Testing and treating immigrants for lymphatic filariasis in south Florida

Lymphatic filariasis (LF) is a mosquito-borne infection caused by the parasite Wuchereria bancrofti. Approximately 120 million people carry LF in 81 countries, 40 million of whom may develop extreme limb or scrotal enlargement. A global effort to eliminate LF includes using mass drug administration to reach 1.3 billion persons at risk of infection; in 2008, 496 million people were treated with antifilarial drugs. There are over 4 million immigrants from LF endemic countries in the U.S. and an estimated 10,000 people have LF. Like many orphan diseases, treatment for LF is readily available in endemic countries. In the U.S., treatment is only available through Centers for Disease Control and Prevention (CDC). CDC has partnered with the Palm Beach County Health Department to implement a pilot program in a refugee clinic to test and treat immigrants at risk of LF. This pilot program took over three years to come to fruition; both the rapid diagnostic test and the drug treatment are not FDA approved and require IRB approval for use in the U.S. Currently, 184 people have been tested for LF in south Florida, of whom 13(7.1%) tested positive and 12 patients were treated. Of the people tested, 182(98.9%) stated their country of origin was Haiti. No adverse events were reported from testing or treatment. The staff and patients highly regard this program and its success. There are plans to expand to additional health centers in Florida; however, additional regulatory review is required to expand the program to other states.