, in 2006. The theme of the meeting is "Towards the Global Elimination of lymphatic Filariasis: Successes and Challenges-.

CH A P T E R

Filariasis in the Pacific THE PACIFIC ISLANDS

The Pacific Ocean is the largest of the world's oceans, covering one-third

Figure

2~ 1:

The Pacific Ocean, $hewing the PaeE.Lf countries and territories

of the earth's surface and containing about 3000 islands in 22 countries and

territories (Figure 2-1 ). Many of the Islands are classified Into three regions: Micronesia, Polynesia. and Melanesia

(Figure 2-2). Micronesia is made up of Guam. Kiribati, the Marshall Islands, the Federated States of Micronesia, Nauru,

lhe Commonweahh of Ille Nor1hem Marlana Island•, and Palau_ The

Mlcrone&lan lelande are scattered '1l'Ollgjl!M fie n01d1ullllm raglan af lhe Paclftc. Polyneala extenda from the

Hawaiian l&lande to New beland and WiplzwaAmen::ana.rat_ Coak ........ Frllf!ch Polyfl.ela, Niue, Iha Piie.im

!eland&. Sa-. Tolilllau, Tqa. Tuvalu, IWld Wela Ind RArla. MS t cawl1a of FIJI, New Caladonta, Papua New

Figure 2-2: Map of Micronesia. Melanesia, and PotylleSla

Qulnee, Sdomon llllanda, Md V•11.11.tu. Pla te tectonics , and volcanic activity and coral growth. formed some

Pacific Islands into tropical mountains and others into atolls (narrow ringlets

I·

D D D

Micronesia Melanesia Polynesia

of coral reef surroundi ng a central lagoon). The l!Opical mountain type of Island has steep terrai n w ith areas of fer1ile coastal plains. Allhough atolls are found throughout the Pacific. the largest concentration of this type of island is in 1 PiWlim

Fren ch Pol ynesi a . Most P acific countries contai n mixtures of both types of island.

Source: SecretaNI of !ht hotic Comm11t1lt)', www.spc.ont

Cnapier 2

@ !JD

The PacELF Way Towards !heElimlnalloo ol lympllaijc Filariasis In !hePa<llic The climate varies throughout the

countries. but air travel has made offÂˇ

Pacific Islands, depending mainly on

island travel faster and more frequent.

latltude. Some islands have distinct

Each ethnic group is unique with

rainy and dry seasons, while others

its own da n ces , songs , a rt . and

receive rain all year. Less rain, rather than no rain, usually characterizes dry seasons . T he region is prone to natural disasters . especia lly devastating cyclones, which of ten strike the Pacific Islands. Earthquakes, volcanic eruptions. and tsunamis are also significant risks. The Pacific Islanders speak 1000 Indigenous languages . composing aboul 20% of all the languages spoken in the world. In addition to loca l languages, French is spoken In French

ceremonies. However, a ll share the

for

values,

1radltlonal are

le ss

individualislic, and keep up strong lies wi th their families and church. The community is always placed above the

Individual; l his makes Pacific Islanders willing to cooperale 10 solve a common problem. Therefore, the countries and territories in the Pacific work naturally

logel her, an d lhey wi ll help one another eliminate lymphatic fila riasis.

The 1otal population of !he 22 Pacific Island countries and territories

and Wallis and Futuna. while English is spoken in most of the other islands

was eslimated at 8.6 million in 2004 (Table 2-1). The largest counlries are

because of a long history of relations

Papua N ew G uinea, with a population

with England, Australia. New Zealand, and 1he Uniled S1a1es of America. Fisheries, agriculture . mining , and tourism are the main activities supportlng the Pacific economy. Mosl of the farming is subsistencÂˇe and provides families wilh daily needs and some income. The bea utiful environment e ncourages tourism, whi ch brings l ocal empl oymenl

of 5.6 million , and Fiji. wilh a population of aboul 836 000. These two countries are much larger than the

other Islands. The Pitcairn Islands has about 50 people. Niue and Tokelau each have fewer than 2000, and N auru

and Tuvalu each have aboul 1O 000. Many Pacific Islanders live overseas in New Zealand, Australia, Hawaii, and

other count ries. bu l vlsl l home

opportunities a nd compensation for

frequently. Some i sland counlrles

sharing Pacific arts and crafts. Foreign aid plays a significant role in almosl

have declining populations of full-lime residents.

all Pacific economies. Australia. N ew

According to estimates of the

Zealand, and Japan provide the mosl

Secretariat of the Pacific Community (SPC),' lhe highest annual population

United States of America and France

growth rates in the Pacific are found

are supported by !heir naliona l

In the Northern Mariana Islands (3.1%) and Vanuatu (2.7%). The highest lotal

governments.

ttlatiasis Ill Ille Paalic

respecl

Polynesia , New Caledonia , Vanuatu,

assistance, while the territories of the

QD @

same

commu n ity

Geographically, l hese islands are lsolaled In a vast ocean and seemingly

fertility rates are seen in the Marshall

cut off from the rest of the world .

the lowest are in the N orthern Mariana

Nevertheless, Pacific Islanders !ravel frequenlly between Isl ands and

Islands (1 .6), New Caledonia (2.4), and French Polynesia (2.4).

Islands (5.7) and Tokelau (4.9). while

maintain close intercu ltura l com Âˇ

T he Infant mortality rate ranges

munica1lons. In the pasl, travel was made possible by large sailing canoes.

from 5 per 1000 live births in Northern Mariana Islands to 66 per 1000 In

Canoes are still kept for daily fishing

Solomon Islands. The prevalence of

and transporl In mosl Paci fic

HIV/AIDS is slill relallvely low In mosl

PAR! I

Country or Tttritory C•nsus y,

Rtgton

l'opulillOn ilt lttl CenM

Miclyo.or

Popu!.tioo Esf1rN l t. 2004

Pop. Density (km') (JJ<OPlt/

Ynd ArN

km')

hdtnted SloltfSof

2000

107 008

112 700

161

"'"w.rn """""

2000

154805

166100

307

2000

8' 494

93100

811

115

1999

50840

55 .:()()

181

306

N1U111

2002

10065

10100

481

Nollhom Mariana blonds

2000

69221

78 000

471

166

P•ilu

2000

19129

20 700

488

536 100

3214

167

.:..bl~

M•rWC

MICRONESIA

Mkrontsla

Amcucan Somo.! Cool Islands

Frendi

Prlllinesia N11,1f

POLYNESIA

57 291

62 600

200

313

2001

18 021'

14 000

237

2002

244 830

250 500

3521

2001

1788

1600

259

Pltct1rn 1'1ands S.moo

2001

176 710

182 700

2935

Toi<flou

2001

1537

1500

125

Tongo

1996

9778'

98300

650

151

2002

9561

9EOO

389

,,.,._

2003

149"

14900

14.

105

6JS100

8021

h,.-..1>

1996

775077

836000

18 2n

1996

196836

236900 18 576

2000

5190186 5 695 JOO •62 840

,.,.,.., w.,,,.r.i Jvwna

Ulodcnl P~Ntw

MElANESIA

2000

GuoOff

Solomon Vanuatu

M• lontsla

1999

'°9042

460 100

28370

1999

186 678

215 800

12 190

7 444 100 540 248

.. '"

. ;

"Only 14 990 of 1hc popo.iltt1on ol Coo'; 1$1-fl(H 1n 1tle ceimus tt'pOfled being permanent residents. Sourc.: SKrNntl ol 1ht ' "1roe ComlniMl•ty, h<ff< ~rrd ~ll)t'IS 10()4 wwwspc.int,

The PacELF Way Towards !heElimlnalloo ol l ympllaijc Filariasis In lhePa<~ic of !he Pacific. Olher health information

related to modernization and lifestyle

for each country is given in Part 2 of

changes are becoming more frequent.

!his book. The morbidi ty pattern In

There ar e two o ther i mportant vector-borne diseases In the Pacific

most of the Pacific countries has shifted significantly over lhe past three dec ades. Alt ho ugh Infectious an d pa rasitic diseases continue to be amo ng the lead i ng causes of ad m i ssi on to hosp ital s , non-

while malaria is restricted to Papua New Guinea. Solomon Islands, and

communicable diseases a nd injuries

Vanuatu (Table 2Âˇ2 ).

in addition lo filariasis. dengue fever and mala ria. Dengue Is a n increasing prob1em in most Pacific countries,

Table 2Âˇ2: Countries at risk for Malaria and countries that actually had dengue outbreoaks

in the last 1oyears in the Pacifi'

Region

Country or Territory

Malaria

Dengue

Federated States of Micronesia

Guam

IClnbati MICRONESIA

Marshall Islands

Nauru Northern Mariana Islands

Palau

American Samoa

Cook ISiands

French Polynesia

Niue

Pitcairn ISiands POLYNESIA

samoa

Tokelau Tonga

Tuvalu

MElANESIA

ttlatiasis Ill Ille Paalic

Wallis and Futuna

Fiji Islands

New Caledonia

Papua New Guinea

Solomon Islands

Vanuatu

PART I

FILARIASIS EPIDEMIOLOGY IN THE PACIFIC

Figure 2·3: Distribution of filariasis types in the Paofic

• l'<!riodic D Subpcriodlc

Source: SK.; PacElf; M

(1976)

Figure 2·4: MtCrofilanal penodlcity in Vanuatu

TYPES OF FILARIASIS The only species of filariasls present i n the Pacific Isl ands is Wuchereria bancrofli. However, at least two physiological types of W. bancrolri exist in the Pacific: nocturnally periodic

2S ~ 20 w 0.

... , -

:::>.<: 1S

O•

:3 K :i;

and diurnally sub·periodic types (Figure 2·3). They differ in the time of day when Mf are present in the peripheral blood

and can th us be Ingested by mosquitoes.

The typi cal fl uctuation of Mf numbers in lhe blood (per µI). as well as the mosquito densities (bites per

person per hour). in two Pacific countries is shown in Figures 2-4 and 2·5. Vanuatu has nocturnally periodic

16 1s HOURS

Sourc•: R(pfodu('Cd from Ati.~ •I (2003). with pel'mlSSiOn

Figure 2·5: Mi(IOfilaticll periodicity in 5amoo

.•

filariasis (Figure 2·4). Mlcrofitariae and mosquilo density are high during the night and almost non.existent during the

••

•

bancroltiin Micronesia, Melanesia, and Polynesia. and the main mosquitoes that serve as Intermediate hosts. It

HOURS 1-- · Ae<les samoanus Sou rc.: ~«'d from

it ~ o.

day. The data from Samoa (Figure 2 .5) show a dally fluctuation In Ml and

mosqui to density. but no extended period of time when Ml density is zero. Table 2·3 lists the types of W.

so: ...E

••

:i;

.______ M l(RO~LARJ.AE lt.tmaiingam f:l •I (1968).. w1h perm1n1on

Chaplet 2

@ OD

The PacELF Way Towards !he Eliminalloo ol lympllaijc Filariasis In lhe Pa<~ic Table 2·3: Filaraasis Transmisston Type and Main Mosquito Vectors 1n Each Pac1ri.c: Counuy W.bancrokl fype

Country/Territory •

Region

Main Vectors

Federated Staies or M..:rones•a GW!m

•

Kinbat1 Marshall islands Nauru

Cu/ex quinquefasdatus

MicronesJa

tlocturnally pe<iodic

Nonhern Marianas Palau Papua New Guinea

Allopheles (J)uncrulorus group)

Solomon Islands

Vanuatu

Melanesia

New Caled0<1ia

Aedes vigi/di

Fiji

American Samoa Cook Islands French Polynes.a

Diurnally S<Jb-penod1c

Niue

Aedes <Scutellar~ g•oop)

Samoa

Polynesia

Tonga

Tokelau Tuvalu Wallis and Futuna •Pitcairn btands not Included f0t la<k. of infOfmation

period ic W. bancroftJ in Melanesia Is transmitted mainly by species In the Anopheles punctulatus group. In the

M OSQUITO VECTORS

sub.pe riodic a reas . some Aedes species in the scutel/arisgroup transmit the parasite during the day. Aedes

Aedes. Culex. and Anopheles are the three main mosqui1oes involved in lymphatic filariasis transmission in the Pacific (Figures 2-6 and 2-7). In most

vigilax is the maj or vector i n New Caledonia, and may transmll filariasls

of Micronesia. filariasis is nocturnally periodi c and tr ansmitted by quinquefasciatus, whereas nocturnally

at nigh t or du ri ng l he day. The g eogra phical distribution o f these vectors is shown in Figure 2-8.

ex.

Aedos. Cuh>x. and Anopheles larvae 1n the Pacific

r"·''"I•

shows lhe known areas of periodic and sub-periodic types of filariasis.

Aedes. Cuh>x, and Anopheles AdullS In lhe Pacific

....

"" ttlatiasis Ill Ille Paalic

.,.

CuffII' qulnqur:f;ucl.trus

PART I figure 2-8: Mosquito ver;tor distribution 1n the Pacific

rJ Cufex quinquefascjarus

mAnopheles (punaulatus) • Aedes (scutelldris) CJ Aedes vigilax

HISTORY OF FILARIASIS BEFORE PacELF

Filariasis has been a scourge in the Pacific for centuries. Waqaqa, big leg.

Figure 2·9: Porceni.ge of people lnfectl>d (Mf posiu,.) in the PacElf countnes befo<e 1950

aoraki man le mata, rektel a rekas1 mumu tutupa mwtraro, filanas1s pwuur, moko pata, kinal. le fu'aa, va'e fua,

eke'eke. filariose, fe1ee, and tegi biki are all common wo rds in the Pacific languages that are used 10 d escribe lymphatic filariasis. While travelling across !he Pacific. Captain James Cook made lhe firs!

ZO-

1-- -...-r. -

I-

notes on e&ephantiasis In Tonga in 1785. Microfilariae were firs! d iscovered In lhe

Pacific as early as 1896. when Thorpe and Manson both observed Mf in blood

films In Fip, Tonga, and Samoa. Also In 1896, Manson described Samoans suffering from an ""elephanioid" disease. The prevalence of lilariasis and

Vector:

0 Cufel: Q'<l((IQVe~rus • AtXJts fscvreHMW I Anop/>ele< (punaull<u.11 CJ Ae<t« "!l;i.x

elephantiasis In the Pacific region used

to be among lhe highest docomenled in lh e world. Figure 2-9 shows lhe

New Guinea, and Samoa have carried

prevalence of the disease as reported

out quite extensive MDA programmes

In studies done before 1950

with DEC. Details of lhe MDA programmes in each country are summarized below. and described In more delall in Part 2 of this book.

FILARIASIS CONTROL PROGRAMMES

The first attempts at mass control Efforts lo control fitariasis have a long history i n the Pacific. In particular, some countries Including American Samoa, Fiji, French Polynesia, Papua

In lhe Pacific began in Fiji in 1944 and focused entirely on vector control- either the elimination of mosquito b reeding sites through mass clean·up campaigns

or the use of insecticides like dichlorodiphenyllrichloroethane (DDT). This vector control strategy was also tried In the Cook Islands and then In Samoa and Tahiti. Malaria control through indoor residual spraying with DDT in Melanesian countries during the 1960s and 1970s appears to have reduced or even eliminated filariasls in some areas.

Elephantiasis of •he legs in a group

Many drugs, ineluding antimonials, ar senoxi des, c ya nine dyes . an d

of men in F-iji, date unknown.

piperazine derivatives. were used to

American Samoa The high prevalence and frequency or elephantiasis in American Samoa

prompted control attempts in the 1960s. Two MOAs were carried out nationwide in 1963 and 1965 with 72 mg of DEC given per kilogram of body weight. A post-treatment survey i n 1970-1972 round that the Ml rate had dropped from 21% to 0 .9% on Tu tu lla island .' elephantiasis to less than 1%. and hydrocoele to 2 .1%. However. Mf prevalence rates Increased again in the 1980s and 1990s.

Figure 2·11: Ag•·SP«rfic p<e-1alence of Ml rn Nor1hem Fiji, 1968-1969

Fiji Fiji has long been notorious for its high prevalence of fllarlasls and !10J-~~~~~~~~~~~....::::::~~~~~__,.,;..:;;L..~-.I

.l!

elephantiasis (Figure 2· 10). The first full-scale trial of MOA was carried out In Fiji between 1952 and 1953. Then In Northern Fiji In the 1960s. a pilot project was carried out on the Islands of Vanua Levu, Taveuni, and Kora.' In a pre~ intervention survey, the prevalence of

•••

10-.14

15-19

20--lO

31)..40

Mf was found to be 13% among females

......

and 17°k among males, for an average prevalence rate or 15% (Fig 2-11). The geometric mean number of Ml ranged

Age group. year$

I .-._. Male

- + - Female

..-eom I Sow<;« Mt~ttfl (1971)

treat fi1ariasis, with lltUe success, until the introduction of DEC in 1947. In rhe 1950s to the 1960s, many pioneering anti.filariasis trials using the recently discovered DEC were conducted In the Pacific Islands Mass DEC treatment

was implemented on a large scale in American

Samoa,

Fiji,

French

Polynesia, Samoa , and Wallis and Futuna. and on a more limited scale In Cook Islands. Niue. Palau. Tokelau. Tonga, and Tuvalu . However. programmes rarely achieved a high compliance rate over large areas for

ttlatiasis Ill Ille Pac.lie

densities in southern coastal and island locations were two to three times higher than in inland areas. apparenUy because of the higher rainfall on the southern coast of islands and the presence of Ae. polynesiensiswtthin 0.8 km of the coast. The prevalence rates, but not the Mf densities. were lower among persons or Indian descent living in the same geographical situations as Fijians wilh higher Infection rates. The prevalence among Indians averaged 8% In both

sustained periods , and filariasis remained endemic In many Pacific

males a nd females . However. the prevalence of elephantiasis in the same areas was no different between Fijians

Island countries.

and lndians.7

' WHOr'Sfl'C.{197&} ' Mai.a!ka M al.(1971} 1 M&t.lilal ti al (i971)

from 2 to 14 per 20 µI In males. and from 1 to 5.5 In females. depending on the location, Prevalence rates and Mf

PART I The pilot MDA in northern Fiji was

lhe rate of decline of Mf prevalence in

followed by a national DEC programme from 1969 to 1975. The dose was 5mg/ kg given weekly for six weeks and then

villages with high initial Mf densities was similar to that seen In villages with low Mf density.

monthly for22 months, for a total of 140 mg/l<g given in 28 doses over a two-year

Despite these encouraging results on one island, wider surveys carried out

period.' The Mf prevalence fell to less than 1% after the MDA, but by 1983 the Mf rete was increasing again In almost

i n Fiji between 1991 and 1995 determined the overall prevalence of Mf 10 be 5.1%. No fu rther MDAs were

all areas. Between 1984 and 1991 a trial project comparing a multi ple-dose

carried oul in Fiji until the start of PacELF.

regimen of DEC with different annual single-dose regimes was carried out In three areas of Fiji. It showed lhal a

French Polynesia In the ea rly 20th century, the prevalence of Mf in French Polynesia

sing le dose of 6 mg/kg annually for five years was almost as effective as the full course of 28 doses given over a period

was thought lo be around 40%, with peaks of up 10 80% in oertain areas. The

of 12 to 18 months.• The single-dose regime was much simpler to administer

fact created in 1949 (under the name tns1i1u1 de Recherches Medicales des

and was likely to achieve higher coverage. Matalka 10 tried out mass single-

Etablissements Fran~ais de l'Oceanie)

dose annual drug administration 1n 43 villages on Kaduvu island, southern Fiji, In the late 1980s and early 1990s. In

1985. a survey of 76.3% of the po pu lallon (n=5799} showed the prevalenoe of Mf in 60 µI blood lo be 6.9 %, although it varied by village from 0.4% to 28.8%. Microfilaria densi ty varied from a geometric mean or 1 to 67.6 by village. The Mf prevalence In Kadavu

decllned from 6.9% (n=4686} In 1985 to a low of 0.7% (n=2611 } in 1990-1991 (Figure 2-12) after five single annual doses of DEC. However, the coverage rate with DEC is not staled, and the number of people surveyed In the last year of the programme was only about 60% of the number surveyed in 1985, suggesting that complia nce had declined significanUy. Although the MDA was Island-wide, 11 of the villages had small populations and poor compliance, and were not included in the results shown in Figure 2-12. On the other

lnstitut Louis Malarde in Tahiti was in

mainly to fight lymphatic filariasis In the French territories (Figure 2-13). French Polynesia has a long history of MDA programmes, starting in

1949- 1952. when various DEC regimes were tried. A mass drug administration was then done in rural Tahiti in 1953, followed by the treatment of positive

EJephantiasis- of the arms In historical postcard from French

Polynesia, date unknown.

......

carriers identified in regular surveys until

Figure 2·12: Oedine in Mf prevalence on l(.)davv lsJand. Fiji, durin.g and after five rovnds of DEC in 1987- 1991

• -!-~~-"'...,._.:..._~~-=-~~-'-~~-'-~~-'-~~~~~~

2 s.i-~~~~~.::....--~~~~~~~~~~~~~~~~--1 .~s

J..

....~~~~~~~~~~~~~~--1

•l-~~~~~~~....:l

> +-~~~~~~~~~-'-~~~~~~~~~~~~~--!

1985

1986

,...,

...

. ,...

hand, it was noted in these studies that 'WHOiSPC.(1 974}

• Klmu1a and Mat<1iU.{1996) ,. Maiab et II 11998)

Cnapier 2

@ !JD

The PacELF Way Towards !he Elimlnalloo ol lympllaijc Filariasis In !he Pa<llic 1964." The prevalence of Ml declined

A trial comparing four annual single

from 30% to 2 1°~ in 1953, and then

doses of DEC plus ivermectin with DEC alone in the East Sepik province in 1994 to 1997 reduced the Ml prevalence by

dropped sharply to 6% in 1955. II plateaued at this level until 1964, despite

86% lo 98% , and greally reduced transmi ssion and the prevalence of hydrocoele and lymphoedema.1<4 A trial

repeated treatments of Mf carriers with DEC. Elephantiasis similarly declined

from 7% in 1949 lo 2% in 1958 and 1964.. The Ml prevalence in Tahiti rurlher declined to 2% after a series of

comparing DEC salt with tablets was

four annual doses of DEC from 1974 to 1977." DEC distribution, through MDA or

done in the 1990s. '' M ining companies have supported several MDA programmes in the regions around the mines. starting with DEC in

limited drug distribution in the vicinity of known carriers, continued In Tahiti. Mourea.and Maupitl during !he 1980s.

the Ok Tedi mine area in the 1980s. In the Samarai district (site of the Misima mine), a community-delivered MDA

Mass treatment continued in Maupiti

untll 1997 (by which lime treatment had gone on for 34 years), but resrdual

programme with DEC and albendazole. was very successful in reducing the antigen prevalence from its initial high

microfilaraemia of 0.4% in people on the island In 1997."

level of 63% to 6 .6% in 2003." There was eircvmstantiaJ evidence that the

Papua New Guinea

MDA programme also had beneficial effects on childhood growth and birth weight In the area, perhaps because of

Papua New Guinea has extremely high Mf prevalence rates in some areas. such as the East Sepik region. II has

the effect of MDA on other worm infections.

also been the site of extensive research and trials or treatment ror filariasis. The

Samoa Eight MDAs w i th DEC were

age·specific prevalence of Mf, leg oedema. and hydrocoele is shown in Figure 2· 14. Overall. the prevalence of

completed in Samoa between 1962 and the start of PacELF. and iwo more with DEC and ivermectin were completed In

Mf In this area was 66o/o. In contrast t'o Samoa and Fiji, no difference was found in prevalence rates beiween men and

1996and 1997. The first MDAwith DEC In 1962 used 5 mg/kg once a week for

women In the area.

four weeks. lhen once a month for 18

Figure 2· 14: Ag~specific pc-evalence 1n Dretkibr are.a, Papua New Guinea, 1993-1994

80+-------------

"'160+--~ !40

i'o 0

5-9

10--19

20-29

3()-39

A~9

2SO

Age gr-oup

I•

Ml • ltg O<doma D Hydrocoelo I Souru: IC.uur4 t"l IA (199n

Uolg!tl l!I ~I (1 966) u ~1gftt ei ~t<t 980) " Es1er11! H .ll (2001) u Bocltatlt l!t ti. (2002)

" sapat.0998)

QD @

'* Sapalt l!t it. (2004) www 1cu «lu.~.

ttlatiasis Ill Ille Paalic

PART I Figure 2-15: Mf prevalence. Mf density; and MDA timi119 In Samoa before PadLF 35

. e

!;' -~

..;;

1! 15

•" "

...

15 ~

1920 1925 1930 1935

1940 1945 1950 1955

1960 1965

1970 1975 1980

1985 1990 1995 2000

1 S m~g wt<>kty for a month. then monthly for 18 mon1hs 2 6 m~g mon1hly fQt a year 3 6 m~g sin9le dose once a ye;tt

MOA A Ml denvty

months; it led to a dramatic reduction in the Ml prevalence (Figure 2-15). A further MDA in 1966-1967 using 6 mg/ kg once a month for 12 months lowered the Ml rate to 1.6% in 1972. After these

..!1. •.....••••••••••••. :'i .... ................... "2_1 • ..•••••••••.,u1 .......... ~; ................. .

campaigns, Mf rates remained low. but they have never reached 0%, and in a

survey of more than 10 000 people in 1982, rates were over 5%. Subsequent MDAs in the 1980s with annual single

I•

I I•

c:·1r1.amt1 ,~,,

Pa~ent's

cord, 1966

2-16; It indicates that he took all the recommended doses. Pages from Samoa registration books for 1971 (with the 12-dose regimen) and 1982 (single

year sustained MDA programme, first

rn Figures 2-

(1996-1997). The MDAs during the 1990s pa i d c lose alten ll on to

It was not until the 1990s that

maintaining high coverage, resulting in a sustained drop in prevalence over that

annual dose) are shown

17 and 2-18.

Samoa conducted a continuous five-

I• '

;t Q t

., " ,, ,,' "

I 1

" I"

~IH.t\ lt l'l,1

doses of 6 mg/kg helped to keep the Ml prevalence below 5%, but the Ml density remained quite high. A patient's card for the 18-dose regimen from 1966 is shown in Figure

with DEC alone 1n a single annual dose for three years (1993-1995) and then with DEC and ivermectin for two year s

The PacELF Way Towards !he Elimlnalloo ol lympllaijc Filariasis In !hePa<llic

""""""'~•u1111

,.. ..,.. ,

l:t

U-

...

1.., 1W4

____ ,.., -.·-.-· I ··.. ' ''..... • '

....., .........

· <

... ..'' ' .• •' .. ' • .... '· . '.... r...

I< ,

·111, ••V Cr A

..,0

...,,, . .

,. .. ,6

,,"·-·-·

rr.·";. ·

'·.

... ,. ...."' ..... .... .' ........ ••

Page from Samoa reglstta1lon book, 1971

Pago from Samoa regislration book, 1982

Table 2-4: MDA coverage, Mf prevalence. and Mf densityln Samoa, I 993-1998

Item Drug used

1993

1994

1995

1996

1997

DEC+

DEC

ivermectin

ivermect:in

1998

remaining positive cases ( Table 24).

MDA c<M>rage (%)

83.3

67.2

80.1

79.4

91.6

Not done

Number of villages

32 10 256 444

30 10 112

23 4551

31 5997

4054

225

133

29 8305 141

7.5 2.0 4,7

3.9 1.0

4.2 0.6

4. 1 1.2

3.4 0.5

2.4

2.6

1.9

Number examined Number positive

M l rate (%)

Males Females Total

1. 7 0.4 11

Mf density

(geome1ric mean per 60 ~I)

Males Females

13. 5 8.0

Total

11 .8

12.1 10.5 11.7

6.6 8.2 6.8

period ( Table 2-4). However there was no marf(ed reduction in Mf density in the

12.6

9.1

5.4

9.4 11.5

8.1

5.8 5.5

8.9

As a result of the many MOAs. the age-specific Mf prevalence curve In Samoa changed dramatically from 1982 to 1998. with the greatest decline in

prevalence being seen among older age groups (Figure 2-19). In 1998, the Ml prevalence in Samoa was estimated at 1.1% overall (1 .7% in males and 0.4% in females). In 1999. lhe coun\ly was

the first to start MDA wi1h DEC and albendazole under PacELF.

Figure 2-19: Age-specific M f prevalence in Samoa, 1982, 1993, and 1998 18

i " .!!

1•+------------------------1"----1 14+-~~~~~~~~~~~~~~~~~~~~~~1 2 ---~~~~~~~~~~~~~~~~-

~ 10+--------------1 l•+--------------1 ~

6 +-~~~~~~~~~~

·---~~~~~~~~~~

' r----..,------1

+---...co..-,.J 20-29

10-19

I•

CE] @

Fllatiasis Ill !lie Paalic

1982 0 1993 • •998

10-19

Ag•g..,up(y•ars)

60+

PART I

Other countries

0.3% in 1000 persons examined in 1972.1 â&#x20AC;˘

Cook Islands. An MDA campaign on Aitulaki in 1968 reduced the Mt rates to 0.8% in 1969 and 0.2% in 1971." However. a survey of the island i n 1992 showed that Mf rates had increased to

Tokelau. An MDA was implemented throughouttheterritory ln 1994, despite the fact that a nationwide survey at I hat time identified only one positive case.

3.2%. Federated States of Micronesia. An MDA using DEC on four islands of Yap in 1974 treated 865 people. Niue. Three MOAs were done:

(1) Arter an MDA in January 1956, when the Mf prevalence was 22.1 %, the rate fell lo 2.9% in December of that year. (2) MDA witllDEC in 1972wastllooght lo have eliminated the disease.

However, a survey In 1996 round an Mf rale of 1.8%. (3) Another MDA was carried out in 1997 usi ng a combination of lvermeclln (200 pg/kg) and DEC (6 mg/kg). Palau. An MDA wilh DEC al a dosage of 5 mg/kg every other month for lwo years was carried out In the early 1970s. This lowered the Mf rale from 12.6% lo

Tonga. An MDA. which was started in May 1977, led to a drop in the Mf rate from 17% to 1%, according to a postireatmenl survey in 1979. A follow-up MDA survey from October 1983 10 January 1984 In some limited areas found lhe rate to be 0.4%. Tuvalu. An MDA using DEC In 1972 lowered the Mf prevalence rate from 14.7% in 1971lo justbelow1 % in 1973. according to lhe post-treatment survey lhal year. An MDA using DEC was also Implemented In 1992-1993. Wallis an d Fu tuna. Monthl y DEC di siribulion bega n i n 1978 an d continued unlil 1987. Mf rates dropped from 5.3% in 1978 lo 3.2% In 1985 in Wallis, and from 1.7% in 1978 to 0.4% In 1985 in Futuna. The di stri bution programme became biannual 1n 1987 and stayed lhal way unlll 2002.

THE PacELF INITIATIVE BIRTH OF PacELF In March 1999, in back-to-back meetings In Palau. the WHO Western

Pacific Regional Office and the Secretariat of the Pacific Community (SPC) took up a call to action set by the World Health Assembly resolulion on eliminating lymphatic filariasis. The meelings encouraged SPC to continue discussions with WHO and other donor agencies on a comprehensive strategy

II WH(l'SPC 1tpor1 {1974) " WHCVSPC ftp01'1 . 1974)

for ellminaling lymphatic filarlasis in all 22 island countries and territories in the Pacific. The WHO Regional Director was asked to consider making the elimination of filariasis a WHO priority. The meeti ngs also Increased awareness of filariasis as a public health problem and alerted Pacific Island communilies 10 lhe need to control and eventually eliminate the disease.

The PacElf Way Towards !he Elimlnalloo ol lympllaijc Filariasis In !hePa<ilic

PacELF family Is Fighting, FlghUng , I kJhlhQ

P•cELF

A STORY OF PacELF FAMILY

...

~'©i

---' ""-- -

IM P'9lSJ' ........ ,,,... ~Oii! fOOU. nu.!tl~ W rflllDIOI

PacaF famty will win a

VICTOR YI

The PacElf- concept A presentation illustrating the coocept of PacELf as a family of countries that can achieve strength and succe•s by w0<1:in9 togethe< and io1nln9 wilh the larger family of coun1rres, helped by wl1er and support from the PacELF home offlce.

Al !his lime. bolh WHO and SPC were well positioned to work together on lymphatic filariasis control. WHO had

lhe World Health Assembly and the Regional meetings. They envisioned a regional programme driven by the

experts in vector· borne and countries themselves. and coined the communicable diseases in Manila, name PacELF-the Pacific Programme Papua New Guinea. Solomon Islands. for the Elimi nation of Lymphatic and Vanuatu. The SPC, on !he other Filariasis (Figure 2·20). They secured hand. was i mplementing !he Pacific funding from WHO and through lhe Regional Vector Borne Diseases AusAIO/SPC vector·borne diseases Project, funded by the Australian Agency project ror a meeting of Pacific country for lnlemational Oevelopmenl (AusAID). representatives. This took pl ace In and had slaff based al SPC Brisbane on 28 and 29 June 1999. headquarters In Noumea and at project Public heallh officials from Pacific offices in Vanuatu, Solomon Islands. countries,'' plusstaffofotherinstitutions and Fiji. in filariasis elimination,20 attended the Dr Kazuyo lchimori of WHO and meeting and d iscussed activities being Dr Tony Stewart of SPC met in Port Vila. carried out or planned worldwide and in Vanuatu on 11April1999 to discuss the Pacific. The country representatives how besl to carry oul !he resolutions of refined and endorsed the regional plan •• AmtflCMI sarno1, Coot f\lands. f11I. f;~ Poly~•. Nlutu, Htw CIJe<fOt'lll, Niue, Papua New Gu11'1N, S.mCM, Sobl'lotl i.!Mlcl), l ot1ga, T~u. Vltlulltu, ll'ld Walls Md futul\I.

4 IJnlvcrSity ot Qu~WM,. A.ldt111!1, Jln'litS Coot.: Ul'llYef»ly, Austr1lla. Smnhklll'le 8Heham il'IOWGl&lO Sm!~h l"Jdlt), ll'ld AMAADlct

PART I of action. and named four country

lymphatic lilaroasi s. In June 1999

repre sentatives to an Interim body that

PacELF already had a n action plan and

woul d coordinate Imp l ementation between meetings. This meeting gave

was looking forward to eliminating the

birth to PacELF, the first regi ona l programme with the goal or eliminating

disease in the Pacific by 2010. Table 2· 5 lists import.anl events in the history of PacELF.

Table 2·5: PacELF chronology. 1999-2005 Date

17- 19 Mar 1999

Activity Resolution endorsed at meeting of Pacific

health ministers

Place

Patau Bnsbane,

28-29 Jun 1999

1s1 annual PacELF meeung (b•nh or PacELf)

Oct 1999

1st MDA in PacELf implemenll!d In Samoa

Samoa

°"' °"'

Australia

1st CB meeting

Suva. Fiji

2 1999 20 Apr 2000

Matailol House opened

Suva, Fiji

5PO!'acELF meeting

Su\'a. Fiji

Apr2000

JICA collaboration started

Suva, Fiji

22-23 Jun 2000

2nd CB meeting

16-20 Oct 2000

2nd annual PacELF meet.Ing

Noumea. New C..le<iont<l Brisbane.

20 Oct 2000

3rd CB meeting

2s-26 Jan 2001

1st super C8 meeting

12-15 Mar 2001

Meeting o1 Pacific ministen

Madang, Papua New Guinea

26- 27 Mar 2001

PacELf visited by GSK team

SUWJ, Fiji

Jun 2001

PacELF logo developed

Suva, Fiji

8Jul 2001

PacELF home oWce opened at Mataika House

Suva, Fiji

24- 29 Sep 2001

3rd annual PacELF meeting

Nadl, Fiji

1999

Australia

Brfsbane, Australia Suva, Fiji

27 Sep 2001

1st PacCARE meeting

Nadl, Fi1i

19-20 Feb 2002

2nd PacCARE meeting

Suva, Fiji

19-23 Aug 2002

4th P-ac.Elf annual meeting

21- 22 Aug 2002

3rd PacCARE meeting

1 Oct 2002

PacELf webshe launched

Rarotonga, Cook Islands Rarotonga, Cook Islands Suva. Fiji

17-18 feb 2003

4th PacCARE meeting

Suva, Fiji

22-26 Sep 2003

5th P-acElf annual meeting

lautoka, Fiji

26 Sep 2003

51'1 PacCAAE meeting

Lautoka, Fiji

23-27 Aug 2004

6th PacELF annual meeting

Apia. Samoa

27 Aug 2004

6th PacCARE meeting

Apla,Samoa

22-26 Aug 2005

7th PacELF annual mee!lng

Suva. Fiji

26Aug 2005

71'1 PacCARE meeting

Suva, Fiji

Cnap1ei2 @

1JD

The PacELF Way Towards !he Eliminalloo ol lympllaijc Filariasis In lhe Pa<~ic

ORGANIZATION AND FUNDING PacELF (see organization chart in Figure 2·21) is an alliance of 22 Pacific Island countries and lerrilories, which have joined together lo help one another

WHO, through its South Pacific office in Suva. Fiji, is the backbone of

support for PacELF. The PacELF home office was established In 2001 et

eliminate fllariasis. It is the Pacific

Mataika House (National Centre for

regional counlerpe rt of the Global Alliance to Eliminate Lymphatic Filariasis, supported by WHO. PacELF Is a support network for !he Pacific countries and a channel for information exchange be tween !h e Paci fi c communities and outside partners.

Scientific Services on Virology and Vector Borne Diseases, now called the Fiji Centre for Communicable Disease Control) In Suva (Figure 2·22). PacELF facilitates regional efforts to eliminate filariasis and negotiates with donors to help coordinate their activities . ll maximiz·es the use of resources by coordinating procurement, shipping, and storage or supplies. PacELF also

Figure 2 21: PacEl.f organitation 4

Partners

serves as a source of technical advice to countries on mass drug administration , health promotional

• (.('fltcri f0t DnNw Con1tol alld~bon

• EmcxyUrwmiry • Q;);a>Smtlhl!Jino

• k»Wl.ll Louk ~t.ltlf

• J"""" Cool Uf'\l«ni.ty

WHO/HQ

• Up.lrl ln\(lft'loll~

C.00ptt~11on ~l!l'l(y

• ~l,F(ctllt'I

WHO

• MIMtiy ol tteoiotth, f11i

RcglonAl OfAc~

• ~I of the hatk

COmn'IUMy

materials, surveillance, and data

management. The PacELF team, headed by a full·time WHO Scientist. started with

only one volunteer staff member

- ~~~t

WHO Country Office

.°"'"'

supported

the

Japanese

Government through the Japanese Overseas Cooperation Volunteer

PACIFIC COUNTRIES

(JOCV) programme. The staff has since grown to include rull·time coordinators in Fiji (started in 2003), Samoa (2003). and mos! recently Papua New Guinea (2005), all supported by WHO. The number of volunteer staff from JOCV and the United Nations Volunteer (UNV) programme working in the PacELF

office now stands at lhree, and a Peace Corps volunteer will join the programme in 2005. Individual country

programmes in Fiji, Samoa. Tonga, and Vanuatu have also benefited from the services of JOCV or Voluntary

Mitlillkil House, Swa. Fiji

Service Overseas (VSO) staff. In addition, the PacELF team includes rep resentatives from the Fiji Government. WHO short-term consultants, and technical advisers from the Centers for Disease Control

PART I and Prevention (CDC) of the United States of America and other academic

Insti tutions. The PacELF Coordination and Review group (PacCARE) approves ann ual applicallons and re-

the member countries. and drawn up a plan of aclion.

PacELF policy PacELF has developed policies to standardize activities in the region.

applications for drugs and supplies.

keeping

This group started as the PacELF coordinating body but cha nged its name to PacCARE in 2001 to better reflect i ts function as an e xternal watchdog over PacELF's applications

requirements of the programme and the resource limitations and challenges in the member countries. A unique characteristic of PacELF Is that each country follows these policies. yet

and annual reports. The group is

retains the flexibility to choose the best

roughly equivalent in function to the

way to Implement activities.

In mind

the

scie ntific

regional programme review groups

The policies of PacELF a re as

establ ished by the olher regional lllarlasis ellmina tlon programmes unde r the GPE LF. ll i s l ed by representatives from Pacific ministries of health. WHO provides major financial support for staff, local costs, meetings, supplies , and equipmen t. The

follows: (1) The implementation unit in each country except Papua New Guinea is the whole country. (2) A ll couniries will impl ement detemiine endemicity. (3) Combination therapy

Japanese Government and the Japan

diethylcarba mazine

baseline surveys using IC T to

of and

International Cooperation Agency (JICA) donate the DEC tablets, ICT cards, and some funds for the PacELF countries. Albendazole tablets are supplied free of cha rg e by the

albendazole will be used in mass drug administralion (MDA). (4) Countri es where lilari asi s i s endemic will conduct five rounds of

manufacturer, G laxoSmithKline. T he

(5) Each MDA will be completed in two months. (6) The following categories of people will not be treated: children under

CDC and Emory University provide technical support and personnel for

American Samoa and other territories of the United States in the Pacific. Other donors are the Ministry of Health or Fiji and t he Liverpool School or Tro pica l Medicine In the United

Kingdom.

POLICY. STRATEGY, AND

PLAN

The goal of PacELF is to eliminate lymphatic filariasis in the Pacific region by 2010. This is 10 years ahead of the global goal or 2020. According to the PacELF definition. the disease will be considered eliminated when the parasite is no longer transmitted to humans. To meet this goal, PacELF has developed policies, chosen a strategy based on scientific evidence and the capacity of

MDA and then assess the impact.

24 months. pregnant women, and

very sick people (hospitalized, sick wi th cancer, or undergoi ng dialysis). (7) ICT will be used In midlemi and final surveys to assess the Impact of MDA_ (8) Appropriate vector control methods will be used. (9) Filariasis control methods will be Integrated where possible with other

country

programmes

Including those for malaria control, dengue control. and other helminth control.

(10) Lymphoedema and other pathology will be clinically managed to minimize the effects of the disease.

The PacELF Way Towards !he Eliminalloo ol lympllaijc Filariasis In !he Pa<llic Pregnant women are excluded only as a precaution. There is no evidence Iha! !he tablets cause hanm to pregnant women or their babies. Pregnant women are advised lo come bacl< r°' lhe tablets after delivery. Individuals who have serious pre · existing health conditions such as cancer or advanced renal disease are discouraged from seeking lreatment.

so !he number of lablets needed can be estimated. Some countries also have

census data available to aid estimates. Mosl countries organize !he MDA by health facility. but some countries have demonstrated effective distribution by church members, women's committees. or other organizations. Usually l he nurse or doctor in charge of a heallh facility estimates the population to be

trealed In the area and orders lhe required number or drugs and register books lhrough the PacELF home office. which ships !he orders 10 the facilities. The tablets are dlstribuled in village or settlement meetings, house to house, or at static booths in public areas or at large events. In all PacELF countries,

the names of those 1tealed are recorded In a register to allow estimates to be made of treatment coverage and number of tablets issued. Oala on each

participant Individual's age. sex, and village are entered in the register. If a

MDA in Kiribati

registered i ndivi dual cannot lake treatment, the reason is documented on the form. The registers and leftover

PacELF st rategy The PacELF strategy for achieving

tablets are sen! back to the country office after the campaign for that year.

elimination invotves two parts: (1) Annual MOA in countries where !he

The DEC tablets supplied by PacELF are 50 mg each and are given

disease is endemic. using DEC. as well as albendazole lo stop

at a dose of 6 mg/kg. Albendazole tablets are 400 mg each, and one tablet is given to people of all ages (Figure 2-

1tansmlssion: and (2) Clinical management of infection.

lo minimrze pathology in indrviduals who are already lnfected. The treatment must achieve high

coverage or the population to ensure

countries use age as an estimate of body slze to determlne the number or DEC tablets required. If exact age is not

within two months. When done in short Intervals, MDA allows !he complete cut·

known, It is estimated to within the nearest age group . Treatment

off of Mf transmi ssion to mosquitoes

schedules for each country doing MOA are shown in Part 2 of lhis book Possible mild reactions lo the MOA

Each PacELF country chooses its own strategies or disltibutlon and social

mobllizalion for MDA. In all cases. a register of the population Is prepared, ttlatiasis ill Ille Paalic

slightly different breakdown of body weigh! categories. Calculating dosage by weight is difficult In !he field, so some

!hat all the infected individuals in an lmplen1entatlon unit receive the required drugs. Mass drug administration should be done in whole implementation units

(and hence 10 people) in the implementation unit

[J£J @

23). Treatment is given either by weight or by age: Ille choice is left to lhe country programme. Each country may have a

drugs include fever, headache, and dizziness. These adverse reactions are frequent and can be managed by !he country MDA headquarters. All severe

PART I adverse effects are reported Immediately lo lhe country MDA headquarters and the PacELF home office. Thus far. there have been no known

life. threatening

adverse

reactions to MDA In the Pacific. All PacELF countries. regardless of endemicity, implement activities to

alleviate and prevent suffering in those already disabled and disfigured by the disease, although the number of such reported cases in the Pacific is low compared with o·ther regions where the di sease is endemic. The PacELF strategy is to conducl morbidity surveys, teach clinical case management, and

(2) Confirming that all countries are filariasis·free and declaring lhe

Pacific free of lymphatic filariasis by 2010. A detailed moni toring and evaluation plan was developed for

PacELF and described in two manuals produced in 2002- the PacELF manual and the book on the PacELF mo nitoring and anal ysis network (PacMAN ). Both are designed for country programme managers. The

manual contains backgro und Information on the biol ogy and pathology of fitariasis, particul arly in the Pacific. It discusses lhe elimination

promote su rgery for hydrocoele. PacELF trains health-care worl<ers to identify cases. provide home-based care, and promote hydrocoele surgery.

knowl edge and techniques, customized to suit the needs of the

Patients and their family members are

diagnostic tools and informalion on

taught clinical case management of lymphoedema to sustain home-based

vector mosquitoes.

care and prevent acute attacks. PacELF

recommends t he following case management guidelines: (1) Washing lhe affected limbs thoroughly and gently wtth soap or antiseptic solution at least twice a

day (Figure 2-24). (2) Drying affected limbs after washing to prevent maceration and super

infections, (3) El evating l he limbs whenever possible,

(4) Doing physical exercises to facilttate lymphatic flow, and (5) Using an antibiotic or antiseptics to

prevent secondary Infections on affected areas.

PacELF plan To meet its target of elimination by 2010, PacELF has drawn up a plan of action. The initial plan focused on these two steps: (1) Confirming that countries where the disease is not endemic are

flla riasi s-free and eliminating filariasis by 2005 In countries

where it is endemic or partially endemic: and

strategies and provides the latest

PacELF members. It also describes

The PacMAN book is specifically concerned with monilori ng and eva luation.

describes

the

methodology used in PacELF surveys, and Includes flow diagrams for the different types of surveys according to

the recommended schedule for each country (see Part 2 of this book). The book a lso has country · specific guidelines on filariasis vector

(mosquito) control.

The PacELF Way Towards !he Elimlnalloo ol lympllaijc Filariasis In lhe Pa<~ic Figure 2-25: PacflF monitoring and evaluation plan from the PacMAN book A: lnhl.i

•o ------.

NO - - + !

B: Mid•tttm

..... ,_,

•stonSn'lcnt

........ 14--

Yts

cotltrol ttit..

CERTiflCAnoN ASSESSME:Nl

The PacElf monitoring and evaluation plan is shown in the diagram in Figure 2-25. Four types of assessment survey

five years depends on the result of this survey. Randomly selected

are conducted. (1) A survey · a baseline assessment of prevalence In a country, using ICT, l o al low countries l o be

are surveyed.

classified by endemicity level (see

Figure 2-25). For thls survey, most countries use a convenience sample or villages or purposely selected villages i n areas wilh known high levels of filariasis.

(4) O survey - an assessment of whether transmi ssion is sllll occurring. This is done by surveying young children using a lot quality assurance sampling (LQAS) design. PacELF countries are divided into three g roups according to the resutls of the baseline (A) survey : none"demic. If all the people tested are antigen.negative; partially endemic. if

done in sentinel sites selected at

there are a few antigen-positives in some areas but overall prevalence is fess than 1%; o r endemic , if the baseline antigen prevalence is 1o/o or higher. Figure 2-25 shows the timing of the surveys and the ones thal a

surveys of prevalence using ICT are done in the same villages to

monitor progress. (3) C survey - a thorough fin al evaluation covering all areas

the country, to determine whether ICT prevalence in all areas is below 1%. The decision whether or not to continue MOA beyond ttlatiasis Ill llie Paalic

villages or groups of households,

(2) B survey - midterm evaluations

the start of MDA. Repealed

CE] @

clusters, each one composed of

country must do, given Its baseline

endemicity. For example , nonendemfc countries do not need to do the B and C surveys, but can proceed

PART I directly to a D survey. Endem ic

Table 2~6: Different approaches to programme monitoring and evaluation

countries do at least five rounds of

The Pa<EU: Way

Global Progrilmm•

MDA followed by a C survey. To develop the PacMAN book and

•pacMAN"

lQAS bytcr

guidelines were modified lo suit lhe situation In the Pacific. The differences

Baseline

sentinel Sites by Ml

(A) Village survey (<onveni0'1ce of cluste<l by1cr

between the PacELF approach to

Midterm

sentinel siles by Ml

(B) Sl!flUnel villages by ICT

Initial asses.sment

the PacELF guidelines, the GPELF

monitoring and evaluation and the approach recommended by t h e

Sen1ineVspo t-<ill!d< silt!S

GPELF are summarized In Table 2 · 6.

II Mf?; t %:more MDA Stop-M CA survey

Timeline

(Q Ousier by ICT lf1Cf<1%: Slop MDA;

11 Ml<1%:LQAS by !Cl in 3000 scoookhildrC1l

Table 2· 7 shows the o r iginal

If ICT a 1%: 1ar9eted MDA.

If ICT<O, 1% stopMDA

timeline for the plan of action developed In 1999. Partially endemic and endemic

countries were grouped together in the timeline. In the first years, individual

Transmis.sio.n interruption

vector control

ICT<0. t % In cillldren

(D) ICT < 0.1% in ch1kfren

country plans were to be established and applications submitted to the

Tab1e 2-7: Otiginal Timeline

G PELF. From 2000 to 2005. MDA

Step

Non~ndemic

Year

interventions would be carried out in

1999

endemic countries and non-endemic countries would conduct evaluation

2000

surveys. The Pacific Region would

2001

become fllariasis-free by 201 O.

2002

Endemic Piaon Ing

Planning

lntel'\'enlion Evaluation

Table 2·8 shows the timeline as it

2003

was revised in 2004. It does not differ

200•

greatly from the original, but country

2005

Country Elimination

elimination in all countries except Papua

2006

Planning

New Guinea is now expected to occur

Evaluation

2007

In 2006 rather than 2005.

Follow-Up ilnd Confirmation

2008 2009

2010 Table 2· 8: RC!llised timellne

Step

Year 1999

Non-endemic

Partially endemic

Endemic except PNG

Planning

Plannulg

Planning

Papua New Guinea (PNG)

2000 2001

Planning

2002 2003

Evafuauon

Tteatment or

Evaluation

MOA

2004 2005 2006

Couotty Elrminatlon

2007 2

2008 2009 20 10

- _· •.:...~ -...i.....;.,,..~

Foltow·Up and Confirmation

MDA

CHAPTER

Approach and Activities

PacELF represents the Pacific community in the Global Alliance and is the Pacific regional counterpart of

the WHO GPELF. It i s a network or support to the Pacific countries and mediator of information sharing between the Pacific communities and outside partners. A review group.

Figure 3Âˇ 1: Roles of the PacElf home office

1. Adm1nlSttation and

ÂˇOffice M anagement

CE] @

Approacn and Attivih<S

PacCARE, led by representatives from the Pacifi c ministries of health coord inates and approves the activities of the various countries. This chapter describes the nine essential services provided by the PacELF office in Suva, Fiji. These seNices are shown in Figure 3-1 .

PART I

ADMINISTRATION AND OFFICE MANAGEMENT The PacELF home office In

programme partners, collaboraling

Mataika House , Tamavua , F iji,

scientists. and technical advisers; and personnel and training. The home

officially opened in July 2001 . A small number or staff at the office carry oul

office keeps correspondence files.

day-to-day administration and office

documents and reports from GPELF

management duties and generally manage PaoELF aclivilies-drug

and PacELF countries. and all IEC materials developed by PacELF staff,

supply coordination (acquisition,

member countries ,

storage, and shipping): operational research: techn ical assistance to

partners . and ships the IEC materials to PacELF countries al their request.

WHO , and

countries; annual PacELF and

The office also keeps contact

PacCARE meelings; informalion.

Information on all PacELF staff.

education. and communication ( IEC)

country programme managers. partners, collaborators, and technical advisers.

materials development; the PacELF website : communications with the PacELF countries and wi th

Thâ&#x20AC;˘ i'o<Et.f home office

SUB-REGIONAL STOCK AND SUPPLY SYSTEM One of the most important

August. PacELF and PacCARE review

functions of the PacELF home office

applications and annual reports during

Is coordinating and controlling drug supplies and equipment, through a simple and efficienl sub-regional stock and supply system (Figures 3-4 and 3-

!heir annual meetings. If an application is approved. PacCARE notifies the PacELF home office, which then ships the requested drugs and equipment to

that the countries can

the country. The country must send

lmplemen1 1heir acti vities wllhout shortages. The home office submits to

5) , so

back a receiving report to confirm the

receipt of shipments. The home office

the partners a single request for

keeps detailed inventories of drugs

supplies and equipment on bel\alf of

and equipment and reports these to

the region.

donor parlners. It also maintains a

Before its first MOA, a country

musl firs! submit to lhe PacELF office

buffer stock at Its main warehouse for

unplanned and immediate needs.

an applicahon form with details about

There are two separate supply

the country and its el imination

programme. as well as lhe amount of albendazol e, DEC , and !CT kils ii needs . 11 must al so re-apply for subsequent MDAs. and must submit

systems: DEC tabiels and ICT kits are supplied to PacELF by the Japanese Government lh roug h JICA for 14 PacELF countries (Cook Islands. Fiji, Kirlball, lhe Marshall Islands. the

at the same time the annual report on

Federated States of Micronesia.

the previous MDA. which the PacELF forwards to lhe Global Alliance for

Nauru . Ni ue, Palau , Papua New

Filariasfs Elimination in February or

Tonga ,

PacEl-F IEC â&#x20AC;˘loci<

Guinea . Samoa. Sol omon Isl ands. Tuva lu ,

and

Vanuatu) ;

Cnaprer 3

@ [2D

The PacELF Way Towards !he Elimlnalloo ol lympllaijc Filariasis In lhe Pa<~ic albendazole is suppli ed by GSK.

February or August each year. A

Figure 3.3 shows the flow of materials

country that is planning an MDA in the

and paperwork belWeen donors and countries through PacELF.

first hall of the year (January lo June) musl have senl in ils order by Augusl

GSK shipped albendazole tablets directly lo the countries until 2000. The

of lhe previous year. If lhe MDA Is in the second half of the year (July lo

company now ships the tablets to the

December) the order must have been

PacELF warehouse in Fiji and PacELF distributes them to the countries twice

placed in February of lhal year. Table 3-1 shows how the countries ordered

a year. Orders for the tablets must be

their supplies and received them from

p laced wi th lhe head office by

PacELF in 2004.

Figure 3-3: S..pply llowchan of DEC. ICT, •nd • lbendazole

DEC and ICT

Application

(MlniStry of Foreign Affairs)

albendazole

----~>· M<iterial flow

·-

- - - - . . . Oocumenl flow

PART I Table 3· 1: Process or ordenng and receiving drug supplies. 2004 Item

Jan

Mar

Feb

Apr

May

Jun

Aug

Jul

Counlty blood

survey

JICA

supply

Nov

Dec

Samoa

Samo.

V41nuci1u

loog•

Wallis

and kJtuna

Tonga

Oct

Al'Y'ltncan

fmlch Pol""""

'°"""Y MDI'

Sep

Cook

fijl

Niue

lr.l.lndS

Kinbati

ivvoslu

Tonga

Samoa

Samo.J

Samoa

Tuvalu

Niue

s._,

Samoa Tuvalu

Tuvalu

llems

Oc!adtine few COUl'I· uyappll-

w.,.,. """' "°""' Albcnda·

<CCei...t at PacELF

cations

Items

,n;pped i>l' Pac£lf

shipped by Pac£l.f

Albenda--

GSK supply

Deadline fCH coon·

uyannua.I reports

zol•

Requesi sent to GSK

received at P.)dlf war~

Albfnd.>•

zole shipped

?Ole

Request

received

sent to

ill' Pidlf

GSI<

a1 P.l<:Elf

zo!e slupped

ware-

byPo<Hf

house

Since 2000, PacELF has supplied close to 6.5 mi llion a lbe ndazole tablets. 80 million DEC tablets. and more l ha n 200,000 ICT ca rds to l he

countries for their various activities to eliminale lymphalic filariasls (Table 3· 2).

Table 3·2: Drug supplies received by 1he PacELf home office, 2001-2004

2001

2002

2003

2004

ALB (tablets)

1 522000

1 365 000

2 070 000

1 535 300

DEC (tablets)

39 925 000

12 5 10000

12 810 000

33 000

38 500

73 000

Item

ICT (test cards)

DATA MANAGEMENT AND COMMUNICATIONS

Data Information System The PacELF home office mainlains

Albef'od•·

have the database file, for standardized data colleclion. Countries collect data

a data management and communication network, which allows the PacELF countries to share information with one

from MDA and blood surveys and enler these into the syslem (step 1 ). The fonowing MDA information is collected by age group, sex. and geographical

another and with the PacELF office. PacELF uses this network 10 collecl

unit the number of people registered, !he number or people treated, and !he

data , reports, and apphcation forms from the countries and to supply the counlries witll drugs. lest kils, reports,

census population. From this information. the system calculates country total s and coverage. Blood survey information collected consists of

data, and IEC materials. T he PacELF Data l nformalion System (D IS) consisls or lwo

!he number of people lesled and lhe number of people found to be anllgen·

dalabases-one for MDA dala (Figure 3· 6) and the oilier for blood survey resulls (Figure 3· 7). Figure 3·8 Is a process

positive , by age group. sex, and geographical unit. The country data are sent by email or fax or on disk 10 the

diagram or the system. AU the counlries

PacELF home office. where they are

Total,

2001 - 2004 6 492 300

15215000 80460 000 68 000

212 500

®~~~.........J # t:.:::i::.=::::- I 1--:::· .....- t

Data inpuC software, MOAdatabase ICr9eO

Oata input software Blood~ daiabase screen

Cnap1er 3 @

f2D

The PacELF Way Towards !he Elimlnalloo ol lympllaijc Filariasis In lhe Pa<~ic figure 3·.S: Fk>w chart of the PacELF Data lnfomiatlon System

PacELF Home Office

Country

8.8

Feedback I Recommendation Email or fax or d1~

Data

Collection

and teporting

E~altor fax '1f<$k

Regional

Reports /

Database

Updates

(on P"cELF Data Form)

Figure 3-9: Home l"Qe of PacELF website

aggregated and stored in the regional database (step 2). Each year, !he home office analyses the data and prepares reports (step 3). From !he submitled data. it determines the age and sex distribution of the total population, the sampled population , the treated

,.,...,,,_"' ,.. .iu

........... .. "...... . . ............ '"'........,.--................ ....

°"'""•a '""°"'"""-'-"'-"""'.,••••• •d-•tW ............ . ,... '""'" ,.....

•cit

st"""

f.allrqn........J:lf#"Wlllllt - - - ·

·~"'-"--...

population. and the infected population for each country. The PacELF home offi c·e also reports prevalence and

;t"" • ..._...... "'C)ll.\ ........... " " ' - - - ... ..., "'........_fl •

treatment coverage data by island group, vil lage, district, or other appropriate implementation unit.

_,,..,,..

-··-

.................. ~4"1-·'- .... ~'-'··...........

............_.'fl' ,,.._f'IW

...,.,...,... ._

"-'I'+

rt."'""""'"'....

l ' ...

Atl.'ll ...'f"H,f'f. .

1..i...i- ........._ • .,.._..

.__....- .... "'_.,..._i...... ............... Pi._,..____, r.u.11,.,..0l!'-...,.,,.. ~ t,_,...........,"...,.,,_..,.,,i.__, ~

,_,.,.,. ,,..,..,,. , .. ,..,,..1/1"\)1 tt

The PacELF website Is a key part of the communication networt<. The web site , www pacelf .or g , launched in

• -l'r nflli

hi O~

PacELF website

f'- ..11w1M

n._....,...""" ,,._...,..

October 2002, Is a means of sharing ideas and enhanci ng advocacy. tnfonnallon aboul PacElf-ils goals,

work, and progress-and the individual country programmes can be found on lhe site (figures 3-9 and 3-10). There are answers to f requently asked questions about filariasls and PacELF, as well as a l ist of all PacELF

°'I- oUlr•-11- .. "WI t<\_e

t111:JWt.o"''·

t1•- •rui

Jobw.,• jlorff• • ,_ toew ..,.........,~._.... ·~"· '" .._._.,,..._

... I lilAI} ...... . ........ ,., f . J ( - - C -11• 0.uM O "'""".KdoAt •1-.AJ "..- .a.... II-~ .......,.,• .,,..'"9ol -1-•,...t l •"''411 4'!-'C. I·- •lli•M•-••• ~ d""'•"'•H••to ... ,.,..,..._o. t4• 'l:t• l\N:

..-..1n.r ••· • • ,...,.._. ............. . . - ....... ,'f'·"-"t-... ,__,..~ ........, ......................_..~~·

. ................... ,... .......... ,... ........ "".._ ... ,... :.1111'1....-...J'J•

publications. links to other pe rtinent websrte. and PacELF contact informalion. The News and Even ts section Is regularly updated , with the help of summaries and photos of current activities submitted by the member countries.

PART I

News & Events 2002 • October The 1st MOA In Fiji Mr Solomon~ N•ival11, Hon0tabf4> M1n1flt1 fo1

Ht-allh. Fi11 ia\ln9 tt.I '11ftia$1i 1,1bloudunn9 MOA launch 1002, Or Sli•;tru Omi WHO ltf9•ona1 Olrtctor for \1~tern P.cif)( (st<tltd on left) wn Chi~ Gvnt and ,t1)Q tQOl lflC' rntd1011om (~untl; 4~h Oct<>bfr 2002) Tr••nfd PU:bUc l'INl1h nu1W"S w~ wh•lt! cf.qruwnn •nd tht oubi.c

tuie·

lOOllllotdt•

News & Events 2003 • Octobet Samoa's St.h M OA w~.s ll)vnehed on the Sth ol October 2003 Samoat SV. MOA \\'.S •mplf'mmt~ th•5o)'Nir•nd lht S1h ot Octobt1 Community .W<lrtf'it15o afld ptomo1lon woit:s~ ror nc:)) tiea!th d!u11ct I'\~• cooducted bC!fl)lf' I.ht MOA "'rl~ lh"• wiu 9ood comrnvn1t)'

v..u olflc1atl)i lilun<h~ on

p.tf'U(lf:ia~•O" trom~Hage tll.l)'Ot\. cliurd'I mlrwnm. P'~•dtl'll1 of wom~1 comm•nttt •nd volvntett

Crug dd.tl bu10t1111hl!wo11i.stiops, 0\;1>119 tt.e r,1\1 wttt;ol thc' MOA.c!ler~ from ltlf'commul'l•t)' WU Ve')' Qood

News & Evenb 2004 • March

The Global Alliance Meeting (GAELF 3} held In Cairo, Egypt on 23 • 25 Marc.h

2004 Tl'lr Tlvd Mttt•ll9 of 'hit Qitwl Ali.Ince M~lng to lhm1N>;c:tympi'l.t!1c f1b11.tu~ lGAEIJ )l 1~cn~ly ""'Id In Caio. £qypt ""''-•Ucnlkd by P.Ktlf Te.am ~t•dcr IC.UV)'O l(hlmon, Hon J.1 n..,,1;e1 rQf ~~Ith &mO.l)Mr MulltMo S1•t•u,_, \'1.11, ~or~I of Huhh iS..niof} 01 Aird i.t1ll E11 lnow. (hoof

°'

Eai:c:-c;-,il!\C: OH•Cet•HC'th!i tr1J1) Dr Lep.ani

Waq.att\11""'• •nd Ch.Jinnan

P.1 ~llf

IDr 1oe

'4ro1vwut On ~~1f of tilt m('mbe1s.of l'1cELF. r,, 1m.1t~ tf)f f0«.1m to our P•'1 ol 1ti.r ttQ!On"' 1006 GA!IJ " Wiii ~ l'I0\1t:d •n f111 •n 2006

News & Evenu 2004 • September

PNG is going to start MDA in June

ncun yt.-.r

MtS1.1ge ficm DI Jamtt W.:11191 (O.ll!!C!Of DISN~ COtl!tOI, P•pu.& Ntw Gll'!ie.A), "'H~llO, t!YCI)' Of'lt uoon.aorval lfol'l'I our good •nd ~oya~ r~f'IO '" 5.lMO.t, ~~ tl4>te QOM lntO KhOn 10 piol OU! ll.l!J!M'l.ll £lf .cuon pla11 1 09~~ Ot ldumoN wu Mtt- tor~ to 1o d.tp .llld .mwl!d ui 10 com~i. out iu11ona1 l)iin •!'Id .XO, p1wncial ,)(t!On j:iln f()( the p10N1cc: w~ Ml launO'I 1ric: MDA '" June nc:.111 )'NI

<~ri.11'11)' ~ h•~~ lOMe- 1n1 ~rC!\111'19

~ foi L~ we~:r-:

Selec1ed news and

e~nts from

the PacELF website

Cnap1er3 @ ~

The PacELF Way Towards !he Elimlnalloo ol lympllaijc Filariasis In lhe Pa<~ic

ADVOCACY AND PUBLICATIONS PacELF has developed and published many documents with one purpose: to increase awareness of filariasis and promote the unique Pacific

PacELF Mon itoring and Anal ysis Networl< (PacMAN) to guide country

programme to eliminate the disease.

IEC materials

Every year since 2001 . PacELF has published a summary report on the annual meeting, which contains brief

PacELF has developed many Information, education, and

programme managers.

descriptions of the presentations and

communication ( IEC) materials for the

special

programme , including posters , pamphlets in English and French, logo

sessions.

well

recommend ations for the various country programmes. Since 2002. it has also published an annual review ol achievements in the O ur Work series.

In 2004, the PacELF office published the PacELF Handbook and a book on the

stickers, a calendar, and a video. The

head office keeps a ready supply ol all IEC materials and ships them lo countries on request. F"tgure 3--11 shows

some ol these IEC materials.

Figure 3-11 : PacELF regular publications and IEC materials

ANNUAL MEETING REPORTS

3rd Annual

4th Annu41

5th AAnual

6th Annual

7th Annual

Meeting Report. 200 1 /ltJl»ll'«/JtJNovrrnW-100'

M<et>ng RA>s>ort. 2002

Mcec;ng RA!s>ort. 2003

Metting Rcf)0<1. 2004

/l'u~in ~ J()IJ}

~11'1Mwrtr.b<-f1001

~ inNQwmbttr 10l>t

Meeting Ref)0<1. 2005 1'vblril!N.,. ~ lOOS

ANNUAL RECORDS OF ACHIEVEMENTS

PacELF

- --PacELF

---Our Work 2002

(Progre" Ropon,

Our Wort 2003 (Prog,..s Ropon.

January-Decem~ 2002)

January-Oec;ember 2,003)

ff.J~.-tkd.JDOJ

~"'k:od 2°""

Our Work 2004 (Progres,s Repoc\. January-December 2004) PubW»d ittAIW 200S

Atla.s the filnrlaa.sh .$1\Ui1JOn and vectors an e~ch PacELF member counuy) Cd~bcs

~'f'ilodift1001

PART I

REFERENCES AND GUIDELINES

JJr~m rh111d: tJ•Jk .,......,.,.....0... ._

PacMAN

--...

Book

~-..

.......

•

PacELF Handbook

(PacElf manual. part 1} ~ll)Apft/:10().I

PadLF Handbook {PacELF manual, part 2) PtlblrfJwd ,., A/Kil200tf

PacEIJ Dahl Book 2003

----1~ 4Jl

............... ................... ......... --@----·-----

. -----====-===

(blood survey and MOA dat.&

Fact Sheet Glvts b.,lc infomlllt'>O<I

on the membercountrie$)

about the programme

PvbWttd #I 200f

~in2()()1

Oat.> Book 200J

IEC MATERIALS k

~:II

"'> PacELF . .

PacELF

OUft COAL 1$ TO lU""IHAfl l't"1P.KATIC rnAflllASIS 9YlHEYEAR2010

f!I O

O IGO ::::.jim- -,.CZ::.I I

•

a •

C mill

Pos1er 1

Poster 2

Calendar

Poster

Pub'dhtd 11'12001

~llt.4ugwt200J

l'vbkshed In 1004

~11t~lOOS

0 PacELF

Pac-ELF

llw!J.P

i'i.~~

=--. ii #J'al.-mm b

"""..

•

I I

Pa,_m phlet lnuoduct1on

MOA P3mphlet (English)

MDA Pbmphlet (Frenth)

Pa,_mphlet (EngJi.sh)

Introduction w mass

Introduction to mass

to PacElF AU4htd"' 1001

drug administration

drug administratk>n

Introduction to PacElf

,,,,,,.,,.. .. XX!J

l'ublq,hfd#I ~ 1004

~he<J#)lOO:J

Pomphlet (.,.ncll) ln1rodU<tlon to Pa<ElF

,.,...,,..,

In No....'ff'lbfr JOO.f

Chapter 3

@ OIJ

The PacElf Way Towards !he Elimlnalloo ol lympllaijc Filariasis In lhe Pa<~ic

r ..shirt., 2002 hodvctd In 1D02

Video Describes filariasis

eflmination activities in the Pacific and Pa<El.F Ptoduttd ~ ~](JIÂť

Pa-cELF lavalava 2004

-~1004

TRAINING AND MEETINGS The PacEL F home office organizes

annual meetings lo share information, set guidelines for the different countries. review their accomplishments. recommend Improvements in their prog<ammes, and train their prog<amme

staff. Al the meetings partners , consultants, and representatives from other regional programmes to eliminate lymphatic filariasls give updates on their activities and on relevant scientific Information . Table 3-3 lists lhe PacELF meetings that have been held so far.

Meeting

No. I

2 3 4 5 6 7

Date

28-29 Jun 1999 16-20 OCI 2000 24- 29 Sep 2001 19-23 Avg 2002 22- 26 Sep 2003 23-27 Aug 2004 22- 26 Aug 2005

Location Bn~bane, Australia Bnsbal'\e, Australi<t Nadl, Fiji Rarotooga, Cook lslaflds

Lautob. Fiji Apia. Samoa Suva, Fiji

Number of

Country Participants

14 16 20 17 21 17 13

The PacELF meetings are a time for sharing, learning. and having fun

Country representatives give updates on their programme and receive feedback from other PacELF members

(Figure 3-12). Each meeting also features workshop~styl e training sessions

(Fig ure 3-13). Al the 2004 annual meeting in Apia. participants had the chance to learn about mosquito

S1h PacELF Annual Meeting

QI] @

Approacn and Attivih<S

i den1ificallon , l ymphoedema case management, and field diagnostic tests (ICT I Mf slides). The evenings are filled with social events, where the meeting participants perform skits and share a little of their culture through traditional songs and dances (Figure 3-14). An annual meeting report is compiled and publrshed shortly after each meeting. Each report contains

PART I highlights of country accomplishments, summaries of presentations, des·

criptions or !raining sessions, and photographs or lhe meeting . It also documents the recommendations developed and approved by the participants. The issues and outcomes al each or the seven annual meetings are listed below.

r"'·m'''''

1st Annual PacELF Meeting in Brisbane, Australia, 1999 Offici ally established PacELF Created the PacELF Coordinating Body and appointed its members

2nd Annual PacELF Meeting in Brisbane. Australia, 2000 Established MDA guidelines Recommended a methodology ror surveys and the use or the ICT kit Called for the establishment or a surveillance network based In the PacELF office in Suva and the development or specillc surveillance guidelines for PacELF countries Recommended that studies be carried out to Increase und erstanding of mosqui to vectorslheir biting habits , biting limes, and preferred breeding sites

Worlcshops during the 6th PacEtf Annual Meeting In 5amoa In 2004

3rd Annual PacELF Meeting in Nadi, Fiji, 2001 Finalized MCA guidelines

Adopted the PacELF data collection and reporting system Reviewed and upda ted the PacELF plan or action Shanng culluros at the PacElf •nnual m9Ung• 2001-2004

4th Annual PacELF Meeting in Ra rotonga, Cook Islands, 2002 Reconfirmed the policy to use ICT for baseline data collection and evaluation Recognized social mobilization as a key factor in maintaining high levels or MDA compliance Identified areas of research to better understand social issues

related to filariasis elimination activities

5th Annual PacELF Meeting in Lautoka, Fiji, 2003 Reviewed country action plans and evalua1ed progress in implementing MDA and midterm surveys

Cnapoer 3

@ [JD

The PacELF Way Towards !he Elimlnalloo ol lympllaijc Filariasis In !he Pa<llic Reviewed progress towards the

Reviewed and discussed

Inclusion of largeted vector control In national lilariasis elimination strategies

potential allemative methods

Identified opportunities fo r Integrating PacELF wi lh olher

after five rounds of MDA Requested the holding of a regional wor1cshop on vector control In 2006

disease control programmes

Recommended the publica路

Recommended the standardization of data collection and reporting Discussed post路MDA activities, and the process of c,onsultation for stopping MDA and confirming

tion of a book on PacELF to share the experiences of the Pacific Island countries In filariasis elimination

elimination in the Pacific Island

countries Agreed on the developmenl of a PacELF handbook and data book 10 provide lnformallon and guide monitoring, evaluation. and post路 MDA aclivities

7th Annual PacELF Meeting in Suva, Fiji, 2005 Recommended thal PacE L F continue to perform its current functions. technical assistance. a nd communications among countries

Stenglhef'.ed the network in suppot1 ol

6th Annual PacELF Meeting in Apia, Samoa, 2004 Developed country action plans for !he following: Morbidity assessment and case management programmes

Integration with other disease control programmes Post-MDA strategies Agreed to support !he 4th Global Alliance Meeting In Fiji ln2006

integrated veclor路bome disease in

the Paci fic focused on capacity building for vector control. social mobilization, and operational

research Recommended the conduct of C and 0 surveys in accordance wilh PacMAN guidelines to determine the next steps Fi nal ized the PacELF Book development Inclu ding the progress and achievements of programmes

TECHNICAL COLLABORATION AND SCIENTIFIC SUPPORT PacELF

col laborates

with

academic and scientific organizations to ensure that PacELF activities are

based on sound scientific evidence. Technical collaborators have provided guidance to PacELF in surveillance

and monitoring. clinical diagnostics, clinical case management, vector biol ogy

Monitoring and Evaluation Meeting in Attan!a, Georgia, USA

and

control,

survey

methodology, d ata management. and operational research (Figure 3-1 5). F rom time to time. WHO p rovides short-term consultants to write

guidelines. conduct workshops. evaluate country programmes. and perrorm other scientifi c work ror PacELF (Figure 3-16). Public health scientists also give advice 10 country programmes or carry out technical support functions such as operational

research, $OCial research, or survey design when asked to do so. Table 3-

3 lists the technica l collaborating organiza tions and their areas of guidance.

Consultant working with PacfLF staff

Table 3-4: Technical collaborating organizauons Organization

Centoo for Disease Control and Prewntion (CDQ, USA

Technical Support Role

Surveillance, clinkaf dtagnosucs, vector

control

Emory Unwe<sity lf Support Center,

Chn1cal diagn0St1CS, operallonal research,

USA lnstltut LO<Jis M aiard~. French Polynesia James Cook Univffiity UCU), Australia Liverpool Lf Cenue. UK Wo1ld Health Orqanizatlon Atlanta U: Monitoring and Evaluation Group, USA

cost analysis

Secretariat of tM. Pacific Community (SPO Aichi Medical Unive<sity, Japan

Demography, mapping

Vector control

Chnkal diagnostics, monltonng Technical S<JPl>Or1 to Vanuatu All areas Surveillance aJ1d monitoring, survey methodology

Ch"lcal dlagnostla , treatment

COORDINATION AND PROGRAMME REVIEW The PacELF Coordinating Body

Implement their plans of action to

(CB) was formed during the first annual meeting In 1999 and its members were appointed by lhe participants at the

eliminate lymphatic filarlasls Coordinate techni cal advi ce . supplies, and local costs for each

meeting . The CB was expected to

country's plan of action and subÂˇ regional programmes Foster support for PacELF by

ensure, on behalr or the 22 member countries, that the aims and objectives or PacELFwere achieved. It met at least once a year and organited sub-regional

maintaining contact wi th WHO,

runclions from time to time. w hen

Keep abreast of issues tackled by

required, to carry out the rollowi ng functions;

the Global Programme to Eliminate Lymphatic Fllarlasis

Promote the purpose and activities of PacELF Set up and maintain information

During the first years of the PacELF CB, the g lobal programme approved country apphcations for activities lo

and communication network s to help the member countri es

eliminate lymphatic filariasis. The CB reviewed PacELF co untry data .

SPC partners. and NGOs

Cnap1er 3 @ ~

The PacELF Way Towards !he Elimlnalloo ol lympllaijc Filariasis In lhePa<~ic suggested strategies, and helped the

lymphatic fila riasi s that are

countries develop action plans. In 2000, the global programme moved to decentralize !he approval of country

policies and consider the specific

consi stent with pu blic health issues In each country, and In

applications and suggested the creation of regional review groups.

reviewing those plans of action

Support countries In implementing

The PacELF Coordination and Programme Review Group (PacCARE) was formed in 2001 to coordinate PacELF aclivities. PacCARE members are nominated by !he PacELF member countries and appoi nted by lhe WHO Regi onal Director for the Western Pacific. They serve ror a term of three years and may be re-appoi nted by the WHO Regional Director for another three. Th ere are now seven members, including one representative from each of the four recognized regions of the Pacific-Micronesia, Melanesia. Polynesia, and the French territories. These regional representatives work together with a PacELF secretariat and other te chni ca l experts In lymphatic fllarlasis from academic Institutions and scientific research organizations (Figure 3-17). PacCARE members meet al least once a year and organize PacELF meetings from lime lo lime . when required, lo fulfill the following functions: Promote the purpose and activities of PacELF Give te chnical guidance to countries in developing national plans of action for eliminating

their national plans according to

global and regional strategies tor eliminating the disease Monitor evaluation after the frfth

MDA. with C- and D-lype surveys Set up and maintain information networks between PacELF member countries. and between the regional and the global programme Promote technical coordination with WHO and scientific agencies and institutions to support country programmes Promote coordination with WHO, other partners and donor agencies, and NGOs to support PacELF Review country programmes and make recommendations to the WHO Regional Director. in line wilh the PacELF strategy PacCARE meetings coincide with PacELF annual meetings to review country programme reports and approve

re-applications for supplies. Between meetings, members communicate by email to quickly respond to country needs. PacCARE develops specific recommendations from the review

meetings to assist individual country programmes.

The 4111 l'a<CARE Meeting in 2003 In Suva, Fiji

ttlatiasis Ill Ille Paalic

Table 3·5: Appl1u11on and MDA Plan, 1999-2006

Amencan 5.lmoa

Cook 111"1ds fed...ted Stal!S

of ~f<roroesi.l

l1i

•

f1mch

~··

•

Guam•

IOObo~

•

M""llall Islands'

t-:auru•

-tl<wC.ledo"'"

-·

•

""•

•

M.wnalsla1

Palau••

---lll•tld•• ~tCJirn

~Go.wlea

Samoa

•'

•

-i

Solomon lslonds•

Tonga

•

T""""''

-Tuvalu --

v.i..,.ru

1wanis

and Futuna

•

@ Application

•

Reapplication

MDA

Future M OA

* N on-endemic country

** Partially endemic country

The PacELF Way Towards !he Elimlnalloo ol lympllaijc Filariasis In lhePa<~ic

IMPLEMENTATION OF COUNTRY ACTIVITIES PacELF supports !he implemen·

Providing technical advice on MDA

tation of country activities to eliminate lymphatic filariasis through the following

strategies, health communications,

and survey methodology S up porti ng the prepara ti on of

functions:

Assi s ti ng the countrie s developing their action plans

annual reports

The PaeELF strategy calls for five

Arr anging the financial supplies means to implement surveys and MDA

rounds of MDA followed by a prevalence survey in a ll sub-d istricts to assess impact and detenmine the next steps.

Table 3· 6 : Countoy programme.by year G

Prcvalcnttrolte

uam

O.l %

PtevJ!tnee rate

Nauru

Non· Endemic (6 countries)

0.0%

Prevalentt rate

Northern Maria na lslnndJ

0.0% 0.0%

Provalence rate

Pitcairn Is lands

PrevalE!fl(e rate

Solomon Islands

0.0%

Prevalence fate

Tokel au

0, 1%

Prevalence r~te

Ftderatcd S~tes

0.2%

of Micronesi a Prt"lale~ rate

Marshall Islands

Partially Endemic

Prevalence rate

New caltdonl•

(5 countries)

o.4%

Prevalence r4te

Wo1llls an d Futuna

0.7%

Pn!val~ r.1te

65%

66%

S2%

SO%

70%

65%

7 .6'1\ 62% 64% 16.6%

98%

88%

93%

70%

62'!1o

69%

9S%

93%

90%

93%

60%

46%

49%

67%

16.5%

MDA · S.p

8.6%

Prevalence rate

Fiji

MDA · Sep Prevalen<:e r41te

Fren'h Polynesia

13.So/o 93% 1.1%

MDA·Mar Prevalence rc.lut

Kiribati

11 .5% 24%

Prevalence rate MOA - Jun

Cook Islands

MOA · Aug

Prev;i!ence nne

Niue

Prtvill~na- ra~

MDA • Mlll Ptevalence rate MDA • Sep

Tuvalu

Prevalence rate

Vanuatu

MOA

57% 2.7%

68'J4

4.5% 60%

SQ% ~

79%

84%

91%

8 1'11.

4N 8.0% 84%

83%

86'1\ 12.t % 79%

87%

SS%

2.5..

22.3% 4 .8%

MOA • Jun

Baseline Assessment (A)

83%

as,.

99%

4.S%

Prev•l<!l'Kt' r• tt MDA · Oct frt.ol/,)lt'n«' ,,,~

Tonga

82% 78% 6.0%

94%

MOA

S•moa

13%

3.1%

MOA - Ma1

P11.pue New Gulne.ai

60%

MOA • APr

Amerkan Samoa

• Non-resident

O.S'll.

Preval«1ee ,,.te

Po11au

Endemic ( 11 countries)

0.1%

84%

Midterm Assessmen t (8)

•

Final Assessment (C)

PART I By 2005, lhe following activities had

Four rounds completed in four

been implemented in the PacE LF

countries Three rounds completed In one

member countries: Baseline prevalence surveys In all

country All endemic countries with a baseline prevalence greater than 1 % had initiated MDA by 2002 except for

22 countries MDAlnlliated in all 11 fully endemic countries Targeted MDA iniUated in tllree out of five partially endemic countries

Papua New Guinea. which was expected to initiate MOA In the second

endemic countries

quarter of 2005. Samoa was the first to complete five rounds of MDA in 2003 and finished the C~pe survey in 2004.

Five rounds completed in five countries

Cook Islands. French Polynesia. Niue. and Vanuatu completed five rounds of

At l east three rounds of MDA completed In 1O out of 11 fully

Figure 3· 18: Endemicity in PacfLF counuies

··-

Partlally Mdetnk

•

Non-tt1dtmk

...... Gu

Figure 3· 19: MOA rounds in PacElF countrie., 2004 MOA flouf\d tndk6to,

Gwm

mitnk: Net ye'! 6f'Htl MDA on 9ofn9 Red. MOA doroe

P.lbu

kiribotl

...... """"

lokel.au

.......

Solomon

W•lliJ ~ h!Wn~

•·'""""~

....

!1~1 ii

....

"• ,

too•

Nw~ )ill!ndl

-ii

·-

....,....

Chapter 3

@ [J!J

The PacELF Way Towards !he Elimlnalloo ol lympllaijc Filariasis In !he Pa<llic Figure 3~20: MOA coverage of 1he at~r1sk populauon, 1999- 20041"

. _,

·-- ··=-·

. ·-· ·=·

---- · --·- --- ·-·= -- r-· =- 1- - r • -:-' I-

MOA i n 2004 . These four island countries are ready to start !heir C·type

·=--·

--·~

Drug coverage varies between islands and rounds of distribulion. High

evaluation survey In 2005. Four more

coverage is recommended, but lower

countries-American Samoa. Kiribati,

coverage results do not change the PacELF strategy. Regardless of treatment coverage, a C~type survey is

Tonga. and Tuvalu-will complete five rounds of MOA In 2005. Among the partially endemic countries. Wallis and Futuna has completed three rounds of MOA, while the Federated States of Micronesia and the Marshall Islands have done one or two MOA rounds fn their endemic regions.

still conducted after five rounds of MDA, and consultati on is requi red to determine whether to continue or stop

the activities.

PARTNERSHIPS AND EXTERNAL RELATIONS One of the slrenglhs of PacELF Is ils networl< of external partners. PacELF

towards the elimination of lymphatic filariasis In lhe Pacific. PacELF has

would not have progressed thi s far

successfully managed Its external

without the persistent commitment and

rela tions with its partners and mafntained financial and technical sopport for all aclivilies. Each country

conlribulions of those partners. Each one plays a vital role in country activities

PART I

also keeps up local partnerships with governmenta l and nongovernmental organizations, as well as prlvale companies and corporations. Besides these partners. PacELF maintains relationships with similar regional and

global programmes, It comes as no surprise, then, that PacELF and Its partners will support the rourth meeting or the Global Alliance to Elimi nate Lymphatic Fllariasis to be hosted by lhe Government or Fiji in 2006.

Thbte 3- 7 : Pad:LF pannefsand 1helr conuibutions Austrafian Agenty for

lntcrt\l)tiona1 Development

. . Auttn11b•C..tn911C91

fAusAID)

Centers for' Disease Control and P~en tion

(COO Emory Univenlty Lf Support Center

GlaxoSmithKline (GSK)

1111 \3)

SUppOrt Centre

secretariat of the P<Klfk Community (SPC)

United Nations Voluntfffs (UNV)

Technical ""slstance

00 I PCA I

·-·!I fliJJl '1lARIASlS SUPPOt!T CE:NTR!

~,:~.~.!8s~~.1 ..········.. : \

·..../

=•II!;,,_~~~ ~

Voluntary Services Overseas

Wotld Health Orgonllatton

fcMncial suppon {loc.al cost for country acuvities) through ltle Wesletn Pacific Regiona.1 Offi(e of WHO; tEC rnat~riab

DEC tablets: 10 le$t kits,; 5 Japan Oilefseas Cooperatioo Volunteer

(JOCV) voluntttn; fln10Cill support

LYMPKATIC

(VSO)

(WHO)

Albenda?()fC t.oblC'lS; fiMn<tal support; technical A$$1$tainclf

IJ11'8!1

• • -•

Ministry of Health, Ffjl

Technlcal assistance

Technlcat ""slstance-

Jopan International Cooperation Agency

UVMpOOI Lymphatic Filariasis

DEC t.,bfcts fof Al'Mfican Sa rno&: financial support: technical assastance

(ii ~

Japanese Government (Ministry of HC!aJth, Labour- and Welfare. Minis:tty of Foroign ,AfftdtS. and Embassy of Japan In fljl)

(JICA)

EMORY U NIVERSITY

C1~

Inst.hut Louis MalardE!

James Cook Unlver.sity (JCU)

Financial jUppon

,\uaA.U>

~ ® · '

World .Health Organization

T«hnical assistance

Office ffciltties (M ata1Q House)

Technical assistance

Volunteer

Voluntt+t"

T«hnbl iusisti.lnc.t, fin.an<ial support,; fogt5tic support; IEC m<il<":nals

Cnap1e13 @ ~

C H AP T ER

Progress and Achievements

This chapter d iscusses the progress and Impact or PacELF

course of their MDAs an d surveys in the

activities from 1999, when the p rogramme began . to 2004. summarizing lnrormation given In earlier

costs of the PacELF activities are also

chapters and In Part 2 or this book. and it looks rorward to what will be done in the next five to 1O years. It describes

first five years or the programme. The estimated. Much of this chapter i s devoted to describing the impact of PacELF on

the dehvery of the programme and the

Filariasis elimination. The health system, and

achievements or the countries in the

Society and politics.

PROGRESS BASELINE PREVALENCE Berore mass drug administration

(MOA). all countries carried out a

All Micronesian countries except Kiribati

baseline survey of !CT prevalence ("A" survey). The survey data were used to

are nonÂˇ endemic or partially endemic;

Kiribati has a low prevalence rate or

classi fy the countries into groups according to their endemicity. Countries with no antigen-positives (excluding

are in Melanesia or Polynesia (Figure 4-1), with the highest prevalence rates

non Âˇresidents and immigrants) are

observed in countries where filariasis is

consi dered non-endemic;

transmitted by Aedes vectors: Tuvalu (22.3%), Fijl (16.6%), American Samoa

countries where up to 1Â°k

those

the

population tested positive for the antigen

are parUally endemic: and those with more than 1% positive for the antigen are endemic .

(}D @

Prog1essand Aollievements

partially endemic, and 11 as endemic.

1.7%. AU of the other endemic countries

(16.5%), and French Polynesia (13.8%). The countries round to be nonendemic are Guam, Nauru, the Northern

Marlana Islands, the Pitcairn Islands,

As shown in Table 4-1 . six countries

Solomon Islands. and Tokelau. In the

are classified as non-endemic , five as

case of the Pitcaim Islands, the PacELF

PART I Table 4·1: Baseline survey rewlts

Endemicity Level

Country

Baseline Year

Guam Nauru Northern Mariana Islands Non~ndemic

Pitcairn Islands Solomon Islands Tokelau

2001 1999 2001 2002 1999 1999

Population

157 629 10 013 71 416 S2 409 042 1 S62

Baseline Antigen + Prevalence (by ICT)

Number of Estimated

Antigen+ Cases

0.0% 0.3%' 0.0% 0.0% 0.0% 0.1%'

0 30 0 0 0 2

649 714

Total Non· endemic

Marshall Islands Federated States of Microf\eS.ia Partially endemic Ne..v Citledon1a Palau Wallis and Futuna

2001 2000 2004 2001 2001

Total Partial/v endemic

Endemic

Baseline

Atner1can Samoa Cook l!lands •111 French Pol"'"""' l(iriba11 Niue Paoua New Guinea Samoa Tonoa Tuvalu

TOTAL

0.1% 0.2% 0.5% 0.4% 0.7%

S2 214 I 18S 78 10S

431 082

1999 1999 2001 2000 2000 1999 2002 1999 2000 1999 1998

Vanuatu Tota l Endemic

S2 66A 107 008 236 900 19 S22 14 988

1634

55 96A 18 821 813 154 239 160 84494 1913 5442 686 172 717 98042 9 503 180854

16.5% 8.6% 16.6% 13.8% 1.7% 3.1% 6.0%' 4.S% 2.7% 22.3% 4.8%

9 234 1 619 134 984 33004 I 436 59 326 561 7 772 2 6A7 2 119 8681

7117 308 8198104

6.5%

528116 529 782

• I noo-resid«1t posittve found. out of 388 tested • 1 Wnm1gran1 posrti'J"l> found, out of 1,311 tested ' Est1m.ated f,om Papua New Guinea's applot1on to PacElf.

baseline survey was its very first survey

Figure 4-1 ; Endemic. partialfy- endemic, and non--endemfC countries in the Pacific

for filariasis. The rest are known to have had filariasis previously. Solomon

•

Islands is the only non· end emic

•

Melanesian country. The six nonendemic counlries are not doing MDA but have received PacELF support for baseline bl ood surveys. Tokelau surveyed its whol e population and conclusively showed that filariasis is no

longer present. The non-endemic countries participate In PacELF

meetings and cooperate f\Jlly with lhe other countries. Of the nearly 8. 2 mrllron people in the PacELF counlries (Table 4- 1 ), the great majorily (7 1 million, or 87%) live

of PacELF roughly 529 782 people in lhe Pacific. or 6.5% of the populalion,

In endemjc countries and are exposed

were infected. The whole country i s l he MDA lmplemenlation unit for lhe endemic member countries except Papua New

lo the risk or filariasis. According to the population dala in Table 4-1 and the baseline prevalence surveys, at the start

Endemic Partially Endemic Non~endemic

The PacELF Way Towards !heEliminalloo ol l ympllaijc Filariasis In lhePa<~ic tsl and on the F ederated S tale s of

Table 4-2: Partiallv end001ic countries

Micronesia had 34.2% prevalence when tested In 2001 . In lhe Federated Slates or Micronesia and the Marshall Islands,

Satawa!

everyone living in known endemic islands o r villages was treated, while In

34.2

507

107 008

2000

44.2 29 I

416 513

50840

1999

Ngardmau VIiia ~

for treatment. Wallis and Futuna. as mentioned above. decided to !real the

2.3

221

19 129

2000

Wallis and Futuna

Wallis island

1.0

9528

14944

2003

whole country even though only Wallis tsland Is endemic,

New

Ouvea 1slar>d

1996

Mare ISiand

3974 6896

196836

C.ledonia •

1.5 2.6

States of Micronesia islar>d Marshall Meiji! •~and lslands Ailuk island Palau

Palau. all positive cases were chosen

• Pttsor\bl communlQtion

MASS DRUG ADMINISTRATION Eleven endemic PacELF countries and one partially endemic country are c a rrying o u l MDA w ith DEC a nd albendazole (Figure 4-2) to eliminate filariasis. The countries are now (2005) in different stages of implementation

(Table 4-3). MDArmplemenlation starts when a

Ad... of cornl>notioo drugo 1DEC $nCI atbend~le

...,..

ToKelau, a non-endemic country, also submitted an application In 1999 before

Fuluna, though only partially endemic , also decided to implement nationwide

deciding MDAwas nol necessary Three more e ndemic countries submitted

MDA. Between 1999 and 2004. 1.76 million people in 1O endemic countries plus Wallis and Futuna participated in

applications in 2000. two in 2001 , and the las! counlry (Papua New Guinea) in

MDA in the region is about 6.2 million in 12 C·ountries. Since five annua l treatments are needed. the actual target number of MOA treatments delivered will therefore five limes this number, o r 31 million.

The partially e ndemic countries account for about 0 .3% of the estimated

number of filariasis cases in the region (Table 4-1 ). Delails of known prevalence

Progress and AollievemenlS

and DEC. As shown In Table 4·3, eight of the endemic countries submitted their firs! appllcation in 1999, and one country (Samoa) started MDA thal same year.

Gu inea , where provinces are lhe implementation u nits . Wallis a nd

MDA. Including lhe 4.4 million living In endemic provinces in Papua New Guinea. Ille total population targeted for

(}D @

country submits Its appllcalion to PacELF for the release of albendazole

2004 Samoa ha s a long history of conducting mass drug administration to control filariasis ( see Part 2). and was able to build on this experience to lead the way for PacELF and the world in the filariasis elimination campaign. Four olher PacELF countries (Cook Islands, French Polynesia. Niue, and Vanuatu) followed c lose behind , In 2000. For

logistical reasons, American Samoa did not complete MDA in 2000. but started and completed MDA In 2001 . Also in

areas in lhese countries are given In Table 4-2. A few isolated islands and

2001, Kinbati, Tonga, and Tuvalu began Iheir MDA programmes. Fiji and Wallis and Futuna j oined in 2002, and Papua

villages have high prevalence. Satawa!

New Guinea in 2005.

PART I Table4-3: PacElf countries implementing MDA. 1999 - 2010'

Number of Couniries tmplemenfirtQ

680837

886722

MDA Humbt!fof

Foopl•lorgeted

172 717

1737211 1759130 I 5971149

forMOA • Celb sticlded gr~ Me completOO MOA and ct'& shaded blue are lutur<! MDA

The MDA programme in each country must be completed in a shor1 period or time (two months) to be most ellective In reducing filariasis transmission. Each country fitted MDA into its schedule and chose which month of !he year to implement it. In 2000. Niue started MDA In February, French Polynesia in March. Cook Islands in May, and Vanuatu In June. The number of countries Implementing MDA reached a peak in 2002 and 2003, when 11 countries wete doing MOA in each year (Table 4· 3). Alter that, the number of MOA programmes started to decrease as countries finished their activities. By the end of 2004. five countries (Cook Islands, French Polynesi a. Ni ue, Samoa, and Vanuatu) had completed

five rounds of MDA, and four other countries (American Samoa, Kiribati. Tonga, and Tuvalu) had completed four rounds. Of lhe remaining countries. all except Papua New Guinea will have completed five rounds by the end of

2006. Papua New Guinea will complete Its MDA programme in 2012. The population targeted for MDA each year l n the Pacific couniries (excluding Papua New Guinea) rose rapidly from less than 200,000 in 1999 to a peak or almost 1.8 million in 2003 (Figure 4·3). From lhis point lhe number of people participating in MDA started to decrease and will reach zero in 2007 unles-s some countries decide to continue beyond five years. Figure 4·3: Number of ~pie targeted Jar MDA. 1999-2006•

":l: 0

~ >

.2 ~ ~

2 000000 1 800000

1 400000 1 200000 1 000000

800000 600000 400000 200 00~

• • •

'600000

=--==::

... I• ,

2000

2001

2002

0>mp1e1ec1 • Planned

-200)

2004

2005

•

::i_J

2006

The PacELF Way Towards !heEliminalloo ol lympllaijc Filariasis In !he Pa<llic Figure 4·4 : Projected numbef of people panicipating in MDA in Papua New Gui,,.,a, 200>-2012 ~ 5 000000~--------------~ ~

4 SOO OOO

.2 4 000000

3500 000

.. l 000000

~ 2 500 000 !! , 000 000

l 500000

;

, 000000

soo ooo o.i.= - ~..._~..._~,.._~.aa.~"""~"'-~"'"--l

;

2005

2006

2007

2008

2009

2010

2011

2012

Figure 4-5: Cumulative number of people receiving MOA ueatment m the PacELF countries,• 1999-2007

.... -

-" g 0

2000000

' 500000

.i;

•

" ~

;;

•E

' 000 000

500 000

a 0 1999

2000

2001

2002

2001

2()0.t

2005

2006

2007

1--At S..SI one MOA •£xdudmg Polpua New Guinea

The planned number of people lo

five treatments means assuming !hat

be covered in Papua New G uinea is

the same people receive treatment each year, since coverage is less than 100%,. PacELF, by the end o f 2004 ,

shown in Figure 4 ·4, The country will start its p rogramme in 2005 in one province with a target population

Progress and AollievemenlS

220 392, and w ill reach a peak target populalion of 4.4 million in 2008 and

was almost h alfway to the target of delivering five MOA treatments to all the residents of 11 PacELF countries.

2009. when all 16 endemic provinces will be doing MOA. In 2012, the last year of MDA implementation in the country,

Organrzlng the MDA programme Is a lull·time job for co untry managers and takes much longer than the one· to two--

about 1.7 million people in five provinces will receive their last round of lreatmenl.

month pe riod when the drugs a re delivered to the community. Other tasks

The target of PacELF is to deliver five MDA treatments to each pe rson l iv ing In a n e n demic countr y.

include securing financial support,

ordering supplies. pursuing advocacy, registering the population, developing and printing health p romotion

Treatments wlil to tal 9.3 million by 2006 and 31.4 million by 2012. By the end of 2001, all of th e target number

materia l s, pac ki ng and s hipping supplies. and compUing data after the

of 1.76 m illion people could h ave received at least one MOA treatment (Fi g u re 4 - 5). To es ti mate the

M DA. Wh er e necessary, PacEL F works with countries to develop annual plans. An annual plan for Fiji is shown

cumulative number of people receiving

in Table 4-4.

PART I Table 44: Filana:s.s progfamme tn Fiji. 2004

.. a. Filinn ---m

···-·· n~t

.•:

b. Arrang4Hl'!cnt of field work and ext'" WOtk In MH Ctransoort me;sl oillow;)nce accommodoition etc.l

c. PlaMlno and handllno of MDA

DRUGS AND ICT TESTS DISTRIBUTED

tablets and 40 million DEC tablets were sent out. The drugs have to be divided into

The PacELF home office i s responsible for dis1<ibuting supplies,

many smaller packages for individual Islands and remote distribution points.

mostly ICT kits and drugs. to the countries. This logistically challenging task requires intensive pJanning, since items need to be ordered well in advance, bu1 It has been efficiently carried out since 1999. Figures 4-6 and

4- 7 show the number of tablets of albendazole (400 mg) and DEC (50 mg) d istributed each year from 2000 to 2004. The tablets were not necessarily used In the same year they were shipped, since the shipments were made at least several months before the MDA. It can be seen from Figures 4-6 and 4·7 that the drug shipments peaked In 2003, when almost 2 million albendazole

Figure 4-6: Albendazole tablets shipped to the counu1.,,, 2000-2004 8000 000 '000 000

,,~

2000000 1

1000000

sooo 000

sooooo

•.

6000 000

• ... 000 3000 000 2000 000

sooooo 0

2000

2001

I ~ Albendazole tablets dllotnbuted

.!:

,Ec

.,~, ",,E v

l 000 000 0 200]

2 ...

-....... Cumulatwe number

Chapter 4 •

I f}D

The PacELF Way Towards lhe Eliminallon ol Lympllaijc Filariasis In lhe Pa<~ic Figure 4-7: OEC tablets shipped to the counules. 2000- 2004

soooo ooo,~-----------------~

90000000 $0000000

•

lS !!

•ooooooo-1-- - - - - - - - - - -r:-,..e:::.;____~'ooooooo

&0000000

•

JOOOO 000

,,•" E z•

sooooooo ; 1-- - - - - 1

20000 000

40000000

lOOOOOOO 20000000

10000 000

-! s

10 000000 0 -l--J:Jlll<1-~-1..__J~_..!'--_J_~_J_....:L~-1.._..!L..l- o

2000

2001

2002

Ir:=r DEC mbleu disuibuttd

200>

-+- Cumul111wt numbtt MDA. The number of ICT kits senl oul by the PacELf home office is shown in Figure 4 8 . Shipments of these kits also peaked In 2003: that year, 73,00-0 ICT kits were shipped to the countries.

Figure 4-8: ICT kits shipped to lhe countries, 2000-2004

DRUG COVERAGE ACH IEVED The logistical efforl involved In

2000

2001

2002

2001

organizing an MDA campaign cannot be overestimated . The campaign Is equ ivalent in scope to a national

2004

-+- Cumulatl\<e numbet

census or election , since everyone

must be contac1ed and registered. For that same reason, it differs from all

but opening lhe bol11es in advance and di vid ing lhel r contents would risk deterioration , especially for albendazole. Also, lhe average number of DEC lablets per person has had to be increased from the recommended six (in 1he GPELF guidelines) 10 eighl, to

Proqressand AollievemenlS

health programmes. The coverage achieved has been generally good , considering the

logislical problems presented by

allow for the large body size of many

dispersed

populations. In most of the countries.

al ways

islands

and

remote

waslage i s inevilable. although unused

the coverage i s estimated from the delailed reglslralion books thal are returned 10 lhe nalional programme managers . This exlremely llme-

drugs are returned after the MDA.

consuming task occupies national staff

Baseline filariasis prevalence is es Ii mated wilh ICT kits, which also help

for many weeks alter an MDA i s completed. Coverage eslimales arrived

in assessing progress in sentinel sites

at in this way are conservative

In lhe endemic countries, as well as in

es1ima1es: lf lhe reglstrallon books for

overeslimate

projecled

case of albendazole). Some drug

immunization and maternal and child

Pacific peoples. Hence, the shipments requirements on purpose (by 20o/o in lhe

other heallh campaigns lhal target only part of the population, such as

determining , during final evaluation

an area are not returned, coverage is

surveys. whether the prevalence has

counted as zero. French Polynesia is

dropped sufficiently after five years or

lhe only PacELF counlry that has

PART I Table 4·5: MCA coverage {%),' 1999-200• 2000

2001

2002

2003

2004

American Samoa

19.3

51.2

47.4

65.6

59.I

Cook Islands

77.9

77.1

100.3'

91.1

92.1

66.6

58.4

64.3

88.5

86.2

89.4

92.I

40.4

60.9

83.4

87.3

Country

1999

f iji 85.7

French Polynesia"

58.4

43.7

97.4

95.4

85 I

52.4

67.4

59.6

77.9

79.1

83.6

90.3

Kiribati Niue Samoa

84.5

Tonga

70.7

46.7

82.4

83.3

80.•

78.8

76.6

77.8

73.6

56.9

61 .9

66.6

69.9

75.3

69. 1

68.7

71 .2

Tuvalu Vanuatu Wallis and Futuna•

Overall

84.5

85.2

• Based onrtparted CCW!rage1n reg1St1ation books andytNJrty001us1l!d popu1"tionesbmates(Secre1ana1of 1hl'Pa<ific. Community, Pacific blind Popula1ions. 2004) • ~t.lge flqurf.'5'. for Frtnch Polynesl.1 .ireC'.Xtrapolllted from cover.lgc WfVt'Y), 'Walllsand Futuna is a partlal)yendem!c country but decided onnatlomwleMOA. .. Over 100% reported coverage in Cook: Islands rep<t$C:nts OtSCre~ncy between regtsteted and census popolabon estim ates. pos.siblydue lo non-full·bmeresidents receMng treatment.

routinely used separate coverage surveys. Table 4-5 shows lhe reported coverage of MDAs in each coun1ry. A ll countries excepl four achieved higher

task on their own. Information mat·erials were produced in Bislama (Vanuatu). English, Fljian, French, Hi ndi (Fiji),

Samoan. Tok Pisi n (Papua New Guinea). and Tongan. Local names for lhe disease {such as waqaqa In Fiji)

than 70% coverage in al least one MDA. and some coun1ries consistently achieved much higher rates lhan 70%. French Polynesia, Niue. Tonga and

were used. Al the PacELF annual meetings. many countries were able to learn from

Tuvalu all had better lhan 80% coverage In lhree or more MDAs. The average

one another. They exchanged ideas for posters and leaflels, which could be

coverage in the PacELF countries ranged from 69% lo 75% (except in 1999, when only one country, Samoa,

adapted for local use. T-shirts. stickers of various sizes and colours. and bags. were also favourite ways of displaying

was doing MOA).

the PacELF logo and messages. In lhe earl y stages of PacELF.

HEALTH PROMOTION

materials were produced to support the

many posters showed photos that rocused on the possible damag ing effects of filariasis morbidity, to capture people's attention and perhaps scare

programme in the Pacific countries. Chapter 3 contains some examples. and

them into complying. For example, there were pictures of hydrocoeles and limbs

Part 2 shows the materials used In each counlty. An auracllve logo was designed

cases, as in Vanuatu. thi s choice of

A large number of health promotion

and used on all posters and reports. Some countries. especially lhe smaller ones, designed and produced materials with lhe help of lhe PacELF home office, while other countries went about lhe

swollen by elephantiasis. Jn some slrategy was based on the results of knowledge, attitude. and praclice (KAP) surveys. As lhe programme matured, the health promotion materials changed

to more posi tive messages. They

The PacELF Way Towards !heElimlnalloo ol lympllaijc Filariasis In lhe Pa<~ic Tuble 4 · 6: Health promotion materiAls produced for first MOA In Fiji, 2002

Postets

Public

Leaflet Pamphlet

Public. nurses Public. nurses Public

C.lemlar Vr<lootape

TV adveruserr..ent Radio spot

Nev;spapcr write-ups

Public Public Public

w~~te

Public Public

T~shi rt

Oisttibution staff

Vehicle advertisements

Public

Two londs of A2·size posters rn Engfish. fl'ian, and Hindi A4 size; in EngUsh, Fi'ian. and Hindi A4 siz-e, in En nsh A2 s1le; in English PacElf vidoota

Adverbsements on the NMese bus (during

MOA) and pr ramme vetuclc:s and for diverse audiences Including community members and hea1th staff. Videos. TV advertisements, radio spols, and press releases were also produced. Finally, a calendar and T·shirts were produced and information was painted on the side of a bus and on programme vehicles (Figure 4 ·9). The PacELF website was also a

described whal sh ould be done lo

prevent filariasis and showed pictures of children and adulls taking !he MOA lablels. Table 4·6 lists lhe IEC materials for the Fiji programme In 2002 (see Part

Table 4·7: PacELF website hit statistics, 2004

Prog1essand AollievemenlS

means of delivering Information. It was launched in October 2002 and has had a steadily increasing impact since then The number of hits to the site in 2004 is shown In Table 4-7. Considering the difficulties or Internet access in many

Pacific islands, it Is encouraging to see that people from the Pacific Island

2). They include booklets, posters ,

countries make up quite a large

lea flets, and pamphlets in th ree languages (English, Fijian, and Hindi)

proportion of those \Yho access the site (Table 4·8).

PART I Table ~8 : PacELf website hJt statistics, by country, 2004

No. I 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

Coun•ru

Netw0rk

Untesolved/UnknO\vn Japan US c.ompanv

Fili Fre'1ch PolvnP<la

us school

Unoted l<madom United Stiltes C.nad• Australia Nethe~ands

US Government france lndJa Finland New Zealand IAotearoa) International

Switzec-land Samoa Brazil Poland

Hits 13378 8969 4 0 17 3903 I 642 I 476 I 431 1 141 1 022 1 002 643 398 313 236 183 171 17 1 151 103 97 93 92

Ph1ljnn1nes

24 25 26 27 28 29 30

Non·orofit Ocqanita1ion Soaln Cook Islands US Milltarv Israel Pant1a Neo.v Guinea

82 69 62 59 56 54

Ge-rmanv

COSTS

...

". % 32.09 21.51 9.63 9.36 3.94 3.54 3.43 2.74 2.45 2.40 1.54 0.95 0.75 0.57 0.44 0.41 0.41 0.36 0.25 0.23 0.22 0.22 0.21 0.20 0.17 0.15 0.14 0.13 0.13 0.1l

No. I 2 3 4

tII •

Countrv Unresolved/IJ nknown

Nehvc>rk US company Fi'i

Australia

6 7

New Zealand (Aotearoa) Jaoan

8 9 10 II 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

Nethe~ands

388

Portutt.lil

386 349 345 252 220 220 209 169 163 143 95 91 77 62 60 54 51 51 50 47 47 47

Belnlum

school Non-profit OtQanizatlon Unlled l(inadom US Government Switzerland Brazil Norwav Mkconesia

Samoa France International India US M1htarv Niue Colombia Czech R""'•blic Vanuatu Poland otd st\M .6.nunet (aftU.1

Austria

pe rmanen t staff but a lso all hi red consultants. Economic costs Include all

PacELPs operations in the Pacific

donated materials.

from 2001 through 2004 were examined to determine the economic cost of MDA

one year to the next Supplies constitute

per person treated. a nd al so to understand how funds were allocated

Figure 4-10; Distribution of finaocial c:csts, 2001-2004

among tra nsportation. personne l, equipment, and supplies. Flnally, plotting the allocation of costs In actua l programme implementation allowed those areas that require the most

Generally, expenses vary little from

800 000

..--_ ~ 5

~ c "~~

resources to be identif.ed. As Figure 4-10 shows, most of lhe PacELF budget goes to supplies and staff salaries. Supplies Include (but are not limited to ) drugs and surveillance

materials, as well as office overhead. Pe rsonnel cost covers not only

" ""

700 000 600 000 5()()

000

400 000 )00000 , . . 000 100000

200)

2002

Year

2004

% 29.38 21 . 13 16.43 6.68 5.82 3.20 1.66 1.65 1.50 1.48 1.08 0.94 0.94 0.90 0.72 0.70 0.61 0.41 0.39 0.33 0.27 0.26 0.23 0.22 0.22 0.21 0.20 0.20 0.20 O.lO

The PacELF Way Towards !he Elimlnalloo ol lympllaijc Filariasis In lhe Pa<~ic Figure~ 11 : Distribution of lmplem&ntation costs, 2001-20()4$

MDA programme implementation can be divided into several categories

of acllvily. Figu re 4-11 gives a breakdown of expenses by category. As lrafnlng. s169 360, 5%

can be seen from the chart, most of the resources are allocated for drug

Mapping.

S106 696, 3%

distribution (52%) and surveillance and laboratory activities (22%), with very little variation between years.

Drug Orsttibutk>ri,

The cost per person treated was

St 964 720. 52% Ad'ltfse Reae1lon

calculated from the total costs of MDArelaled activity, using the MDA coverage

- -

Monitoring,

S0,0%

rates and the number of people at risk

(see Chapter 2). Table 4-9 shows that ii Table 4Âˇ9: Demographic Information and fiscal operating costs per Year, 200 1-2004 Average Average

Year

200t 2002 2003 2004 Total

Persons at Coverage

Risk

1737211 1 759130 1818241 2 833 995 8 148 577

(%)

75 69 69 71

Total Cost (MDA Cost pÂˇer Cost per Implementation) Person Person (S) Treated a t Risk

Per.s-oni Treated

t 308120 1215425 1 249131 2 Ot7 804 5 790 615

805 1t1 673 650 986 287 882 948 3 347 998

($)

(S)

0.62 0.55 0.79 0.44 0.58

0.46 0.38 0.54 0.31 041

cost between S0.44 and SO. 79 lo treal one person In 2001-2004, for an average cos! of S0.58 per person Ifealed.

This analysis does no! take into account !he monies spent on MDA by

Individual countries In the Pacific. and therefore slighlly underestimates the total cos! of treating and preventing lymphatic filariasis. But the low cost per person is positive and encouraging. The cost analysis shows that PacELF Is

about 70% of the total budget, and personnel costs account for 27%. Transportation and equipment

sustainable; !he results may also be extrapolated to provide a roughestimale of the cost of other programmes that are

expenses are minimal in comparison.

starting MDA.

ACHIEVEMENTS IMPACT ON FILARIASIS

(elephantiasis, hydrocoele, etc.) seems

Methods of assessment

relatively low compared with the number in other endemic countries like India, The strategy of PacELF has been lo

PacELF's goal is to rid the Pacific

Island countries of lymphatic filariasis. In order lo know when the disease has been eUminaled, surveys of predefined indicators must be conducted. The main Indicators used In PacELF are !he prevalence of current infections and the

cg] @

Progress and AollievemenlS

stop new cases first and then to reduce morbidity In those with symptoms. Suitable indicators for this aspect of the disease are being developed as attention turns more towards alleviating

incidence of new infections. Another Important indicator is the amount of

the suffering it causes. In PacELF, prevalence is usually estimated using ICT. which detects

morbidity due lo filariasis. In the Pacific, the number of people with symptoms of fllarlasis disease

antigen from adu1t worms circulating in the peripheral blood. Prevalence can also be measured using blood slides to

PART I estimate the number of people with

51 .9% in Vanuatu and 25.4% in Samoa,

microfilaria in the blood. From the blood slide, one can also assess Impact by the reduction in the mean density of

while the negative predictive values

were 99.8% and 100%, respectively. In

microfilariae in the blood. The ICT overestimates by about

other words, only about oneÂˇfourth to one-half of the people who test positive by ICT actually have Ml (although they

two to four times the proportion of

may have adult worms and so are not

people with microfilariae. compared with the blood slide method. This is because

true "false positives"). On the other hand, someone who tests negative by

ICT will detect the antigen In recenUy infected people who have Immature adult worms but no Ml. The antigen from

ICT is very likely negative for Ml. In addition to prevalence surveys, a second major way to assess the

dead or dying adult worms may also

success of PacELF is to determine

persist In the blood tor some time after

whether or not transmission of the

successful treatment. In addition,

di sease has been Interrupted. To

people infected with only one single

determine whether new infections are

adult worm or wtth old adult worms past the reproductive age may test positive

still occurring, young children just

by ICT when no Mt are present in the blood. PacELF's aim is to reduce the prevalence of ICT positives down to less than 1%, which would correspond to a real mierofilaria prevalence of 0.3% to

0.5% . The relative performance of lhe two types of test (ICT and blood slide) was

entering school are tested. The aim is to reduce the rate of new infections

(Incidence) down to less than 1 per 1000 per five years.

In summary. regular blood surveys are scheduled in the PacELF countries to assess both prevalence and

incidence. As described in Chapter 2, the monitoring and evaJuation plan calls

directly compared during the baseline

for four types of assessment surveys: a

surveys in Vanuatu and Samoa in 1998. The majority of people in both of these

baseline prevalence survey ("A"

large surveys were tested by both methods . In Vanuatu. the overall

in sentinel sites after the second or third

survey), mtdterm evaluations conducted

round of MDA (''B" surveys), a

prevalence was estimated at 4.8% by ICT and 2.8% by blood slide (Table 410), while In Samoa it was 4.2% by ICT and 1.1% by blood slide (Table 4-11 ),

prevalence survey after five years of MDA ("C" survey). and an incidence

The d ifferent ratios between ICT and blood slide results in the two countries

Table 4~10: Compansonof JCT a(ld blood slide (60ul)tests In Vanuatu. 19'98

may reflect lower Mf densities in Samoa or other epidemiological differences

Direct comparison of the two tests provi ded justification for PacELF's routine reliance on ICT for prevalence estimates . Only six individuals in Vanuatu, and none in Samoa, tested positive by slide and negative by ICT

representative

final

evaluation

SLIDE Positive

108

114

100

3360

3460

208

3366

3574

Table4~11 : Comparison of ICT and blood slide (60ul) tests m Samoa. 1998

("false negativesÂˇ). However. as

expected, a large number of individuals tested negative by slide but positive by ICT, reflecting the different targets of the two tests. The positive predictive value of ICT compared with microscopy was

SLIDE

Negative

TOTAi.

~~~-~~~~--1

Positive

Negative

126

3885

4011

TOTAL

169

3885

4054

The PacELF Way Towards !he Elimlnalloo ol lympllaijc Filariasis In lhe Pa<~ic Table 4-.12: Number of surveys or each type. completed or planned accoo:hng to the PacMAN book, 1999-20 10

lni1ail assessment

Midterm asses.sment

Final css~smen1

Trar\'Sn'ld$IOn a~nt

Number of coun1ties and areas 1mple· menUng monttOhng

and evatuation

survey conducted among young children ("D" survey) at least two years

consecutive surveys. First, it describes

after the MDAs.Table 4· 12 shows lhe n umber o f surveys compl eted o r planned by PacELF.

between Initial (as part of baseline) surveys and follow-up surveys In selected sentinel sites during !he MDA

Each country used the results of

the baseline surveys to select several sentinel villages-usually villages where the prevalence is higher than average-

lo follow closely d uri ng the impleme ntation of the programme .

Follow..up surveys are done at intervals In these sentinel sites. The PacMAN

the change in prevalence, as measured

activities. Then.

it gives the results for

the change between lhe baseline (A)

assessment and the final assessment (C) surveys among the entire population. Nine of the 11 countries conducting

book recommends a midterm evaluation

MDA have compteled at least one follow-up survey in sentinel sites (Table 4·1 3). Two countries (Samoa and Niue)

after two or three rounds of MDA. but some countries did follow-up surveys In

have also completed a final (C) assessment after five rounds of MDA.

sentinel sites after every round.

A decrease tn ICT prevalence was observed between the initial and followup surveys in sentinel sites In all but one

Decline in prevalence of MDA, analyses country data, and

country. After one round of MDA In three countri es (American Samoa, Cook

between

Islands, and Niue) the percentage

This section describes the Impact

makes

comparison

Table 4 ..13: Prevalence perceruage by ICT at intial (befe<e MOA} and foflow..up (after MDA) survey$ Ins.elected sentinel sites

~~~~ Country

Amerlc:.an Samoa

"..c

e.. ...•

Frtnc:h Polynesia

350 1396 1794 t859

VDnu.atu

627

Fiji•

23• 1943

Coo1t tsla(lds

Niue

Samoa Tonga••

.. ~

90 129 1()8

.. ~

t7.4

602

10.6

9.4 3. 1

460

35 22

7.6 1.5

276

14.9

256 151

'$. -;:.

e.. ...•

131

"..c

13.8 24. 1 38.5

1507 1855

:E ~

'$. -;:. ~

Iic

e.. ...•

f171

6.6

4002 2.7 574 128 22.3 • Fip ptMt SUl'Vey WM c.oaie<I OUI in Feb 2005 • • in Tonga a slightly ddferent ~ion of 'tlllitges (on the same islands) was so~ at follow·up. TuvaJu

(}D @

Progress and AollievemenlS

.. :;: ~

.. ~

'$. -;:.

Iic

e.. ...•

'$. -;:.

7~9

345 214 1

3896

96 96

3800

483

27.6 4.5 2.5 12.7

PART I decline in pr evalence ranged from 19%

ranged from 7% in Tonga to 43% in

In Cook Islands lo 52% in Niue (Figures 4- 12, 4 -1 3 , a nd 4- 14 ). In French

Tuvalu (Figur es 4- 17 lo 4-20). The graphs suggest that, i n general, the higher th e baseline prevalence. the

Polyn esi a, t he preva lence was unchanged after one round of MDA (Figure 4-1 5). Afier two rounds of MDA

steeper the decline between the Initial and follow-up su1veys.

in Vanuatu, ICT prevalence had declined by 6 7",1, (Figure 4-16).Afterthree rounds of MDA in four other c ountries (Fiji,

As mentio ned. two co untri es (Samoa and Niue) have completed the final assessment (CJ survey, in 2004.

Samoa, Tonga, and Tuvalu). the decline

The C assessment is a nationwide

Figure 4-12: Antigen prevalence in sentinel sites 1n Amencan

Figure 4 -13: Antigen prevalence in sentinel srtes 1n Cook Islands

Sam oa at lntia l su rvey after one round of MOA • 25

at lntlal survey after one round of MDA• 12

---

"' ·~

------- -~

f. ~

•

.z ••

# 0

2 0 lnltlll $urv«y

Aftff 1st MDA

Aft• r 11-t MOA

• Bars represent 95% confidence intervals

• Bars repr(!Serlt 95% confidence tnlervak

Figure 4-14: Ant1gen prevalence In s.entinet sites In Nl:ue

figure 4-1 5: Antigen prevalei;ce in senunel sites in French Polynesia

at 1nt1al suJ'Vey after one round of MOA •

a1 lntial survey aftef one round o f MDA •

------ --

..,~

~c ..,"' c

0 lnilb!Su~

•• •• •• •• •

2 0 In itial Suf'WY

Afttr 1 't MOA

Ahe rl.s l MOA

• Bars rcprtStnt 9S% confidence inttNils Figure 4· 16: Antigen prevalence 1n sentinel sites in Vanuatu

Figure 4-17: Antigen prevalence 1n sentinel sites 1n Fiji at mnaf

al ln11al survey after two round of MOA•

survey after three round o f MDA'

"'-

> • i-~~~~.:=....;::..........._ ~~~~~~~--1

:~0 c ·! ~

..............

· ~~~~~~~~~~~~~-=-~~~--! • +-~~~~~~~~~~~~~~~~~~~

lniti.al Suf"ltY

- -------

< •• i-~~~~~~~~_::,""""---~~---1

•• ••

Arter 2nd MI>A

---......;

20 10 0 l nitil1$u~

• Bars represeat 9S% confidence mtervak

Ahttr Jrd MDA

The PacELF Way Towards !he Elimlnalloo ol lympllaijc Filariasis In lhe Pa<~ic Figure 4-18: Antigen ptevale.noe i.n sentinel srtes 1n Samoa at intial 5urvey after three round of MOA•

.. ·f .? #

survey, and thus the results can be compared with the baseline (A) assessment. In both countries a dramatic decline in prevalence was seen between the two surveys (Table 414). In Niue, the prevalence by ICT wasreduced from 3.1%

•~------------------

· ~---~~-------------~ 7

•s

to 0.2%, or by 94% (Figure 4 ·2 1) In Samoa, the decline in prevalence by ICTwas from4.5% to 1.1%, or by 76% (Figure ~

4· 22) . Thus, five rounds of MDA reduced prevalence in Niue and Samoa by an average of 85%. Niue started with a lower

•'

prevalence than Samoa, and brought it down well below the target of 1%. In Samoa, the estimated prevalence at the

l nitlllll Survey

• &rs represent 9S% confidence 1nterva~s

Figure 4-19: Antigen prevalancie ln sentinel sites In Tonga at intial 5urvey after three round of MOA·

Figure 4-20; Antlgt:n prevalience In sentinel shes In Tuvalu at intia1 survey after three roond of MOA• )0

j ~

.a•

1 & .:

-....... ~

~------------------~

o <---------~---------~

""-'i

lnid~I $u.,,.y

Ahtr ~·rd MO.A

lnhilll Su!'WY

• Bars represent 9S% confidence intervals

• Bars represent 95% confidence intervals

Figure ~21 : Redudion rn antigen prevatence In Niue between baseline (A) and final (C) assessment after five rounds of MDA'

Figure 4·22: Reduction In antigen prevalenoe In Samoa between baseline (A) and final (C) 8Ssessment after five rounds of MDA"

•

· ~------------------~

g..

41-~~~~~~~~~~~~~~~---l

·~

l 1----~· -..,,_------------;

•• ·~

< #

o l---------~----------~ • Sa.rs <epreseot 95% conf.lden<e llltervals

-~ 2 ~-------'::.._,-----------I

s )

...

........... ...........

.......__

' 0

S•seNn• Surwy ~

Anal AsMSJmoef'll Swrwy

Bars represeni 9S% confidence iniervat'S

Table 4~14: Ptev<ile<ice percentage by ICT of baseline A assessmeot alld final C assessment in Niue and Samoa (coontryv.iide survey)

Progress and AollievemenlS

PART I

Table 4·15: R~uctfon in Mf density betw~ Initial survey and subsequent surveys in Samoa and Vanuatu (Geometric mean M l per 60 µI)

Nationwide

4.5

I .I

Sentinel (2 villages..)

7.0

1,3

Nabonw1de

4.8

2.5

S"'1bnel (8 villages•• ")

24.1

12.0

Samoa

Vanuatu

5.9 4. t

0.2

14.8

8.0

1.2

17.0

7.9

0.8

t I

0.4

1.0

0.3

3.6

3.0

• Samoa · post lo'd MDA. V6nuaiu · po$1 2nd MOA • · : 2 villages • Sagooe aod Safimu • • • 8 vtUages • Sola, Mcwna, s-ort Resoluttol\ SOU!h nve-, Sak<'!u, Orap, Unmet.and Wanur

final assessment was only slightly

Figure 4·23: Age-sµec:ific prevalen<e of ICT p0si11ves rn Samoa at baseline survey in 1999

higher than the target 1% prevalence. In Samoa , blood slides were

•

prepared for persons who had tested

positive by ICT, to dete rmine Mf prevalence and density. The decline in Mf prevalence in Samoa from 1.1% in 1998 to 0.4% in 2004 paralleled the decline In antigen prevalence (Figure 4·

22). There was also a reduction in the density of microfilariae per 60 µI per

!;1 ..... •

.. • ~

Samoa (Table 4-14). In Vanuatu the reduction was statistically significant.

1998 and 3 after the second round of MDA (p=0.012). In Samoa the density

was much lower than in Vanuatu. It was 5.9 In 1998, before PacELF, and 3.6 In 2004, after five rounds of MDA (p=0.06). There was also a large change in the age-specific prevalence of ICT positives in Samoa , be tween the baseline and subsequent surveys. Figure 4·23 shows that the number of ICT positives had dropped In all age groups, but the decline was especlally marked in people over the age of 20. In 1999, before PacE LF started , the prevalence in the over-20 age group was 7%-10%. By the time of the final evaluation survey in 2004, all age groups had less than 3% positive by ICT.

)

•

.. -

person in two countries, vanuatu and

The geometric mean of Mf was 17 in

and final evaluation In 2004

D-9

l- 1m

./" JO-J,

20-29

10-19

Age group ~ 2004

encouraging results from midterm evaluations in another six countries

show that PacELF is on the road to success in all the endemic countries.

The reduction observed Is presumably due both to effective treatment of cases and to reduction in transmission and, hence, prevent.ion of new cases. Niue and

Samoa achieved an

average reduction of85% afterfiveMOA rounds.Al the start of this chapter, ii was estimated that 500 000 people in the Pacjfic were infected with W. bancrofti

at the start of PacELF. If the 85% reduction figure were to be applied to

The impressive reduction in

this infected population, at least 425 000

filariasis prevalence in Niue and Samoa after five MDA ro unds and the

filariasis Infections would have been treated or prevented by the end of

4'><19

~-59

...

The PacELF Way Towards !he Eliminalloo ol l ympllaijc Filariasis In !hePa<llic PacELF's MOA programmes. If 85%

Only 14% mentioned using mosquito

reduction Is achieved. then the antigen

nets. Knowledge in this area ~s obviously

prevalence in the Pacific region as a whole will be about 0.9%. Thus, there

still lacking. Concerning treatment, very few people mentioned kastom methods

is every reason to expect that PacELF

ln this second susvey and only about one

wlll succeed in its goal of reducing the

third mentioned Westem lrealments. In

antigen prevalence to below 1% in all countries by 201 O.

particular. only a tiny proportion (1%) knew that affected areas of the body need to be kept clean. Thus, between

Increase in health knowledge

the two surveys. there was an increase

In Vanuatu, a social research slUdy was done in 1999 as part of the process

in knowledge about prevention but not about whal to do when lnrected.

of planning for the MDA and designing heallh promolion materials." At that time, most respondents were familiar

In two other countries (American Samoa and Fiji), surveys of knowledge, attitudes, and practices (KAP) shed light

w i th filari asis and ils symptoms . However, most of them ascribed the

on the level of knowledge about filariasis In the population , and how It has

symptoms to germs, lack of hygiene. bad nutrition, and the breaking or taboos. Good hygiene and nutrition

changed over time. The responses to

practices were often cited as possible prevenlive measures, closely followed by mosquito control, kastom (local)

In American Samoa. MDA coverage In 200 1 and 2002 was disappointingly low. T he filarlasis

remedies. and quarantine. Respondents were equally divided between kastom and Westem treatments for the disease.

programme designed and implemented

selected questions in the two countries are shown In Flgures 4-24 and 4-25.

a KAP survey in 2003, several months before MOA The programme used the

Al a second survey in Vanuatu in

survey to determine h ow soci al

2002, after two rounds of MDA. 55% of

mobilization and distribution strategies could be Improved. This survey revealed

the respondents said that mosquitoes

were responsible for 1ransmitting filariasis, but a quarter still did not know how the disease was transmitted. In addition, two-thirds of the respondents thought that "taking tablets" was the best way to prevent the spread of filariasis.

that 35% or the population d id not know what filariasis was, and only 58% knew that mosquitoes can cause and spread

the infection. Partici pation in MOA increased greatly from 2003 onwards. and in

a second KAP survey in 2005,

there was a marked increase in several

Figure 4·24: Resolts of KAP suM')'S 1n American Samoa, 2003 and 2005

aspects of knowledge about filariasis

and the programme (Figure 4-24). In Fiji. the baseline KAP study in

2002 showed t hat the l evel of knowledge about filariasls was quite

....

good, even before PacELF (Figure 225). For example, two· thirds of the

respondents sa id that mosquitoes transmitted filariasis, although 7.5%

"'"

°"'

j.._.&.ii... H~e heafd of f1111rlash

I a 2003 ~

Progress and AollievemenlS

a zoos I

Xl'lowwh•t lf Is

Think fllarl•sis k a problem ~

thought that "drinking d irty water'" was the cause. Other responses such as "person · l o · person con ta cl" and "hygiene" were each given by less

than 5% of the people asked. In

PART I Figure 4-25: Results of KAP sorveys on Fi11. 2003 ond 2005

--....

--I---

I • 2003

• 2005

add11ion, even al lhat early stage of the Fiji campaign. the majority of the people (57%) knew that taking medicine could prevent the spread of fdanasis and a further 32% mentioned mosquito control methods or nets for prevention Al F1~·s second survey In 2005. the propoflion thal knew that mosqunoes transmttted filerlasis had Increased from 67% lo 82% (Figure 4-25), and there were sil1'\1Lar 1ncreas.es in other aspects of knowledge about the disease However. the number of people who knew that taking medicine could prevent fllanasis stayed the same (60%) A somewhat alarming percentage tS the 12% who said that they did not take tablets m the last MDAand did not intend to take them in the future These •systemaltc non..compl!ers· must be

reached or else they may jeopardize the prospect of elimination. In all three countries surveyed, the main reason given for taking the MOA tablets was "to protecl myself from the disease", indlcaling thal dealing wtth a personal threat was more Important to people than reduang tran1mission to others. The meln reason for not taking drugs was ·missed the d11tnbution" or "didn't know about the dlstr1bulion•, suggesting that coverage had decreased not because people refused to take the tablets but because of difficult logistics.

IMPACT ON THE HEALTH SYSTEM PacELF affecled the heallh system 1n all eountries. In some cases. the start ol PacELF marked the first time that the exient of the disease was recognized Even 1f fllanasis was already known, the programme raised the profile of fllarias1s and forced the health system 10 consider how to ease the suffenng caused by the disease Other countnes were glad to know that they no longer had 10 worry about new cases of fllarles1s, since the disease had already been eltm1n1ted 1n the11 territory. Samoa. French Polynesia, and Fiji were the only countries wilh an established or dedicated fllariasis control office or secbon 1n the m1nlslry of heallh before PacELF began. In Fiji's case this was because o f the Ularlas1s resea rch and control activities of Dr J. Mala1ka and his colleagues. white French Polynesia and Samoa both had long histories of MOA programmes (see Chapter 2). In Vanuatu. Sok>mon Islands, and Papua New Guinea. attention 10 malaria overshadowed 01her vector·borne diseases. In these countries. malaria control units were converted 10 '"vector·borne d•sease control units• at about the time lhat PacELF began, reflecti ng o broader In terest In

The PacELF Way Towards !he Elimlnalloo ol lympllaijc Filariasis In lhe Pa<~ic diseases other than malaria . In all

other than W bsncrofti. includi ng

PacELF countries, the neglected task

intesl in al helminths. Resources

or filarlasis control became the clear respons lblllly of someone i n the

available for MDA enabled some health workers to visit remote Islands

ministry or department of health.

and areas, where they could provide

Health system personnel were involved directly with PacELF in most countries. Nurses were atways key people in drug distribution, bul counlry

other services such as immunlzalion and maternal and child health clinics.

were chosen by each country from a variety of health professions. Public

The MDA was typically a time11mited , once-a-year campaign , occupying only a few days of the health workers' and nurses' lime, although !he workload during !hi s

health doctors were closely involved

period was intense. The extra work

In lhe programme In Fiji and Tonga. heallh inspectors in lhe Cook Islands.

was offset by the additional knowledge gained by the heallh workers and the

programme managers and other staff

they provided to lhe

laboratory staff in Tuvalu, and senior

services

nurses In American Samoa. Par11cipatlng in PacELF's activities increased opportunities for health staff.

communities.

In V.nuatu (Figure 4-26), feedback on the MDA was sought from nurses in

MOA rn Vanuatu

SOI.Ir<• . ..

•

Aside from lhe networking and col -

Q£J @

Progress and AollievemenlS

2002 . They sai d that not enough

laboration at PacELF annual meetings,

suppUes (medicine, registration books,

they Improved their computing, data management, and presentation skills. PacELF provided computers lo seven

and health promotion materials) were

dehvered on time, and !here were not enough funds for transport. The

countnes. and promoted the use of email

complaints reportedly Increased as the

for communication. A few staff had !he

programme progressed. and the nurses

opportunity to travel overseas for

seemed unlikely to continue giving

specialized training.

The mass drug admi nistration

slrong support to the programme beyond five years. But !hey Indicated

programmes ensured that everyone

that the programme was generally run

participa ti ng i n lhe MOA was contacted in person by a health worl<er

well.

at least once a year during the

evaluate training workshops and health

programme. The drugs used In MDA

promotion materials In 2003. The great

reduced infections from helminths

majority reported having received

Nurses i n Fiji were asked to

PART I

Table 4-16: Possible effects oi Integration of filariasis conuol and other health plOgrammes"

PacELF: MDA. Morbidity Con11ol and Awareness campaign

+ + + + +

jieafthy Schools Progrnmm• Malana Contt0I Progrnmmes Dengue Control Psogrammes

Environmental H..llh

lmprove:rne:nt ~

+ + + +

•

Down ~now represtnu. a deae.sse tn the problem~ 1n column heading,

up arrow represent\ an lncrei»e.

"very

sufferers often withdraw from social

informative• malerials for the 2003 MDA campaign. Slighlly fewer (aboul IWo • lhi rds) had seen, heard , or read Information through the various mass media, but lhese expressed a strong preference for TV and radio spots ralher than newspaper articles as a means of disseminating intormalion. The nurses also fell Iha! the !raining, while useful, fell short of whal !hey needed to know In order 10 treal Infected people. The PacELF programme lends itself very well to integration with other health programmes such as vector contro l and helmi nth control in children, in support of the concepl of · Healthy Islands· (Table 4·16).22 In Vanuatu and Papua New Guinea. where both fifariasis and malaria are lransmilted by Anopheles mosqulloes, the use of mosquito nels l o help pr event both diseases i s being promoted. Even In Fiji and the Polynesi an countries. insecticide· treated materials are now being tested by PacELF, and may protect against dengue as well.

enough

•informalive·

Interaction. Non-biomedical explanations of causality often attach blame

SOCIAL AND POLITICAL IMPACT Increased auenlion 10 filarlasis is bound to have an Impact on society. Fifa riasi s Is a disfiguring disease, and u

~VHo aoo1)

to the vi ctim . In Vanuatu many respondenls In !he firs! KAP study in 1999 mentioned "breaking taboos• or exposure to female menstrual pollution as causes. As the biomedical expl anations for filari asis are publicized and more people come to believe !hat ii is a di sease that i s mosquito·borne and not self·inflicted . !his will affecl how palients and other people perceive the condition. Stigma and shame are inevitably associ ated with t he pa lhology of elephanttasis and hydrocoele. The publicity engendered by the MOA programmes i n PacELF endemic countries may reduce lhis stigma. but could also direct an unwelcome spotlight on sufferers. Care must be taken to avoid negative connotations of positive status in blood surveys. The stigma must be overcome. to encourage patients to come forward and participate In morbidity reduction programmes. Filariasls elimination in the Pacific was clearly brought onto the regional political agenda when it was endorsed by the Pacific Island heallh mini slers at their meeting In Pal au i n 1999 (see Chapter 2). Al subsequent meetings, the health ministers reiterated thei r support for PacELF. The "Madang

The PacELF Way Towards !he Eliminalloo ol lympllaijc Filariasis In lhe Pa<~ic Commitmenl

towards

Heallhy

activities

and

ministers' meeting In Madang, Papua New Gui nea. i n 200 1 slaled that

Gl obal Technical Advisory Group

countn'es and areas in Iha elimination

of filan·asis was recognized. It was also observed that countries were keen to extend/expand PacELF act,vitles In all territories . The work of PacELF has been supported by many organizations since 1999. The Governmenl of Fiji has provided office and storage space and transport. The office of !he WHO Western Pacific Region in the South

Pacific has provided full-lime staff (lhe projecl direclor and three coordinalors In Fiji, Samoa. and Vanualu} and funds for an nua l meelings. Filariasis ellminalion and PacELF have had a high profile 1n the Western Pacific Region since 1999. A resolulion passed by the WHO regio na l commill.ee in 2002 slaled in part lhal !he committee:

meetings 2'- Private par1nerships in the

Global Alliance and PacELF are represented by GSK , a staunch supporter of PacELF from lhe slart. GlaxoSmilhKllne do nates all lhe albendazole used worldwide for filariasis elimination. A learn from GSK

visited PacELF in March 2001 before committing wholeheartedly 10 support the Pacific countries through the

PacELF regional system. The Japanese Government

supporls PacELF i n many ways , Including lhe dona1ion of supplies and support of Japanese Overseas Cooperalion volunteers through JICA. Reflecting the huge amount of support given to PacELF by the Government

of Japan , PacELF has been lhe subject of a Japanese while paper thal indicates that the Government views

PacELF as a shining example of a successful aid programme.

Further recognmng that the countries of the Pacific have joined

PacELF has greaUy Increased lhe amounl of con1ac1 and networki ng belween health slaff in different Pacific Island countries. Counlry staff are able to meel al least once a year at lhe

together

Pacific

PacELF meetings and compare notes

Programme to Elfmlnafe Lymphatic Fllariasls (PacELF) ...

on their progress. Networking and commun icalion lhrough meetings,

form

the

Urges member states ...

email. and the PacELF website (see

...to mobilize communities to take

Chapler 3) have contributed to a

an active part fn ensunng high levels

cooperative spirit and shared interests

of coverage

drug

among the countries as they unite to

distribution campaigns for the e/lmfnatlon of lymphatic filariasis and other helminthisses. :•

fight filariasis. The PacELF countries have been learning and collaborallng logelher for the last six years lo greatly reduce 1he

with

mass

PacELF was a lso pron1inently

number of cases of filariasis In lhe

mentioned in the WHO Regio nal

Director's report for 2001-2002 and

region, and justifiably take greal pride in this achievement This pride will be

2002- 2003.

clearly apparent when the Fiji Minister

The Global Alliance to Eliminate Lymphatic Fllariasis has laken nolice

of Heallh, representing all 1he Pacific Island counMes. invites lhe inlemalional

JI Mad4ing it YIHO

CornmllMent 10W.l(ds HHotlhy bl.Mdi_ M•tth 2001. WPM:CP/DPM/2001 .

(2002) tt WHO (2004).

Progress and AollievemenlS

PacELF 's

enthusiastically endorsed its plans at

substantial progress made by

[JD @

Islands"'' produced after the health

PART I

filariasis community to Nadi, Fiji. for the

March 2005, the Minister of Health of

fourth meeting of the Global Alliance to Eliminate Lympha1ic Fllariasis In Mar<:h 2006 (Figure 4-27).

Fiji stated:

During the meeling of the Pacific ministers of health In Apia. Samoa, in

I warmly invite all /he Pacific lslalld Ministers for Health to the GAELF 4 to celebrate the Pacific success in this elimination initiative.

Figure 4-27: Proposed poster of the Fourth Global AUiance Meeting in Fiji, 2006

GAELF FIJI ISlANOS

MAtCH 2911>.Jltt, JOOâ&#x20AC;˘

CHAPTER

Success and Challenges

HIGHLIGHTS One of the first achievements of PacELF was lo provide updated, thorough knowledge of the true distribution of filariasis in the Pacific. through baseline surveys in the member countries. The availability of the !CT test for filarial antigen helped: it provided an immediate result and could be done anytime during the day or night, In areas with nocturnally periodic filanasis. The baseline surveys revealed that filariasis was still being transmitted In 16 of the 22 Pacific Island countries and territories. In five of these 16, filariasis had a prevalence of less than 1% and was therefore considered partially endemic. But in this same group or five. three countries (the Federated States of Micronesia, the Marshall Islands, and Palau) and the territory of New Caledonia reported prevalence of more than 1 % (and sometimes much higher) in relatively small isolated areas. In Wallis and Futuna, filariasis was present only on Wallis Island. In 11 countries, prevalence was more than 1 % and was considered endemic. The baseline surveys found prevalence to be highest In Tuvalu, with

22o/o positive by ICT. American Samoa,

[JD @

Success and Cnallenges

Cook Islands, Fiji, French Polynesia, and Papua New Guinea also reported

prevalence above 5% by ICT. The disease is most endemic in Polynesia and Melanesia, where Ae. polynesiensis and Anopheles are primary vectors. The first goal of PacELF is to reduce the prevalence of the filarial antigen to less than 1% in all of lhe PacELF countries. Eleven countries

where the disease is endemic chose the strategy or mass drug administration

with DEC and albendazole once a year for at least five years. Wallis and Futuna also decided to do nationwide MOA. The other countries where filiarias1s is onty partially endemic decided to treat positive cases or do mass treatment in limited areas . Senlinel sites for monitoring progress were selected In each country. except for countries like Niue, where the population was small enough to allow eve ryone to be surveyed.

From the start, PacELF was a collaboration

between

national

governments, WHO, and donors. The

government of each country, particularty the health min istry, was asked to nominate a focal parson who would be

PART I responsible for filariasis. Plans of action were then prepared for the baseline surveys and the MOAs. All countries In

Figure 5· 1: Numbof ot countrtios and •reas ll'l\plomen11ng MOA and moMOtlng and evaluation by year

••

the region committed to PacELF at the Inaugural meeting in 1999. Countries

doing MOA then officially s1arted the process by submitting a formal applicalion for albendazole tablets. Eight countries and territories where the d isease is endemic (American Samoa,

Cook Islands , Fiji , Niu e. Samoa, Tokelau. Tonga, and Vanuatu) applied in 1999, and lhree others (the Federated States of Micronesia. French Polynesia. and Kiribati) did so in 2000. Tuvalu and Wall is and Futuna submitted their applications in 2001, and Papua New Guinea applied in 2004. The MOA programmes started quickly, first in Samoa in 1999, then In five more countries the next year (Figure 5· 1). By 2005. all countries that chose the strategy had started MOA. MOA coverage was generally good, averaging 69% to 75% overall. Midterm evaluations began i n 2002 In some countries, and wil l continue. Two countries (Niue and Samoa) have done final evaluation surveys. Prevalence is

assessed pri marily through the JCT antigen test, which gives a conservatively high estimate compared wilh blood slides. Extremely good progress has been made so far in reducing the prevalence of filariasis . Some preliminary conclusions can be drawn on the basis of the experience in nine countries and territories-American Samoa, Cook Islands, Fiji, French Polynesia, Niue, Samoa, Tonga . Tuvalu. and Vanuatu. In all of these except French Polynesia. the

••

••e ...•• "10 • t

•• • 0" 8

'C 0

•

2 O .j.-~-+-~-+~--+~__,>--~+-~-+-~-+-~-+~--+~~>-----<

1999

2000

2001

2002

200)

2004

2009

2010

5.0

•.o

~ l .S

& ) .0

:t 2.5

2.0

1.S 1.0

o.s o.o

.....

.... .... ~

If!-

HJUE

SAMOA

American Samoa, Fiji, Niue, Samoa.

and Tuvalu , besides Vanuatu . The prevalence of Ml also fell significantly, by 93% (from 12% l o 0.8%). in Vanuatu between the baseline survey and the m idterm evaluation after two M DA rounds.

A dramallc reduction in prevalenceaveraging 85%-between the baseline

the two countties that have completed

significant In

2008

... r

and final assess1nents was observed in

it was

2001

Figure 5-2: Reduction in antigen prevalence between baselin.e assessment (A) .nd flnal assessmen1 (Q

prevalence of filariasis (as estimated

significant in two countries. Tonga and

2006

._ N~ ot ce>.1n11ies 1m~t1ng MDA .... N~ at counti1fl'\ and • tN\ implemmung monitonng ond f'\'.aluollcm$

wilh the ICT test) fell by an average of 38% between the Initial sentinel survey and the survey after the first or second round of MOA . The most dramatic decline was in Vanuatu (67%) and the smallest in Tonga (7%). The decline between surveys was not statistically Cook Islands, but

2005

Year

five rounds of MDA. Niue achieved a

reduction in prevalence from 3.1% to 0.2% after five years (Figure 5·2), thus meeting the target of less than 1%, which had been set at the start of PacELF. Jn Samoa, the prevalence fell from 4 .5% to 1.1%, with some variation

within the country.

Cnap1ers @ ~

The PacELF Way Towards !heEliminalloo ol lympllaijc Filariasis In !hePa<llic

There is not enough information on

and French Pol ynesi a are widel y

the three other MDA countries (Papua

dispersed groups of small islands, some very remote, presenls a significant challenge to maintaining MDA ooverage

New Guinea, Kiriba.li and Wallis and Futuna) to determine ii they are also progressing we11. Papua New Guinea has only just begun its MDA In Kiribati.

at a high rate every year. About 500,000 people i n the

although a formal midterm evaluation

Pacific were infected with filariasis at

has not been carried out, spot checks suggest that the antigen prevalence has decreased to less than 1t14from1.7Â°/c:t. No information is available on Wallis and Futuna, which began MDA relatively late, in 2002. However. in French Polynesia prevalence (a high 13.8% at the start) does not appear to be declining as fast as expected. The fact that both Kiribati

the start o f PacELF. II all MOA countries were to follow the lead or Niue and Samoa, the prevalence of filarial antigen in the region would be reduced to 0.9 %. If 85% reduction in prevalence is achieved by I.he time all countries have completed l ive rounds ol MDA, about 425,000 cases of filariasis will have been treated or prevented.

CONSTRAINTS PacELF, like all other programmes, has had many problems- related to biology, geography, logisti cs , and politics to overcome. The extent of the problemirvarie.s from country to country.

Biology-related constraints are due to the fact that some countries have a diurnally sub-periodic type or fitarlasis, as well as bolh day- and night-biting vectors. including the highly efficient vector Ae. polynesiensis. Transmission is thus more Intense in these areas than

it more flkely that some people

makes

al risk will miss one or more MDAs, or that filariasis may be re-imported inlo countri es from which it has been

remote and inaccessible parts of the

interior, and few roads. Poor and unreliable commu nications and Success and Challenges

with frequent visits back to visit family.

The frequency of travel and migration

in the parts of Miaonesia, for example.

and just means that more effort (and

permanent migration of I slanders to

New Zealand, Australia, and other countries; partÂˇ time residence overseas

where filariasis is transmitted by Cu/ex mosquitoes. This is an inescapable fact perhaps olher control methods In addition to MOA) may be required lo bring disease rates down sufficiently in some parts of Polynesia. Geographical constraints arise because some island countries are widely dispersed and travel between them is infrequent or expensive or both. Even within islands , especially ii mountainous, there are often villages In

infrastructure also oontribute to logistical difficulties and high shipping costs in the region. Movement ol people and migration is a significant phenomenon in the Pacific. This includes, among others, Inter-island travel lor study or work;

eliminated.

Complacency is apparent in certain countries with Jong histories of MDA for

filarlasis. People tend to settle Into the belief that the disease cannot be eliminated and that medication must be

taken year in and year out and Into the foreseeable

future.

Education ,

advocacy, and enthusiastic support from all possible sources. including governments, health workers, and PacELF itself, are needed to overcome

this barrier.

PART I

THE Pa cELF WAY

REGIONAL COLLABORATION WITH A COMMON GOAL An important feature of PacELF is that ll offers a structure for the Pacific Island countries to join together and help

each other to reach a common goal. Such cooperation comes naturally to those countries. Relatively isolated for hundreds of years , they rel y on themselves and their communities to solve problems. Despite their many social and cultural d ifferences. the communities all identify strongly with

one another as Pacific Islanders and share a tradition of cooperati on. Reciprocity is customary. Pacific Islanders are also renowned for the

PROGRAMME OWNERSHIP PacELF owes a major part of its success so far to lhe fact that the governments of the Pacific Island countries initiated and took ownership of the programme from the start.

PacELF staff in the countries also took full responsibility for the programme and relished the freedom it gave them to choose how it should be implemenledwhen MOA should start, who would deliver the drugs- while knowing that

their decisions would be supported by the PacELF home office. Joining a regional program gave even the smallest of the island countries a voice

In the process.

brave. pioneering spirit that moved them

to explore and settle on the far.flung Islands spread across the Pacific

Ocean.

OPERATIONAL FLEXIBILITY Inevitably, when people own a

The social structure within the Pacific Island countri es greatly

programme, they feel free to adapt it to their own circumstances As global

influenced the way i n which PacELF activi ties were carried out in each country. Community leadership and

pi oneers in filariasi s elimination. PacELF member countries modified some recommenda11ons of the GPELF. For example, although the GPELF

organization vary markedly. For example, while the chieny hereditary system of leadership Is still strong in

recommended that they use Ml prevalence as a monitoring and

Polynesia and some parts of Micronesia. leadership and influence in Melanesian societies i s more often

evaluation indi cator. the PacELF countries decided to use ICT to estimate the prevalence of filariasis. Also, the

ach ieved through indi vidual achievements and gift exchanges.

PacELF participants saw no need to map filariasis distribution in great detail before starting MDA. partly because of

Women have markedly dffferent roles and degrees of power, as was sometimes evident In how the MOA was

their long history of filariasis control activities and the resulting knowledge

organized. In Samoa, for example, medicines are distributed by the network of women's groups, e well-established

of the distribution of the disease. From the recommendations of the Pacific Island countries, PacELF prepared Its

feature of this society. In other countries like Vanuatu, where no such women's networks exist, health workers take on

own set of detailed guidelines for country programme operation and for monitoring and evaluation.

the role of drug distribution.

cnap1e1s @ f2D

The PacELF Way Towards !heElimlnalloo ol lympllaijc Filariasis In !hePa<llic MDA planning was decentralized.

over owner ship. The home office

w ith each country being allowed lo decide !he best way to organize

orders supplies of drugs and lest k its, prepares reports and publications, and handles data, relieving the countries of much of lhe b urden of administration, besides offering the advantage of purchasing at bulk rates. Some of lhe smaller isolated countries would nol have been able to lake on these tasks a l one . By provid ing computers to some countries PacELF has helped strengthen local capacity for data management. There have been opportunities to learn new computer software. as well as training workshops i n the clinical management of lymphoedema or mosquito Identification. Certain features o f the PacELF support to countries are also very important. The PacELF home office in Suva strives to be a reli able and trustworthy "homeÂˇ for the PacELF "family'. respond ing quickly to lhe countries' requests. It makes a great effort to order supplies and ship them out to countries early enough so that they are on hand when needed . Supportive technical advice is always freely available and PacELF staff often visit the countries. The PacELF home office also hosts annual meetings at which the programme managers rrom the various countries can exchange i n forma ti on and i deas. These meetings are informal occasions with opportunities 10 dance, sing , and perform skits in true Pacific style, apart from !he serious business of assessing progress. The location of these meetings alternates between Fiji and other PacELF countries.

activities-how lhe MDA would be carried out, and by whom. To distribute DEC/ albendazole. for Instance, some countries go house to house. others issue the drugs at a health center or central location in the village, and slill others have chosen mass distribution in public places. This flexibility in MOA organization, timing, and method of drug delivery is especially important in

countries

where

the

fil ariasi s

programme Is only one of many heallh programmes handled by a small heallh Slaff.

A SIMPLE CORE PACKAGE OF ACTIVITIES PacELF is a success partly because of its straightforward. easily unders tandable package of core functions. The two CÂˇOre functions are

blood surveys and MDA. All other aclivilies support these functions. II Is necessary 10 pl.an, !rain for MOA, pack drugs. deliver drugs where they are needed, adm i nister drugs , keep records. assess coverage. do blood surveys, and ana lyse the results . Although the PacELF home office assists with all of these tasks, they are ti me-consuming and in most countries requi re a fu ll-time programme manager.

EFFECTIVE COORDINATION The central coordinating structure at the PacELF home office in Suva Is a vilal part of the programme. The home office mediates between the countries and donors, and helps to channel and maximize support for the countri es rrom the many outside donors or technical support agencies. One of ils main roles is to support the efforts o f the countries, without taking

Success and Challenges

FOCUS ON TH E POSITIVE OUTCOME PacELF maintains a positive focus on a future in which lymphatic filariasis is no longer a risk to Pacific Islanders. Positive messages are a lways used , In keeping wilh the

PART I Pacific altitude to Ille. Slogans like •For the future of our children", ·we

can do ii". "Let's get the job done together•. and · work together and help each other" capture the essence of this approach.

Having a defined and achievable goal (eliminating filerlasis) has helped keep up the momentum and enthusiasm of PacELF family members and engage k>eal communities in the campaign

WHAT'S NEXT?

--- -------- ------- ------- -- ----- -- ----A SUSTAINED, EXPANDED PROGRAMME The MDA programmes that are soll operating must continue. Although most will be complete by 2007. Papua New Guinea's will continue for several more years. The enthusiasm and momentum must be kept up. Coverage must stay high if MOA is 10 succeed . Special attention must be given to that part of the population that year after year does not take the drugs (systemalic noncompliance) sjnce they represenl a

reservoir for future resurgence MOA by itself may not completely eliminate lhe disease. The MOAs will no doubt have a large Impact. bul other measures may be needed to sustain lhls achievemen t until the disease Is elimi nated . Parts of countri es that remain infected can also opt for vector control or selective treatment. The

lhis problem must be found. It will also be a challenge 10 teach enough health workers and community members how to treat lymphoedema earty to decrease the swel ling and prevent further pathology. The PacELF activities must be betler integrated Into the countries' public health systems. At the moment PacELF Is a vertical programme. This is probably necessary whole MDAs are continuing , but when they a re

compl eted the programme w ill probably become less vertical. and all members of the health services must be alert for any resurgence of l he disease. Opportunities to maximize

the

effects

other ongoi ng be seized whenever possible. For example. anti· helminth drugs provided through school health programmes would ma intain and buUd on PacELF's gains after the main MDA programmes and help prevent resurgence by contfnuing programmes

must

Metalle$lan areas. wt.ere the Anoplleles mosquito is the primary \tettor, can use bed nets or curtains and insecticides. Other methods of vector control like the

Infection s In children . Mosqu i to

use or lnsecticide·treated materials

control ,

have potential in Polynesia and Micronesia as well. PacELF·s first priority was to ellmona1e the risl< of new infections. Now it must give much more attention to reducing morbidity among those who already have the disease. Health

environmental health programmes may also contribute to vector control and must be supported. Continued surveillance after the M DAs Is crucial, even when transmission is believed to have stopped. Thi s could be done through

service limitations in most countries wh ere filariasis Is endemic have

national health Information systems,

the treatment of new filaria sis ma laria ,

deng ue ,

and

restricted lhe possibility of hydrocoele

by alert health workers, at designated sentinel Siles, or th rough specia l

surgeries, for instance: a way around

surveys.

The PacELF Way Towards !heElimlnalloo ol lympllaijc Filariasis In !hePa<~ic

TECHNICAL CHALLENGES

sampling

had

comprehensive than originally planned

Sampling for filariasis prevalence is a complex matter. because the disease is heterogeneous. It became

apparent soon after !he start of midterm evaluations that sampling

difficulti es and the impreci se tools available would make it far from easy country had reached a prevalence of less then 1Â°k . Also because filariasis is heterogeneous, "'hot spots.. of high

enough information on which to base

prevalence could remain unnoticed if they are not selected for testing in the

these deci sions. The Techni cal Advisory Group to !he Global

b aseline or midte rm evaluations. The

P rogramme is devising criteria for

danger is !hat transmission could be

elimination. But the group will also look lo PacELF and ils results over the next few years ror guidance , as the programme Is ahead of most other programmes in the world.

by ICT whether or not a

re-established and these sites could

cause resurgence of the disease In other areas once MDA is stopped. Th erefore , it was decided that

Success and Challenges

Samoa, the first country to finish five

rounds. When lo slop MDA and when to slop surveillance are two very difficult decisions to be made. There is no! yet

to determine

Figure 5Âˇ23: PacElf display

be fore MDA could be stopped . Detailed guidelines for the sampling were included in the PacMAN book. The new sampling scheme was smoothly implemented starting with

PART I A very large amount of data on

undergone at least three MDA rounds.

prevalence and drug coverage has been gathered during the progress of PacELF, and may yi eld i mportant

If MDA coverage and follow~up activiOes

information on the effectiveness of drugs or on the monitori ng and

In all countries in the region. PacELF and filarlasis elimination

evaluation process. This i nformation could be very useful to other filariasis elimination programmes and to

must maintain and even increase their high profile In the regi on , through political and social advocacy at all

PacELF itself i n determining problem areas Jn the region. For example, knowledge of the relationship between

levels. wilh regiona l and national governments. intemational and national organizations, health facilities. village

ICT and Ml prevalence. and the ageÂˇ specific pattern of infection, will help ln planning surveillance stralegies.

and community leaders. and individuals. People with filariasis can make an especially important contribution. A man

PacELF countries will make th is information available to the Global

with advanced elephantiasis in Kiribati, when asked if his photograph could be used in PacELF's health promotion

Alliance as it is analysed and reported,

MAINTAINING THE PacELF WAY So far. the programme is definitely

on track. By 201 O. the target date for eliminating fila riasis in most of the Pacific Island countries, all the countries

except Papua New Guinea will have completed at least five rounds of MDA and, if necessary. targeted or selective treatment or vector control . and

are adequate. PacELF expects filariasis prevalence to be dramatically reduced

materials. agreed and added, "I realize that my own disease cannot be cured. I used to be a teacher. but for a long time now I haven't been able to teach. or even walk by myself. I depend on others to help me do everything . Now, by

showing my photograph and telling my story, I can again be useful and make a contribution. I can help to prevent others

from gettlng this disease." By working together and helping

conducted final evaluation and

one another in the "PacELF way", we can and will eliminate fllariasis from tne

transmission surveys. In Papua New Guinea most of the population will have

Pacific and ensure a better future for our children.

Cnaprers @ ~

Country Programmes Introduction This part of the book gives detailed information on each PacELF country plan and programme. There Is a section for each participating country, arranged alphabetically. Each country has developed a specific plan for moniloring and

evaluation of the programme in their own circumstances, and their plans are shown as a schematic diagram on each country's page. In each country's section, first we glve statistical. economic. geographical, meteorological and demographic information on each country. We include a table listing known mosquito vectors of filariasis and filarial type in each country. This is followed by a graph summarizing the available information on filariasis prevalence in the country in the 1900s. There are tables listing historical and bibliographical lnformallon on filarlasis In the country and any control programmes done in the years prior to the start of PacELF. Then comes the diagram of the country's plan for blood surveys and MDAs under PacELF, followed by the blood survey results, and the MCA coverage achieved, and tables showing the distribution of drugs and tCT kits. The MDA coverage by year is displayed in a bar chart. Each section also gives examples of the country's MDA registration books and health promotion materials. as well as photographs of the country staff. A basic PacELF country plan is shown in Fig 2Âˇ 1 and the key to the symbols used in each country's plan is shown in Fig 2-2. The definition of each assessment survey is In Table 2-1 . (1)

The total population reported to PacELF by the country ('Reported population'):

(2)

The estimated population, derived from the most recent census and the 2004 estimates by SPC assuming constanl counlry-specific growth rates

over the years 1999 to 2004. These population estimates are shown in Table 2Âˇ1 ('Estimated population?; (3)

The population that was actually recorded in the MDA register books ("Registered population">.

Figure 2-1: Algonthm of PacElf coontJy sirategy (basic)

Non•endemic

All(-)

Awaiting Certificate

Some(+)

Anal Evaluation (C)

Endemic

Midterm EvaluatJon (B)

A\vaitlng Certificclte

Post MDA Consultation

Figure 2-2: Keys to the symbols used 111 coontJy plan Legend to Plans Blood Survey

Pf:!.!¥

Done

Need Consullation

Table 2-1: Sul\'ey types for PacMAN pl.lo Survey type A typo

a type

Assessment 1n11>at baselme SU.f\lt")' Midtl'tm

M~ei'll

PurpoS('

M.U.od

Va nous methodologies \Md,e.g,. collYIYlienc.e. duster samplltlQ

SMt1nel sates and spot ehcc:lc si1es

c type

Anal ~ assewnent

All areas. of t~ countiy .and tn senbnel \ltm

D type

Transmission ~t

LQAS 0t complot" SUM!J of s.. to 6· ytar-old chactren

Ta defme 1he country endem1aty and to dedde whedler to lmplemenl MDA no1 To aswss lhe impact of MD.As and to ched; that the programme is being implemented properly To assess lho 1mpict of MDA$, to dc~ne wh~ a§ atN:s are a1 )ess than 1% prevalence and to fmd any n:!fNknlng pod:t"ts of lf

°'

To detenninc die fi~r tnodence

C-Ounlly Programmes

....

Table 2·2: : E'11matod popula1o0n· by yea• In PocELF ccunolos. 1996- 2008

•

ii" ;a n

<;;

f-ederated States of Miaonesia Fiji

7750?7_

782 692

790 308

18 821

18 424

105 585 797 923

French Polynesia

236 325

Guam

151981 82 343

16 836

16 596

16355

16 235

15 995

·1 3

112 700

I 14 100

11 5 500

116.900

118 300

1.2

828 385 247 665

836000

841 500

84o7 100

852 700

858 400

0.7

250 500

170800

264 :iOO 113,200

269 000 175 600

1.8

166100

255 000 168 400

259 600

163 276

93100

95 200

91400

99600

101 900

2.3

107 008

18 027 108 431

17 630 109 854

17 233 111 277

805 539

813 154

820 769

239 160 154 ao·5

241 995 _2~ 830 157 629 160 453

1.4

"' G

I !§

84494

86646

88 797

50840

51 752

52 664

53 576

90949 54488

55400

5'6 300

57 200

59000

1.6

10013

10 030

10 048

10065

10083

10100

10300

10 5.0 0

1.0

;;

211 860

216 868

221 876

226 884

231 892

236900

10 200 241 400

58 <00 10 400.

a ~

246000

250 600

255 400

1.9

1913

1851

1725

1663

1600

·3.8

Northern Mariana l$lands

67026

69 221

1788 71416

73611

75805

3.1

Palau P'apua New Guinea

18 736

19129

19 522

19915

20307

Kiribati Marshall lsl<tnds

Nauru

New C.ledonia

196836

201 844

206 852

Niue

Pitcairn Islands Samoa So1omon Islands Tonga

1·100

82900

85500

1400 88 100

20 700

21 100

21 500

ooo

Z240.0

2.0

5 064 658 5 190 786 5 316 915 5 442 686 5 568889 5 695 300 s 820000 s 94.7 500 6077 800 6 210 900,

2.2

s2·· .. 97 784

Tokelau Tuvalu Vanuatu

1$00

78000

1500 80400

Wallis: and Futuna

97 849

97 913

172 717

174713

176 710

178 707

180 703

182 700

~84

400

1"8,0000

187 700

189 400

0.9

409042

419 254

429 465

449888

460 100

470 700

481 500

492 600

97 978 1562

98 042

98 107

•39 677 98171 1525

98000 1500·

97 700 (500"

2.3 ..(),3

1537

98300 1500

97 400

1549

98 236 1512

503 900 97 100

9503

9522

9561

9581

9600

9700

1.50.0 9700

0.4

192 502 15 010

204 151

209976

14988

14 966

14 944

2 15800 14 900

9600 221 600

9700.

186 678 15 032

9542 198 327

221 500 15.oo<r

233 500 15 100

239 800 1;200

0.5

ceowsyear SPC estimate !or 2004 SPC future prOJKliOnS

"1004 to 2008 figures twO\ided by SPC (2004). Eilrt.ef~ esi1mited by f'.Kftf assumino owtilni growth (orded1ntJ Mweefl censi.=s and 1004 ""COOl I~~ 1ota1 PQ9u\lloon es.t1ma1ed by~~ same 9row1ri r.ate ~ f(ll tts.d«lt p!)91JlaL<On (SPC es111N1~~rt ~ oo ~1 populibOtl) •• • SKdocuf'Mnt does noc <JM! a <iMAA ye;it 101 P•l(#ft. It Sil'fS tllilt 7 of I.he !>2 ~ ien'lpotaiy reWenu.. but dotsn't say whM thfly ~ 1esodetlt

15000

1·5 00

0.0 2.7

}

"' G

1 Summary

An unincorporated territory or the United States. American Samoa consists or seven islands situated between 14• 5 to 15"5 and 168"W to 111 •w . It has a land area of 200 sq

km and a population or 57,291 (2000 census). The estimated population in mid-year 2004 was 62,600 (SPC 2004) The capital ls Pago Pago on the main island of Tutulla. The islands that now compose Samoa and American Samoa were divided into two entities in 1889, and Tutuila came under the control of the US Navy In 1899. The name "American Samoa" was given to the territory in 1911. but it was formally ceded to the USA only In 1929. Since 1951 American Samoa has been administered by the US Department

of the Interior. Many studies of Mr prevalence have been carried out in American Samoa throughout the 20th century. A survey of both American and Western Samoa in 1923 found a 28.7% Mf positive rate in the population of 4,294 surveyed (O'Connor 1923). Surveys in the 1940s and 1950s found Mf positive rates of 16 % to 20% (Dickson et al. 1923, Murray 1948, Jachowski and Otto 1955). In 1930 a survey of the whole population reported elephantiasis rates of 6.7% on both the main island of Tuluila and the Manus group (Phelps et al 1930). Similar elephantiasis rates were reported in a 1943 study that also reported hydrocoele rates of 6% (Dickson et al 1943). The high prevalence and frequency of elephantiasis prompted control attempts in the 1960s. MDAs were carried out in 1963 and 1965 with 72 mg of DEC given per kilogram of body weight. A post-treatment survey in 1970-1972 determined that the Ml rate had dropped lo 0.9%, elephantiasis to less than 1%. and hydrocoele lo 2-1 %. However, surveys In the 1980s and 1990s showe<I Mf rates to be Increasing again (country data. unpublished). American Samoa participated in PacELF activities starting in 1999. A nalionwide baseline survey in 1999 reported an LF antigen·positive rate of 16.5°k (498 positive cases in 3018 people examined) (country report 2000). A yearly MDA using DEC (6 mg/kg) and albendazole (400 mg) began in 2000. The first MDA in 1999-2000 covered 11 081 people (a reported coverage of 23.7%) (country report 2000). Because the MDA in 2000 did not achieve sufficient coverage, a second MDA was carried out, covering 29 991 people ( a reported coverage or 52.4%) (country report 2001 ). After lhe second MDA, a blood survey in four villages in 2001 found 121 antigen-positive cases (11 .5%) and 28 Mf-positive cases (2 .7%) out of 1052 people examined (country presentation at fourth PacELF annual meeting in 2002). A third MDA in 2002 covered 28 400 people (49.6% coverage) (country report 2003) and a fourth MDA in 2003 covered 40 211 people (70.2% coverage). In 2003 a blood antigen survey in rour villages found 135 antigen-positive cases oul of 1000 people examined (13.5%) (country presentation at fifth PacELF annual meeting in 2003). A flflh MDA in 2004 achieved a coverage of 64.6%. treating 37 018 people.

C-Ounlly Programmes

The PacELF Way Towards !he Eliminalloo ol lympllaijc Filariasis In lhePa<~ic

2 Country Profile Filariasis Type and Vectors Endemic WudietMa b.mcroftt DiumaUy 'iub-periocfic

American Samoa

'·

50Hlla

.~--rlu. ~ ......

170'SO'W

SAMOA

170'40'W

Monu'o lslonds T•' Monu'o Is

...

, ~

171' W

Coat of Arms

au s..

o-!

170'W

IWW

16t'40'W

16t')O'W

PART 2

General Information Capital city

Pago Pago

Numbet of Island'

land an:a

200sq Ian

langu6gm

S.:imoan.. Enghsh

P<opl•

Polynesian (8~). Tongan (4%), C.uca~•n (2%), other (5%)

G1os:.s domestk product (GOP) per c,apita

S8000 (2000 est.). Territory of the United States of America

Economy

Gntnts from I.he United States, of Ameria. iunc:i c..nnlng, tourism

loud p0puJatlon by cemus (2000)

57 291

Popu•auon estfmated C2004)

62 600

Populotjon d°"'lty (peoplel\<m')

313

lnfont mortalrty rate (per 1000 live birth') (2001)

Mtit~mol

mort;,hty r.ltC! (per 100 000 fi'lf' birth.$) (2002)

123

life expectancy at birth (1995)

72.0

Leading cau.uos of mortality (2001•

Heart diseaM!,. neoplasms. diabetes, cerebrovascuJar dtSe.aseo, acddenu

•c

WEATHER

POPULATION

700 ..-- - - - - - - - - - - - - - ---,. 35 600

•••••••• ••••

500 400

3.7

30 25 20

-r=i~

300 200

15 10

100

5 0

0 F

C=:J Ra•nfall

--+- Temper.1tu1e

10 9 8 7 6 5 4 ) 2 , 0

, 2 J ..

6 1 8 .9 10

Percent

Sout'Ct': \Vot~t>. ~~ PlllJOP¥JO lt6t to 1990,

RiMlalf· f#J!Jo ~ J966 ro r99.S

3 Filariasis before PacELF, 1900-1997

I•

. 10

1919

1929

i MDA I

• 1948

El<phantiasls

• 1909

•

+ +

1900

Mt Polltlvo

1956

1964

.... .... 197 1

.. •••• .... •

1918

1984

....

1989

1991

Year

C-Ounby Prog1ammes

The PacELF Way Towards !he Elimlnalion ol Lympllaijc Filariasis In lhe Pac~ic

Country Filariasis Activities in the 1900s before PacELF Microfilarla Prevalence and Clinical Surveys Populiltior\/Atea

Date

Age> 15

1923

Nationwide

1930

Age > 4 10vdlag~

Noted O lnfwl features % (n)

% Ml pos (n)

41.3 (422) ....tth either MF or Otf'lic.af Elephantiasis- 6.7 C10 000)

Primary Rcfetcnce

O'Coonor fW (1923)

Plrdp> JR.., al (1930)

1948

19. 1 (5144):A.g. MF/>!;de41.3

Murray WO (1948)

1955

203 (2421)

,,,chowsl:1 LA and Otto GF (195S}

S 'lllligl'.$ tn T1111.i.i.

1962

21 (1000)

WHOISPC (1974)

S vin~es In Tutuila

196S

3. 1 (113S)

WHMPC (1974)

t3 vWllgcs in Tutu!ll

1968

0.3{1053)

WHMPC (1974)

1971

0.8 (14396)

WHC\'5PC(l974)

1973

1.0(16461)

WHC\'5PC(1974)

1975

2.9 (4530)

WHC\'5PC(l974)

1971'

3.7 (7351)

WHOISPC(l974)

1980·1981

5.7 (931)

Country data

9 tAtlagfS lf'I TlJhtlla

Bactenology lab Refmab

1980

34 {2147)

Counuy cf.all

Saaenology Lab llt!e«als

1981

3 1 (1728)

Country data

B.taenology Lab Referrah

1982

3.9 (:IU)

COuntryd.lt.a

s.a<riology l•b llA>fe«als

1983

8.1(99)

Country data

Countty dll,.

Bactenology lab Referrals

1984

5.3 {75)

Nationwide

1985

I I (5230)

Counuydata:

Bactenology lab Referrals

1985

43{46)

Country d.atJ

N1tb0nw1de

1986

1.2 {3535)

Country data

Bat.1eoology Lab Referrah

1986

2.9 (70)

CounttyCU11a

N~tian-.vl~

1987

15{2597)

Country data

Bactenology Lab Referral>

1987

S.7 (70)

Country d.11a

Naoonw.de

1988

26(3451)

Country cfata

Bacteno!ogy lab l\efena!s

1988

3.2 (94)

Country datA

Nationwi<Je Bactenology Lab Referrals

1989

23 (3283)

Counttydllla

1989

1.2(83)

Country cf.at~

Nationwide

1990

2.2 (2180)

Country data

Mass Drug Administration or Other Control M easures

6 mC)l1:;g DEC 9iveo: a IOtal dose of 72 mg/kg ovt'r a period of one yNr

WHO/SPC {1974)

PART 2

4 PacELF Activity PacELF Country Plan

ICT(+ ) ~ 0, 1%

2006-2007 - . . . . . ICT(+ ) < 0. 1%

1999

Cotwen1Cnct

Na..,,wide (18 vlll1gcsl

ICT 16 5'1i. (•9813018)

2001

Ouster

Fagasa. Pago Pago, Fagaitua, Aunu'U n.Sands

ICT 11 5% (121/1052), Mf 2.7% 128/1052)

2005-2006

OuS1et

Str111ffied survey by health cft.Slnct

2006-2007

Compl~~

2.000 lll So iO 6-)flf•Old childr~ SOI.I~• : hcMAll Boolt XJ04

Results of Bl ood Surveys and MDAs un der PacELF Blood Surveys

Presentation 1n AM'1

Ftb-Aug99

ICT

Whole are!il (18 vr11ag~)

co~esample

3018

498

16.5

2001

ICT

SentiOl'f Sitt- {4 \'llf.ages)

<andom

IOS2

121

11.5

ME with CDC

2001

Sentloel ote (4 villages)

random

1052

2.7

ME w.lhCDC

2003

random

135

Presentation 1n AM4 Pr~tatlon

In AM4

Prewn1ation 1n AMS

13 5

ICT

S<ntl,..,. "" (' vllllgl!S)

"°"99-M•iOO

,,,

•6 773

57 291

18657

399

11 081

23 7

19.3

59.4

2000 MOA Ropon

5"p01- D<dl1

2nd

57 291

58 618

52322

91.3

29991

52.4

51.2

57.3

2001 MDA Final Report

1000

MDAs

AUg02-Jan03

3rd

57 291

59 946

57 291

100

28400

•9.6

47 .4

•9.6

2002 MOA Ropon

A.Jg03- N°"°3

• th

57 291

61 273

57291

100

40211

70.2

65.6

70.2

Annuol 1'<j)O<l 2003

5"p04-Dedl4

Slh

57 291

62 600

37 018

64.6

59. 1

Annual Report 2004

'b11ma~ .t\SUITWlg (on~M!t growtti U11ir be1wren Ml~I ~Wl •nd 2004 popul.i1ion C'ltl!Nle (SP()

MDA Coverage, 200 0-2004 100

80 60

114--1)~ 1

2000

2001

·2002

2003

Year

C-Ounlly Prog1ammes

@ [}I]

The PacELF Way Towards !he Elimlnalloo ol lympllaijc Filariasis In lhePa<~ic Supplies Shipped from PacELF, 2000- 2004 Vear

2000

2001

2002

2003

200'1

Al8 (tablets)

1-«lOOO

4 1 600

1SOOO

OEC (,.blets}

1000000

300000

47 000

50000

ICT {lest cards)

Partnership: WHO. GSK. (albend~ole}, CDC (1echnaVfinancia! ~'Sista.nee)

Distribution Dose of DEC and Albcndazole Tablets No. of DEC (SO mg) tablets

No. of albendaiole (400 mg) tabJ~ts

2- 3

4-S

6-10

Age

11-15

16-20

21- 50

so+

R@gist.ration Form

-=====l!.\119tl(•\' "AMl,1/\

C11 Po\tlDfP•, Of' 111Alllf

___

.._....,..

___

IEC Materials

W• Can Gel Rid of FlbrUH11' ul Anwncan Samoa

....,..................... ".... ................. ..,.,..,.....

....-........ =-:=:.=::-.::.<n. ...... _,............. . . . .... ..-·----l!lt nr.w..• .........

....... ................11:11',_. ..,.........,....,....,........ ..... ...................,,.. 'Miii ..........,

---QIOIMO~..,,.

Artl!Nn,,,,, .... ~ . . . . . .......

hi ... -"\

-----fll*llOCllSINJ. .

l - ........-.en ....... "'-"

~MW•tlll!Ot~lo! ~S-----...U*'t'..... _ , . NI . . . ...., . . . .

• 00.»_

'"°"'9 lflllC-OMIU"'1i'r1*•._

.... .................. ..... .........., ...,, ........--........ ,_,,............... ..... _.... . . ~

~c.

"'"~•,...,I

•s• I <"'"" O'A"""''

~°'

tnfl•1 (for school)

PART 2

llmlll ~

JJ i;; JJlllKJU.I! fi*rllCllU

Eliminate Filariasis in Anlerican Samoa 709aM.. c:a-. 46 a

• Kill the filarial worm • Prevent elephantiasis

ELIMINATE FILAJUASIS laAm-..~

~... llfr, C?-

Do tf .,_ T.akt hlar1a.sJJ treatmtnl . - Ktt p your enwlrorunent ct!•n

-~:~~, ~~~~~.,~ --........

f·shln

•

We c•,, 1•• r1d of f lilar1u is In AnMrlcan S.moa

Protect Y our Family Drink Your Pills

_---.. _.... !'#___ -=' -·-· _ .._. ____ _.--·---. . . -·...__ · ____ .._.... _____.. -·-·--___ -·---.--·-· -----_____... 6 ..::_~ ---_..._::-..:...-:;:: :.-::.·.; c:"'=-..: ~;":":::7:.:C-.=:: ..,_ ... .,,.

...

,_,.._, =~------

___ ....

n..JJO lh -~---

-:.::.-;::.-::;:-_-,: ,..=:...-...-----·

.... ·- ---·--

,....... . ,_ .. . ........... ... .... '' ~ ,

~==-J:-

' • ' """ "'"' "'•·• "

-., I

(•

=~~-.::- i::

..........

_........

··-·--···--·· --···-··-,.._ :..-::"' ..:---·--·--

t-------..·................... -......._ ·-··-·-·-It---. ·-------· -...-........ ---·--s....._.__ ~ ----·-·---· ______ . ··-· ··"-------·· -----·--·-·--·-·---

C miuu• lu• !'v.1• '•¥-

...,

Le.a Rel

C-Ounlly Prog1ammes

The PacELF Way Towards !he Elimlnalion ol Lympllaijc Filariasis In lhe Pac~ic Operalfonal Staff: Public heairh nurse. health inspector. labotatory staff

... TUT\i!lA

1 Summary

The Cook Islands is made up ol 15 islands situated between 8"S to 23"S and 1Si1'V'I to 1670\/V. There are lwo distinct groups of islands. northern and southern. The Cook Islands is self-governing In free association with New Zealand. Its land area is 238 sq km with a population of 18.027 at the 2001 census. However.about one-siJcth or those counted are

usually resident in New Zealand. The estimated population of ''usual resKfentsâ&#x20AC;˘ or the Cook Islands in 2004 was 14,000 (SPC 2004). The capital is Avarua. on the island of Raratonga. The first study of Mf prevalence was recorded in 1925. It found extremely high rates (40.1% on Rarotonga and 50.7% on Ai1Ulaki) (McKenzie 1925). In 1926, surveys on Mangaia, Mauke, Mltiaro and Altutaki found Ml rates ranging from 26% to 54.8% (Lambert 1926; quoted in Iyengar 1959). By 1959, Ml rates had fallen to 22.3% on Rarotonga and 29.2% on Aitutaki. The northern atolls were also surveyed in 1959 and Mf rates ranged from 5.8% to 29.4% (McCarthy 1959). Surveys from 1925 to 1959 also found cases or elephantiasis with rates ranging from 0% to 5.6% (reported by Sasa 1976). An MDA campaign was carried out on Aitutaki in 1968 which reduced the Mf rates to 0.8% in 1969 and 0.2% in 1971 (WHO/ SPC 1974). However.a survey of Altutaki in 1992 showed Mf rates had Increased to 3.3% ( country data). In 1999 the Cook Islands participated In PacELF. In a countrywide baseline survey carried out using antigen test kits in 1999, 8.6% (162/1884) or the population was positive by ICT. The Cook Islands was therefore classified as an endemic country. MDA using DEC (6 mg/kg) and albendazote (400 mg) commenced in 2000 under the auspices of PacELF. The first MDA was implemented In 2000 and treated 11 928 of the population, giving a reported coverage of 62.4% (countiy presentation al Fourth PacELF Annual Meeting in 2002). The second MDA ln 2001covered11 562 people ( a reprted coverage of 64.1%) (counliy presentation al Forth PacELF Annual Meeting In 2002). After the second MDA, a blood survey in lour villages in 2001 found 35 antigen-posttive cases in 460 people examined (7.6%) The third MDA in 2002 treated 17 676 people (coverage of 98.0%) (country report 2002). After the third MDA, a midterm countrywide survey was carried out in 11 Islands In October 2001 : nine antigen positives were found In 2025 people examined (0.4%) (country presentation at Fifth PacELF Annual Meeting in 2003). The founll MDA was Implemented In 2003 and 13 048 people were treated with a reported coverage 0188.4%. The fifth MDAin 2004lreated12 900 people with a reported coverage of 92.8%.

Cook ISiands

C-Ounlly Prog1ammes

The PacELF Way Towards !he Eliminalloo ol lympllaijc Filariasis In lhe Pa<~ic

2 Country Profile Filariasis Type and Vectors

!Cook lslandsl

PA C IFIC OCEAN

ealollongo..

•

MtJn1Jr lf

lt ll'S

" s Cook Islands (New Zealand) PACIFIC

, •. s

OCEAN

trs ll 16' s

.........._.

I M•lt

t Ki1ont1elor

1· s l t.4

Coat of Arms

Cooklslands

1£0

ISt

<rw

ISt H 'W

PART 2

General Informati on Avarua

C..p1tul a 1y Number of klands

Land arN

237 sq km

Languages

English. Maori

People

Polyn.,i<ln (80%). m&><cd Poll".,.." and Europo•n (8'14)

Gross domei11c product (GOP) ~capita

S4270 (2001)

Economy

FNi1 prOCMsing. tourism, fishing

Total population by census (2001)

18 027

Population esbmated (2004)

14 000

Poj)ul.>1>0n denuty (peoplelkm?

Infant mortatity ra1e (per 1000 live births) (199~2002)

~tf!'fnal

monl!Jity r.Jtt Cs>« 100 000 live binhd C.Z002)

Not available

Ltfe expecuincy at binh (2001)

72.5

leadmg cauSe;l of mortality (2002)

Diseases of 1he cin:ulatory system. neoplasms. endocrine. nutri1ional and metabotic d tseases. diseases ot the respiratory S)"otem, nutritional and matabofic disl'laSC!, lnfury, pob:oning, and c"'l'tain other conse.queOCt$ of external ca~

WEATHER

55-59 50-54

45-49 4G-44

35-39

Sowtt~Y~. ~~ 1WotMfP

• •

10-14

5-9

" "L

-e- Temperat ure

7.0

I I

G-4

c::::J Rainfall

Females

15-19

0 M

.J1:1'1.

25*29 20-2.a

Ma.les

30-34

70-74 6s-69 61).<;4

POPULATION

Ag0$ 75+

10 9 8 7 f

. .

I 1 J 4

S 4 .) 1 I 0

.o.

S 6 7 8 9 10

Percent

19011a 1991

~.itt:RMOtQt'9118'9MWJ

•m

3 Filariasis before PacELF, 1900- 1998 60

I•

.." "..

•

£ 20

•

1900

•• 1909

1919

E~pha.nti:isis

+MDA I

•

;;; 30

•

Mi Posill-ve

1927

1937

1947

...I ..I

•

1956

1964

1971

1980

1990

1998

Year

C-Ounby Prog1ammes

@ [E]

The PacELF Way Towards !he Elimlnalloo ol lympllaijc Filariasis In lhe Pa<~ic

Co untry Filariasis Act ivities in the 1900s before PacELF M icrofilaria Prevalence and Clinical Surveys Southern Cook Islands

Rafotonga

1925

4-0.1 (197)

Altutab

1925

50.7 (71)

Elophanuasis: 2.0 (197) Elephantiasis: 5.6 (71)

Mcl<Mb• A (1925)

At1u

1926

E1eoph.ant1asis: 2.4 (800)

Lamb<rt SM ( 1926)

Maul:tt tstand Motlato

1926

Elophontlasis: 4.1(560)

Lamb<rt SM (1926)

ElEl>hantiasis; 0.0 ( 180)

Lambon SM ( 1926)

Nationwide

1926

98.0 (45) pos at night 90.0 (4 I.2) pos a1 day

Lamb<n SM (1926)

age > 9; AltuUlb

1949

42.5 (240)

O..os TA (1949)

Ratotonga

1957

23 3 (554)

1926

MclCenzle A (1925)

El!ph.antia!iis: 4.3 <SSA)

Iyengar MT (19S7)

Elephantiasis· 3.7 ( 1297)

Iyengar Mt (1957)

Altutak.i. Altutakf

1957

20.9(1297)

1969

0.8 (2492)

Aitutab

1971

0.2(2600)

WHO/SPC (1974)

Raro1ong& ou\J)l)tients

1991

0.9 (58681

Covntl)'data

Rorotonga outpa;tJent5-

1992

1.0 (2664)

Coun1rydal.i.l

Ailutaki

1992

3.3 (1370)

Country data

WHO/Sl'C (1974)

Northern Cook Islands

Popultlt1on!Atea

Date

%MF pos (n)

Noted Oin1cal Features % {n)

Primary Reference

Pulr.opu..

1954

28.4 (498)

Elephantiasis: 3.8 (4981

Now Zti113nd Modical tteswch Rtpon ( t 954)

Puk.>pu..

1959

29.4 (218)

~foman

1959

58 (274)

Elephonuasis: o.o (274)

Rakahanga

1959

8.4 (226)

El!!phantiasis: 0.0 {2.26}

McG>nhy DD (1959) Mc.Canhy DD ( 1959) McCanhy DD (1959)

Pa.lmMton

1959

8.7 (69)

ElephontlasiS' 0.0 {69)

McCaMy 00 (1959)

Manihlti

1959

19.7 (371)

El<;>hanUaso: O.o(l71)

McCarthy DD ( 1959)

Mass Drug Administration or Other Control M easures

WHO/SPC (1974)

4 PacELF Activity PacELF Country Plan

1999

Convtn1(1nct

N•uonwido (9 bl•nds)

ICTS 6% (162/1884)

2001

OuS1er

Sentinel sites

KT7 6% (35/460)

2005

01JS1Cf

2006

Compl(lte

Cill@

Cook Islands

460 children all S· to 6-ye.11-old ch1fdren

The PacELF Way Towards !he Eliminalloo ol lympllaijc Filariasis In lhePa<~ic Distribution Dose or DEC and Atbendaz.ole Tablets

10-td

75-79

IS-19

SD-84

20-24

85-89

25-29

90-94

9 10

30·34

95-99

35-39

100-104

40-44

105-109

45-49

110-114

50-54

115-119

55-59

120-125

60-0.:

124-129

65-69

t30 Oll'tf

Registration Form

A.. -·- -·-·-

...-

WM 111-0dY•Allllf'tl~

..... ("(IUIC•Nll•

-·-- --

.........

111ce -~-

IEC Materials

_--__..

....,, _ •.. .......,_ _____

_____ ..__ ......-... -·-·--__..._____ ...... ___ _ ::-.,..,......_.,.. -----· -----___ ..,.. .... --·-......·-- ----:::..-:::--....... --... _.._..____ __ ----.. ·--·--__-.....___ ---- --__ ...,. ..... :.:-

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The PacELF Way Towards !he Elimlnalion ol Lympllaijc Filariasis In lhe Pac~ic Distribu1ion Dose or DEC and Atbendaz.ole Tablets

10-td

75-79

IS-19

So-84

20-24

85-89

25-29

90-94

30·34

95-99

35-39

100-104

40-M

105-109

45-49

110-114

50-54

1 lS-119

SS-59

120-125

60~

124-129

65-69

t30CMt

..-

Registration Form

·- ... -·- ·- ·- -.. n....._.•

..... .........

....,..., ,~

llf~

......... '""-~-

IEC Materials

_____ __....___ -·-··-----·--______ ___ ....... ___ _ ...... .. ----------· _....- ----........ -- ... -----·-·-- --- .. ·--·---·-----..----------" ·1 ''t:& ......_ f~·~o)_ ......

....,_ •.. .......,_.. ..:.:_____ ........ _.

c-.,'""'""''lt•

....

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FILARJAS IS

.,.,~_-...,

:::..-:=---..·-

__ --· ----

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-·--·---

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A·"·.. _,-;oi.,... ~·-

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PART 2

M"""····'·

-· -

,_........,._,n1-....•••• ,., ...,a.,,

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:::

-·---·-- .. -...---·-··-.......--·-·· ---..___ _..____ -·-·::------ - =--_ ---·...:r..::::"'--·----·-., ::::i:.=.:4::.-:.:..-:: ............ _ ... --·-·-·-··---- -:.:=-...._ -::::::.:..~

\I AK I

~:E.~:::-~:::.:~~

Operational Staff: Pubtic health nurse, health

.....

~--

_...._*:.,.. -··

,_ --

.......->

EK EEK£

:.:._-- =r.".!..!:.-:

--~-

-----.....·-·..

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';:~::.~:::-:-.-:-

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·--·--·--.. ,.. --·-·--

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---

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leafittt (MfOf'i)

1nspectot

C-Ounlly Prog1ammes

The PacELF Way Towards !he Eliminalloo ol lympllaijc Filariasis In lhe Pa<~ic

General Information Capit.lJ city

Palitir

Nu~

607

or ls&onds

lat'!dar~a

701sq1rm

Ll1nguages

Pohnpeian. Vapesc, Chuuktsf. l(osraca. English

i'ropl•

Micron~ns.

Gross domestic S)roduct (GDP) p(I( c.apita

$2000 (1999 <>t.)

Polynesians, expats

&onomy

Copra. fishing. tourism, most earnings come from US aid

lbt.11 population by C«ISUS (2000)

107 008

Population es11mated (2004 )

112 700

Population dens.ty (people!Vkm')

161

1nfo_n1 mortl)hl)' rb1e (per 1000 five butl\s} (2000)

Mat ern.'11 mo rtafity rate (per I 00 000 llve births) {2002)

317 (based on d'lildbe;uing age ts-44 ye;,rs okl)

Lifo ~JIPKlOflcy 4l bil"lh (2000)

67.0

leading cau5E!S of mortality t2003>

Ofseali't"s of the d rc:ulatory system, neoplavn, diS(!3Ses of r~pir1 tory IYflC!tn. endocrine. ntJtrition.al and metabolic distaJe, lnftctioos and ~~siti< diseases

·c

WEATHER

700

500

• ••••• • •• •• •

400 300 200

---=-

55-59 50-S4

ds-49

100

0 F

c:::J Rainfall $wrc.:~ (emptrlfln, Pohttpe;Wso J96J Mid 1990..

flMf!afl: 1'oNpt •961Mid199S

[@I] @

Feder.lied Slates of Micronesia

0 S

75+ 70-74 65-69 6G-64

POPUIATION

Ages

4Q-44 35-39 30-34 25-29 20-24 15-19 1()..14

5-9 G-4

Ma les

Foemales

l.S

PART 2

2 Country Profile Filariasis Type and Vectors Filariasis latest status ~heterla bancrofti

Filaria type

Olut~l)y sub-peorfodfc

Mosquito vectors

l <O

160 I

ISO ( NOfl h trn

Moflono

l'lflllpplnr

Sro

TirliiOn

PACIFI C OCEAN

11tond 1

I sa.pa•

( U.S.)

' ROIO

t?Gwor1(U.S.)

10 -,.-- :.TJr.tli1J.M --- t

oColo'li..•

Yop IJ I 11 A 9~

f<1f1A1,D(I

a,,

f.otol

AIOI/

o· f-i- n-e- -- --{ ------

N.......110 \gmolttl Atottc.

AColl · Wolf.lt

AtQlf \ • •

.~~~:110 ·•

Chu4Jl

AIOI/• 110/,1 "Joio..al ~· W•n4 t t<•l II.) AtOll , •. 1.;ut N _, L ~'"\.N., . Afoff Atoll ..

{ 1011 ,.,. 1

.., Atoll

.,,.

Aforl#oct lllOtfdJ

·u1t1••q {) , , : _,

Otol-ut .Atoll

P•llklr

' I..

Atoll

S' .. .....

""~:

• '50/l'!'!~Oitl.t. Atoll

I 'I • A

i ll'

, • !O ' 00 t ·,, ,.,~,1op Alo 11 .. .. • l olol

... ....

«o,tor

P ACI FI C OCEAN

- _, I~\ P «!A

'"f."

G lJl!'iLA

F ederated States of Micronesia

Coat of Arms

C-Ountry Prog1ammes

The PacELF Way Towards !he Eliminalloo ol lympllaijc Filariasis In lhe Pa<~ic

General Information Capit.lJ city

Palitir

Nu~

607

or ls&onds

lat'!dar~a

701sq1rm

Ll1nguages

Pohnpeian. Vapesc, Chuuktsf. l(osraca. English

i'ropl•

Micron~ns.

Gross domestic S)roduct (GDP) p(I( c.apita

$2000 (1999 <>t.)

Polynesians, expats

&onomy

Copra. fishing. tourism, most earnings come from US aid

lbt.11 population by C«ISUS (2000)

107 008

Population es11mated (2004 )

112 700

Population dens.ty (people!Vkm')

161

1nfo_n1 mortl)hl)' rb1e (per 1000 five butl\s} (2000)

Mat ern.'11 mo rtafity rate (per I 00 000 llve births) {2002)

317 (based on d'lildbe;uing age ts-44 ye;,rs okl)

Lifo ~JIPKlOflcy 4l bil"lh (2000)

67.0

leading cau5E!S of mortality t2003>

Ofseali't"s of the d rc:ulatory system, neoplavn, diS(!3Ses of r~pir1 tory IYflC!tn. endocrine. ntJtrition.al and metabolic distaJe, lnftctioos and ~~siti< diseases

·c

WEATHER

700

500

• ••••• • •• •• •

400 300 200

---=-

55-59 50-S4

ds-49

100

0 F

c:::J Rainfall $wrc.:~ (emptrlfln, Pohttpe;Wso J96J Mid 1990..

flMf!afl: 1'oNpt •961Mid199S

[@I] @

Feder.lied Slates of Micronesia

0 S

75+ 70-74 65-69 6G-64

POPUIATION

Ages

4Q-44 35-39 30-34 25-29 20-24 15-19 1()..14

5-9 G-4

Ma les

Foemales

l.S

PART 2

3 Filariasis before PacELF, 1900- 1996 60

I•

.. .. 1 ...

Mf Positive

•

El~hantiilsis

l MOA I

...

30 20

•

10 0 1900

• 1909

1919

1929

1939

1948

v..r

1958

1968

1987

1996

Country Filariasis Activities in the 1900s before PacELF M ic.rofilaria Prevalence and Clinical Surveys Noted Clinic.11 F<!uluros '% (n)

Population/Area

031('

% Mf pos (n)

Y.lp OISlrln

1943

126194))

ltuk, CMtnct

1943

22.S (947>

~pldn AC(1953)

Prlm.ary ff(!f<!rcnCC!

Pipldn AC (1953)

PoNpe OiSUtCI

1943

3 2 (647)

P1pkon AC (1953)

Yap; 10 istaods

197•

2.2 (14 14)

Country dAta

14 Wlages: 9 islands in Chuuk:

1992

2.6 (21 93)

oge >

1992

14yri: males: Chuuk

Kimura et al C1994)

Elel)Nn..,;s: O.• (466),

HydrocOl!le: 3 4 (466)

Kimur.i et II< 1994)

M ass Drug Administ ration or Other Cont rol M easures

C-Ounlly Programmes

The PacELF Way Towards !he Eliminalloo ol lympllaijc Filariasis In lhePa<~ic

4 PacELF Activity 4 PacELF Activity PacELF Country Plan For Satawa/ Island

ICT( t-) z: 0 1% A 2001

For other areas ICTC+) ot 0. 1% A 19992001

10(+)<0.1%

typo

Target

Result

Ve.1r

Sum piing

199~2001

Convenience

Chwlc· Yap

!Cf 0.2% (512392) ICT I 910 (191971)

2002

Con~

S.t.r,yal, 8- 15 )'Nt sehool th1ld'cn

200l

Convremence

Potlnpet students

2004

Cluster

Sen11nel sites

2007

Ouster

Satawa!

wos

OUst<.'r

2008

LO/IS

Outskie ot SlltaWal 3000 ct.ldH!n

1cr

°"'

(Olt ooo)

Results of Blood Surveys and MOAs under PacELF Blood Surveys No.

No.

Positive

l.Jrget

Sampling

!CT

Chuuk (12 tslands)

conven1encr sample

2186

0 .2

Mar01

ICT

SWd<fllS ( I 6 schools) In

convenience sample

716

Ocl-Nov01

ICT

Yap$t~t~

921

0.1

Presema11e>n llf'I AM6

Ocl- Nov01

ICT

g...15 y.o sdlOoJ dli\clrtn tn SlltaWal aroo

conYenlenc:e wnple

38 0

PYtstl'!'ltabOn m AM6

2003

ICT

5a1.awalarea

convenience Ample

266

342

""'5entation m AM6

2003

ICT

tamatam cuea

con~umre ~~

100

2.0

Prfstflt.l1JOR 1n AM6

Oate

Method

Nov99-A,.OO

l'o!lnpet

Targeted MOAs

Qill @

Feder.lied S1<11es ol M1c1onesia

t'X1l m tn('(f

of pos1t1ves rate(%) Remarks

Reference

Presentation •n AM3 Report of Pohnpel 'lt.ltt(M.,r·Ol)

PART 2 Supplies Shipped from PacELF, 200!>-2004 Year

2000

AlB(toblâ&#x20AC;¢ tt)

DEC (tablets)

ICT (ttsl c.rds)

2001

2002

2003

2004

1000

10 000

3SOOOO

3000

5000

Partnership: WHO, GSK (atbendazole}. JICA (DEC. ICT}, CDC (epldemlok>qtst)

Operational Staff: Public healtll nurse-, health Inspector, laboratory staff

Counlly Prog1ammes

Summary

The 322 islands of Fiji are located between 12~ 22 •s and 111•w-174•E. Fiji has a land area

of 18 272 sq km and a population or 775 077 (1996 census). The estimated population In 2004 was 836 000 (SPC 2004). The capital is Suva. on the Island of Viti Levu. The other large Island Is Vanua Levu.

The common occurrence or elephantiasis was described as early as 1876 (Messer 1876, quoted in Sass 1976). Messer noted: "Elephantiasis is very common among indigenous people in certain localities, especially in low and marshy parts. The lower limb is more often affected than the scrotum." Opportunistic testing or patients at the Colonial Hospital was carried out by Lynch (1905), who found Ml-positive cases in 25.7% or 608 people tested. People from 15 different provinces were positive, and the rates were highest in !hose from Kadavu (35.5%). Similarly high Ml rates were reported by Bahr (1912) from villages in Viii Levu and the Lau group. Bahr also reported cases of elephantiasis from the Lau group, with rates as high as 8 .7% in Lakeba. A nationwide survey of 57 000 people in 1956 found a 14 .2% Mf rate (Nelson and Cruikshank 1956, quoted in Sasa 1976), 6.3% of people with enlarged lymph nodes, 6.6% with a history of filarial lever, and 3.8% with elephantiasis. In Vanua Levu much higher rates were round on the windward wet side than on the leeward dry side. Control measures before the 1950s concentrated on vector control and village sanitation

(cutting of grass and elimination of breeding sites). This was observed to reduce the number of mosquitoes but there was no evidence of any impact on filariasis transmission. In the 1950s

there was some experimental use of hetrazan (DEC), which reduced the number of Ml circulating In peripheral blood (Symes 1956). There was a pilot MDA in 1961 , followed by a nationw ide MDA programme from 1969 to 1975, m which 5 mg/kg of the drug was given weekly in each area for six weeks. and then monthly for 22 months. Ml prevalence tell t.o less than 1% in all areas after the MDA, but by 1983 the Mf rate was Increasing again In almost all areas: In some areas, Ml

rates had returned to their original rates or higher. From 1984 to 1991 a pilot project was carried outln three areas to compare 1he effectiveness of different drug regimens (country data, unpublished). Giving yearly doses for three years was shown to be most effective in reducing Mf rat.es, with levels having dropped to less than 1°k. Surveys between 1991 and 1995 de1ermlned the overall prevalence or Mf to be 5. 1%. In some places, Mf rates even higher than before the MDAwere found, together with cases of lymph node enlargement. elephantiasis, and hydrocoele, which were seen nationwide (country data, unpublished) Fiji j oined PacELF In 1999. A nationwide baseline blood survey carried out on a sample of 5983 people in 2000-2001 showed 16.6% to be antigen-positive. A pre-MDA blood survey in 48 villages in 2002 found 452 antigen-positive cases (14.1 %) and 203 Mf cases (6.3%) out of 3214 people examined.

An MOA using DEC (6 mgll<g) and albendazole (400 mg) began In 2002 under PacELF. The first MDA covered 546 922 people, for a reported coverage of 70.5%. The second MDA In 2003 treated 483 983 people (reported coverage of 62.4%). and the third MDA In 2004 treated 537 484 (reported coverage of 69.2%). Blood surveys In 2004 In 14 villages found 152 out of 667 people (22.8%) to be antigen-positive, and 35 out of 646 people (5.4%) to be Ml-positive.

PART 2

2 Country Profile Filariasis Type and Vectors EndE'!'fllC

Wtichertina banaofti

O.umally •ub·penodc -

psudoscutellaru

Afdn hofTeKtf21

Al!:des rotumae Mdf!1 li,ot-iuis

A«Jes po,lyne.s1Pnsis

.Vf'IOU(IO

Udv P'olnr

Kio~

rcuowo

•Qtl~ftr;u

Group , ..

rocaro ••

J>~onuo lalovu

.ruvvta 18 $

Lou Croup V01'UO Votu. Votult'l~<l

Kodtitlu ,o~sogt'

177 E

Hotono.

HotlfiiO

••ooloq

oono Vunbc~

I ~.ll lO'$

Kadaw11

>.foolo

Gtoup

TOIO)'O~

Nomuto·i•IOuo

Ko&oro' •

tragosa fl1.1Jtt1

fulo9; oOgto ~<"VII

M atukuo

0 0

PAClFlC

0 H11•s 10 Kilomo&• rs

178 E

O CEAN

•80'

Votoo#I 178

Coat of Arms

C-Ounlly Prog1ammes

The PacELF Way Towards !he Eliminalloo ol lympllaijc Filariasis In lhe Pa<~ic

General Information Capital city

Suva

Number-of islands

322

Llnd area

18 333 .sq km

Fij1an, Hindi, Eng.lb.h

languages

R11an (51%}; lndi.an (44%); European. other Pacific Islanders, ovel'Sffs

""°pie (1998)

Chinese, and other (S%)

Grr>« domes11< product (GDP) por <Apllll

S2000

Economy

Sugar. tourism. mining of gold, ftsh, lumbef, a nd clothing

Total population by census (1996)

775017

Populatk>n estimated (2004)

836000

Population denslty (p. .pl"'1o'1' )

Infant mo«:alrty rate {per 1000 lrve blrchs) (2002)

17.76

Maternal morta!rry rtltO (per 100 000 ltvc bir'lhs) (2002,

35.29

Life expectancy at birth (2000)

66.6

Leadln9 causes of morta~ty (2003)

Circulatory disea.$(', respirJtory disl'ase. infectious and parasitic disease. neoplasm, ln;ury, and poisoning

WEATHER

POPULATION

Ages 75+ 70-74 65-69

600 + - - - - - - - - - - - - - - - - - --+ 30

Females

M ales

400 +--

n--.. -'

300 200 100

15 10

55-59 S0-54 45-49 4o-44 35-39 30-34

I·

25-29

•

••

c::::::J Rainfall

._.

10-14

~ Q-4

63.2

-I

-:a:- .....

10 9 8 ., 6 5 4 3 2 1 0

Temperatur~

15-19

0 +--t-+--t-+--t-+--t-+--t-+--t--+ 0 A S 0 N D F M A M

20-.24

3.4

- I

6o-64 25

1 l. l 4

3).4

J. . . 6 7 8 9 10

Percent

SOVtc•: VJbd:ICArrwct, ~rtlf(>

Lfruc.ilQ Bly 1921to1!181,

R#.nf.JN JN!lwi 191' Mtd 1990

3 Filariasis before PacELF, 1900- 1994 60

•

I•

•

Elephantiasis

MOA

... ,,

.!! 30

MIPO$.tlJllO

•

10 0 1900

1910

1919

1929

1939

1949

,, ,, r

1956

-•

1965

Year

c:I@J @

Frjl

•

·-

... ,,

1912

r r ... ,,

• -· ~· •• ••• - •

•

1979

1985

1989

1994

PART 2

Country Filariasis Activities in the 1900's before PacELF Mlcrofilaria Prevalence and Clinical Surveys Popufot1on/Area N~1i0nw.de

E\lrl)p(\'ltt1 N4tion'h'j(je

'4 (n)

Primary Reference

Onto

'Ki Mf po~ (n)

Noted Olnlcal Features

1912

27 1 (1320)

Elephantlall\.: 55.S (1320)

Sahl PH (1912)

1912

17. 1 (JS)

filarial Diseole: 14.3 (35)

&oht PH (1912)

Elephanti<l'Sl'S: 0.9 {57 888)

s,m., CB (1960)

Pr~J949

tQtlonwlde (8 arNS)

1954·1956

19.8 (1804)

Ministty of HN!lth {1996)

Nationwide (Vitilevu. lavtUrii. Sawsavu, labasa)

1954· 1956

19.5 (1976)

Simes CB 11960)

1954· 1956

18.2 (2142)

Nat1onwldt (V1tiltw. ~ni. Sa'Al'Sa'N. lab~)

N'11onwide CV.tilev\I. Tav~n•.

Sl'IU'Savu. lb~)

El~h.an~ 3.4 (2l4l). S<to1um: O 9 (2142),

19S•H956

f°'CVl"!r Wtlh lymphang1tiS• 5.4 (2142), EnLiit9C"1em of lymph nodes: S2 (2142) Hydroa>Eie; 1 1 (1748), f;Jana f..,.,. 6.6 (1748), EnUrgement of 1-h nodesc 6.3 1110/1748)

Symes CB (1960) Sym., CB (1960)

1956

14.2 (578B)

1968

23.1 (9471

M1Mt1y Of HNI th ( 1996)

1968

18.9 (1314)

Mlne'1JY ol H..11h ( 1996)

Rotu!T\11

1968

29.4 (SUI

Mlmuy ol Heallh ( 19961

MaQlilta/Bua

1969

7.611•37)

Mlnts.tty of Heallh {1996)

N3oonw'dt' ,.._nVl<o!o

s,,,,...,,,

El<'P°"""""" 0.9157881

Nelson S, Crultshank JM (1955)

Lau

1969

13 .8~)

Mrni>try ol 11Nllh ( 1996)

l<odaw

1970

11 9 (3881

MIM,\tty Of Health {1996)

LomaMt.I

1970

1B.5 (902)

MiMtty of Htnlth ( 1996}

Rotuma

1972

2.9 (2015)

Mil\lnry of Ht.lllh {1996)

IC.)davu

1973

0 1 (3124)

Mlrli>U)' Of HNhh (1996)

Taveunil Ko<o

1974

MIMU)' of ....llh ( 1996)

....

So'NSa"'

197•

05(11031 0.91)49)

1974

0.3 (7499)

M!Mtly of Health ( 1996)

Rotuma

1974

lomaMtl

3"9 (2347) 03 (3686)

M1nfstty or JiNh.h {1996)

1914

Lau

1980

44(721)

MIMU)' of tfe>cllth (1996}

Kad.wu I.au

1982

5.80561)

MIMtty of Health ( 1996}

1983

6.8 (3843)

MlllisU)' of HNllh ( 1996)

Ro1Uma

1983

21.1 (171B)

M•MU)' of HNllh ( 1996)

lOMIMll

,...

1983

M1Mt1y of Hoollh ( 1996)

1984

5 7 (23941 8 I (2447)

l<odavu

1985

6.3 (57921

Miots1Jy of Health t 1996)

Sawsavu {Nagig-1}

1985

9.2 ( 184)

Ml""U)' of Heollh ( 1996)

Mintstfy of HNlth ( 1996}

Min1$\f)' of H~hh ( 1996} Mmistry of Heatth {1 996} Elephantiasis: O. S (5601). Hydcocoele 2-.1

tCadavu and t.omalvlti

(560t), fol.I..

1985-1986

r.,., l .3 15601 ), Enl•rg<m•••

of EpitrochlNr g(and!>: 145 (5601), Enlarged "Inguinal nodel: 41 . I (5601)

Mfni<try of ""111h (1996)

Loma!iAl.I

1986

I J.6 (4611)

Mlnistt)'of He....l1h(1996)

KadaYU

1987

4 I 0257)

Mittai1ka JU~ 11(1998)

Kadavu

1988

2.3 (2819)

Mat.ljka; JU M .al (1998)

Roturna

1988

11 1 (2284)

MlrGU)' ol Heohh ( 1996)

l<od.wu lQmaMll

1989

1 6(2967)

Mut.ailr.a JU .n al (1998)

0,6 (2654)

M•"""Y of Heohh (1996)

l<odaw

1989 1990

1.3 (2830)

Molt.ilka JU et al 0998)

tc.ldiM.1 and Lomalvm

1990

Kadaw

Sa""'"' Macuata

Eleph.anbaz: 0.5 (5601 ),H)'drocoeie: 1.8 (5601)1 fllarla Fe-Jtr 0.6 (5601), Enlaigement or

Ep"r1><hl..r glands: 5 9 (5601), EnUfll'd lngwnat nodes: 28.9 (5601)

MfMtty of Hf!tillth {1996)

1990 1991

0 7 (2611)

Mata11cd JU et al (1998)

1991

l 4 (1811)

Mlnistl)' of HNlth (1996}

1991

0.6(1128)

MINsU)' of HNllh ( 1996)

C-Ounlly Prog1ammas

@ QID

The PacELF Way Towards !he Elimlnalion ol Lympllaijc Filariasis In lhePac~ic Populatfon/Atc-a

0.:ite

l.Omatvttl

1991

% Mr pos (nJ

Nitionw1de

1991-1996 5.1 (31 877)

Naoonw1de; Indians only

1991-1993

Primary Reference

M"ls11y ol Hc.>llh ( 1996) Mmlstty of Health ( 1996)

M1n1$1ty of He.llth (1996)

0.0(825)

El•~"''°"'' 0.2 (18 253), Hydocode: 0 .9 (18 253), Lymph nod• •11latg•mon1: 16, I (18 253)

1991-1995

Nationwide

Noted Cltnical Features % {n)

0.9(2704)

Mmiury of Health ( 1996)

Rotu~

1993

15.7 (185")

Mi:n1stry ot HN.1th ( 1996)

Kadavu

199"

I 5 (392)

Ministry of He.llth (1996)

1994-1995

5.1 (3449)

M,.;s11y of H..11h (1996)

1""

Mass Drug Administration or Other Control Measures Populo1tlon1At<:>_a

Date

Rew.>

cuurng 9rMs and &m11'WltJOn of ~mg sites

Sy-CB(1960)

1950s

Experimental use of Helf1un (DEO

SymesCB{1960)

1961

MDA

6 mgt\g DEC given: a tolat dose of '72 n¢g over a period of one year

8umt'11 GI\ M&,.ilr.>JlJ (1961)

MOA

6 m~9 OEC gr.-en: a tot.a& dost of 72 mg/leg over a penocl of ooc year Reduction MF Pos: 12. I to 2.7 (911). MF Density 4. 1 to D.~

Bumeu GF, M.01allca JU (1961)

1962

Rewa Nationwl~

Primary Reference

and VilliJgo Sanitation MDA

Pre-1949

N.Sb0nw161>

Details

Activity

Vector Control

DEC u~ng various Unllf!giM Ptlo1pt~t comparlflg 2 cfifftttn1 DEC regimens arntd out Fif'1t lrN. 1984- 1991 MDA DEC(6mgi\;g) weight 91ven annualty XSyrs, Second area· OEC (Sn9kg) weeklv X 6 then mo<1lh.., X 22, Third arN: COf'ltrol <)JM 1986-1988 DEC using v.uiom sttattgit'S 1986-1990 MDA 5 annual treatments of slng\e dose DEC (6mafcal MDA 1996 DEC (6mg/1<9) •nd t.erme<•n (200ug/1<g) 1968-1969

Pilot area

Lomaiviti K.ad<!l'N

Eas1"" DIWsion

Mlnls11y or H..ilh (1996) Ministry of Health (1996}

MfnlSlry of HMlth (19961 Matalka JU ~l al ( 1998)

M1nlstry of Health ( 1996)

4 PacELF Activity PacELF Country Plan

1997-2001

Convenleme

Setttinel sites all lnhabhanUi

Nd\yo.>r

Con~

~ii~ sitts all

2007-2008

Ouster

Stral.lfl!l'd survey by health s:ubdl'oWOn

200!>-2010

Complete

2t 000 children an S.. to 6·year·old children

fCT 16.6% {99315983)

ln.hab.L;i.nu

Results of Blood Surveys and MDAs under PacELF Blood Surveys Method

Oato

T.lrgC'I

Solmpling

No. No. Poslllw oxaminod of posltivc-s rate(%) Remarks

Reference

1997, 2000.2001

fCT

Rotum.o (9n, Who!~ arN comocolfnce .SAmplt

5983

993

16.6

MOH!ttporl

2002

ICT

Senunel Site (48 viii.ages)

conven1enc;e sampW_

3214

452

14 I

MOH draft report

2002

321•

203

6 .3

Pro-MOA

MOH drtft "90M

667

152

22.8

P~MDA

2004 bJood SUl'Vty tep0r1

646

S.4

200•

fCT

So<llinel Sil• (48 voli.lge) convenience sampfe Sentinc!I Site (14 villa~ convenience sample

2004

SE<llfnel SHe (14 villages) c.onwnlence samp(e

ITIIJ @

Frll

21'.)()d blood stJIW)' report

PART 2 MDAs

2002

lst

n6113

820 769

S7S486

74. 1

5•69i2

70.5

66.6

95.0

Presentation 1n AMS

2003

2nd

776 173

828 385

510 255

65.7

483 983

62.4

58.4

94.9

Prl"SCntotion Jn AM6

2004

31d

776 !73

836000

546.:167

70.4

537 484

69.2

6"3

98.4

Annu.al Repon 2004

'E!timil!eid il\1.\lmil'l9 <M~nt 91owth ra~e bffwttn ta 1~1 <~•Ml 200.C popui.tilltl fStdllolre{SS'O

MDA Coverage, 2002- 2004

40 +-- - -111 20 ~---111'

2003

2002

2004

Year

Supplies Shipped from PacELF, 2000-2004 Ve.:ir

2000

2001

2002

2003

,<>.LB (tabl• is)

868 000

OEC (tablets)

4 700 000

!70000 1100000

980000 1100 000

5000

! O 000

15000

ICT (lest c.'11ds)

2004 930000 8800000 10000

Partnership: WHO, GSK (atbendazole}, JICA (DEC and lCT), JOO/ (voktnletrs)

Distribution Dose of DEC and Albendazole Tablets No. of DEC

Weight (kg) (SO mg) t.tblnts

No o f albe-ndazole (400 mg) tablets

Body

!0-13

14-22

ll-29

30-38

50+

53-63

64-71

71-79

80+

39...6 47- 52

No of albendazole (400 mg) tablets

No. of DEC (50 mg) l<!blets

Weighl (kg)

1~14

15- 19

5 7

20-49

C-Ounby Prog1ammes

@ ITIIJ

The PacELF Way Towards !heEliminalloo ol lympllaijc Filariasis In lhePa<~ic Registration Form

-·--·--- - Ii

bo.i"ta.._ __ _

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IMPORTANT INFORACATION IO< FtLARfA.St$ MASS DRUG AtMAINlSTRATJON (MDAJ

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For more infonnatlon contact ne:irest Health fxl'Uty

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Poster 2002

Cailendcir 2003

Post.tr 2003

• (ii:;.,

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Postet 2004

C-Ounlly Prog1ammes

The PacELF Way Towards !he Elimlnalion ol Lympllaijc Filariasis In lhe Pac~ic

TAROVA SARA GA OQO NA WAQA A!!

Poster 2003 (F1jla n)

Poster 2003

Poster 2003 (Hindi)

11n1111 THI! CHOIC

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PART 2 Operational Staff: Filarias1s unn. public health. laboratory staff

C-Ounlly Prog1ammes

@ [JID

1 Summary

French Polynesia, a tertitory of France, consists of 35 islands and 83 atolls between 7'-29â&#x20AC;˘5 and 131'-156' W. It has a land area of 3521 sq km and a population of 244 830 (2002 census). The estimated population in 2004 was 250 500 (SPC 2004). From the midÂˇ1800s, high prevalence of elephantiasis was reported in the Society Islands (Lesson 1839, quoted in llengar 1965), Elephantiasis was also common In lhe Marquesas In the early 1900s (Buxton 1928) but was rare in both Tuamotu and the Austral Islands (Sasa 1976). Dubruel ( 1909) reported on elephantiasis and its treatment while based al Papeete hospital from 1906 to 1909, noting that elephantiasis was not uniformly

distributed, with the islands of Sous-le-Vent (Leeward Islands) being more affected th an the Society Islands. Until the 1960s, filariasis was a public health priority, as many surveys showed that Ml rates were often over 25<1k, with a large number of people suffering from clinical symptoms of filariasis (Sa.sa 1976) . Since 1949. various control programmes have been conducted.

The first of these was in Tahiti, where various MDA strategies using DEC were tested, resulling in a drop in Mf prevalence from 3 1.9% to 17.7% (Perolat et al. 1986). From 1950 to 1960, a DEC MDA campaign resulled In a decrease in Mf prevalence from 34% lo 4%, and In Mt density in blood from 78 to 11 per 20 mm3 or blood (WHO 1974). Various campaigns had varying degrees of success. Blood surveys from the 1990s showed lhat although Mf levels were much lower than they had been at the start of the 201h century. they still remained as high as 1O"A. In some areas (country data, unpublished). High prevalence In some areas despite prolonged treatment is thought to be due to a low

compliance rate with MDA of 50-60% among adults, allmvlng active transmission to continue. French Polynesia joined PacELF in 1999. A baseline blood survey with ICT antigen test kits on Tavaitoa and Tahuata in 2000 found 256 positive cases out of 1859 people examined (13.8%) (Dr l am 2002. personal communication). French Polynesia is therefore considered en endemic country. MDA using DEC (6 mg/kg) and albendazole (400 mg) began In 2000 under PacELF. So tar, tour annual rounds of MDA have been implemented since 2000. The reported MDA coverage rates have all been over 90%. The first MDA covered 205 000 people (93.2%) (first annual report). The second MDAm 2001covered214 149 people (95.1%) (second annual report). The lhird MDA in 2002 covered 211 052 people (93.3%) (third annual report). The fourth MDA In 2003 covered 221 300 people (90.1%) (country presentation at Fifth PacELF Annual Meeting, 2003). The fifth MDA in 2004 covered 230 737 people (92.8%) (country presentation at Sixth PacELF Annual Meeting, 2004 ). After the third MDA. a midterm survey on thr ee Islands in 2002-2003 ( country presentation at Flf\h PacELF Annual Meeting. 2003) found 42 antigen-positive cases out or 1069 people examined in Maupiti ( 3.9 %), 169 positive cases out or 1220 people examined in Tavail oa (13.9%). and 107 positive cases out o1635 people examined in Tahuata (16.9%).

French Polynesia

PART 2

2 Country Profile Filariasis Type and Vectors Filarlasis latest status

Endt!mlC

\MJchen>ni>bdn<Toftl

Filaria type

Dl1Jtnal~ .$Ub·penodic

Mof.quito vectors

Sou' ": Cuk:ll:br oft~ Aust~ RC'glOt'I, \b\imt 11, 1989

1•o·w

...o--w

ISO' W

KIR I BA'll

IO'

•l

... -- -

"; '-6:'

"°'

I I I

.PA CIFIC OCEAN

lloo • f,forqutJOS Nuku 0 Ua H'1lto ISiands Uivo P • llura Oa IOtu ll1WJ

So<llly IJfot1dJ Moni~

aon,01100.#

Mort11at• I

•

I Atauplhoo

.1 ... ,....,, .

Capncorn

I I #

' .•urut11

...

.,lubt/OI

, Ai,st .. 'O/ fslands

IF ~ ~r-e_n __. ~~ h~P =-o~ ly _n __ e_ s~ ia-..f

••alvovoc I•

·....

P/1co1m Islands (U. K.)

.1tapo

Mototlrl"

Coat of Arms

C-Ounlly Prog1ammes

The PacELF Way Towards !heElimlnalion ol Lympllaijc Filariasis In lhePac~ic

General Information Clpil31 <:ity

Papde tl'!

Number of fslands

3S Islands and 83 atolls

land area

3,52 1 sq l<m

unguages

T.ohitii)n., f rendi Pofynesians {Moohis • 83%). Europeans ( 12%). Asians (5%)

Prople

Gt0ss domestic f)foduct (GOP)

~ ap.11

Sl2 750

Economy

Tourism. pearls. agncultural processing, handlcrafu, pho1phat:es

Total popu,ation by census ~2002)

244 830

Po1><1latoon 0S11ma1<d (2003)

2SO SOO

Pol)<llatlcm deMity (peoploll<m')

Infant mof1allty rate tper 1000 lwe births) (2002)

6.7

M~tcmal m<>ft41ity

Not avaltable

t1'te (l>'f 100 000 live blrths)

t.lfe expectancy <lt birth (1999)

13.0

LNdlng cauS<S of m oruhty 12002)

symptoms, signs, a nd finding, not elsewhere classified, diseases o1 the rf!,$piratory system

Oi.$tases of 1he c:irculatory .fy$tem. neopa.sms, in1urif'S and external taus.es.

•c

WEATHER

700 600 500

75+

70-74 6~9

-- - -

60-64 55-59 50-54 45-49

400

300

4Q-44 35-39 30-34 25-29 20-24

1200

100

POPUIATION

Ages

15-19

0 F

1().-14

5-9

Q-4

CJ Rainfall

10.

Perc·e nt

~:r. T~tl/IC' r.ih111-~ 18Hi Md ~V!foil PMJO P.JOQ 1819~rM/ 1989

Sol.ittt;

Jm,

3 Filariasis before PacELF, 1900-1 998 60

I•

....

., 3 0

1 -

10 0 1900

1909

1919

1929

1939

•

t t ....

1948

a El'Pf\anuas1s

Mf Posltlvo

•

• 1954

1961

Year

1969

MDA

t t •

• ••

• 1977

1985

. • • •• 1992

1998

PART 2

Country Filariasis Activities in the 1900s before PacELF Microfilaria Prevalence and Clinical Surveys

Ogit<S: Tahitt; Papeett

1947-1948

30.3 (916)

l)fnphal'lg,tbo: 18,8 (916) Noted Clinical. 19.91916l

Giiiiard H. Mi"' R (1949)

Malao

1949

27.7 (166)

Laigret Jf(1959)

15 vil&ages; fahttl

1949

37.9(3390)

MMch HN, laigret J, Kes'sel If. Ba:mbndge 8 (1960)

15 Vl1'a9£5; tahrtl

1949-1950

32.3 (8537)

llEje HI(. KesselJF, lleu!sJ et al (1953)

30.9 (825)

Kesse!JF (1971)

Beye HI(. KesselJF. lleubJ eul (1953)

Vair.lo

1950

Tubua1

1953

19.I Q.35)

M>l<atN

1953

416(276)

Beye HI(. KesselJF. lleubJ et al (1953)

Bora, Boltl

1954

24.7 Q.30)

Lh<;f<t Jr (1959) 11¢«n L (1955)

Mdlt.ltt:a and Tatltt1

19SS

9.712390)

l)hltt; PaPttte

1955

11.8(13608)

u1191et Jf <1959J

Moo...

1955

268(2133)

""9••• JF n 959>

rtsiatea

1956

20.5(657)

l.ligrc< JF (1959)

1956

25,0(304)

uogmJF(1959)

l.logret IF (1959)

Mu11hlt

""'•

1956

27.5(342)

Mbvpl1

1956

26.6(514)

Lh<;oe<IF(1959)

V11QIO

1956

30.9 (825)

""5t<l Jf (1971)

M&fquC5.n:S

1960

17 (4227)

lbgrtlule\ J, BotslnM M, f~g~ux G Ct 41l. 0973)

fWnot)t~

1961-1962

I I.I (607)

lns1itut dt' a«httcht M«llG!lfiM ck la PolynMit fr<1nc..ttS(l

Rurutu

1961- 1962

15.5(1281)

ll't1btut d~ ~~ M«lf<:.ales 6' It A:>1~1e fronc.oise

Tubual

1961 1962

8.8 (927)

ln:sbtut dt R«hercM MedJCal(!S de la Pol)nesle franc..sf

f!llV<Wal?

196H962

22.8(901)

lnsti1ut de Rechcrche Mediate de la PolyMsie folnc.Bse

!IOl)hanu-· 2.8 (2706) Lymphangim: 3 6 (2706}

Marqum.M

1972

111.4 12706)

Ru11.1tu

198S

1.0 (200)

Coun1ry plan 2002..200-1

Huahlne (leeward Islands)

1981

15.0(400)

Countl)' plan 2002..2004

llo<•

1981

10.0(200)

Counlry plan 2002..2004

Ra~ac

1991

0 (20)

Country plan 2002- 2004

U• Pou

!992

•·O(713)

Countly plan 2002-2004

Raiate..i

1994

10.0(584)

Country plan 2002-2004

Tahaa

1996

3.0(1978)

Country plan 2002-2004

t.agraulet J, Pichon G, Ou1in·fabre- 0 "t al. (1972•

Maupin

1997

0.4 (990)

fatu Htta Maupin

1991

3.0(2•0)

Country plan 2002-2004 Countly plan 2002-2004

1998

0.2 (1000)

C.Ounuy plan 2002-2004

tahuata

1998

II 0(280)

Country plan 2002-2004

Mass Drug Administration or Other Control Measures 0£C(6mg.tg) ""'!lhl given monthly Xlyrs T•hiu

1949-1953

population; 1200 VArious dOSM of 0£C .and Slttlt"*" ICStOO

fltrolat PGuldi C. Rivierr f, RouxJ (1986)

1950-1960

DEC using vanou\ strat!!gjes

lhoons GC. HeulsJ, Kosse! JF. et •I, (1956}

1954-1955

DEC (]mg/kg} Mry monlh f0< 1 yeor

1968-1973

Maup1tt

1974-1977

Vanous MOA "'~ ttSlcd. F1nntly MOA DEC (6m~g)

every 6 mQl'ltm: w~ uwd. 6mglk.g DEC, more than~ coverage- (of 600), 3d~r

1974-1977 1974-1977 19n- 1984

Perolat P Guidi C, JVvjere F. Roux J ~ 1986) WH()(l980)

WH0(1980) 7 doses ( I dose about (!tJ(!(f S monttn) 2 \ftategi~ tested: a) limited MOA 1n vicinrty of known eottrl~r$

b) MDA Wtth OE:C (3m!)'kg)

WH()(l980)

Pe!ol"t P Guidi C, RMe<e F, RovxJ (1986)

C-Ounlly Prog1ammes

The PacELF Way Towards !he Eliminalloo ol lympllaijc Filariasis In lhePa<~ic

4 PacELF Activity PecELF Counbr Pim

_....

rcr(+) ~ o 1%

2007- 2008 - . . . . . ICl(+)< 0.1%

Ouster

Stnllncl ~•os (3 endemic bl•rd>l Sen11net ~tes all lnhabttants Stratlfll!d survey and $ent.nel sites

LOAS

5,000 atl S· to 6•.Yffr..old children

1997-2000

Ouster

2003

Ouster

c D

2007- 2008

ICI: M•upiti 2.6% (24/993), TC\'art...Tah..ta 13 8% (251>'1859)

ICT 10.9% (31&'292A)

SotltU: f'llt;MAN Boo& ZOO.:

Results of Blood Surveys a nd MDAs under PacELF Blood Surveys Date

Mt:'thod

Target

No.

s.1mplln9

No.

Positive

ff('ft!-roncc

examined of positives rolte (%) Rcmnrkll

2000

!CT

SenMl."1 Site CTevj)1to.Tahuat.)J

con~e s.implo

1859

256

13 8

Pn!Senl.lUon 1n AMS

Nov-02

ICT

Sentmel Site (Maupiti)

convenience sample

1069

3.9

Pn!senlabon '"AMS

feb.03

ICT

Stntln;et Site (Ta'.'a1toa)

converwnce sample

1220

169

13.9

Preseruation Jn AM-S

1CT

Sen1ln~I

convtrhMCt: sample

635

107

16.9

PresfntatJOn tn AMS

Mlr-03

Site (Tahuata}

MDAs

2000

220 000

2001

2rd

2002

3rd

2003 2004

Annual Rf.l'port 2000

85.7

239 160

205000

93.2

225 300

241 995

2 ld 149

95 1

885

Annual Report 200 I

226 172

244 830

211 052

933

86.2

An""31Report 2002

41h

245 516

247 665

221 300

901

89.4

Preseritauon 1n AMS

Sill

248 176

250 500

230737

92.7

92.1

Annv&I R('l)Ol'i 2004

'btJnM!td ~wmmg (OR\1.6flt growlh r•le- beiwecn '-l~t (Cnl.11\ ard 2004 popul.s1lon ntlmaU: ~PO

lmACR• I~ 2000-2004

100

. -80

...~

4<l

0 2000

. 2001

2002 Year

2003

2004

PART 2 Supplies Shipped from PacELF. 2000-2004 Year

2000

2001

2002

2003

2004

ALB (t• bl.U)

220 000

250 000

2•0000

247 300

DEC (tablets)

740 000

ICT (tesl mds)

1000

PAl'tncrshfp: WHO, GSK(at~azole), lnn itut Louis Ma;larcM (1tchnlal aS$1suince) Distribution Dose of DEC and Albendazofe Tablets Weight (for adult), Age (for S<hool children) DEC and albendazole doses depending on age and weight Age and Weight

DEC

.-.lbend.,1:ole (400 mg)

2 - s )'ell') {pro·sichool)

1x100 mg1ablet

5-11 years (primary)

2 x 100 mg Ulblct

12 .. 1 6~ rs (secondary)

3 x 100 mg: tablet

Adult < 80 kg

d x 100 mg tablet

Adult > 80 kg

6 x 100 mg tablet

IEC Materials

~ !· •1S1111 •1111•li

&GRATUITE ... ~J. •

-r.

1tNm.

~ .

The PacElf Way Towards !he Eliminalloo ol lympllaijc Filariasis In lhe Pa<~ic

__ *·-

......

-..:::i::.";'!:,'!..•"

.,... *·"'"' .... Operational staff: Public ht:-ahf\ medicaJ staff, ln.st1tut loul5 MatardC

--· ---··-

1 Summary

Guam is an unincorporated selr..governing US territory island located at 13â&#x20AC;˘N and

144Â°E. It has a land area of 541 sq km and a population of 154 805 (2000). The population In 2004 was estimated at 166100 (SPC 2004). The capital isAgana. The first study In Guam of 244 people in Ynarajan village on the southeast coast found the prevalence of lymphatic filariasls to be 5.3% (Crow 1910). Noevldenceoffitarlasls lnfeclion was found In the 1940s and 1950s (Pipkin 1953. Sasa 1976): the Ynarajan focus had disappeared.

Records do not Indicate the presence of W. bancrofti on the island of Guam (WHO/ SPC 1974). Two imported cases were reported in 1991and1999 (one ease each). In 1999, Guam joined PacELF. The most recent antigen prevalence survey was done in 2001 (Minlslry ot Health): all 980 people tested in 19 vlllages were found negative by ICT. Guam is therefore classified as a non-endemic territory. There is no record of subsequent filariasis activities.

C-Ounlly Programmes

The PacELF Way Towards !he Elimlnalioo ol lympllaijc Filariasis In !he Pacrlic

2 Country Profile Filariasis Type and Vectors filariasis latest st.Jtus

Non· EndemtC ~~baricroft,

Fllaria type

Noaurnall)' pen9d1c

Mosquito vectors

IGuam I 0

~·

S Htlc.t

I) 10· N

Philippine Seu

PA CIFIC OCEAN li 'l O' N

1.c4• 10·

Coat of Arms

14S t

PART 2

General Information Agana

Capital city

Number of 1,aanc1s

lat'ld area

54 1 sq Ian

Languages

Chamorro. English

PEOpk>

47% Cha morro, 25% Fiiipino. 10% Caucasian , Chinese. Jap a nese. Kol'e.an. and 18% other

Gross domestic prodV<t (Gill') pt< e>pit> (2001)

Sl 0.872

Economy

Petroleum ptoducts. tounsm. construction ma terials. fishing

To1'11popul•tion

by"""'" (2000)

154 805

Popul.ot1on e.st1matC'd (2004)

166 100

Pos>ulation density {poople'):m')

307

Infant mo rtality rate (per 1000 fl..-e btrths) (2003) Ma tt'fl\al mortality rate (P"

11.22

too 000 live births)

Not available

Ufo t:-.apect01ncy at bn1ti (2003)

77.8

Leading causef of mona.!hy (2002)

Ofsease.s of the heart. malignant neoplasm, cerebrovascular dfsease, all accidents, suicide

•c

WEATHER

700 600

500

• ••••• • •• •

....

•oo

POPUIATION

Females

6.0

25 20

300

r--'I

200

100

- - ' r- - - - 1

60.8

0 J

=----1.~.---1 33.2

l::::J Roinfa11 Sowce : l'ftlr.bC'ArTlllrt, Tt.'!'flpt!l'aiflln!', Ag.art.t 1911 ro1987, RMnf~. )lg.JM 1905 to 1990

C-Ounlly Programmes

@ [EI]

The PacELF Way Towards !heEliminalloo ol lympllaijc Filariasis In lhePa<~ic

3 Filariasis before PacELF, 1900-1990 60

I+ Ml Positive

"cv

..."

•

~lepl>antl.lsis

l MOA I

40 30 20 10

•

0 1900

19 10

1920

1950

1930

1960

1970

1980

Year

Country Filariasis Activities in the 1900s before PacELF Microfilaria Prevalence and Clinical Surveys

Mass Drug Administration or Other Control Measures

4 PacELF Activity PacELF Country Plan ICT(+ )

2001

2005

0. 1%

-... ICT(+) < 0.1%

zoos

3800 all 5- to ~r·Old chlldtl?n

Results of Blood Surveys and MOAs under PacELF Blood Surveys

1990

PART 2 Supplies Shipped from PacE~F, 2000-2004 Ve;ir

2000

AUi (lalilel>)

2001

2002

2003

20M

DEC (table!>)

ICT (test c.ard$)

1000

Operational Staff: Department of Public Health and Social SeMces

C-Ounlly Prog1ammes

Summary

Kiribati consists of 32 scattered islands located rrom 4°N to 11 • 5 and

15o•w to 1s9 •e In

three distinct groups: Gilbert (formerly known as the Gilbert Islands), Line lslapds, and Phoenix. Kiribati has a land area of 810 sq km and a population of 84 494 (2000). The population In 2004 was estimated al 91 944 (MOH 2005). The capital Is Tarawa. The earliest records of filarlasis in Kinbati describe the common occurrence of hv.drocoele among males (Buxton 1928, Knoll 1944 unpublished·quoted in Sasa 1976). Reports from the 1940s showed filariasis to be endemic in most islands of lhe Giibert group (Sasa 1976). lnfectton rates were low In the northern Islands but high in the central group. Filariasis was also noted in the southern group, bul no data on this were available. By 1974, according to the WHO/SPC seminar on filariasis (WHOISPC 1974), "on the 17 Gilbert islands, there does not appear to be a significant filariasi s problem". In 1999 Kiribati became a member of PacELF. A baseline blood survey of 2824 people of lhe Gilbert Islands in 1999-2000 found 1.7% to be antigen·positive: a similar survey of 400 people on Christmas Island in the Line Islands group in 2001 showed an antigen-positive rate of 6.8%.

Thus, Kiribati was classified as an endemic country. An MDA campaign using DEC (6 mg/kg) and albendazole (400 mg) was begun In 2000 under PacELF. The first MDA in 2001treated50 560 people (59.8%), the second in 2002 lfealed 38 802 people (45.9%), and lhe third in 2003 treated 36 742 people (43.5%). A midterm blood survey in 2003 in lhe Gilbert Islands found four antigen-positive cases oul of 1169 tested (0.3%), but none among lhe 1051 people tested on Christmas Island (Line Island group). The fourth MDA in 2004 covered 56 741 people (67.2%). In 2004, lour out or 876 people In the Gilbert Islands (0.5%) and 12 out of 1472 people on Christmas Island (0.8%) were found to be antigen·

positive.

PART 2

2 Count ry Profile Filariasis Type and Vectors Fllariasis latest status

Endemc

Filaria type MO$qulto vectors

lKiriba ti l •

•

- 041lt'

~1 A KSll Al. l.

T•raw•

•

•,,.•

•"•onott.o I (0C<Onl.)

....,•• •••,....... d••• •• ...... ••• ......... .. .•.. .... ,..., •re ,.,,,...... •• ....,,-,. •••••

cu..s >.

o f tlte latenalloaal D•t9 llae.

( Bairiki)

PACI FIC OCEAN

llt'

- Allltl••4•••.t o f1IO• w1tlll• t • .ctn9,ar1.tttl(l/.S.) Ill• ••p••Hc o f Klrtltatl ~o.myro Aroll

IS i.A 'IOS

•I

llO w

llO'

hlondi

• ..,•.

'- _•

,_ow/llnd I. l 1.1.S.J

.·.,

~ ,

((hrnttnO) I) \

":>

~··· 0 \

'\ \

\ \

Stotb.icl. 1 •

\•

\------------------------~ ---" • rcA,Jou • 0

.......... , ,..,,.,•• , •• 19 •••

••11ttc Oc••• are ••t.•••• •lt•tl••

' ''

· ••11 an 41._pleted •thlJ to ,.,,, .1 9ent.ral ••••• • f l•,l•lf(cU... .... ~

0 11C1ot1mor;

,110<11•• IJIOttili

I I

(U.SJ

. ...

}Otttll I'

• ' :I ______________ J_ __

--'

1otluofton

'--::.!.·~~.;.'""'"u"'s_,.J' -----..

C1lf'l(rt

I U \'Al. l1°,

- • ftfa,,,o .

.•

- (N I.) ••

' , D JA \f ()A Woll1J It ' • • "

AMtlKd~ Samoa (U. l.J

I I I

A.follt/JttJurn I.

VoJloA: t.•

Cool ls.londJ

lult'N (l~NCI>

•

I I

--------

IUfH I '

(N l} '·

JSO H ~ltt

Coat of Arms

C-Ounlly Prog1ammes

The PacELF Way Towards !he Elimlnalloo ol lympllaijc Filariasis In lhe Pa<~ic

General Information C:.ph•I thy

lllnlW>

Number of tslands

lbnd l)rt.t

811'q km

Languages

Englil-h. !·Kiribati (Gilbe«ese)

Poopl•

Economy

Micronesian, some Polyn~n S8SO Fishing, h•ndlaafts

Total populatjon by ce~us {2000)

84 494

PoP"la"on "'1im.,.d (2004f

93 100

Gross domestic product (GDP) per ca pfta (2000 ~-)

Population density !people/km~

t!S

Infant mortaiit'y rate (per 1000 liw birttu) (2000)

M•temal morllllrty rate (pe.- 100 000 IM> blnhs) (2002)

103

Life expectancy at birth

61.5

l.e~ng

Symptoms. signs and ill-de-fined conditions. diseases of the drculatory system. diseases of the digestive system. infectious and parasitic system. certain concbtions

cau*

o f mortality (2002)

ortg 1~ting penn~ to>I

•c

WEATHER

700

600

500

•••••• ••• ••

400

300

200

100

--.• . .. ..

. ..

POPULATION

Ages 75+ 70-7d 6S-09 60-04 5S-59 50-54 45-49 40-44 3S-39 30-34 2S-29 20-24 lS-19

Males

3.5

10-14

S-9 ()-4

Percent Soun-o:~t'.

~"tllll':

r.w.-. J951 Mid'"°'

Rwilatr ~°' 1910.,w! J98J

3 Filariasis before PacELF Country Filariasis Activities in the 1900s before PacELF Microfilaria Prevalence and Clinical Surveys

•mm"·liR'M--;e11;.1z•!w1mm•1··=m~wm.11 ;~11mm11-~·=w1-~!lm11=s1sz·,,.,mm111•%il'·iM!ili1''· --

LThere ate no epedem1olog1C" record$1n the l900s

Mass Drug Administration or Other Control Measures

m®IJ.ilf+.M~fa·'',lf@M+!i~ ~ .>rt' no records of controlprograrm 1n the l900s

[!ill @

Kiribati

PART 2

4 PacELF Activity PacELF Country Plan

_....

ICT(+) " 0 1%

2007

-.... ICT(+) < 01%

19'»-2001

Convenience

$ tinet site$ Gdben. islands

ICT 1.7% (<Ulf.lB24)

2001

ConvtntMCil!

Senunei sites Chnstmas ni.ne1s

ICT 6.~ (27/400)

•

200312004

Ouster

Senbn01 Siles Chnstmas bf.ands, Tarawa. NJk.unau

Ous:tt'f

StratifM!d wrvey t,.,. istaod group

2007

Compl~te

2500 all S.. Lo 6-yeaM>ld childten

Results of Bloo d Su rveys an d MDAs u n der PacELF Blood Surveys

NCW/99 - Mar/00

ICT

2001

ICT

cocwt!'nien«" sami*

282•

1.1

Blood Sul\<OY Repon

Sentinel Srtt (ChristmM ts l cotWMienc~ sam~

400

PitientatlM 11'1 AM4

corwenlence sample

1169

•

0.3

Report of MOO, 1S.Ngy.()4

0 .0

Rew1 of MOil, 1S.N°"()4

Sentinel Site {G1lben ts.)

Oec-03

ICT

Sentinel Site (Giibert lsJ

Dec-03

1CT

Sentinel Sit~ (Olrlstmas 11)

snmplf

1051

5<p-Ocl04

ICT

Stnt1nt4 Sitt> (Chr1~tm.!ls tsJ COfl''•'l''f'11ence sample-

1472

0.8

Report of MOO, 1S.Ncw-()4

NQy-1)4

ICT

colWC.."f'lience sample

876

•

Rew1 of MOil, 1S.N...0-

Sentinel She {Gilbert fS.)

«il'Wt"niC!'~

MDAs

2oa1

84494

86 6<16

60 537

46767

55.4

3rd

84•94 84494

88 797

90949

41 256

48.8

4th

84494

93 100

2002

1'1 2nd

2003

2004

71.7

50560

59.8

58.4

83.5 83.0

MOAA<i>c<12002

89.1

ReportofMOH, 14-J,,,..04

33802 36742

•S.9

43.7

43.5

40.4

56741

67.2

60.9

•'OA!lepoo 2001

Annual REpOt1 2004

C-Ounlly Programmes

@ Qm

The PacELF Way Towards !he Elimlnalloo ol lympllaijc Filariasis In lhe Pa<~ic MOA Covorago, 2001- 2004

100

...!! ft

...~

80 60 40

20 0 2001

2002

2001

2004

Vear

Supplies Shipped from PacElf, 2000-2004 Year

2000

2001

2002

2003

2004

Al.8 ( table ts)

8S 000

99 600

100000

900000 500

800000 l 000

800000 3 000

900000

DEC (IAbl• u )

•er (ten cards)

3000

Partnership: WHO, GSK (olbendozole), JICA (0£C.1Ct)

Distribution Dose of DEC and Albendazole Tablets Age

No. of DEC tableU

No. of albendaiofo tablets

2-5

6-10

11- 15

•

16-20

, 1

21-50

51 and up

Regis-tration Form

n ~' Go\ ll...\.O"A S: TIJIA~(.A, ..f 1111

110~

l'(Ht>k (l<\lli TC AC)AAIO AIO

---...---

ITEJ @

Kiribati

PART 2

IEC Ma terials

BWJf:p·Ap@ld.aN

Te. Bwatin alka uadcJld n

aran:

DEC ao Albendazofe

Tararuaan ma kakal!.f.akall ract te mant1ea n te llbw3ta

Kabutakin talanl bwa~ n1koi1 aomata nl Utoa

TE TIBU MAN TE

Mij

1<a1.-_.,,. ..

MANI-N -ARA

taabo ake e na kona nl kNbung I.II te tl'laN-n-.ra

ake a tOOtald

l(abongllnalldn to cream

Kcibonganaaldn te tiwanga n taln tt maw 1\ltUO rlain iUtl

Kabongana te oera lbtlkln

te lo.an n df'lnga tt man!· n-.va lnanon am taogk.e n

.....

TptpkgiM

KlbltlNkln te •"GI r'tlrel lbl.*ln taekan te aorald fl8• t:ola aomata man te o-n·

FILA RI AS JS

....

Pamphlet

If) I f)

:s<(

~ .. __

•H---• • I

•

··-

••• ,,.,.

[][J

µ..,i

T-shirt

Pamphlet

C-Ounlly Prog1ammes

The PacELF Way Towards !he Elimlnalloo ol lympllaijc Filariasis In lhe Pa<~ic Operational Staff: MOH medical service. Ministry of Education. lsfand council

[IE) @

Kiribati

1 Summary

The Marshall Islands is a group of five i.slands and 29 atolls situated between 5Â°-15Â°N and 162'-173' E. It has a land area of 181 sq km and a population of 50 840 (1999) . The estlmated population in 2004 was 55 400 (SPC 2004). The capital Is Majuro. The Marshall Islands was formerly part of the US-administered UN Trust Territory of the Pacific Islands. Filariasis prevalence was 1% on Majuro in 1944. and 3.6% on Namorik in 1953 (Pipkin

1953). The other islands were apparently non-endemic for filariasis. In 1999, Marshall Islands joined PacElF. A nationwide antigen prevalence survey of 2004 people in 2001 found two positive cases (0.1%) on Mejit Island. The Marshall Islands

was therefore classified as a partially endemic country. In 2002. a blood antigen survey (Ministry of Health; country presentation at Fttth PacElF Annual Meeting in 2003) on two islands found 130 antigen-positive cases among 294 people

examined on Mejit (44.2o/o). and 71 antigen.positive cases among 244 people examined on Alluk (29%). A similar survey in 2003 found no positive cases among the 217 people

examined on Wolje and the 318 people examined on Ebon. The first round of MDA with DEC (6 mg.l kg) and albendazole (400 mg) was done on Mejit and Ailuk In 2002 (Ministry of Health; country presentation al fifth PacELF annual meeting in 2003). The coverage achieved was 81 .0% on Mejit (337 people treated) and 67 .6% on Aituk ( 346 people treated). The second MDA in 2003 treated 286 people (68.8%) on Mejil and 346 people (67.6%) onAlluk.

C-Ounlly Programmes

The PacELF Way Towards !he Elimlnalloo ol lympllaijc Filariasis In lhe Pa<~ic

2 Country Profile Filariasis Type and Vectors Filariasis latest

statu~

-IW!<rofo

Fllaria type

Oiwnall'/ sub-periodic

Mosquito vectors Soumo:CuJodlreofrMAu~~ ~11,

IMarshall Islands I

1aong1 AtOll

PA. C IFIC O C EA.N • M"otAroll I

I I

I I I

---------,

UUl•l

Alo/I

''"""''to4 Alo/I

Ujtlong AIOll

I N

0 M<l1AIOffQ

•Kno1 AloH ICOft~

1'1\l>l.RA I U ) S I A 11-:s O 01' M ICROSt:SIA

uo (

Coat of Arms

[!ill @

Marshall islands

·~

(

- 17r1 -

1989

PART 2 Capital city

Majuro

Number of island$

5 lslonds and 29 atolls

Land area

181 sq km

Languages

Marshallese, 8'gbsh. Jap.>n...,

People

Mjcroneslan

Gto<s domostic product (GOP) per aplt>

USS1830

Economy

Copra, fishing, tourism, craft IU!nu, off•horo ban~ing (cmbl)'Ol1k)

TotA1 population by census (1999)

50840

Population osr1mated (2004)

55400

Population density (p<oplell<m1

306

tnlant mortality ra1e (per 100011.., births) (1999)

Maternal mortality rate (per 100 000 live births)

Not available

Ufe oxpeclal1<)' at birth (1999)

67.5

Leading causM of mortality (2002)

sepsis Injury, poisoning and certain other consequences of exiernal causes,

Malootrition, dise.lses of the circulatory sys1em. acddoots (all types), neoplasms, pneumonia, diseases of the digettive system. cancer (all types), diseases of the respltatory systt!('l'I

·c

WEATHER

100

EiOO

500

•••••• ••••••

400

300

200

100

.. -1""1-b

2S 20 15 10 5 0

0 f

M A

[=:J Rainfall

POPULATION

Ages 75+ 70-74 05-69 00-04 5S-59 50-54 45-49 4()-44 35-39 30-34 25-29 20-24 15-19

% Females

Males

10..14

5-9

°""'

Soun;•: \Vor.toC'Aml~. ~.:ti"

ltfm.t~·

Mli1JfO 1961and1990,

M.J;uro t95'1 ro 1995

3 Filariasis before PacELF Country Filariasis Activities in the 1900s before PacELF Mic.rofilari a Prevalence and Clinical Surveys

~M@fJ.ii§-- 1 iH@AIM§l31Mi@!ii!§#A-iil::f!.li@iilH-~

- lheteare no epidemlologk records In the 1900s

Mass Drug Administ.ration or Other Control Measures • o •

. ll!o!ol.ft • " '

' '" I

•

< .. O U ! l '

lhete are no record$ of control program$ In 1he 1900s

C-Ounlly Prol)•ammes

@ Qm

The PacELF Way Towards !heElimlnalloo ol lympllaijc Filariasis In lhePa<~ic

4 PacELF Activity l'lio!LF Comt1V P1111 For M ejit Island

ICT(+l" 0.1%

For other areils

ICTl+h 0.1% A 2001

ICT(+) < 0.1%

2001

COnventMCc

2002

Counuyw1de

ICT 0.1% (2/2004)

Mejit island

ICT 44 2% (13CV294)

2004

Clust~I

~1>n~ sites Me1i1 Island

2007

Oune1

Slr.)bfled SUM"/ MflJ11 l~and

ioo1

LQAS

1500 all S- to 6-year-old children

2007

vmo£e popula11on

Me1jl1

Results of Blood Surveys and MDAs under PacELF Blood Surveys

2001

ICT

VJholearee

convenf(lnce samplt

2004

0.1

May-02

ICT

M<'l'I bland

convt'nience sample

294

130

44.2

Presentation in AMS

Jun-02

ICT

Ailuk blond (00¥enieoce sample

24'1

29.1

Pre-sien1Jt10n '" A.\<1.5

2003

ICT

Wotje l•land <Ol'!Venieoce sample

217

o.o

Presen1ation in AMS

2003

ICf

Elion lslall<i <onveniente sample

318

0.0

Presentatlon in AMS

2 positives ftom Mejit Is.

MOH R'POtl 200 I

Target ed MD.A< for Mejit a nd Alluk Island

2002 k1rgeled MDA Mq1t, 4 16 2002 Targeted MDA A<lu~ 512

416

294

70.7

337

81.0

8 10

114 6

512

346

67.6

346

67.6

676

100.0

Pttser11a1JC1n 1n AW.6

2003 Tal'gtled MDA Mtfit. 4 16

416

318

76.4

68.8

89.9

Pttsttlt.U.on in AM6

2003 Targeted MDA AIM, 512

512

410

BO.I

67.6

84.4

~tatlOO in AW6

286 346

-&11tNt«l assum1ng c.om1M119rowth ra~ ~!ween lttt!St ctMUS and 200.C popul.t.1101\ est1tnatt (SPQ

Marshall Islands

Psesen1at1an in AW-6

PART 2

Supplies Shipped from PacElF, 200()-2004 Year

2000

2001

2002

2003

ALB (,.blets}

1000

DEC (tâ&#x20AC;¢blets)

10000

1000

3000

ICT (tes:t cards)

2500

2004

Partnership: WHO. llCA !OEC. ICll

Operational Staff: Public health staff

C-Ounlly Prog1ammes

@ [JIO

Summary

Nauru is an island situated at 0.3'S and 167'E It has a land area or 22 sq km.;.and a population of 9919 in 1992 and 10 065 In 2002. tn 2004 the population was about 10 100 (SPC 2004). In a 1926 survey or the entire population (excluding Infants), the prevalence of Mf was found to be 28.8% (332 positives out of 1151 examinedXBray 1931 ). Elephantiasis was rare, but fever attacks, lymphangilis, and adenltis were very common. and 10% of the male population had hydrocoeles with minor swelling. In 1933 the Mf prevalence was reported to be 36.1% nationwide, with 21 cases or elephantiasis and no cases or hydrocoete in a total population or 1500 (Grant 1933). In 1999, Nauru joined PacELF. A nationwide blood antigen suivey that year (Ministry of Health, reported in 2000) round only one positive in the 388 people examined (0.26%). As this

positive case was not a resident. Nauru was classified as a nonÂˇendemic country. There is no record of further filariasis control activities in Nauru after this survey.

PART 2

2 Country Profile Fflariasis Type and Vectors Filariasis latest status Filaria type

Mosquito vectors

INaurul

PAC IFIC

OCEAN

• Anet•

____....

o· Jl"S

" II•

1 ltlloffltrtt

oNlbok

l • fj

Central Plateau

nlgomodu

Jf (L • { 70 ,,.,

I ·o

eJ.ctill

• Aiwo

Anlbar~

llu d

co;o:,,

Anlb1re

Bar

. e..

PACIFIC OCEAN

Coat of Arms

C-Ounlly Prog1ammes

The PacElf Way Towards !he Elimlnalloo ol lympllaijc Filariasis In !he Pa<~ic C.pdal aty

Yaren

Numbef of isl.ands

landa1~

21 sq km

1.angtiag~

Engh.sh. Nauru

People

Melanes.an, Polynesian, Pacific lslandets. Asi.ani. Europeans

Gtoss domesbc produ(t (GOP) per c.apita

SSOOO (2000 est.)

Economy

PhospJiate mining

Total population by census {20'02)

10 065

Population estimated ~2004)

10 100

Populatiol" density {people/km') lnfont mort.Jlrljr rote (per 1000 '""' brrths) {2002!

~· 12.7

M•temal mortality ra1e (per I00 000 five births) (2002)

300

Life expectancy at birth

62.3

leading causes of mortality (2002)

Diabetes, dB.eases of resplratoiy system, disease of the circulatory system (exdude hypertension), neoplasm. transport accident and drowning

·c

WEATHER

POPULATION

Ag..

75+

• • • • • • •• • • ••

500

65-69

55-59 50-54 45-49

400

300

200

100

0 F

Ft~les

Mates

70-74 600

4o-4d

35-39 30-34 25-29 20-24 15-19 10-14

5-9 o-4

[=:! Ra•nfali

10.

- 9 - Tempeta1ure

Percent

Sourc•: 1'/0ttfCMlfir.

ffom,oer.tf\I"'°. H«iw r96t ¥td 191¢ NcfVN 1'92 to l 'J11

~f;/JI

3 Filariasis before PacELF, 1900-1990 60

,..... Mf Positive ...,.Elephantiasis 50 v ""' .!!!

"'>

~ MD~

•

20 10 0 1900

1910

1920

1930

19411

1950 Year

1960

1970

1980

1990

1.5

PART 2

Country Filariasis Activities in the 1900s before PacELF M icrofilaria Prevalence and Clinical Surveys Smali hydrocoele:

10~11S1)

Eloph•hU•sis: 1.4!1500)HydrocO<'le: 0(1151)

M ass Orug Administration or Other Control Measures

4 PacELF Activity PacELF Country Plan

D fa\__. 10(+) ,, 0. 1%

A 1999

>-~~--.~...._. 10(+ ) < 0. 1%

Results of Blood Surveys and MDAs under PacELF Blood Surveys

Supplios Shi pped from PacELF, 2000-2004 Y<tolr

2000

2001

2002

2003

AlB (tableu)

DEC (table!$) ICT {test cards)

. 500

2004

1000

Partnership: Vv'HO, JICA (OEC, ta)

C-Ounlly Prog1ammes

The PacELF Way Towards !he Eliminalloo ol lympllaijc Filariasis In lhe Pa<~ic

Operational Staff: Medical officer, Pubhc health nur$-e

Summary

The French Overseas Territory of New Caledonia consists of 12 islands, between 19'5 to 23Â° Sand 163Â°E lo 16a0 E. Its land area is 19 103 sq km with a population of 196 836 at the 1996 census. In 2004 the population was estimated to be 236 900 (SPC, 2004). The capital is Noumea on the island of Grande Terre. New Caledonia includes !he Loyally Islands group. Cases of elephanllasis and other filarial disease symptoms were common, judging by early medical records during !he 18th and 19th centuries. According lo Iyengar (1965).

the main foci of filarial infection in New Caledonia were: (1) Balade. Pouebe. Touho, Mou and Ouasse in the East coast: and (2) Koumac. Gomen, Voh. and Nepou on !he West Coast. In the Loyalty Islands, cases of filarial infection were recorded from lifou and Ouvea. However, only a small number ol elephantiasis cases were observed. A survey of 382 adults on Ouvea Island in 1997 found an Mf rate of 3.1% and a filarial anlibody-posillve

rate of 32.5% without any clinical cases being found (country data, unpublished). In 1999 New Caledonia joined PacELF and a blood survey was carried out in school children in Ouvea in 2001 : 2 antigen p<>sitive cases in 136 children were found (1 .5%) (country presentalion at Four1h PacELF Annual Mee&>g in 2002). In 2003-2004, a larger baseine survey carried out in 13 districts found 7 antigen positives out of 1384 people tested (0.5%) (country presentalion at Sixth PacELF Alnlal Meeting in 2004).

C-Ounlly Programmes

The PacELF Way Towards !he Elimlnalion ol Lympllaijc Filariasis In lhe Pac~ic

2 Country Profile Filarlasls Type and Vectors Filariasis latest status d . _J• I

Filaria type

Oiumal!y sub-penodic

Mosquito vectors

llJ' l

1'6' E

1N ew Caledonia I Coral Su

VA!\ilu\I U

Coral SH

n •s

c- ~

General Information Capl~lcity

NO<Jmea

Number of ulat1ds

Land 11rea Language

18,576sq km Fr~n<h,

People

Melan£'1ian (44, l %), European (31.4%), Pacific lslandecs and Indonesians

33 MelaMSian and Polyntsian dialects

Gn>S> dom..11< P<odllC1 (GOP) por <Api1' ( 1997)

S16 679

£C'onomy

Nickel mining. agricuhure, 1ourism

Total population by ceosu.s (1996)

196836

Populat.on estlma1ed (2004)

236900

Population densjty (people/km~

tnf1n1 mortality rate {ptr- 1000 1...-e births) (2001)

4,9

Matemal mortahty r.,lte (per 100 000 hw blnhs)

33.30 (1991- 2001)

Uft- txpe<tancy .1u birth (:Z001)

73.1

leading causes o f mo rta\Jty (2002)

Oise"ses of the ciKulatory system. malignant neoplasms, external causes of l'l"IO<bidlty and mortafity. dlse.'ISb of the rasplra1oty system, symptom.s. signs- and abnormal clinic.al and laboratory fi ndings. not elsewhere classified

SOUftt: COVM!'yHHJlh /flfomwto'I

""''*

1(JO,I M'FK> ~Of~ for lite~ P¥:J(icJ. l~~r of r~ P.k//lc COll'N!Xlnlily(SPO. ~~I OMlNto'IS

PART 2

•c

WEATHER

POPULATION

Ages 75+ 70-74 65-69

35 30

Males

Females

...

6G-64 25

CJ Rainfall Sov~ :

-+- Temperatu1e

65.1

~·

S-9 0-4

. . . 10 9 8 1 6

29.7

'~-

'-"'5 • J

---

2 1 0

1 2 .3 4 5 6 1 8 9 10

Percent

WorldC'Aim.1(1!. N«imN 189 • ¥ttl 1

rfl'llPe'•rlft!'

"~'''

,. -

10-14

0 M

I ~

~ =

35- 39 30-34 25- 29 20-24 15-19

.. I

4G-44

5.2

I I

55-59 S0-54 45- 49

NolJmff

18}4~nd 1990

3 Fi lariasis before PacELF, 1900-1995 60

.. ..... u

I + Mf Posi11ve •

•

c SI ~ 30

Ek'phan 1~

MDA

•

20 10

0 1900

•

• 1908

1918

1928

1938

1948

1955

1965

1975

1985

1995

Year

Country Filariasis Activities in the 1900s before PacELF Microfilaria Prevalence and Clinica l Surveys Population/Area

Date

% Ml

po~(n)

Noted Olnic~i l features % (n)

Prim.:iry Refeorancc

Age > 20, New Caledonia

1903

34 ( 117)

NewC.ledof>oa

1950

5.8(521

PerryWJ (1950)

Ponenhouen. Mou Village; adults

1950

49.1 (571

Morlet Y (1950)

Fonefthooen. Mou village

1954

37 2 (~)

lyengat MT (1954)

Gato~

22.2 (45)

Me<IO!t Y(1950)

Ound)o

1950

24.8 (129)

Merlet '( (1950)

Elephon.,..is: 2.7 (117)

Laog, Noc (1903)

1950

Gomcn

1951

7.7113)

""'"'"JM (1952) l(etre<1 JM (1952)

OIM'•

1995->997

31 (382)

COuntry Report

IC<>umac

1951

59.3 (81)

ir.t•estJM(l952)

1951

16.6 (24)

Mass Drug Ad ministration or Other Control Mea sures

C-Ounlly Prog1ammes

The PacELF Way Towards !he Eliminalloo ol lympllaijc Filariasis In lhe Pa<~ic

4 PacELF Activity PacELF Country Plan

TyP"

Target

Result

Yeur

S:impl1n9

1999

Cluster

School ch~klten 9-11 year old in Owea island

2004

Ouster

Keeh.l'I filldlities tn 13 districu

LQAS

;all 5Â· and 6-yeaf"Old children

Cando

1cr. 0

Results of Blood Surveys and MDAs under PacELF Blood Surveys

Supplies Shipped from PacELF. 2000-2004 Vear

AlB (1ablcu1

DEC (tablets) ICT (1~St cards)

2000

. . .

2001

2002

2003

2004

. .

Partnenhlp: WHO

Operational Staff: Preventive Oepar1ment. Direction des AHa1res. Sanhaires et Sociales

ICT. 1.S% (2/136)

s,. (7/1384)

1 Summary

Niue, a self-governing island In rree association with New Zealand, is located al 19' S and 169' W. ll has a land area of 259 sq km and a population of 1788 ( 2001 ). The resident population In 2002 was estimated lo be 1600 (SPC 2004). The capital is Alofi. Filariasis prevalence was 22.1% in 1954 ( Simpson 1957). An MDA wilh DEC in January 1956 reduced the rale lo 2.9% in December of lhal year (Iyengar 1958) and lo 3 .2% in 1960 (PacELF dala, unpublished). However, a survey of 99.7% or the population in 1971 showed lhal lhe Ml rate had increased to 16.3%. Another MDA using DEC in 1972 was thought lo have eliminated the disease (WHO/SPC 1974), bul a survey in 1996 found an Ml rate of 1.8% (country data, unpublished). In 1997. another MDA using a combination of ivermectin (200 mcg/1<g) and DEC (6 mg/kg) was implemented. Niue ioined Pac ELF In 1999. Despite an MDA in 1997, 64.3Â°~ of cases were still antigen-positive two years later. A 1999 survey of the whole population found 3.1% or the people lo be antigen-positive (country report 1999).

In 2000. an MDA using OEC (6 mg/kg) and albendazole (400 mg) was administered under PacELF. This first MDA covered 1802 people (94.2%) (firs! annual report). The second MDA in 2001 covered 1706 people (99.1%) (second annual report). After the second MOA, a blood survey or the entire populalion round 22 positives out of 1630 people examined (1.3%) (country presentation atThird PacELF Annual Meeting In 2001 ). The third MDA In 2002 covered 1469 people (82.2%) (third annual report). The four1h MDA in 2003 covered 1386 people (77.5%) (correspondence, Niue). Follow-up surveys of positive cases in 2002 and 2003 found 12 or 20 still positive in 2002, and 16 or 26 still positive in 2003. The fifth MDA in 2004 treated 1397 people (85.2% of the population) and a final evaluation survey of 1285 people round only three antigen-positives (0.23%).

C-Ountly Programmes

The PacELF Way Towards !he Eliminalloo ol lympllaijc Filariasis In lhe Pa<~ic

2 Country Profile Filarlasis Type and Vectors Filariasis latest status

Endemic

Wuchererld bancrohi

Filtiria type

DiurM!ly $Ub-ptJlodlc

Mosquito vectors

J4t ' SO' H

INiuel 0

JH1Ju

) fC t!OlftC\Cn

l't 4!l' N

l f' N

. .,. ..,

N iv e ( N. l .)

fam.tlwutonq• A ••lt'lt' . .,

''"°rs.

eAv.n t Jt

PACIFIC OCEAN

•v•>tt11

General Information cap1u.1dty

Alofi

Number of islands

IJlnd ar~1

2S9 sq km

Lilngwges

Engtlsh, Nwean

l'Nplc

Potynesl.n.n (85%) Nlu~an. plus 10ogan;, Tuvaluan, samoan, New Z~al,1nden

Gross domestic product (GOP) J>ef capita ('2000}

S417

Economy

Philately. &gricullul'e productt. hancliet-afts. fruit pr0<Mslng

Total population by ten.SUS" (2001)

1788

Poj)ulonlon 6timlltcd (2004)

1600

Popui.1;on deo5'1y (P<'09k>'l<tn~

Infant mortality rate (per 1000 live b.rths) (2001)

29.4

Maltrnal mottlllhy ratt (pet 100 000 ll'YC births) (2002)

Not available

I.de expectancy a t birth (2001)

70.l

Lading Ga USC!S Of mort.a-llty (2002)

lnjurie$ from gunshot, diabetes and hyperteru.lon complteations, p1emature births, pneumonia. accidental drowning

PART 2

•c

WEATHER

POPULATION

Ages

.----~~~~--.,,.------.~~~----,

700

600

500

400

300

75+ 70-74 65- 69 60-64 5S-59

Fe males

8.3

SQ...54

200

'1::-

100

. . . .

CJ Rainfall

. !

45-49 4()-44

3S-39 30-34 25-29 20-24 15- 19 10-14

N D

S-9 0-4 10.

- . - Temperatuic

8 'i 10

Percent

Sournt: ~rit. ftmplf.ttutt 1911to1990, R.ttnf-4 A1oli 1905 to 1990

"'°"

3 Filariasis before PacELF, 1900- 1996 60

I•

.. ..

l MOA I

• Elephanuasis

c ;; 30

...~

Ml PositiYe

•

10 0 1900

•

• 1909

1919

1929

1939

1949

1957

• 1967

1976

1986

1996

Vear

Country Filariasis Activities in the 1900s before PacELF Microfilaria Prevalence and Clinical Surveys PopulaborVArea

Date

% Mf pos (n) Noted Cllnltal ~.J1tu1~ 04 {n)

Pt1mary Rcf<rrenco

Simpson ES t 1957) Simpson ES (I 957)

1954

2V (748)

/VJ< > 2

19S6

2.9 (2791)

99. 7% of tota popu!aoon

1972

16,4 {• 408)

WHQ'SPC (1974)

82'% ot IOtal popiJiatlOn

1996

1.8(1471)

Country Rej>on (I 996-97)

M ass Drug Administration or Other Control Measures S.mi><O" ES (195?)

1956 MOA

DEC at monthly doses

1972 MDA

DEC 6mgllr:g, once a weet: fOI' 12 weeks, follo....W by once a month tor 12 months

WHOISPC (lfJ74)

1997 MOA

M!t""""'n (200mcg/l<g) and 0£C (6m¢g)

Counuy Ropon (1996-97)

C-Ounlly Prog1ammes

The PacELF Way Towards !heElimlnalion ol Lympllaijc Filariasis In lhe Pac~ic

4 PacELF Activity PacELF Country Plan

r:\l "LJ L;8,

2001

Type

_...

ICT(+ )

2002

2003

Year

S0tmpl1ng

1999

2001

CJndO

2004

0. 1%

Target

Result

W'hole population

All inhabitants

ICT 3 1% (5611794)

Whok> popul.)tion

A!l lnhabluints

ICT 1.3% (22/1630)

Whole population

All Jnholbit.ants

ICT 0.2% !3/1285)

Results of Blood Surveys and MDAs under PacELF Blood Surveys

1999

ICT

Wholeatea

All Inhabitant'

1794

3.1

2001

ICT

Whoktatta

Ali lnhat>tanu

1630

1.3

2002

ICT

Positive cases

follow up

600

2003

ICT

PoSlti'-e cases

rolkiwup

2004

Whotear~a

All inhabftants

128S

0.2

MOH Report (Dec/99) ME

Present.abOn Wl AMl

MOH R<pon (27/ll7~2) Prts~lalM)n 1t'I AMS f>re"~nlcltion 111 AM6

MDAs

2000

Mnval Ropon 2000

1913

1851

1802

94.2

97.4

2001

2nd

1722

1788

1706

991

95.4

Annual Report 2001

2002

3rd

1788

1725

1469

85 16

Mnoal R<pon 2002

2003

â&#x20AC;¢1h

1788

1663

1~6

77.S

83.34

Presentation 1n AM6

2004

Slh

1639

1600

1397

85.2

87.3

Presentation In AM6

"Esb~ted ol:SSllf'IWl9 COOS'lilf'll

grOWlt! rate bEo!Mttl \lten ~s ar-cJ 2004 populatiOfl estitNte ISPC:I

MDA Coverage, 2000-2004

60 +-- -0. 40 +--

-II

20-1--

-1 -

-l---"'~-a..-~

2000

_ __...__ _.__ _ _..___ ~

2001

2002

Year

L.__~

_.,_ _......_~--'----"L-----1

2003

2004

PART 2

Supplies Shipped from PacELF, 2000-2004 Ye11r

2000

2001

2002

2003

ALB (tablets)

2500

2000

900

2000

DEC (..bleu)

25 000

20000

tcT (test card:s)

2000

1000

2000

2004

Partnership: WHO, GSK (al!J<ndazole), JICA (DEC. ICI)

Distribution Dose of DEC and Albendazol e Tabl ets Age

No. of DEC (SO mg) t,iblcts

No. of .ilbendatolc (400 mg) tabll!ts

2 yrs

3-Syn

6-IOy"

11-15 yr.s

16-20 ylS

2 1--50 yrs

SI+

Operational Staff: Laboratory technologist. public health nurse

Counlly Prog1ammes

1 Summary

The North em Marlana Islands Is a commonweallll of the USA and comprises 15 islands This erchlpelogo Is situated between 13'-20' N and 144'-146'E. It has a land area ol 471 sq km end e population of 69 221 (2000). The population in 2004 was estlmaled to be 78 000 (SPC 2004). The capital Is Susupe on the island of Saipan. The Northern Mariana Islands was formerly part of the USÂˇadminlstered UN Trust Territory of the Pacific Islands. In 1944. the Mf prevalence was 13.5% among 243 people tested on Salpan (Knott 1944. quoted In Sasa 1976): all other areas tested were negative Only one out of 7000 surveyed had elephanbasis. The Northern Mariana Islands became a PacELF member in 1999. A blood antigen turvey of 1037 people nationwide In 2001 found no evidence of filariasis infection (Department of Public Heallh 2001) The Northern Mariana Islands was therefore declared nonÂˇendemlc No further filariasls act.vities have been undertaken since this survey.

NOflhern Mart.ina ISiands

PART 2

2 Country Profile Filariasis Type and Vectors

...

Filariasis latest status

~ · ··

~\l\lch!IW bancrolr1

Filaria type

Nocwmatty periodic

Mosquito vectors

Northern Mariana Islands

1'1taftan 4r ra1arot* ~upply Rttlfa Moug

10 N

• 1srotfds

AsuncRJn ( •

____

14S.3S-E

14S"40"E

14S WE

14 S'SO'E

14S'SS"E

Prlnton l.og9ua 15 15' N

__,

o O

100 " "•' 100 Kllolotcirt

1a• N AJoma90t1 <t)

Guguon i

Northern M oriono

IS/ands

Sor;gon 9

(U.S.)

'1.HUOn ltosolol;

AltOIOhOllQ

r.======= ===I l •S· oo'E

W N

PACI FIC

14.IO' N ~

OCEAN

a 0 144' E

Rol\ t

146 E

14S0 20'E

, .., E

10 t1il•• 10 Kt101n•tett.

14' N

Coat of Arms

C-Ountoy Prog1ammes

The PacELF Way Towards !he Elimlnalloo ol lympllaijc Filariasis In lhe Pa<~ic

General Informati on Capital cl~

saipan

Number of islands

t..end 3t'N

4?1 sq km

Languages-

English, Chamorro. Carolinian

People

Filiplno (34%), Ch•mo.ro (30%), Olin"" ( 12%), Mlcro,,.,iao (8%), Or•ohnlan (5%)

Gross dom'5tic p1oduct (GOP~ per c.aprui

S8400

Economy

Touosm. construction, gorments. hand1cnf\s

Total population by census (2000)

69 221

Popul•tk>n C"'omatC!d (2004)

18000

Poil"la!lo<i den•"Y (peoploitm' )

166

Infant morhl11ty rat.e Cpe1 100011\le births) (2000)

Maternal mo'1.altty rate (pc:r 100 000 live b1t1hs)

Not availabJe

I.de ele:pedancy ll t birth {1998)

7S,8

Lea<11ng au.1.ses of mortalrly (1998)

Diseases of the he.an, neoplasm, cerebrovascuJar diseases, pec-inatal conditions, motOf \lehkle acdde.nts

WEATHER

Ages

5 0

1S-19 10-14

25 20 15 10

M ales

70.-74

65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24

1.6

I I I

' .,

I I

. .. ~~ ~

11. 5

I I

~·

10 9 8 7 6 5

Temperatu1e

·-.

S-9

Females

0-4

c::::J Rainfall

75+

POPULATION

J 2 1 0

I 26. 9

I I

1 2 3 4

6 7

Percent

Sourw;~(C'.

9mptr*Mt: 511.p.M 19Sf ~ 1985,

RINrlfil.. ~ 198811nd 199S

3 Filariasis before PacELF, 1900-1998 60

I•

Mf PoslUve

•

Elepl\an1ias1s

MDA

... ~

•

10 0 1900

1910

1920

1930

1940

1949

Year

19S9

1969

1979

1989

1998

9 10

PART 2

Country Filariasis Activities in the 1900s before PacELF Microfilaria Prevalence and Clinical Surveys

Mass Drug Administration or Other Control Measures

4 PacELF Activity PacELF Country Plan

A 2001

D r:\_... ICT(+)~0.1'1;

>-~~--+~...._.,. ICT!+) < 0 1%

Results of Blood Surveys and MDAs under PacELF Blood Surveys Date

Method

Target

Samphrttj

No No Po!.lttvl'.! ex.amlned of positives riltc (%) Remarks

---~~--

Reference

---~

Supplies Shipped from PacELF. 200()...2004 Ye<"

2000

2001

2002

2003

2004

AlB (,.blots)

. .

DEC (table!S)

ICT (test cards)

2000

Partnenhip: W'HO

C-Ounlly Prog1ammes

The PacELF Way Towards !he Elimlnalloo ol lympllaijc Filariasis In lhe Pa<~ic Operational Staff: Departmt!llt of Public Health

N0<111e1n Mariana ISiands

1 Sum mary

The Palau archipelago of 340 islands (only nine of them inhabiled) is siluated belWeen 2'-9Â°N and 131'-135Â°E , and has a total area of 494 sq km and a population of 19 129 (2000 census). In 2004 the eslimaled populalion was 20 700 (SPC 2004) The capilal Is Koror. Palau Is the westernmost group in lhe Caroline Islands and was formerty part of the USadmlnislered UN Trust Terrilory of the Pacific Islands. The Mf rate In the villages in 1953 ranged from 0% to 37.3%, and was estimated at 24.2% overall (Pipkin 1953). By 1967, the Mf rate had fallen 10 12.6% (WHO/SPC 1974). An MDA in the early 1970s administered 5 mg/kg DEC once every other month for two

years. By 1972, the Ml rate had gone down to 0.3% in 1000 persons examined (WHO/SPC 1974).

Palau joined PacELF in 1999, and participated in a baseline antigen prevalence survey in 2001 (countty report 2002). Nine positive cases. all of them in Ngardmau village, were reported out of 2031 people examined (0.4%). Palau was therefore classified as a partially endemic country. A filariasis antigen survey in 2002 (country report 2003) found three positive cases out of 131 people examined in Ngardmau (2.3%). All 141 people examined in Ngchesar were negative for filaria.sis. Another survey in the Southwest Islands in 2003 found no positive cases among the 98 people examined

C-Ounlly Programmes

@ QEJ

2 Country Profile Filariasis Type and Vectors Filarlasis latest status Wl>chen>r0 bancroftJ

Filaria type

Noclurn.,lfy ptrlodic

Mosquito vectors

IPalau l 0

1S 11 11*1

2S Kllontt1•r$

Plalllppln l!

IOO Htlos

100 Kilom•'•"'

Sonsotol f~1Jo~nno•

Sl!a

efJ K°'or(Ortot) I

t Mtr f

u~thllptl (Ngttultab<I)

~olt

Rock lslonds ccllttt har) (Ch~lb«Mb)

PACJFJC OCEAN 7' N J• N

Tojll

•

Hrl<n ~R..f

1)1 C

Coat of Arms

IJl C

114 JO' l

PART 2

General Information Capltul city

l(oror

Number of islands-

8 principal and 252 smaller Islands

t..lnd 43/f.'I

488 sq km

languages

English. Palauan, Sonsoralese, Tobi, Angau-r

V.Ople

Micronesian. Malaya!'\. MNncsiaf\. Asian

G~s domestic

product (GOP) per capita

s.9700

Economy

Tourism, cr1ft items, ffshlng, •griculture

Total population by cenSU$ (2000)

19129

Population estimttt'd (2004)

20 700

Population density (people/k.m1) tnfant mo.rt.ahty 1<ttt' {pe-- 1000 l.iW? blrths} (.2003~

Matemal moml1ty rate (ptr 100 000 ll'IC b1nhs)

Not available

Li fe expectancy at birth (2003)

69.5

Wdino causes of mortality (2002)

Cardiovascular diseases. unknown and other, other cirrulatory diseases, oth" lnjuries, ULncer

15.76

WEATHER

700

• •

500

• •

300 200 .

• ••• ••

---

Ages

35 30

75+ 70-711 6s-<;9

SS-59

-·-

100

. . M

. . S

4$-49 4()..44 3S-39 30-34 2$-29 20-24 15-19

~ ··

68.0

•

I I

S-9 ~

c::::J Rainfall

5.2

L "

10-t4

~males

I MttlH

50-54

POPULATION

....

10 '

8 7 6

'"'

••

1 ·~ .

4 ) 2 1 0 1

:z J " s

....

26.8

6 7 8 ' 10

Per,ent

Socntt: WOrk!Om.erto, ietfV»tMurt ~ 1914 to 1990,

~41

K«ot ,92J Md J990

3 Filariasis before PacELF, 1900-1998 60

I + Ml Positive

• El"!>hanbasls

MDA

.. ..

~ 30

...

•

... 20 10 0 1900

1910

1920

1930

1940

1950

1959

1969

1978

1988

1998

Year

C-Ounby Prog1ammes

The PacELF Way Towards !he Elimlnalion ol Lympllaijc Filariasis In lhe Pac~ic

Country Filariasis Activities in the 1900s before PacELF Microfilaria Prevalence and Clinical Surveys % Mf pos(n)

Noted Cllniwl F('aturcs '% (n)

Ptimi'lty Rc-fercncc

Populatlor\IArea

031e

Tobi

1953

0.0 (81)

Sonsorol

1953

0.0(59)

Pipl<in AC (1953)

Angaur

1953

1.0 (102)

f'lpl<ln AC (1953)

P<lilleu

1953

16.6(108)

Pipkin AC (1953)

KJ>ytngel

1953

23.0(74)

P•plOn AC (1953)

Pipl<in AC (1953)

Babeldob

1953

37.3 (510)

f'lpl<in AC (1953)

KO<or

1953

2•1 (158)

Pip~in AC (1953)

Ma.ss Drug Administration or Other Control Measures

4 PacELF Activity PaeELF Country Plan For Ngardmau

A 2002

For Koror /sfand and the resr of Palau

A 2001

Type

Yedr

S.1mphng

Target

Res.ult

2001

Conwnlence

Nauonwme

ICT0.4% (!112031)

Whole popul41tJOn

,All lnhabttants Ngardmau

Cando

Who4e: popula110n

All lnh.lbftants Ngo)rdmau

Ous1er

Nationwide (except Ngardmau)

LOAS

aoo "" S- to 6·)'(':ar-dd chl'cltt'ft (e.xc~pt Nga1dmaW

2005

Results of Blood Surveys and MDAs under PacELF Blood Surveys

S-t.allfiaiuon for kialtlomand conven1ience sampling

203 1

Conw..on1ence wmpling

131

2.3

Presentation in AMS

Con\otnience s.amphng

14 1

0.0

Pteseni.otlon In AMS

0 .0

Presentation In AMS

Jun-Sep/2001

1CT

NOOJ-02

lCT

0«·02

ICT

Ng~r

Jon-July/2003

ICT

South West Islands

ConYenlence s.ampling

GD @

Palau

14 states Ngi>.rdmau (senonel site

o.•

Pos11rve ~are

from N()MdrNu Presen1a1to1" In AMA mainly

PART 2 Supplie• Shipped from PacElF, ZG00-2004 Year

2000

2001

ALB (tablets)

DEC (tablets)

ICT (test ca1ds)

2500

2000

2002

2003

2004

1000 10000

2000

1000

P•rtner>hip: WHO, JICA (DEC, IC!)

Operational Staff: Pu~lic health staff

C-Ounlly Prog1ammes

1 Summary

Papua New Guinea has about 600 islands and a mainland situated between 0!.12•s

and 141 '-160' E. It has a land area of 473 180 sq km and a population of 5190 786 (2000 census). The populalion in 2004 was estimated at 5 695 300 (SPC 2004). The capital ls Port Moresby. Many studies of Ml prevalence were carried out In Papua New Guinea throughout the 2oth century. The first survey recorded was in the coastal belt of Port Moresby and North

Samarai to the Mambare River in 1912 (Brelnt 1915). Twenty-four positives were found among 166 people examined (15.0°4 ) and elephantiasis cases were seen in varying numbers. In 1930-1935 a blood and clinical survey was carried out on Makada island.

Matty island, and Rabaul (Backhouse and Haydon 1950). The Mf rates were 22.7% In Makada, 25.3% in Matty, and 19.4% In Rabaul. In 1944-1945 a survey In !he Milne Bay area found Mf rates of 33%-55% (Hopta 1946). In 1950. the prevalence range in five villages was 0 .0%-44.0% (Bearup and Laurence 1950). Mf surveys from 1966 to 1989 found prevalence rates varying from 0% in Gembogl to 68% in the Ambunli·Dreikikir region of East Sepik province. tn 1900-1999, studies using Knoll's method, or Og4C3, were described. The Mf prevalence range was 0%-68%and

the antigenaemta range was 0%-8204. Papua New Guinea joined PacELF in 1999. In May of tha1 year. 1he Government recognized filarlasis as a public health priority. It joined forces with !he privale sector in the fight against the disease. Some privale companies (OK Tedi Mining in 1987-1989, Misima Minning In 1996-2001, Lihir in 2000 - 2001. and Porgera in 2000-2001) have complete MOAs in their areas. and some campaigns have also been conducted In the Western Province

and the East Sep1k region with external funding and assistance. More recent extensive baseline surveys wilh the ICT test in every d istrict in lhe counlly have eslablished the overall prevalence to be around 6% (country plan 2004). Papua New Guinea began MDA with PacELF in May 2005.

Papw Nil•• Gulfle3

PART 2

2 Country Profile Filariasis Type and Vectors

Nocnunally penod1c Anopheles; punctu.laUJf.

Cu/er qudJquef.nocuus Anopheles fiJraurl 11,nOp1>e1~s ko6clu&s ~ 11n1fotm1s. Ochferorarus kochl

!Papua New Guineal 0

P.tCI F I C

OCE.tlll

lqu•tor 0

ISO ""91 MU,Mh1 I

Monut I.

L• rt>n9• u AdmJtolry ~ '· l1smarck

otaM•

$t M QllltlOt Group

•

Archlp~logo

tW HOfl01tt f

• 1obo1h

'i'XN<"'9 ol''"'' GtOtlp

r r11n90 h "''"' h

SOI OMO N IS i ANO S ArofNro

Sro

14 • L.

Corol Sro source· !.f.l(lll)unr com

Coat of Arms

C-Ounlly Prog1ammes

The PacELF Way Towards !he Eliminalloo ol lympllaijc Filariasis In lhe Pa<~ic

General Information Capitill city

Port Moresby

Number of aslands

600

l.Mnd area

462 243 sq km

U ngu.ges

English 1%2%, pidgin fflglish. Motu (P;,pu~ reglon), ?1S Indigenous languagf'S

Prople

Melanesian. Papuan, Negrito, Mkronesia.n, Polynesian

Gross dom.,tlc P<Odu<t (GDP) por Cllpite (2001)

$497

Econ omy

Coffee, copper, gold, sll'l('r, copra awhin9, palm oiJ, logging

101111 populatjon by c~nsus (2000)

5 190786

Population estimat ed (2004)

5 695 300

Populatioo d<m.ty (peopltlktn')

tnf.ant morta!lty rate (per 10Q0 live births) (2000)

Mat ernal n"NXUl1ty r'<' te (per 100 ODO lrve b1rttu) (l996~

310

lJfe- expectancy a t btrth (2000)

53.0

lfSKting cauws of mortality (2002)

Pl\C'Umonia. perinatal conditions, maloria. tuberculosis, meningitis

•c

WEATHER

100

POPULATION

2.4 600

500

30 ~

400

300

200 100 0

If l

~. . .

.. F

c:::J Raiofall SOCJrce: ~~fl', ~.tf'tlm' llorf MQt-tsby 190J t.o 1991, /Wfl(4i/I Port M<llt'Viy 1891 ..rrd1990

[!ill @

Papw Nil•• Gulfle3

. . . A

Tempct'ature

D • 10

Perc.e nt

PART 2

3 Filariasis before PacELF Country Filariasis Activities in the 1900s before PacELF Microfilaria Prevalence and Clinical Surveys Population/Area

Date

Coostal belt of Port Moresby and

Nonh of Samaraf M far as

1912

Mambare Ri'o'er

Coastal beh of East Ne'N Guinea

Coastal reg10n West ol Pon Moresby as far ~ Datu

1930-1935

8titain Makada Island, New Btitaln

1950

9"'nl A (1915)

numbM, p.'ltthy dl!ttnbuuon tNHkrd 61<uil A 11915) Thm SfTlNri! 4.8 (166)

(17•); from Ntw 8nU1t0 7.6 (172)

ll<MI A (1915)

Elephan'°""" 0.7 (427)

Enlargement of epitrocttlea.t glands:

U.d<hoU<t TC. lleyclon GM (1950)

29.7 (390)

Enlargement of cphtochloar glands:

1930-1935

8us.luN lfCiJ

Primary Reference

Elephantia:sG: seen rn varying

hom NENIM Guinea 2S 3

L:lbourM from various fl'QIOns ol

Ml'0ncsia, t6tcd at R3b.1ul, New

Than smears: 14 .S (166)

1912- 1913 1913

Note-ct Clinical Features OJ. (n)

% Mf pos (n)

60.9 (220)

U.cthouse TC, lleyclon GM (1950)

Bearup.AJ. ~JJ. (1950)

20.8 (24)

Ka.aph

1950

440 (25)

Bearup AJ, Lawrence JJ. (1950)

P.uep

1950

0.0(15)

S..rup AJ, ~oJJ, (19501

K.tlvai.ana

1950

16.9 (65)

Bearup AJ. Lawrence JJ, (1950)

Purafi Delta

1950

30.0 (10)

B<•ruP AJ, ....,...,.. JJ, (1950)

Trobriand 1,t.,nds

1966

15 2 (3 10)

Oesowhz RS, Sa.lve JJ,

Saw~,) T (1966)

c.ape Glouce.1er. New Bntain

1966

172(203)

Ol'sowitz RS, Sa.ave JJ,

Sawada T(1966~

Gembogl, Ea<l<m Hfghlands

1966

0.0(73)

C..0.vl1Z RS, S..W.JJ, S.w>daT(19661

Middle fly, W('Sll!'f n

1974

52 (233)

North Ry, Western

1983

34(8001

Klllghlel al H979) canan•4N al (1983)

Arnbunti·Drcltibt. Ean Seipik: Province

1984

F'dtration; 68 C99l

1<.111ura eta!. (1984)

J<omo.-Marganrn. SHP

1991

"1trouon: 95 (220)

Pry("'k' et al (1994)

Mass Drug Administration or Other Control Measures

COl.lntry PrcstntJtlon, PacElf Meeting 2001

DEC with atbendazole

Mi:slma Mine.'$,. Milne Bay ProY'lnte

4 PacELF Act ivity Pdpua New Guinea follows WHO Guideline ond began MDA with PacELf In M.ey 2005.

Supplies Shipped from PacELF, 2000-2004

....,

At.B (tablets)

2000

2001

2002

2003

2004

8000

2000

350 000

DEC (t.1bl<ts)

800000

20000

25 240 000

3 660000

ICT (test cards}

5000

10000

15000

5000

Panners:hlp: VMO. JICA (DEC, KO. GSK (a!bendatole), James Cook Un~ty hectmlcaVfwoal suppon)

C-Ounlly Programmes

The PacELF Way Towards !he Eliminalloo ol lympllaijc Filariasis In lhePa<~ic IEC Materials

wanam alld . _____Em_....,.,... ..... ......................... ..._ __ .......... ,........,..._.....,.... fll.AHIM....~.

Operational Staff: Deparime'11 of Pubf1( Health

1 Summary

The Pitcaim Islands comprises four islands located at 25Â°5 and 130Â°W. II is a British dependency with a land area of 37 sq km and a population of 48 (2002 census). No cases were found in any of the 54 people examined in 1953 (Beye et al. 1953). In 1999 the Pitcairn Islands joined PacELF. An antigen prevalence survey of all inhabitants In March 2002 (country report 2002) found no positive cases among 33 pe<>ple examined. Clinical cases were not observed at that time. The Pitcairn Islands was therefore

classified as a non-endemic country. Additional filariasis activjties have not been undertaken since this survey.

C-Ounlly Programmes

@ [J2D

2 Country Profile Filariasis Type and Vectors Filariasis latest status

Non-endiernK

Wuclle,.,.,_bMCro _;.~~ '-~~~~~~~~~~~~~~~~~~~~~

Fllaria type

0.Umally wb-p«MXIK

Mosq uito vectors

IPitcairn

Islands I

PACll'IC OCEAN

IJI W

""I ............... . SOK•

flllcolrn Islands

(U.IC. )

ll' O)'S

• ,,,._I llO' W IJt W

Owt>tl • 1S' S

121' W

11& W

12" W

Pitcairn Island

toulomo U OS' S

uo·or w

PACIFIC OCEAN l>O'OS' W

IJO 04' W SOUl'Cr : l.~t com

Coat of Arms

• Q2Ij @

fllcai:n ISl:llldS

PART 2

General Information Capital city

Adamstown

Humbet of •slilnds

l.and CHN

39 sq km

Languages

English

People

Polynesian and European

Gt05J domestic plodUC1 (GOP) per capilll

Not avallable

Economy

Not avallable

tou.1popul->don by census (2002)

4ll

Population e"S'timated (2003}

S-0

Population d.,..;ty (peoplalkrn' )

fnfant rno«ahty rate (pet 1000 lwe bftths)

Not avallabJe

Miltemat niort.allly rate (per 100 000 lfve. btr1hs)

Not tvallable

Ofe expe-c.tancy at birth

Not available

leading cauSes of mortality

Not

available

•c

WEATHER

POPULATION

Ages

75+

700

600

65-69

SS-59

70-74 ~

500

- -

400

_...

-...........

So-54

300

200

100 0

I/ ll F

. A S

" '

l'I

45-49 41)-44 35-39 31)-.34 25-29 20-24 15-19 11).t

5-9

°""

,___. Tem~<t ture

;_,,,-----! 10 g

1 2 J •

No '-: ''~ ono/, 15'/IOI tt-.rf!d

19. 1

6 7 8 9 10

~rcent

Source: WOrld(Im.Tlf. ~.1t!N\t Arc-..-m 1940 t.o 1981. llMrfal· Atc.wn 1940 ~ 1981

3 Filariasis before PacELF, 1900-1998 60

I + Ml Positive

.. ..

•

Elephantiasis

l MOA I

...~

30 20 10 0 1900

1909

1919

1929

1939

1949 Year

1958

1968

1978

1988

1998

C-Ounlly Prog1ammes

The PacELF Way Towards !he Eliminalloo ol lympllaijc Filariasis In lhePa<~ic

Country Filariasis Activities in the 1900s before PacELF M icrofilaria Prevalence and Clinical Surveys

IMH't/.iif--~'!11~''mW:·mwD•atm~tm·a·•a·1"·=!!111m•zt¥m·'~''="·l&m..1m•%&HM'+"•"--

LThere are no eptdem1o\og.lc record)

in the

19()(h

Mass Drug Administration or Other Control Measures

...

' •"• ,

There are no recOrd$ of control p1ograms Jn the 1900s

4 PacELF Activity PacELF Country Plan

A, C and D ) - - - - - - •

2002

Sourw: PKt.tAN bi; 1004

Results of Blood Surveys and MOAs under PacELF Blood Surveys

Supplies Shipped from PacELF, 2000-2004 Voar

2000

AlB (tablets)

2002

2003

2004

DEC (l•blolS)

ICT (test cards)

Partnership: WHO

QEJ @

2001

fllcairn ISl:llldS

1 Sum mary

Samoa consists of nine Islands located at 14' $ and 172'W. It has a land area of 2935 sq km and a population of 176 710 (2001 census). The estimated population In 2004 was 182 700 (SPC 2004). Between 1878 and 1914, many scientists described the frequent occurrence of patients with elephantiasis (reviewed in Sasa 1976). Surveys in the 1920s found elephantiasis rates of 2.7%-5.6% and hydrocoele rates of 13.5%-17.1%. Many studies of Ml prevalence have been completed. Mf rates of 23. 7% on Upoli (Upolu) and 41 % on Sava Ii were reported in 1928 (Buxton 1928), and 19.2% on Upoli and 24.1% on Savaii in 1954 (Iyengar 1954). A nationwide survey of 10 129 people in 21 villages in 1965 recorded an Ml rate of 19.1%. An MDA with DEC in 1965-1967 reduced the Mf rate lo 1.6% In 1972. Seven other MDAs with DEC were completed (1971, 1982. 1983, 1986, 1993, 1994. 1995), followed by two MDAs with DEC and ivermectin in 1996 and 1997 (unpublished country data). Despite these efforts, Mf rates have never reached Oo/o. The lowest Mf rate recorded was 0. 14o/o in 5145 people tested in 1973, but a survey or more than 10 000 people in 1982, found Ml rates of more than 5%. The national Mf survey In 1998 found an Mf rate of 1. 1% (43 out of 4054 positive). In 1999 Samoa joined PacELF. Nationwide baseline ICT antigen tests in 27 villages later that year found 317 antigen-positives in 7006 people examined (4 .5%) (country report).

Samoa is thus considered an endemic country. Yearly MDAs using DEC (6 mg/kg) and albendazole (400 mg) began in 1999 under PacELF. The first MDA covered 145 952 people for a reported coverage of 90.5% (1999 country report). In 2000 a blood survey at three sites after the first MDA (country report 2001 ) found an Ml rate of 8.0% among 88 people examined and an antigen-positive rate of 8.1o/o among 676 people examined. The second MDA in 2000 covered 91 613 (56.8%) (country report). After this MDA. a blood survey in lour villages in 2001 (country presentation at Fourth Paci:LF Annual Meeting in 2002) found an Mf rate or 14.9% among 67 people examined and an antigen positive rate of 4 .8% among 1392 people examined. The third MDA in 2001 covered 119 100 people for 4

a coverage of 68.4% (country presentation al Fourth PacELF Am-.al Meebng in 2002). After the third MDA. a blood survey in 10 villages in 2002 (country presentation at Fifth PacELF Annual Meeting In 2003) round Mf prevalence to be 0.3% among 2265 people examined. and lhe antigen-positive rate lo be 4.5% among 2141 people examined. The fourth MDA covered 106 561 (60.3%coverage) (counlry presentation at Fifth PacELF Annual Meeting in 2003). After the fourth MDA, a blood survey In six villages in 2003 found an Ml rate of 0. 7% and an antigen ~p ositive rate of 1.6% among 881 people examined. Samoa completed its fifth MDA in 2003, with 140 855 people treated (79.7%). The final evaluation survey of 2004 found Mf prevalence of 0.4% and antigen prevalence of 1.1% in 12 719 people tested.

C-Ounlly Prog1ammes

2 Country Profile Filariasis Type and Vectors Fllarlasis latest st.Jtus

Endemic

Fllaria type

w"'"""""' b41>ao/lJ 01utl'lal>f sub-pc-riodic

Mosquito vectors

Aede< po/yflesl<'rul• Aedes -/eruls -

OCf{)fNCU1

At!des samo.MUS

Aede:t tuw11.lt>

112 JO· w

1/l•JO' W

PACIFIC OCEAN

13 JO'S 0

,.•,...,,

10 Mlle•

10 IC1Jo11t•t•n

Copt Tua11vl

1letotog1 ltti i4Pol1md Strott

ApOlimoo

Nol tt.lf

--~--~

0 Afonono

\'.:'.:::::O~~~i;:E!!lii~~1 · s

ISamoa I Coat of Arms

SOurteo. w~'

'T""h'o 0

~<91o(

PART 2

General Information Capital city

Apia

Number of bl4nd5

2 Islands and 6 1.sfou

t.and a1ea

2.93S sq km

l.ar,guages

Samoan. Englts:h Sa moan ~93'°), Euronesians (7%)

People Gross domestk product (GOP) per capitl (2000

~1443

Economy

Tourism, food processing, building materials, auto pans

Total popula tion by census (2001)

176 848

Population estlm11ed (2004)

182 700

PopuJatJon densiw (ptoplelkm' )

Infant mon.afity ro>tl! (pef 1000 I~ births) {2001 )

19.3

Matemal mon ahty rate (per 100 000 l1ve births) (2002)

19.6

Llfo "'P'='"'Y 61 blnh (2001)

12.8

leading caus~ of mortafity (2002)

CerebcovaKular d~ases, septicaemia. congt'fttve heart failure, pneumonia., myoc.ardla.1 lnf8tCtion

•c

WEATHER

35 30

POPULATION

Ages 75+ 70-74 6s-69

~malos

4.5

60-64 25

20 15 10 5

0 F

55-59 50-54 45-49 4().44 35-39 3()-'34 25-29 2()-24 15-19 10-14 5-9 ~

Temperature

10rt11CAmal'f,

s~: 11

AfW 1!90.iNJ 1990. Ra1nf111 "IJia J 890 .irid 1990 ~re:

3 Filariasis before PacELF, 1900-1998 60

I•

Mf Posltivt

• EJ4!iphantiasis

MOA

ec: 40

20 10 0 1900

•

1919

1928

•.

• • 1909

1937

1947

·~·

19S7 196S Year

1971

•• • ••• • 1976 1983

t t •••

.........

1990

C-Ounby Prog1ammes

1996

The PacELF Way Towards !heElimlnalion ol Lympllaijc Filariasis In lhe Pac~ic

Country Filariasis Activities in the 1900s before PacELF Microfilaria Prevalence and Clinical Surveys £a5ttrn (Aml!!lioan) and Wt$trm 5.lmob

1923

28.7 (4294)

Elepl>antiMd. 2 7 (4294>

Upolu

1928

23.7 (1103)

Elepllanrio= 5.6 (1103)

1964

21 1 (20n)

~nllydbt.'1

1965

19.1{10129)

CovnttydiJlit

1967

1.6(42 697)

CoUntJY do'IUJ

1968

1.3 (5371)

Countrydalil

21 Wlages

<>'Conner fW 11923) 8u<IOn PA (1928)

1969

1.7 (7393)

Colintry dara

1972

0.24(6361)

Country dcnoi

1973

0 14(5145)

Country da1.a

1974

0.33 (30 272!

Country da1a

1975

2.1(11499)

Country data

1976

1.4 (3649)

Countryda~

28Wlages

1979

3.8(838S)

Kimura E. Spears GFS. Singh Kl (1985)

27 "'1119es

1982

5 J (10 361)

"'mur• £.Speirs GFS. Singh IO f'I al (1992)

17 vr.llages

1983

4.2 (9627>

3• ,(jl•ges

1984

2.8(11

Kimura£. S~a1s GF:S, SJngh IO et al (1992)

26Wlages

1987

2.3 (13 708)

.Kimura E. Spears GFS. 5.ingh Kl et al (1992)

1993

4.3 (10 256)

khlmori K(2001)

1994 1995

1.2 (10 112) 1.9 (4551)

kh1motl K (2001)

1996

2.2 ('S997)

khrmori K(2001)

1997

1.7 (8305)

kh1m0ri K(2001)

1998

1. 1 (4054)

khlmori K(2001)

Natfonwide

Ximura E. Spears GFS. Singh Kl et al (1992)

klumon ~ (2001)

Mass Drug Administration or Other Control Measures Population/Area

Date

ActiVJty

8/19651()11966

DEC MDA 5mg/l<g once a week for 6 '~ follovml by monthly dooe for 12 Monttis

1/1971

DEC MOA 6mgllcg monthty for 12

month•

Ot'talls

Primary RJ.>f<!rcncc

94 6 covtfaige for flrs,1 ~ 20.4 tookail 18 dOS<!S 98.8 <overage for l dOsc., 46. t ca.oerage for all 12 doses

Kimura E. Spear< GFS, Singh Kl ( 1985)

Kimura E, Spea.rsGFS, Singh KJ(l98S)

1982

DEC MDA 6mgil<g 1 do,.

Kimur• E. Spo•rs GfS. Singh Kl.: •I (1992)

1983

DEC MOA 6mglkg 1 dose

Kimu1a E, Spears GFS. Singh Kl et al 0992)

1986

IGmura E. Spoacs GFS. Singh Kl" al (1992)

"°"

Nationwide

1993

DEC MDA 6mg/l<l) 1 DEC (6mg/l<g) »ngle dose treatment

NatJOrrwidc:

1994

DEC (6mgl'<g> ,..,gi. do.., 11.. unen1

khimori K(2001)

Nattonwide

1995

DEC (6"¢9) stngie do~ ueaunen1

kh<mon K(2001)

Naoonwide:

1996

DEC(6mg/l<g)andl"""""tin (200u!)'l<g)

klwmori K(2001)

NabOn\vide

1997

DEC (6mglkg) •nd ''''""tctin

kt.mori K12001)

(200u~g)

kt.-• K(2001)

PART 2

4 PacELF Activity PacELF Country Plan

1999

Convtnkoce

Coun\l')W1de

ICl: 4.5% (311/7006)

2002

Clust~r

Scnunel sites

ICl 4.S'll (9612 141), Ml 0.3% (&'2265)

2004-2005

Closter

Stratified SUM'!y

2006-2007

complete

•800 all 5· to 6-ytar·old chlldrtn

Results of Blood Surveys and M DAs under PacELF Blood Surveys

ICI ICI

27 virt;,ges

co~1amplc

7006

317

4.S

BS99 Rl!Pon

Sen1mel sites (3 villages)

con\l"'eNence sample

676

8.1

BS R<port (Ma)'/01)

2000

Stn1.ln~I

Sites (3 v1ll.Jget.)

con~51mple

BS "'Port <Ma\Y'O 1)

2001

ICI

St'ntin~I

sctes (4 ti11llages)

conveNMCe sample

1392

P1esentation In AM4

1999 2000

2001

Sen1lnel sues (4 'l'lllages.)

ronvervence "Sample

14,9

Presentation 111 AM-4

2002

ICI

SCnt1nel sittS HO villages)

con'ltl"llMct! -sample

2141

•.S

Ptt'S«llilt1on 1n AM4

2002

Sent1n('I sites {10 vil!itge,s}

conW!l\ll!Oce sample

2265

0.3

Presentation tn AM4

2003

ICI

Senonel sites <6 '"111ages)

con~e sample

831

1.6

Presentation Jn AMS

con~c~ samp!~

831

BS R<port (Email 30/07/03)

stratified duster sampling W'ltiflcd d1.atft Ja!'npflf'!g

12 719

144

M"N Repon (l l/04'05)

12 ?19

0.4

M"N Rcpon (I l/O<VOS)

90.5

84.5

96.0 96.2

MOH R<po~

Presentauon ln AM4

2003 2004

St'nttot'I Site (6 ..,11agt'$)

ICT

~area

2004

Wholtarea

MOAs

1999

MDA99~

161 298

1n111

2000

2nd

161 298

174 713

95 196

59.0

91 613

56.8

52.4

2001

3td

174 140

176 710

1271!18

130

119 100

684

67.4

936

2002

4111

176848

178 707

115086

65 I

106561

60,3

59.6

92.6

~tDt1on 1n AMS

2003

5111

176848

180 703

150 596

85.2

140855

79.7

77.9

93 5

Pres.eotation in AM6

152022

94.3

145 952

•fSt.ma1<!d ~1'.lming <Olhl.aflt growth r•tt btl.Wf'tf\ latest Cen.iU'!. and 2004 l>Ol)ll.lllOl'I estimate (SPC)

C-Ounby Prog1ammes

The PacELF Way Towards !heElimlnalloo ol lympllaijc Filariasis In lhePa<~ic MDA Coverage, 1999- 2003

1999

2001

2000

2002

2003

Year

Supplies Shi pped from PocEl F, 2000-2004 Vear

2000

AUi (t• bleu)

2001

2002

2003

2004

DEC (table15)

170000 1 260000

170000 1 200000

200000 1 500000

fCI' (tM t cards)

3000

5000

. . 15000

P1trtncrship: WHO, U.SK {a~ncf.ll?ole), JICA (0£C :ind ICT), JOCV {VoluntctrS)

Distri bution Dose of DEC and Albendazole Tablets ~" 2..;I

No. of DEC (50 mg) tablets

No. of a lbendarole {400 mg} tablets

S-9

10--14

15-19

2o-49

50+

Registration form

-·

Utl•\ftU,Ml'ICI. •I n1o1'4.U.tt..\ Wiii t 4 M\Ull,IM.,,\ t) "''-"'I\

Al'1 Kt';til'tA ~A

f\.,\ L~OOA \Al

L-\L,r.J.e 'I() Lf CA.~CGASE() I.I! '1l"MU 'M.t'R -l"A

!! Al \ r \\L\1\/1\.,.,,.,.....\1(»11-

'" lU f11

Ul\HUI \_\fl

r1,nA11C1'Ur~111 1•

• ~••11oooo.o_

I -

.................. '''"" ' " ' \111\l lJ

. h

~·!!b_1y41u:' "'

\!)11'-IWr+..u.urA•'

~:~~11:li\'t,'l.cl

••

_..........,_,

PART 2 IEC Materials

--==------

- ,....

°'

-~·--

........

T·shlrt

.........__..

QeS'•A

FAAINUGA VAi 0 LEMUMU

UIPUIA MAI I LE MUMU

ASO: Upolu 4-10 Iulai 1993 Savail 11· 17 Iulai 1993

E MANAOMIA LE INU FUALAAU 0 TAGATAUMA

''.E sili le Puipuia i lo le Togafltia" i' ·

T•wt•" Lau Tino

C-Ounlly Prog1ammes

The PacELF Way Towards !he Eliminalloo ol lympllaijc Filariasis In lhePa<~ic Operational Staff: filariasis control unit.

h~alth

inspector, pubhc

h~alth

nurses

1 Summary

The Solomon Islands is composed of 992 islands situated between 5•-12·s and 155°170' E. It has a total land area of 28 370 sq km and a population or 409 042 (1999 census). The population in 2004 was estimated at 460 100 (SPC 2004). In 194S, the Ml prevalence was 10.2%on Guadalcanal. 10.2% on Malaria, and 31 .5% on San Cristobal (Schlosser 1945), In 1965 the prevalence was 28.5% on Guadalcanal and 40.2% in the Florida Islands (Mataika 1965). Large-scale vector control spraying programmes for malaria eradication were conducted in the 1960s and 1970s, ellmlnating

one vector. Anopheles k.ollens;s, and possibly interrupting the transmission of filariasis (Webber 1975). The Solomon Islands Medical Training and Research lnstltute (SIMTRI) conducted a clinical survey in all provinces except Malaita and Choiseul 1n 1998. Information was

collected in two ways: through peripheral health workers and through surveillance wot1<ers. The health workers reported 104 elephantiasis and 40 hydrocoele cases. The average age was 51 , with a range of 4 to 8 1 years; 67% of the cases were among males. The

surveillance workers reported 66 elephantiasis cases and 10 hydrocoele cases. The average

age of cases was 48, with a range of 14 to 70 years; 58% of the cases were males. In 1999, Solomon Islands joined PacELF. An antigen prevalence survey later that year (SIMTRI 1999-2000) found no filariasis antigen-positive cases among 3035 people

examined In eight provinces. In 2001, a survey was conducted in remote villages or Western and Temotu provinces. which were not fully covered by the residual spraying programme

during the malaria eradication period. Five hundred people in the Western Province and another 500 in Temotu Province were examined by ICT; all were negative. Solomon Islands was ciassifred as a non-endemic country according to these survey results. In 2003, 11 364 people were surveyed in the 10 provinces, and 30 (0.26%) were found 10 be positive.

C-Ounlly Programmes

@ I t 83 I

The PacELF Way Towards !he Eliminalloo ol lympllaijc Filariasis In lhePa<~ic

2 Country Profile Filarlasis Type and Vectors Filarlasis latest status

Fllarla typo

. ..

Mosquito vectors

!Solomon lslandsl Onlone tovo ( \,.. Atolr .... •

PACU:IC OCEAN

,..___, ......

IOOMtl••

100 Kllo.-et•n

,Oufl 11

...

HJpa•t • ....fttlll r1...t .io • l4'14'

Htttd/J

Santo Cruz 0 V••Pll• Islands

160' [

Coat of Arms

16S E

a Von1lolo

A"rll.O.

110 E

PART 2

General Information Capital city

Honiara

NumbC!r of i~lands

992

Land at<>a

28 370sq km

t.angu.>ges

Mcl:inosian pldgrn.

!'wple

Melaneslan (95%), Pofynesian (4%), Asian and Mtcroneslan (1'%)

Gross dome1tic produCI (GOP) per c.lpit.a (2002)

S494

Ec;onomy

Timber. fish, palm 011

Total population by census 0999)

4-09 042

l'<>P"latioo estimated (2004)

460 100

Population density (peoph~/ltm,)

lnfan1 monahty raH~ {peor 1000 lrve bll'lhs-) (l999)

Maternal mortality rate (per 100 000 ltve births) (2003)

295

t.ift t):pt(t4ncy 6t birth (1999)

61.1 N~p&asm.

Leading causes of mortalil)' (1999)

•c

700

600

- -

120 Indigenous tnnguagcs

nconbtal avses, m11!.aria, cardiovbsculat diseasM (CVA as i.hc respir1itory dls<!a5e$ (pneumonia as ihe l~ing c.1u.1se}

l~ ing cau~).

WEATHER

500

Engfl~.

- -

POPULATION

Ages 7$+ 70-74 65- 69

Females

Males

55-59 SO-S4

400

300

200

100

=..

.. ..

0 F-

10 5

.. A

0 0

--+-- Temperature

45-49 4C>-44 35-39 30-34 25-29 20-24 IS-19

• I

5-9

• I I

·-

• .,~

"""

•

52. 0

I I

•

1 ~1 4

Q-4

c::::::J Rainfall

2.6

6')-64

•I

10 9 8 1 6 S C 3 2 I 0

I 45. 4

••

I 2 J .1 S 6 7 8 9 10

Percent

Solllftt>: WorloCNrNrt. r~r~ Hooiitta 1951 a"" rm, k•-nf.0; Holl~ J951w1!J'JO

Solomon lslandS

Counlly Prog1ammes

The PacELF Way Towards !heEliminalloo ol lympllaijc Filariasis In lhePa<~ic

3 Filariasis before PacELF, 1900- 1 996 60

I+

• Elephantiasls

Mf Positive

i DOT I

;;; " 30

...e 20

...

•

0 1900

1909

1919

1929

1939

1948

1958

1967

19?6

1986

1996

Year

Country Filariasis Act ivities in the 1900s before PacELF Microfilarla Prevalence and Cl inical Surveys GuOOalcanal

1945

10.2 (15?)

9.6(S84J

Schlosser RI (1945) 5cNos1« RI (1945)

Maf.cltta

1945

San Ctistobal

1945

31 5 (558)

GuMlalanal· C-0astal

1965

28.5 (245)

flephonrnlsi>: 0.8 (245)

Mo1'r~1JU

Guadalc.a.nal· Bush

1965

25 0 (88)

Eleph•ntialls: 0.0 (88)

Ma,..i:aJU (1965)

Aent\8 and Bellol'la, Ten;,ru

1965

1.3 (77)

El<phanU.S.S:

o.o<2•5)

Ma1'oka JU (1965)

Aondahland

1965

40.2 (266)

Elephanti;ms: 3.0 (266}

Matal"taJU (1965}

Schlossec RI ( 1945) (1965)

Mass Drug Administration or Ot her Control Measures

4 PacELF Activity PacELF Count ry Plan

ICT(+ ) • 0 1%

,__.. ,(;\_... v -...

A 19982001

ICT(+ ) < Ol'll

1998·2001

Clustet

Notionwidt

ICT 0% /0/4035)

2003-2004

lQAS

Nabonwfde

ICT 0.3% (30/11364)

2006

Comptt'le

14 •OO all S· 10 6-year-<rld cMdten

Results of Blood Surveys and MDAs under PacEL.F

2003

Whole area (t OprOYfna!S)

11 364

Gov. AnnlJ.o'll Reporl 2003..2004

SuppllM Shipped from PacEU:, 2000-2004 Y('Jr

2000

ALB (tabl•lS)

. .

DEC(1ablets)

1cr (l°'t carck)

2001

2002

2003

2 400000

3000

15000

2004

6000

Partnership: WHO, JfCA (DEC and tCT)

Operational Staff: Vector Borne Di.s~ase Conlfol. SIMTRI

Solomon lslandS

C-Ounlly Prog1ammes

1 Summary

Tokelau consists of three atolls located between 8°- 1o•s and 111°-173'W. Tokelau 1S11 non·seff-govemlng territory under New Zealand. It has a land area of 12.2 sq km and a population of 1537 (2001 census). In 2004 lhe population was esti mated at 1500. In the early 1900s, surveys of the three atolls revealed that filariasis was endemic. with

rates of 18.8% for the whole population and 22.2°4 for males over the age of 20. However, no cases of elephantiasis were found (O'Connor 1923 and Buxton 1928). In 1955, the Ml rale remained high, al 25.8% for adults (Laird 1955). All atolls were endemic according to a survey in 1959 {Laird and Calles 1959, quoted in Iyengar 1965). The Mf prevalence rates were 28. 1'lo among 32 males and 12.5% among 40 females in Nukunonu. 46.9°/o among 32 males and 14.3% among 42 females in Fakaofo. and

38.9% among 36 males and 18.2% among 44 females In Atafu. A nationwide prevalence survey of 1243 people In 1994 found only one positive case (a Samoan imn1igrant), in Fakaofoin. Anationwide MDAwas implemented In 1994.

In 1999, Tokelau joined PacELF and a baseline antigen prevalence survey of all lnhabitanls was conducted (Ministry of Health). Of 1311 people in all atolls examined, only one positive

case was found, in Nukunonu: a female Tuvaluan immigrant. Tokelau was classified as a non· endemic country according 10 this survey result. Additional filanasis activities have not been undertaken.

PART 2

2 Country Profile Filariasis Type and Vectors

Wu-

Filariasis latest status Filaria type

boll(/1)/o

D1um.alty sub-periodic

···-

Mosquito vectors

e lT~lu v. ' o.......>S H •

-U< oloto-111

• 4*\

• <\'\

l/l"fO~··

Tokelau

A f

I OU

o U!too I J•·-" '

ro11110>hf'l

"''°•'.:;-•.,,.«.. ''tot

r ACl l'IC l)Cf; A llo' N.utw.nionuu

l'AC.11-' I C QCliAN t 6'S

~ "'

,,,.,ual~""''~

12 11·w

t7t

so·w

~Alali1

IT o k e l a u I

Ml Koo

17l'lt*

171

O·

•r s

.,.w

>O'S 2 "' 1 JC•

• 1o·s

,__ ...........211...

0 0

Nui.unonu Vlll.a

M4'1t1hD~o No~...

l,fuh1IA1uo

TrAlllOO

• 14'$

171 .SO"W

_,_

MCXll 1-

~J.·· Motu t ·~ttAIN

General Information Capltaldty

Nukunonu

Number of islands

3 atolls

I.and arei

12 sq km

languages

lOktlauan. Enghsli

P<:oplo

Polynesian

Gron domestic product (GOP) per capita (2003)

1612

Economy

Philately, copra, ha ndicrafts, fishing licences

Total popula lion by census {200 l)

1537

Poputa11on estima1td (2004)

1500

Popula11on density (people/km')

125

Infant mof1ality rau:• {J)ef 1000 IM!' bir1hS) (1997 2000)

Matemal mortaliry rate (per 100 000 live b[nhsl ~2001-2002)

Ult ""pocuncy Al blnh (1996)

69.0 Diseases of t he circula tory system, dlSNSt>S o f the respiratory system ,

t.u.ding c.au.JeS O'f momliiy (199G-l 995)

~smic di~scs.

ill-cit-fined and undi3gn<l'S4!d condiUora. congcnit41

anomalies Sour<-.: C'Olllltl)'HHA!h ft){OON(.(ltl Profile 20(}.( fWHO ~0~ (Of 'he \'lt°'Sffl'tl l'dlC). S«Yl'c.irlfl ol theP«)/ic C'ommt.il'll!y(SPO,

~ P'iol~r Of>srklil(J(W

C-Ounlly Prog1ammes

@ Qill

The PacElf Way Towards !he Elimlnalloo ol lympllaijc Filariasis In lhe Pa<~ic

WEATHER

POPULATION

Ag°' 75+ 70.74 65-69 60-64 55-59

600 t;::+:+::+:=:+:=:-=::;:::;::::e::::e::::e:;::::;;~ 30

• •••• •••• •••

Males

'·· ,..

50-54 300

45-49 40-44 35-39 30-34 25-29 20-24 1S-19

200

100

O.f.--1---1~.+--+---!~.+--+-~~i--l-~~ O

c::J l\ainfall

·-

6.7

.51.6

5-9

0-0

-e- Temptitature

Females

,_, _

10-14

•

I J

10 , !!I 7 6

s •

l 2 1 0

1 2- l 4

6 7 8 g 10

Perc.e nt

3 Filariasis before PacELF, 1900-1994 60

I•

MJ Posilive

•

Elephan1.asis

l MOA I

ec 40

•

.Si 30

"'>

•

• •

10 0 1900

1909

1919

1928

1937

1947

1956

1965

1975

1985

Year

Country Filariasis Activit ies in the 1900s before Pa cELF Microfilaria Prevalence and Clinical Surveys 3 atolls. 1/3 population

1923

18.8 (320)

agt!' < 20; ~1e1;

1928

S.9 (17)

•90 > 20: m.>les

1928

22 2(90)

Budon PA 11928)

agt < 20,

ma~

1955

0 .0(3 1)

Laird M (1955)

age >20, ma"'1

1955

25.8 (66)

u ird M ( 1955)

< IOyrs

1959

0 .0(31)

l.1<1d M ( 1955)

•90 < 20yfs ageo > • ?(Jyr's

1959

4.5 (67)

Lo<1d M ( 1955)

1959

25.2 (226)

l.aHd M (1955)

Nationwid'

1994

0 1124 3)

Country date

agt

Eleph•nriasl>: 0.0 (320)

Mas.s Drug Administration or Other Control Measures

O'Conne<IW ( 1923)

Bux.ton PA (1928)

41.7

PART 2

4 PacELF Activity PacELF Country Plan

_... --.

ICTH J "' 0.1%

A 1999

ICT(+) < 0. 1%

Results of Blood Surveys and MDAs under PacELF Blood Surveys Date

M"thod

Target

S.:impllng

No No Positive . d rt (%) examine o1 pos ives rdte

Rem<lrks

Rofercnctt

. . . . . . .IJll!l!ml!!!IElll---~im:mmmll Supplies Shipped from PacELF, 2000-2004 Vear

2000

2001

2002

DEC (1â&#x20AC;¢bl<1S) ICT (test cards}

ALB (tablets)

2003

2004

Partnership : WHO

Operational Staff: Public health nur>e

C-Ounlly Prog1ammes

@ Q2D

Summary

Tonga consists or 169 islands located between 15"-23"S and 173"-t77'W ll has a land area of 147 sq km and a population of 97 784 (1996 census). In 2004 the populatiop was esbmated al 98 300 (SPC 2004). Filariasls has long been noted to be prevalent In Tonga. In 1785, Captal~ Cook on his voyage in the South Pacific wrote of the common occurrence of enormous swelling of the leg,

arm. and scrotum among the natives of Tonga (Iyengar 1965). Elephantiasis was still reported to be common well into the 1900s (Leber and Prowazek 1914, quoted In Sasa 1976). Jn 1896 Thorpe discovered the absence of nocturnal periodicity of the South Pacific strain of Wuchereda bancrofll. He also round the Ml prevalence in adults to be 28.8% in Nomuka, 46.9% In Liluka (Ha'apal group), 20% in Vava'u, and 29.2% In Tongatapu. In 1925 the Ml prevalence was 13.5% in Tongatapu, 14.3% in Ha'apa1, and 46.2% In Vava'u (Hopkins 1925, quoted in Buxton 1928). In 1957 hospital patients were randomly tested and the Ml rate was 28.2%-48.5% in Vaiola Hospital. Tongatapu. and 49.6% In Ngu Hospital. Vava'u (Iyengar 1965). Surveys of almosl 10 000 people in 1976 found lhe Ml prevalence to be 17.4%. An MDA was started In May 1977, and the post-treatment survey In 1979 found that the Mf rate had fallen lo 1%. A follow-up MDA survey from October 1983 to January 1984 in Ha'apai, Vava'u. 'Eua, Tongatapu, and Niualoputapu found lhe rate to be 0.4% (unpublished counlly report), In 1999 Tonga became a PacELF member. In 1999 to 2000. a baseline survey using ICT antigen tests found an antigenaemia rate of 2.7% among 4002 people examined (2001 country report). Tonga is therefore classified as an endemic country. Yearly MDAs using DEC (6 mg/l<g) and albendazole (400 mg) began In 2001 under PacELF The first MDA covered 77 595, for a reported coverage of 7g.4% (country report 2002). The second MDA in 2002 covered 82 023, for a reported coverage of 83.9"A. (country presentation at Fourth PacELF Annual Meeting Jn 2002). The third MDA in 2003 covered 88 752 people (90.8% of the population), and the fourth MDA in 2004 treated 83 719 people (85.6% reported coverage). Random blood surveys In 2003-2004 found 96 antigen-positives oul of 3896 on the main Island (2.5%) and two positives out of 59 examined in Ha'apaf."Oua (3.4%).

PART 2

2 Count ry Profile Endt!mlC

Wuch!YefJoJ bdncr0h1

Dlu1nally sub-perlodfc ANes: rong.>eo Jledes tabu A~ OC&lf)KU.S

91o1."9"

Mo'1n90'0M. • .llA'O

JC,

t uohoto I/lo

lokur.

l'orv.

ao· s

NM".ul o H-lo 111 P

t1u090 Ha'opo1 llS W

N1uo1opu1opu Group

.,,,,..,

'ttt<ltt•

1rs

ronoHuo • .Tnot.,,,.•9"

fotWt>to•°" MonjO 10tt.l"'t0l

,.Hung• toa90

H1uorop11topu•

'C/l~cY' IJot,_o

1ufl9SJ'' ...

Ho 'opol Group 0

!oloM

loM•o'd ,.,!'ll"_,!!lllu~o

lol

: (oloPo Ttltt nonoo

'"''''"••

°.__.,..._,is "'

o 10 "1 ""' Ton901opu 0~--10-1ta Gtoup

11$' 1$'W

.........

Vovo'u

Group

fottuolti

Vovo'u Gioup

•1o•v

_;,,..··

Loll'·

SH1

,, , $

PA Clf'IC OC EAN

SK•

Koo

100 H.S.•

,.,.~

Ho'opol Group

17t" W

1n· w

,. tl(ut o

.._~ulo

lonuofo 'ou.

N uku' alofa To.topu Ton901opu Group

,, .. w

(.Ho'ot>O ~

II' S

'C••

11s· w

11.)

IT o n ga l

Coat of Arms

C-Ounlly Prog1ammes

The PacELF Way Towards !he Elimlnalion ol Lympllaijc Filariasis In lhe Pac~ic

General Information Nuku'aJof;)

CapftaJ oty

Numbet of blonds

171

lanci area

649"' km

UngvngM

Tongan, English

People Gross do.,.,tK P'Odu<t (GOP) per capita (2002)

Polyoesian S1331

Economy

Agriculture, fishrng, tourism

Tor>! pgpul•tlon bl' <tnsus (1996)

91184

Population estimated 42004)

98 300

Population density (people/km')

ISi

1nfan1 mortality tate {per 1000 hvc births) (2002)

Matt'!mat mortality rate (per 100 000 fiYf! birtM) (2002)

9.8 18.2

Lift expectancy -at birth

71.0

leading causes of mortality (2002)

OiseaSH of the circulatory system, ntoplasms, symptoms, ~ ns and illdefined conditions, d iseases of the respiratory synem, endocrine. n utritional and meta~1c collditions

·c

WEATHER

Ag.es ?S+ 7~74

6$-69

SS-59

60-64

300 +-~~~~~~~~~~~~~~-+

SG-54 45-49 4G-4A 35-39

200

30-34

100

2~2·

10-14

O+--+--t~+--+--t~t--+--+~t--t--+-+

25-29 15-19 5-9 ()-4

c:::::J Rainfall Sourw:~e. r~•f1A"'.

Fcu'...xirv

,ga,

f(.;,if.o NWlr.t!of• 1926 ro 1981

QEJ i)

Tonga

rm.

__.,._ Temperature

POPULATION

PART 2

3 Filariasis before PacELF, 1900-1995 60

I• Ml Positive

MOA

•

• S ephantiaStS

•

10 0 1900

1909

1919

1929

1939

1949

1959

1969

1977

198S

1995

Year

Country Filaria5i5 Activities in the 1900s before PacELF Microfilaria Prevalence and Clinical Surveys Population/Ate.a

Nttk>nw1Cft

Na1IOl'lwide Ha-.apa1, 'l/1Na'u, Eua, Tongatapu. N1Ua1oputapu

Date

1976 1976 1979 1983-1984

% M, pon {n)

17.4 (9882)

Nott•d Olnical ~atures % (n}

Prlmtuy Rt'fCrl.:!nCCl'

Cc!Yl'l 1ry Rcpon

0 1(899)

Se1115 (19771

1 0(9676)

Coum .y Rlpori

0.3 (4875)

Country RePQn

Mass Drug Administration or Other Control Measures

e11«.ffi·''f~4' 1111,:1;a1111 111._ ~tlonwide Countrydata ~

C-Ounby Prog1ammes

The PacELF Way Towards !heElimlnalion ol Lympllaijc Filariasis In lhe Pac~ic

4 PacELF Activity PacELF Cou ntry Plan

ICT{ + } ~

0. 1%

Target

Result

Convenience

Main island

ICT: 2.7% (10814002)

0US:tl'1

5entlnel !ti~ 3 villages

2006-2007

dust«

Sentinel sites. Stratified wrvey by island group

2007- 2006

Complete

2500 al 5· co 6-year-d'Mldreo

Type

Vear

Samptin9

1999-2000

2003

c D

Results of Blood Surveys and MDAs under PacELF Blood Surveys

1999-2000

ICT

Moinl~•nd

COM'~l<'nc~ sam,.

4002

108

2.7

De<Oh•ug 04

ICT

M>ln~l.!nd

1a_f\dom sampl1t1g

3896

2.5

200•

ICT

Ha'apaj ·'Ou.a

random sampltng

3.4

MOA R<j>on 2001

~·(Aug 2004} Mmtty of Health Repon {Email I IJ'Ol,IM)

MDAs

2001

1st

97 784

97 526

8H10

85.2

77 595

79.•

79.6

93. l

Presentation in AM4

2002

2nd

97 784

90720

92.8

82 023

83.9

90.4

Pi estntation rn AM4

2003

3rd

97784

gs 042

93660

95.8

88752

90,8

90.5

94.8

Annual Rlport 2003

2004

4th

97 784

83 719

85.6

85.2

98 300

AnnU>I Rlport 2004

•fS1if'll.tltd assum.ng «WlMlt gl'ON!tl 1itt ~ l.llf1:t CMW.\ arid 2ooa Pol)l1hruon e.\IJIMU! CS.PO

MDA Covorago, 2001 - 2004

l so r:-=:-=~~iiiiii~~:-=:-=:-=:-=~ 60

~ .,.

+-- -

20 +-- -

2001

2002

2003

Year

om @

Tonga

2004

PART 2 Suppli~s Shipped

from PacELF. 2000-2004

Year

2000

2001

2002

2003

2004

ALB (1able1s)

12 600

125 200

100 000

DEC (tablets)

1 600000

1 000000

1 000 000

I 000 000

2000

3000

2 000

ICf (test cards)

Partnersh1p: WHO. GSK (a!benc!Jtolcl. JtCA {t>EC and 10').

~ (Volun1cers)

Distribution Dose of DEC and Albendazole Tablet. Age

No. of DEC {SO mg) t,-,blcts

No. of ;1lbc-nd.."lzole (400 mg} t<lblc-ts

3-7

8- 10

11-15

16-20

21 ..50

51-llO

R(lgiatratlon Form

---------- ----

ICA)lomoW'• DiWkf

• Longolongo

C-Ounlly Prog1ammes

@ QEJ

The PacELF Way Towards !he Eliminalloo ol lympllaijc Filariasis In lhe Pa<~ic IEC M.aterials

KOEMAHAKI KULOKULA

PART 2 Operational Staff:

Pu~lic

health staff

C-Ounlly Prog1ammes

1 Summary

Tuvalu consists of nine atolls situated between s•-1o•s and 176°-179.E. It has a land area or 25.9 sq km. !Is population was 9043 at the 1991 census and 9561 at tl1e 2002 census. In 2004, the population was estimated at 9600 (SPC 2004) Surveys carried out in Tuvalu In 1919 and tl1e 1920s showed Ml prevalence to be very hlgl:L and elephantiasis and hydrocoele common (McNaughton 1919, O'Connor 1923. Buxton 1928). Ml rates remained high unhl lhe 1940s (Venner 1944, Lewis 1945, quoted in Sasa (38%~6%)

1976) and 1960s (annual report of Medical Department, quoted in Sasa 1976). The Mr prevalence in 1971 was reportedly 14.7% (unpublished country data). The following year, an MDA using DEC was carried out. The post-treatment survey in 1973 found t11e Ml prevalence to be Just below 1% (First PacELF Annual Meeting in 1999). An MDAuslng DEC was implemented 11 1992-1993. In 1999, Tuvalu Joined PacELF and a baseline blood survey using !CT antigen tests was conducted in Funafuti; 22.3% of the 574 people tested were positive. Tuvalu is therefore classified

as an endemic country. Annual MDAs using DEC (6 mg/kg) and albendazole (400 mg) began in 2001 under PacELF The first MDA covered 6742 people, for a reported coverage of 81 .2% (country annual report) The second MDA In 2002 covered 4467 people. for a reported coverage or 46.7% (country presentation at fifth PacELF annual meeting in 2003). During tl1e second MDA in 2002. a blood survey in Funafuti found 70 positive cases out of 318 people examined (22.0 o/o) (country presentation at Fifth PacELF Annual Meeting in 2003), The third MDA In 2003 treated 7896 people (82.6% coverage) and a blood survey tl1at year found 114 positives in652 people tested (17.5%) (2003 annual report). In 2004, the fourth MDA treated 8000 people (83.7% coverage). A blood survey of the whole population in 2004 found that 973 of 8173 people tested were positive ( 11.9%).

I 200 I @

Tuvalu

PART 2

2 Count ry Profile Filariasis Type and Vectors F11ariasis latest status Filaria type

Mosquito vectors

_p Nonu,.,to

ITuvalul

' '0

HhllOO

' s

O .atf" l tit:"',

a• s

PllCI FIC

O CEllN

17' f

171 (

110'

Coat of Arms

~ •• ;::-or .

~."f(t4 )1u_,# ~~·

C-Ountty Prog1ammes

The PacELF Way Towards !heEliminalloo ol lympllaijc Filariasis In lhePa<~ic

General Information Capital dty

Funafuti

Numbl'r of lslanm

Lind area

265<1 lrm

U.ngu;,ges

Tuvaluan, English

People

Polynesian (96'1,), Micronesian (4%)

Gross domestic product (GDP) pef uiptta (2000)

$1475

Economy

Textiles. soap, philately, copra

fotal populahon by census (1991)

9043

Popul.auon Mtimated (l004)

9600

Popul.ltion deNity (people/lrn1~

369

Infant morUllty 1ato (pet 1000 llvC! births) (2002)

19.2

Matetnal mo«ality rate (per 100 000 IM: blnhs) (2002}

Not .\Vo'11lc'l ble

Ufo ~t.iuicy .11 btrlh (2002)

65.0

--IJNK:ling causes of mon:ahty (2002)

Heart prob~m• .semllty, u ndiagnosed, hypertens.on, CVA (st1oke)

WEATHER

POPULATION

Ages

7S+

70-74 600

500

• • ••• • • • •• ••

30 25

400

300

200

100

0 J

Males

Fem.ales

6$-69 60-64 55-59 50-54 45-49 4G-44 35-39 3G-34 25- 29 20-24 1S- 19 10-14

5-9 G-4

c:::J Raonf.>11 Sourcto: V/OltK'M'natl!.

hlPef•n....· l't.t1Mfur; r931. •'111 r990, Rlftif.il Fv""Mi 1917 W rno

1202 1@

Tuvalu

-9- Tempeanute

10.

l A S 6 1 8 9 10

6.6

PART 2

3 Filariasis before PacELF, 1900- 1998 60

.. ..

•

J • Mf Po51bve

•

;;; 30 ~ &

...

i MOA I

• Elophontiasls

•

1900

•

0 1901

191S

1921

1928

1936

1944

1951

\959

1961

1974

1982

1990

1997

Year

Cou ntry Filariasis Activities in the 1900s before PacELf Microfilaria Prevalence and Clinical Surveys PopulatlotVArea

Dale

NaUol'lwide

1919

Nationwide

1923

46.0(1169)

E!ephantiasi~

1928

38 ' (333)

Elophanu•5ls: 8 1 (333), Hydro«!• 23 (333)

1944

S0.8{6S)

NanumfNI;

'4 Mf pos (n)

Not~d

Oink.ii FcaturC'~ % (n}

Elophanoasos: 2.6 (34341 10.3 (1 169)

Primary Refc-rC>nc:o

McN&ugtnon JG ( 1919) O'Conne< fW cI 923)

Sw<.on PA (1927. '28) Venner RS (1944)

Mass Drug Administration or Other Control Measures

1992-1993

DEC

Coon try data

C-Ounlly Prog1ammes

203

The PacELF Way Towards !he Eliminalloo ol lympllaijc Filariasis In lhePa<~ic

4 PacELF Activity PacELF Country Plan

ICTC>l~0.1%

8 2004

,_ Samphng

Ti!rgl.)t

Al}~Ull

ICT: 22.3% (1261574)

2003-2004

Cluster

Sc:hod chlld~. ~unafutl Sentinel sit~ school chtidren

200&-2007

CIUStL'f

sltOtlOed SU.Ney Na\IOnWldt

2007- 2008

LQAS

230 111 5.. to 6-)'Nt•okl children

Type

Vear

1999

<: D

Results of Blood Surveys and MDAs under PacELF Blood Surveys

1999

ICT

Nr'lllfull

C{)f'Wf'n1~nGe sample

574

128

22.3

Mn myol H..hh Mrluil ~ 2001

July lle</2002

ICT

Funafuti

converuence ~mple

318

22.0

Pmentauon 1n AMS

2003

ICT

Nukulat'lat'. Funafuti, Va1,upu. Nu1

C<IM'tf'lienc.e sample

6S2

114

17.5

Annual R_, 2003

2004

ICT

Whole area

convenience sample

8113

990

12. 1

Mod Tf!m ~ (OMW05)

M DAs

2001

lsl

8307

9542

7175

86.4

6742

81.2

70.7

94.3 94.4

2002 2nd

9561

4738

49.6

4467

46.7

2003

3rd

9561

9581

8360

87,4

7896

82.6

2004 41h

9561

9600

n38

80.9

7509

785

82.4 78.2

• fsbnw1i!d a:sswi-."19 (O!IS1i1119toWU1 nn~ be'IWl!IM "~t ~•nd 2004 poput,Hiontsll!Ntt: ~PO

Tuvalu

94.0

97.0

Ministry of Heahh Annual fli;ipon 200 ! PtMMt.atlon In AMS Ann~

Repon 2003

MDA 2004 Repon

PART 2 MOA Covcrago, 2001 - 2004 100 80 60

20 0

2001

2002

2004

2003

Year

Supplies Shipped from PacHF. 2000-2004 Year

2000

Al.II (..bl. ts) DEC (rabletsl

. .

ICT (tl!Sl cards)

2001

2002

2003

2004

13000

10400

6000

9000

84 000

90000

100000

2000

10000

Partn<'Nhip: WHO, GSK (bl~azole), J'CA (DEC, ICT)

Distribution Dose of DEC and Albendazole Tablets Ago

No. of DEC (50 mg} tablets

No of albenda1ole {400 mg) tablets

2-5

6-10

1l-1s

16-20

2 1-511

so+

____

Registration Form

•

•• ••• •• •

, TUVALU

HATIONAL ,,LARIASIS PROGRAMllE

_.........

,_,___.,_.1...._. •- ""'-r.....

-......----- ...__

'<Oo______ ...._____ •)11'·--1,-

N·~-

llllCW

C-Ounlly Prog1ammes

@ I 205 I

The PacELF Way Towards !heElimlnalion ol Lympllaijc Filariasis In lhe Pac~ic Operational Staff-: Public health doctor and nurse

~ @ Tuvalu

1 Sum mary

Vanuatu consists of 80 islands located between 12'-21'S and 166'-171 ' E. It has a land area of 12195 sq km and a population of 186678 (1999 census). In 2004 the population was estimated at 215 800 (SPC 2004). The first survey of Mf prevalence found the rate lo be 31 .4%; elephantiasis had a prevalence of 6% and hydrocoele, 7.2% (Buxton 1927). There were no other studies after that until 1997-1998, when a baseline fllariasis prevalence survey was conducted nationwide. The Mf prevalence was 2.5% among 4269 people examined and the ICT antigen-positive rate was 4 .8% among 4362 people examine<! (screening survey data book 1998).

In 1999 Vanuatu joined PacELF as an endemic country. Yearly MDAs using DEC (6 mg/kg) and albendazole (400 mg) began in 2000 under PacELF. The first MDA covered 154 739 people, for a reported coverage of 82.9% (country report 2000). The second MDA in 2001 covere<l 156 368 people, for a reported coverage of 83.8% (country report 2001 ). A mid-term survey Jn selected sttes Jn 2002 found an Ml prevalence rate or 1.2% and an antigenÂˇpositive rate or 8.0% among 1940 people surveyed (report on the MDA evaluation). The third MDA ln 2002 covered 156 35-0 (83.8% coverage) (correspondence with Mr TsukijJ 2003). The fourth MDA in 2003 covered 163 271 people. for a coverage of 87.46%. An antigen prevalence survey of 629 people in 1003 found 52 to be positive (8.3%). and a spot-check survey in North Ambrym 1n 2004 found 19.7% positive (106 out of 538 tested). The fifth MDA in 2004 treated 158 758 people (85% coverage).

C-Ountly Programmes

@ I 207 I

The PacELF Way Towards !he Eliminalloo ol lympllaijc Filariasis In lhe Pa<~ic

2 Country Profile Filariasis Type and Vectors Filarlasis lat est status

Endemic

IMK""""1o ban<10h1

Fllaria type

Nocwrnalty periodic

. .. ..,,.

Mosquito vectors

lvanuatul

IS S 0

100 H1*t1

100 KtlollfteC•n

PACIFIC

OCEAN Corid

• A_,fwo • ruruM 10

160 E SOUl'Cr: l.~t com

Coat of Arms

I 2os I @

Vanuatu

PART 2

General Information Capital city

Port Vila

Number of k lands

Land arc.

12 190sq km

Lan91.1ages

Bis1Dm3, English, Frtnch

Peoolo

Melanesian and Potynesia n (94%). French (4%), Chinese, Pacific lstanders

Gross domes-tic pioduct (GDP) pc!'r ca,pit:i

Sl400

Economy

Agriculture (copra, timber, beef. cocoa, coffee), tounsm

Total poputaUon by censu.t. (1999)

186678 215 800 18 27 68 68.3 Asthma, stroke. he.>rt failure, dl01~tes mefhtus, molana

Pop.>lat""' est>motod (2004) PopulatlOO cf<IUOty (peopl.ilcm~ 1nrin1 mor1clfhy rt1e 4'ff 1000 live birth$) (1999)

Matt'tnal monality rate (pet 100 000 hve b!nhs) ( 1993)

Lift exp«eancy at blrt.h (2003) f.Hdjng causes of mon.altty (2003)

•c

WEATHER

POPULATION

Ages

75+ 70-14

6s-69

5S-59 50-54 4S-49

Males

Ftmales

20 15

oc--

30-34

20..24

·-

2S-29 I '.

IS-19

54.0

" I I I

1: ~.

S-9 0-4

c:::J RainfaQ

10-14

4().44

3S-39

0 F

10 t

tl~~~ .. -a" -,,~ a1 ' s

2.8

o 1 l 1 • s Percent

6 1

43.2

l I

4 1 1 1

a '

Sourc.: \~Al'Ntto, ~t.lftlrt-: Ponv..:t J948co I~ ~in/1111. lb't V..t.1 1948 lll'td 1985

3 Filariasis before PacELF, 1900-1998 60

.."

•

Mf PosibV*

•

Elephanti.!ls1s l MDA

40 ~

;; 30

.€ 20 10

•

1900

1910

1920

1929

1939

1949

1959

1969

1919

1989

1998

Year C-Ounlly Prog1ammes

@ I 209

The PacELF Way Towards !he Eliminalloo ol lympllaijc Filariasis In lhe Pa<~ic

Country Filariasis Activities in the 1900s before PacELF M icrofilaria Prevalence and Clinical Surveys E'"""'"""•~ 6 (318), Hydroc°""' 7 2 (318),

16 islands

Palpable Eprtrochl..r Glands: 16,7 (318)

8"><10n PA, HOp<!nS GHF (1927)

M ass Drug Administrati on or Other Control Measures

D.ffl' 11/.IM*·4'~'"··''4@rn++~ 11~ no t«Otds or arry eot1trol programmes In tho 1900s

4 PacELF Act ivity PacELF Country Plan

fype

Year

Sampling

Target

Reiult

1997- 1998

Cof'Wtnlcnct-

Nation~e

IC1! 4 8'll: 120814362) tCT 8 0% (155/1940), Mf 1.2% (2311940)

2002

OldU!r

S<-nllnel ~tt('S

2005-2006

Ousm

Suatified survey

2007- 2008

Complett

8,000 ltl S· 10 6·yt"ar-dd children

Resul ts of Blood Surveys and MDAs under PacELF Blood Surveys No. No examined of po!1tt'lel

Method

Target

Sampling

1997-1998

Whole""" (6 J>IOVlnces)

1997-1998

convenience 11mp)t co1wemeoce sample

2002

ICT

Date

2002

2003

ICT

2004

IC!

.,.. (6

"'"""""3

+ other ar&lS col'l\'et'lience sample Senbtle'I Yt.eS + ol.htr •~s con~samplt SenblMf ~us .. other iftlM convenlencii: sample Spot theck ote (A:nbr,m) convmitnct sampleSe!tbnE.4 M

Positive rate(%) Rom.1rk1

Rcfl!r~ncCt

4362

209

4,8

5cr<<110n9 Su"'Y O.u hoct (97-98)

4269

106

5oemwJ SuMy 0.1' hoct(9M8)

1940

155

1940

1.2

629

Presaltat1on In AMS

Sla

106

19.7

M>nis1r; ol HN!th l'.<pon (!m•ll 2'11ll051

Orah repon of MOA Ml.lit.on 2002 Ora!t r~ ot MDA ~·JIUbtiot'I 2002

M DAs

2000

186678

192 502

196210

10S.1

154 739

82.9

80.4

78.9

2000 MDA Ropou

2001

2nd

186678

t98 327

188132

1008

156 368

83 8

78.8

83.1

2001 MOA R•pott

1.1..,r;ol Holllh""""" 1&'1111 I!W!.<lll Annual Report 2003

2002

3rd

186678

204 151

183 779

98.S

156 350

83 8

76.6

SS.I

2003

•1h

186678

209976

196400

1052

163 271

87.S

77.8

83.I

200.0

S1h

186678

215800

158 758

85.0

73.6

•£s11m111c:d 11»~ c.Qtl\.tant gf'OWttt ,.tebetworn t..t('\t «"!WI and

v.n.aw

l004 PQpullltlC)ll ('\lltNte tSPO

Mn"'I Repo~ 2004

PART 2 MDA Covaraga. 2000-2004 100

80 60 40 20

,, ,,

II II ·~

2000

2001

2002

2003

2004

Year Supplies Shipped from PacELF, 2000-2004 Ye.;ir

2001

2000

2002

2003

20011

380000

239000

230000

OEC (lOblcu)

2 700000

I 500000

1 500000

500000

ICT (test catds)

2000

3000

2500

5000

Al8 (tablets)

Partnership: WHO, GSK (•!bendazo)e}, l,J""pool School for Trof)ICal MiE!dic•ne. JICA (DEC, JCO, JOCV (volunteer), VSO vo/u11teer

(SO mg) tdblcts

No. of .'tl bi:ond~tol~ (400 mg) tablets

2- 9

10-19

Age

20-29 30-39 ~9

No. of DEC

8 8

Weight

No o f DEC

(50 mg) tablets

No. of albendazole (400 mg) tablets

8-12

13- 20

21- 29

30-37

•

38-45

50-59

46-54

> 60

Ss.-0

63-70

71- 79

> 80

C-Ounlly Prog1ammes

@ [1DJ

The PacELF Way Towards !he Elimlnalion ol Lympllaijc Filariasis In lhe Pac~ic Registratio n Fo rm

VANUATU FILARIASIS CONTROL PROGRAMME Mass Drug Admlnlslration Registration Book

\.IDA .?0V"'1

_,_,

CODE.

Hull!ICrua:

NllftltlnO..p: 1~ .. 1-ildmar1

VANUATU FILARIASIS CONTROL PROGRAMME

Aid Pow ?oiunet V1!1qe \'olullCICICe: fMPWl~V11fiMll-.""1

ViJl:at1:;

,., """'

f\'ilq)

',...,, """'

Dittc ~CIC MOA llMr .. )'*'*"f:llllMMD.\)

Pn)v"'°';

l'*°"""'-.1

1 l''umbcr Of r1111a 11 is..111 .........1 1

Mass Drug Administration Registration Book (MOA Reglstrat.on Boo~)

JICA

Nmd!a ar tabkt

......

Jill •W)'tlMlilllft

Iii p J;C

•

t'\-*-....,_

,.., ,.,'"

Toca»No IAlllll rro1110. bd

-"'

1111111

"'~

l2:)~J~nd11Ulk: Sik llcbe~0..!1

!!!!!

'" ,,,'"

•.a.N ·~ ~0..- Conlnl

1Tm1- - wei i....:.....-...1

Taal 1muJPQPUIMloliiT•~--1.-i111111

,.,

12 ToW ic&"tcr pop

SLJ

n"" RrfllM

''"........_ltl__ "'-"'•.......... .,.....,........... Tmuu ruw1

""''""'

hl Hlflii11U

11w-c-....1.......

"UIWrT"" ltullllo l'..\1.11.-.l'Wt \ll-. •- •~WA lf...,...._

,..,.,.. .....i - -..., , _............. ,.. . . . . . . . . . , _ . . _......,

C"..-1 .,,_,._........,tloll.1'!olll<1'1'l'nl1V... -•lb,,....,._,_, OA1

Hom bfoog tam!!! :

...

+-"1° Pill Uldm yla long age oroup 00m0.

YM~·

• • :tl~I~ a~ i!2

•

" 1 J

--- .. ..

OEC

....

~ ~

1I -i • I

•

-- _,_

• • •

Mo~FROM ?

I~ j 1 I i

..• .. 1 •a J

(f}COMM£Hf

';:

-- -- -

I I

• • ,.•

I-

.. ..

lOTAL 8LOHO HA-WA

Vanuatu

" " ••

-- - -

-- f- -

- -

--I-

rf x

I i

PART 2 IEC M;11terials

PROKRAM BLONG AOTEM

SIK FILARIASIS

LONG VANUATU (VAN-Elf)

l\ I A::.~ ORUG Q

A OMJ N ISTR ESEN

2000 . 2004

MASS ORUG AOM INISTRISEN

IMOA)

PRO IFl..:fF\I F\\lll l '111 k.O·\H,•1'-H+rno\1 ~II\ I\

•tVRI MA•, ..ONI" YANCIAIA NO rl!ININI

'•

lONO \!Alhl,\IU 011 M,U D• uts MfRESIH ll0fl0 $1K fltARIASIS W~# f~fll lOllC WAit VIA IWtM r.uv ¥'IA

2000 . 2004

•

INF<JMESEN A8AOT SIK:

FILARIASIS (Jlllokl

----· - •I'll••" WruWMt KMIC. Sik io. F~i47

C-Ountty Progtammes

The PacELF Way Towards !he Eliminalloo ol lympllaijc Filariasis In lhePa<~ic Operational Staff: Malana and Vector Borne ~sease Unit

1 Summary

The French overseas territory of Wallis and Futuna Is composed of 23 islands located between 14Â°-16Â°$ and 176"-178'W. It has a land area of 145 sq km , and had a population of 14166 al the 1996 census and 14 944 at the 2003 census. In 2004, lhe population was estimaled 10 be 14 900 (SPC 2004). In the late 1800s, elephantiasis was reported to be common, even among Europeans and in 1909 half of the adult population was said to suffer from elephantiasis (Reynaud 1896, Viala 1909, quoted In Sasa 1976). Wallis was found to have an Mf rate of 40% in 1954 (Touze 1954) and 20.4% In 1959 (Rageau and Estlenne 1959). In 1977 lhe Ml rate was 21 .8% (Bessenay, quoted in Sasa 1976). Ml rates for Futuna were lower, at 8.1% in 1977 (Country report 2001). Monthly DEC distribution began in 1978 and continued until 1987. when DEC distribution became a biyearly programme that continued until 2002 Following the start of the control programme in 1978, Mf rates dropped to 5.3% In 1978 and 3 .2% in 1985 in Wallis. and 10 1.7% in 1978 and 0.4% in 1985 in Futuna (country report 2001 ). Wallis and Futuna joined PacELF in 1999. The most recent baseline filanasis survey was carried out in 2000-2001 using ICT antigen test cards:1% antigenaemia was recorded for Wallis and 0% for Futuna. Wallis and Futuna was classified as a partially eooemic country according to this survey. Although Wallis and Futuna is partially endemic. MDA in the whole count I)' using DEC (6 mg/kg) and albendazole (400 mg) began in 2002 under PacELF. The first MDA covered 8522 people (60.2% coverage) (Ministry of Health. 2002 annual report), In 2003, the second MDAcovered 9252 people (65.3% coverage) (Mlnistl)' of Health. count!)' presentation at Fifth PacELF Annual Meeting in 2003). The third MDA in 2004 treated 9918 people (66.4%

coverage).

C-Ounlly Prog1ammes

The PacELF Way Towards !heEliminalloo ol lympllaijc Filariasis In lhePa<~ic

2 Country Profile Filariasis Type and Vectors Filariasis latest status Filaria type

Mosquito vectors

_.....

W a llis a nd Futuna

SOH1

~--+- I)

50 " "'

l!:::1:1ti:•=w=='=1=1·=w=='=7i:4•=w==:!I P.4CfPIC

P,t C lf."IC

OCIUN

OCliAN 1'4' 1S•s

toltUt

1(poto

Jjgflr~o Ol~golt ~

Nut"hU41/ol:J

11• •• , ...~}tl,•

Nuku

••

•o••

•l•lcu

~-.,, 41010

Ur11

l411YfiJ,hlU

t•'•tofo

1>.. 2o·s

to1nrt' Motola'o

o'lohJ•I

Point,

...,... 111· 10-w

WaJlisanoFuwna

t11 · 0~· w

·s

....

ott1JC • eu

! If'... )

~•ntt Afooo

Ol'lllf

rutu"'''

PART 2

General Informati on Ca-pttal city

M_,ta·Utu

N1.1mbtr of lsllnds

) Islands and 20 LsletJ

Land area

255 <q km

Li1ngu4gfS

French. Wa11i$ian

People

Potynesian (93%), Frtnc-h (7%)

Gross domes1ic product (GDP) J)Cf apita

S2000

Economy

Copra. fishing. trocchus shells, handlcrafu, lumber

To1al popvlat'°" by cenM (2003)

14944

Population estsmated (2004)

14900

Population den;:iry (peopltlkm')

105

lf!fant mortafity rate (per 1000 llve binh$) (2000-2003)

7.4

Materna.I momllty rate (per 100 000 five b(rths) (1996)

Ufe e11pcctanqr ~t btnh (1991-1995)

68.7

~cadtng eow.ses ol moc1A11ty (2002)

symptoms, signs and findings not elsewhete classified, d iseases of the

Oiseases of the circulatory system. neoplasms, Injuries and txlC<NI cause$, respiratory system

•c

WEATHER

Ages

POPULATION

~------

700 ~---------------~ 35

75+ 70-74 1 - - -M - a.., les _ _ _ '1:-.f---,f;:ec:m"a"les,,-,----!

600

6>-69 ,__ _ _ _ __

•••• •

• • ••

•

6()-64

55-59

1------

400

50-54 4 5-49

1-----1 - - - - ---.

300

40-44 1 - - - - - - - ' 35'-39 1 - - - - - -

30-34

25-29 1 - - - - - --' 20-24 ,__ _ lS.-19

1()..\4

500

200 100 0 F

c::J Rllinfall Sollff•:

~ Tempcratu~

5.2

1 - - - ----, 1-- --,,

S-9 i----, G-4 '-'-~-'--'

10 9 8 1 6 5 4 1 2 1 0 1 l

.J •

6 7 8 .9 10

Percen t

Worbe""*' •· Porr W.. 1948 to t'85'

~.MIPt'

RmJ41t· /'off v.Q J948""" 1985

Counlly Prog1ammes

The PacELF Way Towards !he Elimlnalloo ol lympllaijc Filariasis In lhePa<~ic

3 Filariasis before PacELF, 1900-1995 60

I•

Mf Posilive

• Efophantia.s1s

i MOA I

::: c

...">

~ "- 20

•

0 1900

1910

19)0

19'10

1950

1959

1969

1978

• 1986

1995

Year

Country Filariasis Activities in the 1900s before PacELF Microfilaria Prevalence and Clinical Surveys Popul"tlon/Arc:-.:i

Date

% Mf pos (n)

\ ValUs

1959

20.4 (1029)

R21ge>u J, Esti~not J (1959}

\Vanis

1977

21 .8(1069)

Coon1ty cepon (2001)

waui.s

1978

5.3 (4758)

C<runuy report (2001)

Wallis

1985

l.l (4308)

C<run1ry <<90'1 (2001)

1992

0.0 (500)

C<runlry """'1 !2001)

Noted Cllnic.:11 Features% (n)

M a.ss Drug Administration or Other Control Measures Monthly cf1stribu1JOn or DEC un~ 1987 -..nd lht n 1wlce yea~ Plu$ vector control.

wamsano Fu1una

Primary Reference

PART 2

4 PacELF Activity PacELF Country Plan

KT(+) >: 0 ,1%

KT(+) < 0. 1%

lY••

Y('..ir

s.implm9

Target

R~u lt

2001

Convenience

Foe.al testing around povtM cases

ICT: 0.7% (6/803)

2004

Ouster

Scntfnd sites Wa!li-s

2006

OtJstt!I'

W•ll~

2007

Comple•e

340 al 5· to &year-old dlddren

- --.::..._

Results of Blood Surveys and MDAs under PacELF Blood Surveys Date

Method

Target

Sampling

No.

ex.'lmlnOO of positives

Positive

,,,tc- (%) Remarks

Reference

----~~-------~ MDAs

2002

ISi

14 166

I• 966

8521

60.2

2003

2nd

14 166

14 944

13 S40

95.6

9252

65.3

61 g

68.J

Annual Report 2003

2004

3td

1• 900

12 580

842

9918

66,4

66 6

78.8

Presen~1jon In AM6

Ann~I

Rt!por; 2002

C-Ounlly Prog1ammes

The PacELF Way Towards !heEliminalloo ol lympllaijc Filariasis In lhePa<~ic MOA Covoragc, 2002- 2004

2002

2003

2004

Ye-ar

Su pp li°' Shipped from PacElF, 2000-2004 Year

2000

ALB (l•bfeU) DEC (tabf.U)

ICT (Ifft cords)

2001

2002

2003

16500

15600

17 000

2004

. -

Partt1ership: GSK (albendazole), 1ns111ute l~1s Malard~

Distribution Dose of DEC and Albendazole Tablets Age and Weight

No. of albendarole {400 mg) tablets

3· to 6-)<Nr-old

1· to 1l·YNt'°'d

12· io 1S·ye1;r-okl

Adulu < 70kg

Adults > 10 kg

1 1

Operational Staff: Public heal1h medical officer

I 220 I @

No. of DEC tablets (100 mg)

Wallisand Fuiuna

Photo Album

Photo Album Annual Meeting Group Photos

The PacELF Way Towards !he Elimlnalion ol Lympllaijc Filariasis In lhe Pac~ic

Blood Survey ~

[

Tuvalu

!(iribatl

AmetiC-.ln Samoa

federated States of Mic:ronesia

Fiji

Fretich Polyrwsla

Photo Album

Fiji

M4rshall Islands

Niue

Palau

Vanuatu

Tonga

C-Ounlly Programmes

Fiji

Tonga

Tuvalu

Kiribati

American Samoa

Fiji

l(inbau

Papua New Guinea

Tuvalu

Vanuatu

C-Ounlly Prog1ammes

The PacElf Way Towards !he Elimlnalloo ol lympllaijc Filariasis In lhe Pa<~ic

Packing

Fiji

Samoa

Tonga

Vanuatu

Variuatu

Vanuatu

Photo Album

Â·~

Americ.an Samoa

fiji

Tonga

Fiji

Samoa

Vanuatu

The PacELF Way Towards !heElimlnalion ol Lympllaijc Filariasis In lhePac~ic

:.l':l

I'" I

American Samoa

Cook Islands

Fiji

French Polynesia

Kiribati

Samoa

Tonga

Vanuatu

Photo Album

â&#x20AC;¢

Vanuatu

Fiji

Vanuatu

Kiribati

Tongo

Fiji

The PacElf Way Towards !he Eliminalloo ol lympllaijc Filariasis In lhe Pa<~ic

-Â·~

Cook l sla~ds

Samoa

Vanualu

Photo Album

Patients Fiji

Photo Album

PacELF Home Office

PacELF Home Office Mata1ka House FiJI Cent.re for Communtcable Disease Control Tamawa. SUva, Aji

Bibliography Part 1 Chapter 1 Cao WC, Van der Pfoeg CP, Plaisier AP, Van def Sluijs IJ, Habbema JD. lvermectin fa< tl>e chemotherapy of bancrofban filarias1s: Amelaanalysis of lhe effect ol single treatment Tropical medicine and lntemal/onal health, 1997, 2(4):393-403. Gyapong JO, Kumaraswaml V, Biswas G, Ottesen EA Treatmantslrategies underpinning lhe global prograrrme toelininate lymphatic lilariasis. expel! opinion ()(I p/larmBÂŤJlherapy, 2005, 6(2): 179-200. Kimura E, MalaikaJU. Control of lymphafic filariasis by annualsingfe.dooe dielhylcarbamazine treatments. Parasffology today, 1996, 12(6);24-0244. MansooÂˇBahr P. Manson's tropical diseases. 19th ed Philadelphia, Baillil!fe Tindal, 1987 Pichon G. Limitation and facifitation in100 veclors and other aspects ofll>e dynamics of lilarial transmission: The need for VilCtor control against Anophele,,,.transmiUed filariasis. Annals oflropical madlcine and parasffology, 2002, 96(Supp 2):S14J..S 1;2. Rozendaal JA. Vector control: Methods for use by individuals and communities. WHO Geneva 1997 W011d Health Organization, Lymphatic filariasis: The disease and its control. Tedlnical Repon No 821 . WHO Geneva 1992 W011d Health Organization. Annual report on lymp/latic filarissis. 2003. www.filariasis.org. Global Alliance to Elfminate l ymphatic Fiariasis.

Chapter 2 Abe M, Yavlong J. Taroo G. lchimori K. Miorofilarial periodicity of Wuch&reria bancrofilin Vanuatu. Transactions of the Royal Soelelyof Tropical Medicine and Hygiene. 2003. 97(;):498-500.

Bockerie MJ. Tisch OJ, Kastens W, Alexande< NO, Dimbe< Boekarie F, lbam E, Alpe<s MP, Kazura JW. Mass treatment to eliminate filarias!s In Papua New Guinea. New England joumal of medicine, 2002. 347(23):1841-1848. Este<re P, Plicllarl C, Seehan Y, Nguyen NL. The impacc of 34 years of massive DEC chemotherapy on Wuchereria /Jancrolti mfeclJoo and llansmlssion: The Maup1ti cohort Tropical medicine and mtematlonal heaffh, 2001, 6(3): 190-195 lchimori K. Entomology of the fdariasis control progranvne in Samoa: Aedes polytlesiensis and Ae. samoanus. Medical enlomology and zoology, 2001, 52(1):11-21.

Kazura JW. Boe!<arie M, Alexander N, Pe"Y R. Boe!<arie F. Oagoro H. Olmber Hyun P,Alpers MP Transmission Intensity and lls relationship 10 infection and disease due to Wucherelia bancroffiin Papua New Guinea. Journal of infectious diseases, 1997, 176( I ):242-246, Kimura E. MataikaJU. Control of lymphatic filariasis by annual S>ngle-<lose diethylcarbamaziie ueaiments. Parasffology today, 1996, t2(6).240244. Laigret J, Fagneaux G, Tulra E. Mass chemotherapy wllh spaced doses of dlelhylearbamazine: Etrec1s in Tahiti on mierofilataemia due 10 Wuchereria bancroffi. Bulletin of the World Heaffh Organilati<ln, 1980, 58(5):7711-783, Laigret J, Kessel JF, Bambndge 8, Adams H. 11 years of ehemoprophytaxis of non-periodic lymphatic filariasis wilh dielhylcarbamazine In Tahiti. Bulletin of the World Heaffh Organization, 1966, 34(6):925-938 Mataika JU, Dando BC, Spears GF, Macnamara FN. Mosquito-borne Infections in Fiji. I. Filanasls in noflhem Fiji: Epidemiological evidence regarding factors influencing lhe prevalence of microfilaraemia or Wucherelia bancroffiinfections. Journal ofhygiMe. 1971. 69(2):273-286. Mataika JU, Dando BC, Speers GF, Macnamara FN. Mosqul10-borne lnfec1rons In Fiji. Ill. Filarias!s in norlhem Fiji: Epidemiological evidence regarding the mechanisms of pathogenesis. Journal of hygiene, 1971, 69(2):297-306. Ma1aika JU, Kimura E. Korolvueta J, Shimada M. Effocacy of nve annual single doses of diethylcarbamazine for treatment of lymphatic filariaSIS ln Fiji. Bulletin of the World Health OrganizaliM, 1998, 76(6):57;..579. Ramalfngam S. Tl>e epidemiology of filarial transmission In Samoa and Tonga. Annals of tropical medicine and parasho!ogy, 1968, 62(3):305324. Sapak PJ. Cost eReetiv9 strategies In con/rolling bancronian filariasis In Papua New Guinea [PhD dissertation], Universlly of Queensland, Australia, 1998. Sapak PJ, Melrose W, Ourtheim 0, Pawa F. Wynd S, l~at P, Taula T, Bocilane M.. Evaruabon ol lhe fymphalle fiariasis oontrOI program, Samarai Nurua distnct, Papua New Guinea.Aug 2004. www.jcu.edu.au

Blbllograglly Sasa. M.. Human lilarias/s: A global suNey ol epidemiology and cootrol. University of Tokyo Press. 1976. World Health Organization/South Pacttic Commission. Roporl on tho foorlh joint WHOISPC seminar on filariasis and voctor control. WPR/FIU 12,Apia, Samoa, 1974. www.odc.gov. US Centers for Disease Control and Prevention. www.fiariasis.org. GlobalAltiance to Eliminate lymphatic Filariasls www.sopac.a<g. Soulh Pacific Applied Geoscience Commlssloo. www.spc.inl Secretariat of lhe Pacific Community.

Chapter 4 ChevalierC. Social rosearchon hlariasis In Vanuatu. Rllj)0<1 on consuliancy forlhe SPCPacific Regiooal Vector-Born Diseases Project. Vanuatu 2-11August, 1999.pp. Wolld Health Organization. Madang commNment towards h<Jahhy islands, WPR/ECPfDPM/2001, March 2001. World Heallh Organization. Repo11 on the finh meeting olthe TechnicalAdvisory Group on the Gfobtll Elimination of Lymphatic Filllnasis (TAG-

ELFJ,Geneva, SwllZeriand, 3-6 Februaiy 2004. World Health Organization. Repo!I on the filly~hifll sessionol the Regional Committee for the Westom Pacific. Kyoto, Japan, 16-W September 2002; Summary records ol the plenary meeting, Manila. November 2002. Wolld Heailh Orgenizalion. The vision ol h<Jalthy Islands for the 21st century. Regional implementallon guideline. 2001.

Part 2 Backhouse TC, Heydon GM. Fi ariasis in Melanesia: Observation al Rabaul relating lo incidonce and veetors. Transactions of th• Royal Society ol Tropica/ Medicine and Hygiene. 1950, 44:291-306. BahrPH. Fiaria>ls and elephantiasis in Fiji. Research momoITT; of tho London Schoo/of Tropical Medicine. 1912. 1:1- 192. BearupAJ, Lawrence JJ. Aparasitological survey ol five New Guinea vll ages. Medicaljoomal olAustralia, 1950, 22:724-732. Beye HK, Kessel JF, Heuts J. Thooris G, Bambridge G. i'louvenes recherches surl'importance. les manifestations cliniques et lalutte oonue la filariose Tahiti, oceanie franyaise. BuUelin de ta societe de pathologle exotiquo, 1953, 46:144-163.

Stay GW. Oiswsslons folio'Mng Brug'spaper ·fnariasis in the Dulx:h East Indies: Proceedings ofthe Royat Society of Medicine, 1931, 24:673674. Bteinl A. On the occurrence and prevalence of diseases in Bri1lsh NewGuinea. Annats ollropical medicine and perasHology, 1915, 9:285-334. Burnett GF. Matalka JU. Mass administration of diethylcarbamazinecitrale in preventing transmissionof aperiodic human filariasis. TransacUons of the Royal Society of Tropical Medicine and Hygiene, 1961. 55:176-187.

Buxton PA, Hopkins GHF. Researches In Polynesia and Melanesia . Paris 1-4. Research memoirs of the London School of Hygiene and Tropical Medicine 1927, 1, 260 pp. Buxton PA. Researches In Polynesia and Melanesia, parts 5-7, Research memoirs of the London School of Hygiene end Tropical Medicine 1928, 2, 139 pp. Callan! J, Taula T, Anderson W, Lourie J. Malaria and filariasis in the Ok Tedi Region of the Star Mountains, Papua New Guinea. Papua New Guinea medicaljoomal, 1983, 26(2):122- 126. Crow GB. Fllariasis in the island of Guam. Joomal olthe American Medical Association, 1910, 55:595-596. Davis TA. Fiariasis control In the Soulh Pac~ic. New Zealand medical joumal, 1949. 48:362-370. Desowltz RS, Saave JJ, Sawada T. Studies on the lmmuno-epidemlology of parasitic infections In New Guinea. I. Population studies on the relationship of a skin test to mlorofilaraemia. Annats of tropical medicine and parasitology, 1966, 60:257-264. Dickson JG, Huntingdon RW, Behold S, Filariasis In defence forces, Samoa group. Naval medical bulletin 1943, 41 :1240-1251 Oubruel CME. Contribution a!'elude de l'etiologie de l'~phantiasis arabum. Bulletin de Ill socieM de palhologie exotique. 1909, 2: 355-359. Galr.ard H, Mille R. Un nouveau medicament anlifiarien, le 1-dielhylcatbamyl·4melhyl·piperazine, experimenle aTahtu. Butfetin de t'Academle Nalionale de Medecine, 1949. 133:83. Grant AB. A medical survey of the island of Nauru. Medicaljournel ofAustral/a, 1933, 1:113-118. Hopla CF. Studies on filariasis in Papua N'ew Guinea. Mosquito news, 1946,6:189-192 lchimori K. Entomology ol the filariasis oontrol programme in Samoa: Aedes polynesiensis and Ae.samoanus. Medlcalentom<Jlogy and zoology, 2001, 52(1):11-21. C-Ounlly Programmes

@ I 235 I

The PacELF Way Towards !he Elimlnalloo ol Lympllatlc Filariasis In lhe Pa<~ic Iyengar MOT. Preliminary report lo /he South Paclfrc Commission on en investigation on filariasls;,, New Caledon/a, February 1954. Iyengar MOT. A raport to th• &uth Pacific Commissioo on an inW>Sligatioo on filariasis in tho Cook Islands, 1957, 21:15. Iyengar MOT. An lnvesllgallon on filariasls in Niue. South Pacific Commission Technical Information Circulart-lo 30, 1958, 10pp (mimeograph). Iyengar MOT. A reviewol lhe ilteralure on the distribution and epidemiology or filarlasis in the South Pacific region. &uth Pacifrc Commission Technical Paper No. 126, 1g59, SPC Noumea, New caJedonla. 172 pp, Iyengar MOT. Summary dala on filariasis In lhe Soulh Pacific. &uth Pacific Commission Technical Paper No 132, 1960. SPC Noumea. New Caledonia. 92pp Iyengar MT. Epidemiology or filarlasis in the South Pacific. &uth Pacific Commission Technicsl Paper No. 148, 1965. SPC Noumea, New Caledonia 183 pp. Jachowski LA. Otto GF. Fffariasis in American Samoa. VI. Prevalence of microfiaremia in the human populatlon. Americsn journal of hygleoo, 1955, 61:334-348. Kazura NI, Spark R, Forsyth K, Brown G, Heywood P. Peters P, Alpers M. Parasilologic and clinical features or bancroftian filariasis in a community In East Sef)ll< Province. Papua New Guinea. American journal of tropical medicine and hyglenfl, 1984, 33(6): 1119-1123. Kerrest JM. Epidemiological aspeclS of bancroftlan filariasis In New Caledonia. South Pacific Commission quarterly bulfelin, 1952, 2:34-36. Kessel JF. An effective progranvne for !he conlrol of filarlasis in Tahiti. &JlleHn ofthe World Hea"h Organization, 1957, 16(3), 633·664. Kessal JF. Areviewol lhe filariasis control programme in Tahiti from November 1967 loJanuary 1968. &1/elln ofthe World Heakh Organiuition, 1971, 44:783-794. Kimura E, Spears GFS. Epidemiology of subperiodic bancroflian filariasis In Samoa 8 years afler control by mass 11ealmen1 with dielhytcarbamazine. &llelin of the World Heahh Organizafioo. 1985, 63:869-880. Kimura E. Spears GFS, Singh Kl, Samarawicl<rema WA, Penaia L. Sone PF. Pelenatu S, Faaiuaso ST, Sell LS, Oazo BC. Long-term efficacy of single-dose mass treatment wnh dielhylcarbamazine citrate against diurnally subperiodic W. bencroht. cighl years' experience in Samoa. &JlleHn of the World Heshh Organization, 1992, 70:769-776. Kimura E, Remit K. Fujiwara M, Aniol K. Siren N. Parasitological and clinical studies on Wuchoreria banaofti infection in Cliuuk (formerly Truk) Stale, Federaled Slates of Mbonesia. Tropical medicine and paf8Silology, 1994, 45(4):344-.346. Knight R, McAdam KP, Matola VG, Kiikham V. Bancroltian filariasis and other parasitic infections in the Middle Fly River region of Westem PaP<Ja New Guinea. I. Clinical parasilogical and serological sludies. Anna/soltropical medicinfl and paras#o/ogy, t979. 73(6):563-576. Lagraulet J, Pichon G. Oulin-Fabre O. SlanghelliniA. Moreau JP. I. Enquete epidemiologique surla filariose fymphalique aux Marquises. BuNelin de la S<JCleM de palho/ogie exolique, 1972, 65:447-455. Lagraulet J. Barsinas M, Fagnaux G. Teahui M. Curren I status of filariasis intile Marquises and differenl epidemiological aspects. &Jllelin de fa societ6 de pathologieexolique. 1973, 66{1) 139-155. Lalgret JF. Rapport annue/ 1958. lnslilut de Recherches Medicales de la Polynesie, 1959. Laird M. Noles on the mosquitoes of tile Gilbert. emce and Tokelau Islands. and on filariasis in the laller group. &Jllefin of entomological research, 1955, 46:291-300. Lamben SM. Health survey of lhe Cook Islands, with special reference lo hookworm disease. Appendix lo report ol Cook Islands administration, 1926, 27-40. Lang. Noc. Les filaires en Nouvelle CalOOonie. A/chives de parasftologie. 1903. 7:377-388. Lesson P. Voyage aulour du monde enlrepris par ordre du Gouvememenl sur la 00\Jrvelle la Conqullle. vol 1: 493-495. Lynell GW. A note on the occurrence of filariasis In Fijians. Lancet, 1905, f: 21·22. McCarthy DD. Fllariasis in the Cook Islands. New Zealand medicaljournal, 1959. 58:738-748. McKenzie A. Observations on filariasis, yaws. and intestinal helrnlnthic lnfectlons in !he Cook Islands, wilh notes on the brooding habits of S. pseudoscufe/taris. Transaclions offhe Royal Society of Tropical Medicine and Hygiene. 1925, 19:138-149 McNaughton JG. Noles on filarial Infections In the Gibert and Ellice islands. Journal ollropical medicine and hygiene. 1919, 22:1-2. March HN. Lalgret J. Kessel JF, Baml><idge B. Reduction In the prevalence of cfinical ffiariasis in Tahiti fotJowing adoption or a control program. American journal offroplcal medic/Jle sod hyglenfl. 1960. 9: 1~184. Matalka JU. FUarlasls in the Solomon Islands: A survey on Guadalcanal and Florida Islands. Report on the World Heallh Organization seminar on filariasis, 1965 (mimeograpl\00), 6 pp. Matalka JU, Kimura E. K0<olvueta J, Shimada M. Efficacy or five annual single doses or diethylcarbamazlne to. treatment of lympha!ic filariasis In Fiji. BuUetfn of/he World Heallh Organization, 1998, 76(6):575-579. Merlet Y. Preliminaires el'~tude de la filariose en Nouvelle-Caledonle. BufleOn de f'assoclabon m6dica/ede Nouvelle-C816donle, 1950, 13:7-10.

Blbllograglly Messer AS. Contribulion ala geographie medlcaie : les nes Viti au Fldp conslden!es principalemenl au point d vue de retal sanitaire del la populalion balnche. AtchiV&s du mMicine nava/e 1876, 26:321. Murray WO. Filariasis studies in American Samoa. Naval medical bul/eNn, 1948, 48:327·341 . O'Connor FW. Researches in lhe Western Paclfc being a report on the results of lhe expedition sent from the London School of Tropical Medicine to the Ellce, Tokelau and Samoan Islands in 1921·22. Research memoirs of the London School of Tropical Medicine, 1923, 4:57pp. Nelson S. Cruilrshank JM. Filariasis in Fiji, 1944·1955. Annual reporl of Medical Oep811menf, Fifi, 1955. 50 pp. Perolat P, Guidi C, Riviere f, Roux J. Bancroltian filariasls In French Polynesia: E.pidemiologicslatus and perspeclives after a35-year preventive campaign. BuUotin de la socielO de palhologieexotique, 1986, 79:7S-SS. Perry WJ. The mosquitoes and mosqulto-bome diseases on Newcaledonia, an his!oric acxount 1885-1946. 1950. Phelps JR. Smith OA, Carrofl HH, Washburn WA, Beagley KE. Experimental chenopodlum. Naval medical bulle6n, 1930, 28:459-487.

~eatmenl

of filariasis with intramuscular lnjeclions of oil of

Pipkin AC. Wuchereria ooncro/li in Micronesia. Eighth Pacific Science Congress, Manila. 1953, vol. 6A, 589-605. Prybylsl<i 0, Alto WA. Mengeap S, Odaibaiyue $.Introduction of an Integrated oommunity·based bancroltian fiariasis control program into the Mt Bosavi region of the Soulhem Highlands of Papua New Guinea. Papua New Guinea medicaljournal, 1994, 37(2):82-9. Rageau J, Estienne J. Enquete sur la filarlose aWallis. fnslifut Fran~ls d'Oceanle, 1959, Noumea. New Caledonia. 37pp. Rosen L Obse<Vations on the epidemioiogy of human filariasis in French Oceania. Americanjournal ofhygiene, 1955, 61:219-248. Schlosser RJ. Observations on the incidence of Wuchereria /Jafl(;(ofli larvae in the native population or lhe Solomon Islands area. American joumalof tropical medicine, 1945, 25:493-495. Simpson ES. M<lss lherapy in marlasls: A note on conl/01 In Niue fsland. New lea/and medicaljournal, 1957, 56:136-137. SPC. Pacific Island Populations 2004, http:/twww.spc.lnVdemogl, Symes CB. Observations on the epidemiology of filariasis In Fi~. Journal of tropical medk:ine and hygiene, 1960. Part 163:1-14, Part fl 63:3144, Part 11163:59-67. Thooris GC, HeulsJ, Kessel JF, Hoiry, Bambridge 8. Etude sur les methodes de diagnostic et de traitemenl de ta fiariose aWuchen>ria banetofli

en Ooeanle fran<;alse. BuUotin de la societe de palhologie exotique, 1956, 49: 1138-1157. Touze M. Presence d'amas microfilariens encapsulesdans le liquide lfhydrocele aw. bancrofti. Six cas observee aux ties Wallis. Bullalin de la soclete de pathofogie exotique 1954. 47:284-286.

Venner RB. Fllarial problem on Nanumea. Naval medical buUolin, 1944, 43:955-963. Webber RH. Vector oonlrol of filariasls in the Solomon Islands. Southeast Asian journal oftropical medicine and public heallh. 1975, 6(3):430434. WHO/SPC. Report on the fourth joint WHOISPC seminar on filariasls and vect0< oontrol. Apia. Westem Samoa, 1-10 July 1974. sponsored by WHO Regional Office for the Western Pacific and South Pacific Commission, 1974, World Heal1h Organisallon. WHO expert commlUeo on filariasls, third report, 1974, WHO technical re/)Oll series No 542, 54 pp. WOlld HeaUh Organlsalion. A review and annotated bibliography on subperiodic bancroftlan filariasls with special reference to its vectOIS in Polynesia, South Pacific. 1980. Zahar AR, King M. Chow CY. eds. WHO Regional Office f0< the Western Pacific:, Manija, Philippines. www.cdc.gov. US Centers for Disease Control and Prevention www.mapqr.rest.oom. Mapquesl

www.spc.int • Secretariat of the Pacific Community, Noumea, New Caledonia www.SPC.org.nc www.wll<ipedia.org. Wlkipedia, the freo encyclopedia. www.woridatlas.com www.woridcflmale.com

Selected Papers, Post-PacELF (1999·2004) Abe M, Yavlong J, Taleo G, lchimori K. Mlcrofilarial periodicity of WIJchereria bancrohiin Vanuatu. Transactions oflhe Royal Society of Tropical Medicine and Hygiene, 2003, 97(5):498-500. Alexander NO. Wuchereria bancrolti Infection and disease In a rural area of Papua New Guinea. Papua New Guinea medical journal, 2000, 43(3-4):166-171. Alexander NO. Bocitarie MJ, Olmbe1ZS, Griffin L. Kazura JW, Alpers MP. Mlgra1ion and dispersal of lymphatic fllarlasls in Papua New Guinea. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2001, 95(3):277-279. C-Ountry Programmes

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The PacELF Way Towards !he Elimlnalion ol Lympllaijc Filariasis In lhe Pac~ic Alexander ND, Grenfell BT. The effect of pregnancy on Wuchereris bsncronl microlilarial load in humans. Parasitology. 1999, 119(Pt 2): 151156. Alexander ND. Pe<ry RT, Dimber ZB, Hyun PJ, Alpers MP, Kazura JW. Acule disease episodes in a WUchereris bsncrofli-endemic area of Papua New Guinea. Americanjouma/ oflropical medicine and hygiene, 1999. 61(2):319-324. Beebe NW. Bakole"e B. Ellis JT. Cooper RD. Differential ecology of Anopheles pundulatus and lhree members of !he Anopheles larauti oomplex of mosquitoes on Guadalcanal, Solomon Islands. identified by PCR-RFLP analysis. Mediwll and veterinary entomology, 2000. 14(3):308-312. Beebe NW, Coope< RD. Distrib<rlionand evolulion ol lhe Anopheles punclulalusgroup (Diple<a: Cui~idae) inAustralia and Papua New Guinea. lnlema6orral joumal for parasitology, 2002, 32(5):56H74. Bockarie MJ, rooher P, Williams SA. Z'immerman PA. Griffin L, Alpers MP, Kazura JW. Application of a polymerase chain reaclion- EUSA to detect Wuchereria bancrol!lin pools of wild-caught Anopheles punctulatus in a lilariasisoonlrol area In Papua New Guinea. Americanjoumar of tropical medicine and hygiene. 2000, 62(3):363-367. Bockarie MJ, Hil JLK, Alexandet NOE, ~rie F, Dagoro JW, Katura JW, Alpeis MP. Mass 1reaunen1wilh ivermecUn for filariasls oonlrol In Papua New Guinea: lmpacl on mosquitosurvival. Medical and velerinaryenlomology, 1999, 13:120-123. Bockarie f.1.1, lbam E. Alexander ND, Hyun P, Dimber Z. Bockarie F, Alpers MP, Katura JW. Towards eliminaling lymphatic filariasis in Papua New Guinea: lmpacl ot annual single-dose mass trealmenl on l/ansmission ot Wuche1eria bancrofliln Easl Seplk Province. Papua New Guinea medicilljouma/, 2000, 43(3-4):172-182. Bockarie MJ. Jenkins C. Blakie WM, Lagog M, Alpers MP. Control oflympha1ic filariasis ina hun1er-galhere1group in Madang Province. Papua New Guinea medical journal. 2000. 43(3-4):196-202. Bockarie MJ, Kazura JW. Lymphalic lilariasis in Papua New Guinea; Prospects for elimination. Medical microbiology and immunology, 2003, 192(1):9-14. Bockarie MJ, Tavul L, Kastens W, Michael E, Katura JW. Impact of unlrealed bednels on prevalence of Wuche1eria banetoni lransmlt1ed by Anopheles fsrauti in Papua New Guinea. Medical and veterinary enlomology, 2002, 16( 1):116-119. Bockarie MJ, Tisch DJ, Kasiens W, Alexander NO, Dimber Z, Bockarie F, lbam E, Alpers MP, Kazura JW. Mass l!ealmenl to eliminate liariasis in Papua New Guinea. New Engtand journal ofmedicine, 2002. 347(23):11341-1848. Burl<ol T. lchlm0<i K. The PacELF programme: Will mass drug administration be enough? Trends in plifSSRology, 2002, 18(3):109-115. Burl<ol TR. Taleo G, Toeaso V, lchlmori K. Progress towards, and challenges 10<, lhe e6mlna1ion of filariasls from Pacific-island communities. Annals oftropical medicine and parasitology, 2002. 96(Suppl 2):S61-S69. Chapman HF, Kay BH, Rilchie SA, van den Hur1<AF, Hughes JM, Definillon ot species in lhe Cutex siliens subgroup (Oiplera: Culicidae) from Papua New Guinea and Ausl/afia. Journal ofmedical enromotogy. 2000. 37(5):736-742. Cooper RD. Frances SP. Biting sites of Anophekls koliensis on human colieclors in Papua New Guinea. Journal of the American Mosquito Conlro/Association, 2000. 16(3):266-267. Daley AJ. Noo-tube<culous mycobaclerial eeMcal lymphadenopa1hy. Journal ofpaediatrics and child health, 2001, 37(1):78-80. Dean M. Pacific nations lead lhe way In fighting lymphatic fifariasis: Region aims lo efimlnale. Lancet, 2003, 362(9399):1906. Dean M. Launching a lymphalic fifariasiscampaign in !he Pacific l.slands. Lancet, 2000, 356(9224):143. Dissanayake S, Rocha A, Noroes J, Medejros Z, Dreyer G, Piessens WF. Evaluation of PCRÂˇbased methods fa< lhe diagnosis ot infection In bancroflian lilariasis. Transaclions of the Royal Society of Tropical Medicine and Hygiene, 2000, 94(5):526-530. Esterre P, Plichart C. Sechan Y, Nguyen NL. The lmpacl of 34 years of massive DEC che~erapy on Wuohereria bancroltl infection and uansmission: The Maupili cohon. Tropical medicine and inlemational heaffh, 2001. 6(3): 100-195. Es1e1re P. Vlgneron E, Roux J. The history ot !he lymphatic filarlasis oonlrol programme in French Polynesia: lessoos from a 50-year effort. Bulle/in de la societe de palhologie exolique, 2005, 98(1):41-50. Frances SP, Cooper RD, Popat S, Beebe NW. Field evaluation ot repellents containing deel and Al3.J722Q against Anophales koliensis In Papua New Guinea. JoumaloltheAmerican Mosquito Control Assccielion, 2001, 17(1):42-44. Frances SP, Coope< RD, Popa! s. Sweeney AW. Field evaluation ol the repellents dee!, CIC-4, andAIJ.37220againstAnopheles In Lae, Papua New Guinea. Journal of theAmarican Mosqu~o Conl!OIAssocialion, 1999, t5(3):339-341. Hii J, Bockarie MJ. Flew S. GenIon B, Tall A. Dagoro H, Waulas B. Samson M. Alpers MP. The epidemiology and control ol lymphalic fdariasis on Lihir Island, New Ireland Province. Papua New Guinea 111<!dical;oumal, 2000, 43{3-4):188-195. Horton J. Win C, Onesen EA, Lazdins JK,Addiss OG.Awadzi K. Beach MJ, Befizario VY, Dunyo SK, Espinel M, Gyapong JO. Hossain M, Ismail MM, Jayakody RL, Lammie PJ, Makunde W, Richard-Lenoble D, Selve B, Shenoy RK, Simoosen PE, Wamae CN, Weerasooriya MV. An analysis of !he safety ol lhe singleÂˇdose, IW<Hlrug regimens used In programmes lo eliminale lymphatic filariasls. Parasitology. 2000, 121 (Suppl):S147-S160.

Blbllograglly Jacquemart Y. Josse R. Papua New Guinea. Medecine lrop/cale, 2002, 62(6):583-588. King CL. Human immune responses to lymphatic filariasis in Papua New Guinea. Papua New Guinea modic81jouma/, 2000, 43(3-4):203-212. King Cl, Connelly M. Alpers MP, Bockarie M, Kazura JW. Transmission Intensity detetmlnes lymphocyte responsiveness and cytokine bias In human lymphatic filariasis. Joumalofimmuno/ogy, 2001, 166(12):7427- 7436. LardeuxF, Cheffort J. Ambient temperature effects on Ille eJClrinsic incubation period ol WuchBtllria bancroffiin Aodes potynesiensis: Implications lor filariasis transmission dynamics and distribution in French Polynesia. Medical and velotinary Mlomo/ogy, 2001. 15(2):167- 176. Lardeux F, Riviere F, Sechan Y. loncke S. Cootrol ol the Aedes vectors of lhe dengue viruses and Wuchereria bancro/ti: The French Polynesian experience. Annals of tropical medicine andparasdo/ogy. 2002, 96(Suppl 2):S10S-S116. Lawrence G, Leafasia J, Sheridan J, Hills S, Wate J, Wate C, Montgomery J, Pandeya N, Purdie O. Control o/ scabies. skin seres and haematuria In children in Iha Solomon 15"'nds:Another role for lvermectln. Bulle/in oltho World Hea8h Organlzallon, 2005, 83(1):34-42. Epub 21 January 2005. Melrose W. Lymphatic mariasis, A review 1862-2002. www.jcu.odu.aulschoollsphtmldocuments/tfreviewnlre'liew.pdl.

Melrose W, Pisters P. Turner P, Kombati Selve BP, Hi Jeffrey, Speare R. Prevalence of filarial antigenaemia in Papua New Guinea: Results of suNeys by Iha Schoel of Public Health and Tropical Medicine, James Cook University, Townsvlne, Australia. P•JXJ• New Guinea modical joumal, 2000, 43(3-4):161- 165. Melrose WO, Turner PF, Pisters P, Turner B. An improved Knoll's concentration test 10< the detection ol microfilanae. Transactions oflhe Royal Society of Tropical Modlclne and Hygiene, 2000, 94:176. Me<ce< OR. Effects of larval densily on the size of Aedes polynesionsis adults (Oiptera: Cuticidae). Journal of medical enlomology, 1999, 36(6):702-708. Molyneux DH, Zagaria N. Lymphatic Filariasis elimination progress in global programme dove1opnenl Annals o/ tropicalmedicine andparasiology, 2002, 96(Suppl 2):S1S-S40. Nuunan TB. ed. lymphatic filariasis. London: Imperial College Press ..2000 Ottesen EA. The global programme to eliminate lymphatic r..riasls. Tropical medicine and International heaffh, 2000, 5(9):591-594. OUesen EA, lsmai MM, Horton J. The role ofAlbendazole in programmes to eliminate tympl>atic fllariasis. Parasitology today. 1999, 15{9):382-

386. PaupyC, Vazellle-Falcoz M. Mousson L, RodhainF, FaillouxAB. Aedes aegypllin Tahiti and Moorea (Frooch Polynesia): lsoenzyme differentiation In the mosquito population acco<ding to human population density. American joumat ollropical medicine and hygiene, 2000, 62(2):217-224. Reeder JC. Health research in Papua New Guinea. Trends in parosilotogy, 2003, 19(6):241-245. Sang DK, Oum a JH, John CC, Whalen CC. King CL, Mahmoud AA, Heinzet FP. Increased levels ot soluble interteultln4 receptor in lhe sera of patients with visceral lelshmanlasis. Joumal of Infectious diseases, 1999. 179(3):743-746. Sapak P. Williams G, Bryan J, Riley I. Efficacy of mass single.close dlethylcarbamazine and DEC-fortified sail against bancroftian filariasis in Papua New Guinea six months after treatrnenl. Papua New Guinea modicalfoumal. 2000, 43(3-4):213-220. Schmidt ER. Foley DH, Bugoro H, Bryan JH. A morphological study of the Anopheles JJ<Jndu/a/us group (Oiptera: Culicidae) in the Solomon Islands. with a description of Anopheles (Cellia} irenicvs Schmidt. sp.n. Bulletin of entomological research. 2003. 93(6):515-526. Seive BP, Bwadua S, Mlsa M, James K. Usurup JP, Turner P, Melrose W, Yad W, Samuel R, Eddie C. Community ernpowemienl in lhe control of lymphatic filariasis in Misima, Milne Bay Province using dlethylcarbamazine in oombination with albendazole. Papua New Guinea medical joUtnal, 2000, 43{µ):183-187. Steel C. Ottesen EA, Weller PF, Nuunan TB. Worm burden and host responsiveness in Wuchereria bancroni infection: Use of antigen detection to refVie earfle1 assessments from the South Pacific. American journal ol tropical medicine and hygiene, 200 t, 65(5):498-503. Taylor B, Maffl M. Anopheles (Cellia} rennellensis: Anew species within the punctulatus complex of Anopheles (Oiptera: Culicidae) from Rennell Island. The natural histO')I ol RMneN Island, British Solomon Islands. 1991. 8:193-198. Tisch DJ, Hazlett FE, Kastens W, Alpers MP, Bockarie MJ, Kazura JW. Ecologic and biologic determinams ot filarial antlgenemla in bancroftian filanasis in Papua New Guinea. Journal of infectious diseases, 2001, 184(7):898-904.

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