Continued research on lymphatic filariasis is essential

December 04, 2002

ATLANTA -- 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.

Emory University Health Sciences Center

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