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2015 ; 8
(ä): 547
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Modelling strategies to break transmission of lymphatic filariasis--aggregation,
adherence and vector competence greatly alter elimination
#MMPMID26489753
Irvine MA
; Reimer LJ
; Njenga SM
; Gunawardena S
; Kelly-Hope L
; Bockarie M
; Hollingsworth TD
Parasit Vectors
2015[Oct]; 8
(ä): 547
PMID26489753
show ga
BACKGROUND: With ambitious targets to eliminate lymphatic filariasis over the
coming years, there is a need to identify optimal strategies to achieve them in
areas with different baseline prevalence and stages of control. Modelling can
assist in identifying what data should be collected and what strategies are best
for which scenarios. METHODS: We develop a new individual-based, stochastic
mathematical model of the transmission of lymphatic filariasis. We validate the
model by fitting to a first time point and predicting future timepoints from
surveillance data in Kenya and Sri Lanka, which have different vectors and
different stages of the control programme. We then simulate different treatment
scenarios in low, medium and high transmission settings, comparing once yearly
mass drug administration (MDA) with more frequent MDA and higher coverage. We
investigate the potential impact that vector control, systematic non-compliance
and different levels of aggregation have on the dynamics of transmission and
control. RESULTS: In all settings, increasing coverage from 65 to 80 % has a
similar impact on control to treating twice a year at 65 % coverage, for fewer
drug treatments being distributed. Vector control has a large impact, even at
moderate levels. The extent of aggregation of parasite loads amongst a small
portion of the population, which has been estimated to be highly variable in
different settings, can undermine the success of a programme, particularly if
high risk sub-communities are not accessing interventions. CONCLUSION: Even
moderate levels of vector control have a large impact both on the reduction in
prevalence and the maintenance of gains made during MDA, even when parasite loads
are highly aggregated, and use of vector control is at moderate levels. For the
same prevalence, differences in aggregation and adherence can result in very
different dynamics. The novel analysis of a small amount of surveillance data and
resulting simulations highlight the need for more individual level data to be
analysed to effectively tailor programmes in the drive for elimination.
|*Models, Theoretical
[MESH]
|Disease Transmission, Infectious/*prevention & control
[MESH]