Author(s): Maria P Rebollo 1 , Moses J Bockarie [*] 2
endgame; London declaration; lymphatic filariasis; mass drug administration; monitoring and evaluation; neglected tropical diseases; preventive chemotherapy; transmission assessment surveys; xenomonitoring
Lymphatic filariasis (LF) affects 120 million people in 73 countries and 1.4 billion people are also at risk of acquiring the disease. It is an important public health problem and a major impediment to socioeconomic development in many endemic countries  . Over 90% of the infections are caused by Wuchereria bancrofti . Brugia malayi and Brugia timori are responsible for the remaining infections, and they are mainly found in the Southeast Asian region. These nematode parasites are carried by various species of mosquito vectors from the genera Anopheles , Aedes , Culex , Mansonia and Ochlerotatus . Eliminating LF can provide economic benefits in excess of US$22 billion over an 8-year period [2,3] .
The Global Program to Eliminate LF (GPELF) was launched in 2000 as a disease-specific intervention initiative to interrupt transmission and alleviate morbidity. The goal is achieved through two main objectives: interruption of parasite transmission through mass drug administration (MDA) using albendazole in combination with either ivermectin or diethylecarbamazine citrate and morbidity management and disability prevention through care for those who suffer the devastating clinical manifestations of the disease.
Drugs currently used for interruption of LF transmission, albendazole, ivermectin and/or diethylcarbamazine citrate (DEC), are used mostly in combination to reduce microfilariae in blood. They are mainly microfilaricidal and temporarily clear microfilariae without significantly affecting adult worms. However, in areas in Africa where LF coexists with loiasis, progressive neurologic decline and encephalopathy following treatment with ivermectin or DEC have caused great concern. Comprehensive reviews of the attributes, safety and efficacy of these drugs have been published [4-7] . To achieve the second objective associated with morbidity management, access to a basic package of care should be provided to every affected person for management of lymphodema and prevention of disabilities. This includes simple hygiene measures and access to antibiotics. Surgery is recommended for hydrocele and is offered to an increasing number of communities in endemic countries  .
Disease-specific vertical approaches to tackle neglected tropical diseases (NTDs) are being discouraged in favor of a common integrated approach to prevention and control [8-10] . A clear vision for an integrated approach to tackling NTDs is presented in a roadmap published by WHO in January 2012  . Inspired by this, 22 partners signed up to the London Declaration 'Uniting to Combat NTDs', including the UK and US governments, WHO, Bill & Melinda Gates Foundation, World Bank and major pharmaceutical companies committed to sustaining and expanding NTD programs to control or eliminate ten NTDs, including LF, by 2020  . Nearly two decades of collaborative work between the WHO and partners including pharmaceutical companies, academic institutions, nongovernmental organizations and endemic country governments have produced the drugs and tools necessary to achieve this goal  .
Many countries are now scaling down MDA activities after reaching 100% geographic coverage and instituting monitoring and evaluation processes to establish the impact of several rounds of...