Sustaining Progress towards NTD Elimination: An Opportunity to Leverage Lymphatic Filariasis Elimination Programs to Interrupt Transmission of Soil-Transmitted Helminths

Résumé

In light of the unprecedented momentum to control or eliminate ten neglected tropical diseases (NTDs) by 2020, the NTD community is at a crossroads of opportunity.Efforts to eliminate lymphatic filariasis (LF) using mass drug administration (MDA) platforms have dramatically and simultaneously increased the number of individuals treated for soil-transmitted helminths (STHs) in many areas, owing to overlaps in endemicity and drug efficacy.A concomitant reduction in STH infection raises the possibility of moving beyond current World Health Organization (WHO) morbidity control guidelines to actual disease elimination for STHs [1].We identify specific rationale, opportunities, and challenges associated with leveraging existing LF elimination platforms for the purpose of interrupting STH transmission.Over 1,500,000,000 people globally are infected with STHs, including roundworm (Ascaris lumbricoides), whipworm (Trichuris trichiura), and hookworm species (Necator americanus and Ancylostoma duodenale).STHs are transmitted when infected persons shed eggs in feces that then contaminate soil or water and are ingested by or penetrate the skin of others.An individual's worm burden, or the intensity of their infection, is directly related to their risk of STH-associated morbidity.Moderate to heavy STH infections are associated with diarrhea, malnutrition, chronic malaise, impaired cognitive development, disrupted linear growth, chronic inflammation, and anemia [2].Current WHO recommendations focus on the control of STH-associated morbidity via MDA of albendazole (ALB) or mebendazole, often donated to endemic countries by the pharmaceutical industry.Target populations include pre-school age children (PSAC), school age children (SAC), and women of childbearing age, including pregnant women in their second and third trimesters.The WHO strategy for SAC recommends that MDA programs target SAC annually where prevalence is 20%-50% and biannually where prevalence is over 50%.These programs are primarily delivered using school-based platforms with teachers serving as drug distributors.In alignment with the WHO NTD Roadmap, this sustained control strategy aims to decrease worm burden and reduce STH-associated morbidity by ensuring that 100% of endemic countries are reaching PSAC and SAC with at least 75% coverage by 2020 [3].However, in 2013, only 39% of SAC and 49% of PSAC in need of treatment were reached with MDA, and only 27% of endemic countries currently attain London Declaration coverage

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