(WP)MVP/PIC/CPCII.2/00 I-E
Report Series Number: RS/2007/GE!20(FIJ)
English only
REPORT NINTH WORKSHOP FOR PACIFIC LYMPHATIC FILARIASIS PROGRAMME MANAGERS
Convened by: WORLD HEALTH ORGANIZATION Western Pacific Region Nadi, Fiji 20-21 June 2007
Not for sale
Worl4 flealth Organization Regional Office for the Western Pacific Manila, Philippines January 2008 WHO/WPRO LIBRARY
MANILA. PHILIPPINES
27 JUN ~008
The views expressed in this report are those of the participants in the Ninth Workshop for Pacific Lymphatic Filariasis Programme managers and do not necessarily reflect the policies of the Organization.
This report has been prepared by the World Health Organization Western Pacific Region for governments of Member States in the Region and for those who participated in the Ninth Workshop for Pacific Lymphatic Filariasis Programme Managers, held in Nadi. Fiji from 20 to 21 June 2007.
CONTENTS ABBREVIATIONS EXECUTIVE SUMMARY I. INTRODUCTION ................................................................................................................................. 3
1.1 1.2. 1.3.
Objectives .................................................................................................................................. 3 Participants and resource persons ............................................................................................. 3 Organization .............................................................................................................................. 3 Opening ceremony .................................................................................................................... 3
1.4.
2. PROCEEDINGS .................................................................................................................................... 4
2. I 2.2 2.3
Global updates ........................................................................................................................... 4 Overview of the Bill and Melinda Gates Foundation grant to the Global Alliance to Eliminate Lymphatic Filariasis (GAELF) ................................................ 6 Liverpool LF Support Centre (LFSC) and GAELF update .................................................... 7 Partnership in the Global Programme to Eliminate LF ........................................................... 7 James Cook University LF Support Centre ............................................................................. 8 Current challenges facing the Pacific Programme to Eliminate LF (PacELF) ...................... 8 Update on the Papua New Guinea ELF programme ............................................................... 9 Morbidity control in the Pacific: Key elements to be incorporated into national plans ...... 10 Draft five-year surveillance plan for the Pacific .................................................................... 12
2.4 2.5 2.6
2.7 2.8 2.9
2.10 Review and recommendations trom PacCARE .................................................................... 13
2. I I Group work ............................................................................................................................. 13 2.12 Presentation of two-year plans of action and budget estimates by PICs .............................. IS
2.13 Closing ceremony ................................................................................................................... 22 ANNEXES Annex 1 Annex 2 Annex 3 Anne~
PROVISIONAL AGENDA LIST OF PARTICIPANTS REGIONAL DIRECTOR'S SPEECH
4
- WELCOME ADDRESS
ABBREVIATIONS COMBI DEC GAELF GPELF GSK ICT ITN JCU LF LFSC MDA Mf NGO NTD PacCARE PacELF PIC Communication for Behavioural Impact Diethylcarbamazine citrate Global Alliance to Eliminate Lymphatic Filariasis Global Programme to Eliminate Lymphatic Filariasis GlaxoSmithKline Immunochromatographic test Insecticide-treated bed net James Cook University Lymphatic filariasis Liverpool Lymphatic Filariasis Support Centre Mass drug administration Microfilaria/microfilaremia Nongovernmental organization Neglected tropical disease Pac ELF Programme Review Group Pacific Programme to Eliminate Lymphatic Filariasis Pacific island country
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EXECUTNE SUMMARY
The Pacific Programme to Eliminate Lymphatic Filariasis (PacELF) began with 22 countries, of which II were endemic for lymphatic filariasis (LF). Three of these countries have now reduced their LF prevalence rates to below 1%, with the other eight continuing activities to eliminate the disease. In June 2007, PacELF national managers, with the support of WHO and others, met in Nadi, Fiji, to review the progress of national elimination programmes and build skills and knowledge for future actions. Issues and topics covered during the two-day programme included a review of the Global Programme to Eliminate Lymphatic Filariasis (GPELF), an update on the activities of various partners, identification of the current challenges to eliminating LF from the Pacific region, morbidity control, and a five-year surveillance plan for the Pacific. During the latter half of the programme, group activities were conducted with the aim of preparing two-year action plans for each country. The action plans included a list of key activities and budget estimates. Each country presented its two-year plan to the rest of the group. Figure I : Map ofthe Pacific islands ~ ~-...-
.. --
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... ,NQrthern M~n\ilna IslanrJ~
Ha~il
~
I>
Ouam Fed~rated
States
of"1l~roP.!eSla
... , "1'arshalllslands
KirjIJoli J(iribati .'TuvallJ . Kiribati
"
-Tokelau ~amoa
., VanlJatu,\
Wallis and Futuna ,..... I'"IJI ... o.-~
~
-Am Saml}\iI . Niue
."
'-.". 'New ~aledcinia
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Freri~'h.;f'OI~~I.a~ . ~60(lklSlandS
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•
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. Tonga
Pitcairn
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I. INTRO DUCT ION
d by lympha tic filariasis WHO estima tes that over 120 million people worldw ide are affecte incapacitated as a result of (LF), and 40 million to date have been are severel y disfigured and d, in 83 countri es throug hout the infection. At present , over I billion people are at risk of being infecte is (PacEL F) began, II of its 22 world. When the Pacific Progra mme to Eliminate Lymph atic Filarias mme of mass drug progra a ing Follow Pacific island membe rs were endem ic for the disease . es have reduced their LF countri ic admini stration and prevale nce monito ring, three of those II endem y activel implem ent activiti es to prevale nce rates to below I %. The remain ing countri es continu e to elimina te LF. are the Australian Agenc y for The main partner s contrib uting to LF control in the Pacific region Diseas e Contro l and Prevention International Develo pment (AusA ID), the United States Center s for (GSK) , Institut Louis Malard e, (US-C DC), Emory Univer sity LF Suppor t Centre , GlaxoS mithKl ine tional Cooper ation Agency James Cook Univer sity, the Govern ment of Japan, the Japan Interna of Health Fiji, the Secreta riat of ry Minist the , (JICA) , Liverpool Lymph atic Filariasis Suppor t Centre Overse as (V SO) and WHO. Service the Pacific Comm unity, United Nation s Volunt eers, Voluntary
1.1
Object ives By the end of the meetin g, particip ants would have, achiev ing the elimina tion (I) identified the challen ges that have preven ted some countri es from ying and develo ping next target level of less than I % prevale nce and collabo rated on identif steps; progra mmes and finalized (2) review ed the status of national lympha tic filariasis elimina tion plans of action for the next 12 months; and tion, social (3) been update d on key technic al matters, including monito ring, evalua es. mobiliz ation and disabil ity control and alleviation activiti
1.2.
Participants and resource person s
(PICs) attended the meetin g. Progra mme manag ers from nine Pacific island countri es and areas WHO secreta riat membe rs. In additio n, there were six tempor ary adviser s, six observ ers and ten
2. The agenda and the list of particip ants are attached as Annex es I and 1.3. Organi zation
ed of plenary and group The meetin g was held in Nadi , Fiji, on 20-21 June 2007, and consist RE) meeting was held (PacCA Group Review y work session s (see Annex I). A two-da y and one-da eitlm side Qfthe PacELF Jl1eeting.
,-1-
Openin g ceremo ny
Slama, Progra mme Dr Joe Koroiv ueta from Fiji welcom ed the participants. Dr George on behalf of the WHO ants Manag ement Officer , WHO South Pacific Office , welcom ed all particip hosting the worksh op. for of Health Representative for the South Pacific and thanke d the Fiji Ministry Regional Director for the Western He then read out the openin g messag e from Dr Shigeru Omi , WHO 3. Pacific. The text of the Regional Directo r' s speech is attached in Annex
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This was followed by an address by Dr Tui Taoi , Director of Health Service s, Western Division (see Annex 4). 1.5 Appointment of Chairperson and Vice-Chairperson
Mr Manila Nosa from Niue and Dr Fasihah Taleo from Vanuatu were appointed Chairperson and Vice-Chairperson, respectively.
2. PROCEEDINGS
2. 1
Global updates
The progress made in the Global Programme to Eliminate Lymphatic Filariasis (GPELF) was reviewed by Dr Gautam Biswas of WHO Headquarters. Orlhe estimated 1300 million people at risk oflymp hatic filariasis transm ission, over 40% have been brought under mass drug administration strategies. Howev er, only around 10% are following the WHO-recommended two-drug strategy. For example, India, which started its programme in 1996, began by implementing MDA primarily using DEC only. [n 2007, after reviewing all the evidence from internationally and nationally conduc ted studies , the Indian Ministry of Health changed its strategy to the WHO-recommended two-drug combin ation. Substantial progress has been made in mass drug administration accord ing to WHOrecommended strategies. Starting from 3 million co-administered treatme nts in 12 countries in 2000, around 90 million such treatments were being administered in 42 countri es by 2006. However, this progres s has not been uniform among the different WHO regions. The African and the Eastern Mediterranean regions have lagged behind the South-East Asia as well as the Mekong area. 100% 90% 80% 70% 60% 50% 40% 30% 20% 10%
Figure 2: Proportion of at risk population currently under MDA
AFR
AMR
EMR
• At-risk popoulation yet to be covered by MDA Total population under MDA by 2005
SEAR
MEK
PAC
Following initial rapid scaling up, MDA coverage has somewhat stagnat ed at the 2004 levels, mainly due to a lack of resources and of timely availability of DEC.
-5The second component of the programme strategy, the prevention and management of LF-associated disabilities, has lagged behind the rapid scaling up of the mass drug administration campaigns .. Presently, only half ofthe 42 countries that .have already begun implementing MDA have also hi/Hated disabilit¥-prevention activities. WHO held a eoHsl!ltation in August 2006 to fitialize thartUal to assist LF progriimttle thaiiiig~rs iii plartning iind ittlplethentiiig dlsiibility~prevehtjon programmes, as well as a protol:ol for the management of acute dettnatolymphangioadenitis (AOLA) in the field. The manual is currently being pre-tested in a few countries.
a
In December 2006, a workshop was held in WHO Headquarters to review the impact of MDA on lymphatic filariasis globally. In this workshop, data, as reported to WHO in annual reports and various research studies, were reviewed. Data were available from 710 sentinel sites, of which 442 had at least two measurement points. [t was concluded that the mass drug administration programme has led to a significant reduction in the public health burden of filarial infection and disease. It was also found that MDA has had a broader impact on onchocerciasis, soil-transmitted helminthiasis and scabies. Available data indicate that two to six rounds ofMDA with co-administered drugs are able to reduce microfilaria prevalence below I% in most areas. However, in some areas, more than six rounds may be necessary, since the effectiveness of the annual rounds of treatment was found to depend on the initial infection level, the treatment coverage rate and the type of mosquito vector responsible for transmission in the area. The December 2006 workshop highlighted the critical need to continue the systematic collection of data on public health impact. In addition, the workshop acknowledged the importance ofthe initiative towards the coordinated use of a set of drugs to tackle multiple helminth infections (preventive chemotherapy) and the opportunities this initiative provides to sustain MDAs where required. The following operational and technical actions were identified as the way forward: Ensure regular and timely availability of quality anti-filarial drugs. A global drug facility necessary.
IS
Ensure access to funds from within the government and from development partners at the national level. Complete mapping in certain remaining countries of Africa and in Indonesia. Develop an alternative and simplified mapping strategy. Develop a safe and effective MDA strategy for Loa loa co-endemic areas of Africa. Ensure the availability of affordable and field-friendly diagnostic tests. Strengthen monitoring and reporting as an integral part of the plans leading to decisions regarding when to stop MDA. Develop guidelines for post-intervention surveillance verification of non-endemicity. Use vector control methods (including ITNs) as a potential supplement to MDA where cost-effective.
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2.2
Overview of the Bill and Melinda Gates Foundation grant to the Global Alliance to Eliminate Lymphatic Filariasis (GAELF)
Dr Eric Ottesen, acting PAC are Chairperson, gave a presentation on the Bill and Melinda Gates Foundation grant. A grant totalling US$ 11.7 million over four years was recently awarded by the Foundation to GAELF to support a project entitled "Resolving the Critical Challenges Now Facing the Global Programme to Eliminate LF," which was developed by the LF research community. This grant is managed on behalf of GAELF by the LF Support Center in Atlanta, United States of America. Its goal is to ensure the ultimate success of the Global Programme to Eliminate Lymphatic Filariasis (GPELF) by finding solutions to the operational challenges and potential barriers it is facing. There are eight specific objectives that support three major goals: Goal I: Define programme end-points and determinants of success Objective I: identify best measure of impact on LF transmission Objective 2: identify key indicators of programme success Objective 3: identify most effective surveillance strategies Objective 4: assess potential impact of non-compliance
Goal II: Identify effective and cost-effective supplemental measures Objective 5: define optimal role and strategies for vector control Objective 6: assess effectiveness of increased drug dosage and frequency schedules for the current LF regimens Goal III: Develop innovative financing strategies Objective 7: carry out financial situation analysis for LF Ineglected tropical diseases (NTDs) in selected countries Objective 8: bridge gap between available international development funds and LF or NTD programmes in ministries of health. To accomplish the first of these objectives, a comprehensive and highly-standardized multicentre study will be carried out at sites in nine countries (representing the principal epidemiological differences in LF) to compare the effectiveness of eight available diagnostic tools in demonstrating the absence (or persistence) ofLF transmission after multiple rounds ofMDA (see Table 1). Two of these countries will be from the PacELF region (French Polynesia and Tuvalu). The result will be of particular importance and relevance to the Pac ELF countries, because it will guide the selection of tools and criteria for deciding when to stop MDA and how to carry out the necessary post-MDA surveillance. The LF community is extremely fortunate to have this means of carrying out operational research, essential for GPELF success, but the continued cooperation and input of the entire LF community will be necessary to take full advantage of this unique opportunity.
-7Table I: Tool-testin study design objective I). Counny Target # ofMDA Vector genus Filaria cycles Pop. Seh All Enny # iet ages child # # # mf og4c3 Bml4 # # urine
Bmr l
# QPCR: blood pools
# QPCR: Vector pools
French Polynes ia PICT-?
5 5 5 5
Aedes Aedes Anoph Anoph AnoDh Culex Culex Culex Ma nsonia
Wb M-b Wb
1001 1001 1001 1001 1001 1001 100( 100( 100(
35( 351 3541 3541 3541 3541 350 350 350
1350 1350 1350 0 135( 135C 135C 135C C
135( 135( 135( 135C 135C 135C 1350 1350 15~
1350 135( 135( C I35C 135C 1350 0 9450
135( 135( 135( 135C 135C 135C 1350 1350 1350 12 15~
a (
1350 1350 ( (
15( 15C 15C 15C 150 150
50( 50( 50C 50C 50( 25C 250 250 500 3750
Ghana ndonesia AJor) Nigeria Zanziba r Haiti !odia IMalays ia rrOTALS 2.3
C 135C C C
Bt Wb
4 5 6
C 135( 135C 135C 1350 8101
Wb Wb Wb Bm
1350 1350
Various
a a 1350 2700
ISO 150
5
ISO 1350
94541 12
Liverp oo l LF Suppor t Centre CLFSC) and GAEL F update
Lymphatic Fi lariasis This update was presen ted by Ms Joan Fahy, Progra m me Coordinator, activiti es of LFSC The m. Su pport Centre, Liverp ool School of Tropical Medici ne, United Kingdo riat of GAEL F secreta the is and the overlap of its work with that of GAEL F were presen ted. LFSC Secreta ry ofGAE LF. LFSC and Profess or David Molyn eux, Directo r ofLFS C, is the Execut ive Tanzan ia, as well as suppor t for provid es funds for MDA to Bangla desh, Burkin a Faso, Ghana and be channe led wherev er needs are operati onal research, evalua tion and morbid ity control , which can cy and fundrai sing initiati ves were advoca s LFSC' of identifi ed . The strateg y for and curren t positio n of the PacEL F region. Detai ls of needs the describ ed, with an assuran ce that there is an awaren ess of 2008, were provide d. April the GAEL F meetin g to be held in Arusha , Tanzan ia, from I to 3 2.4 Partnership in the Global Programme to Eliminate LF several notable events that had The GlaxoS mithKl ine (GSK) represe ntative provid ed an update on in 2006: occurr ed in the Global Progra mme since the last PacEL F meetin g Town, South Africa . A ll albend azole produc tion has been transfe rred from France to Cape implications for tablet India has adopte d the WHO- recomm ended two-dr ug therapy , with supply . r-Gene ral of WHO, Follow ing the untime ly and tragic death of Dr J.W. Lee, former Directo to address WHO the new Directo r-Gene ral, Dr Marga ret Chan, has firmly positio ned neglect ed disease s. critical challen ges The Bill and Melind a Gates Founda tion is fu nding GAEL F to address facing GPELF . with Preside nt Carter, The Preside nt of Pharma ceutical Operations GSK visited Nigeria GSK's commi tme nt to ed reaffirm and arters attende d the partner s meetin g in WHO Headqu global public health.
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There has been a change in the Global Comm unity Partner ships departm ent at GSK: Mr Andy Wright is now Directo r of coordin ated public health initiativ es. The GSK representative also presen ted an update on the compa ny ' s albend azole donatio n to the Global Progra mme, specify ing that 626 million treatments had been donate d to 44 countrIes as of the end of April 2007. Of this total, 16.3 million were donated to the progra mme In the Pacific, includi ng Papua New Guinea (see Figure 3). GSK reiterat ed the compa ny's commi tment to the Pacific progra mme, indicat ing that the supply of albend azole will continu e until regional elimina tion has been achiev ed. In addition, GSK will continu e to provid e financial assista nce to the PacEL F progra mme and the LF Suppor t Centre at James Cook Univer sity. Fi re 3: Albendazole shi ments to PacELF 1999-2007 • Island nations D PNG
"399
1000
1001
2002
2003
2004
2005
1006
2007
Operational Year
2.5
James Cook University LF Suppor t Centre
Dr Wayne Melros e, Director, WHO Collab orating Centre for Contro l of Lymphatic Filaria sis, James Cook Univer sity, Towns ville, Austra lia, outlined how the James Cook University LF Suppor t Centre suppor ts PacEL F and Mekon g Plus by providi ng technic al suppor t and training and by conduc ting operati onal, applied and basic research. Curren t activiti es are focusing on Papua New Guinea , Tuvalu and Timor-Leste. The major source of operational fundin g is GSK. The main constra ints facing the Centre involve person nel and funding. 2.6 Curren t challen ges facing the Pacific Progra mme to Elimin ate LF (pacEL F)
Dr Capuan o, the newly appoin ted coordi nator of PacELF, describ ed the main challen ges facing Pacific island countri es as they move toward s the elimination of LF. An in-depth review of the curren t epidem iologic al situation in each PIC, carried out in Octobe r 2006, acknow ledged the progre ss made and identified a numbe r of issues in relation to progra mme implementation: dispari ties in (1) MDA distribution strategies; (2) treatme nt regimens; (3) method s of reporting covera ge; (4) compli ance; (5) collection of data; (6) implem entatio n of morbid ity control ; (7) plans for stoppin g MDA; and (8) plans for continu ed surveil lance. The review focused particularly on: (I) obtaini ng data on the current LF situations in all of the Pacific countri es and areas by early 2008 ; (2) develo ping and implem enting a surveillance plan for the PICs; and (3) develo ping and implem enting a morbid ity-con trol strateg y. In this exercis e, Papua New Guinea was conside red separately from the other PICs in view of its high infection rates and its limited progres s in implementing a national elimina tion progra mme until recently, due to econom ic, political and technic al problems. A worksh op was conducted in April 2007 in Port Moresb y to review
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the situation in Papua New Guinea and come up with a revised strategy for elimination for the period from 2007 to 2020 . The revised strategy is now in place. A summary of this strategy and future plans for Papua New Guinea are reported under item 2. 7 of this report by Mr Leo Makita, the LF Programme Manager for Papua New Guinea. In summing up the challenges facing Papua New Guinea and the other Pacific island countries and areas, Dr Capuano suggested and recommended that the way forward for the next five years towards successfu l implementation of LF elimination would require: strong technical and financial support to all PICs for the development of survey protocols, data analysis and report writing; and development of surveillance plans for all countries, followed by their implementation. Dr Capuano indicated that programme managers should discuss and agree on these new plans of action . She said that financial sustainability and political commitment at the national level are critical to achieve PacELF's goals. 2.7 Update on the Papua New Guinea ELF programme
The Papua New Guinea ELF update was presented by Mr Leo Makita, the national LF Programme Manager. Filariasis is highly prevalent in Papua New Guinea (see Figure 4), with local prevalence of microfilaria antigen ranging from 10%-98%. It is estimated that more than I million people are infected, with another 3 million people at risk of infection . In a population of 5.8 million people, this risk is very high for the whole country.
.'
Figure 4: Distribution ofLF in Papua New Guinea
. L~hatic filariasis _ EndemiC
o
No d_I_yet
. . None..end erric
.
•
'
..... . ,
... . ', - -
.
......... ,. ....
The programme for the elimination of LF was initiated in Papua New Gui nea with SUppOlt from the PacELF office in Fiji in 2004. After the preparatory phase in 2004, the first round of MDA was conducted in Milne Bay province in 2005. In 2006, the second round ofMDA was conducted in Milne Bay province and another five provinces conducted their first MDA. Baseline surveys for the
- 10provinces prior to MDA showed ICT-positivity rates ranging from 15% to 40%. The plan is to add several more provinces to the programme each year until the whole country is covered. There are 20 provinces in the country and each province is an implementation unit. To date, coverage has been variable in the implementation units conduc ting MDA, varying depend ing on the resources available. In its initial plan, Papua ew Guinea opted for door-to-door delivery of the drugs for MDA using the existing health infrastructure. However, MDA implementation has taken a very long time due to use of this method by the health service in each village. After the first National Meeting, conducted in April 2007, the origina l implementation plan for 2004-2012 was revised to reflect global strategies and the constraints being faced by the programme. The revised strategic plan for 2007-2020 addresses MDA, monitoring and evaluation and disabilitycontrol issues, and includes strategies for implementation. The new plan also considers alternatives to MDA, such as DEC-fortified salt or tinned fish to address the logistic al problems of drug delivery. The programme in Papua New Guinea is currently facing many challen ges that may affect its continuation. These challenges include: a lack of human resource capacity at the national level ; a lack of sustainable funding support for the programme; a need to find alternative strategies for delivery of drugs; the fact that filariasis elimination is not a national priority; and insufficient funding for activities. The issues that need to be addressed urgently include: investigation of sustainable funding sources (donor agencies, develo pment banks, etc.); investigation of possible alternative intervention methods (DEC-fortifie d saltJtinned fish); investigation of alternative methods of drug delivery (mobilizing commu nities, church groups, NGOs, etc.); lobbying for the prioritization of the LF programme and inclusion of a recurrent budget line for the programme in the government budget; review of the areas that were indicated as being non-endemic in the initial mapping exercise; survey and registration of persons living with disabilities; and communication and education (very important for good coverage). 2.8 Morbidity control in the Pacific: Key elements to be incorporated into national plans
Dr Ottensen discussed the key elements of morbidity control. The goal of the Global Programme is to prevent LF disability- first, by preventing acquisition of infection (through MDAs) and second , by preventing disabilities in those already infected from getting worse.
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Figure 5: Disability-prevention activities
'; 'I
--The new, simple approaches to managing LF disability are based on solid clinical science. Since the major cause of progression of lymphoedema to elephantiasis is recurrent inflammation, careful attention to hygiene and local limb care (elevation, washing, etc.) is an effective clinica l strategy to reduce the progression of the disease (see Figure 6). For hydrocoeles, the principal treatment approach is surgery, which is simple, quick and effective. Figure 6: Report of acute attacks in lymphoedema sufferers after introduction offoot care in Madagascar.
" ,----------------------------------------------------------, 4'.6%
" SIStIne 11"65 Month 1
,""
Month 2 n-65
Montll 3
Home vi'it.
,--,
Month 4
,
.,
Since much progress has already been made in decreasing the transmission of LF, attention must now be turned to creating or strengthening morbidity management in national programmes. The key elements in establishing morbidity components are to: identifY and contact affected LF patients; develop a sustainable care/support system, including the training of patients, families , health workers, nurses and doctors; enable patients to manage lymphoedema themselves; increase access to safe, affordable hydrocelectomy; provide LF patients with psychosocial support and motivation; and improve the socioeconomic inclusion of LF patients. Fortunately, WHO has prepared excellent documents and supportive materials to assist in establishing these programmes, and it is very feasible for morbidity management to become a key goal for all national PacELF programmes during the next two years of programme activity.
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2.9
Draft live-year surveillance plan for the Pacilic
Dr Clare Huppatz was recru ited as a WHO consultant from 8 to 23 June 2007 to develop and finalize a draft LF Su rve illance Strategy for the Pacilic, which she presented . By the end of2007, several Pacilic island countries will be in the Iinal stages of their LF elimination programmes. There is an urge nt need to offer them advice about surveillance to ensure that interruption of transmission has occurred and is maintained in all areas. No other region in the world has commenced widespread ongoing surveillance for LF . As a result, there are no existing strategies on which to base a Pacilic surveillance programme. The task of developing a Pacilic survei llance strategy began with a consu ltation process. Opinions from recognized LF experts were sought and collected regarding issues of diagnostics, treatment, sampling, re introduction, c linical surveillance, vector behaviour and control. This information was used to write a preliminary draft surveillance strategy. During the consultation process it was determined that there are some issues surround ing LF surveillance for which no evidence exists, making precise recommendations problematic. In order to gain a detailed overview of the Pacilic LF e limination activities completed thus far, a comprehensive review of data from all Pacilic island countries and areas was performed. Where possib le, an attempt was made to gauge the progress, or otherwise, of each country ' s participation in the LF elimination programme to date. Analysis of these data was used to infonn the surveillance strategy. An in-depth discussion fo ll owed with Dr Capuano and other members of the WHO/SP LF Elimination Programme team . Each country' s situation was reviewed in detail and the information was used to furt her modify the draft survei llance strategy. The proposed strategy uses a primary surveillance strategy, called the Child Transmission Survey (CTS). This is a modilication of the previ ous 0 Survey. Built into this new strategy is a mechanism for detecting and eliminating the source of transmission within the community. In addition, the recommended survei lIance algorithms require repeated conlirmation over several years that transmission has been interrupted, so that a country can be sure that transmission has stopped permanently. Two add itional strategies are recommended. The Iirst of these, termed a ' Hot SPOt' Survey,was designed to augment the CTS and expand the sampling of children in areas that are thought to be of high prevalence within the country. Another strategy, termed Border Detection, is recommended as a tria l in some countries to detennine the risk of reintroduction that is posed by migrants and retuming nationals that missed the MDAs . The draft surveillance plan was presented at the PacCA RE meeting on 19 June, 2007, and the group discussed various aspects of the plan. It was decided that a trial of the draft surveillance strategy should occur in one or two countries. During the LF Programme Managers Meeting, the draft survei llance strategy was outlined to the LF Managers as a group, and the details were discussed with those countries that are nearing completion of their elimination programme. Several countries are facing important decision points in their LF elimination programmes. Ongoing surveillance is required to ensure that the s ignilicant ga ins achieved by each country to date are not lost. While severa l issues regarding ongoi ng surveillance for unanswered questions remain, it is important that the Pacilic is land countries and areas do not lose momentum as they near their goa l. The LF Managers for Vanuatu, Tonga and Ni ue have agreed to trial various aspects of the draft LF surveillance strategy during the next two years. It is recommended that a trial of the CTS and ' Hot Spot' surveillance strategies occur in Vanuatu between November 2007 and May 2008, and that Niue commence a trial of the Border Detection strategy.
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2. I 0 Review and recommendations from PacCARE Dr Ottesen, presented the outcomes of the PacCARE meeting, held on 19 June 2007. PacCARE examined, country by country, the status, problems and plans for all 22 Pac ELF countries following the October 2006 review, and identified gaps in the group's understanding of the current situation at the country level. It was decided to take advantage of the programme managers' presence during the LF Managers Meeting to clarify issues and identify opportunities for support. PacCARE debated the draft protocol for LF surveillance in the Pacific . The group focused special attention on the challenges and opportunities for Papua New Guinea. The current and past financial situation of PacELF and the projected costs for 2008-2020 were discussed (see Figure 3). The group agreed on: the need to ensure resources for post-MDA surveillance in the Pacific; and the need to take advantage of international development fund opportunities, especially for the challenges of Papua New Guinea. The group reaffmned its commitment to providing technical and resource support to all PacELF countries. Figure 7: Budget gaps 2008-2020 16,000,000
14,000,000
12.000,000
1'0,000,000
"
on
c
_ 8,000,000
PNGBudget Total Budget
E:J Other PIC
6,000.000
4,000,000
2.000,000
o 2008 2009 2010 2011 2012 2013 2014 Year 2015 2016 2017 2018 2019 2020
2.11
Group work
The meeting participants were split into four groups, countries being grouped according to the current stage of dleir LF elimination programmes, as follows : Group I: Papua New Guinea Group 2 (Child Transmission Surveys): Niue, Tonga, Vanuatu Group 3 (C Surveys): Fiji, French Polynesia, Kiribati, Tuvalu Group 4 (Repeat C Surveys): Cook Islands, SanlOa
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The country participants first met without facilitators to freely raise and discuss their concerns . The facilitators then joined the groups and each country participant was requested to prepare a pragmatic, achievable and realistic two-year plan of action (see Table 2 for a summary). The following material was provided to assist each group: A list of points for discussion, relevant to each group. A summary of activities to be reviewed, and mod ified/completed if necessary. Budget estimates up to 2020 for the PICs. A folder containing all documents currently available at the WHO/SP Office for each country. Each participant was requested to review the content of his/ her country file and to inform the secretariat about any document available at country level not contained in the WHO/SP folders . A PowerPoint presentation template to report the final two-year plan in a standardized format. Table 2: SummaI}'of2008-2009 workplans Country Cook Islands
2008 • • • • D survey Surveillance Analysis of C survey Development of recommendations for future action
2009 • Verification • Dependent on results of C survey
Fiji
French Polynesia
• • •
C survey Possible D survey Training for morbidity control Following results of2007 C survey, either CTS or MDA integrated with deworrning (April) Continue morbidity progranlme Implement system for border detection Deoendent on results of2007 C survey Morbidity survey (Jan) Dependent on results of2007 C survey CTS " hot spot" survey Follow-up and treatment of ICT positives Data entry and analysis MDA in each oflhe four province groups B survey in Group 2
Kiribati
• • •
• Dependent on results ofC survey, but may include MDA, targeted MDA, or surveillance • Follow UD morbidity control • Second C survey if M DA in 2008 • Morbidity programme. • Continue border detection • Surveillance plan • Repeat CTS • Follow up treatment of ICT positives • Consider border surveillance.
Niue Samoa Tonga Tuvalu Vanuatu
• • • • • • • •
Papua New Guinea
• MDA in each of the four province groups • B survey in Gro up 3 • C survey in Group I
- 15 -
2.12 Presentation of two-year plans of action and budget estimates by PICs Cook Islands (presented by Mr Charlie Ave, Two-year plan : 2007Carry out C survey, follow up and treat ICT-positives. 2008Carry out D survey and continue LF surveillance. 2009Prepare for verification. Discussion: Dr Capuano asked for more information about the surveillance plan and the follow up of positive individuals. Mr Ave explained that a first treatment will be given on the spot when an individual is identified as positive . An updated record will be kept for follow up and further treatment every six months. Fiji (presented by Dr Mike Kama, Acting Senior Medical Officer, Fiji Center for Communicable Disease Control , Ministry of Health) Three-year plan A (Additional MDA): 2007 Conduct sixth MDA with vector control, social mobilization and morbidity control. Recruit and train a Programme Coordinator. Hire consultants to (I) conduct a review of the present national ELF plan and determine the resource costs required for effective MDA and (2) develop a COMBI plan and provide technical assistance for its implementation. Implement the consultant' s recommendations. Carry out analysis and documentation for sixth MDA. Conduct seventh MDA with vector control, social mobilization and morbidity control. Carry out C survey with vector control and morbidity control. Continue LF surveillance. ational Filariasis Coordinator)
2008
2009
Three -year plan B (C survey): 2007 2008 Carry out C survey (stratified cluster sampling). Conduct analysis ofC survey. Make decision on next set of actions and plan for maintenance of elimination status (additional MDAs and/or LF surveillance). Conduct additional MDA.
,009
Discussion: Dr Kama expressed a preference for plan A (COMBI followed by additional MDA). ProfC.P. Ramachandran cited the 11.4% ICT prevalence found by the latest B survey at sentinel sites (2005) and expressed concern that a C survey (plan B) would not be helpful in deciding whether or not to conduct additiona l MDA. He also expressed concern regarding Fiji's lack ofa Programme Coordinator. He pointed out that clinical data from the MDAs, such as records of adverse reactions to the drugs, appear to be missing, and emphasized that reported coverage and actual coverage need to be well defined . Finally, he asked for clarification of the plan for distribution in urban centres. Dr
- 16 -
Koroivueta, Medical Superintendent, TamavualTwomey Hospital, Fiji, explained that, in towns, the teams wou ld go door to door and set up booths at public events. He acknowledged that these methods are not very effective and identified problems with the transportation of nurses in urban areas. Dr Koroivueta said that the immediate plan is to write officially to the Ministry of Health to recommend additional MDA. He asked WHO for support on this. French Polynesia (presented by Ms Laurence Renou) Two-year plan: 2007 2008 Conduct eighth MDA (completed) and morbidity control (update data on LF cases). Carry out C survey (stratified cluster sampling) and training for morbidity control. If lCT prevalence < I % throughout all C survey sites, carry out D survey. Conduct ninth MDA (national or targeted, based on C survey results) using the door-to-door strategy, with proper eva luation of coverage. If a D survey is conducted in 2008 , continue LF surveillance. Conduct morbidity control (follow up of LF cases).
2009
Discussion: Dr Bradley, GSK, clarified that an estimated 20% of the infected population were covered by door-to-door delivery during the 2007 MDA in French Polynesia, and that this percentage was not an intended target as such. Dr Capuano noted that this was actually an excellent outcome. She visited French Polynesia only six weeks prior to the commencement of the 2007 MDA and made the recommendation for pilot testing of door-to-door and directly observed treatment strategies. To have covered 20% of the treated population via door-to-door delivery is very encouraging considering the short notice and the initial resistance to the recommendation. Niue (presented by Mr Manila Nosa) Two-year plan: 2007 2008 2009 Conduct a C survey (whole popu lation), plan for border detection. Implement a system for border detection. Continue border detection, implement surveillance plan.
LF surveillance-DIan decision tree C Survey Date planned: Nov 2007 decision
Border Surveillance
r
Yes How: testing immigrants
Control Measures Consider: Targeted MDA Treatment I follow up of teT
I
2: 1%
/'
I
I
<1%
...
I
cases
pas_
Surveillance
- 17 -
Discussion Dr Biswas suggested that it may not be necessary to repeat a C survey as one was already carried out in 2004, and Dr Ramachandran suggested focusing only on children. Dr Bradley raised a question regarding possible ongoing surveillance and how to implement it. Dr Capuano proposed further discussion of the case of Niue during the upcoming PacCare meeting.
Papua New Guinea (presented by Mr Leo Makita) Activities in 2007: I. Conduct MDA in six provinces: Milne Bay Province, Bougainville, New Ireland Province, East ew Britain Province, West ew Britain Province and Oro. Carry out a coverage survey in the above six provinces. Conduct a mid-term assessment for Milne Bay Province (conducted first MDA in 2005).
2. 3.
4. Carry out a baseline survey for the five new provinces. 5. Liaison with church groups: coordinate the inclusion of the five new provinces for 2008 MDA; and discuss the feasibility of joint action to secure the continuity of MDA in the current six provinces (listed above). 6. Consider MDA altcrnatives (DEC sa lt or DEC fish) : hire a consultant to conduct a situation analysis of the feasibility, plan, negotiation, etc. Fol low up on the budget line with the Government. Ensure all activit ies are included in the annual plan of the Department of Hea lth; coordinate with the Planning and Monitoring Unit of the Department of Health.
7. 8.
9. Carry out a re-mapping survey to clarify LF prevalence in the three provinces classified as " uncertain') .
I O. Implement disability control and patient registration . Activities in 2008: I. Conduct MDA in six current provinces and five additional provinces. 2. Carry out coverage surveys in six current and five additional provinces.
3. Decide on MDA vs. an alternate strategy (e.g. DEC salt) and plan accordingly. 4. Conduct a mid-term assessment for five provinces (Bougainville, NIP, EBP, WBP and Oro) 5. Plan according to pending confirmation of three uncertain provinces : If positive, include above under # I; and if negative, maintain LF survei llance (based on plan to be developed).
- 18 -
6.
Implement disability control: home based self-care, surgery.
Current timeline for MDA implementation by province:
Group and name of provinces
Group 1
MBP
Group 2 (5 provinces)
Discussion: Dr Biswas emphasized the importance and resource-demanding nature of the Papua New Guinea programme and suggested linking with other programmes to take advantage of existing logistics. Mr Makita indicated that this possibility has been the subject of continuing discussion. He mentioned possible coordination with World Vision deworming efforts. He also suggested mobilizing churches, which reach all communities, to assist in drug delivery. He said that there are no NGOs that would reach enough people. Dr Ramachandran pointed out the importance of securing resources to complete additional rounds of MDA in those provinces that have already begun MDA, so that gains that have been made will not be lost. Mr Makita acknowledged the importance of this task and said that MDA will begin in new provinces only when resources are sufficient to continue MDA in the current six provinces. Therefore, the addition of new provinces may have to be moved back several years pending immediate efforts to secure resources. Dr Ottesen requested clarification on the targeted population figures. Mr Makita explained that 1.5 million people are targeted for MDA in 2007. If five provinces are added in 2008, it is expected that 3.5 million would be covered that year. Reaching the 3.5 million population by 2008 would require US$ 3.7 million over the two years. Samoa (presented by Ms lokapeta Mailei, Senior Vector Control Officer, Ministry of Health) Two-year plan: 2007 Carry out a C survey (stratified cluster sampling) with an integrated morbidity survey. Conduct targeted MDA for men *. If necessary, conduct additional targeted MDA, followed by a third C survey in targeted areas.
2008
- 19-
2009
Carry out a 0 survey.
* The planned 2007 targeted MDA was removed on the advice of Dr Biswas, as described in the discussion below. Discussion: Dr Biswas raised a concern regarding the trend lines in the data. He pointed out that the data cannot be compared and that this was also an issue in previous meetings. Dr Biswas asked why MDA targeted at men was planned if the ICT prevalence from the 2007 C survey were found to be less than 1%. Ms Maiava explained that the Ministry of Health planned to conduct the targeted MDA simultaneously with the second C survey, since the previous C survey had shown a high prevalence among adult males. Dr Biswas suggested conducting the targeted MDA after the second C survey, so that the most recent survey results could be used to accurately identifY priority areas where intervention is needed. In response to a question from Mr Ave regarding morbidity, Ms Maiava said that, at the moment, Samoa does not have complete data on morbidity. A need for a morbidity register was identified. Dr Melrose brought up the issue of conducting a survey for hydroceles, which is prone to underreporting. Dr Capuano suggested a strong awareness campaign to promote the surgical treatment of hydroceles through success stories and a focus on the simplicity ofthe procedure, to encourage affected males to actively seek care from the health system. Dr Ottesen noted that, in the Dominican Republic, treatment awareness led to better reporting of hydroceles. Dr Bradley cautioned that the health system must be prepared, with trained surgeons and a budget, before offering and promoting treatment. Dr Koroivueta mentioned that the Pacific Leprosy Foundation recently made a commitment to assist with morbidity control and management. He suggested a possible system for sending LF cases from the PICs to Fiji for treatment; the Foundation would pay for airfares and accommodation. He was unsure how much such support the Foundation could provide. but Dr Capuano indicated that she had been in contact with the Foundation and that they are interested in helping. Dr Ehrenberg said that the extent of the morbidity control task will have to be evaluated in order to know how much support will be necessary prior to setting up a new system.
Kiribati (presented by Ms Teiti Bwenawa, Principal Nursing Officer, Filariasis Programme) Two-year plan: 2007 2008 Carry out a C survey (stratified cluster sampling), implement a morbidity control programme. If ICT prevalence <I % in all C survey sites, carry out CTS. If ICT prevalence:;.: I % in certain areas, conduct targeted MDA integrated with deworming. Continue the morbidity control programme.
2009
IfMDA is conducted in 2008, carry out a second C survey. Continue the morbidity control programme.
Discussion: Mr Ave brought up the issue of data analysis, noting that it poses problems for most LF managers. Dr Capuano reiterated WHO's commitment to providing technical support to country programmes based on the needs identified during the meeting. She said that WHO will continue to
- 20-
keep in touch with programme managers after the meeting to discuss what specific assistance can be provided. Ms Maiava said that data management tends to be difficult and is a weakness in many country programmes. She requested that training in data management be arranged, possibly during the annual PacELF workshop, so that representatives from each country can be updated on this aspect of the programme. Dr Melrose indicated that the LF Support Centre in Townsville, Australia, could help with data management, but requests for such help would have to come through Dr Capuano. Tonga (presented by Dr Louise Fonua Senior Medical Officer in charge of Communicable Diseases, Ministry of Health) Two-year plan: 2007 Finalize and report the results ofCTS. Plan for a morbidity survey (possible need for WHO assistance). Conduct a morbidity survey, input and analyse data, plan for follow up (e.g. train nurses and community health care workers). Carry out a second CTS, follow up and treat lCT -positives.
2008
2009
LF surveillance-plan decision tree: D survey I CTS Date: May-June 2007 Outcome: awaiting Ab testing ~
CTS Method
1<01%1
-+
Control Measures Consider: Targeted MDA Treatment J follow up of leT posttive cases
Primary school
-.: +i~0.1%: CTS Expected date: 2009
~ decisions ~
"Hotspot" Surveys None
I<0.1% I ~ Continued Surveillance
" "
---.
Border Surveillance None
II
Discussion: Dr Biswas noted that, during the 2006 C survey, one of the clusters was found to have a high prevalence and he request~d clarification on the follow-up activities. Dr Fonua indicated that everyone III the area was treated dunng the MDA and that, during the D survey, all previously positives were fe-tested. All were then found to be negatives.
- 21 -
Dr Bradley mentioned that positive test sera are available to help clear up doubts regarding the validity of leT results. Mr Ave asked Dr Capuano if an Excel template is available to analyse data from a 0 survey. Dr Capuano explained that the existing template for C survey data is not applicable to 0 surveys but mentioned that WHO/SP can provide support to countries that need help in data analysis. Dr Ramachandran inquired about what would be done if all of the antibody tests submitted during the 0 survey were found to be negative. Dr Melrose said that the exact significance of antibody testing is not yet known, but he remains optimistic that completing the tests on samples from Tonga can yield information to determine whether programmatic decisions can be made based on the test. Dr Fonua indicated that Tonga would plan to conduct a CTS in 2009 to continue surveillance.
Tuvalu (presented by Ms Falealili Feagai, Senior Environmental Health Officer, Princes Margaret Hospital) Planned 2007 activities: I. Carry out a C survey (whole population) using ICT and Mf, with technical assistance from JCUlmplement immediate treatment of ICT-positives. Make a decision on future MOA based upon results of survey (will need the assistance of PacELF).
3.
Discussion Dr Melrose clarified that the budget indicated was given in local currency, not United States dollars. When asked about the capacity to conduct Mftesting in Tuvalu, Ms Feagai confirmed that there is a laboratory technician in Tuvalu who can read Mf slides. In addition, Dr Melrose said that a laboratory technician from leU will be in Tuvalu to assist with the Mf slides. Prof Ramachandran noted that a mid-term survey showed leT prevalence rates as high as 17% in certain areas. Dr Melrose said that, at the time of that survey, problems with the ICT tests led to numerous false positives, therefore the mid-term survey results are not reliable. He emphasized the importance of the 2007 survey in light of this lack of reliable data.
Vanuatu (presented by Ms Fasihah Taleo, National Filariasis Coordinator) Two-year plan: 2007 Carry out CTS (community method) and Hot Spot surveys. Update the morbidity register. follow up lind treat leT-positives. Conduct data entry and analysis of CTS. Consider border surveillance.
2008
2009
LF surveillance-plan decision tree:
- 22-
CTS Date planned: Sept 2007 - 2008 1 decision
.....
CTS Method Community
Control Measures Consider: Targeted MDA Treatment I follow up of ICT pos~ive cases
"0.1%
J
V
~ Ongoing Surveillance
"Hotspot" Surveys
r-----
names: 1. NorthemAmbrym 2.Southem Pentecost
S~e
Border Surveillance ~ Not yet (consider after CTS)
Discussion: Ms Taleo confirmed that no clusters were found to have ICT prevalence above 1% during the 2005 C survey. Dr Melrose commended the success of the Vanuatu programme, which did tremendous work with little outside support. He said that this success deserves global attention. Dr Melrose also identified a possible need to set up a reference laboratory in the Pacific to handle any additional antibody testing, since his laboratory may not be able to cope with the increased load. 2.13 Closing ceremony The Chairperson thanked participants for their contributions and acknowledged the practical and useful outcomes of a very successful meeting. He then passed the floor to Dr Capuano for her closing remarks. Dr Capuano thanked the country participants, the Chairperson and all the other participants. There is now a clear vision, and pragmatic plans of action have been developed for at least the next two years. At the next LF managers meeting in 2008, the country participants will be requested to report on the plans of action and estimated budgets they have developed. The objective of this meeting was to focus on the endemic countries as they had burning questions and issues that needed clear and specific answers. However, the non-endemic and 'partially-endemic' countries were not forgotten. During the PacCARE meeting on Tuesday 19 June 2007, recommendations were made for them as well. WHO is committed to continuing to provide technical support to countries and discussions will continue after the meeting with each individual country to review needs and identity ways to address them. Dr Ehrenberg thanked all the participants for their active participation and acknowledged the financial support received from the Government of Japan over the past few years. He congratulated Dr Capuano and her team for a well-managed and very successful workshop and for the open spirit that prevailed during this meeting. He remarked that, despite a very tight agenda, the outcomes are excellent and he expressed confidence that much can be achieved in the next few years. Integration of LF with other NTD should also be kept in mind and further developed whenever possible. Dr Ehrenberg officially closed the meeting.
II II II
ANNEX I
NINTH WORKSHOP FOR PACIFIC LYMPHATIC FILARIASIS PROGRAMME MANAGERS Nadi, Fiji 20-21 June 2007
WPRlPIC/CPC/ 1.2/00 I/MVP(2)/2007.1 A 14 June 2007
ENGLISH ONLY
PROVISIONAL AGENDA
I. 2. 3. 4.
Opening ceremony Recent Gates Foundation Grant to the Global Alliance Global programme to eliminate lymphatic filariasis Liverpool School Lymphatic Filariasis Support Center/Global Alliance to Eliminate Lymphatic Filariasis (GAELF) Partnership in the global programme to eliminate lymphatic filariasis: Focus on the Pacific James Cook University Lymphatic Filariasis Support Center Current challenges of the Pacific programme to eliminate lymphatic filariasis Update on the Papua New Guinea's programme to eliminate lymphatic filariasis Draft five-year surveillance plan for the Pacific Morbidity control in the Pacific: key elements to be incorporated into national plans Review and recommendations from PacELF* Programme Coordinating and Review Group (PacCARE) Guidelines for preparing the national five-year plans of action Presentation on group work and objectives Country presentations: five-year plan ofaction and budget estimates Piscussions Closing ceremony
5. 6. 7. 8. 9. 10. 11.
12. 13. 14.
15. 16.
ANNEX 2
LIST OF P ARTICIPANTS
1. PARTICIPANTS
AMERICAN SAMOA
Dr Tagilima I'AtaIa Chief of Paediatrics Department of Health American Samoa Government Pago Pago AS 967991 Tel No.: 684-633-1222: Fax No: 684-633-\869 E-mail: tagiilimafiatala@yahoo.com
FIJI
Dr Mike Kama Acting Senior Medical Officer Fiji Center for Communicable Disease Control Ministry of Health Tamavua Suva Tel. No.: 9409733 E-mail: mikekanner(wyahoo.co.lIk
FRENCH POLYNESIA
Ms Laurence Veronique Renou Assistante technique en evaluation des programmes pour la surveillance des maladies transmissibles Direction de la Sante BP 61. rue des Poilus Tahitiens 98713 Papeete, Tahiti Polynesie Franyaise Tel. No.: (689) 20 54 17/ (689) 48 8222 Fax No.: (689) 488224 E-mail: laurence.renourWsante.gov.pf
l\lRmAn
Ms Teiti BwenaWI\ P.rincipal Nursing Officer Filariasis Programme Ministry of Health and Medical Services P.O. Box 268, Nawerewere Tarawa Tel: No 686 28317
NIUE
Mr Manila Nosa Chief Public Health Officer Niue Health Department P.O. Box 33 Alofi Tel. No.: (683) 4100; Fax No.: (683) 4265 E-mail: mnosalmmail.gov.nu
PAPUA NEW GUINEA
Ms Nonna Sagom National Coordinator, Elimination of Lymphatic Filariasis Program Department of Health Disease Control Branch P.O. Box 807 Waigani Tel. No.: (675) 3013975/3013709; Fax: (675)3250568 E-mail: nonna.sagom@health.gov.pg
SAMOA
Ms lokapeta Setu Mailei Senior Vector Control Officer Ministry of Health Private Box., Apia Tel. No.: (685) 21212 Ext. 367; Fax No.: (685)21106 E-mail: siatual@health.gov.ws
TONGA
Dr Louise Fonua Senior Medical Officer in charge of Communicable Diseases Ministry of Health P.O. Box 59 Nuku'alofa Tel. No. (676) 23-200; Fax: (676) 24 291
TUVALU
Ms Falealili Feagai Senior Environmental Health Officer Princes Margaret Hospital Ministry of Health Funafuti Tel No. 688-20480; Fax: 688-20832 E-mail:
VANUATU
Mrs Fasihah Taleo National Filariasis Coordinator Ministry of Health PMB009 Port Vila Tel. No .. : (678)25171/22512; Fax: (678)25438 E-mail: ftaleorWvanuatu.gov.vu
2. TEMPORARY ADVISERS
PacCARE members:
Dr Charlie Ave Senior Health Inspector National Filariasis Coordinator Public Health Department P.O. Box \09, Tupapa Rarotonga Cook Islands Tel. No.: (682)29110 E-mail: c.ave@health.gov.ck
Fax:
(682)29100
Dr Kennar Briand Director of Public Health Department of Health POBox 16 Majuro 96960 Marshall Islands Tel: (692) 625 3355; Fax (692) 6253432 Email: briandk@ntamar.net Dr Josefa Koroivueta Medical Superintendent TamavualTwomey Hospital Ministry of Health Dinem House Army Street, Toorak Suva Fiji Tel. No.: (679) 3321066; Fax: (679) 3321559 E-mail: joekv@connect.com.fj Mr Leo Sora Makita Principal Aqvisor Malaria &. Vect()r ~ome Disease~ Department of Health P.O. Box 807 Waigani, N.C.D. Papua New Guinea Tel. No. (675) 301 3972; Fax: (675) 3253523 E-mail: makitals@global.net.pg
Dr Wayne Melrose Director WHO Collaborating Centre for Control of Lymphatic Filariasis James Cook University Townsville, Queensland 4811 Australia TeI.No.61747816175; Fax: No: 61747815254 wayne.melroseia)jcu.edu.au; wayne.melrose@optusnet.com.au
Dr Jean-Fran,.ois Yvon Pharmacien Biologiste Laboratoire de Biologie Medicale / Hopital de Sia Agence de Sante des lies Wallis & Futuna BP 4G Mata'Utu 98600 Uvea Wallis & Futuna Tet/Fax No. : (681) 7211 80; (681) 722324 E-mail: jf-yvon@adswf.org Dr Eric Ottesen Director, Lymphatic Filariasis Support Center Department of International Health Rollins School of Public Health Emory University 1518 Clifton Road, NE, Atlanta Georgia 30322, United States of America Tel. No.: (404) 712 9263; Fax: (404) 727 5530 E-mail: eottese@sph.emory.e
OTHERS:
Prof David Durrheim Director Health Protection Hunter New England Population Health and Professor of Public Health University of Newcastle Hunter New England Area Health Service Locked Bag 10, Wallsend NSW2287 Australia Tel. No.: 61-2-69246267; Fax No.: 61-2-69246048 E-mail: david.durrheim@hnehealth.nsw.gov.au
Dr Patrick Lammie Chief Immunobiology Section lmmunobiology Branch DPDINCID,Mailstop F-13, 4770 Buford Highway, NE Atlanta, GA 30341-3724 United St, USA. Tel: (I) 770-488-4054, Fax (I) 770-488-4108, E-mail: pjll@cdc.gov Professor Dato (Dr) c.P. Ramachandran 8A-4-4, Belvedere, lalan 1-63 Off Jalan Tunku, Bukit Tunku 50480 Kuala Lumpur Malaysia Tel. No : +603 298 6152; Fax ITO: +6032986152 E-mail: ramacprWhotmail.com Ms Clare Huppatz Hunter New England Population Health Locked Bag 10 Wallsend NSW 2287 Tel No.: 61- (0)2-4924 6353; Fax No.:61-(0)2-4924 6215 E-mail: Clare.Huppatz@hnehealth.nsw.gov.au
3. REPRESENTATIVESfOBSERVERS
GLAXOSMITHKLINE
Dr Mark Bradley Lymphatic Filariasis Programme Global Community Partnerships Corporate Communications GlaxoSmithKline GSK House, 980 Great West Road Brentford Middlesex, TW8 9GS United Kingdom Tel. no. : +44 208 0475521; Fax no. :+44 208 047 0684
LIVERPOOL SCHOOL OF TROPICAL MEDICINE
MsJoan Fahy Programme Coordinator Lymphatic Filariasis Support Centre Liverpool School of Tropical Medicinil Pilmbrpke Placlt kiverpool. p 5QA United Kingdom Tel. No.: 44 (0) 151 705; 3145 Fax No.: 44 (0) lSI 7090354 E-mail: fahy@liverpool.ac.uk
4. SECRETARIAT
WHO Headquarters
Dr Gautam Biswas Medical Officer Lymphatic Filariasis Elimination (CDS/CPElCEE) Strategy Development and Monitoring for Eradication and Elimination World Health Organization CH-1211 Geneva 27 Switzerland Tel. no.: +4122 7913850; Fax no.: +4122 7914777 E-mail: biswasg@who.int
WHO Western Pacific Regional Office
Dr John Ehrenberg (Responsible Officer) Regional Adviser in Malaria, Other Vectorborne and Parasitic Diseases World Health Organization Regional Office for the Western Pacific United Nations A venue P.O. Box 2932 1000 Manila Philippines Tel. No.: (632) 528 9725; Fax No.: (632) 521 1036 E-mail: ehrenbergj@wpro.who.int Dr Corinne Capuano Team Leader Pacific Programme to Eliminate Lymphatic Filariasis (Pac ELF) Office of the WHO Representative in the South Pacific P.O. Box 113 Suva Fiji Tel. No.:(679) 3304600; Fax No.: (679) 3300462 E-mail: capuanoc((vtij.wpro.who.int Dr Le Anh Tuan Technical Officer, Malaria, Other Vectorborne and Parasitic Diseases World Health Organization Regional Office for the Western Pacific lJl1i~Q Nations Avenue P.O. Box 2932 1000 Manila Philippines Tel. No.: (632) 528 9754; Fax No.: (632) 521 1036 E-mail: tuanl@wpro.who.int
Dr Zhang Zaixing Malaria Scientist Office of the WHO Representative in Papua New Guinea Port Moresby Papua New Guinea Tel: (675) 325-7827; Fax: (675) 325-0568 E-mail: loud@png.wpro.who.int
PacELF OffICe
Ms Emma Gibbons Secretary Pacific Programme to Eliminate Lymphatic Filariasis (PacELF) Office of the WHO Representative in the South Pacific P.O. Box 113 Suva Fiji Tel. No.: (679) 3 304 600; Fax No.: (679) 3 300 462 E-mail: gibbonse@fij.wpro.who.int
Ms Maca Colata Pacific Programme to Eliminate Lymphatic Filariasis (PacELF) Office of the WHO Representative in the South Pacific P.O. Box 113 Suva Fiji Tel. No.: (679) 3304600; Fax No.: (679) 3300462 E-mail: colatam((i)fij. wpm. who.int
ANNEX 3
Speech by Dr Shigeru Omi, Regional Director WHO Western Pacific Regional Office at the Ninth Workshop for Pacific Lymphatic Filariasis Programme Managers Nadi, Fiji, 20 and 2 I June 2007 FRIENDS AND COLLEAGUES, ladies and gentlemen, Lymphatic filariasis has been known for centuries and depictions of people afflicted with elephantiasis are found in old civilizations. Today, WHO estimates that I billion people in 80 countries are at risk with over 120 million already affected and 40 million severely disfigured and incapacitated. Even when no clinical symptoms are present, hidden lymphatic pathology and kidney damage exists. The consequences of the disease, such as elephantiasis and hydrocele, are not only disabling but can also drag entire families into poverty. The social and economic burden, as well as the suffering of affected individuals, is enormous. New diagnostic tools and a more effective combination of drugs now make elimination an attainable goal. In 1997, the World Health Assembly adopted resolution WHASO.29 to eliminate lymphatic filariasis as a public health problem. The strategy has two components: To interrupt transmission of lymphatic filariasis. To address and alleviate associated morbidity, including residual morbidity even after interruption of transmission has been achieved. A generous pledge in 1998 by GlaxoSmithKline or GSK, then, SmithKline Beecham, to collaborate with WHO concentrated on the donation of albendazole for as long as necessary to ensure success of the elimination programme. In addition, the company continues to support other key elements of the programme such as the regional programme review groups. The Global Alliance, of which GSK is a member together with other key partners, has helped strengthen the regional initiative and increase chances for success. The Pacific Programme to Eliminate Lymphatic Filariasis was launched in 2000 under the auspices of WHO. However, several countries and areas in the Pacific such as Cook Islands, French Polynesia, and Samoa have a long history of fighting the disease. Among the 22 countries covered by the Pacific Programme to Eliminate Lymphatic Filariasis, 16 countries are endemic. It is estimated that about 7.9 million people are at risk, most of them in PilPUIi New Guinea. Since 2000, great efforts have been made to eliminate lymphatic filariasis in the Pacific area in partnership with the Pacific countries, the Government of Japan and other stakeholders. Great progress has been achieved. So far, 14 countries have conducted mass drug administration and II of these have completed at least five rounds. However, we can not drop our guard. The morbidity component must be fully tackled and programmes for verification of elimination need to be completed. Since 2000, I.S million people
have been reached by mass drug administration in the Pacific. Although some countries have achieved high treatment coverage rates, mass drug administration coverage of at-risk people in this area - except for Papua New Guinea - has so far been 59%. If Papua New Guinea is included, this proportion drops to 19%. Clearly, these issues are an important challenge to the elimination of lymphatic filariasis. Various partners are now joining forces to provide adequate support for proper monitoring and evaluation ofthe Papua New Guinea's programme. This is an important milestone that is expected to have an impact on the entire Pacific Programme to Eliminate Lymphatic Filariasis. This meeting is critical as it addresses the next steps and strategies for the coming five years. With only 13 years left before the global target of 2020, there remains much to be done. Elimination of lymphatic filariasis in the Pacific islands is feasible but will require continuous support and strong commitment from all partners. I would like to take this opportunity to express my deepest appreciation to Governments of the Pacific Island Countries for their efforts and achievements, the Japanese Government for its generous financial support and donation of drugs and test cards, GlaxoSmithKline for its donation of drugs and financial support, and for all other partners and stakeholder's support in the global war against lymphatic filariasis. I wish you a successful workshop and look forward to its positive outcomes.
ANNEX 4
Speech by Dr Dr Tui Taoi, Director of Health Services, Western Division at the opening ceremony of the Ninth Workshop for Pacific Lymphatic Filariasis Programme Managers Nadi, Fiji, 20 and 21 June 2007
Foremost I wish to convey to our WHO, donor partners, and stakeholders our utmost gratitude and appreciation from the Ministry of Health for your enormous support that is quite visible, tangible and continuing. You have made profound impact to health services here in Fiji and surely the same could be said for my Pacific neighbors. May I thank you most sincerely for that and to thank WHO again for having confidence in hosting the 9th Annual Meeting of PacELF programme managers here in Fiji amidst times of challenges. This critical interphase in time is to recognize Pacific Island Countries that have completed 5 rounds of Mass Drug Administration with DEC and Albendazole and pursuing mopping up of endemic foci of infection in their countries. The successes and challenges will be discussed in greater detail during the course of the meeting and for that Fiji looks forward to receiving your deliberations so that we will be able to learn from that and apply its practicality to better LF programme implementation here in Fiji. Certain things need mention here. Countries like Samoa have committed their people and their government to this national undertaking. They have walked the many miles, sailed the rough seas and sweated the terrains primarily to reach the community for drug distributions. The passion of the Pacific countries for the betterment of health for their people cannot be overemphasized. Last year this meeting was scheduled to prelude the 4th Meeting of the Global Alliance to Eliminate LF at the Warwick International Hotel. Fiji hosted the Global Alliance Meeting on behalf of our Pacific member countries and yourselves. Glad to say that the meeting was a true success and wish to thank you all for all your support and valued assistance. The PacELF flag should rise high despite the many challenges we face at programme and at country level. The will do things conceived the PacELF way and we should not lose sight of our community obligations. Today will be remembered as a time that you will reflect on the status of your national elimination programmes within the Pac ELF initiative, exchange information of LF and related issues, share your experiences in the elimination initiatives and more to that to celebrate the PacELF successful achievements amidst many challenges such as our smallness and diversity within the global village. All is not over yet as we embark on prevalence surveys to guide the next sets of actions. Fiji is committed as always to this meeting and looks forward to harmonizing that with the 5th Global Alliance Meeting to be convened in Africa next year. Our commitment goes further to the days when LF is eliminated from Fiji and the Pacific Shores. We have experienced interesting public health emergencies here in Fiji. We had a measles outbreak; we also had an outbreak of acute hemorrhagic conjunctivitis in 2006 and like you too preparing for an influenza pandemic. Building capacities for International Health Regulations and its implementation in 2007 pose urgent attention to all of us. These are just a few. Within all these initiatives, the Pac ELF has taught us many lessons that regional initiatives need to learn from. The strong leadership of WHO needs commendation in time as we take stock of the interesting times we sailed through. Clearly the LF eliminative is embedded in the Ministry of Health Strategic
Plan 2007-2011. We have challenged ourselves that by 2008 we have eliminated LF and measles in Fiji. There is still hard work to do given existing factors that affect the health system deliveries, human resource developments and technical capacities. We, the Pacific Island Countries need to learn and apply strategic public health principles undertaken in this regional elimination initiative. Your full participation and ongoing attentiveness to resurgence of LF and control should be enshrined in our implementation strategies and actions. Let us be remembered as the passionate professionals of the Pacific that worked tirelessly to eliminate a neglected tropical disease: Lymphatic Filariasis. As a developing country with restricted resources and capacities, I pledge herewith that evidence based practices should be our guiding pillars in the elimination. Our system therefore will have to be assisted, supported and more so refurbished to ensure that we also are in par with all endemic countries worldwide. Our country continues to look forward to your collaboration, support and advise as we address cross border transmissions and spread. Elimination of LF calls for collective and collative work. It calls for team efforts and working together as a team, like what Pac ELF champions. Barriers and bureaucracies further harm the affected communities who are in dire need of assistance and support. I urge you all to work with great serenity and dignity whereby you could craft a national sense that will touch affected individuals and communities in our beloved Pacific. As health professionals and partners, we are critically looked upon by our people to provide sound and effective interventions to minimize disease impacts and more so continue to prevent reemergence of LF. Given the enormous efforts put into your own national programmes and the mode we are in now, preparedness at all levels cannot be overemphasized. Fiji looks to you with respect, trust and hope that what you continue today will assist our communities in the elimination of LF. Fiji has gained some tangible products from the LF programme which ranges from technical capacity building, operational support, equipment and supplies, and more so making connections for health. I will be looking forward towards the deliberation and outcomes of this very important meeting in due course. May I wish the forum the very best in your deliberations and hope that good sense and understanding will prevail to enable you to meet the outcomes and outputs of the meeting. Last but not least, let us never forget the very people we are obligated to serve. They have placed their trust and hope in us. Let us not diverge trom that in our business of health delivery. Let me close by saying this quote: Small minds talk about people. Average minds talk about events. Great minds talk about ideas. May great ideas be encouraged and translated to actions. With those few words, I now take the privilege to officially declare the Ninth Workshop of the PacELF Programme Managers officially open. Thank you very much, Vinaka Vaka levu and Baa! Dhanbard. May God Bless LIS
all.··