Expert mission to Maldives for verification of elimination of Lymphatic Filariasis

Abstract

Lymphatic filariasis (LF) is a neglected tropical disease that continues to be a major public health problem in the South-East Asia Region (SEAR) of the World Health Organization (WHO). Nine of the 11 Member States are endemic for LF. The Region has a disproportionate burden of illness with 63% of the population at risk and 50% of the infected people in the world. SEAR has made significant progress towards achieving the goal of elimination having completed mapping and launched the WHO-recommended two-drug strategy for mass drug administration (MDA) in all the endemic countries. Maldives completed five rounds of MDA in 2008, stopped MDA in 2009 and is implementing post-MDA surveillance. Based on the recommendations of the seventh meeting of the Regional Programme Review Group (RPRG) for Elimination of Lymphatic Filariasis in 2010, an expert mission to Maldives was organized by the WHO Regional Office for South-East Asia (WHO-SEARO) from 19–26 June 2011 as the first step to initiate the process of verification of elimination. The mission also provided technical inputs and guidelines to carry out further follow-up action such as Transmission Assessment Surveys (TAS) and preparation of the dossier. A list of members of the expert mission can be found in Section 1.1 of this report. The terms of reference of the mission were to review the programme and assess the quality of testing and data collection; to review the steps taken by the country to stop MDA; and to assess the steps taken as part of post-MDA surveillance activities, including the preparation of the dossier in accordance with the LF TAS Manual of WHO 2011.1 The team held consultations with the programme managers and senior officials of the Ministry of Health (MoH) along with representatives of the WHO Country Office in Maldives. The team examined documents and undertook field visits to observe ICT card testing in the schools to verify the interruption of LF transmission among six-seven year-old children as per the LF TAS Manual, WHO 2011. At the end of the mission, the team had debriefing meetings with the same officials to discuss the field observations, and compilation of the dossier required for certification of elimination of LF in Maldives. The National Programme for the Control of Lymphatic Filariasis began in 1969. LF case detection and treatment as well as antilarval measures were carried out in endemic islands. In 1998, 10 islands were found to be endemic and the micro filarial (Mf) prevalence rate ranged between 0.19–0.91%. A sample survey carried out in 2003 in Laamu atoll showed that 223 (17.9%) children were positive for filarial antigenaemia. MDA was launched only in Fonadhoo Island in that atoll in 2004 and five annual rounds were completed in 2008. No child in the age 1 WHO (2011): Monitoring and Epidemiological Assessment of Mass Drug Administration: Lymphatic Filariasis TAS, A Manual for national Elimination Programmes