Elimination or Resurgence: Modelling Lymphatic Filariasis After Reaching the 1% Microfilaremia Prevalence Threshold

Joaquin M. Prada, Emma L. Davis, Panayiota Touloupou, Wilma A. Stolk, Periklis Kontoroupis, Morgan E. Smith, Swarnali Sharma, Edwin Michael, Sake J. de Vlas, T. Deirdre Hollingsworth

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)


The low prevalence levels associated with lymphatic filariasis elimination pose a challenge for effective disease surveillance. As more countries achieve the World Health Organization criteria for halting mass treatment and move on to surveillance, there is increasing reliance on the utility of transmission assessment surveys (TAS) to measure success. However, the long-term disease outcomes after passing TAS are largely untested. Using 3 well-established mathematical models, we show that low-level prevalence can be maintained for a long period after halting mass treatment and that true elimination (0% prevalence) is usually slow to achieve. The risk of resurgence after achieving current targets is low and is hard to predict using just current prevalence. Although resurgence is often quick (<5 years), it can still occur outside of the currently recommended postintervention surveillance period of 4–6 years. Our results highlight the need for ongoing and enhanced postintervention monitoring, beyond the scope of TAS, to ensure sustained success.
Original languageEnglish
Pages (from-to)S503-S509
JournalThe Journal of Infectious Diseases
Issue numberSupplement_5
Publication statusPublished - 19 Dec 2019
Externally publishedYes

Bibliographical note

Funding Information:
Financial support. This work was supported by the Bill and Melinda Gates Foundation through the NTD Modelling Consortium (grant number OPP1184344).

Publisher Copyright:
© 2019 The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America.


  • breakpoints
  • elimination
  • lymphatic filariasis
  • modelling
  • postvalidation surveillance
  • resurgence
  • thresholds

ASJC Scopus subject areas

  • Immunology and Allergy
  • Infectious Diseases


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