Determinants of Success in National Programs to Eliminate Lymphatic Filariasis: A Perspective Identifying Essential Elements and Research Needs

Dominique Kyelem Lymphatic Filariasis Support Center, Task Force for Child Survival and Development, Decatur, Georgia; Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland; Lymphatic Filariasis Support Centre, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Global Community Partnerships, GlaxoSmithKline, Brentford, United Kingdom; Department of Public Health, Ain Shams University, Cairo, Egypt; School of Medicine, Washington University, St. Louis, Missouri; Center for Global Health & Diseases, Case Western Reserve University, Cleveland, Ohio; Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Nairobi, Kenya; Vector Control Research Centre, Indian Council of Medical Research, Pondicherry, India; Carter Center, Atlanta, Georgia; Clark Science Center, Smith College, Northampton, Massachusetts

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Gautam Biswas Lymphatic Filariasis Support Center, Task Force for Child Survival and Development, Decatur, Georgia; Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland; Lymphatic Filariasis Support Centre, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Global Community Partnerships, GlaxoSmithKline, Brentford, United Kingdom; Department of Public Health, Ain Shams University, Cairo, Egypt; School of Medicine, Washington University, St. Louis, Missouri; Center for Global Health & Diseases, Case Western Reserve University, Cleveland, Ohio; Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Nairobi, Kenya; Vector Control Research Centre, Indian Council of Medical Research, Pondicherry, India; Carter Center, Atlanta, Georgia; Clark Science Center, Smith College, Northampton, Massachusetts

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Moses J. Bockarie Lymphatic Filariasis Support Center, Task Force for Child Survival and Development, Decatur, Georgia; Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland; Lymphatic Filariasis Support Centre, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Global Community Partnerships, GlaxoSmithKline, Brentford, United Kingdom; Department of Public Health, Ain Shams University, Cairo, Egypt; School of Medicine, Washington University, St. Louis, Missouri; Center for Global Health & Diseases, Case Western Reserve University, Cleveland, Ohio; Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Nairobi, Kenya; Vector Control Research Centre, Indian Council of Medical Research, Pondicherry, India; Carter Center, Atlanta, Georgia; Clark Science Center, Smith College, Northampton, Massachusetts

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Mark H. Bradley Lymphatic Filariasis Support Center, Task Force for Child Survival and Development, Decatur, Georgia; Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland; Lymphatic Filariasis Support Centre, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Global Community Partnerships, GlaxoSmithKline, Brentford, United Kingdom; Department of Public Health, Ain Shams University, Cairo, Egypt; School of Medicine, Washington University, St. Louis, Missouri; Center for Global Health & Diseases, Case Western Reserve University, Cleveland, Ohio; Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Nairobi, Kenya; Vector Control Research Centre, Indian Council of Medical Research, Pondicherry, India; Carter Center, Atlanta, Georgia; Clark Science Center, Smith College, Northampton, Massachusetts

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Maged El-Setouhy Lymphatic Filariasis Support Center, Task Force for Child Survival and Development, Decatur, Georgia; Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland; Lymphatic Filariasis Support Centre, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Global Community Partnerships, GlaxoSmithKline, Brentford, United Kingdom; Department of Public Health, Ain Shams University, Cairo, Egypt; School of Medicine, Washington University, St. Louis, Missouri; Center for Global Health & Diseases, Case Western Reserve University, Cleveland, Ohio; Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Nairobi, Kenya; Vector Control Research Centre, Indian Council of Medical Research, Pondicherry, India; Carter Center, Atlanta, Georgia; Clark Science Center, Smith College, Northampton, Massachusetts

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Peter U. Fischer Lymphatic Filariasis Support Center, Task Force for Child Survival and Development, Decatur, Georgia; Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland; Lymphatic Filariasis Support Centre, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Global Community Partnerships, GlaxoSmithKline, Brentford, United Kingdom; Department of Public Health, Ain Shams University, Cairo, Egypt; School of Medicine, Washington University, St. Louis, Missouri; Center for Global Health & Diseases, Case Western Reserve University, Cleveland, Ohio; Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Nairobi, Kenya; Vector Control Research Centre, Indian Council of Medical Research, Pondicherry, India; Carter Center, Atlanta, Georgia; Clark Science Center, Smith College, Northampton, Massachusetts

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Ralph H. Henderson Lymphatic Filariasis Support Center, Task Force for Child Survival and Development, Decatur, Georgia; Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland; Lymphatic Filariasis Support Centre, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Global Community Partnerships, GlaxoSmithKline, Brentford, United Kingdom; Department of Public Health, Ain Shams University, Cairo, Egypt; School of Medicine, Washington University, St. Louis, Missouri; Center for Global Health & Diseases, Case Western Reserve University, Cleveland, Ohio; Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Nairobi, Kenya; Vector Control Research Centre, Indian Council of Medical Research, Pondicherry, India; Carter Center, Atlanta, Georgia; Clark Science Center, Smith College, Northampton, Massachusetts

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James W. Kazura Lymphatic Filariasis Support Center, Task Force for Child Survival and Development, Decatur, Georgia; Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland; Lymphatic Filariasis Support Centre, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Global Community Partnerships, GlaxoSmithKline, Brentford, United Kingdom; Department of Public Health, Ain Shams University, Cairo, Egypt; School of Medicine, Washington University, St. Louis, Missouri; Center for Global Health & Diseases, Case Western Reserve University, Cleveland, Ohio; Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Nairobi, Kenya; Vector Control Research Centre, Indian Council of Medical Research, Pondicherry, India; Carter Center, Atlanta, Georgia; Clark Science Center, Smith College, Northampton, Massachusetts

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Patrick J. Lammie Lymphatic Filariasis Support Center, Task Force for Child Survival and Development, Decatur, Georgia; Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland; Lymphatic Filariasis Support Centre, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Global Community Partnerships, GlaxoSmithKline, Brentford, United Kingdom; Department of Public Health, Ain Shams University, Cairo, Egypt; School of Medicine, Washington University, St. Louis, Missouri; Center for Global Health & Diseases, Case Western Reserve University, Cleveland, Ohio; Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Nairobi, Kenya; Vector Control Research Centre, Indian Council of Medical Research, Pondicherry, India; Carter Center, Atlanta, Georgia; Clark Science Center, Smith College, Northampton, Massachusetts

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Sammy M. Njenga Lymphatic Filariasis Support Center, Task Force for Child Survival and Development, Decatur, Georgia; Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland; Lymphatic Filariasis Support Centre, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Global Community Partnerships, GlaxoSmithKline, Brentford, United Kingdom; Department of Public Health, Ain Shams University, Cairo, Egypt; School of Medicine, Washington University, St. Louis, Missouri; Center for Global Health & Diseases, Case Western Reserve University, Cleveland, Ohio; Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Nairobi, Kenya; Vector Control Research Centre, Indian Council of Medical Research, Pondicherry, India; Carter Center, Atlanta, Georgia; Clark Science Center, Smith College, Northampton, Massachusetts

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Eric A. Ottesen Lymphatic Filariasis Support Center, Task Force for Child Survival and Development, Decatur, Georgia; Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland; Lymphatic Filariasis Support Centre, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Global Community Partnerships, GlaxoSmithKline, Brentford, United Kingdom; Department of Public Health, Ain Shams University, Cairo, Egypt; School of Medicine, Washington University, St. Louis, Missouri; Center for Global Health & Diseases, Case Western Reserve University, Cleveland, Ohio; Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Nairobi, Kenya; Vector Control Research Centre, Indian Council of Medical Research, Pondicherry, India; Carter Center, Atlanta, Georgia; Clark Science Center, Smith College, Northampton, Massachusetts

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Kapa D. Ramaiah Lymphatic Filariasis Support Center, Task Force for Child Survival and Development, Decatur, Georgia; Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland; Lymphatic Filariasis Support Centre, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Global Community Partnerships, GlaxoSmithKline, Brentford, United Kingdom; Department of Public Health, Ain Shams University, Cairo, Egypt; School of Medicine, Washington University, St. Louis, Missouri; Center for Global Health & Diseases, Case Western Reserve University, Cleveland, Ohio; Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Nairobi, Kenya; Vector Control Research Centre, Indian Council of Medical Research, Pondicherry, India; Carter Center, Atlanta, Georgia; Clark Science Center, Smith College, Northampton, Massachusetts

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Frank O. Richards Lymphatic Filariasis Support Center, Task Force for Child Survival and Development, Decatur, Georgia; Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland; Lymphatic Filariasis Support Centre, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Global Community Partnerships, GlaxoSmithKline, Brentford, United Kingdom; Department of Public Health, Ain Shams University, Cairo, Egypt; School of Medicine, Washington University, St. Louis, Missouri; Center for Global Health & Diseases, Case Western Reserve University, Cleveland, Ohio; Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Nairobi, Kenya; Vector Control Research Centre, Indian Council of Medical Research, Pondicherry, India; Carter Center, Atlanta, Georgia; Clark Science Center, Smith College, Northampton, Massachusetts

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Gary J. Weil Lymphatic Filariasis Support Center, Task Force for Child Survival and Development, Decatur, Georgia; Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland; Lymphatic Filariasis Support Centre, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Global Community Partnerships, GlaxoSmithKline, Brentford, United Kingdom; Department of Public Health, Ain Shams University, Cairo, Egypt; School of Medicine, Washington University, St. Louis, Missouri; Center for Global Health & Diseases, Case Western Reserve University, Cleveland, Ohio; Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Nairobi, Kenya; Vector Control Research Centre, Indian Council of Medical Research, Pondicherry, India; Carter Center, Atlanta, Georgia; Clark Science Center, Smith College, Northampton, Massachusetts

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Steven A. Williams Lymphatic Filariasis Support Center, Task Force for Child Survival and Development, Decatur, Georgia; Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland; Lymphatic Filariasis Support Centre, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Global Community Partnerships, GlaxoSmithKline, Brentford, United Kingdom; Department of Public Health, Ain Shams University, Cairo, Egypt; School of Medicine, Washington University, St. Louis, Missouri; Center for Global Health & Diseases, Case Western Reserve University, Cleveland, Ohio; Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Nairobi, Kenya; Vector Control Research Centre, Indian Council of Medical Research, Pondicherry, India; Carter Center, Atlanta, Georgia; Clark Science Center, Smith College, Northampton, Massachusetts

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DOI:
https://doi.org/10.4269/ajtmh.2008.79.480
Volume/Issue:
Volume 79: Issue 4
Page(s):
480–484
Restricted access
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The Global Programme to Eliminate Lymphatic Filariasis (GPELF) was launched in 2000. To understand why some national programs have been more successful than others, a panel of individuals with expertise in LF elimination efforts met to assess available data from programs in 8 countries. The goal was to identify: 1) the factors determining success for national LF elimination programs (defined as the rapid, sustained reduction in microfilaremia/antigenemia after repeated mass drug administration [MDA]); 2) the priorities for operational research to enhance LF elimination efforts.

Of more than 40 factors identified, the most prominent were 1) initial level of LF endemicity; 2) effectiveness of vector mosquitoes; 3) MDA drug regimen; 4) population compliance.

Research important for facilitating program success was identified as either biologic (i.e., [1] quantifying differences in vectorial capacity; [2] identifying seasonal variations affecting LF transmission) or programmatic (i.e., [1] identifying quantitative thresholds, especially the population compliance levels necessary for success, and the antigenemia or microfilaremia prevalence at which MDA programs can stop with minimal risk of resumption of transmission; [2] defining optimal drug distribution strategies and timing; [3] identifying those individuals who are “persistently non-compliant” during MDAs, the reasons for this non-compliance and approaches to overcoming it).

While addressing these challenges is important, many key determinants of program success are already clearly understood; operationalizing these as soon as possible will greatly increase the potential for national program success.

Author Notes

Copyright:
Copyright 2008 The American Society of Tropical Medicine 2008
Received:
16 Jun 2008
|
Accepted:
20 Aug 2008
|
Published Online:
Oct 2008
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
  • 1

    Molyneux DH, Zagaria N, 2002. Lymphatic filariasis elimination: progress in global programme development. Ann Trop Med Parasitol 96 :S15–S40.

  • 2

    Ottesen EA, Bradley M, Hooper PJ, Biswas G, 2008. The global programme to eliminate lymphatic filariasis: health impact after 8 Years. PLoS NTDs (in press).

    • PubMed
    • Export Citation
  • 3

    Ramzy RM, El Setouhy M, Helmy H, Ahmed ES, Abd Elaziz KM, Farid HA, Shannon WD, Weil GJ, 2006. Effect of yearly mass drug administration with diethylcarbamazine and albendazole on bancroftian filariasis in Egypt: a comprehensive assessment. Lancet 367 :992–999.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    El-Setouhy M, Abd Elaziz KM, Helmy H, Farid HA, Kamal HA, Ramzy RM, Shannon WD, Weil GJ, 2007. The effect of compliance on the impact of mass drug administration for elimination of lymphatic filariasis in Egypt. Am J Trop Med Hyg 77 :1069–1073.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    De Rochars M, Direny A, Roberts J, Addiss D, Radday J, Beach M, Streit T, Dardith D, Lafontant J, Lammie P, 2004. Community-wide reduction in prevalence and intensity of intestinal helminths as a collateral benefit of lymphatic filariasis elimination programs. Am J Trop Med Hyg 71 :466–470.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Mathieu E, Direny AN, De Rochars MB, Streit TG, Addiss DG, Lammie PJ, 2006. Participation in three consecutive mass drug administrations in Leogane, Haiti. Trop Med Int Health 11 :862–868.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Grady CA, de Rochars MB, Direny AN, Orelus JN, Wendt J, Radday J, Mathieu E, Roberts JM, Streit TG, Addiss DG, Lammie PJ, 2007. Endpoints for lymphatic filariasis programs. Emerg Infect Dis 13 :608–610.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Ramaiah KD, Das PK, Vanamail P, Pani SP, 2003. The impact of six rounds of single-dose mass administration of diethylcarbamazine or ivermectin on the transmission of Wuchereria bancrofti by Culex quinquefasciatus and its implications for lymphatic filariasis elimination programmes. Trop Med Int Health 8 :1082–1092.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Ramaiah KD, Das PK, 2004. Mass drug administration to eliminate lymphatic filariasis in India. Trends Parasitol 20 :499–502.

  • 10

    Rajendran R, Sunish IP, Mani TR, Munirathinam A, Arunachalam N, Satyanarayana K, Dash AP, 2006. Community-based study to assess the efficacy of DEC plus ALB against DEC alone on bancroftian filarial infection in endemic areas in Tamil Nadu, south India. Trop Med Int Health 11 :851–861.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Vanamail P, Ramaiah KD, Subramanian S, Pani SP, Yuvaraj J, Das PK, 2005. Pattern of community compliance with spaced, single-dose, mass administrations of diethylcarbamazine or ivermectin, for the elimination of lymphatic filariasis from rural areas of southern India. Ann Trop Med Parasitol 99 :237–242.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Ramaiah KD, Vanamail P, Das PK, 2007. Changes in Wuchereria bancrofti infection in a highly endemic community following 10 rounds of mass administration of diethylcarbamazine. Trans R Soc Trop Med Hyg 101 :250–255.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Oqueka T, Supali T, Ismid IS, Purnomo, Rückert P, Bradley M, Fischer P, 2005. Impact of two rounds of mass drug administration using diethylcarbamazine combined with albendazole on the prevalence of Brugia timori and of intestinal helminths on Alor Island, Indonesia. Filaria J 4 :5.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Richards FO, Pam DD, Kal A, Gerlong GY, Onyeka J, Sambo Y, Danboyi J, Ibrahim B, Terranella A, Kumbak D, Dakul A, Lenhart A, Rakers L, Umaru J, Amadiegwu S, Withers PC, Mafuyai H, Jinadu MY, Miri ES, Eigege A, 2005. Significant decrease in the prevalence of Wuchereria bancrofti infection in anopheline mosquitoes following the addition of albendazole to annual, ivermectin-based, mass treatments in Nigeria. Ann Trop Med Parasitol 99 :155–164.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Bockarie MJ, Tisch DJ, Kastens W, Alexander ND, Dimber Z, Bockarie F, Ibam E, Alpers MP, Kazura JW, 2002. Mass treatment to eliminate filariasis in Papua New Guinea. N Engl J Med 347 :1841–1848.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Bockarie MJ, Kazura JW, 2003. Lymphatic filariasis in Papua New Guinea: prospects for elimination. Med Microbiol Immunol (Berl) 192 :9–14.

  • 17

    Tisch DJ, Bockarie MJ, Dimber Z, Kiniboro B, Tarongka N, Hazlett FE, Kastens W, Alpers MP, Kazura JW, 2008. Mass drug administration trail to eliminate lymphatic filariasis in Papua New Guinea: changes in microfilaremia, filarial antigen, and Bm14 antibody after cessation. Am J Trop Med Hyg 78 :289–293.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Wamae N, Njenga SM, Kisingu WM, Muthigani PW, Kiiru K, 2006. Community-directed treatment of lymphatic filariasis in Kenya and its role in the national programmes for elimination of lymphatic filariasis. Afr J Health Sci 13 :69–79.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Njenga SM, Wamae CN, Njomo DW, Mwandawiro CS, Molyneux DH, 2008. Impact of two rounds of mass treatment with diethylcarbamazine plus albendazole on Wuchereria bancrofti infection and the sensitivity of immunochromatographic test in Malindi, Kenya. Trans R Soc Trop Med Hyg [Epub ahead of print].

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    World Health Organization, 2004. Report on the mid-term assessment of microfilaraemia reduction in sentinel sites of 13 countries of the Global Programme to Eliminate Lymphatic Filariasis. Wkly Epidemiol Rec 40 :358–367.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    World Health Organization, 2007. Global Programme to Eliminate Lymphatic Filariasis: progress report on mass drug administration in 2006. Wkly Epidemiol Rec 82 :361–380.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    World Health Organization, 2008. Global Programme to Eliminate Lymphatic Filariasis: progress report on mass drug administration in 2007. Wkly Epidemiol Rec 83 :333–348.

    • PubMed
    • Search Google Scholar
    • Export Citation
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