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The Effect of Compliance on the Impact of Mass Drug Administration for Elimination of Lymphatic Filariasis in Egypt

We studied effects of compliance on the impact of mass drug administration (MDA) with diethylcarbamazine and albendazole for lymphatic filariasis (LF) in an Egyptian village. Baseline microfilaremia (mf) and filarial antigenemia rates were 11.5% and 19.0%, respectively. The MDA compliance rates were excellent (> 85%). However, individual compliance was highly variable; 7.4% of those surveyed after five rounds of MDA denied having ever taken the medications and 52.4% reported that they had taken all five doses. The mf and antigenemia rates were 0.2% and 2.7% in those who reported five doses of MDA and 8.3% and 13.8% in those who reported zero doses. There was no significant difference in residual infection rates among those who had taken two or more doses. These results underscore the importance of compliance for LF elimination programs based on MDA and suggest that two ingested doses of MDA are as effective as five doses for reducing filariasis infection rates.

Received June 18, 2007. Accepted for publication September 18, 2007.

Acknowledgments: We are grateful for technical assistance provided by the field research teams and laboratory staff at the Research and Training Center for Vectors of Diseases at Ain Shams University.

Financial support: This work was supported by National Institutes of Health grants AI-35855 and AI-65715.

Disclosure: The filariasis antigen card test used in this study uses reagents licensed from Barnes-Jewish Hospital, an affiliation of Gary J. Weil. All royalties from the sales of this test are donated to the Barnes-Jewish Hospital Foundation, a registered not-for-profit organization. This statement is made in the interest of full disclosure and not because the authors consider this to be a conflict of interest.

^* Address correspondence to Gary J. Weil, Infectious Diseases Division, Washington University School of Medicine, Campus Box 8051, 660 South Euclid Avenue, St. Louis, MO 63108. E-mail: gweil{at}wustl.edu

Authors’ addresses: Maged El-Setouhy, Khaled M. Abd Elaziz, Hanan Helmy, Hoda A. Farid, and Reda M. R. Ramzy, Research and Training Center on Vectors of Diseases, Faculty of Science Building, Ain Shams University, Abbassia, Cairo, Egypt, Telephone and Fax, 20–2–26839622. Hussein A. Kamal, Ministry of Health and Population, Cairo, Egypt, Telephone and Fax 20–2–7945467. William D. Shannon, Division of General Medical Sciences, Department of Internal Medicine, Washington University School of Medicine, 660 South Euclid Ave., St. Louis, MO 63110, Telephone: 314–454–8356, Fax: 314–454–5113. Gary J. Weil, Infectious Diseases Division, Washington University School of Medicine, Campus Box 8051, 660 South Euclid Avenue, St. Louis, MO 63108, Telephone: 314–454–7782, Fax: 314–454–5293, E-mail: gweil{at}wustl.edu.

Reprint requests: Gary J. Weil, Infectious Diseases Division, Washington University School of Medicine, Campus Box 8051, 660 South Euclid Avenue, St. Louis, MO 63108.