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Friday, June 21, 2013
Peter Hotez provided commentary on Haiti's first round of mass drug administration in Infectious Disease News.
Lymphatic filariasisis (LF) a parasitic infection associated with lymphedema and hydrocele; 90% of the cases are caused by a worm caused by Wuchereria bancrofti. It’s been a huge problem globally for thousands of years. The first country to eliminate it was the People’s Republic of China. In the 1970s and 1980s, they began to scale up the concept of mass drug administration. The idea is that you can interrupt the transmission of the disease, and eliminate it as a public health problem, by treating everybody around the same time. The concept worked, and WHO, in collaboration with public and private partnerships such as the Global Alliance to Eliminate Lymphatic Filariasis, worked to apply this concept to other areas. Now the disease has been eliminated in more than 20 countries, including several countries in the Americas, such as Costa Rica, Trinidad, Tobago, Suriname, all countries in the Americas.
Applying this concept to Haiti — one of the four remaining LF-endemic countries in the Americas —has been challenging. Among the reasons for the persistent LF problem in Haiti is the country’s extreme poverty and depleted health system infrastructure, as well as periodic social unrest and associated low compliance rates. Then, just as progress was being made, the earthquake struck in 2010, which further disrupted the health system, ultimately leading to a vicious cholera outbreak. This paper gives us some cause for optimism. It indicates that now there is a level of coverage that could one day reach levels required to eliminate LF when done over a period of 4 to 5 years. These data suggest that if Haiti’s national program to eliminate LF continues to improve its level of coverage, we might eventually eliminate the disease in Haiti, just like we have in other countries in the Americas.