Prevalence and risk factors associated with lymphatic filariasis in American Samoa after mass drug administration

doi:10.1186/s41182-017-0063-8

. 2017 Aug 4:45:22.

doi: 10.1186/s41182-017-0063-8. eCollection 2017.

Prevalence and risk factors associated with lymphatic filariasis in American Samoa after mass drug administration

Shaun P Coutts¹, Jonathan D King², Molisamoa Pa'au³, Saipale Fuimaono³, Joseph Roth⁴, Mary Rose King⁵, Patrick J Lammie⁶, Colleen L Lau⁷, Patricia M Graves⁸

Affiliations

¹ College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Australia.
² Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland.
³ American Samoa Department of Health, Pago Pago, American Samoa.
⁴ Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, USA.
⁵ Independent Nursing Consultant, Geneva, Switzerland.
⁶ Neglected Tropical Diseases Support Center, The Task Force for Global Health, Atlanta, USA.
⁷ Department of Global Health, Research School of Population Health, Australian National University, Canberra, Australia.
⁸ Australian Institute of Tropical Health and Medicine and College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Australia.

PMID: 28794687
PMCID: PMC5543440
DOI: 10.1186/s41182-017-0063-8

Prevalence and risk factors associated with lymphatic filariasis in American Samoa after mass drug administration

Shaun P Coutts et al. Trop Med Health. 2017.

. 2017 Aug 4:45:22.

doi: 10.1186/s41182-017-0063-8. eCollection 2017.

Authors

Shaun P Coutts¹, Jonathan D King², Molisamoa Pa'au³, Saipale Fuimaono³, Joseph Roth⁴, Mary Rose King⁵, Patrick J Lammie⁶, Colleen L Lau⁷, Patricia M Graves⁸

Affiliations

¹ College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Australia.
² Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland.
³ American Samoa Department of Health, Pago Pago, American Samoa.
⁴ Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, USA.
⁵ Independent Nursing Consultant, Geneva, Switzerland.
⁶ Neglected Tropical Diseases Support Center, The Task Force for Global Health, Atlanta, USA.
⁷ Department of Global Health, Research School of Population Health, Australian National University, Canberra, Australia.
⁸ Australian Institute of Tropical Health and Medicine and College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Australia.

PMID: 28794687
PMCID: PMC5543440
DOI: 10.1186/s41182-017-0063-8

Abstract

Background: In 2000, American Samoa had 16.5% prevalence of lymphatic filariasis (LF) antigenemia. Annual mass drug administration (MDA) was conducted using single-dose albendazole plus diethylcarbamazine from 2000 to 2006. This study presents the results of a 2007 population-based PacELF C-survey in all ages and compares the adult filarial antigenemia results of this survey to those of a subsequent 2010 survey in adults with the aim of improving understanding of LF transmission after MDA.

Results: The 2007 C-survey used simple random sampling of households from a geolocated list. In 2007, the overall LF antigen prevalence by immunochromatographic card test (ICT) for all ages was 2.29% (95% CI 1.66-3.07). Microfilaremia prevalence was 0.27% (95% CI 0.09-0.62). Increasing age (OR 1.04 per year, 95% CI 1.02-1.05) was significantly associated with ICT positivity on multivariate analysis, while having ever taking MDA was protective (OR 0.39, 95% CI 0.16-0.96). The 2010 survey used a similar spatial sampling design. The overall adult filarial antigenemia prevalence remained relatively stable between the surveys at 3.32% (95% CI 2.44-4.51) by ICT in 2007 and 3.23 (95% CI 2.21-4.69) by Og4C3 antigen in 2010. However, there were changes in village-level prevalence. Eight village/village groupings had antigen-positive individuals identified in 2007 but not in 2010, while three villages/village groupings that had no antigen-positive individuals identified in 2007 had positive individuals identified in 2010.

Conclusions: After 7 years of MDA, with four rounds achieving effective coverage, a representative household survey in 2007 showed a decline in prevalence from 16.5 to 2.3% in all ages. However, lack of further decline in adult prevalence by 2010 and fluctuation at the village level showed that overall antigenemia prevalence at a broader scale may not provide an accurate reflection of ongoing transmission at the village level.

Keywords: American Samoa; Epidemiology; Lymphatic filariasis; MDA; PacELF; Prevalence; Wuchereria bancrofti.

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Conflict of interest statement

Author’s information

Not applicable.

Ethics approval and consent to participate

The 2007 survey was conducted under routine monitoring and evaluation activities for the LF programme of the American Samoa Department of Health. This study was reviewed by the CDC/OPHPR human subjects official, and it was determined to be public health research not involving human subjects.

For the original 2010 leptospirosis study, ethics approvals were obtained from the American Samoa Institutional Review Board, the Medical Research Ethics Committee of the University of Queensland (2010000114, approved 25 February 2010, amended 16 October 2012 to allow LF testing) and Queensland Health Forensic and Scientific Services Human Ethics Committee (HREC/10/QFSS/1). Permission was also sought from the Department of Samoan Affairs and village chiefs before village visits.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

**Fig. 1**
Village-level filarial antigenemia prevalence in the 2007 lymphatic filariasis C-survey in American Samoa—Tutuila and Aunu’u

**Fig. 2**
2007 village-level filarial antigenemia prevalence in the 2007 lymphatic filariasis C-survey in American Samoa—Ofu-Olosega and Tau

**Fig. 3**
Age-specific prevalence for *W. bancrofti* antigenemia in the 2007 lymphatic filariasis C-survey in American Samoa. Bars indicate 95% confidence intervals

**Fig. 4**
Comparison of overall and village-level adult filarial antigenemia prevalence between the 2007 and 2010 lymphatic filariasis surveys in American Samoa

See this image and copyright information in PMC

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[1] Heymann DL, American Public Health Association . Control of Communicable Diseases Manual. Washington, DC: American Public Health Association; 2004.

[2] Heymann DL, American Public Health Association . Control of Communicable Diseases Manual. Washington, DC: American Public Health Association; 2004.

[3] Ichimori K, King JD, Engels D, Yajima A, Mikhailov A, Lammie P, Ottesen EA. Global programme to eliminate lymphatic filariasis: the processes underlying programme success. PLoS Negl Trop Dis. 2014;8:e3328. doi: 10.1371/journal.pntd.0003328. - DOI - PMC - PubMed

[4] Ichimori K, King JD, Engels D, Yajima A, Mikhailov A, Lammie P, Ottesen EA. Global programme to eliminate lymphatic filariasis: the processes underlying programme success. PLoS Negl Trop Dis. 2014;8:e3328. doi: 10.1371/journal.pntd.0003328. - DOI - PMC - PubMed

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[8] World Health Organization. Lymphatic filariasis: monitoring and epidemiological assessment of mass drug administration. In: Ichimori K, editor. A manual for national elimination programmes. Geneva: World Health Organization; 2011. p. 1–78.

[9] Lambdin BH, Schmaedick MA, McClintock S, Roberts J, Gurr NE, Marcos K, Waller L, Burkot TR. Dry season production of filariasis and dengue vectors in American Samoa and comparison with wet season production. Am J Trop Med Hyg. 2009;81:1013–1019. doi: 10.4269/ajtmh.2009.09-0115. - DOI - PMC - PubMed

[10] Lambdin BH, Schmaedick MA, McClintock S, Roberts J, Gurr NE, Marcos K, Waller L, Burkot TR. Dry season production of filariasis and dengue vectors in American Samoa and comparison with wet season production. Am J Trop Med Hyg. 2009;81:1013–1019. doi: 10.4269/ajtmh.2009.09-0115. - DOI - PMC - PubMed

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