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Lymphatic Filariasis (LF) Program

Lymphatic Filariasis (LF) Program. Trinidad and Tobago. Dr. B. Shivnauth Principal Medical Officer (EH) Ministry of Health. Background. Trinidad and Tobago is a twin-island state Most Southerly Caribbean island Estimated population: 1.3 million. Map of Trinidad and Tobago.

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Lymphatic Filariasis (LF) Program

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  1. Lymphatic Filariasis (LF) Program Trinidad and Tobago Dr. B. Shivnauth Principal Medical Officer (EH) Ministry of Health

  2. Background • Trinidad and Tobago is a twin-island state • Most Southerly Caribbean island • Estimated population: 1.3 million Regional LF Program Managers Meeting, Costa Rica, 2005

  3. Map of Trinidad and Tobago Regional LF Program Managers Meeting, Costa Rica, 2005

  4. Mission Statement • The mission of IVCD is to provide a service for the protection of the nation’s health from vector-borne diseases through the application of safe, affective and economical integration of all appropriate, sustainable vector-control measures that are acceptable to the people of • Trinidad and Tobago within prescribed limits. Regional LF Program Managers Meeting, Costa Rica, 2005

  5. Age and Gender Demographics • Slightly more males 50.15 % compared to females 49.85 % (population 1,262,366) • 20-39 year age group comprises the largest proportion (31.9 %) • Slightly more males than females in all age groups except in the 60+ age group Regional LF Program Managers Meeting, Costa Rica, 2005

  6. Government Health Facilities • There are • 105 health centers (HC) • 10 Hospitals (3 major hospitals) • 4 District Health Facilities • Number of HC ranged from 8 to19 per county, with Tobago having the largest number. Regional LF Program Managers Meeting, Costa Rica, 2005

  7. Health Professionals 2004 • Health professionals numbered 6,618 • Nurses and midwives comprised 34.9 % • Physicians 19.5% • Nursing Assistants, Nursing Aides 32.9% • Pharmacists comprised 7.7% Regional LF Program Managers Meeting, Costa Rica, 2005

  8. Regional Bancroftian LF • Endemic countries include • Dominican Republic • Haiti • Guyana • Listed as positive by the World Health Organization (WHO) • Suriname • Trinidad & Tobago • Costa Rica • In the Americas, 300,000 LF cases, including Brazil (WHO) Lymphatic Filariasis Program, Trinidad & Tobago Regional LF Program Managers Meeting, Costa Rica, 2005

  9. International LF Collaboration • Pan American Health Organization (PAHO/WHO) • Caribbean Epidemiology Centre (CAREC) Regional LF Program Managers Meeting, Costa Rica, 2005

  10. Synergieswith other Public-Health Interventions • Dual screening of blood smears in primarily malaria surveillance • Recent identification of W. bancrofti and P. vivax in imported case in December 2004 • Active community Surveillance System using blood smears • Random smears of Pyrexia of unknown Origin at Health facilities Regional LF Program Managers Meeting, Costa Rica, 2005

  11. Historical Trend of LFin Trinidad & Tobago (1) 1893–1937 • Average cases per year • 24 elephantiasis cases • 54 hydrocele Source: T&T Surgeon General Report Regional LF Program Managers Meeting, Costa Rica, 2005

  12. Historical Trend of LFin Trinidad & Tobago (2) • 5% positive microfilaria • 6.7% had elephantiasis n=500 1902 George A. Vincent Survey Patients from Port of Spain Colonial Hospital, St. Ann's and private practitioners Regional LF Program Managers Meeting, Costa Rica, 2005

  13. Historical Trend of LFin Trinidad & Tobago (3) 1908 George C. Low Survey N=400 10.8 % Positive for microfilaria (44.2 % symptomatic) (55.8 % asymptomatic) (n=43) 20.8% had elephantiasis Regional LF Program Managers Meeting, Costa Rica, 2005

  14. Historical Trend of LFin Trinidad & Tobago (4) 1909 A.B. Herrick Survey 1 case Chyluria Case was Trinidadian but lived in Panama for 22 years Positive for microfilaria Regional LF Program Managers Meeting, Costa Rica, 2005

  15. Historical Trend of LFin Trinidad & Tobago (5) 1928 Low prevalence of LF n=33,970 0.1% 1945 Platzer 0.0003% 1961 Beve Naval base employee survey T&T Surgeon General Report Regional LF Program Managers Meeting, Costa Rica, 2005

  16. Historical Trend of LFin Trinidad & Tobago (6) 1976 Nelson & Davis 6.3% positive for microfilaria n=300 Elephantiasis & Hydrocele reported in north coast village Regional LF Program Managers Meeting, Costa Rica, 2005

  17. Historical Trend of LFin Trinidad & Tobago (7) 1978-1979, Nathan 1981, Nathan 1982 Blanchisseuse survey n=562 15.3% positive for microfilaria 2.1% amicrofilaria with lymphoedema 16.7% (n=12) had elephantiasis Regional LF Program Managers Meeting, Costa Rica, 2005

  18. Historical Trend of LFin Trinidad & Tobago (8) Nathan 1981 Human bait capture mosquito population 2.1% infected with 0.1% with mature larvae Resting vector population 7.0% infected with 0.1% with mature larvae Regional LF Program Managers Meeting, Costa Rica, 2005

  19. Historical Trend of LFin Trinidad & Tobago (9) Nathan 1987 DEC efficacy survey in 1980–1981 Dosage was 6mg/kg body weight monthly for one year (Apr. 1980 – Apr. 1981) Regional LF Program Managers Meeting, Costa Rica, 2005

  20. Historical Trend of LFin Trinidad & Tobago (10) Nathan 1987 cont’d Survey Results Regional LF Program Managers Meeting, Costa Rica, 2005

  21. Historical Trend of LFin Trinidad & Tobago (11) Chadee 1995 12 years post treatment 66.92% of total population sampled in 1992 (n=520) All negative for microfilariae Regional LF Program Managers Meeting, Costa Rica, 2005

  22. Criteria for Elimination of LF Cumulative 5-year transmission rate is < 1 new infection per 1000 individuals Consensus at 50th World Health Assembly Request for certification of elimination was made in 2002 Regional LF Program Managers Meeting, Costa Rica, 2005

  23. Monitoring Ongoing risk of re-introduction of LF from imported cases originating in endemic countries Regional LF Program Managers Meeting, Costa Rica, 2005

  24. Epidemiological Monitoring 1 Blood smearing in community surveys serves dual purpose for LF and malaria surveillance Immunochromatographic Card Testing (ICT) 1998 (Rawlins et al. 2000) Regional LF Program Managers Meeting, Costa Rica, 2005

  25. Epidemiological Monitoring 2 Results ICT 1998 211 Adults from 8 locations in north, central and south Trinidad 139 Children from previously endemic Blanchisseuse and neighboring Matelot and Grand Reviere All results were negative included adults treated in 1981 DEC campaign Regional LF Program Managers Meeting, Costa Rica, 2005

  26. Vector Surveillance Chadee et al. 2002 Xenomonitoring of Culex quinquefasiatus Uses blood-engorged resting mosquitoes rather than ethically questionable Human Bait captures Collection using electrical or mouth respirators ‘Cocoyear broom’ flushing technique for hard-to-reach mosquitoes Regional LF Program Managers Meeting, Costa Rica, 2005

  27. Xenomonitoring Results 3000 Culex quinquefasciatus from 1400 households in St. George and Caroni 3-6 Culex quinquefasciatus collected per household Stored mosquitoes not yet analyzed by PCR-based assay Regional LF Program Managers Meeting, Costa Rica, 2005

  28. Challenges 1 Detection of imported cases from “underground visitors” Need a humane and diplomatic approach Regional LF Program Managers Meeting, Costa Rica, 2005

  29. Challenges 2 Promotion of Regional inter-country communication linkages: This may assist in the management of the aforementioned problem. Regional LF Program Managers Meeting, Costa Rica, 2005

  30. Challenges 3 Technical corporation and assistance needed for epidemiological and vector surveillance on an ongoing basis Regional LF Program Managers Meeting, Costa Rica, 2005

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