Clear evidence that elephantiasis can be eliminated

Clear evidence that Lymphatic Filariasis (LF, commonly known as elephantiasis) can be eliminated is reported in The Lancet. LF is one of the world's most disfiguring and disabling parasitic diseases, and the target of one of the largest global public health programs using mass drug administration (MDA).

Commenting on the data Professor David Molyneux of the Liverpool School of Tropical Medicine says "In this landmark publication, new data from the national program in Egypt show that we can, using the World Health Organization (WHO) recommended strategy of an annual drug distribution, end the cycle of transmission of lymphatic filariasis by mosquitoes."

LF has plagued Egypt since the time of the pharaohs; yet this simple strategy -- to provide diethylcarbamazine (DEC) plus albendazole once a year for five years to the majority of people in affected communities -- reduces infection rates, leading to elimination of the disease.

The world has seen the successful elimination of only one disease -- smallpox -- and these promising data provide imminent hope for eliminating another. As part of the WHO led global effort to eliminate LF, Egypt was among the first countries to implement a national program.

Gary Weil, M.D. senior author and professor of medicine and molecular microbiology at Washington University in St. Louis, Missouri commented, "Our assessments suggest that the Egyptian campaign to eliminate LF, which was implemented by the Egyptian Ministry of Population and Health, has achieved its goals in most areas of the country."

Using several tests, Egyptian scientists were able to assess infection and transmission parameters over the five years of the mass drug administration. All the tests revealed sharp declines. For example, community parasite loads (a broad measure of infection) declined by more than 90% after MDA; antibody tests in 5 year old school children showed that levels of exposure to infection declined by 99 -100%.

LF threatens over one billion people in 83 countries. Approximately 120 million people are infected with the parasites, 40 million of whom have clinical symptoms of the disease. The Global Alliance to Eliminate LF was formed with the support of the pharmaceutical companies GlaxoSmithKline (GSK) and Merck to help countries with LF respond. GSK has donated over 440 million albendazole tablets to date, which serve as a cornerstone of the program.

JP Garnier, CEO of GlaxoSmithKline added, "The Egypt data show that we can now eliminate a disease that has plagued the world for centuries. We remain committed to donating as much albendazole as required to eliminate this disabling disease, but ultimate success will depend on continued long-term commitments by all partners across the globe."

The Global Alliance to Eliminate LF will meet in Fiji next week where the future prospects and challenges for eliminating LF by the year 2020 will be discussed. The Alliance brings together national Ministries of Health and more than 40 diverse public and private partners including the World Health Organization, private sector companies, international development agencies and foundations, non-governmental organizations, research institutions, and local communities.

Despite this promising scientific validation from Egypt and the building of the global partnership, many challenges lie ahead. As LF affects the world's poorest countries, there is an urgent need for additional external resources to continue the momentum towards elimination. Several countries in Africa and Asia that are poised to initiate elimination programs or scale-up activities cannot do so because of lack of funding. More help and support from existing and new donors is desperately needed.

Reaching the world's entire at-risk population for at least five years presents a daunting task; but, as the data from Egypt confirm, country by country, it is possible to defeat this disease and protect future generations.