Comparison of the cardio-respiratory response of a training session on cycloergometer or treadmill versus an Adapted Physical Activity session on Nintendo Wii, in patients with chronic respiratory disease.

OBJECTIVES: During a pulmonary rehabilitation program (PRP), patients frequently report that the classically proposed activities (as cycloergometer or treadmill) are not playful. The goal of adapted physical activities is to maintain physical activity that is more playful for patients. The Nintendo Wii Gaming Console allows a playful physical activity. However, it seems important to know if this tool allows physical activity with an effective cardiorespiratory effect. The objective was to compare the cardiorespiratory response of a 30-minute training session on cycloergometer (C) and treadmill (T) versus a 30-minute training session with Wii. METHODS: Patients admitted to the PR unit of Brest University Hospital (France) were eligible for this randomized study if they had a chronic pulmonary disease. The endpoints were heart rate (HR), pulse oxymetry, dyspnea, lower limb penibility and pleasure felt. RESULTS: Twenty patients were prospectively included. HR was significantly higher at the end of the Wii session in comparison with C session (P=0.001); there was no significant difference in HR between Wii and T. We found no significant difference for dyspnea and lower limb penibility between Wii and C (respectively P=0.8 and P=0.7) and between Wii and T (respectively P=0.96 and P=0.5). The pleasure felt was significantly greater during Wii compared to C and T (respectively P=0.001 and P=0.001). CONCLUSIONS: Exercise training using Wii with identifiable games require higher HR at the end of the session compared to C and a similar cardiorespiratory response compared to T with the same dyspnea and lower limb exertion and with a pleasure felt significantly higher. Wii can be used for exercise training during PRP.

Improving the quality of modelling evidence used for tuberculosis policy evaluation.

Mathematical modelling is commonly used to evaluate policy options for tuberculosis (TB) control in high-burden countries. Although major policy and funding decisions are made based on these analyses, there is concern about the variability of results produced using modelled policy analyses. We discuss new guidance for country-level TB policy modelling. The guidance was developed by the TB Modelling and Analysis Consortium in collaboration with the World Health Organization Global TB Programme, with input from a range of TB stakeholders (funders, modelling groups, country TB programme staff and subject matter experts). The guidance describes principles for country-level TB modelling, as well as good practices for operationalising the principles. The principles cover technical concerns such as model design, parameterisation and validation, as well as approaches for incorporating modelling into country-led policy making and budgeting. For modellers, this guidance suggests approaches to improve the quality and relevance of modelling undertaken to support country-level planning. For non-modellers, this guidance describes considerations for engaging modelling technical assistance, contributing to a modelling exercise and reviewing the results of modelled analyses. If routinely adopted, this guidance should improve the reliability, transparency and usefulness of modelling for country-level TB policy making. However, this guidance will not address all challenges facing modelling, and ongoing work is needed to improve the empirical evidence base for TB policy evaluation and develop stronger mechanisms for validating models. Increasing country ownership of the modelling process remains a challenge, requiring sustained engagement and capacity building.

Global tuberculosis targets and milestones set for 2016-2035: definition and rationale.

BACKGROUND: Global tuberculosis (TB) targets were set as part of the World Health Organization's End TB Strategy (2016-2035) and the Sustainable Development Goals (2016-2030). OBJECTIVE: To define and explain the rationale for these targets. DESIGN: Scenarios for plausible reductions in TB deaths and cases were developed using empirical evidence from best-performing countries and modelling of the scale-up of under-used interventions and hypothetical TB vaccines. Results were discussed at consultations in 2012 and 2013. A final proposal was presented to the World Health Assembly in 2014 and unanimously endorsed by all Member States. RESULTS: The 2030 targets are a 90% reduction in TB deaths and 80% reduction in TB incidence compared with 2015 levels. The 2035 targets are for reductions of 95% and 90%, respectively. A third target-that no TB-affected households experience catastrophic costs due to the disease by 2020-was also agreed. CONCLUSION: The global TB targets and milestones set for the period 2016-2035 are ambitious. Achieving them requires concerted action on several fronts, but two things are fundamental: 1) progress towards universal health coverage to ensure that everyone with TB can access high-quality treatment; and 2) substantial investment in research and development for new tools to prevent TB disease among the approximately 1.7 billion people infected.

Estimating the tuberculosis burden in resource-limited countries: a capture-recapture study in Yemen.

BACKGROUND: The lack of applicable population-based methods to measure tuberculosis (TB) incidence rates directly at country level emphasises the global need to generate robust TB surveillance data to ascertain trends in disease burden and to assess the performance of TB control programmes in the context of the United Nations Millenium Development Goals and World Health Organization targets for TB control. OBJECTIVE: To estimate the incidence of TB cases (all forms) and sputum smear-positive disease, and the level of under-reporting of TB in Yemen in 2010. METHODS: Record-linkage and three-source capture-recapture analysis of data collected through active prospective longitudinal surveillance within the public and private non-National Tuberculosis Programme sector in twelve Yemeni governorates, selected by stratified cluster random sampling. RESULTS: For all TB cases, the estimated ratio of notified to incident cases and completeness of case ascertainment after record linkage, i.e., the ratio of detected to incident cases, was respectively 71% (95%CI 64-80) and 75% (95%CI 68-85). For sputum smear-positive TB cases, these ratios were respectively 67% (95%CI 58-75) and 76% (95%CI 66-84). CONCLUSION: We estimate that there were 13 082 (95%CI 11 610-14 513) TB cases in Yemen in 2010. Under-reporting of TB in Yemen is estimated at 29% (95%CI 20-36).

Estimating tuberculosis burden and reporting in resource-limited countries: a capture-recapture study in Iraq.

BACKGROUND: The global target for tuberculosis (TB) control set by the Millennium Development Goals is a decrease in TB incidence by 2015. Direct measurement of country-level TB incidence using population-based methods is impractical, emphasising the need for well-performing surveillance systems and, where these are not available, accurate quantification of incidence and under-reporting of TB. OBJECTIVE: To estimate TB incidence and TB under-reporting in Iraq in 2011. METHODS: Prospective longitudinal surveillance was established among all eligible public and private non-National TB Programme (NTP) providers in a random sample of eight of the 18 Iraqi governorates from May to July 2011. Record linkage with the NTP and three-source capture-recapture analysis of data were then conducted using log-linear modelling. RESULTS: A total of 1985 TB cases were identified after record linkage. The NTP registered 1677 patients (observed completeness 84%). The estimated total number of TB cases was 2460 (95%CI 2381-2553), with identified TB cases representing 81% (95%CI 69-89) after adjusting for sampling design. The estimated ratio of notified to incident cases was 69% (95%CI 58-76). CONCLUSIONS: We estimate 14 500 TB cases in Iraq in 2011, of which 31% (95%CI 24-42) were unreported. TB surveillance needs to be strengthened to reduce under-reporting.

Protease inhibitor-containing antiretroviral treatment and tuberculosis: can rifabutin fill the breach?

OBJECTIVE: To assess how to best manage co-administration of rifabutin (RFB) and human immunodeficiency virus 1 (HIV-1) protease inhibitor (PI) containing antiretroviral treatment (ART). Recommended for initial anti-tuberculosis treatment, rifampicin (RMP) lowers PI concentrations below therapeutic levels, posing significant challenges for ART. As RFB has little effect on PI concentrations, it could be an alternative to RMP. METHODS: A review of the scientific literature on the safety and efficacy of RFB for adult tuberculosis (TB) treatment was conducted, focusing on ART-TB co-therapy. A cost comparison was performed between treatment regimens, and estimates of the burden of TB disease in patients on ART were used to model RFB demand in low- and middle-income countries (LMICs). RESULTS: Eleven clinical studies were identified, comprising 1543 TB patients treated with RFB; 980 (64%) were living with HIV. RFB was as safe and effective as RMP, including in 313 patients receiving co-administered ART (unboosted PIs included indinavir, nelfinavir or saquinavir; a minority received ritonavir [RTV] boosted amprenavir or saquinavir). The total cost for 6 months of all HIV and TB treatment containing RTV-boosted lopinavir (LPV) and RFB is US$410, compared to US$455 if RMP is used with LPV super-boosted with RTV. Our model suggests that demand for RFB in LMICs could be between 10,000 and 18,000 courses by 2012. CONCLUSION: RFB is effective and safe in combination with the PIs studied, cost-saving for co-therapy with currently recommended boosted PIs, and may have a pivotal role in the roll-out of ART. Further research into a daily dose of RFB to simplify dosing regimens and developing fixed-dose combinations can enhance the public sector roll-out of ART.

Estimating tuberculosis case detection rate in resource-limited countries: a capture-recapture study in Egypt.

SETTING: Most countries endemic and highly endemic for tuberculosis (TB) still do not have reliable TB surveillance systems. Indirect estimation of TB incidence is needed to monitor the performance of the National Tuberculosis Programme (NTP) in the context of the World Health Organization implementation and impact targets for TB control. OBJECTIVE: To estimate the case detection rate (CDR) of all TB cases and sputum smear-positive TB cases in Egypt in 2007. METHODS: Record linkage and three-source capture-recapture analysis of data collected through active prospective longitudinal surveillance within the public and private non-NTP sector in four Egyptian governorates selected by stratified cluster random sampling. RESULTS: For all TB cases, the estimated CDR of NTP surveillance and completeness of case ascertainment after record linkage was respectively 55% (95%CI 46-68) and 62% (95%CI 52-77). For sputum smear-positive TB cases, these proportions were respectively 66% (95%CI 55-75) and 72% (95%CI 60-82). CONCLUSION: This pilot study shows that representative sampling, prospective surveillance in the non-NTP sector, record linkage and capture-recapture analysis can improve CDR estimation. For global, standardised and reliable use, this methodology should be further developed. Until then, all resource-limited countries should strengthen their national surveillance systems in the context of the Stop TB strategy.

Protecting patients' rights, ensuring safety and quality assurance in tuberculosis prevalence surveys.

The conduct of biomedical studies is guided by statements of internationally recognised principles of human rights. The first principle of the Nuremberg Code was the centrality of voluntary participation of subjects with informed consent. All prevalence surveys should be reviewed by the appropriate ethics review committees. Each potential survey participant should be adequately informed of the aims, methods and sources of funding of the survey, any possible conflicts of interest, the institutional affiliations of the researchers, the anticipated benefits and potential risks of the study, and any discomfort it may entail. Attention should be paid to safety in each component of the survey. Test procedures that require particular attention are chest radiography (CXR) and bacteriological examination. Quality assurance should be applied to all aspects of research and, in particular, to any measurements undertaken, including CXR assessments, laboratory examinations and questionnaire and data management. Furthermore, to ensure comparability of data from different surveys, it is important to apply the same survey design and methodology and to use the same reporting format.

Tuberculosis prevalence surveys: rationale and cost.

This article is the first of the educational series 'Assessing tuberculosis (TB) prevalence through population-based surveys'. The series will give overall guidance in conducting cross-sectional surveys of pulmonary TB (PTB) disease. TB prevalence surveys are most valuable in areas where notification data obtained through routine surveillance are of unproven accuracy or incomplete, and in areas with an estimated prevalence of bacteriologically confirmed TB of more than 100 per 100,000 population. To embark on a TB prevalence survey requires commitment from the national TB programme, compliance in the study population, plus availability of trained staff and financial resources. The primary objective of TB prevalence surveys is to determine the prevalence of PTB in the general population aged >or=15 years. Limitations of TB prevalence surveys are their inability to assess regional or geographic differences in prevalence of TB, estimate the burden of childhood TB or estimate the prevalence of extra-pulmonary TB. The cost of a prevalence survey is typically US$ 4-15 per person surveyed, and up to US$ 25 per person with radiographic screening. A survey of 50,000 people, of limited precision, would typically cost US$ 200,000-1,250,000.

[Serological study carried out in Cambodia during a tetanus vaccination in adults]. / Résultats d'une enquê te sérologique réalisée au Cambodge lors d'une vaccination antit ténique des adultes.

In 1997, the Ministry of Health tested the feasibility and serological activity of a two-dose vaccine at one year interval within a catch-up tetanus immunization programme in a rural population. In the district of Angkor Thom in the Siem Reap province (15,000 inhabitants), a team of nurses and administrative clerks travelling by motorcycle, conducted between February 1998 and February 1999 an EPI and tetanus immunization of the whole population gathered in meeting points. In 132 childbearing age female volunteers, 49 following a two-dose schedule at one year interval, and 70 following a WHO three-dose schedule, with two doses at one month interval and a booster dose one year later tetanus antibodies have been measured before vaccination, one year after the first dose or the two first doses, and six months after the second or third dose of vaccine. 129 male volunteers of the same age were also recruited in the serological study following only the two-dose schedule. The titration was done first with monoantigen ELISA, then with mouse seroneutralisation, the reference method for measuring tetanus seroprotection. Only 148 (57%) volunteers completely attended the serological study Compared to seroneutralisation, sensitivity for seroprotection with ELISA was 89% (CI95%: 85%-94%) and specificity 84% (CI95%: 81%-89%). The coverage of the general population vaccinated with two doses, in both sexes and in all age-groups, increased on average from 5% to 70%. The three-dose schedule gave significantly more protection than the two-dose schedule in women tested with seroneutralisation. On a first sample in those with no protective antibodies and testifying they had not been vaccinated before, 51% of these volunteers after one dose and 93% after two doses acquired protective antibodies. On first sample, 52% of female volunteers had protective antibodies in seroneutralisation, against 11.7% in men. 14% of subjects tested in ELISA and 6.8% tested in seroneutralisation showed in a second sample a decrease in titres, although they had received a tetanus vaccine. For unprotected volunteers on first sample and testifying they had not been vaccinated before, neither age nor past chronic cutaneous lesions or cows living around their houses, two possible sources of contact with CI. tetani, increased significantly seroconversion. Only female volunteers were significantly more seroconverting (81%) compared to men of same age (51%) (RR: 1.60, CI95%: I. 17-2.18) suggesting a memory bias in women supposed to be vaccinated by EPI. 30% of volunteers in ELISA and 14% in seroneutralisation showed spontaneous protecting antibodies in the first sample without having any document or memory of a past tetanus vaccination. Tested by seroneutralisation, no relation was to be found for having spontaneous antibodies with past chronic cutaneous lesions and cows living around their houses. Only the eldest (35-45 y.o.) female volunteers showed significantly more spontaneous antibodies (RR: 3.83, CIs%: 1.74-8.2) than men in the same age-group. A memory bias may be found also in this female age-group. Good serological response should encourage implementation of a catch-up tetanus vaccination in this country considering the large number of unprotected adults, mainly male adults. Due to problems with notification and recalling past vaccinations, only a prospective study in an unimmunized large cohort, studying all possible factors of tetanus toxin neutralisation, could confirm the existence and cause of spontaneous antibodies. Excluding vaccination in at-risk population for such a study would be however ethically unacceptable.

Measuring tuberculosis burden, trends, and the impact of control programmes.

The targets for tuberculosis control, framed within the United Nations' Millennium Development Goals, are to ensure that the incidence per head of tuberculosis is falling by 2015, and that the 1990 prevalence and mortality per head are halved by 2015. In monitoring progress in tuberculosis control, the ultimate aim for all countries is to count tuberculosis cases (incidence) accurately through routine surveillance. Disease prevalence surveys are costly and laborious, but give unbiased measures of tuberculosis burden and trends, and are justified in high-burden countries where many cases and deaths are missed by surveillance systems. Most countries in which tuberculosis is highly endemic do not yet have reliable death registration systems. Verbal autopsy, used in cause-of-death surveys, is an alternative, interim method of assessing tuberculosis mortality, but needs further validation. Although several new assays for Mycobacterium tuberculosis infection have recently been devised, the tuberculin skin test remains the only practical method of measuring infection in populations. However, this test typically has low specificity and is therefore best used comparatively to assess geographical and temporal variation in risk of infection. By 2015, every country should be able to assess progress in tuberculosis control by estimating the time trend in incidence, and the magnitude of reductions in either prevalence or deaths.

[Prevalence of hepatitis A, B, C and E virus markers among patients with elevated levels of Alanine aminotransferase and Aspartate aminotransferase in Phnom Penh (Cambodia) and Nha Trang (Central Vietnam)]. / Prévalence de marqueurs d'infection des hépatites virales A, B, C et E chez des patients ayant une hypertransaminasémie a Phnom Penh (Cambodge) et Nha Trang (Centre Vietnam).

In order to describe the respective part of viral hepatitis in liver diseases observed in Cambodia and Vietnam, ninety consecutive patients with Aspartate aminotransferase (AST) and Alanine aminotransferase (ALT) > or = 100 Ul/l were tested for hepatitis A, B, C and E markers in Phnom Penh and Nha Trang. The markers were IgM antibodies to hepatitis A virus (anti-HAV IgM), hepatitis B surface antigen (HBsAg), antibodies to hepatitis C virus (anti-HCVAb) and IgG antibodies to hepatitis E virus (anti-HEV IgG). Recruited patients were predominantly adults and male (sex ratio 76%). Among these patients, 81% were tested positive to at least one marker in Nha Trang and 79% in Phnom Penh. In Nha Trang, HBsAg was more frequent (73%) than anti-HCV Ab (9%) while in Phnom Penh both markers were closely similar (HBsAg: 41%, anti-HCV Ab: 39%). In both population samples, HBsAg was more prevalent among young people whereas anti-HCV Ab were only detected in adults. No case of acute HAV infection was diagnosed in Nha Trang while anti-HAV IgM were detected in 20% of Cambodian patients. Anti-HEV IgG were infrequent (2% in Nha Trang, 5.5% in Phnom Penh). Only one case was notified, a male Vietnamese patient probably suffering from acute hepatitis E. More studies would be useful to improve the control measures against viral hepatitis in the public health programs.

[Serological study of toxoplasmosis in Vietnam in a population of drug users (Ho Chi Minh city) and pregnant women (Nha Trang)]. / Etude sérologique de la toxoplasmose au Vietnam dans une population de toxicomanes (Ho Chi Minh ville) et de femmes enceintes (Nha Trang).

Toxoplasmosis is a neglected disease in Vietnam particularly in populations with a high risk of developing complications. The seroprevalence of Toxoplasma gondii was calculated by testing blood samples for Toxoplasma specifically immunoglobulin G and immunoglobulin M on 300 intravascular drug users and on 300 pregnant women. Among intravascular drug users, the seroprevalence of IgG and IgM was 7.7% and 0.08%, respectively. In pregnant women the prevalence of anti-toxoplasmosis IgG and IgM was respectively 11.2% and 0%. 0.28% of all estimated pregnancies in Vietnam are affected with toxoplasmosis, i.e. around 4800 pregnancies per year. In conclusion, a screening of Toxoplasma infections should be recommended in HIV/AIDS patients.

Prevalence of pulmonary tuberculosis among HIV-infected persons in a home care program in Phnom Penh, Cambodia.

SETTING: Phnom Penh, Cambodia. OBJECTIVE: To determine the burden of active pulmonary tuberculosis among an HIV-infected cohort and the proportion of drug-resistant strains, using active case-finding adapted to a home care setting. DESIGN: Cross-sectional study. Measures include the prevalence of culture-confirmed Mycobacterium tuberculosis, utilizing a single spot sputum specimen; the proportion of pulmonary TB, detected and undetected; proportion of cases resistant to isoniazid, rifampicin, ethambutol, streptomycin; and the diagnostic value of symptoms. RESULTS: Of 441 persons surveyed, 41 (9%) had active pulmonary TB by culture; 29 were smear-positive (71%), and only one case was on treatment. The total burden of pulmonary TB was 12% (54/441), with a ratio of undetected to detected cases of 3:1. Primary isoniazid resistance was detected in six new cases (15%); no MDR-TB was identified. Symptoms were not predictive of active pulmonary disease. Mortality was high among those not surveyed (20%) and those found to have TB (49%). CONCLUSIONS: Tuberculosis is epidemic in this HIV-infected population. Active case-finding yielded three times the number of cases already detected and should be considered where resources allow. However, effective passive case detection and improved coordination of TB and HIV care programs are required to address HIV-associated TB morbidity and mortality.

[Incidence of HIV infection in consultants reviewed after a first negative test in an anonymous and free screening center at the Institut Pasteur of Cambodia, 1996-1999]. / Incidence de l'infection VIH parmi les consultants revus après un premier test négatif au centre de dépistage anonyme et gratuit de l'Institut Pasteur du Cambodge, 1996-1999.

A retrospective study was performed to determine the incidence of HIV seroconversion among repeat consultants attending the voluntary testing and counselling centre of the Institut Pasteur of Cambodia as well as factors associated with HIV seroconversion. From 1996 to 1999, 5541 repeat consultants were selected for the study. Exclusion criteria included being aged under 15 years, having initially tested positive or inconclusive and a time span of fewer than 30 days since the last test. In all, 276 persons had seroconverted to HIV, giving an incidence rate of 5.56 per 100 person-years. The seroconversion rate declined from 8.46% in 1996, to 3.06% in 1999 (chi 2 test for trend, p = 10(-5)). Among the risk factors analysed, 3 were significantly associated with lack of seroconversion: being a student (RR = 0.53, p = 0.032) or a civil servant (RR = 0.63, p = 0.012) and systematic condom use with causal partners (RR = 0.37, p = 10(-5)). The decline of HIV seroconversion among repeat consultants attending the VCT centre over the study period may reflect changes in risk behaviour and the beneficial impact of counselling.

Etiologies of acute, persistent, and dysenteric diarrheas in adults in Bangui, Central African Republic, in relation to human immunodeficiency virus serostatus.

A study of the etiologies of diarrhea in adults in relation to their human immunodeficiency virus (HIV) serostatus and number of CD4+ cells was carried out in the Central African Republic. In cases and controls, multi-parasitism was observed. Salmonella spp. were identified mainly during acute diarrhea, with 50% of the S. enteritidis isolated during the study being responsible for septicemia and/or urinary tract infection in immunodeficient patients. Enteroaggregative Escherichia coli (EAggEC) were the most frequently identified agent in HIV+ patients with persistent diarrhea; 42.8% of the patients with EAggEC as sole pathogens had bloody diarrhea, and these strains were negative for the presence of a virulence plasmid. Coccidia were found in those with acute and persistent diarrhea. Blood was observed in 53.3% of infections involving coccidia as the sole pathogen. Microsporidium spp. and Blastocystis hominis were found only in HIV+ patients with persistent diarrhea. Shigella spp., Campylobacter spp., and Entamoeba histolytica were found in HIV+ and HIV- dysenteric patients; bacteria resembling spirochetes that could not be cultivated were identified only in HIV+ cases with dysentery. Shiga-like toxin-producing E. coli O157:H- was isolated from two cases with hemolytic-uremic syndrome. Fungi were identified as the sole pathogen in 6.4% of the HIV+ patients with persistent diarrhea. Most of enteropathogenic bacteria identified were resistant to ampicillin and trimethoprim-sulfamethoxazole, remained susceptible to ampicillin plus clavulanic acid, and were susceptible to amikacin, gentamicin, and ciprofloxacin.

High mortality rates among patients with tuberculosis in Bangui, Central African Republic.

PIP: Survival time until death was investigated in a prospective cohort of 224 tuberculosis patients from Bangui, Central African Republic, who were randomly selected from among 1492 such patients registered in 1993 and 1994. 6 patients (2.7%) presented with extrapulmonary tuberculosis, 186 (83%) were smear-positive, and 139 (62%) were infected with HIV-1. 23 (10.3%) had multidrug-resistant tuberculosis strains. The treatment regimen (isoniazid, rifampicin, ethambutol, and pyrazinamide for 2 months, followed by isoniazid and ethambutol for another 6 months) was successful in 46.4% of HIV-infected patients compared with 67.1% of HIV-negative patients. At the end of 8 months, 39.1% of HIV-infected patients but only 8.2% of HIV-negative patients had died. 24 months after the start of tuberculosis treatment, the cumulative death rate was 58% in HIV-seropositive patients compared with 20% in seronegative patients. Median life expectancy to death among HIV-infected tuberculosis patients was 15 months. Decreased survival was significantly associated with HIV-seropositivity, older age, failure to complete the full treatment regimen, and a low CD4 cell count. Multidrug-resistant tuberculosis was not linked to increased mortality.^ieng

Variation in the vector competence of Aedes polynesiensis for Wuchereria bancrofti.

The vector competences of 6 geographic strains of Aedes polynesiensis for Wuchereria bancrofti were studied using two types of experimental infections. Experimental infection of laboratory-bred mosquitoes fed on the carriers' forearms with different levels of microfilaraemia showed that microfilariae (mf) uptake was directly proportional to the carrier's mf density and, as mf densities decreased, concentration capacity of Ae. polynesiensis increased. It was also shown that infection has an important effect on mosquito mortality, and that the mortality rate differed among mosquito strains. In infections using artificial feeders, the mf uptake was closely regulated, thus showing differences in the vectorial efficiency of Ae. polynesiensis related to the geographic origin of the mosquito strain. The mosquitoes from the Society archipelago were more efficient intermediate hosts than geographically distant strains when infected with W. bancrofti from an island within the archipelago (Tahiti). Mosquito strains from the Society archipelago developed the highest proportion of infective-stage larvae and exhibited the lowest mortality rate when infected with sympatric Tahitian W. bancrofti.