MEETING OF THE INTERNATIONAL TASK FORCE ON DISEASE ERADICATION

Thursday, 20th of October 2011

MEETING OF THE INTERNATIONAL TASK FORCE ON DISEASE ERADICATION

Full text is at http://www.who.int/wer/2011/wer8632.pdf

Conclusions and recommendations:

1. Africa’s 74% coverage of MDA [mass drug administration] for onchocerciasis is considerably better than the continent’s MDA coverage for lymphatic filariasis, which was about 18% of the at-risk population in 2009. However, the task force believes that it is possible to eliminate lymphatic filariasis from the African continent by the global target year of 2020 set by the World Health Assembly in 1997 (WHA 50.29). Achieving this goal will require complete mapping of the distribution of lymphatic filariasis by 2013, and rapid scaling up of MDA or other interventions in all endemic areas by 2015. Concurrent increases in Africa in the distribution of bednets treated with long-lasting insecticide to prevent malaria will also help stop transmission of lymphatic filariasis

2. The task force welcomed APOC’s recent transition towards a policy of onchocerciasis elimination. However, it was recognized that attainment of this objective by 2015 is not feasible. The task force is concerned about the rapid reduction in MDA for onchocerciasis being considered by APOC, given the uncertainty over the extent of zones where the

disease is being transmitted and the likely lack of treatment in parts of those transmission zones.

Linking an APOC goal to eliminate onchocerciasis to the 2020 date for elimination of lymphatic filariasis would be more feasible, but it would still require surmounting several challenges, including: finding effective strategies to stop transmission of onchocerciasis in areas that are coendemic for loiasis and where ivermectin-based MDA cannot be used; delineating untreated zones where transmission of the disease continues (instead of the

project areas that have defined APOC-supported control measures); extending MDA to all transmission zones where this can be done safely; and making it a priority to reach as soon as possible highly endemic areas and populations at risk that have never received treatment through MDA.

3. The task force considered it imperative that the 2 initiatives to eliminate lymphatic filariasis and onchocerciasis work together more closely to coordinate mapping activities and delivery of MDA in Africa at the continent, national and district levels. Programmes to eliminate lymphatic filariasis and programmes to control malaria should also join forces to benefit mutually from village-based drug administration and bednet distribution. WHO should help to ensure that these 3 programmes begin working together as soon as possible. MDA with ivermectin and albendazole for lymphatic filariasis and onchocerciasis, and distribution of bednets treated with long-lasting insecticide, are cost-effective interventions

that will have synergistic and beneficial impacts on lymphatic filariasis, malaria and onchocerciasis.

These interventions also have an impact on soil-transmitted helminths.

4. APOC and programmes to eliminate lymphatic filariasis should prioritize the 4–6 African countries that contain a large share of the at-risk populations for these diseases and target them for rapid scaling up of appropriate interventions.

5. In devising and implementing coordinated activities against onchocerciasis and lymphatic filariasis in Africa, the task force emphasized the need for flexibility to account for complex differences among and within countries. A single approach will not address the needs and epidemiological conditions in all countries or all transmission zones within countries. Providing better maps of the overlap of lymphatic filariasis, onchocerciasis

and areas of loiasis will help policy-makers and programme leaders to design better integrated elimination programmes for lymphatic filariasisand onchocerciasis.

6. The task force acknowledged the beneficial impact programmes have had, especially the onchocerciasis programmes (the Onchocerciasis Control Programme and APOC), in

reducing the burdens of disease in Africa. However, the task force also noted that APOC’s coverage of treatment is <70% in several countries. Treatments in difficult areas need to be launched immediately (security permitting), and treatments may need to be delivered

more than once each year in some areas to help them catch up with other areas that have been treated for longer periods.

7. To facilitate comparisons of the impact of MDA on lymphatic filariasis or onchocerciasis, it would be ideal to know the baseline prevalence of infection, the frequency and duration of MDA, the coverage attained by MDA, the prevalence of infection after MDA and the results of entomological and epidemiological assessments.

8. Participants at the meeting endorsed the view of previous meetings that developing a practical macrofilaricide should be the highest priority for onchocerciasis research. Developing an effective diagnostic tool for detecting viable adult worms is another high priority.

9. The task force expressed its gratitude for the donations of medicines made by Merck & Co. and GlaxoSmithKline that have advanced the fight against these 2 diseases so remarkably.