Current Bancroftian Filariasis Elimination on Thailand-Myanmar Border: Public Health Challenges toward Postgenomic MDA Evaluation

Figure 2

Strategic approaches to lymphatic filariasis elimination used in the National Program to Eliminate Lymphatic Filariasis (Thai PELF). (A) MDA 2-drug regimen (6 mg/kg DEC plus 400 mg albendazole) is given once a year for 5 consecutive years to local Thai populations with ≥2 years of age in certain transmission areas. This first strategic approach is dependent on interrupting transmission and hence eliminating human infections. (B) Multiple-dose DEC that makes use of DEC administration during renewal of work permit and hospital-based heath examination, community outreach for biannual DEC mass treatment, and supportive DEC treatment via malaria clinics or mobile clinics. For both strategic approaches, PELF management mechanisms involve direction and command (➝), coordination (i.e., managerial, financial, and technical) (⇢), data flow and integration (↕), and elimination strategy operation (↓). The implementers at different administrative levels (i.e., central, provincial, and local) of existing national public health system are involved in strategic deployment: a—Thai PELF program manager; b and c—PELF program coordinators at provincial level; d and e—implementers in charge of the implementation of MDA 2-drug distribution to Thai target population, surveillance and monitoring of filarial infections, and followup as well as of biannual DEC mass treatment to Myanmar migrant workers; f—implementers in charge of supportive PELF activities of filaria day campaign, followup, and surveillance and monitoring of filarial infections as well as supportive DEC treatment via malaria clinics or mobile clinics; g and h—implementers providing not only a single-dose administration with 300 mg DEC recommended by the PELF as provocative-day test to assess filarial infections but also a 400 mg albendazole recommended by migrant worker health service program to treat geohelminth infections.