The Impact of the COVID-19 Pandemic on People With Lymphedema in an Endemic Area for Lymphatic Filariasis in Brazil.

Objectives: To investigate the repercussions of the COVID-19 pandemic on lymphedema patients from an endemic area of lymphatic filariasis. Methods: The study descriptive compared sociodemographic and clinical aspects, risk of falling and quality of life, prior and during the COVID-19 pandemic in 28 lymphedema patients, older than 18 years old and under investigation of filarial infection. For the evaluation of functional mobility, the Time Up and Go test and The Medical Outcome Study Short Form-36 Health for quality of life, was used. Results: An increase in interdigital and dermal lesions, a higher frequency of acute dermatolymphangioadenitis crises and risk of falling, worsening of quality of life in the domains of physical functioning, general health, vitality, and mental health during the pandemic was observed. Conclusion: Our findings of clinical worsening and quality of life of patients during the COVID-19 pandemic indicate the need to reinforce the goal of the Lymphatic Filariasis Program regarding the follow-up of these patients in the actions of the Global Program for the Elimination of Lymphatic Filariasis, due to the discontinuity in the care during the pandemic.

Coverage and compliance of mass drug administration in lymphatic filariasis amidst the COVID-19 pandemic: A community based epidemiological study.

Background: Despite the target of elimination of lymphatic filariasis by 2015, a few districts of West Bengal including Bankura district failed to achieve it. Under-coverage and unsupervised consumption of medicines during mass drug administration (MDA) campaign were implicated for the failure. Thereby, directly observed therapy (DOT) and mop up by repeated home visits for MDA were adopted. Objective: The objective of this study is to assess the coverage of anti-filarial medicines distribution and rate of consumption as well as to find out the causes of nonconsumption. Materials and Methods: A cross-sectional survey was conducted in three sub-centers each of three blocks and three wards of Bankura municipality of Bankura district, WB, India, selected through the stratified random sampling method. Information was collected interviewing inhabitants of the house hold selected through the systematic random sampling technique. Results: Overall, appropriate medicine distribution was 82.9% with 95.3% of correct consumption of both medicines under supervision. 91.87% of the respondents were aware about Lymphatic filariasis (LF) of which 89.95% reported swelling of leg/foot/hand, 9.57% as pain, 6.22% fever, and 1.44% reported swelling of testis as symptoms of LF. Altogether 10.6% individual, who consumed any medicine (527), reported AEs, out of that 66.1%, 19.6%, and 14.3% complained of dizziness/headache, nausea/vomiting, and drowsiness, respectively, and 28.6% of them sought consultation with health workers. Conclusion: Substantial supervised consumption in the form DOT in this round too leads to the fact that the effective coverage of MDA has reached the target. It seemed that some segment of the beneficiary is remaining as persistent noncomplaints. Mass mobilization for motivating this persistent defaulter section is the need of the hour.

Summary of the 31st meeting of the international task force for disease eradication, 20-21 October 2020

This article provides a brief overview of the 31st meeting of the International TaskForce for Disease Eradication (ITFDE) that was convened at The Carter Center in Atlanta, GA, USA on 20-21 October 2020 to discuss "The impact of the COVID-19 pandemic on eradication and elimination programmes and the way forward." It highlights the results of 7 eradication programmes, with specific conclusions and recommendations for each: Guinea Worm Eradication Programme(dracunculiasis;GWEP);Global Polio Eradication Initiative (GPEI);elimination programmes for measles and rubella (MR), malaria, river blindness (onchocerciasis;RB), and lymphatic filariasis (LF);and the program for the Global Elimination of Trachoma.

Global programme to eliminate lymphatic filariasis: progress report, 2020

This article describes the Global Programme to Eliminate Lymphatic Filariasis (GPELF), which aims to stop the spread of infection by mass drug administration (MDA) and ease the suffering of patients through morbidity management and disability prevention (MMDP). In 2020, LFMDA treated 21.6 million 2-4-year-olds and 98.5 million 5-14-year-olds. Given the impact of LF MDA on soil-transmitted helminth (STH) infections, WHO advises adding STH infection assessment into transmission assessment surveys (TAS) to increase NTD intervention efficiency. Once preTAS and TAS standards are met, an IU's population no longer needs MDA. 692 million people didn't need MDA. This 49% decline in LF cases is a huge step toward meeting the Sustainable Development Goal (SDG). Thirteen countries and 171 IUs performed TASs in 2020. A total of 4316 TAS have been conducted in EUs, which are greater or smaller than IUs. 100% of EUs passed a TAS, according to 2020 reports (the proportion of children who tested positive for LF infection was below the threshold for considering transmission unsustainable). Several 2020 TAS were postponed because to COVID-19 pandemic restrictions. Despite a global epidemic, GPELF achieved progress in 2020, demonstrating the resolve and inventiveness of national LFprogrammes to end this illness.

Elimination of human onchocerciasis: progress report, 2020

In this report, four countries (Colombia, Ecuador, Guatemala, and Mexico) have completed the WHO-recommended process for verification of the interruption of human onchocerciasis transmission, and many others have ceased mass drug administration (MDA), completed post-treatment surveillance (PTS), or both in at least one transmission area on their territory. Interruption of transmission enabled governments to preserve the benefits acquired over many years of effective MDA with Ivermectin and to discontinue MDA permanently, thereby protecting populations living in endemic areas from morbidity and infection. The eradication of human onchocerciasis would contribute significantly to achieving Sustainable Development Goal (SDG) 3.3, which calls for the eradication of neglected tropical diseases (NTDs) by 2030. All countries endemic for onchocerciasis have reported instances of COVID-19. The impact of the pandemic on NTD interventions has been discussed elsewhere. In many countries, scheduled MDA rounds were postponed due to efforts to prevent the spread of SARS-CoV-2 in onchocerciasis-endemic nations. In 2020, 26.9% fewer patients were treated for onchocerciasis than in 2019. MDA was implemented in fewer nations and implementation units in 2020 (1096 versus 1538 in 2019), resulting in a 27.7% decrease in global geographical coverage. The WHO Global Health Observatory provides access to data submitted by governments.

The Connection between Climate Change, Surgical Care and Neglected Tropical Diseases.

The surgical burden of neglected tropical diseases (NTDs) is set to rise alongside average temperatures and drought. NTDs with surgical indications, including trachoma and lymphatic filariasis, predominantly affect people in low- and middle-income countries where the gravest effects of climate change are likely to be felt. Vectors sensitive to temperature and rainfall will likely expand their reach to previously nonendemic regions, while drought may exacerbate NTD burden in already resource-strained settings. Current NTD mitigation strategies, including mass drug administrations, were interrupted by COVID-19, demonstrating the vulnerability of NTD progress to global events. Without NTD programming that meshes with surgical systems strengthening, climate change may outpace current strategies to reduce the burden of these diseases.

Mass drug administration for lymphatic filariasis elimination amidst COVID-19 pandemic in Odisha, India: A step towards achieving SDG-3.

Sustainable Development Goal-3 (SDG) aims to eliminate lymphatic filariasis by 2030 through >65% coverage and compliance of mass drug administration (MDA), the preventive chemotherapy strategy of delivering anthelminthic drugs. However, the ongoing COVID-19 pandemic has disrupted such programmes, yet MDA was administered during February 2021 in Odisha, India. We aimed to assess the coverage and compliance of the present round of MDA amidst the pandemic and explore factors for non-compliance in Cuttack district of Odisha, a filariasis endemic area. Community-based participants enrolled through multistage stratified sampling were administered a semi-structured questionnaire following COVID-19 protocols. The coverage of MDA was 93.2% whereas consumption was 73.7%. Participants reported that healthcare workers were motivated and satisfactorily explained the benefits of MDA but still fear of side-effects was the major cause of non-compliance. Nonetheless, this recent round of MDA was effective, despite challenges posed by the ongoing pandemic.

Community-based trial assessing the impact of annual versus semiannual mass drug administration with ivermectin plus albendazole and praziquantel on helminth infections in northwestern Liberia.

We assessed the impact of three annual vs five semiannual rounds of mass drug administration (MDA) with ivermectin plus albendazole followed by praziquantel for the control or elimination of lymphatic filariasis (LF), onchocerciasis, soil-transmitted helminth (STH) infections and schistosomiasis in Lofa County, Liberia. The study started in 2012 and was interrupted in 2014 during the Ebola virus outbreak. Repeated cross-sectional surveys were conducted in individuals 5 years and older to measure infection markers. Wuchereria bancrofti antigenemia prevalences decreased from 12.5 to 1.2% (90% reduction) and from 13.6 to 4.2% (69% reduction) one year after three rounds of annual or five rounds of semiannual MDA, respectively. Mixed effects logistic regression models showed decreases in odds of antigenemia positivity were 91 and 74% at that time in the annual and semiannual treatment zones, respectively (p < 0.001). Semiannual MDA was slightly more effective for reducing Onchocerca volvulus microfiladermia prevalence and at follow-up 3 were 74% (from 14.4 to 3.7%) and 83% (from 23.6 to 4.5%) in the annual and semiannual treatment zones, respectively. Both treatment schedules had similar beneficial effects on hookworm prevalence. Thus, annual and semiannual MDA with ivermectin and albendazole had similar beneficial impacts on LF, onchocerciasis, and STH in this setting. In contrast, MDA with praziquantel had little impact on hyperendemic Schistosoma mansoni in the study area. Results from a long-term follow-up survey showed that improvements in infection parameters were sustained by routine annual MDA provided by the Liberian Ministry of Health after our study endpoint.

Summary of national data of class A, B and C communicable diseases in China, October 2021

In October 2021 (from 00: 00, 1 October to 24: 00, 31 October), a total of 523 006 cases of notifiable communicable diseases, including 2 040 deaths, were reported in China (except Hong Kong, Macao Special Administrative Regions and Taiwan Province, the same below). In communicable diseases in class A, 2 cases of cholera were reported without death. In communicable diseases in class B, no cases and no deaths of severe acute respiratory syndrome, poliomyelitis, human infection with highly pathogenic avian influenza virus, diphtheria and human infection with avian influenza A (H7N9) virus were reported. For the remaining 22 communicable diseases in class B, 249 605 cases were reported, a decrease of 8% compared with last month (272 332 cases) and a decrease of 3% compared with the same period in 2020 (258 591 cases). The first 5 diseases in terms of reported case number were viral hepatitis, pulmonary tuberculosis, syphilis, gonorrhea and AIDS, accounting for 95% of the total reported cases in class B. A total of 2 039 deaths were reported, a decrease of 6% (133 deaths) compared with last month (2 172 deaths) and an increase of 17% compared with the same period in 2020 (1 737 deaths). According to the website of the National Health Commission of China, a total of 1 081 confirmed COVID-19 cases were reported, without death, by 31 provinces (municipalities, autonomous regions) and Xinjiang Production and Construction Corps from 00: 00, 1 October to 24: 00, 31 October, 2021. In class C communicable diseases, a total of 273 399 cases were reported, an increase of 20% compared with last month (228 597 cases) and a decrease of 13% compared with the same period in 2020 (315 366 cases). The first 3 diseases in terms of reported case number were hand foot and mouth disease (HFMD), other infectious diarrhea and influenza, accounting for 95% of the total reported cases in class C. Compared with last month, except filariasis which had no incidences in both months, the diseases with reported cases increases were HFMD (45 435 cases, 52%), influenza (17 811 cases, 50%) and rubella (11 cases, 12%), but the reported cases of other diseases all decreased, the diseases with obvious case decreases were other infectious diarrhea (16 519 cases, 18%), mumps (1 490 cases, 12%) and acute hemorrhagic conjunctivitis (327 cases, 14%). Compared with the same period in 2020, except filariasis which had no incidences in both years, the diseases with reported case increases were influenza (33 177 cases, 164%), typhus fever (15 cases, 9%), rubella (8 cases, 9%) and leprosy (3 cases, 17%), but the diseases with reported case decreases were HFMD (65 002 cases, 33%), other infectious diarrhea (4 111 cases, 5%) and mumps (1 574 cases, 12%). One death caused by class C communicable diseases was reported, an increase of 1 death compared with last month and a decrease of 1 death compared with the same period in 2020 (2 deaths).

Summary of national data of class A, B and C communicable diseases in China, September 2021

In September 2021 (from 00:00, 1 September to 24: 00, 30 September), a total of 500 929 cases of notifiable communicable diseases, including 2 172 deaths, were reported in China (except Hong Kong, Macao Special Administrative Regions and Taiwan Province, the same below). In communicable diseases in class A, no case and no death were reported. In communicable diseases in class B, no cases and no deaths of severe acute respiratory syndrome, poliomyelitis, human infection with highly pathogenic avian influenza virus, diphtheria and human infection with avian influenza A(H7N9) virus were reported. For the remaining 22 communicable diseases in class B, 272 332 cases were reported, a decrease of 0.9% compared with last month (274 917 cases) and a decrease of 5% compared with the same period in 2020 (287 923 cases). The first 5 diseases in terms of reported case number were viral hepatitis, pulmonary tuberculosis, syphilis, gonorrhea and brucellosis, accounting for 94% of the total reported cases in class B. A total of 2 172 deaths were reported, an increase of 5% (95 deaths) compared with last month (2 077 deaths) and a decrease of 5% compared with the same period in 2020 (2 291 deaths). According to the website of the National Health Commission of China, a total of 1 264 confirmed COVID-19 cases were reported, without death, by 31 provinces (municipalities, autonomous regions) and Xinjiang Production and Construction Corps from 00:00, 1 September to 24: 00, 30 September, 2021. In class C communicable diseases, a total of 228 597 cases were reported, an increase of 10% compared with last month (207 153 cases) and a decrease of 7% compared with the same period in 2020 (247 112 cases). The first 3 diseases in terms of reported case number were other infectious diarrhea, hand foot and mouth disease (HFMD) and influenza, accounting for 93% of the total reported cases in class C. Compared with last month, except filariasis, visceral leishmaniasis, leprosy and other infectious diarrhea which decreased by 1 case, 11 cases (39%), 12 cases (33%) and 12 747 cases (12%) respectively, the reported cases of all other diseases increased, the diseases with obvious case increases were HFMD (15 352 cases, 22%), influenza (14 160 cases, 66%) and mumps (4 253 cases, 51%). Compared with the same period in 2020, the diseases with reported case increases were influenza (17 269 cases, 95%), visceral leishmaniasis (4 cases, 31%), rubella (19 cases, 27%) and typhus fever (32 cases, 18%), filariasis had no incidences in both years, and the diseases with obvious reported case decreases were HFMD (26 506 cases, 23%). other infectious diarrhea (5 628 cases, 6%) and mumps (523 cases, 4%). No death caused by class C communicable diseases was reported, same to the last month and a decrease of 3 deaths compared with the same period in 2020 (3 deaths).

Progress towards control and elimination of neglected tropical diseases targeted by preventive chemotherapy in São Tomé e Príncipe.

The São Tomé e Príncipe government is committed to achieving neglected tropical disease (NTD) control and elimination as a public health problem by 2025. In 2014, the Ministry of Health led a national survey to determine the prevalence of soil-transmitted helminths (STHs) and schistosomiasis across the country. Following this survey, a preventive chemotherapy (PC) campaign with mebendazole and praziquantel reached 31 501 school-age children in 2015. A follow-up 2017 survey to determine the impact of the intervention showed success in controlling schistosomiasis, as no infections were found, but limited impact on STHs, with prevalence similar to pretreatment levels. The survey also investigated the prevalence of a third NTD, lymphatic filariasis (LF), which was found to be endemic in the country. Since then the Ministry of Health has developed the Strategic Plan for the Fight Against Neglected Tropical Diseases 2019-2025 and identified gaps to be addressed. This narrative review systematises the existing literature reporting on the epidemiology of NTDs for which there are PC programs in São Tomé e Príncipe. PubMed was searched for relevant papers that measured the prevalence of LF, schistosomiasis and STHs. Additionally, data provided by the Ministry of Health surveys were analysed. Finally, we discuss current NTD control, including the impact of the coronavirus disease 2019 pandemic and identify priorities for program strengthening and operational research.

Investigating immunological interaction between lymphatic filariasis and COVID-19 infection: a preliminary evidence.

The foremost concerns of COVID-19 vaccines are safety and efficacy, which becomes grave in countries with a high burden of Neglected Tropical Diseases. Studies proposed helminthic infections might alleviate the efficacy of COVID-19 vaccines. We share preliminary evidence on the association between filariasis and COVID-19 infection. We collated 2 ml of blood from 174 participants residing in filariasis endemic area. To determine filarial antigen, the Og4C3 test and for COVID-19 antibodies, tests through ELISA was performed. COVID-19 antibodies were present among 74/174 (42.5%), whereas filarial antigens were detected in 24/174 (13.8%) participants. An insignificant association [OR = 0.855 (0.36-2.034)] between two was observed. Hence, people in filarial endemic regions can continue taking vaccines without worrying about their efficacy due to the helminthic load in community.

Infrared Thermal Imaging as a Novel Non-Invasive Point-of-Care Tool to Assess Filarial Lymphoedema.

Lymphatic filariasis causes disfiguring and disabling lymphoedema, which is commonly and frequently exacerbated by acute dermatolymphangioadenitis (ADLA). Affected people require long-term care and monitoring but health workers lack objective assessment tools. We examine the use of an infrared thermal imaging camera as a novel non-invasive point-of-care tool for filarial lower-limb lymphoedema in 153 affected adults from a highly endemic area of Bangladesh. Temperature differences by lymphoedema stage (mild, moderate, severe) and ADLA history were visualised and quantified using descriptive statistics and regression models. Temperatures were found to increase by severity and captured subclinical differences between no lymphoedema and mild lymphoedema, and differences between moderate and severe stages. Toes and ankle temperatures detected significant differences between all stages other than between mild and moderate stages. Significantly higher temperatures, best captured by heel and calf measures, were found in participants with a history of ADLA, compared to participants who never had ADLA, regardless of the lymphoedema stage. This novel tool has great potential to be used by health workers to detect subclinical cases, predict progression of disease and ADLA status, and monitor pathological tissue changes and stage severity following enhanced care packages or other interventions in people affected by lymphoedema.

Current Use of Ivermectin in Dermatology, Tropical Medicine, and COVID-19: An Update on Pharmacology, Uses, Proven and Varied Proposed Mechanistic Action.

Ivermectin is a broad-spectrum antiparasitic drug with anti-inflammatory, anti-viral, anti-bacterial, and anti-tumor effects. In this review, we discuss the history, pharmacology, multimodal actions, indications in dermatology and tropical medicine, therapeutic and prophylactic use of ivermectin in COVID-19, safety, adverse effects, special considerations, and drug interactions of ivermectin.

Lack of detectable short-term effects of a single dose of ivermectin on the human immune system.

BACKGROUND: Ivermectin is widely used in human and animal medicine to treat and prevent parasite nematode infections. It has been suggested that its mode of action requires the host immune system, as it is difficult to reproduce its clinical efficacy in vitro. We therefore studied the effects of a single dose of ivermectin (Stromectol®-0.15 mg/kg) on cytokine levels and immune cell gene expression in human volunteers. This dose reduces bloodstream microfilariae rapidly and for several months when given in mass drug administration programmes. METHODS: Healthy volunteers with no travel history to endemic regions were given 3-4 tablets, depending on their weight, of either ivermectin or a placebo. Blood samples were drawn immediately prior to administration, 4 h and 24 h afterwards, and complete blood counts performed. Serum levels of 41 cytokines and chemokines were measured using Luminex® and expression levels of 770 myeloid-cell-related genes determined using the NanoString nCounter®. Cytokine levels at 4 h and 24 h post-treatment were compared to the levels pre-treatment using simple t tests to determine if any individual results required further investigation, taking p = < 0.05 as the level of significance. NanoString data were analysed on the proprietary software, nSolver™. RESULTS: No significant differences were observed in complete blood counts or cytokine levels at either time point between people given ivermectin versus placebo. Only three genes showed a significant change in expression in peripheral blood mononuclear cells 4 h after ivermectin was given; there were no significant changes 24 h after drug administration or in polymorphonuclear cells at either time point. Leukocytes isolated from those participants given ivermectin showed no difference in their ability to kill Brugia malayi microfilariae in vitro. CONCLUSIONS: Overall, our data do not support a direct effect of ivermectin, when given at the dose used in current filarial elimination programmes, on the human immune system. Trial registration ClinicalTrials.gov NCT03459794 Registered 9th March 2018, Retrospectively registered https://clinicaltrials.gov/ct2/show/NCT03459794?term=NCT03459794&draw=2&rank=1 .

How should Indonesia consider its neglected tropical diseases in the COVID-19 era? Hopes and challenges (Review).

During the coronavirus disease 2019 (COVID-19) pandemic, some countries, including Indonesia, have faced a double burden with regards to disease control. As Indonesia is a tropical country, it serves as a suitable host for disease vectors and multiple microorganisms of causative agents of disease. In total, five of the neglected tropical diseases (NTDs) should be a consideration in Indonesia during the COVID-19 pandemic, including leprosy, yaws, filariasis, soil-transmitted helminths and schistosomiasis. The present review summarises the preparedness of Indonesia in facing NTDs during the COVID-19 pandemic. Strengthening government leadership will be a valuable factor for combating NTDs in Indonesia. For instance, strong leadership can lead to precise management, by increasing the number of health facilities, engaging in active case identification, conducting health campaigns and instituting new regulations to prevent the stigmatization faced by patients. Preventive medicine in the first level of health facilities can be prioritized and presented to the community via health campaigns, health advocacy and improvement in follow-up after active case surveillance. Government-supported integrated management is also a key component in eliminating NTD. Moreover, healthy lifestyle campaigns that include social distancing, wearing a mask and regularly washing hands should be promoted continuously to reduce the transmission of COVID-19, which is potentially associated with a poor outcome in individuals with NTDs. This review concluded that the Indonesian government should strengthen their efforts toward NTD control using alternative methods, such as involving key citizens in the collaboration of the detection of new cases and introducing mobile health as a means of detecting health problems or following up on patient progress. To reduce the transmission of COVID-19, testing, tracing and treatment must be improved, so that the gap between suspected cases and confirmed cases of COVID-19 can be closed. If the transmission of COVID-19 can be decreased, case detection and efforts toward NTD control can be conducted effectively.