(WP)MVP/ICP/MVP/l.2/001-E Report Series Number: RS/2003/GE/22 (FIJ) English only
REPORT
FIFTH ANNUAL WORKSHOP ON FILARIASIS ELIMINATION IN THE PACIFIC
Convened by: WORLD HEALTH ORGANIZAnON REGIONAL OFFICE FOR THE WESTERN PACIFIC Nadi, Fiji 22-26 September 2003
Not for sale Printed and distributed by: World Health Organization Regional Office for the Western Pacific Manila, Philippines July 2004 WHO/Wl'RO LIBRARY l'rlAl"\ILA, Pl!lLl:.'i)~i\E~
NOTE
The views expressed in this report are those of the participants in the Fifth Annual Workshop on Filariasis Elimination in the Pacific and do not necessarily reflect the policies of the OrganizatIOn.
This report has been prepared by the World Health Organization Regional Office for the Western Pacific for governments of Member States in the Region and for those who participated in the Fifth Annual Workshop on Filariasis Elimination in the Pacific, which was held in Suva, Flji, from 22 to 26 September 2003.
CONTENTS BACKGROUND SUMMARY 1. INTRODUCTION .................................................................................................... '" ....... 1
1.1 Objectives ................................................................................. 2 1.2 Opening and closing ceremonies ....................................................... 2 1.3 Appointment of Chairperson and Vice-Chairperson ................................ 2 2. PROCEEDINGS ................................................................................................................. 3
2.1 PacELF update ................................... '" ............................................................ 3 2.2 Mekong Plus ELF ............................................................................................. 3 2.3 Americas ELF ................................................................................................... 4 2.4 The global programme to eliminate LF ............................................................ 4 2.5 PacELF handbook and databook .................................................................... 13 2.6 Monitoring and evaluation .............................................................................. 13 2.7 Serious adverse events ............. ........ ............ ............... ...................... .............. 14 2.8 Disability identification and morbidity survey ............................................... 14 2.9 Social mobilization and communication ......................................................... 15 2.1 0 K.AP and lEC materials................................................................................... 16 2.11 Entomology and vector control.. ..................................................................... 16 2.12 Opportunities for programme integration ........ ............ ........................ ..... ...... 18 2.13 Filariasis in the Pacific .................... ...................... ....................... ................... 18 2.14 PacELF administration of supplies and application request forms ................. 19 2.15 Data information systems ............................................................................... 19 2.16 PacELF website and the star network ............................................................. 19 2.17 PacELF documents and IEe materials ............................................................ 20 2.18 PacCARE update ............................................................................................ 20 2.19 Partner presentations ....................................................................................... 20 2.20 Discussion of issues ane needs for monitoring and evalaution ....................... 21 3. CONCLUSIONS ............................................................................................................... 21 4. ACKNOWLEDGEMENTS ............................................................................................... 22
APPENDICES APPENDIX 1 - PACELF CONTACT DETAILS AND FUNCTIONS ............... 23 APPENDIX 2 - P ACELF PROGRESS ................................................................. 25 APPENDIX 3 - COUNTRY PROGRAMME BY YEAR .................................... 27 APPENDIX 4 - FLOW CHART OF PACELF MDA AND ASSESSMENTS .... 29 APPENDIX 5 - SURVEILLANCE GUIDELINES ............................................. 31 APPENDIX 6 - DATA INFORMATION SYSTEM ........................................... 33 APPENDIX 7 - LIST OF PARTICIPANTS ......................................................... 35 APPENDIX 8 - PROGRAMME OF WORK ....................................................... 41 APPENDIX 9 - OPENING REMARKS OF THE REGIONAL DIRECTOR ..... 47 APPENDIX 10 - OPENING ADDRESS .............................................................. 49 APPENDIX 11 - LYRICS (IMAGINE PACELF) ............................................... 53 TH APPENDIX 12 - OUTCOME FOR THE 5 PACELF ANNUAL MEETING ... 55
\ Key words:
Elephantiasis, Filarial- prevention and control! Filariasis - prevention and control! Pacific Islands
SUMMARY
The Fifth Annual PacELF Workshop was held in Lautoka, Fiji, from 22-26 September 2003. The 20 programme managers attending the workshop reported on the status of their countries' activities over the last 12 months. The country reports were largely encouragmg, with midterm evaluations from five countries showing reductions in filarial antigens of 40% and III microfilaraemia of90%. In addition, Samoa's imminent completion of five full rounds of mass drug administration (MDA) will mark a major milestone in the global programme's overall effort to eliminate LF by 2020. PacELF's achievements in the first nine months of2003 included the distribution of 37 930 000 DEC tablets, I 318 000 albendazole tablets and 73 000 immuno-chematographlc test (ICT) cards to 14 countries. In addition, PacELF developed the STAR Network, a communications and supply system linking the PacELF countries to the main PacELF office. One of the STAR Network's communication features is a website on which country programme activities are posted. Technical advisors to PacELF updated workshop attendees on LF elimination activities in other regions of the world. They also presented information on momtoring and evaluation, vector control, and morbidity alleviation programmes. GlaxoSmithKline (GSK) reported on the importance of continued investigation and reporting of suspected serious adverse events (SAE), despite their infrequent occurrence. Observers provided examples of developing social mobilization strategies and information, education and communications (1EC) material based on local social science research. Participants agreed on post-MDA activities to ensure the elimination ofLF. These activities include: maintaining high levels of advocacy; assessing morbidity; integrating LF activities with other related programmes; and developing surveillance systems to detect introduced or re-emergent LF infections. At the end of the workshop, programme managers concluded that PacELF should produce a handbook to provide country-specific guidance for monitoring, evaluation and post-MDA activities. The objectives of the workshop were to: • • • • • Review country progress and plans for MDA; Review progress toward the incorporation of targeted vector control as part of national filariasis elimination strategies; Review progress toward the standardization of data collection and reporting; Finalize post-MDA activities, the criteria for stopping MDA, and measures for validating elimination in the Pacific Island countries; Agree on the development of a PacELF handbook and databook.
1. INTRODUCTION
The Fifth Annual Workshop on Filariasis Elimination in the Pacific was held from 22-26 September 2003. Fiji hosted the workshop at the Waterfront Hotel in Lautoka. Attending were representatives from 20 Pacific countries (11 males and nine females from a range of disciplines), one consultant, four temporary advisers, eight observers and six Secretariat members. Lymphatic filariasis (LF) is a mosquito-transmitted parasitic disease that affects an estimated 120 million persons throughout the tropics. Ranked by the World Health Organization (WHO) as the second leading cause of permanent disability worldwide, lymphatic filariasls causes debilitating genital disease in an estimated 25 million men and lymphoedema or elephantiasis of the leg in 15 million persons, mostly women. Recent advances in treatment using a combination of albendazole with either diethylcarbamazine or ivermectin, together with the development of a rapid diagnostic test, have, for the first time, made elimination of the disease an attainable goal. In May 1997, the World Health Assembly passed a resolution calling for the global elimination ofLF as a public health problem by the year 2020. In March 1999, Ministers of Health from the Pacific island countries, meeting in Palau, unanimously adopted a resolution calling for the elimination ofLF from the Pacific lsland region by the year 2010, ten years earlier than the worldwide target. Shortly afterwards, the Pacific Programme to Eliminate Lymphatic Filariasis (PacELF) was established as a regional collaborative body, representing the 22 island countries in the Pacific region. In February 2002, the PacELF Coordinating and Review Group (PacCARE) was established to review activities, applications and recommendations of Pac ELF countries. In the Western Pacific Region, the disease has historically had the greatest impact among the small island countries of the Pacific. In the past, it was not uncommon to find islands where more than 40% of the population was infected with the parasite Wuchereria bancrofti. Attempts have been made to control the disease, with some success, but results have always been shortlived.
PacELF objectives are to first interrupt transmission of LF and then alleviate suffering due to the disease. To interrupt transmission, DEC and Albendazole is used through mass drug administration (MDA). As of 2003, 11 countries in the Pacific are conducting MDA. Samoa will be the first to complete five rounds of MDA. Four Pac ELF countries have completed their fourth MDA round (Cook Islands, French Polynesia, Niue, Samoa and Vanuatu), two have completed their third round (American Samoa and Tonga), three have completed their second (Kiribati, Tuvalu and Wallis and Futuna) and Fiji has completed thelf first round. Papua New Guinea plans to start MDA soon in certain provinces and further investigations continue in countries where the status ofLF is doubtful. Guam, Nauru, Solomon Islands and Tokelau will soon be conducting final surveys to certify elimination. With many countries completing all five rounds ofMDA in the near future, the next step for Pac ELF is to implement activities that will ensure the achievement of elimination.
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1.1
Objectives
The objectives of the workshop were to:
• • • • • 1.2
review country progress and plans for MDA; review progress toward the incorporation of targeted vector control as part of national filariasis elimination strategies; review progress toward the standardization of data collection and reporting; finalize post-MDA activities, the criteria for stopping MDA, and measures for validating elimination in the Pacific Island countries; and agree on the development of a PacELF handbook and databook.
Opening and closing ceremonies
Dr Nuualofa Potoi gave the opening invocation for the Fifth PacELF Workshop, which was held from 22-26 September 2003 at the Waterfront Hotel in Lautoka, Fiji. Salusalu was presented in honor of the opening speakers and Dr Josefa Koroivueta introduced the opening ceremony. Dr Kazuyo Ichimori read the opening remarks from the WHO Western Pacific Regional Director, Dr Shigeru Omi. Dr Omi urged the countries to agree on a new set ofpost-MDA guidelines and proposed that they carry out morbidity surveys, engage in vector control, integrate anti filariasis activities with related programmes, and develop surveillance methods to ensure the successful elimination of LF.
In his opening address, Mr Luke Rokovada, the Permanent Secretary for Health of Fiji, reIterated Fiji's commitment to eliminate LF. He observed that PacELF was a good role model for other public health initiatives in the Pacific. Finally, he challenged countries to be vigilant and targeted in their quest to eliminate LF. The workshop ended with a benediction from Ms Trishia Olaofa Tauasi and closmg remarks from Dr Josefa Koroivueta.
1.3
Appointment ofChair:person and Vlce-Chair:person
Dr Viliami Puloka of Tonga and Dr Ma. Christie Cabungcal of Kiribati were appointed Chairperson and Vice-Chairperson of the Workshop, respectively. Dr Tom Burkot, Medical EntomologIst, Centers for Disease Control and Prevention, provided an introduction to and overview of the workshop.
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2. PROCEEDINGS
2.1
PacELF update Dr Kazuyo lchimori, Pac ELF Team Leader gave an update on the progress of Pac ELF.
Pac ELF is a regional collaborative body that represents the 22 Pacific island countries that are working together, with support from outside organizations, to eliminate LF by 2010. PacELF provides the following services: • • • • • Administrative support and drug distribution; Health education and advocacy; Communication; Training and meetings; and Scientific basis and operational research.
LF is endemic in 16 of the PacELF countries. MDA has been given to 1.7 million people in 11 of the endemic countries, for a 71 % coverage rate. Recent midterm evaluations in five countries show reductions in filarial antigen of 40% and in microfilaraemia of more than 90% (See appendix for PacELF progress). In 2002, PacELF distributed 42 500 immuno-chromatographic test (lCT) kits, 12850000 DEC tablets and 1 134800 Albendazole tablets to the Pacific countries. PacELF's first objective is to stop the transmission of LF through use of MDA and vector control. Its second is to reduce and control the morbidity caused by LF through intensified hygiene, home-based patient care, and surgery. The strategies necessary to meet these objectives include integration of Pac ELF's activities with other programmes, social mobilization, operational research, partnerships and training. Current issues: 1. 2. 3. 4. 5. Integration with helminth, malaria and dengue control Advocacy and political commitment Operational research Post-MDA surveillance Morbidity control surveys and treatment programmes
2.2
Mekong Plus ELF
Professor CP Ramachandran, University Putra Malaysia gave a presentation on MekongPlus ELF. The goals of Mekong Plus ELF are to eliminate LF transmission by 2020 and to reduce and prevent morbidity in the Mekong countries. The Mekong Plus ELF covers countries in both the South-East Asia and Western Pacific regions of WHO, extending from India to Australia. The region suffers from high transmission and morbidity rates and is host to over 25 specIes of vectors and the three species of parasites, with Brugia being the most common. The mapping of LF endemic areas is currently underway and will be completed by 2005. MDA will be implemented in all endemic areas by 2010.
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Current issues: 1. Necessity of funding and political support for the LF programme 2. Scaling up of activities 3. Advocacy and training 4. Diagnosis of brugian infections 5. Migration across borders
2.3
Americas ELF
The situation in the Americas was presented by Dr Eric Ottesen, Director, LF Support Center, Emory University Before 1980, LF disappeared spontaneously from several countries in the region. Transmission remained a problem in Brazil, Costa Rica, the Dominican Republic, Guyana, Haiti, Surinam, and Trinidad and Tobago. Culex vectors transmitting Wuchereria bancrofti are responsible for all LF in the Americas Region. Summary of the activities of the LF endemic countries in the Americas ELF region: • In Brazil, selective or mass treatment with DEC has effectively reduced LF in many parts of the country. MDA is being conducted in the remaining endemic areas.
•
The Dominican Republic implemented a successful MDA by relying on partnerships and interagency collaboration. In Haiti, which has the Region's highest infection rates, MDA is achieving positive results.
•
•
Guyana has successfully implemented a DEC salt fortification programme with high levels of social mobilization. In Costa Rica, recent surveys found no LF, suggesting the country is ready for elimination.
•
• •
Xeno-monitoring and ICT testing found no LF in Trinidad and Tobago. Monitoring and evaluation remains the biggest challenge for Surinam. Current Issues: 1. 2, 3. Scaling up of activities Disability and morbidity management Monitoring and evaluation
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2.4
The Global Programme to Eliminate LF
Dr Sergio Yactayo, Epidemiologist, LF Elimination, WHO, presented an overview of the Global Programme to Eliminate LF. In 2002, the global programme involved 32 countries and 59 million people, over half of whom were located in the Indian subcontinent. Approximately 135 million people have been targeted for intervention activities in 2003. Since the programme began in 2000, it has achieved exponential growth. LF mapping has been completed in 45 countries, and is currently underway in 16 others. The number of disability alleviation courses increased from 15 in 2000 to 314 in 2002, with over 18 000 staff trained. Overall, LF infection levels tend to be highest in the poorer countries. The costs of LF include direct costs to the patient; indirect costs, such as lost productIvity; and hard-to-quantify socio-psychological costs. The progress indicators used in the global programme are prevalence of microfilaria (MF), microfilaria density (MFD) and drug coverage. The Technical Advisory Group (TAG) has recommended that five years of MDA at coverage levels exceeding at \east 65% are necessary to achieve elimination.
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Country Reports
PI
ACTI\' ITII'S
MnA RI'SI ILTS
SUln'EY RESULTS
• Three rounds of MDA - Nurses distribute and AMS observe via both house-to-house programmes and fixed sites. In 2003, churches and trained volunteers distributed the drugs in a new strategy.
2000: 19% 2001: 53%
ICT survey 1999: 16.6% (50 1/ 30 18) 2001 : 11.5%( 12 111053)
2002: 49%
• E
Evaluations conducted by nurses and community. Based on Census 2000, total population estimate of 57 291.
2003 : 13.5% (135/ 1000)
• Vector identification and control workshop held.
•
New comprehensive lEC campaign is being developed - aSK video shown on TV, radio spots, press releases and fliers.
• Four rounds of MDA - Distributed by public health staff situated on all main islands. C OK
2003: 88.39% (13 048114 762)
ICT survey 1999: 8.6% (16211884) 2001: 7.6% (35/460) 2002: 0.4% (9/2025) (2002: Random tests of people from census list within tile sentinel sites of 6 southern islands and 7 northern islands)
• IEC programme. • Integrated vector control programme.
E
• Final MDA planned for June 2004. • Final assessment planned for 2005.
•
One round ofMDA- Distributed through fixed stations in urban areas and a combination of house-to-house delivery and fixed stations in rural areas by nurses, health workers and volunteers. Doses were age-determined. IEC- research supported, ongoing process.
2003: 70.5% (546922/776 173) Some data may be missing due to cyclone.
2001 : 16.6%ICT+ 2002: 14%ICT+ 6.4% MF+
• FIJ
• Integrated vector control approach . • Plan to integrate with helminth programme.
E COMMENTS:
• • •
Programme needs continued monitoring and evaluation, local donors and links with training institutes. Legal issues exist with respect to volunteers distributing drugs. Need to ensure that all registration books are returned in order to provide accurate coverage data. Need to give responsibility for distribution money management to nurses.
•
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1'1
AfTI\ ITIES
MDA RESLILTS
SUR\'EY RESULTS
Baseline JeT survey
• •
DEC had been given by MDA for many years prior to 2000. Four rounds ofMDA - Distributed by public bealth workers, nurses, physicians and pharmacists through house-to-house delivery in rural areas and urban fixed stations. Used Filariasis Day/Week approach. Doses were agedetermined for children, and by weight for adults. Midterm evaluations conducted.
2003 : 90.1% 1997: Maupiti 2.4% (24/992) (2213001245516) 2000: Tevaitoa I J. 7% Estimates based on a post-MDA survey. (144/ 1226)
2000: Tabuata 17.7% ( 11 2/633)
• • FRP
Midter m lCT survey Vector control study underway. 2002: Maupiti 3.9% (42 /1069) Final evaluations are planned for 200412005 . 2003: Tevaitoa 13.8% E (16811220) 2003: Tahuata 16.9% (107 /635)
•
COMMENTS:
• • • •
A problem with DEC quality was resolved by using 100mg tablets. Difficulties in retrieving albendazole from small islands. Problems with compliance are increasing. After 4 MDAs, ICT results remain high. It is unclear if this is due to resistance or non-compliance.
FSM
• One round of MDA in YAP States.
2003: 50-60% Based on MDA ofthree islands with target population of 1520.
• Plan to treat residents of target areas Iiving abroad. PE
ICT survey 2002: 36% (Satawal school children) 2003: 34% (Satawal all ages) 2003: 2% (Tamatam all ages)
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1'1
ACTJ\ !TIES
MD ·\ RESI ILTS
SUR\'EY RESULTS
• IEC programme underway. GUM
None conducted
Baseline TCT survey 2001: 0% (0/950)
•
Surveillance integrated with regular monitoring of communicable diseases.
NE
• Integrated vector control programme.
•
Survey planned for 2005 due to threat of imported cases.
•
Three rounds of MDA- Distributed by Ministry of Health staff, nurses, Ministry of Education Youth and Sport and Peace Corps partnerships. Doses are age-determined. IEC programme includes radio spots, leaflets and information sheets, as well as Manaeba visit to religious groups.
2003: 22.99% (19431 /84494)
Not presented
KIR
• E
These are provisional data from Tarawa only. Results are pending from 17 outer islands.
• VeClOr control programme underway, workshop to be held in 2004 .
• Plans for case management workshop and blood surveys in sentinel and spot check sites in 2004 .
• • • MAR
MDA conducted on Mejit in June 200 I and on Ailuk in 2002 for people older than five years. Plans have been made to screen two more atolls. Vector control programme is planned.
2002: > 85% (Mejit) 2002: > 85% (Ailuk)
ICT s urvey 2001: 212004 (Majuro, both are residents of Mejit) 2002 : 4.42% (Mejit) 2002 : 11.9% (Ailuk) 2003: 0% (Wotje)
PE COMMENTS:
2003 : 0% (Ebon)
• •
Challenged by scattered islands, transportation and communication issues, lack of community awareness and low priority for the Ministry of Health. Plan to advocate support from Ministry of Health and increase community awareness and participation.
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PI
ACTI\
n IES
~II)'\
RESl > LTS
SURVEY RESULTS
• Training conducted for health personnel. NAU
None conducted
1999: 0.3% (1/388 - case is non-resident)
COMMENTS: NE
• • NEC
Challenged by poor public awareness,lack of personnel, and low priority for the Ministry of Health. Will do MDA if necessary, but need resources.
• •
Public Healtb staff carries out activities. 3000 to be given ICT and questionnaires in 19 districts in north island provinces. No morbidity information available.
None conducted
2002: 1.47% (Ouvea schoolchildren) 2002: 2.35% (Middle- aged)
PE
• • • NlU
Four rounds of MDA since 2000. Vector control programme underway.
2003: 80% (138611788 )
ICT test of positive cohor ts 2002: 0.6% (12/22) 2003 : 0.6% ( 16/26 )
• •
lEC campaign includes media, posters, and leaflets.
Concentration on testing and treating positives.
E COMMENTS:
• •
Problems with immigration, a new policy in the country to test all new immigrants. Some who have tested positive have refused to take tablets .
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PI
ACTIVITIES
MD-\ RESl'LTS
SI!R\,[Y RI'SlJl TS
• Integrated vector control programme. • lEe materials include posters and leaflets. • Selective treatment of ICT positive cases, directly PAL observed therapy (DOT). Nurses distribute drugs and dose is weight-determined.
None conducted
2001: 0.4% 2002 : 1.3% (Ngardmau) 2002: 0% (Ngchesar) 2003: 0% (SW Islands)
PE
COMMENTS:
• •
Problem with recording information. Proposal submitted to J[CA for vector-control funding. Depending on funding, may re-test total population with ICT in 2004.
• • • • PNG
Participating in PacELF.
2002: 70%
• 42 endemic districts, covering 50% of total population.
Baseline surveys underway. Five rounds ofMDA in Samurai Murna District and MDA plans for Milne Bay and Western Province . Adapting four-comer strategy. Community-based approach. IEC campaign .
Samurai province only where ICT positive rates began at 63%, went down to 3% and then increased to 6%.
•
18 non-endemic districts, covering 19% of population . 24 districts with surveys in process.
•
• • E
• 6 districts with no data.
•
COMMENTS:
•
Need to decide whether Papua New Guinea is going with PacELF or Mekong Plus region. Integration with treated bednets programme planned.
•
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PI
ACTIVITIES
MDA RESULTS
SURVEY RESlJLTS
•
Four rounds ofMDA -.Distributed by women's committee, village mayors, ministers and health clinics. Dose is age-determined. Social marketing multi-media campaign. Midterm evaluation conducted, including survey by health staff
2002: 603%
1999: 4.5% (31717006) 2002: 4.4% (96/2141) 2003: 1.6% (14/881 )
• SMA
•
E
COMMENTS:
•
MF prevalence recorded from 1964 to 1994. Need to buildlocaLcapacity, strengthen information collection, review social mobilization methods, and integrate with child health and vector control programmes. Plan end-of-programme and morbidity surveys for whole population.
• • • •
SOL
Past malaria programme thought to eliminate LF. Plan to complete final eradication survey by end of2003.
None conducted
NE
ICT survey 1999-2000: 0% (0/3055 in 9 areas surveyed)
TOK
• •
IEC materials produced. Vector control programme established.
None conducted
ICTsurvey 1994: I migrant ICT+
1999: I more mi grant ICT+
NE
•
Elimination certification survey planned by 2005 . )
•
TNG
Three rounds ofMDA - Distributed by Ministry of Health staff and volunteers on one target day. Age-determ ined doses given to all over three years of age. Health promotion unit coordinated MDA and churches were used as distribution sites. Midterm evaluation planned by end of2003 .
200 I and 2002: excellent coverage 2003: 90.7% (88 752/97 784)
ICT survey 2000: 2.7% (108/4002)
• E
COMMENTS :
• •
In 1977, a successful DEC MDA programme was conducted for three months. Plan to develop a vector control programme.
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, 1'1 ACTIVITII'S MIlA RF.SlILTS SUR\'F.\ RF.SUL TS
I ,
•
MDA distributed bYl'ublic health statT, nurses, doctors, community bealth committee and volunteers on a Sunday. Dose originally weightdetermined, changed to age-determined. Integrated media campaign. Integrated vector control programme. Training workshop for health workers held. Clinical management at bealth centres and hospital.
2001 : 81.2% (674217175) 2002: 46.7% (4467/ 9561 - data missing from three islands)
ICT survey 1999: 22.3% (1281574)
2002: 22% (Funafutti 70/318)
• TlJV
• •
E
•
COMMENTS:
• • • •
Need monitoring and evaluation, better data management, KAP study and financial support. Plan to carry out blood survey after third round of MDA and to develop IEC materials in local languages.
Four roun ds ofMDA distributed house-to-house and DOT by nurses and public health statT. Midterm evaluations conducted.
2000: 82.9% 2001 : 83 .0%
2003 se ntinel sites: Sakau: ICT 14.4% (1 4/97) MF 0% (0197).
2002 : 83.8%
•
In-depth studies in low coverage areas conducted as well as ongoing monitoring in one sentinel site per year. Case management programme started. Island is working in partnership with NGOs.
(1563501186575)
South ri ver: ICT 2 1. 5% (14/65) 2003 cross-sectionaIICT : Port Navrin school : 7.2% (11115 1) Santo Malaria lab: 4. 1% (3/73)
• VA
• •
IEC programme developed. Port Vila Malaria lab : 0%
E
Lolowai Malaria lab: 0% Norsup Malaria lab: 13 .5% (10/74)
COMMENTS:
• •
Plan to integrate programme with Healthy Islands Initiative, helminth control,and bednet distribution . Local customs and beliefs remain problematic in target province of Penama. Problems enforcing DOT in urban areas.
•
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PI
ACTI\HIES
MIJ.\ RI.Sl LTS
SUR\'EY RESULTS
• WAF
Three rounds ofMDA - Distributed by health workers, biologists, pharmacists and medical officers at schools, offices, shops and village meeting places. IEC Campaign conducted on radio and TV.
2003: 65.3% (9252/14166)
ICT Survey
2001 : 0.72% (6/803) (Wallis: 1%; Futuna: 0%)
• PE
COMMENTS:
•
Problem with side-effects when giving dose by age. Plan to resolve by changing to weight-based dosage in 2004.
2.5
PacELF handbook and databook
Dr Tom Burkot, Medical Entomologist, Centers for Disease Control and Prevention; and Dr Kazuyo Ichimori, PacELF Team Leader presented an outline of the draft PacELF handbook and databook.
The PacELF handbook and databook, a guidebook to assist countries in developing plans for monitoring MDA and certifying elimination, is under development. It is intended to be a resource for PacELF programme managers and anyone else interested in LF elimination. The handbook will include essential information about LF, programme updates and, most importantly, the latest knowledge and techniques presented in a customized format for PacELF members. The handbook is divided into three sections. The first section is a "dictionary" which defines the basic terms and concepts of both LF and the PacELF elimination programme. This is followed by a set of "recipes" which explain in detail how to carry out the procedures introduced in the "dictionary". The final part is devoted to the monitoring and evaluation ofMDA and contains country-specific plans for assessing LF prevalence after five rounds ofMDA, and for determining if transmission has been interrupted. The handbook also has two appendices that include copies of all PacELF forms and the health communication materials developed by the PacELF countries.
2.6
Monitoring and evaluation
Dr Eric Onesen, DireclOr, LF Support Center, Emory University gave a presentation on monitoring and evaluation.
Monitoring and evaluation (ME) activities are essential to the success of the global programme. It is necessary to evaluate the impact of intervention activities and monitor the processes of the programme through the use of available tools . Impact is evaluated by sening a prevalence baseline, with which midterm and fmal prevalence rates can be compared.
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Elimmation is confirmed by an additional evaluation conducted at the programme's conclusIOn. The entire process is monitored through coverage assessments after each round ofMDA. The global programme has set general monitoring and evaluation guidelines for all countries, which may be modified to fit country-specific situations. The TAG recognizes that its recommendations must be tested and that alternative strategies may be necessary in different countries. As an example, the global programme and PacELF have different methods for determming baselines, stopping MDA, conducting post-MDA survei11ance, and verifying elimination. Some of the differences include: • • • Midterm evaluations for the global programme are based on MF tests at sentinel Sites, as opposed to PacELF's practice of using ICT. The global programme uses coverage data reported by surveys, while PacELF uses data from registers. The global programme's criteria for stopping MDA after five rounds is MF prevalence of less than 1% and an ICT positive rate of less than 0.1 %; PacELF's criteria is less than 1% ICT positive rate.
Tools currently used for ME include the detection ofMF in a blood smear and detection of parasite antigen by ICT card test or Og4C3. Antibody detection tests, which could also be used for survei11ance, may be available for use in the near future.
2.7
Serious adverse events
Dr Mark Bradley, Manager Scientific Support LF Programme, GlaxoSmithKline (GSK), discussed reactions to drugs. Whenever drugs are administered, the potential for adverse events or reactions to therapy exists. Most reactions to albendazole are due to the interaction of the drug with microfilana and adult worms. Fewer reactions will take place after each successive round ofMDA. Serious adverse events (SAE), which are defined as any reaction that results in death, hospitalization, disability, incapacity, congenital anomaly or birth defect, are extremely rare. Out of 150 million people treated by MDA to date, only 30 suspected SAEs have been reported. Upon further investigation, it was found that only two of these were due to direct reaction to the drug. If a possible SAE occurs, the country must investigate the case, manage it to resolutIon, fill out an SAE reporting form, and submit the form to both the WHO country office and GSK. GSK then reports the SAE to WHO Headquarters and the appropriate regulatory authorities to fulfill its legal obligation to report SAE within 15 calendar days of being informed by the country.
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2.8
Disability identification and morbidity survey
Dr Eric Ottesen, Director, LF Support Center, Emory University gave a presentatIOn on morbidity associated with LF. The two objectives ofLF programmes, as noted previously, are the elimination of transmission and the reduction and control of morbidity associated with LF. PacELF's strategy has been to focus on the first objective through MDA, with the plan to address morbidity at a later stage. LF is a chronic disease and, as such, morbidity associated with it will not be resolved through a fixed-length programme. In order to address the issue appropriately, it is first necessary to understand the burden of disease. Case management programmes can subsequently be developed and evaluated.
The principles of a case management programme include: (1) lymphoedema management through home-based self-care; (2) urogenital management through surgery; (3) referral system for complex problems; and (4) psychosocial support. As with MDA, monitoring and evaluation activities are necessary for success. Unfortunately, while impact indicators exist at the individual patient level, they do not cross over to the programme level. In other words, the steps for patient care are well established, but difficult to measure. A case management programme should be developed through the following steps: (1) IdentIfication of clinical problems using pictorial guides and laboratory diagnostIc tools such as ultrasound. (2) Identification of affected individuals through MDA questionnaires, sentinel site assessment or coverage surveys. (3) Enrollment of patients in a programme in which progress can be assessed and recorded, and later shared with other countries.
2.9
Social mobilization and communication
The importance of social mobilization and communication was outlined by Dr Shona Wynd, Senior Social Scientist, School of Public Health and Tropical Medicine James Cook University. The Multiple Perspectives Approach (MPA) is a method of collecting data that is socioculturally sensitive, reliable and robust. It aims to improve the understanding of: • • communities' conceptualization of LF; local communication and power structures; and
- 16 -
•
factors that influence behaviour with regard to compliance, morbidity management and prevention of transmission.
Interviews with opinion leaders and local residents are guided by flexible question outlines. The interview transcripts are analysed for emergent themes and the findings are used to help develop future programmes and projects more effectively.
2.10 KAP and lEC materials This presentation was delivered by Mr Jonathan King, Public Health Advisor, Centers for Disease Control and Prevention, American Samoa Department of Health, and Ms Margaret Fraser, Volunteer Service Overseas, Vanuatu Filariasis Programme. The LF programmes in American Samoa and Vanuatu used social science research to develop social mobilization and IEC strategies. In American Samoa, health worker evaluations and a community KAP survey were conducted to identifY ways to improve MDA coverage. In Vanuatu, an in-depth baseline survey consisting of interviews, focus group discussions. and observations was conducted. This was supplemented with an extensive KAP survey undertaken in the community during midterm evaluations. Based on the information gathered in each country, lEC materials such as posters, pamphlets, drama, radio and TV spots, were developed. The materials provided information on the disease, the purpose of the medicines, side-effects and the logistics of the MDA programme. In Vanuatu, the IEC materials integrated filariasIs, helminths and malaria control by promoting MDA combined with bednet use.
2.11
Entomology and vector control
Dr Tom Burkot, Medical Entomologist, Centers for Disease Control and Prevention presented this item.
Vector control to reduce the population of mosquitoes and their human contact rates is another method of managing LF transmission. Local vectors must first be identified, and control strategies selected based on the mosquitoes' biology. After vector control is implemented, It is necessary to monitor the programme on a regular basis. For example, it is necessary to watch for the development of resistance to insecticide. Insecticide-treated bednets are the primary strategy for vector control where night biting mosquitoes such as Anopheles and Culex transmit filariasis. The bednets also protect young children from the Aedes vectors, which transmit filariasis and dengue through daytime bitmg. Polystyrene beads and Bacillus sphaericus can reduce the population of the Culex vectors when applied to appropriate breeding sites. The daytime biting vector of Aedes poiynesiensis can be controlled through a reduction m human-provided breeding sites.
- 17 -
Insecticideimpregnated bed nets
+++
++
+
++
Breeding site reduction (containers)
++
+++
++
++
++
++
(diltchi:ng, runnelling)
Abate, Methoprene, Bti B. sphaericus Oils ?
+ ++
++
+/-
?
+
Biocontro1
+
+
+
+
+ Effective - Not effective ? Unknown efficacy
- 18 -
2.12
Opportunities for programme integration
This item was presented by Dr Kazuyo Ichimori, PacELF Team Leader; Dr Iosefa Koroivueta, Chief Medical Officer, National Centre for Scientific Services on Virology and Vector Borne Diseases, Ministry of Health, Fiji; and Dr Tom Burkot, Medical Entomologist, Centers for DIsease Control and Prevention.
Kiribati's KOM programme integrates LF elImination activities with efforts to control soil-transmitted helminthes. Helminths, or worms, mhibit the growth of a child by competing for protein, iron and essential vitamins. Helminths can be controlled through mass treatment of albendazole or mebendazole every six months. The drugs are simple to use, safe and very effective in reducing the prevalence and intensity of infections. Combining LF MDA activities with ongoing helminth programmes represents an ideal example of integration.
In Fiji, the programmes for LF elimination and dengue have been integrated under the Pacific Regional Vectorbome Diseases Control Project. Most of the vector control activities have taken place on a research level, since implementation would have required additional funding and political commitment. The project has successfully increased community awareness of dengue, built capacity and illustrated the need for IEC materials. It IS hoped that, with adequate resources and commitments, sustainable vector monitoring and source reduction will help reduce the transmission of both filariasis and dengue. In the PacELF countries of Papua New Guinea, Solomon Islands and Vanuatu, the same mosquitoes transmit LF and malaria. Both malaria and LF transmission can be reduced through the use of insecticide-treated bednets and rapid diagnostic tests, as noted by Pac ELF , the Roll Back Malaria Programme, and the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM). In lIght of these commonalities, the integration of LF and malaria control programmes would take advantage of a natural synergy. Solomon Islands has successfully integrated the two disease programmes through the use of insecticide-treated bednets, residual insecticide wall spraying, larviciding and IEC materials.
2.13
Filariasis in the Pacific
Dr Kazuyo Ichimori, Pac ELF Team Leader, presented an overview of the filariaSIS situation in the Pacific. LF was found throughout the Pacific islands from 1920 to 1950. While It disappeared from many islands spontaneously between 1997 and 2000, several islands continue to suffer from persistent low levels of LF prevalence. LF in the Pacific region is caused by the Wuchereria bancroft! parasite, which can lIve in its adult stage in the human lymphatic system for 4 to 6 years, where the female releases millions ofMF into the human blood through reproduction before it dies. The parasite causes lymphangectasia, or dilation of the human lymphatic vessels. Elephantiasis, a relatively rare complication of LF infection, is caused by the calcification and obstruction oflymphatic vessels due to the death of the adult worm combined with recurrent secondary bacterial and fungal mfections. While MF periodicity is not fully understood, it is believed that the biting pattern of the vectors may be a contributing factor. MF is nocturnal in Micronesia and Melanesia but
- 19 -
sub-periodic in Polynesia. The Culex vector, which is found throughout the Pacific, is night-biting. The Anopheles vector, found in Melanesia where malaria is present, is also night-bIting. The Aedes vector bites in the early morning, but is opportumstic during the day and will bIte when there is activity. These mosquitoes are found everywhere in the Pacific and are the main vector in Polynesia. In the past, the Pacific islands used DEC alone to stop LF transmission. With this treatment, a low level of MF persisted. Combining DEC with albendazole has proved to be more effective, as albendazole works to sterilize the adult worm. Levels of infectIOn are evaluated through ICT cards, which detect parasite antigen levels, or through blood smear tests, which detect MF. ICT results must be read 10 to 20 mmutes after testing to avoid false positives.
2.14 PacELF administration of supplies and application request forms This item was presented by Ms Akiko Takamiya, PacELF Operational Officer, PacELF Office Team. In 2003, PacELF received donations of 12 810 000 DEC tablets and 73000 ICT cards from the Japan International Cooperation Agency (JICA), and 1 358000 albendazole tablets from GSK. To request DEC tablets and ICT cards, countries must submit an A4 form to the Japanese embassy by the end of February each year. The embassy forwards the request to JICA, who delivers the supplies to PacELF. PacELF distributes them to the countries and collects receIpt reports to send back to JICA. PacCARE reviews each country's annual report and re-application for albendazole from GSK. Country requests for albendazole must be sent to PacELF, which then forwards them to GSK. PacELF receives the drug shipments from GSK, distributes them to the countries and collects receipt reports to send back to GSK. In 2004, re-application forms and annual reports will be due at the end of January for MDAs that took place in the second half of 2003, and in July for MDAs which took place in the first half of2004.
2.15 Data Information Systems (DIS) Reporting This item was presented by the PacELF Office Team. PacELF has developed a Microsoft Excel-based data reporting system called Data Information Systems (DIS) Reporting (see Appendix 6). Separate modules for MDA and blood surveys exist. Once countries have input their data, DIS Reportmg can total and calculate percentages, providing information standardization across the region.
- 20-
2.16 PacELF website and the Star Network Mr Yoshio Furuya, Pac ELF Assistant Programme Coordinator, presented this item. The Star Network is a system of communication and supply between the PacELF countries and the PacELF office. PacELF collects data, reports, applications and forms from the countries. and in return supplies them with drugs, test kits, reports, data and IEC materials. The PacELF website was launched in October 2002 and, since then, has received an average of 300 hits per day. Items to be posted on the website should be submitted to the PacELF office, and may include photographs, news and event information from country programme actIvities.
2.17 PacELF documents and IEC materials PacELF Office Team outlined PacELF documents and materials. IEC materials available from PacELF include posters, logos and two pamphlets. These materials can be ordered for use in country programmes.
2.18 PacCARE update Dr Josefa Koroivueta (PacCARE Chairman), Chief Medical Officer, National Centre for Scientific Services on Virology and Vector Borne Diseases, Mmistry of Health, Fiji, gave an update on PacCARE. PacCARE coordinates and reviews PacELF's activities and recommendations. It consists of one representative each from Polynesia, Melanesia and Micronesia. One of its major functions is to review the annual reports and reapplications from the PacELF countries. PacCARE meets once a year concurrent with the Pac ELF annual meeting. Recent issues addressed include: • • • • • Representation of French Territories; Publishing PacCARE recommendations on the website; Establishmg mformation sessions on SAE reporting; Conducting training on inventory reporting and stock control; Capturing sub-national activities, such as the MDA m Satawal, Federated States of Micronesia.
PacCARE's current priorities are the development of recommendations for monitoring and evaluation and the need to establish a technical monitoring and evaluation group.
- 21 -
2.19
Partner presentations
The global programme's partners include the Emory University LF Support Centre, the Centers for Disease Control and Prevention, GSK, the LF Support Centre at the UniverSIty of Liverpool School of Tropical Medicine, the School of Public Health and Tropical Medicine at James Cook University, nCA, and the Volunteer Services (VSO). Representatives from each of the partners attended the workshop, and made brief presentations about their specific commitments to the elimination of LF in the Pacific. 2.20 Discussion of issues and needs for monitoring and evaluation Dr Tom Burkot, Medical Entomologist, Centers for Disease Control and Prevention, led the discussions. After reviewing the country-specific momtonng and evaluation plans presented In the draft PacELF handbook, it was determined that countries needed assistance in the follOWIng areas: • Human resources; • • • • • • Technical support and training; Institutional Review Board issues; Mosquito control; ICT tests; Regional and national advocacy; and IEC materials in French and English.
3. CONCLUSIONS
The participants concluded that the draft PacELF handbook and data book should be further developed to provide country-specific guidance on monitoring, evaluation, and post-MDA activities. The guidelines in the handbook should be reviewed and approved prior to finalization. In addition, the handbook should serve as a resource for training and improving country capacity to undertake filariasis elimination. During the workshop, participants developed the following specific conclusions relatIng to morbidity control, advocacy, surveillance and integration: Morbidity control: • A morbidity assessment (e.g., hydrocele, lymphedema, acute filarial fevers) should be carried out to provide an estimate of cases for presentation at the next meeting.
Advocacy: • There should be lobbying to include LF elimination as a goal of the Healthy Islands Initiative.
- 22 -
•
Effective mechanisms should be developed, possibly through the Star Network, for providmg feedback on MDA successes, failures and constraints to relevant stakeholders. The high levels of political commitment to the goal ofLF elimination in the Pacific, should be maintained, particularly following completion of five successful MDA campaigns.
•
Surveillance: • Sensitive and cost-effective country surveillance systems to detect introduced or reemergent filariasis after five rounds ofMDA should be developed and integrated. Mechanisms should be established for sharing information on Imported cases with the country of origin for follow-up investigation.
•
Integration: • Country-specific integration plans that account for existing central structures, peripheral health service delivery, political and public health priorities, and available resources, should be designed. Appropriate vector control strategies for LF. malaria and dengue should be integrated, based on community knowledge of the diseases.
•
4. ACKNOWLEDGEMENTS
PacELF extends its appreciation to the Government of Fiji, WHO and GSK for sponsoring the Fifth Annual PacELF Workshop.
- 23 -
APPENDIX 1
PacELF Contact Details PacELF Office: Matai ka House, Tamavua, Suva Tel: (679) 3323 346 Fax : (679) 3323 341 E-mail: pacelf1@connect.com.fi
PacElF Staff: Dr. Kazuyo Ichimori Ms. Akiko Takamiya Mr. Yoshio Furuya Ms. Martha Colata Ms. Emma Gibbons
Team Leader Operational Officer Assistant Program Coordinator Promotion Project Coordinator WHO Secretary
PacELF Functions
- 25 -
APPENDIX 2
PacELF Progress
,--- ---- ---- ---- ---- ---- ---- ---- ---- ---- -- -Progress of MDA implementation in Pac ELF Updated after 5th PacELF Annual Meeting
-
1200000 '" 1000000 ~ 0 Co 800000 iii 600000 0 f400000 200000
c: 0 :;;
1800000 1600000 1400000
12 10
< 8 c 6 4 2 1999 .Q
:;; -o .!:! ~
Z
:::J
E
~ c: CD :::J 0
0
'"
a 2000 Year
a 2001 2002
I_
Total Population covered - - Number of countries implementing MDA I
MDA impact by Mf Prevalence Sentinel sites 16.0 14.0 CD tJ
12.0 10.0 8.0 6.0 4.0 2.0 0.0 SMA
c: ~
.. > CD ~
Il....
Ilil Initial Survey • M d-term Survey
I
I
==
VAN 'Country
- 27 -
APPENDIX 3
country programme by year
Country
1997
1998
1999
2000
2001
·2002
2003
countries)
Partially Endemic (4 cou ntries)
PacELF participation: March 1999 ": non resident Baseline Survey
_
Midterm Evaluation
FLOW CHART OF PACELF MDA AND ASSESSMENTS
> 0% prevalenc e overall?
" prevaJenc overa:ll?
> 1% prevalenc e some tv
'" 5- year incidenc
Continue
survei ll ance
"C
~
X .".
~
Endemicity category
Population size category
I Couutry
SURVEILLANCE GUIDELINES B: Mid-term C : Final prevalence Population I A : Baseline prevalence assessment prevalence assessment (sen tinel sites) assessment; in sentinel sites plus stratified c1nster or
D: Transmission assessment in scbool entering cbildren
< 10,000
Non-endemic 0% positive
Partially endemic 0-1% p ositive
w ~
10,00.0 200,000
Endemic
> 1% pos/iive
?; '"t:I
>< v.
~
- 33 -
APPENDIX 6
Data Information System (DIS)
1fl 6e
f D"' ~ e l .£l>. ::>· I ~ i!ollll<' ln- ~ -I".
, . " 0 Mass Drug Administration Data Navigator ,. t"iII. ~"'''' -11).
tdt ~. lr-t FIr'ftII:
1"" ~ ~
Heb
IILliIl!llllll!lLlIllIlSllI/IIIlJ!\If ...w2!l
::i
~
PacELF
-Pacific Programme to Eliminate Lymphatic Filariasis-
~~ Y,,2Q03
" . . \
I I
I·
~.
INPUT:
•
Input 1 ·I\ofJA & National Census Data (for Report 1-21-
mInput II. - MOA Darn bV Area (for Report 3)· OUTPUT:
.J See Report 1. .J See Report 2 . !!l See
. M)A Somm"" . - M)A Coverage by Age & Sex group-
Report 3. - MDA Coverage by Ares·
a Save' • •
Save'*" and Close Close without Save • FUll-Screen Toggle SWtch : [Ctr!] ... t ·
"Filename 4 pV\h" C 'PacELF Country Datal MDA.Q31001.(nll).xls If you prefEr to name thIS fll!! by yourself. plcao:e click 011 "tile' then 'save as' ,
- 35 -
APPENDIX 7
COUNTRY PARTICIPANTS AMERICAN SAMOA Mrs. Molisamoa Pa'au Associate Director Public Health Nursing Department of Health P.O. Box 631 Pago Pago Tel. No.: (684) 633 7224 Fax No.: (684) 633 5379 GUAM Ms. Lourdes Duguies Communicable Disease Control Coordinator III Supervisor Department of Public Health and Social Services Bureau of CDC P.O. Box2816 Agana, Guam 96932 Tel. No.: (671) 735 71541735 7135 Fax No.: (671) 734 147517357318 E-mail: laduguieslal.dphss.govguam.net KIRIBATI Dr. Ma. Christie Cabungcal Public Health Specialist Ministry of Health Tarawa Tel. No.: (686) 28330 Fax No.: c/o (686) 28188
COOK ISLANDS Mr. Charlie Ave Senior Health Inspector Public Health Department Ministry of Health P.O. Box 109 Tupapa, Avarua Rarotonga Tel. No.: (682) 29 110 Fax No.: (682) 29 100 E-mail: mata@health.gov.ck
FIR Dr. Josefa Koroivueta Chief Medical Officer National Centre for Scientific Services on Virology and Vector Borne Diseases Ministry of Health P.O. Box 2223 Government Buildings ~uva
NL\RSHALLISLANDS Dr. Kennar Briand Director of Public Health Ministry of Health P.O. Box 16 Majuro, MH 96960 Tel. No.: (692) 625 3355 Fax No.: (692) 625 3432 E-mail: briandk@ntamar.com
Tel. No.: Fax No.: E-mail:
(679) 332 0066 (679) 332 3276 ioekv@connect.com.fi
FRENCH POLYNESIA Dr. Daniel Dumont Head School Health Services Centre de la Mere et de I 'Enfant P.O. Box 1740 Papeete Tel. No.: (689) 509 170 Fax No.: (689) 436 653 E-mail: danieltevadumont@yahoo.com
FEDERATED STATES OF MICRONESIA Dr. Victor Ngaden Staff Physician Yap Health Services P.O. Box 148 Keng Weloy Colonia Yap 96943 Tel. No.: (691) 3502115 Fax No.: (691) 350-3444 E-mail: directordhsyap@mail.fm
- 36 -
NAURU Sister Gano Mwareow OIC CornmunitylPublic Health Acting Chief Nursing Officer Ron Hospital Department of Health Tel.lFax No.: (674) 444 3883 Ext 116 E-mail: ernmac126@hotmail.com
PAPUA NEW GUINEA Dr. James Wangi Acting Director Disease Control Branch National Department of Health P.O. Box 807 Waigani, N.C.D. Tel. No.: (675) 301 3708 Fax No.: (675) 3254515 E-mail: jwangi@health.gov.pg SAMOA Dr. Nu'ualofa Tu'u'au-Potoi Assistant Chief Executive Officer Preventive Health Services Ministry of Health Private Mail Bag Apia Tel. No.: (685) 21212 Ext. 376 Fax No.: (685) 21 106 SOLOMON ISLANDS Mr. Bernard Bakote'e DirectorNBDCP Ministry of Health SIMTRl, P.O. Box 349 Honiara Tel. No.: (677) 30655 Fax No.: (677) 20 085 E-mail: simtri@solomon.com.sb TOKELAU Dr. Tekie Timu Iosefa Director of Health Tokelau Apia Liaison Office Health Department Savalalo, Apia Samoa Tel. No.: (685) 20 822 Fax No.: (685) 21 761 Mobile: (685) 73618 E-mail: tekie.iosefa@clear.net.nz
NEW CALEDONIA Dr. Sylvie Tardieu Medecin Biologiste BP S Laboratoire CHNKoudac 98850 Koudac Tel. No.: (687) 772 169 Fax No.: (687) 243 702 E-mail: sylvietardieuia>.lagoon.nc NIUE Ms. Trishia Olaofa Tauasi Diagnostic Radiographer Lord Liverpool Hospital Alofi Tel. No.: (683) 4100 ext 852 Fax No.: (683) 4265 E-mail: xray@mail.gov.nu PALAU Dr. Helen Sokau Division of Communicable Disease Focal Point for Filariasis Program Ministry of Health P.O. Box 6027 Koror Tel. No.: (680) 488 2450 Fax No.: (680) 488 1211 E-mail: hns@palau-health.net
- 37 -
TONGA Dr. Viliami Puloka Medical Officer Special Grade In-Charge of Health Promotion and NCD Ministry of Health P.O. Box 59 Nuku'alofa Tel. No.: (676) 23 200 Fax No.: (676) 24 291 E-mail: mohtongaiiUkalianet.to
CONSULTANT Dr. Tom Burkot Research Entomologist National Center for Infectious Diseases Centers for Disease Control and Prevention Division of Parasitic Diseases 4770 Buford Highway Atlanta, GA 30341 United States of America Tel. No: (770) 488 3607 Fax No.: (770) 488 4258 E-mail: Tburkot@cdc.gov I txb9(a)cdc.gov
TUVALU Dr. Nese Ituaso Conway Acting Chief Public Health Ministry of Health clo Princess Margaret Hospital Funafuti Tel. No.: (688) 20 482 Ext 1291 Fax No.: (688) 20 481 E-mail: njtuaso@yahoo.com
TEMPORARY ADVISORS Dr. David Durrheim Associate Professor and Head School of Public Health and Tropical Medicine James Cook University . 7 Kendall Street Annandale, Townsville Queensland 4814 Australia Tel. No.: (617) 4781 5959 Fax No.: (617) 4781 5254 E-mail: David.Durrheim(a).jcu.edu.au Dr. Eric A. 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 No.: (404) 727 5530 E-mail: eottese@sph.emory.edu
VANUATU Mr. Morris Amos Acting Manager Malaria and other Vector Borne Diseases Ministry of Health Private Mail Bag 009 Port Vila Tel. No.: (678) 25 171/22512 Fax No.: (678) 25 438/26 204 E-mail: mamos@vanuatu.gov.vu
- 38 -
W ALLIS and FUfUNA Dr. Laurent Morisse Internist CD and NCD, VB Agence de Sante de Wallis et Futuna B.P. 49 Mata Utu 98600 Uvea Tel. No.: (681) 720 700 Fax No.: (681) 722 399 E-mail: lmorisse(a)wallis.co.nc sante.wf@wallis.co.nc Dr. Isao Tada Fonner Member, Global PRG on LF and Director Eijuen Elderly Care Institution Taaihei Hospital 14-7 Shinbaru, Sue, Kasuya-gun Fukuoka 811-2111 Japan Tel. No.: (8192) 921 7705 Fax No.: (8192) 921 7705 E-mail: isaotada@nifty.com
Professor Dato (Dr.) c.P. Ramachandran Faculty of Medicine & Health Sciences Universiti Putra Malaysia' 43400 UPM, Serdang Selangor Malaysia TeL No.: (603) 2698 7275 Fax No.: (603) 2695 6152 E-mail: ramacp@hotmail.com JAPAN INTERNATIONAL COOPERATION AGENCY (JICA) Mr. Takashi Toyama Assistant Resident Representative JICA Fiji Office JICA Private Mailbag Suva, Fiji Tel. No.: (679) 330 2522. Fax No.: (679) 3302452 E-mail: jica@connect.com.fj Mr. Mosese Waqa Research Associate JICA Fiji Office JICA Private Mailbag Suva, Fiji TeL No.: (679) 3302522 Fax No.: (679) 3302452 E-mail: iica@connect.com.fj
OBSERVERS CDC/AMERICAN SAMOA Mr. Jonathan King Public Health Advisor CDC Division of Parasitic Diseases American Samoa Department of Health Pago PagQ, AS 96799 Tel. No.: (684) 633 2135 Fax No.: (684) 633 2136 E-mail: jvk4(a)cdc.gov GLAXOSMITHKLlNE Dr. Mark Bradley Manager Scientific Support Lymphatic Filariasis Programme Global Community Partnerships Corporate Communications G laxoSmithKline GSK House, 980 Great West Road Brentford Middlesex, TW8 9GS United Kingdom Tel. No.: (4420) 8047 5521 Fax No.: (4420) 8047 0684 E-mail: mark.h.Bradley(a)gsk.com
Ms. Akiko Takamiya Senior Japan Overseas Cooperation Volunteer (JOCV-Fiji) PacELF Operational Officer Mataika House, Tamavua Suva, Fiji TeL No.: (679) 3323 346 Fax No.: (679) 3323 341 E-mail: pacem@connect.com.fj
- 39 -
JAMES COOK UNIVERSITY Dr. Shona Wynd Senior Social Scientist WHO Collaborating Center for the Control of Lymphatic Filariasis School of Public Health and Tropical Medicine James Cook University 7 Kendall Street Annandale, Townsville Queensland 4814 Australia Tel. No.: (617) 47815697 Fax No.: (617) 47815254 E-mail: Shona.Wvnd@jcu.edu.au NATIONAL CENTRE FOR SCIENTIFIC SERVICES ON VIROLOGY AND VECTOR BORNE DISEASES Dr. Ilisapeci Kubuabola Medical Officer National Center for Scientific Services on Virology and Vector Borne Diseases Mataika House, Building 30 Tamavua, Suva Fiji Tel. No.: (679) 3320066 Fax No.: (679) 3320 276
LIVERPOOL SCHOOL OF TROPICAL MEDICINE Ms. Joan Fahy Programme Coordinator Lymphatic Filariasis Support Centre Liverpool School of Tropical Medicine Pembroke Place Liverpool L3 5QA United Kingdom Tel. No.: (44 151) 7053145 Fax No.: (44 151) 709 0354 E-mail: fahy@livemoo1.ac.uk
SECRETARIAT WHOIHQ Dr. Sergio Yactayo Epidemiologist Lymphatic Filariasis Elimination (CPE/CEE) Communicable Diseases Eradication and Elimination World Health Organization CH-1211 Geneva 27 Switzerland Tel. No.: (4122) 791 2767 Fax No.: (4122) 791 4777 E-mail: yactayos@who.int WHOIWPRO Dr. Kazuyo Ichimori Scientist Office of the WHO Representative in the South Pacific Level 4 Provident Plaza One Downtown Boulevard 33 Ellery Street Suva, Fiji Tel. No.: (679) 3304 600 Fax No.: (679) 3300462 E-mail: IchimoriK@sp.wpro.who.int
Sister Ateca Lepper National Center for Scientific Services on Virology and Vector Borne Diseases Mataika House, Building 30 Tamavua, Suva, Fiji Tel. No.: (679) 3320 066 Fax No.: (679) 3320 276
- 40 -
VOLUNTEER SERVICE OVERSEAS (VSO) Ms. Margaret Fraser VSO Volunteer Filariasis Prograrrune Voluntary Service Overseas Vanuatu Programme Office P.O. Box 514 Port Vila, Vanuatu Tel. No.: (678) 26508 Fax No.: (678) 24311 E-mail: vso(a).vanuatu.com.vu
Dr. Dapeng Luo Scientist Office of the WHO Representative in Papua New Guinea 4th Floor, AOPI Centre Waigani Drive Papua New Guinea TeL No.: (675) 325 7827 Fax No.: (675) 325 0568 E-mail: loudlal.png. WPrD. who.int
Mr. Yoshio Furuya PacELF Assistant Programme Coordinator Office of the WHO Representative in the South Pacific Level 4 Provident Plaza One Downtown Boulevard 33 Ellery Street Suva, Fiji Tel. No.: (679) 3304 600 Fax No.: (679) 3300 462 E-mail: furuyayllilsp.woro.who.int
- 41 -
APPENDIX 8
PROGRAMME OF WORK Monday, 22 September 2003
0800 0900
Registration Opening ceremony Opening remarks - Regional Director, WPRO Opening address - Minister of Health, Fiji Self-Introductions Designation of Chairman, Vice-Chairman and Rapporteur Administrative Announcement Group photograph
1000 1030
Coffee break Introduction to the Workshop - Dr. Thomas Burkot PacELF Update - Dr. Kazuyo Ichimori Mekong Plus ELF - Professor c.P. Ramachandran Americas ELF - Dr. Eric Ottesen Global ELF - Dr. Sergio Yactayo Lunch break Country reports • • • • American Samoa Cook Islands Federated States of Micronesia Fiji
1200 1330
1500 1530
Coffee break Continuation of country reports
• • • •
French Polynesia Guam Kiribati Marshall Islands
- 42 -
Tuesday, 23 September 2003
0800
Continuation of country reports • • • • • Nauru New Caledonia Niue Northern Mariana Islands Palau
1000 1030
Coffee break Continuation of country reports • • • • Papua New Guinea Samoa Solomon Islands Tokelau
1200 1330
Lunch break Continuation of country reports • • • • Tonga Tuvalu Vanuatu Wallis and Futuna
1500 1530 1600
Coffee break Summary of country reports - Professor C.P. Ramachandran Pacific Handbook and Databook - Dr. Thomas Burkot and Dr. Kazuyo Ichimori
------- - --
- 43 -
Wednesday, 24 September 2003
0800 0830 0930 1000 1030 1100
Monitoring and Evaluation - Dr. Enc Ottesen Serious Adverse Events - Dr. Mark Bradley Disability Identification and Morbidity Survey - Dr. Eric Ottesen Coffee break Social Mobilization and Communication - Dr. David Durrheim KAP study and IEC materials - Mr. Jonathan King and Ms. Margaret Fraser Entomology and Vector Control - Dr. Tom Burkot Lunch break Integration Helminth Control- Dr. Kazuyo Ichimori (Kiribati) Dengue Control - Dr. Joe Koroivueta (Cook Islands, Fiji, Tonga, Wallis and Futuna) Malaria Control- Dr. Tom Burkot (Vanuatu)
1130
1200 1330
1500 1530
Coffee break Group Work: Countrv Plan for Surveys Group 1: Group 2: Group 3: Group 4: Non-Endemic Partially Endemic Endemic (small) Enderruc (large
- 44 -
Thursday, 25 September 2003
0800 0830 0900 1000 1030 1100
PacELF Administration and supplies - PacELF Office Team ApplicationlRequest Fonns - PacELF Office Team Action Plan for 2004 - PacELF Office Team Coffee break Star Network and PacELF Website - PacELF Office Teanl Data Infonnation System (DIS) Reporting - PacELF Office Team PacELF documents and IEC - PacELF Office Team Lunch break Group Discussion - PacELF Future Team 1: Team 2: Team 3: Team 4: Team 5: Integration (Moderator: Dr. David Durrheim) Advocacy/Political Commitment (Moderator: Dr. Joe Koroivueta) Operational Research (Moderator: Dr. Tom Burkot) Surveillance (Moderator: Dr. Mark Bradley) Morbity (Moderator Dr. Eric Ottesen)
1130 1200 1330
1500 1530
Coffee break Continuation of Group Discussion
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Friday, 26 September 2003
0800 0900 1000 1030 1200 1300 1400 1530
Presentation of Group Discussion - Dr. David Durrheim PacCARE Report and PacCARE Membership - Chairperson, PacCARE Coffee break Presentations by Partners - CDC, Emory University, GSK, JCU, JICA, Liverpool LF Centre, MOIDJPN, UNV, VSO Lunch Break Conclusions and Recommendations - Dr. David Durrheim, Dr. Tom Burkot, and Dr. Kazuyo Ichimori Closing Ceremony PacCARE Meeting
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APPENDIX 9
OPENING REMARKS OF THE REGIONAL DIRECTOR AT THE FIFTH ANNUAL WORKSHOP ON FILARIASIS ELIMINATION IN THE PACIFIC 22-26 SEPTEMBER 2003, LAUTOKA, FIJI
Honourable Minister of Health, representatives from our partners, participants, colleagues, ladies and gentlemen: It is my sincere pleasure to welcome you once again to the fifth annual PacELF programme managers meeting here in Lautoka. I wish to thank the Government of Fiji for arranging such a beautiful venue for this year's meeting. I sincerely regret not being able to join you this week, but please be assured that I shall fully support you, your colleagues and the people ofthe Pacific towards the elimination oflymphatic filariasis.
I would like to welcome our partners including the Government of Japan, nCA, CDC, GlaxoSmithKline, Liverpool Support Centre, Emory University, James Cook University, UNDPIUNV and Mataika House and also our colleague from Geneva. Your combined support has enabled the countries of Pac ELF to accomplish what will be reported on during the next few days. During the next four days you will have a very full agenda. It is essential, however, that you reach agreement on the adoption of the new set of PacELF guidelines. You will see that section three of the guideline sets out the criteria and sampling methods for measuring the impact of your five years of mass drug administration. The criteria and methods proposed may be different for each country because they take into account the unique epidemiological situation for the Pacific island nations. Therefore, I urge you to carefully consider the sample method being proposed in your country and in doing so, ensure that the method is practical and, most importantly, feasible to accomplish. I also urge you to seriously consider the next steps, beyond MDA. First, each country should carry out a morbidity survey to identify chronic cases of elephantiasis and hydrocoele. With this survey, the victims of symptomatic lymphatic filariasis can be targeted and properly managed. Second, you should carefully consider the application of mosquito control strategies. Ideally, mosquito control should be part of an integrated vector control strategy that includes dengue and, in some countries, malaria. Third, an effective surveillance mechanism needs to be established to ensure that lymphatic filariasis does not surreptitiously return once declared eliminated. Finally, I urge you to consider integrating lymphatic filariasis activities with· other programmes, especially the control of soil-transmitted helminths. The integration of these two programmes was discussed in past PacELF meetings and a few countries have taken up the challenge. I urge those countries that have not yet done so to reconsider. By integrating the two programmes, the energy and resolve that has driven the lymphatic filariasis elimination programme in the Pacific would carry on to reduce the scourge that soil transmitted helminths place on our children. There is absolutely no reason or excuse why we cannot eliminate the handicap of worms from our children's development.
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PacELF remains a shining example of what a region can do if everyone works together to eliminate an old and debilitating disease such as lymphatic filariasis. Many of you nnght know that two weeks ago during the 54th Regional Committee held in Manila, I cited PacELF as an example of how countries, by working together, could accomplish great things. WHO is proud to have been your partner in the reduction of lymphatic filariasis and it looks forward to continued upport towards your efforts of eliminating lymphatic filariasis from the Pacific by 2010. Together, we can do it. Thank you and I hope that you have a pleasant week here in Lautoka.
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APPENDIX 10
Opening Address On the Official opening of the 5th Annual Meeting for the Pacific programme to Eliminate Lymphatic Filariasis Mon 22 nd
Sept 2003, Waterfront Hotel, Lautoka
By Mr. Luke Rokovada, Fiji Permanent Secretary for Health
The Representative of the Global Programme, WHO Headquarters, Geneva; The Pacific Team Leader, Dr Kazuyo Ichimori; Dr Nualofa, Dr Koroivueta. WHO Technical Advisors; Members of the PacELF Secretariat; International Developmental Partners; GlaxoSmithKline, Government of Japan, Liverpool University, Emory University and James Cook University; Distinguished Speakers, Delegates and Participants, Ladies and Gentlemen. I would like to convey the apology of the minister for Health, Hon. Solomoni Naivalu who is unable to be with you today. He is touring the Lomaiviti Group oflslands with other Cabinet members which includes Dr. Joe Koroivueta's Island of Nairai. First of all let me say Bula Vinaka to you all, a very good morning and a very warm and heartIest welcome of the Fiji Islands. We are privileged as a nation to welcome all of you as true Pacific friends and colleagues working closely together for a common goal in health. Also, let me thank foremost, the continued support and assistance provided by WHO, the Global Alliance Members and our International Development Partners in facilitating this annual meeting and having absolute confidence to having it here in Fiji and the implementation ofthe PacELF Programme as a whole in the region. I am indeed pleased and honored to be here this morning to share a few thoughts with you at this very crucial point in tine where the PacELF Programme stands proud in the world today as far as the elimination programme is concerned. Since its conception in 1999 and the nurturing period thereafter you, as PacELF Members, have been persistent in tackling the knowns and the unknowns. You have been involved in many forums like this where you have discussed, deliberated and shared your country experiences in the elimination initiative. That has provided new insights and openings into the way PacELF has been driven. Consequently, the road this far has been long and winding. There would have been times of turbulence and rectification. There have been times of personal and professional sacrifices. The challenges you encountered have been treaded upon with great understanding, enthusiasm and commitment. I congratulate you all for that.
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PacELF is looked upon as a model to the world. It is open to close scrutiny to obtain valuable lessons for other regions and other Pacific based elimination initiatives in public health. I salute the Pacific effort and all the network partners that have been there to provide solutions, techmcal assistance and above all the logistic support needed to facilitate the implementation of the programme. This annual convention will be the opportune time to reflect on your performance last year and then strategize on areas of improvement for the next twelve months. Proper plannmg, coordination, monitoring and evaluation are key components in the harmonization of your national programmes. There would also be presentation updates in the new information and products that will be of immense benefit and application to the programme. This forum will also be a high call advocacy campaign for our community. Social mobilization is a crucial factor for the successful outcome of Lymphatic Filariasis an d this needs to be addressed repeatedly by you as programme managers and facilitators. Hence, this meeting also provides the opportunity to make recommendations and to advocate pressing regional issues in infectious disease control strategies that should be highlighted in the next Pacific Ministers Meeting to be held here in Fiji from the 10 th - 11th Nov this year. Thls is forward thInking by PacELF, which undoubtedly will provide some substance in the framework to this year's theme "Pacific Response to Infectious Diseases". My Ministry is committed to the tasks under PacELF Plan of Action and Strategies for the elimination of Lymphatic Filariasis. We did our first round ofMDA in 2002 for which over 550,000 individuals received their Filariasis medications. This year as Fiji embarks on the second round of MDA, we aim to improve our performance compared to last year by 15%. This sets our target to 85% or even higher. By WHO definition it is acknowledged that we will never reach 100% coverage rate but we will try our very best to keep improving our performance in the national MDA programme. I also commend the efforts and persistence of the Government of Western Samoa, who would be completing 5 rounds of annual treatment and looking towards the mopping up phase for the final certification assessment. So congratulations to our colleagues from Western Samoa. For the other countries, let me encourage you to show courage and strength to shoulder the tasks ahead. The job is not yet done until we have validated and confirmed the elimination of Lymphatic Filariasis from the region. This will be a challenge to PacELF and one that you should stand fast and firm to in your daily reflections. Within the last three weeks, Fiji hosted the very first EpiNET meeting of the Pacific health Surveillance Network followed by the Pacific Public Health laboratory Network Meeting and now the5th PacELF Meeting and some of you distinguished co\leagues had participated in these forums. This not only reflects the mUltiple important roles you play in public health but also the zeal and commitment you are entrusted in to ensure that you tackle and keep the PacELF ship sailmg in the right directions with wider and broader horizons ahead in the Pacific. That is what
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the public health entails in our part of the world given the scarcity of human resources and the need to envelope the widening initiatives in public health. As mentioned during the recent SARS epidemic, the world has become a mere global village through fast international air travel and has become more exposed to threats of new and reemerging infectious diseases due to rapid urbanization and increasing interactions of humans and vectors and this place an important responsibility to all of you to be vigilant, targeted, strategic and be well prepared fir future epidemics. History has shown emergence and reemergence of diseases such as Dengue, Leptospirosis, Cholera, Typhoid, Influenza and Measles in the Pacific Region and the human and economic impact it has on our population and limited resources. The Pacific cannot be complacent to the threats of outbreak of communicable diseases and the threats of bio terrorism. The onus is for all of us to play proactive roles in disease prevention so that our surveillance network is able to meet the monumental tasks ahead. Our region will count on your expertise and vision in pulling our skills, knowledge and expertise and other resources together for effective surveillance network and response, collaborating extensively and more so communicating for awareness, coordination, and collaboration on these emerging and reemerging Public Health issues. I am convinced without any doubt whatever, that Lautoka will fulfill some of the exotic tropical settings for our visitors who have traveled from Americas and the European continent. Fiji is blessed not to have anopheles mosquito so your risk of catching malaria is not an issue. We too like other Pacific neighbors have not had any clinical case ofSARS. We encourage you all to adventure in safely to interesting sites around here to see and learn first hand our culture, people and society at large. May I express my sincere wishes that your meeting will be a successful and shining one and wish you the very best in your deliberations and discussions and hope the objectives of this meeting will be achieved. I look forward to receiving any resolutions and recommendations from this meeting. It is my hope too that in this symposium the bonds of friendship and partnership will take PacELF to newer heights. It is on this very note that I have the greatest honor and pleasure of welcoming you and to officially declare the 5 th Annual PacELF Meeting open. May God bless us all. Thank you.
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APPENDIX II
IMAGINE PacELF By John Lennon (Modified by P. Graves and K. Ichimori)
VERSE 1 Imagine there's no mossies, C C C C Cmai7 Cmai7 F Cmai7 F Cmai7 F F
It's easy if you try, No bites upon us, Or buzzing in the sky, Imagine all the people F G Am Dm G7
Living life worm-free .... oh oh, o-o-oh VERSE 2 Imagine PacELF countries, It isn't hard to do, No albendazole, No DEC too, Imagine all the nurses, Living life in peace ....... oh oh, o-o-oh CHORUS You may say I'm a dreamer, F F F F G G
G G
C C C C
E7 E7 E7
But I'm not the only one, I hope some day you'll join us, And filariasis will soon be gone. VERSE 3 Imagine no disease, I wonder if you can, No elephantiasis, Or hydrocoele for man, Imagine all the islanders, Nothing left to do ....... oh oh, o-o-oh Repeat CHORUS
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Outcome by the Evaluation sheet for the 5th PacELF Annual Meeting in Lautoka, Fiji 22-26 September 2003 26 attendees replied
16 11 II
10 14 14 II
0 0
0
0 0 0 2
13 18 19 15 14 14 11 16 15 13 11 11 14 14 16 16 14 13 13
7 7
0 0
0 0 0
11 12 11 13
0 0
10 8
0
0 2
11 13
2
0
12 11 12 9 10 II
2 0
0
0
0 0 0 0 0 0
13
0
12 11 8 8 9
12 17
2 0 0 0 0
18 17
0 0 0 0
25 20 6
0