Lymphatic Filariasis Transmission and Elimination in Papua New Guinea

巴布亚新几内亚的淋巴丝虫病传播和消除

• 批准号: 8368954
• 负责人: Daniel J. Tisch
• 金额: $ 55.34万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-07 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8368954
• 关键词: 10 year old; Accounting; Address; Adult; Africa; Age; Albendazole; Antibodies; Antigens; Archives; Area; Asia; Biological; Biological Assay; Blood; Child; Communities; Country; Culicidae; Data; Decision Making; Diagnostic; Diagnostic Procedure; Diethylcarbamazine; Elephantiasis; Evaluation; Exposure to; Extinction (Psychology); Filaria bancrofti; Filarial Elephantiases; Goals; Helminths; Human; Hydrocele; IgG4; Immunoglobulin G; Individual; Infection; Insecticides; Ivermectin; Knowledge; Limb structure; Link; Low income; Lymphedema; Malaria; Male Genital Organs; Measures; Methods; Microfilaria; Microscopic; Monitor; Pain; Papua New Guinea; Parasites; Pathology; Pharmaceutical Preparations; Population; Prevalence; RNA; Recombinant Proteins; Relative (related person); Reproducibility; Research; Risk; Sampling; Schedule; Sensitivity and Specificity; Sentinel; Serological; Staging; Swelling; Techniques; Testing; Time; Transcript; Tropical Disease; United States National Institutes of Health; base; cost effective; evidence base; experience; feeding; neglect; novel; programs; prospective; serological marker; tool; transmission process; vector; vector control; vector mosquito; vector transmission

DESCRIPTION (provided by applicant): More than a billion people in 80 mid- and low-income countries of Africa, Asia and the Pacific are at risk for lymphatic filariasis (LF), a mosquito bore parasitic worm "Neglected Tropical Disease" (NTD) that causes elephantiasis, disfigurement of the male genitalia and painful swelling of the extremities. For the past 10 years there has been intense global effort to eliminate LF due to Wuchereria bancrofti (Wb) with a target date of 2020 (WHO). The strategy relies on repeated annual mass drug administration (MDA) of donated anti-filarial drugs (5-7 years of MDA with albendazole plus diethylcarbamazine or ivermectin) with the aim to reduce the reservoir of blood borne microfilaria (MF) below a level required for continuing transmission by local mosquito vectors. However, recent observations indicate that progress toward LF elimination is stalled and difficult to ascertain in many areas. This application will address two major deficiencies. The first is a lack of robust methods for monitoring and evaluation that allow for informed decision making with respect to a) whether MDA should be continued or stopped and b) how vector control measures (such as long lasting insecticide treated bednets; LLIN) will accelerate elimination using MDA. Existing national LF elimination programs are based on the WHO recommended Binax rapid card test, which detects adult Wb antigen in the blood. Although this card test is rapid and convenient, it often produces high false positive and false negative rates following MDA when compared to parasitological assays, more sensitive parasite-antigen specific serological assays. The second deficiency is lack of robust quantitative data assessing of the relative added benefit of combining vector control using LLIN with MDA to reduce LF transmission. In the current application we combine >25 years experience and access to a large archive of samples obtained in studying LF transmission in Papua New Guinea (PNG) using novel antigens provided by colleagues at NIH and the recent introduction of LLINs in PNG for malaria control in a endemic area where the vectors for malaria and LF are the same. This study a) characterizes the critical variables and monitoring tools for LF elimination, b) quantifies the impact of LLIN on LF elimination programs using MDA, and c) links entomological and human markers of LF transmission during LF elimination monitoring. Effective LF elimination monitoring tools and strategies as tested in this study are essential to achieving and maintaining LF elimination in PNG and the stated 2020 goals of the Global Program for the Elimination of LF (GPELF). PUBLIC HEALTH RELEVANCE: Progress toward LF elimination is difficult to ascertain due to poor understanding of the optimal monitoring tools needed to inform decision making with respect to a) whether MDA should be continued or stopped and b) how vector control measures (such as insecticide treated bednets; LLIN) will accelerate elimination using MDA. This RO1 application will test lymphatic filariasis monitoring tools and strategies in Papua New Guinea communities receiving mass drug administration with and without LLIN. Effective LF elimination monitoring tools and strategies as tested in this study are essential to achieving and maintaining LF elimination in PNG and the stated 2020 goals of the Global Program for the Elimination of LF (GPELF).

描述（由申请人提供）：在非洲，亚洲和太平洋80个中和低收入国家中，有超过十亿人有淋巴丝虫病（LF）的风险，这是一种蚊子孔“被忽视的热带疾病”（NTD），会导致大象症，对男性基因的极端性和痛苦的肿胀。在过去的10年中，由于Wuchereria Bancrofti（WB）的目标日期为2020年（WHO），全球努力消除了LF。该策略依赖于捐赠的抗抗物药物（5 - 7年使用Arbendazole加上MDA以及二乙基甲基苯丙胺或ivermectin的MDA）重复的年度大规模药物管理局（MDA），旨在降低低于当地蚊子vectors的传播所需水平所需的血液寄生的微教脂（MF）（MF）。但是，最近的观察结果表明，在许多领域，逐渐消除LF的进展是停滞不前的，难以确定。该应用程序将解决两个主要缺陷。首先是缺乏监视和评估的可靠方法，该方法允许有关a）是否应继续或停止MDA，b）载体控制措施（例如持久的杀虫剂处理过的床网； LLIN）将加速使用MDA加速消除。现有的国家LF消除计划基于WHO推荐的Binax快速卡测试，该测试检测到血液中的成年WB抗原。尽管此卡测试既快速又方便，但与寄生学测定，更敏感的寄生虫 - 抗原特异性血清学分析相比，MDA后通常会产生高的假阳性和假阴性率。第二个缺陷是缺乏强大的定量数据评估使用LLIN与MDA结合矢量控制以减少LF传输的相对附加益处。在当前的应用中，我们结合了> 25年的经验，并使用NIH同事提供的新豚鼠（PNG）在研究巴布亚新几内亚（PNG）中获得的大量样品档案，以及在疟疾和LF的媒介区中提供的疟疾控制中的LLIN在PNG中引入了LLIN的LLIN，用于疟疾和LF。这项研究a）表征了消除LF的关键变量和监测工具，b）使用MDA量化LLIN对LF消除程序的影响，c）在LF消除监测过程中链接LF传播的昆虫学和人类标记。本研究中测试的有效消除LF监测工具和策略对于实现和维持PNG中的LF消除至关重要，以及全球消除LF（GPELF）的2020年目标。 公共卫生相关性：由于对a）是否应继续或停止的最佳监测工具的了解不足，因此很难确定消除LF的进展，而b）b）载体控制措施（例如杀虫剂处理的床网； LLIN）将如何加速使用MDA加速消除。该RO1应用将测试巴布亚新几内亚新几内亚社区的淋巴丝虫病监测工具和策略，该社区有或没有LLIN接受大众药物管理局。本研究中测试的有效消除LF监测工具和策略对于实现和维持PNG中的LF消除至关重要，以及全球消除LF（GPELF）的2020年目标。