Module 7 Verification of elimination

1. Training in monitoring and epidemiological assessment of mass drug administration for eliminating lymphatic filariasis Module 7 Verification of elimination

2. Learning objectives By the end of this module, you should understand why you should: • Compile and analyse all data related to LF • Prepare a national dossier • Submit the national dossier to the RPRG

3. Overview • Process for verification of elimination • Dossier overview • Timing

4. Process for verifying elimination • The national programme for the elimination of LF compiles all data related to LF from each IU before, during and after the national programme was initiated. • The national programme analyses the data and prepares a national dossier. • Can request assistance from WHO, the RPRG or WHO collaborating centres • The national programme submits the dossier to the RPRG through WHO.

5. Process for verifying elimination (continued) • The RPRG reviews the proposal and makes a recommendation to the Strategic and Technical Advisory Group on Neglected Tropical Diseases (STAG-NTD) working group on monitoring and evaluation (M&E WG) through WHO headquarters. • Can request that an expert team review the dossier and visit the country if necessary • The M&E WG reviews the recommendations of the RPRG and makes a recommendation to STAG-NTD. Post-MDA surveillance Verification STAG-NTD endorses the claim Submit dossier to WHO/RPRG RPRG endorses and recommends to STAG-NTD (via its M&E Working Group)

6. Dossier overview • A national dossier is a systematic presentation of evidence of the absence of transmission of LF for the entire country, containing: • a general description • the history of LF in the country • interventions • assessment of interventions • surveillance • additional data • bibliography   • Spatial presentation of data is encouraged: • maps of endemic and non-endemic areas • maps showing IUs and EUs

7. General description • Overall geographical and economic features of the country • Health system • Capacity to detect cases of infection • Capacity to provide treatment for clinical cases • Vectors • Geographical distribution • Feeding behaviour • Density and competence

8. General description (continued) • Immigration patterns • To and from areas endemic for LF, including other countries • Occurrence of LF in neighbouring countries and the status of LF control or elimination in those countries

9. History of LF • Detailed description • Maps of past and present foci of transmission • Review of data on prevalence and intensity of infection in humans • Review of data on prevalence of infection in vector mosquitoes • Clinical filarial disease • Geographical distribution and prevalence • Access to treatment for lymphoedema and hydrocoele

10. History of LF (continued) • Non-endemic areas • How non-endemic areas were defined • What surveillance there was in those areas to ensure that they remained non-endemic

11. Interventions • Details for all measures to control or interrupt transmission: • Screening, testing and treating positive cases • MDA • Environmental and economic improvement • Vector control

12. Assessment of interventions • Detailed description of surveys and studies conducted to evaluate the impact of intervention • Mapping surveys • Sentinel and spot-check sites • Surveys for stopping MDA: C surveys, child transmission surveys, TAS • Description should include: • Dates • Sampling methods and procedures • Diagnostic tests used • Follow-up of positive test results

13. Surveillance • A full review of any surveillance activities undertaken since stopping MDA and other interventions • Post-MDA surveillance, such as TAS • Other active surveillance • Case reports of filariasis obtained through routine disease surveillance and other systems • Follow-up of each positive case detected

14. Surveillance (continued) • Evidence that adequate sampling or surveillance was conducted in all previously endemic areas and in areas that were defined as non-endemic • Details of surveys done in cross-border areas and among immigrants from filariasis-endemic areas • Demonstration that any positive cases detected after MDA represented isolated events not traceable to an area of active transmission

15. Additional data • Any other data to support absence of transmission • Other sources of information • Need not be a separate section

16. Bibliography • Articles and reports on LF, its geographical distribution and interventions • Ministry of health records • Published studies • Academic theses and dissertations

17. Timing • Dossier should be submitted only when all evaluation units have completed post-MDA surveillance • Data collection and archiving should start early • Do not wait until interventions are complete in all EUs to start collecting and archiving data.