Objective:To compare Wuchereria bancrofti(W.bancrofti)infection rates of Culex quinquefasciatus,using dissection and PCR-EUSA in two consecutive time periods(from 2007to 2008 and from 2008 to 2009).Methods:Mosquitoes ...Objective:To compare Wuchereria bancrofti(W.bancrofti)infection rates of Culex quinquefasciatus,using dissection and PCR-EUSA in two consecutive time periods(from 2007to 2008 and from 2008 to 2009).Methods:Mosquitoes were collected in 30 sentinel and 15 nonsentinel sites in 15 Medical Officer of Health areas of Gampaha District known for the presence of W.bancrofti transmission in two consecutive time period of 2007 to 2008 and 2008 to 2009.Captured mosquitoes were dissected to determine the W.bancrofti larvae(L_1 L_2,L_3,).PCR was carried out using DNA extracted from mosquito pools(15 body parts/pool)utilizing the primers specific for Wb-Sspl repeat.PCR products were analyzed by hybridization ELISA using fluorescein-labeled wild type specific probes.The prevalence of infected/infective mosquiloes in PCR pools(3 pools/site)was estimated using the PoolSereen^(TM)algorithm and a novel probability—based method.Results:Of 45 batches of mosquitoes dissected,W.bancrofti infected mosquitoes were found in19 and 13 batches,with an infection rate of 13.29%and 3.10%with mean larval density of 8.7 and1.0 larvae per mosquito for two study periods in the Gampaha District.Total of 405 pools of head,thorax and abdomen were processed by PCR-EUSA for each year.Of these,51 and 31 pools were positive for W.bancrofti in the two study periods respectively.The association of dissection based prevalence rates with PCR based rates as determined by the Pearson correlation coefficient were0.176 and 0.890 respectively for the two periods.Conclusions:Data indicate that PCR-EUSA is more sensitive than the traditional dissection techniques for monitoring transmission intensity.展开更多
The study reports the prevalence of bancroftiasis in three Local Government Areas (LGAs) of Taraba State, Nigeria. Night blood samples collected from one thousand and thirty one individuals were stained with haematoxy...The study reports the prevalence of bancroftiasis in three Local Government Areas (LGAs) of Taraba State, Nigeria. Night blood samples collected from one thousand and thirty one individuals were stained with haematoxylin and examined microscopically for the presence of Wu-chereria bancrofti. The overall prevalence of infection in the study area was high (21.2%) but mean microfilaria densities were generally low. Statistically, prevalence rate differed significantly (χ2d.f.2 = 10.498;P χ2d.f.1 = 1.385;P > 0.05) between sexes. Infection also did not statistically differ between age groups (χ2d.f.5 = 13.219;P > 0.05) even though infection rate increased steadily with age and reaching a peak at the 40 - 49 year age group. Lymphoe-dema was the commonest (M = 12.4%, F = 19.2%) clinical manifestation of bancroftian morbidity encountered in the survey. Overall, the findings indicate that bancroftian filariasis is a public health problem in Taraba state and there is an urgent need to establish an elimination programme with a view of halting transmission in the area.展开更多
<strong>Objective:</strong> To study the value of the filarial dance sign as a diagnostic sign in scrotal ultrasonography in human Bancroftian filariasis. <strong>Methods:</strong> We studied 3...<strong>Objective:</strong> To study the value of the filarial dance sign as a diagnostic sign in scrotal ultrasonography in human Bancroftian filariasis. <strong>Methods:</strong> We studied 3 patients with scrotal pain, with high-resolution ultrasonography (HRUS) of scrotum including power and color Doppler study. All patients underwent peripheral blood smear. <strong>Results:</strong> Multiple cystic spaces containing motile echogenic twisted tubular structures were observed in the 3 patients. Peripheral blood smears in the 3 patients confirmed the presence of microfilaria. Mild hydrocele in two patients. <strong>Conclusions:</strong> HRUS is a useful technique for diagnosing scrotal filariasis in symptomatic patients and is very useful in the follow-up treatment.展开更多
<b><span style="font-family:Verdana;">Introduction:</span></b><span style="font-family:Verdana;"> Lymphatic filariasis (LF) and malaria are two vector-borne</span&g...<b><span style="font-family:Verdana;">Introduction:</span></b><span style="font-family:Verdana;"> Lymphatic filariasis (LF) and malaria are two vector-borne</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> diseases which parasites can simultaneously infect human or mosquito. In Burkina Faso, studies mainly focused on the control of these diseases independently. Hence, there is a lack of information on their co-transmission of to both human and vector. The present study aimed at providing baseline data </span><span style="font-family:Verdana;">from endemic areas in Burkina Faso towards a successful integrated man</span><span><span style="font-family:Verdana;">agement of both diseases. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> The study was carried out in six sites</span></span><span style="font-family:Verdana;"> dist</span><span style="font-family:Verdana;">ributed in the East, Center-East and South-West regions of Burkina Faso. </span><span style="font-family:Verdana;">Data were collected in August 2014 and September 2015. The infection rates in human and vector populations, vector diversity, trophic and resting behavior were investigated. To determine the disease prevalence nocturnal finger-</span></span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">p</span><span style="font-family:Verdana;">rick blood sample and microscopic observations were performed. Vect</span><span style="font-family:Verdana;">ors </span><span style="font-family:Verdana;">collected by human landing catches and pyrethrum spray collections. Bio</span><span style="font-family:Verdana;">chemical and molecular analyses were performed to identify <i></i></span><i><i><span style="font-family:Verdana;">Anopheles gam</span><span><span style="font-family:Verdana;">biae </span><span style="font-family:Verdana;">sensu lato</span></span></i></i></span><b><span> </span></b><span style="font-family:Verdana;">sibling species, and to determine vector infection rate and</span><span style="font-family:Verdana;"> their blood meal origins. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Results indicate residual transmission of LF and malaria in human and vector populations. A low co-infection rate (<1%) with <i></i></span><i><i><span style="font-family:Verdana;">Wuchereria bancrofti</span></i></i><span style="font-family:Verdana;"> and <i></i></span><i><i><span style="font-family:Verdana;">Plasmodium falciparum</span></i></i><span style="font-family:Verdana;"> was noted in both human and mosquito. <i></i></span><i><i><span style="font-family:Verdana;">Anopheles gambiae s.l.</span></i><span> </span><i><span style="font-family:Verdana;"></span></i></i><span style="font-family:;" "=""><span style="font-family:Verdana;">, <i></i></span><i><i><span style="font-family:Verdana;">An. funestus s.l.</span></i></i></span><i><span> </span><i><span style="font-family:Verdana;"></span></i></i><span style="font-family:;" "=""><span style="font-family:Verdana;"> and <i></i></span><i><i><span style="font-family:Verdana;">An. nili</span></i></i></span><span style="font-family:Verdana;"> were by order the main potential vectors encountered. It was in majority parous females and exhibited endophagic and exophagic behavior. Parasite’s co-infec</span><span style="font-family:;" "=""><span style="font-family:Verdana;">tion was found with <i></i></span><i><i><span style="font-family:Verdana;">An. coluzzii</span></i></i></span><span style="font-family:Verdana;"> and <i></i></span><i><i><span style="font-family:Verdana;">An. nili</span></i></i><span style="font-family:Verdana;"> only. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> The present study has provided basic information on the (co-)transmission of both diseases in the study areas. These results will be useful for further investigations towards the development and implementation of a better integrated strategy to control these diseases.</span>展开更多
There are two species of filarial parasites with sheathless microfilariae known to commonly cause parasitaemias in humans:Mansonella perstans and Mtinsonella ozzardi.In most contemporary accounts of the distribution o...There are two species of filarial parasites with sheathless microfilariae known to commonly cause parasitaemias in humans:Mansonella perstans and Mtinsonella ozzardi.In most contemporary accounts of the distribution of these parasites,neither is usually considered to occur anywhere in the Eastern Hemisphere.However,Sir Patrick Manson,who first described both parasite species,recorded the existence of sheathless sharp-tailed Mansonella ozzardilike parasites occurring in the blood of natives from New Guinea in each and every version of his manual for tropical disease that he wrote before his death in 1922.Manson's reports were based on his own identifications and were made from at least two independent blood sample collections that were taken from the island.Pacific region Mansonella perstans parasitaemias were also later(in 1923) reported to occur in New Guinea and once before this(in 1905) in Fiji.Although Mansonella-parasilaernias are generally regarded as benign,they are thought to be of public health importance because they can affect the epidemiological monitoring of other filarial diseases.In this article,we reviewed the historic literature concerning Pacific-origin Mansonella-parasitaemias in an attempt to explain how,despite repeated reports of Pacificregion Mansonella-parasilaemias,by as early as the 1970 s,the WHO had arrived at the presentday view that Wuchereria bancrofti is the only cause of filarial parasitaemias in Papua New Guinea.We have also evaluated the evidence supporting the contemporary existence of Pacificarea parasitaemia-causing Mansonella parasites and assessed the relevance such parasites could have for present-day lymphatic filariasis elimination efforts in the region.展开更多
Background:The Global Programme to Eliminate Lymphatic Filariasis(GPELF)was launched in response to the call proposed at the 50th World Health Assembly.The goal of the GPELF is to ensure that all the countries where t...Background:The Global Programme to Eliminate Lymphatic Filariasis(GPELF)was launched in response to the call proposed at the 50th World Health Assembly.The goal of the GPELF is to ensure that all the countries where the disease is endemic would have been transmission-free or would have entered post-intervention mass drug administration(MDA)surveillance by 2020.However,several countries are still not on track to discontinue MDA as planned.Thus,issues remain regarding the achievement of stated goals and how to effectively monitor the disease in the post-control and post-elimination phases.Main text:China was once a lymphatic filariasis(LF)endemic country with heavy disease burden.There were three milestones in the LF control phase of China,including:the proposal that the major focus of the control strategy should be on infectious sources;the three regimens of diethylcarbamazine(DEC)administration according to LF endemic extent;and the establishment of the threshold for LF transmission interruption.It has been ten years since China entered the post-elimination stage(declaration of LF elimination in China was in 2007).Two schemes and a diagnostic criterion were issued to guide all levels of disease control and prevention workers that conduct LF surveillance,as well as those caring for chronic filariasis patients.Regular training courses are held to maintain LF control skills in grass-root institutions.The Notifiable Diseases Reporting System,which included LF in 2004,plays an important role in LF post-elimination surveillance.Until now,no resurgence of LF cases has been detected,except for LF residue foci being found in Fuchuan County of the Guangxi Zhuang Autonomous Region.To confirm that transmission is no longer achievable after a decade since the declaration of LF elimination in China,it is expected within the next two years a transmission assessment survey,conducted in previous LF-endemic areas.Conclusions:DEC-fortified salt can help accelerate the progress of GPELF before the sprite phase.Sophisticated diagnostic criteria,systematic surveillance regimes,the Direct Network Report system,and regular trainings can effectively prevent the recrudescence of LF during surveillance phases.展开更多
Background:Lymphatic filariasis(LF)is endemic in Myanmar and targeted for elimination.To highlight the National Programme to Eliminate Lymphatic Filariasis(NPELF)progress between 2000 and 2014,this paper describes the...Background:Lymphatic filariasis(LF)is endemic in Myanmar and targeted for elimination.To highlight the National Programme to Eliminate Lymphatic Filariasis(NPELF)progress between 2000 and 2014,this paper describes the geographical distribution of LF,the scale-up and impact of mass drug administration(MDA)implementation,and the first evidence of the decline in transmission in five districts.Methods:The LF distribution was determined by mapping historical and baseline prevalence data collected by NPELF.Data on the MDA implementation,reported coverage rates and sentinel site surveillance were summarized.A statistical model was developed from the available prevalence data to predict prevalence at township level by year of measurement.Transmission assessment survey(TAS)methods,measuring antigenemia(Ag)prevalence in children,were used to determine whether prevalence was below a level where recrudescence is unlikely to occur.Results:The highest baseline LF prevalence was found in the Central Valley region.The MDA implementation activities scaled up to cover 45 districts,representing the majority of the endemic population,with drug coverage rates ranging from 60.0%to 98.5%.Challenges related to drug supply and local conflict were reported,and interrupted MDA in some districts.Overall,significant reductions in LF prevalence were found,especially after the first 2 to 3 rounds of MDA,which was supported by the corresponding model.The TAS activities in five districts found only two Ag positive children,resulting in all districts passing the critical threshold.Conclusion:Overall,the Myanmar NPELF has made positive steps forward in the elimination of LF despite several challenges,however,it needs to maintain momentum,drawing on international stakeholder support,to aim towards the national and global goals of elimination.展开更多
基金Supported by the WHO/SEARO/TDR(Grant No.SN 1152)University of Kelaniya(Research Grant No.RP/03/04/06/01/2006)
文摘Objective:To compare Wuchereria bancrofti(W.bancrofti)infection rates of Culex quinquefasciatus,using dissection and PCR-EUSA in two consecutive time periods(from 2007to 2008 and from 2008 to 2009).Methods:Mosquitoes were collected in 30 sentinel and 15 nonsentinel sites in 15 Medical Officer of Health areas of Gampaha District known for the presence of W.bancrofti transmission in two consecutive time period of 2007 to 2008 and 2008 to 2009.Captured mosquitoes were dissected to determine the W.bancrofti larvae(L_1 L_2,L_3,).PCR was carried out using DNA extracted from mosquito pools(15 body parts/pool)utilizing the primers specific for Wb-Sspl repeat.PCR products were analyzed by hybridization ELISA using fluorescein-labeled wild type specific probes.The prevalence of infected/infective mosquiloes in PCR pools(3 pools/site)was estimated using the PoolSereen^(TM)algorithm and a novel probability—based method.Results:Of 45 batches of mosquitoes dissected,W.bancrofti infected mosquitoes were found in19 and 13 batches,with an infection rate of 13.29%and 3.10%with mean larval density of 8.7 and1.0 larvae per mosquito for two study periods in the Gampaha District.Total of 405 pools of head,thorax and abdomen were processed by PCR-EUSA for each year.Of these,51 and 31 pools were positive for W.bancrofti in the two study periods respectively.The association of dissection based prevalence rates with PCR based rates as determined by the Pearson correlation coefficient were0.176 and 0.890 respectively for the two periods.Conclusions:Data indicate that PCR-EUSA is more sensitive than the traditional dissection techniques for monitoring transmission intensity.
文摘The study reports the prevalence of bancroftiasis in three Local Government Areas (LGAs) of Taraba State, Nigeria. Night blood samples collected from one thousand and thirty one individuals were stained with haematoxylin and examined microscopically for the presence of Wu-chereria bancrofti. The overall prevalence of infection in the study area was high (21.2%) but mean microfilaria densities were generally low. Statistically, prevalence rate differed significantly (χ2d.f.2 = 10.498;P χ2d.f.1 = 1.385;P > 0.05) between sexes. Infection also did not statistically differ between age groups (χ2d.f.5 = 13.219;P > 0.05) even though infection rate increased steadily with age and reaching a peak at the 40 - 49 year age group. Lymphoe-dema was the commonest (M = 12.4%, F = 19.2%) clinical manifestation of bancroftian morbidity encountered in the survey. Overall, the findings indicate that bancroftian filariasis is a public health problem in Taraba state and there is an urgent need to establish an elimination programme with a view of halting transmission in the area.
文摘<strong>Objective:</strong> To study the value of the filarial dance sign as a diagnostic sign in scrotal ultrasonography in human Bancroftian filariasis. <strong>Methods:</strong> We studied 3 patients with scrotal pain, with high-resolution ultrasonography (HRUS) of scrotum including power and color Doppler study. All patients underwent peripheral blood smear. <strong>Results:</strong> Multiple cystic spaces containing motile echogenic twisted tubular structures were observed in the 3 patients. Peripheral blood smears in the 3 patients confirmed the presence of microfilaria. Mild hydrocele in two patients. <strong>Conclusions:</strong> HRUS is a useful technique for diagnosing scrotal filariasis in symptomatic patients and is very useful in the follow-up treatment.
文摘<b><span style="font-family:Verdana;">Introduction:</span></b><span style="font-family:Verdana;"> Lymphatic filariasis (LF) and malaria are two vector-borne</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> diseases which parasites can simultaneously infect human or mosquito. In Burkina Faso, studies mainly focused on the control of these diseases independently. Hence, there is a lack of information on their co-transmission of to both human and vector. The present study aimed at providing baseline data </span><span style="font-family:Verdana;">from endemic areas in Burkina Faso towards a successful integrated man</span><span><span style="font-family:Verdana;">agement of both diseases. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> The study was carried out in six sites</span></span><span style="font-family:Verdana;"> dist</span><span style="font-family:Verdana;">ributed in the East, Center-East and South-West regions of Burkina Faso. </span><span style="font-family:Verdana;">Data were collected in August 2014 and September 2015. The infection rates in human and vector populations, vector diversity, trophic and resting behavior were investigated. To determine the disease prevalence nocturnal finger-</span></span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">p</span><span style="font-family:Verdana;">rick blood sample and microscopic observations were performed. Vect</span><span style="font-family:Verdana;">ors </span><span style="font-family:Verdana;">collected by human landing catches and pyrethrum spray collections. Bio</span><span style="font-family:Verdana;">chemical and molecular analyses were performed to identify <i></i></span><i><i><span style="font-family:Verdana;">Anopheles gam</span><span><span style="font-family:Verdana;">biae </span><span style="font-family:Verdana;">sensu lato</span></span></i></i></span><b><span> </span></b><span style="font-family:Verdana;">sibling species, and to determine vector infection rate and</span><span style="font-family:Verdana;"> their blood meal origins. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Results indicate residual transmission of LF and malaria in human and vector populations. A low co-infection rate (<1%) with <i></i></span><i><i><span style="font-family:Verdana;">Wuchereria bancrofti</span></i></i><span style="font-family:Verdana;"> and <i></i></span><i><i><span style="font-family:Verdana;">Plasmodium falciparum</span></i></i><span style="font-family:Verdana;"> was noted in both human and mosquito. <i></i></span><i><i><span style="font-family:Verdana;">Anopheles gambiae s.l.</span></i><span> </span><i><span style="font-family:Verdana;"></span></i></i><span style="font-family:;" "=""><span style="font-family:Verdana;">, <i></i></span><i><i><span style="font-family:Verdana;">An. funestus s.l.</span></i></i></span><i><span> </span><i><span style="font-family:Verdana;"></span></i></i><span style="font-family:;" "=""><span style="font-family:Verdana;"> and <i></i></span><i><i><span style="font-family:Verdana;">An. nili</span></i></i></span><span style="font-family:Verdana;"> were by order the main potential vectors encountered. It was in majority parous females and exhibited endophagic and exophagic behavior. Parasite’s co-infec</span><span style="font-family:;" "=""><span style="font-family:Verdana;">tion was found with <i></i></span><i><i><span style="font-family:Verdana;">An. coluzzii</span></i></i></span><span style="font-family:Verdana;"> and <i></i></span><i><i><span style="font-family:Verdana;">An. nili</span></i></i><span style="font-family:Verdana;"> only. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> The present study has provided basic information on the (co-)transmission of both diseases in the study areas. These results will be useful for further investigations towards the development and implementation of a better integrated strategy to control these diseases.</span>
文摘There are two species of filarial parasites with sheathless microfilariae known to commonly cause parasitaemias in humans:Mansonella perstans and Mtinsonella ozzardi.In most contemporary accounts of the distribution of these parasites,neither is usually considered to occur anywhere in the Eastern Hemisphere.However,Sir Patrick Manson,who first described both parasite species,recorded the existence of sheathless sharp-tailed Mansonella ozzardilike parasites occurring in the blood of natives from New Guinea in each and every version of his manual for tropical disease that he wrote before his death in 1922.Manson's reports were based on his own identifications and were made from at least two independent blood sample collections that were taken from the island.Pacific region Mansonella perstans parasitaemias were also later(in 1923) reported to occur in New Guinea and once before this(in 1905) in Fiji.Although Mansonella-parasilaernias are generally regarded as benign,they are thought to be of public health importance because they can affect the epidemiological monitoring of other filarial diseases.In this article,we reviewed the historic literature concerning Pacific-origin Mansonella-parasitaemias in an attempt to explain how,despite repeated reports of Pacificregion Mansonella-parasilaemias,by as early as the 1970 s,the WHO had arrived at the presentday view that Wuchereria bancrofti is the only cause of filarial parasitaemias in Papua New Guinea.We have also evaluated the evidence supporting the contemporary existence of Pacificarea parasitaemia-causing Mansonella parasites and assessed the relevance such parasites could have for present-day lymphatic filariasis elimination efforts in the region.
基金the National Key Research and Development Program of China(No.2016YFC1202000,2016YFC1202002,2016YFC1202003).
文摘Background:The Global Programme to Eliminate Lymphatic Filariasis(GPELF)was launched in response to the call proposed at the 50th World Health Assembly.The goal of the GPELF is to ensure that all the countries where the disease is endemic would have been transmission-free or would have entered post-intervention mass drug administration(MDA)surveillance by 2020.However,several countries are still not on track to discontinue MDA as planned.Thus,issues remain regarding the achievement of stated goals and how to effectively monitor the disease in the post-control and post-elimination phases.Main text:China was once a lymphatic filariasis(LF)endemic country with heavy disease burden.There were three milestones in the LF control phase of China,including:the proposal that the major focus of the control strategy should be on infectious sources;the three regimens of diethylcarbamazine(DEC)administration according to LF endemic extent;and the establishment of the threshold for LF transmission interruption.It has been ten years since China entered the post-elimination stage(declaration of LF elimination in China was in 2007).Two schemes and a diagnostic criterion were issued to guide all levels of disease control and prevention workers that conduct LF surveillance,as well as those caring for chronic filariasis patients.Regular training courses are held to maintain LF control skills in grass-root institutions.The Notifiable Diseases Reporting System,which included LF in 2004,plays an important role in LF post-elimination surveillance.Until now,no resurgence of LF cases has been detected,except for LF residue foci being found in Fuchuan County of the Guangxi Zhuang Autonomous Region.To confirm that transmission is no longer achievable after a decade since the declaration of LF elimination in China,it is expected within the next two years a transmission assessment survey,conducted in previous LF-endemic areas.Conclusions:DEC-fortified salt can help accelerate the progress of GPELF before the sprite phase.Sophisticated diagnostic criteria,systematic surveillance regimes,the Direct Network Report system,and regular trainings can effectively prevent the recrudescence of LF during surveillance phases.
基金The LF programme activities were supported by the Ministry of Health and Sports,and funds from the Centre for Neglected Tropical Diseases(CNTD)Liverpool,UK through a grant from the Department for International Development(DFID)and GlaxoSmithKline(GSK)for the elimination of lymphatic filariasis。
文摘Background:Lymphatic filariasis(LF)is endemic in Myanmar and targeted for elimination.To highlight the National Programme to Eliminate Lymphatic Filariasis(NPELF)progress between 2000 and 2014,this paper describes the geographical distribution of LF,the scale-up and impact of mass drug administration(MDA)implementation,and the first evidence of the decline in transmission in five districts.Methods:The LF distribution was determined by mapping historical and baseline prevalence data collected by NPELF.Data on the MDA implementation,reported coverage rates and sentinel site surveillance were summarized.A statistical model was developed from the available prevalence data to predict prevalence at township level by year of measurement.Transmission assessment survey(TAS)methods,measuring antigenemia(Ag)prevalence in children,were used to determine whether prevalence was below a level where recrudescence is unlikely to occur.Results:The highest baseline LF prevalence was found in the Central Valley region.The MDA implementation activities scaled up to cover 45 districts,representing the majority of the endemic population,with drug coverage rates ranging from 60.0%to 98.5%.Challenges related to drug supply and local conflict were reported,and interrupted MDA in some districts.Overall,significant reductions in LF prevalence were found,especially after the first 2 to 3 rounds of MDA,which was supported by the corresponding model.The TAS activities in five districts found only two Ag positive children,resulting in all districts passing the critical threshold.Conclusion:Overall,the Myanmar NPELF has made positive steps forward in the elimination of LF despite several challenges,however,it needs to maintain momentum,drawing on international stakeholder support,to aim towards the national and global goals of elimination.