Continued Research on Lymphatic Filariasis is Essential for Success
of Global Elimination of Debilitating Disease
A global public-private partnership
sponsored by the World Health Organization (WHO) has resulted in significant
progress over the past five years in reaching the goal of eliminating
lymphatic filariasis (LF) a profoundly disfiguring disease, caused
by a mosquito-borne parasite, that is endemic in 80 countries. Ongoing
scientific research must accompany treatment, however, if the elimination
program is to continue to succeed in additional countries and affected
populations, according to an editorial in the Dec. 5 issue of the New
England Journal of Medicine.
Eric A. Ottesen, MD, research
professor of international health in the Rollins School of Public Health
(RSPH) at Emory University, director of the RSPH Lymphatic Filariasis
Support Center, and former project leader for the WHO elimination program,
wrote the editorial in response to an article by M. J. Bockarie in the
same issue of the journal, entitled "Mass Treatment to Eliminate Filariasis
in Papua New Guinea."
Dr. Bockarie determined that
the annual combination drug therapy prescribed by the WHO protocol rapidly
and dramatically reduced levels of infection and disease transmission
of LF in remote regions of Papua New Guinea, an area with very high
infection rates of 42 to 77 percent. He also found that the major clinical
and highly debilitating manifestations of disease were significantly
decreased after treatment a surprising finding not accounted for
by current medical knowledge.
Dr. Ottesen emphasizes that
long-term clinical research projects such as Dr. Bockarie’s are critical
to measuring LF elimination efforts and making adjustments as the program
moves into countries with new challenges.
In 1993 the International
Task Force for Disease Eradication identified lymphatic filariasis as
one of only six diseases that met the criteria for potential eradication.
At the time LF infected 120 million people globally and was exerting
a major economic, social and developmental impact. Globally, the infection
has been recognized as one of the leading causes of permanent and long-term
disability, resulting not only in physical suffering but also in serious
psychosocial problems and poverty. One-third of infected individuals
live in India, one-third in Africa and the remainder in South Asia,
the Pacific and the Americas. An additional 1.2 billion people are believed
to be at risk of infection. Following the 1997 Resolution of the World
Health Assembly to eliminate LF as a public health problem, a Global
Alliance for the Elimination of Lymphatic Filariasis was created as
a coalition of more than 35 public and private partners.
"Were it not for the earlier
successes of research in lymphatic filariasis, the global elimination
program could not have been launched," Dr. Ottesen says. "The current
research findings offer results that will continue to be useful in developing
programs in additional countries and in monitoring the effectiveness
of therapies throughout the world. As different challenges are presented
in communities with different disease patterns and different mosquito
vectors, the scientific community must continue to work closely with
government and philanthropic partners to ensure the long-term success
of our elimination program," he says.
The WHO efforts have been
supported by major philanthropic commitment, especially from GlaxoSmithKline
along with Merck & Co., Inc., the Bill and Melinda Gates Foundation,
the Arab Fund for Economic and Social Development and the United Kingdom’s
Department for International Development. This collaborative effort
of more than 35 public, private and international institutions, has
led to the creation of national elimination programs in 38 of the 80
countries where LF is endemic, reaching almost 90 million people. The
WHO goal is to reach 350 million people by 2005 and all 1.1 billion
individuals at risk by 2020.