1. Post-MDA surveillance ( including xeno-monitoring) Krishnamoorthy K. Vector Control Research Centre Pondicherry India

2. Table 2. Number of districts covered under MDA in relation to drugs No. roundsDEC alone DEC + albendazoleTotal 31351 41563 5188331 6992970 7942327 84176 95117 10161 114117 12181 13072 14114 State to review the results of Mf survey in the MDA districts every year and the districts recording less than 1% Mf prevalence in all the sentinel and spot-check sites should complete Mf survey in 10 additional sites so as to generate information before next round of MDA. MDA need not be conducted in districts recording less than 1% in all the 10 additional sites. Resources for one round of MDA can be saved.

3. The coverage is reported as number out of eligible population (drug coverage). Due to wide variation in the proportion of eligible population, the coverage becomes inflated. Therefore, it will be useful if the coverage is calculated out of total population. Directorate to make necessary changes in the reporting formats. Independent assessment of coverage and compliance is not carried out in many districts. This information is required to identify the gap and identify methods to bridge it. Programme governance is observed to be weak in some states. There is no feedback from the reviews at higher levels and action plans suffer. Inadequate supply of drugs was common even during last round at all level. This results in low levels of coverages. Along with activity reports, action taken reports also should be reviewed at the Directorate of NVBDCP. Drug compliance was observed to be below the threshold level in some district, warranting strong social mobilization activities.

5. Country Populatio n (M) Population requiring PC for LF (M) Endemi c IUs Numbe r of IUs require MDA Numbe r of IUs stoppe d MDA Numbe r of IUs require d MDA in 2012 Numbe r of IUs covere d Geograph ical coverage Total population of Ius covered (M) Reported number of people treated (M) Program me (drug) coverage Nationa l coverag e Number of IUs subjected to TAS Banglades h 156.0077.233419514 100.0%27.0114.4186.43%*18.7%5 India1221.00617.17250 0 17670.4%380.65286.8375.35%46.5%0 Indonesia237.60123.48334301163018628.6%52.5323.6244.96%19.1%24 Maldives0.3901110Post MDA surveillance1 Myanmar48.3041.9445 54000.0%0.00 0.00%0.0%5 Nepal26.5025.0061 5565191.1%15.767.3146.38%29.2%0 Sri Lanka20.3008880Post MDA surveillance8 Thailand67.500.08357 0Post MDA surveillance357 Timor- Leste 1.141.0713 0 00.0%0.00 0.00%0.0%0 Total1778.73885.961104105539767432748.5%475.95332.1769.79%37.5%400 Table 1. Details of MDA carried out in SEA Region during 2012

6. Mapping and remapping protocols Mapping protocolRe-mapping protocol Number of sites230 Selection of sitesProbable (risk)pps Target age15 yrs or older10 yrs Sample100450 ToolMf/AgAg Cut-off1%2%

7. Development of an appropriate and feasible surveillance strategy to monitor the post-MDA epidemiological situation is necessary to: a)declare the areas/intervention units are free from LF transmission or b)take steps to prevent resurgence of infection, if any. Antigenaemia prevalence has been recommended to monitor post MDA situation. However, the change in this parameter during the post MDA period (five years) is not known to understand the usefulness of this indicator and also to decide on the frequency of post MDA survey. Rationale

8. Study area VillagesPopulation Mf prevalence Pre MDA Post 3 rounds Post 6 rounds % reduction (pre-post 6) Kallakulathur12037.610.00 100 Keelidayalam26094.272.950.4190 Sendiampakkam51711.364.350.00100 Sitheni208310.954.670.4796 Total64128.103.800.3496 Intervention = Mass annual single dose DEC + albendazole Six rounds – supervised administration (2001-2007) Coverage = above 70% Post 6 rounds of MDA = <1% mf Ag prevalence (3-6 years) = 0/93 Stopped MDA in 2008

11. Objectives To understand the post-MDA changes in antigenaemia prevalence in children (6-10 years) To relate the post-MDA changes in antigenaemia prevalence in children with the antigenaemia prevalence in adult groups (16-45 years) To evaluate the value of xenomonitoring as a tool for post- MDA surveillance To determine the required duration of post-MDA surveillance period

12. Evaluation Unit Evaluation Unit - four villages VillageHouseholdsFemaleMaleTotal Kallakulathur127449419868 Keelidayalam359104210312073 Sendiampakkam101364352716 Sitheni27710399031942 Grand Total864289427055599

14. Overall 7.76 % n=580 Overall 0.05% n=585

15. Indicators and tools 1.Antigenemia (mass) survey in : Diagnostic tool – ICT Target age class o 6-10 years (children) o 16-45 years (adults) 2.Entomological survey: 5000 vector mosquitoes Gravid traps Dissection to assess the vector infection These surveys were repeated after two years. The first survey was done in 2011 and the second in 2013

17. 2013 Villages 6-10 years16-45 yearsTotal Sample Ag +ve%Sample Ag +ve%Sample Ag +ve% Kallakulathur8400.0035551.4143951.14 Keelidayalam18200.001281120.941463120.82 Sendiampakkam8111.2341440.9749551.01 Sitheni20531.461361221.621566251.60 Total55240.723411431.763963471.19 2011 Villages 6-10 years16-45 yearsTotal Sample Ag +ve%Sample Ag +ve%Sample Ag +ve% Kallakulathur6100.029931.036030.8 Keelidayalam17521.1672263.9847283.3 Sendiampakkam19621.0754182.4950202.1 Sitheni6911.526351.933261.8 Total50151.01989522.62490572.3

18. Year 6-10 years PopulationSample Coverage (%) PopulationSampleCoverage (%) 2011 (post MDA 3)55050291.32728191870.3 2013 (Post MDA 5)73555275.103411243271.30 Coverage for ICT survey

19. Ag prevalence during post MDA

21. 2011 2013

23. TAS exercise (6-7 years) YearPopulationSampleCoverage (%) Ag +ve 201126214454.90 201323415565.40

24. Ag survey Longitudinal (cohort) folllow-up Total = 1053 Positive in 2011 = 23 Loss in 2013= 19 (82.6%) Negative in 2011 = 1030 Gain in 2013= 15 (1.46%)

25. Entomological survey – (2011) VillageTraps Vector (C.q) Trap density InfectionIntensityInfectivity CollectedDissectedPositive Kalla Kulathur901219 013.540.000.00 Sithani941920 520.430.261.40 Keezh Edayalam1071195 011.170.000.00 Sendiampakkam1071208 211.290.172.00 Total3985542 713.920.131.60

26. Entomological survey – (2013) VillagePopulatio n No. collections No. traps No. collecte d Density range per trap Per trap density No. dissecte d No. infected No. infective Sithani208312591328 1-6922.51132800 Keelidayalam2609131011306 1-3212.93130600 Kallakulathur12037541381 1-5425.57138100 Sendiampakkam51712931267 1-6413.62126700 Total6412443075282 1-6917.21528200 Period of survey3 months 04-12-201226-02-2013

27. Absence of recent transmission in two consecutive post-MDA surveys indicate that 1% Mf prevalence was safe to discontinue MDA. Prevalence of antigenemia prevalence among children (6-10 years) is less than 1% during post MDA period. Post-MDA Ag-prevalence between children and adult age class is not related, and therefore adult age class cannot be targeted for evaluation. There was reduction in antigenemia prevalence in both children (28%) and adult age classes (33%). The relative change in Ag prevalence between the age classes was also not significant. Loss of infection was about 83%. Xenomonitoring after two years of stopping MDA did not show evidence for vector infection implying absence of potential mf carriers in the study community. Conclusion

28. Achieving the sample size (census) Migrant children Assessing school enrolment rates “hotspots” Challenges in implementing TAS