[Challenge and strategy of prevention and control of important parasitic diseases under the Belt and Road Initiative].

China was once a country with the heaviest burden of parasitic diseases. Under the leadership of the Communist Party and national authority, after more than 60 years' efforts of prevention and control, the remarkable results have been achieved in China. However, affected by the social and economic development and environmental changes, the prevention and control of parasitic diseases, especially imported parasitic diseases, are facing new challenges, and the parasitic diseases, such as malaria, schistosomiasis, leishmaniasis, filariasis and trypanosomiasis, appear increasingly. With the development of the Belt and Road Initiative, the transmission risks of these diseases are more increased. The purpose of this paper is to describe the experience and results of parasitic disease prevention and control in China, understand the present parasitic disease epidemic situation of the Belt and Road Initiative related countries, analyze the transmission risks of important parasitic diseases, and present some relevant suggestions, so as to provide the evidence for the health administrative department formulating the prevention and control strategies of such parasitic diseases timely and effectively.

Challenges for the integration of mass drug administrations against multiple 'neglected tropical diseases'.

Simple and safe medications for some of the common, but often neglected, diseases that afflict the poor are not only available but are often donated. Other medications indicated for neglected diseases are extremely cheap and cost-effective. These drugs can be administered together and combined, when feasible, into rapid-intervention packages based on mass drug administrations. It is therefore logical to integrate mass drug administrations when possible. Integration is, however, not always as simple as it seems, and 'integration' means different things to different people. Drugs are needed at different frequencies for different lengths of time, sometimes for the whole population, sometimes only for children. Care has to be taken that parallel systems are not created that bypass primary healthcare. Much can be achieved, however, by sensible integration, whether it be in the mapping of diseases or the setting up of treatment platforms that tackle several diseases at once. As governments and international organizations seek to create policies for integration that include not only mass drug administration but also morbidity control, and as various partnerships develop for implementation, there is the possibility to scale up health interventions, which will have a very positive impact on the poorest communities globally. Nevertheless, integration should not be forced for the sake of policy. Where things fit well they should be developed, where not, coordination within the primary-healthcare system can produce an equally long-lasting impact.

Field evaluation of an insect growth regulator, pyriproxyfen 0.5% GR against Culex quinquefasciatus, the vector of Bancroftian filariasis in Pondicherry, India.

Pyriproxyfen, 0.5% granular formulation (GR), an insect growth regulator (IGR) was tested against Culex quinquefasciatus larvae and pupae in disused wells, cesspits and drains at the dosages of 0.1, 0.25, and 0.5kg(ai)/ha to determine the most appropriate field dosage. The IGR was found to be effective against C. quinquefasciatus larvae and pupae in all the larval habitats tested. In drains with slow moving water, application of pyriproxyfen 0.5% GR at 0.5kg(ai)/ha resulted in >80% emergence inhibition (EI) of adults for 4 weeks. At 0.1 and 0.25kg(ai)/ha, the EI was always less than 80%. In stagnant drains, the IGR yielded >80% EI for 1-week period at 0.1kg(ai)/ha. At 0.25 and 0.5kg(ai)/ha, the efficacy was 5-10 times higher. In cesspits, the EI was >80% for 6 weeks when pyriproxyfen 0.5% GR was applied at 0.1kg(ai)/ha, for 11 weeks at 0.25kg(ai)/ha and 9 weeks at 0.5kg(ai)/ha. In disused wells treated at the dosage 0.1kg(ai)/ha, there was >80% EI for 15 weeks and at 0.25 and 0.5kg(ai)/ha, the effective duration was about 1.6-1.8 times longer (24-28 weeks). Considering the quantum of IGR required and the cost and also for safety reasons, the low dosage 0.1kg(ai)/ha is recommended as the field dosage to be applied at weekly interval in stagnant drains, 6 weeks interval in cesspits and 15 weeks interval in disused wells. Since pyriproxyfen 0.5% GR has a relatively longer residual effect than the other IGRs the operational cost could be minimized. Pyriproxyfen 0.5% GR could be one of the choices in the chemical control strategy in Integrated Vector Control Programmes.

[Filariasis control: entry point for other helminthiasis control programs?]. / La lutte contre les filarioses: porte d'entrée pour le contrôle des autres helminthiases?

Filariasis control programs are based on a decentralized drug distribution strategy known as "community-directed". This strategy could also be applied to the control of schistosomiasis and intestinal nematode infections. Integration of these control programs could be highly cost-effective. However, as a prerequisite for integration, it would be necessary to identify zones where these helminthic infections co-exist, specify the population categories that should receive each medication (ivermectin, albendazole, mebendazole, and praziquantel), check that combined administration of these drugs is safe and ensure that an integrated program would have no detrimental effect on the health care system and on the efficacy of ongoing programs.

The Innovative Vector Control Consortium: improved control of mosquito-borne diseases.

Few new insecticides have been produced for control of disease vectors for public health in developing countries over the past three decades, owing to market constraints, and the available insecticides are often poorly deployed. The Innovative Vector Control Consortium will address these market failures by developing a portfolio of chemical and technological tools that will be directly and immediately accessible to populations in the developing world. The Bill and Melinda Gates Foundation has supported this new initiative to enable industry and academia to change the vector control paradigm for malaria and dengue and to ensure that vector control, alongside drugs, case management and vaccines, can be better used to reduce disease.

Effect of yearly mass drug administration with diethylcarbamazine and albendazole on bancroftian filariasis in Egypt: a comprehensive assessment.

BACKGROUND: Egypt was one of the first countries to implement a national programme to eliminate lymphatic filariasis based on WHO's strategy of repeated rounds of mass drug administration (MDA) with diethylcarbamazine and albendazole (target population, 2.5 million in 181 localities). We assessed the effect of five yearly rounds of MDA on filariasis in four sentinel villages in Egypt. METHODS: We studied two areas with different infection rates before MDA: the Qalubyia study area had a low infection rate because of previous treatment with diethylcarbamazine; this was typical of most filariasis-endemic villages in Egypt before MDA. The Giza study area had a high baseline infection rate. We undertook repeated surveys in villages for treatment compliance and tests for microfilaraemia and circulating filarial antigenaemia, antibodies to filarial antigen Bm14 in schoolchildren, and infections in indoor-resting mosquitoes (assessed by PCR). FINDINGS: MDA compliance rates were excellent (>80%). In Giza after MDA, prevalence rates of microfilaraemia and circulating filarial antigenaemia fell from 11.5% to 1.2%, and from 19.0% to 4.8%, respectively (p<0.0001). Corresponding rates in Qalubyia fell from 3.1% to 0% and 13.6% to 3.1%, respectively (p<0.0001). Rates of antifilarial antibody and circulating filarial antigenaemia in schoolchildren (aged about 7-8 years), fell from 18.3% to 0.2% (p<0.0001) and from 10.0% to 0.4% (p<0.0001) in Giza, respectively, and from 1.7% to 0% and 1.7% to 0% (both p=0.13) in Qalubyia, respectively. Mosquito infection rates fell from 3.07% (95% CI 2.38-3.88) to 0.19% (0.08-0.38) in Giza and from 4.37% (3.07-5.99) to 0% (0-0.05) in Qalubyia. INTERPRETATION: MDA greatly affects variables related to infection (microfilaraemia and circulating filarial antigenaemia prevalence rates) and transmission (antifilarial antibodies in young children and mosquito infection rates). Our results suggest that after five rounds of MDA filariasis is likely to have been eliminated in most endemic localities in Egypt.

Independent assessment of Mass Drug Administration in filariasis affected Surat city.

The Mass Drug Administration (MDA) done in Surat city (Gujarat) during 2005, revealed good impact on infection and infectivity in mosquitoes and also on microfilaria rate & mean infection density. The overall impact seen was 23% on mf rate, 28% on mean mf density, 65% on infection rate and 50% on infectivity rate in vectors. Indigenous population contribution to microfilaria cases was 9.7%, whereas migratory population contributed 72.2%; predominant 51.9% from Orissa and 20.3% from U.P. Of the total 3640 persons interviewed for MDA compliance in seven zones of the Surat city revealed that actual drug consumption was 76.7% (2792/3640). Another 11.9% although took the drug but did not consume and 11.4% refused. Important reasons for consuming was fear to get the disease (40.7%) and for not consuming; 'will consume after meal' (6.9%), too many tablets (1.7%), seek consent from doctor (1.5%), lack of awareness (1.4%) etc. Refusal was mainly due to the reason as respondents felt apparently healthy. Assessment of IEC activities suggested that main awareness was created by media (local or national TV, banners or handbills, local news papers or mike announcement) alongwith some impact made through NGO's. These observations clearly indicated the utility of effective health education for optimum community participation and shown that it was crucial for successful community based elimination campaign. However some gray areas also suggest the scope for further improvements.

[Scientific knowledge and public health policies: reflections on the occurrence of filariasis in Recife, Pernambuco, Brazil]. / A produção do conhecimento científico e as políticas de saúde pública: reflexões a partir da ocorrência da filariose na cidade do Recife, Pernambuco, Brasil.

This article discusses the relationship between the production of scientific knowledge on filariasis in Brazil and health policy-making and implementation related to control of the disease. The study presents a review of scientific output on filariasis from the creation of the Program to Combat Filariasis in the mid-20th century until the creation of the Unified National Health System (SUS) within the framework of decentralized control of endemic diseases in the country. The focus on empirical observations in Recife, a city where filariasis is present, highlights the relevant institutional processes and the role of various players. The hypothesis is that in the first half of the 20th century there was a lack of scientific knowledge and technological development to control the problem, but that after these advances were obtained, new requirements of a political nature came into play and acted as determinants for persistence of the endemic in the city.

Mass administration of DEC-medicated salt for filariasis control in the endemic population of Karaikal, south India: implementation and impact assessment.

DEC (diethylcarbamazine)-medicated salt, at a concentration of 0.1 to 0.2 mg per 100 mg, was given to the entire population of Karaikal (119 978) in South India for a 4-year period from 1982. The per capita consumption of DEC in medicated salt was 13.3 grams for the entire period. The prevalence of microfilaraemia declined significantly from 4.5% in 1982 to 0.14% in 1985 and 0.4% in 1993. Vector infection declined from 0.6% in 1982 to zero after two years. The mechanism of preparation and regulated distribution of DEC-medicated salt in the locality is presented. Long-term follow-up suggests that DEC-medicated salt distribution is cheap, safe and efficient for the elimination of filariasis.

[Cost-benefit analysis on Malayan filariasis control in Miaoxi Township, Huzhou City, Zhejiang Province during 1964-1987].

The methods adopted in this paper were as follows: (1) The cost of the filariasis control was estimated to be direct cost and indirect cost; (2) Using the reduction rate of acute inflammatory attack as the measurable indicator of control effectiveness; (3) Estimating the case number of acute inflammatory attack occurred after control year by year basing on the goodness by fitting in the reduction trend of acute inflammatory attack with hyperbola formula; (4) Assuming that the case number of acute inflammatory attack would be relatively stable at the same level of pre-control if filariasis control measures were not implemented; (5) The benefit from the filariasis control was estimated by transforming the increasing man-working day and saving the medicine expenses of patients due to the reduction of acute inflammatory attack. By allowing seven percent discount on cost and benefit, the total cost was 21,182 Yuan, the total benefit was 119,859 Yuan, the ratio of cost-benefit was 1:5.7, implying that putting in one Yuan to filariasis control in this township may gain benefit 5.7 Yuan.

A cost benefit analysis of fish culture strategy towards the control of mansonioides in Shertallai, Kerala state.

The cost benefit analysis of fish culture as a means for vector control towards the containment of Brugian filariasis in Shertallai, a highly endemic tract for this disease in Kerala was carried out. While the financial gain accrued to the community was to the tune of Rs. 1,82,052 in ponds (under monoculture) with Chinese grass carp from 763 ponds, it was Rs. 1,83,740 from 1000 ponds under polyculture with Catla catla, Cyprinus carpio, Labeo rohita, Labeo fimbriatus, Cirrhina mrigala and Ctenopharyngodon idella (Chinese grass carp). Monoculture with Giant gourami (Osphronemous goramy) fetched an income of Rs. 7,654 to the community from 128 ponds. A marked reduction in weed reinfestation/vector breeding was observed in ponds under fish culture than other without fishes. The study clearly indicates that fish culture is an ideal strategy for Mansonioides control as it can bring perceptible benefits to the community.