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 bancrofti (CDC photo, DPDx) Microfilaria of Brugia malayi (CDC photo, DPDx)

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

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  Present in 73 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. Passive Surveillance ( > 5 years) “Mapping” TAS n Monitoring & Evaluation 1 Rounds annual mass drug administration (MDA) 2345 Coverage Impact Assessment WHO Guidelines for LF Elimination Programs Post-MDA Period 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 Haiti  3 rounds of MDA have been completed in Haiti, including the urban capital of Port-au-Prince  Many departments of Haiti are ready to begin transmission assessment surveys (TAS) to determine if MDA can be stopped  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 2012, nearly 9 million persons living in Americas had received MDA  Elimination in the Americas is within reach

14. 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. 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. Thank you www.cdc.gov/winnablebattles/lymphaticfilariasiswww.cdc.gov/winnablebattles Center for Global Health Division of Parasitic Diseases and Malaria