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Chapter 4 : The Filarial Infections: Lymphatic Filariasis (Elephantiasis) and Dracunculiasis (Guinea Worm)
Elephantiasis is the most severe and dramatic complication of lymphatic filariasis (LF), a chronic infection caused primarily by the filarial parasite Wuchereria bancrofti. Dracunculiasis is another chronic infection caused by a filaria-like parasite, Dracunculus medinensis, also known as the guinea worm. Although both LF and dracunculiasis are still important public health problems in the developing world, we are much farther along in our global efforts to control these ancient scourges. For LF, ivermectin, diethylcarbamazine (DEC), and albendazole are donated free of charge. Therefore, LF mass drug administration can be provided for less than US$1 per person. Similarly, the estimated cost of the Dracunculiasis Eradication Program (DEP) between 1987 and 1998 was $87.5 million, or approximately US$5 to $8 per prevented case. In their own ways, LF mass drug administration and the DEP have been wildly successful. Given dramatic rates of guinea worm reduction over the last 25 years and now the stepped-up measures in Sudan through a new Sudan Guinea Worm Eradication Program, there is optimism about achieving these goals. Major reasons for success include the availability of simple interventions together with President Carter’s high-level advocacy and excellent coordination by the Carter Center and its partners. For LF, wherever elimination efforts have been aggressively pursued, the outcome has been extremely favorable.