Haiti takes on dreaded disease elephantiasis one mouth at a time

After years of mass drug administrations, nine countries — Burundi, Cape Verde, Costa Rica, Mauritius, Rwanda, Seychelles, the Solomon Islands, Suriname, and Trinidad and Tobago — were declared free of lymphatic filariasis in 2011 by the World Health Organization. Haiti hopes to join them.

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Until the earthquake of Jan. 12, 2010, Haiti and its foreign donors fought the disease only where it was most prevalent. Over time, more and more parts of the country were included in the campaign. However, Port-au-Prince, a place where the disease was uncommon, was always judged out of reach. The capital was simply too crowded and chaotic for mass drug administration.

Ironically, the earthquake changed people’s minds about what was possible — and necessary.

One-third of Haiti’s population was affected by the quake. More than 2 million people became homeless or chose to move. Internal migration threatened to redistribute the disease, interrupt the every-year treatment for many people, and generally undo all the gains of the previous decade.

At the same time, the earthquake brought a flood of money and human energy to Haiti. Suddenly, nationwide drug administration — including in Port-au-Prince — became just one more ambitious task that had to be done.

“There was this feeling that we just couldn’t quit. Things had come too far to walk away,” said Patrick J. Lammie, a scientist at the U.S. Centers for Disease Control and Prevention who has worked on filariasis in Haiti for more than two decades.

As a consequence, for four weeks this past winter, two medicines — albendazole and diethylcarbamazine (DEC) — were handed out in Port-au-Prince’s schools, markets, churches, factories and public places. They were also delivered to the squatter camps where more than a half-million earthquake-displaced people still lived. In all, about 70 percent of the capital’s population took them, according to a CDC survey in the spring.

Today, more than two years after the earthquake, “everyone in Haiti has gotten the drugs,” Lammie said. (The actual estimate is 8.7 million.) “That’s the success story of Haiti. Now we have to do it on an annual basis.”

The rationale for such an ambitious effort is this: Albendazole and DEC kill off the larval form of the filariasis parasite, which if not treated matures into an unkillable worm in about a year. If an entire population takes the drugs regularly — adults once a year, children twice — the amount of parasite larvae circulating in people and mosquitoes falls so low that no new transmissions occur.

Biologists think that 70 percent coverage for eight years is enough to stop new cases, assuming the same people are not missed year after year. If they are, those people can become a permanent reservoir from whom mosquitoes can pick up the parasite and pass it on to new victims through bites.

Haiti will know by the end of the decade whether it has pulled the trick off.

Missed mouths

In Haiti, the government’s health ministry is doing most of the work. Two charities, IMA World Health and RTI International, provide advice, along with the University of Notre Dame. A foundation associated with the drugmaker Abbott Laboratories is helping with salaries.