Evaluating the Evidence for Lymphatic Filariasis Elimination

Highlights

The current target of elimination as a public health problem (EPHP) for lymphatic filariasis was originally devised with the intention of interrupting transmission. However, some countries that have achieved EPHP are still finding new cases.

Analysis of the evidence for key biological determinants suggests that a target threshold of <1% microfilaria (mf) prevalence is not likely to be sufficient for transmission interruption in communities with a mid-to-high annual biting rate.

The experimental evidence underlying estimates is insufficient or inconsistent, particularly transmission rates from vector to human, leading to high uncertainty in confidence of elimination success.

Local biting rate is expected to be highly variable between settings and could have a large impact on elimination feasibility for a given target prevalence.

Further experimental studies are needed to refine our understanding of LF elimination thresholds.