Samoa rolls out triple drug therapy to eliminate lymphatic filariasis

PHOTO: Young girl receiving IDA

Source: World Health Orgnisation
Photos by Dr. Rasul Baghirov

TUESDAY 18 SEPTEMBER 2018: Samoa has become the first country to implement the new triple drug regimen recommended by WHO for the treatment of lymphatic filariasis (LF), a disabling and disfiguring neglected tropical disease.

Annual mass treatment of the entire eligible population of Samoa began on 14 August and is expected to be completed by 26 August.

In 2017, WHO published guidelines on alternative mass drug administration (MDA) regimens to eliminate filariasis, in which IDA (that is, a combination of ivermectin, diethylcarbamazine and albendazole) is recommended for annual treatment in settings where its use is expected to have the greatest impact.

Together with the Ministry of Health Samoa, we have ensured that dispositions are in place to enable the mass treatment of an estimated 180 000 people as part of their renewed national plan to eliminate lymphatic filariasis1 as a public health problem” said Dr Rasul Baghirov, WHO Representative in Samoa.

With the support of partners2 and donated medicines from the pharmaceutical industry, the Government of Samoa has been demonstrating its strong commitment to ensure that filariasis is finally eliminated from Samoa“.

Besides children, every eligible person, including adolescents and adults were treated.

Health teams in all communities started mass treatment of children in primary schools and made house-to-house visits to provide the treatment to all eligible individuals in the community in Savaii, the largest island of Samoa. Health workers and volunteers ensured that people took the medication under their direct supervision.

Engaging communities and making sure everyone takes the medication is crucial to ensure success through the use of this new treatment regimen, and thereby accelerate the achievement of elimination” said Dr Rabindra Abeyasinghe, acting Director of Division of Communicable Disease of WHO’s Regional Office for the Western Pacific.

We are encouraged to note the careful planning and preparations, including communication and training of health workers and volunteers that has preceded the implementation of this Campaign and are hopeful that the community will respond positively“.

Renewed efforts
The Ministry of Health of Samoa is prepared well for this MDA campaign with the new strategy through a renewed national Lymphatic Filariasis Elimination Action Plan. A series of consultations were held with all relevant stakeholders, including national and local policy-makers, community leaders, religious leaders, school principals and doctors as well as all ministerial staff.

Schoolchildren waiting for their turn to receive IDA treatment during the campaign.

More than 1500 community health workers and youth groups have been trained in basic epidemiology and transmission of the disease, the elimination strategy, and prevention and management of any adverse events which, although rare, are more likely to occur after infected people ingest the tablets. A comprehensive social mobilization and advocacy campaign has been implemented.

Samoa joined Pacific Programme to Eliminate Lymphatic Filariasis (PacELF) in 1999 and conducted its first MDA campaign that year, followed at regular intervals with other campaigns. However, countrywide surveys including blood tests in 2017 noted persistent transmission of LF. In response, the Government of Samoa, supported by WHO, renewed its efforts to accelerate elimination of the disease using the new triple drug regimen.

Similarly American Samoa also detected continuing transmission of LF through post-MDA surveillance in 2016. Considering the significant movement of populations between these two neighbouring countries, efforts have been made over the year to coordinate MDA campaigns in both countries. American Samoa plans to initiate MDA in September 2018.

The Pacific Island nations that have eliminated lymphatic filariasis as a public health problem include Cook Islands, Marshall Islands, Niue, Tonga and Vanuatu.

Children proudly showing their marked thumbs, implying they have already had IDA treatment.

The disease
LF, commonly known as elephantiasis, is a parasitic disease of humans transmitted by mosquitoes. Infection is usually acquired in childhood and causes hidden damage to the lymphatic system. The painful and profoundly disfiguring visible manifestations of the disease, notably lymphoedema, elephantiasis and scrotal swelling, occur later in life and lead to permanent disability.

In 1997, the Fifth-World Health Assembly resolved to eliminate LF as a public health problem (Resolution WHA50.29). In 2000, WHO launched the Global Programme to Eliminate Lymphatic Filariasis (GPELF), which has the goal of eliminating LF as a public health problem by 2020. The aims of GPELF are to (i) stop the spread of infection through large-scale annual treatment of all eligible populations in affected areas with MDA and (ii) alleviate the suffering caused by LF through morbidity management and disability prevention (MMDP) activities.