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

Research output: Contribution to journalArticlepeer-review


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

External organisations

  • Department of Statistics, University of Warwick
  • Erasmus University Medical Center
  • Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, USA
  • School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom.
  • Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK.


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 languageUndefined/Unknown
JournalThe Journal of Infectious Diseases
Publication statusPublished - 19 Dec 2019
Externally publishedYes