Certifying lymphatic filariasis elimination in the Pacific--the need for new tools

Experience from successful global elimination programmes highlights the pivotal role of functional surveillance programmes for confirming cessation of local disease transmission. Lymphatic filariasis is targeted for global elimination by 2020 with an earlier target of 2010 for the Pacific Island countries. No surveillance protocol for confirming filariasis elimination in small island countries has yet been agreed evaluated. Currently recommended surveillance strategies for confirming lymphatic filariasis elimination are not ideal for small Pacific countries. Relying on occasional surveys to detect an increasingly rare health condition has inherent epidemiological weaknesses. Characteristics of effective surveillance for confirming filariasis elimination would include adequate sensitivity for detecting residual transmission, ongoing population scrutiny, and integration within a resource-sensitive system that includes other important conditions requiring public health surveillance. We propose that acute adenolymphangitis (ALA) may prove a suitable surveillance condition. ALA surveillance nested within a syndromic communicable disease surveillance programme implemented universally by health facilities may provide a solution to the current conundrum facing Pacific lymphatic filariasis elimination programmes and should be carefully evaluated.