Lymphatic Filariasis Elimination in Brazil
Introduction Brazil is one of four nations in the Americas Region with ongoing transmission of lymphatic filariasis. It is located in northeastern South America, bordered by the Atlantic Ocean. Efforts to eliminate LF have been ongoing in Brazil since the 1980s. Quick Facts1
The strategy adopted until now has been selective treatment, with approximately 1,500 people treated annually. Mass drug administration (MDA) pilot projects are being initiated in Recife in 2003 covering 25,000 people; and in Jaboatão and Olinda in 2005 covering 20,000 people.
Approximately 1,765,000 people live in endemic areas in Brazil. In 2002, the estimated number of infected individuals was 69,000 (0.04% of the total population)2. LF is currently found in foci in three states: Pernambuco (1.65 million people at risk), Alagoas (65,000 at risk) and Para (50,000 at risk). The parasite responsible for LF in Brazil is Wuchereria bancrofti which is spread mainly by Culex mosquitoes.
Objectives
Strategies
Organization In 2001, the national health council passed Resolution 190,
which commits Brazil to both reducing transmission of LF and preventing
LF-related disability. Until June 2003, the National Epidemiological Center (CENEPI) of the
Ministry of Health’s National Health Foundation (FUNASA) coordinated the
national LF program. In turn, FUNASA coordinated with the Ministry of Health
offices at the state level. In June
2003, the recently created Secretaria de Vigilância em Saude/MoH (SVS) replaced
FUNASA in the coordination and management of the Program to Eliminate LF (PELF)
at the national level.
Mass Drug Administration Activities The situation in Brazil requires a mixed strategy to achieve LF elimination. The national program is looking at strategies including conventional treatment, mass drug administration (MDA) campaigns and diethylcarbamazine (DEC)-fortified salt. Currently, a treatment regimen of DEC is offered to patients identified during mass surveys. Guidelines state that, in areas with greater than 10% MF prevalence, a MDA campaign or fortified salt strategy may be implemented. The 2003 national plan aims to cover 2600 individuals with conventional treatment, with a estimated consumption of 250,000 DEC tablets. In addition, pilot MDA projects will cover 25,000 people in Recife in 2003 and 20,000 people in Jaboatão and Olinda in 2005. Social Mobilization In pilot areas in Recife, communities were educated about LF and vector control through art workshops, lectures at schools, and house-to-house visits by health agents. Health Worker Training Fifty-four health professionals took part in a training course in May 2001. Since 2001, almost 2,600 health care workers, patients, medical students, and program coordinators have been trained in lymphedema treatment. Community health workers in Recife have been trained in vector control. In Para State, laboratory technicians and other health professionals have been trained in LF epidemiology and control. In Alagoas, 800 health workers were trained in 2002 in a course using morbidity prevention videos. In 2003, a urogenital disease training course was conducted. Brazil has sponsored international training courses on lymphedema management in 2001, on ultrasound techniques in 2002, and on the pathogenesis of bancroftian filariasis disease in 2003. Monitoring and Evaluation Mapping was concluded in Pernambuco in 2002, showing a range of MF positivity from 0.24% to 3.79% at the district level, with the largest focus in Recife. A number of surveys were conducted in Alagoas from 1993 to 1996. The highest area of endemicity found was in the city of Maceio, where 2% of the population tested positive. In Para State in 1998, only one case was found in the 99,000 individuals surveyed by blood smear technique. Extensive hemoscopic surveys of 95,000 people will be conducted in 2003. Surveys using ICT cards in Para State are planned to be conducted in 2003 and 2004. Morbidity/Disability Activities The Brazilian national program aims to integrate LF disability prevention services into family health program services. Three primary care units are specialized to deal with LF-related disability in Recife, Pernambuco with a referral hospital for complicated cases.In 2001, over 1000 patients were treated for lymphedema and 482 hydrocele surgeries were performed in Recife. A morbidity study conducted in 2003 found 75 cases of lymphedema, 17 cases of elephantiasis, and 75 cases of hydrocele. In Alagoas State, almost 80% of all infected persons have been treated by the health services and LF treatment is being integrated into three primary health units. A specialized health unit is being established in Para State, where 25 patients were found with lymphedema in 2000. Mass Drug Administration Outcomes
Disability Prevention Outcomes
Partners collaborating with the Brazilian Ministry
of Health
For more information and to provide support to Brazil LF Program or other LF elimination programs contact:
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LF Elimination in the Americas