Mathematical models for lymphatic filariasis transmission and control: Challenges and prospects

BACKGROUND: Mathematical models developed for describing the dynamics of transmission, infection, disease and control of lymphatic filariasis (LF) gained momentum following the 1997 World Health Assembly resolution and the launching of the Global Programme to Eliminate Lymphatic Filariasis (GPELF) in 2000. Model applications could provide valuable inputs for making decisions while implementing large scale programmes. However these models need to be evaluated at different epidemiological settings for optimization and fine-tuning with new knowledge and understanding on infection/disease dynamics. DISCUSSION: EPIFIL and LYMFASIM are the two mathematical simulation models currently available for lymphatic filariasis transmission and control. Both models have been used for prediction and evaluation of control programmes under research settings. Their widespread application in evaluating large-scale elimination programmes warrants validation of assumptions governing the dynamics of infection and disease in different epidemiological settings. Furthermore, the predictive power of the models for decision support can be enhanced by generating knowledge on some important issues that pose challenges and incorporating such knowledge into the models. We highlight factors related to the efficacy of the drugs of choice, their mode of action, and the possibility that drug resistance may develop; the role of vector-parasite combinations; the magnitude of transmission thresholds; host-parasite interactions and their effects on the dynamics of infection and immunity; parasite biology, and progression to LF-associated disease. SUMMARY: The two mathematical models developed offer potential decision making tools for transmission and control of LF. In view of the goals of the GPELF, the predictive power of these models needs to be enhanced for their wide-spread application in large scale programmes. Assimilation and translation of new information into the models is a continuous process for which generation of new knowledge on a number of uncertainties is required. Particularly, a better understanding of the role of immune mechanisms in regulating infection and disease, the (direct or immune mediated) mode of action of current drugs, their effect on adult worms, their efficacy after repeated treatment, and the population genetics of drug resistance are important factors that could make the models more robust in their predictions of the impact of programmes to eliminate LF. However, if these models are to be user-friendly in the hands of programme managers (and not remain as research tools), it would be necessary to identify those factors which can be considered as the minimum necessary inputs/outputs in operational settings for easy evaluation and on-site decision making.