Cost of mass drug administration for filiriasis elimination in the province of Sorsogon, Philippines

OBJECTIVE: Elimination eforts for lymphatic flariasis are underway in the Philippines using mass drug administration (MDA) of diethylcarbamazine and albendazole as one of the main strategies. This cost analysis was done to determine the MDA implementation cost and provide useful information to the control programme on how to best utilize limited resources. METHODS: This cost analysis study was conducted in the province of Sorsogon, Philippines in 2004. The study was done from a program perspective. Cost data for 2003 was obtained retrospectively via key informant interviews and records review using a standardized guide from a multi-country cost analysis study of flariasis elimination programs. Cost fgures were classifed as either economic or fnancial costs and expressed in real terms using 2002 as base year. Sensitivity analysis was likewise performed. RESULTS: The total economic cost and cost per person treated with MDA were estimated at US$223,549.55 (Php12,116,385.48) and US$0.40, respectively. The fnancial costs were less than half of the economic costs. The main cost driver was drug distribution. The highest economic and fnancial costs were incurred at the national (54.5%) and municipal (74.4%) levels, respectively. High variation in costs of MDA activities was observed. CONCLUSION: This cost analysis provides reasonable estimates which may be used to assist government and other stakeholders in program planning and resource generation for flariasis elimination programs in endemic areas.

Brugia malayi asparaginyl-transfer RNA synthetase induces chemotaxis of human leukocytes and activates G-protein-coupled receptors CXCR1 and CXCR2.

Background. Lymphatic filariasis is a chronic human parasitic disease in which the parasites repeatedly provoke acute and chronic inflammatory reactions in the host bloodstream and lymphatics. Excretory-secretory products derived from filariae are believed to play an important role in the development of associated immunologic conditions; however, the specific mechanisms involved in these changes are not well understood. Recently, human cytoplasmic aminoacyl-transfer (t) RNA synthetases, which are autoantigens in idiopathic inflammatory myopathies, were shown to activate chemokine receptors on T lymphocytes, monocytes, and immature dendritic cells by recruiting immune cells that could induce innate and adaptive immune responses. Filarial (Brugia malayi) asparaginyl-tRNA synthetase (AsnRS) is known to be an immunodominant antigen that induces strong human immunoglobulin G3 responses.Methods. Recombinant B. malayi AsnRS was used to perform cellular function assays--for example, chemotaxis and kinase activation assays.Results. Unlike human AsnRS, parasite AsnRS is chemotactic for neutrophils and eosinophils. Recombinant B. malayi AsnRS but not recombinant human AsnRS induced chemotaxis of CXCR1 and CXCR2 single-receptor-transfected HEK-293 cell lines, blocked CXCL1-induced calcium flux, and induced mitogen-activated protein kinase.Conclusions. Our findings suggest that a filarial parasite chemoattractant protein may contribute to the development of chronic inflammatory disease and that chemokine receptors may be therapeutic targets to ameliorate parasite-induced pathology.

Contrasting Wuchereria bancrofti microfilaria rates in two Mangyan-populated Philippine villages.

Lymphatic filariasis caused by infection with Wuchereria bancrofti and Brugia malayi is endemic in 45 of 77 provinces in The Philippines. To prepare the island of Mindoro for mass treatment using diethylcarbamazine and albendazole, complete census data were collected in rural villages. A sample of individuals selected from each of two adjacent villages was examined for microfilaremia. Microfilariae were detected from thin smears in 34 (13%) of 272 patients examined from the village of Bayanan and 10 (3.4%) of 292 in the village of Mangangan (P < 0.01, by chi-square test). In these villages, the majority of those infected were members of the ethnic group known as Mangyans: 33 (97%) of 24 in Bayanan and 7 (70%) of 10 in Mangangan (risk ratio = 89, 95% confidence interval = 33-240, P < 0.001.) In children examined who were less than 10 years of age (n = 165), girls were more commonly infected than boys, even though the proportion of males in the general population was greater. Understanding sociocultural characteristics and related behaviors in future observations among the Mangyan may help to explain local differences in the distribution of filariasis. This information should also be helpful in designing more culturally appropriate strategies for the control of lymphatic filariasis among ethnic minorities in The Philippines.