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Lymphatic Filariasis (LF) Program. Trinidad and Tobago. Dr. B. Shivnauth Principal Medical Officer (EH) Ministry of Health. Background. Trinidad and Tobago is a twin-island state Most Southerly Caribbean island Estimated population: 1.3 million. Map of Trinidad and Tobago.

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Lymphatic filariasis lf program l.jpg

Lymphatic Filariasis (LF) Program

Trinidad and Tobago

Dr. B. Shivnauth

Principal Medical Officer (EH)

Ministry of Health


Background l.jpg
Background

  • Trinidad and Tobago is a twin-island state

  • Most Southerly Caribbean island

  • Estimated population: 1.3 million

Regional LF Program Managers Meeting, Costa Rica, 2005


Map of trinidad and tobago l.jpg
Map of Trinidad and Tobago

Regional LF Program Managers Meeting, Costa Rica, 2005


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Mission Statement

  • The mission of IVCD is to provide a service for the protection of the nation’s health from vector-borne diseases through the application of safe, affective and economical integration of all appropriate, sustainable vector-control measures that are acceptable to the people of

    • Trinidad and Tobago

within prescribed limits.

Regional LF Program Managers Meeting, Costa Rica, 2005


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Age and Gender Demographics

  • Slightly more males 50.15 % compared to females 49.85 % (population 1,262,366)

  • 20-39 year age group comprises the largest proportion (31.9 %)

  • Slightly more males than females in all age groups except in the 60+ age group

Regional LF Program Managers Meeting, Costa Rica, 2005


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Government Health Facilities

  • There are

    • 105 health centers (HC)

    • 10 Hospitals (3 major hospitals)

    • 4 District Health Facilities

  • Number of HC ranged from 8 to19 per county, with Tobago having the largest number.

Regional LF Program Managers Meeting, Costa Rica, 2005


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Health Professionals 2004

  • Health professionals numbered 6,618

    • Nurses and midwives comprised 34.9 %

    • Physicians 19.5%

    • Nursing Assistants, Nursing Aides 32.9%

    • Pharmacists comprised 7.7%

Regional LF Program Managers Meeting, Costa Rica, 2005


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Regional Bancroftian LF

  • Endemic countries include

    • Dominican Republic

    • Haiti

    • Guyana

  • Listed as positive by the World Health Organization (WHO)

    • Suriname

    • Trinidad & Tobago

    • Costa Rica

  • In the Americas, 300,000 LF cases, including Brazil (WHO)

Lymphatic Filariasis Program, Trinidad & Tobago

Regional LF Program Managers Meeting, Costa Rica, 2005


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International LF Collaboration

  • Pan American Health Organization (PAHO/WHO)

  • Caribbean Epidemiology Centre (CAREC)

Regional LF Program Managers Meeting, Costa Rica, 2005


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Synergieswith other Public-Health Interventions

  • Dual screening of blood smears in primarily malaria surveillance

  • Recent identification of W. bancrofti and P. vivax in imported case in December 2004

  • Active community Surveillance System using blood smears

  • Random smears of Pyrexia of unknown Origin at Health facilities

Regional LF Program Managers Meeting, Costa Rica, 2005


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Historical Trend of LFin Trinidad & Tobago (1)

1893–1937

  • Average cases per year

    • 24 elephantiasis cases

    • 54 hydrocele

Source: T&T Surgeon General Report

Regional LF Program Managers Meeting, Costa Rica, 2005


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Historical Trend of LFin Trinidad & Tobago (2)

  • 5% positive microfilaria

  • 6.7% had elephantiasis n=500

1902 George A. Vincent Survey

Patients from Port of Spain Colonial Hospital, St. Ann's and private practitioners

Regional LF Program Managers Meeting, Costa Rica, 2005


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Historical Trend of LFin Trinidad & Tobago (3)

1908 George C. Low Survey

N=400

10.8 % Positive for microfilaria

(44.2 % symptomatic)

(55.8 % asymptomatic)

(n=43)

20.8% had elephantiasis

Regional LF Program Managers Meeting, Costa Rica, 2005


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Historical Trend of LFin Trinidad & Tobago (4)

1909 A.B. Herrick Survey

1 case Chyluria

Case was Trinidadian but lived in Panama for 22 years

Positive for microfilaria

Regional LF Program Managers Meeting, Costa Rica, 2005


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Historical Trend of LFin Trinidad & Tobago (5)

1928

Low prevalence of LF

n=33,970

0.1% 1945 Platzer

0.0003% 1961 Beve

Naval base employee survey

T&T Surgeon General Report

Regional LF Program Managers Meeting, Costa Rica, 2005


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Historical Trend of LFin Trinidad & Tobago (6)

1976 Nelson & Davis

6.3% positive for microfilaria

n=300

Elephantiasis & Hydrocele

reported in north coast village

Regional LF Program Managers Meeting, Costa Rica, 2005


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Historical Trend of LFin Trinidad & Tobago (7)

1978-1979, Nathan 1981, Nathan 1982

Blanchisseuse survey

n=562

15.3% positive for microfilaria

2.1% amicrofilaria with lymphoedema

16.7% (n=12) had elephantiasis

Regional LF Program Managers Meeting, Costa Rica, 2005


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Historical Trend of LFin Trinidad & Tobago (8)

Nathan 1981

Human bait capture mosquito population

2.1% infected with 0.1% with mature larvae

Resting vector population

7.0% infected with 0.1% with mature larvae

Regional LF Program Managers Meeting, Costa Rica, 2005


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Historical Trend of LFin Trinidad & Tobago (9)

Nathan 1987

DEC efficacy survey in 1980–1981

Dosage was 6mg/kg body weight monthly for one year

(Apr. 1980 – Apr. 1981)

Regional LF Program Managers Meeting, Costa Rica, 2005


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Historical Trend of LFin Trinidad & Tobago (10)

Nathan 1987 cont’d

Survey Results

Regional LF Program Managers Meeting, Costa Rica, 2005


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Historical Trend of LFin Trinidad & Tobago (11)

Chadee 1995

12 years post treatment

66.92% of total population sampled in 1992

(n=520)

All negative for microfilariae

Regional LF Program Managers Meeting, Costa Rica, 2005


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Criteria for Elimination of LF

Cumulative 5-year transmission rate is < 1 new infection per 1000 individuals

Consensus at 50th World Health Assembly

Request for certification of elimination was made in 2002

Regional LF Program Managers Meeting, Costa Rica, 2005


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Monitoring

Ongoing risk of re-introduction of LF from imported cases originating in endemic countries

Regional LF Program Managers Meeting, Costa Rica, 2005


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Epidemiological Monitoring 1

Blood smearing in community surveys serves dual purpose for LF and malaria surveillance

Immunochromatographic Card Testing (ICT) 1998

(Rawlins et al. 2000)

Regional LF Program Managers Meeting, Costa Rica, 2005


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Epidemiological Monitoring 2

Results ICT 1998

211 Adults from 8 locations in north, central and south Trinidad

139 Children from previously endemic Blanchisseuse and neighboring Matelot and Grand Reviere

All results were negative included adults treated in 1981 DEC campaign

Regional LF Program Managers Meeting, Costa Rica, 2005


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Vector Surveillance Chadee et al. 2002

Xenomonitoring of Culex quinquefasiatus

Uses blood-engorged resting mosquitoes rather than ethically questionable Human Bait captures

Collection using electrical or mouth respirators

‘Cocoyear broom’ flushing technique for hard-to-reach mosquitoes

Regional LF Program Managers Meeting, Costa Rica, 2005


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Xenomonitoring

Results

3000 Culex quinquefasciatus from 1400 households in St. George and Caroni

3-6 Culex quinquefasciatus collected per household

Stored mosquitoes not yet analyzed by PCR-based assay

Regional LF Program Managers Meeting, Costa Rica, 2005


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Challenges 1

Detection of imported cases from “underground visitors”

Need a humane and diplomatic approach

Regional LF Program Managers Meeting, Costa Rica, 2005


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Challenges 2

Promotion of Regional inter-country communication linkages:

This may assist in the management of the aforementioned problem.

Regional LF Program Managers Meeting, Costa Rica, 2005


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Challenges 3

Technical corporation and assistance needed for epidemiological and vector surveillance on an ongoing basis

Regional LF Program Managers Meeting, Costa Rica, 2005


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