Lymphatic Filariasis in Mainland Southeast Asia: A Systematic Review and Meta-Analysis of Prevalence and Disease Burden.

Accurate prevalence data are essential for the elimination of lymphatic filariasis (LF) as a public health problem. Despite it bearing one of the highest burdens of disease globally, there remains limited reliable information on the current epidemiology of filariasis in mainland Southeast Asia. We conducted a systematic review and meta-analysis of available literature to assess the recent and current prevalence of infection and morbidity in the region. Fifty-seven journal articles and reports containing original prevalence data were identified, including over 512,010 participants. Data were summarised using percentage prevalence estimates and a subset combined using a random effects meta-analysis by country and year. Pooled estimates for microfilaraemia, immunochromatographic card positivity and combined morbidity were 2.64%, 4.48% and 1.34% respectively. Taking into account pooled country estimates, grey literature and the quality of available data, we conclude that Lao People's Democratic Republic (PDR), Myanmar and Northeast India demonstrate ongoing evidence of LF transmission that will require multiple further rounds of mass drug administration. Bangladesh, Malaysia, Thailand and Vietnam appear close to having eliminated LF, whilst Cambodia has already achieved elimination status. We estimate that the burden of morbidity is likely high in Thailand; moderate in Cambodia, Myanmar, and Northeast India; and low in Bangladesh. There was insufficient evidence to accurately estimate the disease burden in Lao PDR, Malaysia or Vietnam. The results of this study indicate that whilst considerable progress toward LF elimination has been made, there remains a significant filariasis burden in the region. The results of this study will assist policy makers to advocate and budget for future control programs.