Lymphatic filariasis affects about 120 million people in more than 80 countries. Adult worms live in the lymphatic system and produce larvae (microfilariae, mf), which migrate to the blood and are ingested by the mosquito vector. In the absence of a safe and effective drug to kill adult Wuchereria bancrofti or Brugia malayi, the current strategy is to interrupt transmission by reducing mf.
In the 1990s, research suggested enhanced suppression of mf with albendazole (Jayakody et al. 1993; Ismail 1998; Ottesen et al. 1999). In 1998, the Global Programme to Eliminate Lymphatic Filariasis (GPELF) recommended annual mass treatment (treating all community members where the disease is endemic) with two-drug regimens: albendazole plus either ivermectin or DEC (GPELF, 2005). Although albendazole has secondary benefits against intestinal helminths (Ottesen et al. 1999; Dickson et al. 2003), we were asked by the GPELF to assess the effects of albendazole alone or in combination with DEC or ivermectin on mf.