1. Eliminating Lymphatic Filariasis in the Americas
A Winnable Battle
Center for Global Health
Division of Parasitic Diseases and Malaria

2. Lymphatic Filariasis (LF)
 Caused by worms spread from person-to-person by the
bite of infected mosquitoes
 The worms live in the human lymphatic system and can
cause:
 lymphedema (swelling) and elephantiasis in limbs and breasts
 hydrocele (severe fluid accumulation) affecting men’s genitalia
Microfilaria of Wuchereria Microfilaria of Brugia malayi
bancrofti (CDC photo, DPDx) (CDC photo, DPDx)

3. Health and societal impacts of LF
 Usually develop years after initial infection
 Cause pain, severe and irreversible disfigurement, loss
of productivity, and social stigmatization
lymphedema elephantiasis
CDC photos

4. LF: A costly and disabling NTD
 One of the most disabling and economically costly
neglected tropical diseases (NTDs)
 NTDs are a group of poverty-associated parasitic and bacterial
infections affecting more than 1 billion persons
 NTDs are responsible for tremendous suffering and economic loss
 More than 120 million persons are infected with LF, a
disease that can be eliminated
Photo courtesy Carter Center/Emily Staub

5. Worldwide distribution of LF
1.34 billion at risk in world

6. Global impact of LF
 A leading cause of disability globally
 Endemic in 81 countries
 44 million persons suffer from chronic manifestations
Photos courtesy of CDC. Left: Dr. Susan Montgomery, Middle and Right: CDC PHIL

7. Global Programme to Eliminate LF (GPELF)
 Target elimination date of 2020
 Launched by World Health Organization (WHO) in 2000
 Two-pronged strategy to:
1. Interrupt the spread of infection
2. Reduce the suffering of persons already infected
 To interrupt infection, medication is
distributed to entire at-risk population through mass
drug administration (MDA)
 At least 5 rounds on MDA are needed to interrupt transmission
 Treatment kills worms circulating in the blood

8. GPELF: Progress and successes
 53 countries have ongoing MDA campaigns
 37 countries have administered 5 or more rounds of MDA in many
target areas
 2.8 billion doses of medicine delivered in first 9 years
 Treatment cost typically less than US $0.50 per person
and often less than $0.10
 Transmission interruption has protected 6.6 million
newborns from becoming infected with the disease
 Economic benefit of first 7 years of program estimated
at $24 billion
 Full economic benefit could exceed US $55 billion

9. The economic impact of GPELF, 2000-2007
Table courtesy of WHO GPELF

10. WHO Guidelines for LF Elimination Programs
Rounds annual
mass drug administration (MDA)
Post-MDA Period
1 2 3 4 5 n
Monitoring & Evaluation Passive Surveillance ( > 5 years)
Coverage
Impact Assessment
“Mapping”
TAS TAS TAS
TAS = transmission assessment survey

11. LF elimination in the Americas
 The Americas is the first region targeted for elimination
of LF
 Improvements in standard of living have reduced disease
prevalence in continental Americas and Caribbean Islands
 In areas where disease remained (Costa Rica, Suriname, and
Trinidad and Tobago), transmission was interrupted through
selective and community treatment
 Transmission still occurs in Guyana, Haiti, and parts of Brazil and
the Dominican Republic

12. Notable achievements in the Americas
 Surveys carried out in the Dominican Republic suggest
transmission interruption
 MDA treatment scaling up in Guyana and Haiti
 4.5 million of 8.6 million at-risk Haitians received MDA
 3 million Haitians treated since January 2010 earthquake
 Disease management programs operating in all four
endemic countries
CDC photo

13. Notable achievements in the Americas
 Although there is still active transmission in Guyana,
Haiti, and parts of Brazil and the Dominican Republic,
each country has achieved notable success in the fight
against LF
 As of late 2009, nearly 5 million persons living in
Americas had received MDA
 Elimination in the Americas is within reach

14. Progress in MDA for LF, WHO’s Region of the
Americas, 2000-2009
Graph courtesy of WHO GPELF

15. CDC and partner support
 CDC and its partners:
 Work with each country’s ministry of health to offer
advice and expert consultation
 Develop monitoring and evaluation strategies
 Provide technical support
 Carry out operational research including working to
understand:
• Adherence to medication
• Optimal surveillance methods
• Strategies to accelerate elimination

16. Winning the battle against LF:
What more can be done to eliminate LF by 2020?
 Continue and scale-up MDA programs to interrupt
transmission
 Use operational research to develop strategies to
accelerate the elimination of LF
 Increase each country’s efforts to provide appropriate
care for persons with filarial disease
 Expand the reach of LF programs to include service
delivery for other NTDs and health priorities

17. CDC partners
 We would like to acknowledge and thank our partners
working to eliminate lymphatic filariasis:
 The Bill & Melinda Gates Foundation
 CBM International
 Eisai
 GlaxoSmithKline
 IMA World Health
 Inter-American Development Bank
 Merck
 Pan American Health Organization
 RTI International
 The Task Force for Global Health
 University of Notre Dame
 United States Agency for International Development (USAID)

18. Thank you
www.cdc.gov/winnablebattles
For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: cdcinfo@cdc.gov Web: www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official
position of the Centers for Disease Control and Prevention.
Center for Global Health
Division of Parasitic Diseases and Malaria