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Integrated School-Based Surveillance for Soil-Transmitted Helminth Infections and Lymphatic Filariasis in Gampaha District, Sri Lanka

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  • Department of Parasitology, Faculty of Medicine, University of Colombo, Sri Lanka; Department of Parasitology, Faculty of Medicine, University of Kelaniya, Sri Lanka; Anti Filariasis Campaign, Ministry of Health, Sri Lanka; Department of Internal Medicine, Infectious Diseases Division, Washington University School of Medicine, St. Louis, Missouri; Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, United Kingdom

We explored the practicality of integrating surveillance for soil-transmitted helminthiasis (STH, assessed by Kato-Katz) with transmission assessment surveys for lymphatic filariasis (LF) in two evaluation units (EUs) in Gampaha district, Sri Lanka (population 2.3 million). The surveys were performed 6 years after five annual rounds of mass drug administration with diethylcarbamazine and albendazole. Each transmission assessment survey tested children (N = 1,462 inland EU; 1,642 coastal EU) sampled from 30 primary schools. Low filarial antigenemia rates (0% and 0.1% for the inland and coastal EUs) suggest that LF transmission is very low in this district. The STH rates and stool sample participation rates were 0.8% and 61% (inland) and 2.8% and 58% (coastal). Most STH detected were low or moderate intensity Trichuris trichiura infections. The added cost of including STH testing was ∼$5,000 per EU. These results suggest that it is feasible to integrate school-based surveillance for STH and LF.

Author Notes

* Address correspondence to Gary J. Weil, Infectious Disease Division, School of Medicine, Washington University in St. Louis, St. Louis, MO 63110. E-mail: gweil@dom.wustl.edu

Financial support: This work was supported by grants from the Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, UK to the Anti Filariasis Campaign, Sri Lanka Ministry of Health, the University of Colombo, and to the University of Kelaniya. Financial support was also provided to the AFC by the World Health Organization (WHO) for TAS surveys. Work by Washington University personnel on this project was supported by grants from NIH (AI 06571), the Barnes-Jewish Hospital Foundation, and the Bill and Melinda Gates Foundation (GH5342).

Disclosure: The filarial antigen test used in the TAS surveys uses reagents licensed from Barnes-Jewish Hospital, an affiliation of G. Weil. All royalties from sales of these tests go to the Barnes Jewish Hospital Foundation, a not for profit charitable organization (http://www.barnesjewish.org/giving/about-us).

Authors' addresses: Sharmini Gunawardena and Nadira D. Karunaweera, Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka, E-mails: sharminigunawardena@hotmail.com and nkarunaw@hsph.harvard.edu. Nipul K. Gunawardena and Nilanthi R. de Silva, Department of Parasitology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka, E-mails: gune1@yahoo.com and nrdesilva@gmail.com. Ganga Kahathuduwa, Regional Anti Filariasis Unit, Base Hospital Premises, Kiribathgoda, E-mail: gangakahathuduwa@yahoo.com. Udaya B. Ranasinghe, Sandhya D. Samarasekara, and Kumara C. Nagodavithana, Anti Filariasis Campaign, Ministry of Health and Nutrition, Colombo, Sri Lanka, E-mails: usbr65@gmail.com, dilhani_sm@yahoo.com, and chamilanagodavithana@yahoo.com. Ramakrishna U. Rao and Gary J. Weil, Infectious Diseases Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, E-mails: rrao@dom.wustl.edu and gweil@dom.wustl.edu. Maria P. Rebollo, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK, E-mail: mrebollo@liv.ac.uk.

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