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Filaria control and elimination: diagnostic, monitoring and surveillance needs.
[dracunculiasis]
Gold
standard
diagnosis
using
blood
films
or
skin
snips
has
dimished
relevance
as
mass
drug
distribution
programmes
for
control
of
filaria
infections
expand
.
The
view
of
'
diagnosis
'
and
its
relevance
at
the
individual
level
has
changed
,
as
it
has
been
recognised
that
the
spectrum
of
programmatic
processes
(
mapping
,
mass
drug
interventions
,
monitoring
and
evaluation
,
and
surveillance
)
require
different
approaches
as
different
questions
are
asked
at
each
stage
.
The
feasibility
and
relevance
of
skin
biopsy
or
blood
film
examination
is
challenged
when
mass
drug
distribution
seeks
to
treat
all
eligibles
in
communities
.
The
need
to
expand
programmes
rapidly
by
identifying
the
highest
risk
communities
has
seen
the
development
of
rapid
assessment
methods
,
such
as
rapid
epidemiological
mapping
of
onchocerciasis
(
REMO
)
and
rapid
epidemiological
assessment
(
REA
)
for
onchocerciasis
,
immunochromatographic
test
(
ICT
)
-
based
mapping
for
lymphatic
filariasis
(
LF
)
,
and
Rapid
Assessment
Procedure
for
Loiasis
(
RAPLOA
)
for
Loa
,
to
reduce
the
risk
of
serious
adverse
events
and
to
guide
projects
in
high
-risk
communities
.
As
programmes
reduce
the
prevalence
through
mass
drug
distribution
,
more
sensitive
techniques
are
required
to
define
endpoints
,
for
LF
in
particular
where
the
programmatic
goal
is
elimination
;
for
onchocerciasis
,
sensitive
surveillance
tools
are
required
particularly
in
those
areas
where
such
risks
of
recrudescence
are
high
.
Whilst
much
progress
has
been
made
in
the
development
and
deployment
of
rapid
methods
,
there
are
still
specific
needs
for
antigen
detection
in
onchocerciasis
,
whilst
standardisation
of
a
panel
of
tools
for
LF
will
allow
the
definition
of
endpoint
parameters
so
that
countries
can
decide
when
mass
drug
administration
(
MDA
)
can
be
stopped
and
have
a
sensitive
post-
MDA
surveillance
system
.
Diseases
Validation
Diseases presenting
"been recognised that the spectrum"
symptom
dracunculiasis
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