Global elimination of lymphatic filariasis

Lymphatic filariasis is one of the most debilitating neglected tropical diseases, the clinical manifestations of which include painful and incapacitating lymphoedema.1 Among the estimated 68 million people infected, 36 million are microfilaria carriers and 40 million are symptomatic.1 Additionally, 946 million people live in areas of southeast Asia and sub-Saharan Africa where mosquito-borne filariasis is endemic and are, therefore, at risk of infection.1 In 2000, WHO launched the Global Programme to Eliminate Lymphatic Filariasis (GPELF), which aims to interrupt transmission of lymphatic filariasis by 2020.2 To achieve this elimination goal, GPELF recommends annual mass drug administration at a minimum population coverage of 65%.3,4 The double-drug regimens currently administered are a combination of albendazole with either ivermectin or diethylcarbamazine. Civil unrest (eg, in South Sudan), the Ebola virus disease outbreak in Liberia, Sierra Leone and Guinea, and non-compliance to treatment are just some of the myriad factors that complicate programme implementation.9 A principal consideration for the optimisation of elimination strategies, particularly in resource-constrained settings, is the cost-effectiveness of innovative interventions that integrate new diagnostic methods and treatment of lymphatic filariasis in the context of economic constraints and logistical barriers. Since drugs for the lymphatic filariasis programme are donated by manufacturers,11 and...