title: A practical strategy for responding to a case of lymphatic filariasis post-elimination in Pacific Islands.
abstract: BACKGROUND
  Lymphatic filariasis (LF) due to Wuchereria bancrofti is being eliminated from Oceania under the Pacific Elimination of Lymphatic Filariasis Programme. LF was endemic in Solomon Islands but in the 2010-2020 Strategic Plan of the Global Programme to Eliminate LF, Solomon Islands was listed as non-endemic for LF. In countries now declared free of LF an important question is what monitoring strategy should be used to detect any residual foci of LF?
  
  
  METHODS
  The index case, a 44 year old male, presented to Atoifi Adventist Hospital, Malaita, Solomon Islands in April 2011 with elephantiasis of the lower leg. Persistent swelling had commenced 16 months previously. He was negative for antigen by TropBio Og4C3 ELISA and for microfilaria. A week later a survey of 197 people aged from 1 year to 68 years was conducted at Alasi, the index case's village, by a research team from Atoifi Adventist Hospital and Atoifi College of Nursing. This represented 66.3% of the village population. Blood was collected between 22:00 and 03:00 by finger-prick and made into thick smears to detect microfilaria and collected onto filter paper for W. bancrofti antigen tests. A second group of 110 specimens was similarly collected from residents of the Hospital campus and inpatients. W. bancrofti antigen was tested for using the Trop-Bio Og4C3 test.
  
  
  RESULTS
  One sample (1/307) from an 18 year old male from Alsai was positive for W. bancrofti antigen. No samples were positive for microfilaria. Although antigen-positivity indicated a live worm, the case was regarded as having been acquired some years previously.
  
  
  CONCLUSIONS
  We propose that when LF has been eliminated from a country, a case of elephantiasis should be a trigger to conduct a survey of the case's community using a decision pathway. W. bancrofti antigen should be tested for with screening for microfilariae in antigen positive cases. The field survey was designed and conducted by local researchers, highlighting the value of local research capacity in remote areas.
authors.forename: Humpress
authors.initials: H
authors.lastname: Harrington
authors.forename: James
authors.initials: J
authors.lastname: Asugeni
authors.forename: Christopher
authors.initials: C
authors.lastname: Jimuru
authors.forename: John
authors.initials: J
authors.lastname: Gwalaa
authors.forename: Elmer
authors.initials: E
authors.lastname: Ribeyro
authors.forename: Richard
authors.initials: R
authors.lastname: Bradbury
authors.forename: Hayley
authors.initials: H
authors.lastname: Joseph
authors.forename: Wayne
authors.initials: W
authors.lastname: Melrose
authors.forename: David
authors.initials: D
authors.lastname: MacLaren
authors.forename: Rick
authors.initials: R
authors.lastname: Speare
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000947:Antigens, Helminth / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D003625:Data Collection; D060740:Disease Eradication; D004605:Elephantiasis, Filarial / Q000453:epidemiology* / Q000469:parasitology / Q000517:prevention & control; D004797:Enzyme-Linked Immunosorbent Assay; D006801:Humans; D007223:Infant; D008297:Male; D008842:Microfilariae; D008875:Middle Aged; D010139:Pacific Islands / Q000453:epidemiology; D014958:Wuchereria bancrofti / Q000276:immunology* / Q000302:isolation & purification; D055815:Young Adult
chemical_list: D000947:Antigens, Helminth
references.citation: PLoS Negl Trop Dis. 2012 Jan;6(1):e1479
references.pmid: 22272369
references.citation: Trends Parasitol. 2005 Oct;21(10):441-4
references.pmid: 16099721
references.citation: Natl Med J India. 2002 Sep-Oct;15(5):263-6
references.pmid: 12502137
references.citation: Int J Equity Health. 2012 Dec 18;11:79
references.pmid: 23249439
references.citation: Rural Remote Health. 2012;12:2139
references.pmid: 23094978
references.citation: Trop Med Int Health. 2000 Sep;5(9):591-4
references.pmid: 11044272
references.citation: Am J Trop Med Hyg. 1945 Nov;25:493-5
references.pmid: 21010816
references.citation: Trends Parasitol. 2002 Mar;18(3):109-15
references.pmid: 11854087
references.citation: Ann Trop Med Parasitol. 2011 Dec;105(8):567-78
references.pmid: 22325816
references.citation: Trans R Soc Trop Med Hyg. 1981;75(4):499-506
references.pmid: 7324123
references.citation: Pac Health Dialog. 2003 Sep;10(2):149-54
references.pmid: 18181427
references.citation: Parasitol Res. 2012 Sep;111(3):1379-83
references.pmid: 22392137
references.citation: Wkly Epidemiol Rec. 2011 Aug 26;86(35):377-88
references.pmid: 21887884
references.citation: Trans R Soc Trop Med Hyg. 1977;71(5):396-400
references.pmid: 595094
references.citation: Acta Trop. 2011 Sep;120 Suppl 1:S39-47
references.pmid: 21172296
references.citation: Trans R Soc Trop Med Hyg. 1979;73(6):722-4
references.pmid: 395730