Tonga eliminates kulokula fua [1]
Monday, July 31, 2017 - 19:33. Updated on Tuesday, August 1, 2017 - 09:31.
Tonga has finally eliminated lymphatic filariasis (kulokula fua), after more than three centuries, validated by the WHO. This is a health problem that caused the swelling of one's limbs, scrotum and breast.
Tonga’s Director of Health Dr Siale ‘Akau’ola said on July 28 this is a milestone for Tonga to eliminate this disease after a long struggle.
He said a big credit goes to WHO for driving this program with other partners to eliminate lymphatic filariasis in the Pacific region, which brought in the necessary test kits, medical consultants and medication to Tonga.
Another big factor commended, is the Tongan people for embracing the treatment especially back then when we had mass statistics of sufferers in the 1970s. People complained of the side effects and reaction from the medication, they stilll persisted to take it because they wanted to get rid of this disease and it gradually decreased, he said.
Dr 'Akau'ola said the success is due to the collaboration between the Tongan people, WHO, partners, and donors in coming together to fight this.
WHO
Devex.com reported that Tonga eliminating the disease last week, meant the incidence rate is less than one percent, which is the WHO mandated benchmark indicating a disease has been eliminated as a public health problem in all endemic areas in the country.
WHO Director for Pacific Technical Support Division and Country Representative in Fiji, Dr Corinne Capuano had said they may or may not be completely free of the infection this time, Tonga needs to remain vigilant and continue post elimination surveillance for potential emergencies or reintroduction of the disease over the next five to 10-years.
She said the likelihood of that happening is small as the process leading up to the announcement has been rigorous as it required Tonga to conduct three transmission assessment surveys for the past five-years and provide WHO with documents containing a huge amount of information on the disease in the country, including interventions and assessments.
Those documents were reviewed for validation by a group of independent global experts.
"It is a very rigorous assessment. We have so far not seen a country that has reached this level of threshold going back to the original level of spread."
Worst
Tonga has been one of the worst affected countries in the world by this neglected tropical disease.
In 1976, a study referred to by Capuano revealed 45-percent of Tonga’s population had the infection. A separate study done in the same year found one in 12 people had elephantiasis, swelling of the limbs and one in two adult males had hydroceles, swelling of the scrotum.
The launch of the Global Program to Eliminate Lymphatic Filariasis in 2000, following a World Health Assembly resolution, proved to be a game changer not just in Tonga, but globally.
That provided direction for a vision to eliminate lymphatic filariasis and action among different stakeholders to contribute toward that goal.
Devex reported two of the world’s largest pharmaceutical companies, glaxosmithkline and Merck & Co [2], made long-term drug donation commitments. Eisai Inc. [3], a Japanese pharmaceutical company, also agreed to donate over 2 billion diethylcarbamazine (DEC) tablets.
A combination of these drugs has been used in mass drug administrations to treat the entire population at risk, help control the disease and stop the spread of infection. But reaching a good” level of coverage, over 65 percent of the population annually for more than six-years, was what proved pivotal in Tonga’s success, Capuano said.
“They in fact had a reported coverage of over 80 percent in each of the six rounds ranging between 81 percent and 92 percent. That is among the best consistent treatment coverages we ever had anywhere.”
Support by different stakeholders and sustained leadership from the Ministry of Health were also instrumental, she added.
Tonga is the seventh country in the Western Pacific region to achieve WHO validation on the elimination of lymphatic filariasis as a public health problem. Marshall Islands [4] achieved the same in March this year as well as Togo [5] in April.