American Journal of Infectious Diseases and Microbiology
ISSN (Print): 2328-4056 ISSN (Online): 2328-4064 Website: Editor-in-chief: Maysaa El Sayed Zaki
Open Access
Journal Browser
American Journal of Infectious Diseases and Microbiology. 2013, 1(1), 5-12
DOI: 10.12691/ajidm-1-1-2
Open AccessReview Article

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?

Anne Lanham1 and Lillian Mwanri1,

1Discipline of Public Health, School of Medicine, Faculty of Health Sciences, Flinders University, Adelaide, Australia

Pub. Date: February 28, 2013

Cite this paper:
Anne Lanham and Lillian Mwanri. The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?. American Journal of Infectious Diseases and Microbiology. 2013; 1(1):5-12. doi: 10.12691/ajidm-1-1-2


Lymphatic filariasis (LF) is a significant public health problem across the developing world and is highly prevalent in Papua New Guinea (PNG) with 16 out of 20 provinces recorded as endemic areas. This paper provides a comprehensive overview and discussion of various strategies to eliminate LF, explores the use of appropriate antifilarial drugs and examines the ways they can be taken to develop the most effective method for PNG. A systematic search of English literature was conducted using the National Library of Medicine (PubMed) and Science Direct databases between 1980 and 2012. Due to lack of high level research evidence, narrative as opposed to systematic review was conducted to identify major emerging themes. More than 1.3 billion people in 72 countries including PNG are threatened by LF. Over 120 million people worldwide are currently infected, with about 40 million disfigured and incapacitated. In 2000, the PNG National Department of Health (NDOH) began preparatory studies for a national program for LF elimination, but lack of commitment and funding has curtailed any significant progress and the disease remains highly prevalent in this country. Challenges and opportunities for elimination of LF in PNG exist and the authors predict that a combination of methods specifically tailored for PNG will have the greatest chance of success. There is an emphasis on calling for more research in a range of areas but this should not delay or compromise the introduction of a nation-wide LF elimination program or deny access to treatment for those afflicted with LF.

Papua New Guinea lymphatic filariasis Wuchereria bancrofti DEC salt vector control elimination

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


Figure of 2


[1]  Hawking, F., Marques, R.J,“Control of Bancroftian filariasis by Cooking Salt medicated with Diethylcarbamazine”, Bulletin of World Health Organisation, 37, 405-414, 1967.
[2]  World Health Organisation (WHO), Lymphatic filariasis Fact sheet No. 102 January 2012.
[3]  Milner, T,An Investigation into the feasibility of a National Program of DEC salt for Papua New Guinea for the Elimination of the Transmission of Lymphatic Filariasis; PNG, 2007.
[4]  Manguin, S., Bangs, M.J., Pothikasikorn, J., Chareonviriyaphap, T,“Review on global co-transmission of human Plasmodium species and Wuchereria bancrofti by Anopheles mosquitoes,”Infection, Genetics and Evolution, 10, 159-177, 2010.
[5]  Melrose, W.D,“Lymphatic filariasis: new insights into an old disease”,International Journal for Parasitology 32, 947-960, February 2002.
[6]  Centers for Disease Control and Prevention, “Life Cycle of Wuchereria bancrofti”.
[7]  World Health Organisation (WHO), Western Pacific Region Website Country Profile.
[8]  Bockarie, MJ., Ibam, E., Alexander, NDE., Hyun, P., Dimber, ZB., Bockarie, F., Alpers, MP., Kazura, JW,“Towards eliminating lymphatic filariasis in Papua New Guinea; impact of annual single-dose mass treatment on transmission of Wuchereria bancrofti in East Sepik Province,”PNG Med. Journal, 43, 172-182, 2000.
[9]  Bockarie, MJ., Tisch, DJ., Kaasterns, W., Alexander, NDE., Dimber, ZB., Bockarie, F., Ibam, E., Alpers, MP., Kazura, JW, “Mass treatment to eliminate filariasis in Papua New Guinea”. New England Journal of Medicine, 347(23), 1841-1848, December 2002
[10]  Bryan, J.H, “Vectors of Wuchereria bancrofti in the Sepik provinces of Papua New Guinea”,Transactions of the Royal Society of Tropical Medicine and Hygiene, 80, 123-131, 1986.
[11]  Melrose, W., Pisters, P., Turner, P., Kombati, Z.,Selve, BP., Hii, J., Speare, R., “Prevalence of filarial antigenaemia in Papua New Guinea: results of surveys by the School of Public Health and Tropical Medicine, James Cook University , Townsville, Australia,”PNG Medical Journal, 43 (3-4),161-165, Sep-Dec 2000.
[12]  Wynd, S., Melrose, WD., Durrheim, DN., Carron, J., Gyapong, M, “Understanding the community impact of lymphatic filariasis: a review of the sociocultural literature,”Bulletin of the World Health Organisation, 85(6), 493-498, June 2007.
[13]  Ottesen, E.A., Duke, B.O.L., Karam, M., Behbehani, K,“Strategies and tools for the control/elimination of lymphatic filariasis,”Bulletin of the World Health Organisation, 75 (6): 491-503, 1997.
[14]  Papua New Guinea, Department of Health: National Strategic Plan to Eliminate Lymphatic filariasis, PNG, 2004-2020, 2007.
[15]  Haddix, A.C., Kestler, A., “Elimination of lymphatic filariasis as a public health problem: Lymphatic filariasis: economic aspects of the disease and programmes for its elimination, Transactions of the Royal Society of Tropical Medicine and Hygiene, 94, 592-593, July 2000.
[16]  World Health Organisation (WHO),Global Malaria Programme WHO and DDT for Malaria Control-June 2009.
[17]  Sapak, P., Melrose, W., Durrheim, D., Pawa, F., Wynd, S., Leggat, P., Taufa, T., Bockarie, M, Evaluation of the Lymphatic Filariasis Control Program, Samarai Murua District, Papua New Guinea, James Cook University, 2004.
[18]  Wynd, S., Durrheim, DN., Carron, J.,Selve, B., Chaine, JP., Leggat, PA., Melrose, W,“Socio-cultural insights and lymphatic filariasis control-lessons from the Pacific”.Filaria Journal, 6(3), February 2007.
[19]  Gasparyan,A.Y.,Ayvazya, L., Blackmore,H., Kitas, G.D, “Writinganarrative biomedical review: considerations for authors, peer reviewers, and editors, ”Rheumatol Int,31,1409-1417,2011.
[20]  Gyapong, M., Gyapong, J.O., Owusu-Banalene, G., “Community-directed treatment the way forward to eliminating lymphatic filariasis as a public health problem in Ghana”,Ann Trop Med Parasitology, 95, 77-86,2001.
[21]  Nandha, B., Krishnamoorthy, K., “School-based health education campaign – a potential tool for social mobilization to promote the use of DEC-fortified salt towards elimination of lymphatic filariasis,”Health Education Research, 22(4), 539-545, 2007.
[22]  Fernando, S.D., Rodrigo, C., Rajapakse, S., “Current evidence on the use of antfilarial agents in the management of bancroftian filariasis,”Journal of Tropical Medicine.
[23]  Leggat, P.A., Melrose, W.D., Durrheim, D.N., “Could it be Lymphatic Filariasis?” Journal of Travel Medicine, 11, 56-60, 2004.
[24]  Ottesen, E. A., “The Global Programme to Eliminate Lymphatic Filariasis,”Tropical Medicine and International Health, 5(9), 591-594, September 2000.
[25]  Sapak, P., Williams, G, “The influence of bed nets on Bancroftian Filariasis in Buhutu Valley, Papua New Guinea”, Pacific Health Dialogue, 4(1), 35-38, 1997
[26]  Molyneux, D, “Lymphatic Filariasis (Elephantiasis) Elimination: A public health success and development opportunity,” Filaria Journal, 2:13, September 2003.
[27]  Kazura, JW., Bockarie, MJ, “Lymphatic filariasis in Papua New Guinea: interdisciplinary research on a national health problem,”Trends in Parasitology, 19(6), 260-263, June 2003.
[28]  Weil, G.J., Kastens,W., Susapu, M., Laney, S.J., Williams, S.A., King, C.L., Kazura, J.W., Bockarie, M.J, “The Impact of Repeated Rounds of Mass Drug Administration with Diethylcarbamazine plus Albendazole on Bancroftian Filariasis in Papua New Guinea,” Neglected Tropical Diseases, 2(12), e344.
[29]  Gelband, H, “Diethylcarbamazine salt in the control of lymphatic filariasis,” American Journal of Tropical Medicine and Hygiene, 50(6), 655-662, 1994.
[30]  Zhongguo, J.S., Chong, X.Y., Yu, J.C., Sheng, C., Bing, Z.Z, “A great success in lymphatic control in China. National Technical Steering Group for Filariasis Control and Research,”Chinese Journal of Parasitology and Parasitic Disease, MOPH, PMID 7554168, 1995.
[31]  Adinarayanan, S., Critchley, J.A., Das, P.K., Gelband, H, “Diethylcarbamazine (DEC)-medicated salt for community-based control of lymphatic filariasis,” Cochrane Database of Systematic Reviews, 2007,1.
[32]  Ichimori, K., Graves, PM., Crump, A, “Lymphatic filariasis elimination in the Pacific: PacELF replicating Japanese success,” Trends in Parasitology, 23(1), 36-40, November 2006.
[33]  Melrose, W, Deforestation in Papua New Guinea: Potential Impact on Health Care School of Public Health and Tropical Medicine, James Cook University; 1999.
[34]  Boreham, P., Marks, E., “Human filariasis in Australia: introduction, investigation and elimination,”Proceedings of the Royal Society of Queensland, 97, 23-52, 1986.
[35]  Bryan, J.H., Southgate, B., “Factors affecting transmission of Wuchereria bancrofti by anopheline mosquitoes. Uptake of microfilariae,” Transactions of the Royal Society of Tropical Medicine and Hygiene, 82, 128-137, 1988
[36]  Encyclopedia Smithsonian: Pheromones in Insects
[37]  Bray, DP, Bandi, KK, Brazil, RP, Oliveira, AG, Hamilton, JGC, “Synthetic Sex Pheromone Attracts the Leishmaniasis Vector Lutzomia longipalpis (Diptera: Psychodidae) to Traps in the Field”, J Med Entomol, 46(3),428-434, May 2009.
[38]  Burkot, TR., Ichimori, K,”The PacELF programme: will mass drug administration be enough?” Trends inParasitology, 18(3),109-115, March 2002.
[39]  Charlwood, D., Dagoro, H, “Impregnated bednets for the control of filariasis transmitted by Anopheles punctulatus in rural Papua New Guinea”, PNG Medical Journal, 30, 199-202, 1987.
[40]  World Health Organisation (WHO), Global Malaria Programme WHO and DDT forMalaria Control-June 2009.
[41]  Alexander, N.D.E., Bockarie, M.J., Dimber, Z.B., Griffin, L., Kazura, J.W., Alpers, M.P, “Migration and dispersal of lymphatic filariasis in Papua New Guinea,” Transactions of the Royal Society of Tropical Medicine and Hygiene, 95, 277-279, 2001.
[42]  Burkot, TR., Durrheim, DN., Melrose, WD., Speare, R., V., Ichimori, K,“ The argument for integrating vector control with multiple drug administration campaigns to ensue elimination of lymphatic filariasis”,Filaria Journal, 5(10), August 2006.
[43]  Ramaiah, K.D., Das, P.K., Vanamail, P., Pani, S.P, “Impact of 10 years of diethylcarbamazine and ivermectin mass administration on infection and transmission of lymphatic filariasis,”Transactions of the Royal Society of Tropical Medicine and Hygiene, 101(8), 555-563, March 2007.
[44]  Huppatz, C., Durrheim, D., Lammaie, P., Kelly, P., Melrose, W., “Eliminating lymphatic filariasis- the surveillance challenge,” Tropical Medicine and International Health, 13(3), 292-294, March 2008.
[45]  Esterre, P., Plichart, C., Sechan, Y., Nguyen, NL, “The impact of 34 years of massive DEC chemotherapy on Wuchereria bancrofti infection and transmission: the Maupiti cohort,” Journal of Tropical Medicine and International Health, l6(3), 190-195, March 2001.
[46]  Noroes, J., Dreyer, G., Santos, A., Mendes, VG., Medeiros, Z., Addiss, D.,“Assessment of the efficacy of diethylcarbamazine on adult Wuchereria bancrofti in vivo,” Transactions of the Royal Society of Tropical Medicine and Hygiene, 91, 78-81,1997.
[47]  Lahariya, C., Tomar, S.S, “How endemic countries can accelerate lymphatic filariasis elimination? An analytical review to identify strategic and programmatic interventions,” Journal Vector Borne Diseases, 48, 1-6,March 2011.
[48]  Tisch, DJ., Michael, E., Kazura, J.W, “Mass chemotherapy options to control lymphatic filariasis: a systematic review,” The Lancet, 5, 514-523,August 2005.
[49]  Fan, P.C,“Filariasis eradication on Kinmen Proper, Kinmen (Quemoy) Islands, Republic of China,”Acta Tropica, 47(3),161-169,1990.