title: Impact of six rounds of mass drug administration on Brugian filariasis and soil-transmitted helminth infections in eastern Indonesia.
abstract: BACKGROUND
  The lymphatic filarial parasite Brugia timori occurs only in eastern Indonesia where it causes high morbidity. The absence of an animal reservoir, the inefficient transmission by Anopheles mosquitoes and the high sensitivity to DEC/albendazole treatment make this species a prime candidate for elimination by mass drug administration (MDA).
  
  
  RESULTS
  We evaluated the effect of MDA using DEC and albendazole on B. timori and soil transmitted helminths (STH) in a cross-sectional study of a sentinel village on Alor Island annually over a period of 10 years. Pre-MDA the microfilaria (MF) prevalence was 26% and 80% of the residents had filaria-specific IgG4 antibodies. In 2010, 34 months after the 6(th) round of MDA, MF and antibody rates were only 0.17% and 6.4%, respectively. The MDA campaign had also a beneficial effect on STH. Baseline prevalence rates for Ascaris, hookworm and Trichuris were 34%, 28%, and 11%, respectively; these rates were reduced to 27%, 4%, and 2% one year after the 5(th) round of MDA. Unfortunately, STH rates rebounded 34 months after cessation of MDA and approached pre-MDA rates. However, the intensity of STH infection in 2009 was still reduced, and no heavy infections were detected.
  
  
  CONCLUSIONS
  MDA with DEC/albendazole has had a major impact on B. timori MF and IgG4 antibody rates, providing a proof of principle that elimination is feasible. We also documented the value of annual DEC/albendazole as a mass de-worming intervention and the importance of continuing some form of STH control after cessation of MDA for filariasis.
authors.affiliation: Department of Parasitology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.
authors.forename: Taniawati
authors.initials: T
authors.lastname: Supali
authors.affiliation: Department of Parasitology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.
authors.forename: Yenny
authors.initials: Y
authors.lastname: Djuardi
authors.affiliation: Global Health Programs, GlaxoSmithKline, Brentford, Middlesex, United Kingdom.
authors.forename: Mark
authors.initials: M
authors.lastname: Bradley
authors.affiliation: Institute for Research in Molecular Medicine, Universiti Sains Malaysia, Penang, Malaysia.
authors.forename: Rahmah
authors.initials: R
authors.lastname: Noordin
authors.affiliation: German International Co-operation (GIZ), Kupang, Indonesia.
authors.forename: Paul
authors.initials: P
authors.lastname: Rückert
authors.affiliation: Department of Internal Medicine, Infectious Diseases Division, Washington University School of Medicine, St. Louis, Missouri, United States of America.
authors.forename: Peter U
authors.initials: PU
authors.lastname: Fischer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015766:Albendazole / Q000008:administration & dosage; D000818:Animals; D000871:Anthelmintics / Q000008:administration & dosage*; D000909:Antibodies, Helminth / Q000097:blood; D002009:Brugia / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D004049:Diethylcarbamazine / Q000008:administration & dosage; D004358:Drug Therapy / Q000379:methods; D005260:Female; D005368:Filariasis / Q000188:drug therapy* / Q000453:epidemiology*; D006373:Helminthiasis / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007214:Indonesia / Q000453:epidemiology; D007410:Intestinal Diseases / Q000188:drug therapy* / Q000453:epidemiology*; D007411:Intestinal Diseases, Parasitic; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000871:Anthelmintics; D000909:Antibodies, Helminth; D007074:Immunoglobulin G; D015766:Albendazole; D004049:Diethylcarbamazine