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 .

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dracunculiasis

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