Global Elimination of Lymphatic Filariasis Addressing the Public Health Problem 英文参考文献.docVIP

ExpertCommentary GlobalEliminationofLymphaticFilariasis:Addressing thePublicHealthProblem DavidG.Addiss* FetzerInstitute,Kalamazoo,Michigan,UnitedStatesofAmerica Background strategy, there has been no scientific evidence that lymphedema managementactuallyimprovesacceptanceofMDA.Thus,ithas been difficult to dispel the notion that investing in lymphedema management drains limited resources from the primary goal of interruptingtransmission. OnJuly15,1997,twomonthsaftertheWorldHealthAssembly (WHA) passed a resolution calling for the ‘‘global elimination of lymphaticfilariasis(LF)asapublichealthproblem,’’asmallgroup ofpublichealthleadersandscientistsgatheredatMagneticIsland, near Townsville, Australia. They were meeting to consider the elementsofaprogramtoachievesuchaloftygoal.Theevening before the meeting began I asked several of those present, all veterans of global efforts toeradicate smallpox,polio, or Guinea worm disease, whether the LF elimination program should concern itself with providing care to those who already suffer the clinical manifestations of LF. Their response was uniformly negative: LF elimination should focus solely on interrupting transmission of the parasite. As with other disease eradication efforts,theintendedbeneficiarieswerefuturegenerations;saddling the LF elimination program with responsibilities for clinical care coulddilutefocus,divertresources,andcomplicatestrategiesand partnerships. InthisissueofPLoSNeglectedTropicalDiseases,PaulCanteyand colleagues elegantly demonstrate how program evaluation, at its best, can both improve program effectiveness and contribute to scientific knowledge. They provide the first solid evidence that lymphedema management, far from competing with MDA, actually enhances drug coverage [11]. The importance of high coverage for interrupting LF transmission cannot be overstated; indeed,successdependsonit[12]. Findings Following the 2008 MDA in Orissa, India, an area with substantialmorbidity,Canteyandcolleaguesu