Elimination of lymphatic filariasis as a public health problem in Niue under PacELF, 1999-2016

Carlingford, Catherine N., Melrose, Wayne, Mokoia, Grizelda, Graves, Patricia M., Ichimori, Kazuyo, Capuano, Corinne, Kim, Sung Hye, Aratchige, Padmasiri, and Nosa, Manila (2019) Elimination of lymphatic filariasis as a public health problem in Niue under PacELF, 1999-2016. Tropical Medicine and Health, 47. 20.

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Lymphatic filariasis (LF) is a mosquito-borne parasitic disease which is targeted for elimination as a public health problem worldwide. Niue is a small self-governing South Pacific island nation with approximately 1600 residents that was formerly LF endemic. Here, we review the progress made towards eliminating LF in Niue since 1999.


This study has reviewed all the available literature relating to LF in Niue to assess surveillance efforts and the elimination of transmission. Reviewed documentation included both published and unpublished works including historical reports of LF, WHO PacELF records, and Niue Country Reports of the national LF elimination program.


Niue conducted mapping of baseline LF endemicity by testing the total present and consenting population for LF antigen with immunochromatographic test (ICT) in 1999, when circulating filarial antigen prevalence was 3.1% (n=1794). Five nationwide annual mass drug administration (MDA) rounds with albendazole (400mg) and diethylcarbamazine citrate (DEC) were undertaken from 2000 to 2004, with coverage reported from distribution records ranging from 78 to 99% of the eligible population, which excluded pregnant women and children under 2years of age. A further whole population survey using ICT in 2001 found 1.3% positive (n=1630). In 2004, antigen prevalence had reduced to 0.2% (n=1285). A similar post-MDA survey in 2009 indicated antigen prevalence to be 0.5% (n=1378). Seven positive cases were re-tested and re-treated every sixmonths until negative.


After five rounds of MDA, Niue had reduced the LF antigen population prevalence in all ages from 3.1% to below 1% and maintained this prevalence for a further fiveyears. Due to Niue's small population, surveillance was done by whole population surveys. Niue's results support the WHO recommended strategy that five to six rounds of annual MDA with effective population coverage can successfully interrupt the transmission of LF. Niue received official acknowledgement of the validation of elimination of LF as a public health problem by the WHO Director-General and WHO Western Pacific Regional Office (WPRO) Regional Director at the 67th session of the Regional Committee for the Western Pacific held in Manila in October 2016.

Item ID: 57831
Item Type: Article (Research - C1)
ISSN: 1349-4147
Keywords: lymphatic filariasis, mass drug administration, Niue, microfilaria, epidemiology, Wuchereria bancrofti, PacELF
Copyright Information: Copyright © World Health Organization 2019. Open Access This article is licensed under the terms of the Creative Commons Attribution 3.0 IGO License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the World Health Organization, provide a link to the Creative Commons licence and indicate if changes were made.
Funders: United States Agency for International Development (USAID)
Date Deposited: 03 Apr 2019 07:42
FoR Codes: 45 INDIGENOUS STUDIES > 4516 Pacific Peoples health and wellbeing > 451605 Pacific Peoples epidemiology @ 20%
32 BIOMEDICAL AND CLINICAL SCIENCES > 3207 Medical microbiology > 320704 Medical parasitology @ 40%
42 HEALTH SCIENCES > 4202 Epidemiology > 420202 Disease surveillance @ 40%
SEO Codes: 92 HEALTH > 9205 Specific Population Health (excl. Indigenous Health) > 920599 Specific Population Health (excl. Indigenous Health) not elsewhere classified @ 30%
92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920109 Infectious Diseases @ 30%
92 HEALTH > 9202 Health and Support Services > 920204 Evaluation of Health Outcomes @ 40%
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