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Community-Wide Distribution of Long-Lasting Insecticidal Nets Can Halt Transmission of Lymphatic Filariasis in Southeastern Nigeria

Frank O. RichardsThe Carter Center, Atlanta, Georgia; The Carter Center, Owerri, Nigeria; Ministry of Health, Owerri, Nigeria; Ministry of Health, Ebonyi, Nigeria; Imo State University, Owerri, Nigeria; The Carter Center, Jos, Nigeria

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Emmanuel EmukahThe Carter Center, Atlanta, Georgia; The Carter Center, Owerri, Nigeria; Ministry of Health, Owerri, Nigeria; Ministry of Health, Ebonyi, Nigeria; Imo State University, Owerri, Nigeria; The Carter Center, Jos, Nigeria

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Patricia M. GravesThe Carter Center, Atlanta, Georgia; The Carter Center, Owerri, Nigeria; Ministry of Health, Owerri, Nigeria; Ministry of Health, Ebonyi, Nigeria; Imo State University, Owerri, Nigeria; The Carter Center, Jos, Nigeria

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Omeni NkwochaThe Carter Center, Atlanta, Georgia; The Carter Center, Owerri, Nigeria; Ministry of Health, Owerri, Nigeria; Ministry of Health, Ebonyi, Nigeria; Imo State University, Owerri, Nigeria; The Carter Center, Jos, Nigeria

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Lawrence NwankwoThe Carter Center, Atlanta, Georgia; The Carter Center, Owerri, Nigeria; Ministry of Health, Owerri, Nigeria; Ministry of Health, Ebonyi, Nigeria; Imo State University, Owerri, Nigeria; The Carter Center, Jos, Nigeria

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Lindsay RakersThe Carter Center, Atlanta, Georgia; The Carter Center, Owerri, Nigeria; Ministry of Health, Owerri, Nigeria; Ministry of Health, Ebonyi, Nigeria; Imo State University, Owerri, Nigeria; The Carter Center, Jos, Nigeria

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Aryc MosherThe Carter Center, Atlanta, Georgia; The Carter Center, Owerri, Nigeria; Ministry of Health, Owerri, Nigeria; Ministry of Health, Ebonyi, Nigeria; Imo State University, Owerri, Nigeria; The Carter Center, Jos, Nigeria

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Amy PattersonThe Carter Center, Atlanta, Georgia; The Carter Center, Owerri, Nigeria; Ministry of Health, Owerri, Nigeria; Ministry of Health, Ebonyi, Nigeria; Imo State University, Owerri, Nigeria; The Carter Center, Jos, Nigeria

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Masayo OzakiThe Carter Center, Atlanta, Georgia; The Carter Center, Owerri, Nigeria; Ministry of Health, Owerri, Nigeria; Ministry of Health, Ebonyi, Nigeria; Imo State University, Owerri, Nigeria; The Carter Center, Jos, Nigeria

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Bertram E. B. NwokeThe Carter Center, Atlanta, Georgia; The Carter Center, Owerri, Nigeria; Ministry of Health, Owerri, Nigeria; Ministry of Health, Ebonyi, Nigeria; Imo State University, Owerri, Nigeria; The Carter Center, Jos, Nigeria

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Chinyere N. UkagaThe Carter Center, Atlanta, Georgia; The Carter Center, Owerri, Nigeria; Ministry of Health, Owerri, Nigeria; Ministry of Health, Ebonyi, Nigeria; Imo State University, Owerri, Nigeria; The Carter Center, Jos, Nigeria

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Chidiebere NjokuThe Carter Center, Atlanta, Georgia; The Carter Center, Owerri, Nigeria; Ministry of Health, Owerri, Nigeria; Ministry of Health, Ebonyi, Nigeria; Imo State University, Owerri, Nigeria; The Carter Center, Jos, Nigeria

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Kenrick NwoduThe Carter Center, Atlanta, Georgia; The Carter Center, Owerri, Nigeria; Ministry of Health, Owerri, Nigeria; Ministry of Health, Ebonyi, Nigeria; Imo State University, Owerri, Nigeria; The Carter Center, Jos, Nigeria

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Andrew ObasiThe Carter Center, Atlanta, Georgia; The Carter Center, Owerri, Nigeria; Ministry of Health, Owerri, Nigeria; Ministry of Health, Ebonyi, Nigeria; Imo State University, Owerri, Nigeria; The Carter Center, Jos, Nigeria

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Emmanuel S. MiriThe Carter Center, Atlanta, Georgia; The Carter Center, Owerri, Nigeria; Ministry of Health, Owerri, Nigeria; Ministry of Health, Ebonyi, Nigeria; Imo State University, Owerri, Nigeria; The Carter Center, Jos, Nigeria

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Lymphatic filariasis (LF) in rural southeastern Nigeria is transmitted mainly by Anopheles spp. mosquitoes. Potential coinfection with Loa loa in this area has prevented use of ivermectin in the mass drug administration (MDA) strategy for LF elimination because of potential severe adverse L. loa-related reactions. This study determined if long-lasting insecticidal net (LLIN) distribution programs for malaria would interrupt LF transmission in such areas, without need for MDA. Monthly entomologic monitoring was conducted in sentinel villages before and after LLIN distribution to all households and all age groups (full coverage) in two districts, and to pregnant women and children less than five years of age in the other two districts. No change in human LF microfilaremia prevalence was observed, but mosquito studies showed a statistically significant decrease in LF infection and infectivity with full-coverage LLIN distribution. We conclude that LF transmission can be halted in southeastern Nigeria by full-coverage LLIN distribution, without MDA.

Author Notes

* Address correspondence to Frank O. Richards, Malaria, River Blindness, Lymphatic Filariasis, and Schistosomiasis Programs, The Carter Center, 453 Freedom Parkway, Atlanta, GA 30307. E-mail: frich01@emory.edu

Financial support: This study was supported by the Bill and Melinda Gates Foundation. A generous donation by Vestergaard Frandsen of 15,000 PermaNets® enabled us to quickly convert the vulnerable group arm to full LLIN coverage in the sentinel villages of Ohaukwu LGA in Ebonyi State in 2010.

Authors' addresses: Frank O. Richards, Patricia M. Graves, Lindsay Rakers, Aryc Mosher, Amy Patterson, and Masayo Ozaki, Malaria, River Blindness, Lymphatic Filariasis, and Schistosomiasis Programs, The Carter Center, Atlanta, GA, E-mails: frich01@emory.edu, pgraves.work@gmail.com, lrakers@emory.edu, awmoshe@emory.edu, aepatte@emory.edu, and masayo.ozaki@gmail.com. Emmanuel Emukah, Chidiebere Njoku, Kenrick Nwodu, and Andrew Obasi, The Carter Center, Owerri, Imo State, Nigeria, E-mails: emukahe@yahoo.com, feb4real@yahoo.com, kenrome@yahoo.com, and andyobasi2@yahoo.com. Omeni Nkwocha, Ministry of Health, Owerri, Imo State, Nigeria, E-mail: occnten@yahoo.com. Lawrence Nwankwo, Ministry of Health, Ebonyi, Ebonyi State, Nigeria, E-mail: eb4rbm@yahoo.com. Bertram E. B. Nwoke and Chinyere N. Ukaga, Imo State University, PMB 2000, Owerri, Nigeria, E-mails: bebndie@yahoo.com and chinyukaga@yahoo.com. Emmanuel S. Miri, The Carter Center, Jos, Nigeria, E-mail: emmamiri@yahoo.com.

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