Overview

Wuchereria bancrofti, one of the parasites that cause lymphatic filariasis (LF), was brought to America with forced migrations from Africa in the 1600s.  Transmitted by mosquitoes that live in polluted water, it flourished and spread due to terrible sanitary and environmental conditions. Today, in many countries once endemic, the disease has died out due to improvements in sanitation, vector control, and LF control programs.  However, much remains to be done to achieve regional elimination. 

Four countries in the Americas region, indicated on the map in yellow, are endemic for LF and have ongoing elimination programs: Brazil, the Dominican Republic, Guyana and Haiti.  In addition, Costa Rica, Suriname, and Trinidad & Tobago have had LF transmission in the recent past and are currently working to obtain certification of elimination based on WHO criteria.

Prospects for elimination are good in the Americas.  First, the region leads the way in operational research and morbidity control.  Currently, the program in Haiti is comparing the accuracy, efficiency and cost of various techniques to assess mass drug administration coverage.  The Brazilian program is at the forefront of developing techniques to teach those suffering from lymphedema to care for themselves.  A Quality-of-Life survey being conducted in the Dominican Republic is helping to further define the physical, emotional and social burden associated with LF-related disability.  Guyana, the first country to implement a diethylcarbamazine (DEC) fortified salt intervention nationally, is sharing lessons learned from its experience with other programs.  Second, sustainability is an important component of the LF elimination programs.  Countries are integrating their programs into existing health systems, drawing on available resources instead of creating new structures.  Training is increasing country capacity by enhancing the program administration and epidemiology skills of staff at the national, district and community levels.

Nevertheless, the campaign to eliminate LF in the Americas faces many challenges.  Country programs are facing a lack of human resources and political commitment.  In the face of other diseases that cause much mortality, it can be difficult to recognize the health, social and economic impacts of LF.  Further research is crucial to illuminate the socioeconomic effects of LF-related disability and the benefits of elimination programs.  However, even after governments become convinced of the effects of LF, they often do not have the resources to support program activities without external help.  The commitment to eliminate LF is a long-term one.  To be effective mass drug administration campaigns must continue for at least five years.  Continued advocacy is necessary to raise funds for scaling up and continuing program activities.  

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Country Technical Assistance

One of the major assets of the Americas program region is the expanding partnerships among the endemic countries, non-profit organizations, academic institutions, and the private sector.  The Pan American Health Organization (PAHO) has a lead role in supporting country programs at an international level and in aiding in program implementation in the field.  The LF Support Center collaborates with the U.S. Centers for Disease Control and Prevention (CDC) to support its mission of providing technical assistance to countries in the Americas region.  To find out more about the country programs, click on the links below: