WHO lists the milestones towards validation of elimination as:
- Stop the spread of infection through mass drug administration
- Implement MDA in all endemic areas (100% geographical coverage)
- Reduce infection below a threshold at which transmission is not sustainable in all endemic areas and stop MDA
- Demonstrate sustained reduction of infection below the threshold no earlier than 4 years after stopping MDA
- Alleviate suffering by managing morbidity and preventing disability (MMDP)
- Define burden of disease (estimates of the number of patients)
- Recommended minimum package of care available in all areas of known patients (100% geographical coverage)
The latest WHO Weekly Epidemiological Report published in 2016 reads: “Of the 73 countries considered endemic at the start of 2015, MDA was no longer required in 18 countries where post-MDA surveillance has been ongoing, and the remaining 55 countries were considered to require MDA. At least one round of MDA has been implemented in every endemic implementation unit (IU, the administration unit at which the programme is implemented) now in 25 countries (13 in 2015), i.e. achieved 100% geographical coverage. An additional 20 countries are implementing MDA but have not yet reached all endemic IUs. Among 10 countries that have not started MDA, 1 country was determined not to require MDA, and 3 countries still need to confirm their requirement for MDA.
Since 2000, a cumulative total of 6.2 billion treatments have been delivered to >820 million people at least once. In 2015, national programmes targeted 698.3 million people for treatment during MDA and according to the data reported to WHO by September 2015, treated 556.2 million for a programme coverage of 79.6%. Coverage of the total population requiring MDA was 58.8%, an improvement over 2014, but indicative of the need for scale-up of MDA. Updates on individual countries are posted in the PCT databank.
The number of people considered to require MDA has decreased from the highest estimate of 1.410 billion in 2011 to 947 million in 2015. In 2015 TAS (Transmission Assessment Survey) were implemented in 18 countries covering 339 IUs (201 IUs in TAS1, 120 IUs in TAS2, and 18 IUs in TAS3). Where countries implemented both MDA and TAS in the same IUs in 2015, the reduction in the population requiring MDA will be reflected in 2016.
LF accounts for at least 2.8 billion DALYs not including significant co-morbidity of mental illness commonly experienced by patients and their caregivers. As many as 36 million cases of hydrocele and lymphoedema remain and in these patients, health care services are required for morbidity management and disability prevalence to alleviate suffering and further progress of the disease”.
See WHO Weekly Epidemiological Report for the full detailed report.