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Haiti is Saying Goodbye to Lymphatic Filariasis, In Spite of Earthquake

Categories: child health, mosquito-borne disease, neglected tropical diseases (NTDs), parasitic diseases

 

Valery E. Madsen Beau De Rochars, MD, MPH

Our teams gave a two-medicine dose to Haitians in our capital city, Port-au-Prince—but most people had no water to swallow the pills. How would we overcome the ongoing cholera outbreak and displacement from the 2010 earthquake to finally rid Haiti of the horribly disfiguring and painful disease called lymphatic filariasis

Lymphatic filariasis, sometimes known as elephantiasis, is delivered by mosquitoes infected by young, blood-born parasites. The worms lodge in a person’s lymph nodes, causing fluid to pool in their legs and testicles, forcing them to swell dramatically. 

Humans are the only known host for the parasite in Haiti, which means it’s an ideal infectious disease to eliminate. Once we eliminate it from people, it can’t be brought back by animals carrying the parasite, which is the case for many infectious diseases. 

Lymphatic filariasis wasn’t always in Haiti or the Americas; it was imported through slave trade. The costly disease is still endemic in four countries in the Americas; one shares an island with Haiti, the Dominican Republic, which will also benefit from Haiti’s efforts. It’s been gone from the United States since the 1930s but also remains in some areas of Brazil and in Guyana. 

Dr. Madsen Beau de Rochars (second from right) in Haiti with collaborators Dr. Abdel Direny (far left) of IMA World Health LF program, Jean Marc Brissau (far right) of the Notre Dame LF program, and an associate (second from left)

Haiti has some of the worst rates of lymphatic filariasis in the world. As much as 50 percent of school children in some parts of the country were infected before CDC started the elimination program twenty years ago. Haiti and its partners are implementing an innovative and manageable drug treatment program to stop the spread of this infectious, parasitic disease.  

The Haitian Ministry of Health has been working with CDC and other important partners to deliver this community-wide treatment since 2000: we’ve trained hundreds of public health workers, not just to administer the drugs, but to monitor the program and verify results so we know when to stop treatment. 

We’ve succeeded in rural areas, in fact, some are finished and now we are tackling the hardest and largest part of Haiti, Port-au-Prince. The transient nature of the population there means that the gruesome disease could continue to radiate far beyond the city’s borders. 

Now that Port-au-Prince is covered for the first time despite the earthquake, cholera, violence, and political instability, we have full coverage for the 10 million people of Haiti. Haitian public health workers and nongovernmental partners have put their lives on the line to eliminate this terrible infectious disease. Every one of them has withstood devastating personal sacrifice. Some of our colleagues were murdered, others shot. Haiti’s program manager’s 7-year-old was kidnapped, and I also was kidnapped while working on the elimination program in Port-au-Prince. 

This is why our recent verification that Haiti has effectively shielded its entire population from lymphatic filariasis is such a milestone, a real-life testament to public health initiatives as well as human persistence, creativity, courage, and collaboration. We have met the World Health Organization’s standards, and exceeded them in our first round of treatment. Although more work is needed (treatment requires five rounds) this milestone is important. 

The lead expert in this remarkable program, Dr. Patrick Lammie, a CDC senior scientist, likes to say that Haiti is now at the top of the mountain and can start thinking how to get down. Eliminating lymphatic filariasis is also a winnable battle for CDC. 

An added benefit of the treatment, called mass drug administration, is that it kills other intestinal parasites that cause nutritional and growth deficiencies. As a result of this treatment, children will now perform better at school and experience less diarrhea and other health problems. 

The treatment program is also a public health best buy. It costs only about 50 cents a dose. Although it can’t cure those with the disease, now future generations will live free from suffering the pain and ostracization. 

Mass Drug Administration for lymphatic filariasis in Port au Prince, Haiti

The campaign hasn’t been easy. When I learned that people were declining treatment in numbers greater than expected, we investigated and found that people were worried about side effects. So I altered the campaign to help people understand the drugs protect their children. We formed a lymphatic filariasis soccer team and organized themed drawing contests in local schools. Our participation numbers went up, and we are on the road to elimination. 

Haiti’s Ministry of Health and its partners have gone to extraordinary measures to protect people in rural and urban areas and measure the program’s effectiveness; eliminating lymphatic filariasis is truly a collaboration. Our partners include Inter-American Development Bank, Pepsi, Abbott Pharmaceuticals, Digicel, Hopital Sainte Croix in Leogane, University of Notre Dame (funded by the Bill & Melinda Gates Foundation, and IMA World Health (funded by RTI/USAID). 

Succeeding in Port-au-Prince was the last—until now—and most crucial step leading to controlling the disease. We fully expect that our experience will help public health officials refine future efforts to combat lymphatic filariasis around the world, where it afflicts more than 120 million people worldwide. If we can do it in Haiti, we can do it anywhere. 

Read about verification efforts. 

Learn more about lymphatic filariasis.

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