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Historically, the human prevalence of Wuchereria bancrofti infection in Wallis and Futuna (WAF) was among the highest in the Pacific and mass drug administration (MDA) against lymphatic filariasis (LF) either with diethylcarbamazine citrate (DEC) or the combination of DEC and albendazole had been implemented for decades. To determine whether LF antigen prevalence in WAF was lower than 1%, the infection threshold for elimination in an area where Aedes spp. are the principal vectors, we conducted the WHO-recommended transmission assessment survey in 2012. We present the results of a school-based survey, which targeted 1,014 students in all 13 elementary schools in WAF. From a fingerprick, the circulating filarial antigen (CFA) positivity was checked for grade 2-5 students using BinaxNOW filariasis test (immunochromatographic test). Of 935 children tested, three were positive for CFA in two schools. At the territory level, this was below the critical cutoff of nine cases, if the whole territory was considered as a single evaluation unit. The prevalence of CFA in WAF is less than 1%, reaching the goal for LF elimination set by the WHO. We were able to recommend stopping LF MDA and move to post-MDA surveillance to detect any recrudescence. This survey successfully paved the way for WAF to be validated as achieving LF elimination as a public health problem by 2020.

Neglected tropical diseases (NTDs) cause serious health, social and economic burdens in the countries of the World Health Organization Western Pacific Region. Among the NTDs, helminth infections are particularly prominent with regard to the number of infected individuals and health impact. Co-endemicity is common among impoverished and marginalized populations. To achieve effective and sustainable control of helminth NTDs, a deeper understanding of the social-ecological systems governing their endemicity and strategies beyond preventive chemotherapy are required to tackle the multiple causes of infection and re-infection. We discuss the feasibility of implementing multi-disease, multi-sectoral intervention packages for helminth NTDs in the Western Pacific Region. After reviewing the main determinants for helminth NTD endemicity and current control strategies, key control activities that involve or concern other programmes within and beyond the health sector are discussed. A considerable number of activities that have an impact on more than one helminth NTD are identified in a variety of sectors, suggesting an untapped potential for synergies. We also highlight the challenges of multi-sectoral collaboration, particularly of involving non-health sectors. We conclude that multi-sectoral collaboration for helminth NTD control is feasible if the target diseases and sectors are carefully selected. To do so, an incentive analysis covering key stakeholders in the sectors is crucial, and the disease-control strategies need to be well understood. The benefits of multi-disease, multi-sectoral approaches could go beyond immediate health impacts by contributing to sustainable development, raising educational attainment, increasing productivity and reducing health inequities.

The prevalence of hepatitis B virus (HBV) in Wallis and Futuna (WAF) was one of the highest in the Pacific and was the driving factor for introducing hepatitis B (HepB) vaccination in 1992 and HepB birth dose (HepB-BD) in 2006. Using lymphatic filariasis (LF) transmission assessment survey (TAS) as a survey platform for eliminating LF, we assessed HBV surface antigen (HBsAg) seroprevalence, HepB vaccination coverage, and its timeliness among schoolchildren in WAF. From one finger prick of all registered fourth and fifth grade students, we tested HBsAg and filariasis antigen simultaneously, and estimated HepB vaccination coverage and timeliness by reviewing students' immunization cards. Since the children targeted were born when the three-dose HepB schedule was 2, 3, and 8 months, we defined timely vaccination if each dose was given by 3, 4, and 12 months. Of 476 targeted, 427 were enrolled. HBsAg prevalence was 0.9%. Estimated HepB vaccination coverage was 97%, 97%, and 96% for the first, second, and third doses, respectively, yielding coverage for all three doses of 96%. Proportion of timely vaccination was lower: 80%, 56%, and 65%, respectively, and less than 50% for all three doses combined. The seroprevalence of HBsAg among schoolchildren in WAF is less than 1%, close to the control goal. HepB vaccination coverage was high, but many children were vaccinated late. We recommend increasing the efforts for timely HepB vaccination. By combining an HBV seroprevalence survey and coverage assessment, we demonstrated the benefit of using TAS as a public health platform to access schoolchildren.

Infection with soil-transmitted helminths (STH) is a major public health problem in many developing countries, with pregnant women and children particularly at risk. Preventive chemotherapy, which is the intervention currently recommended by the WHO against the main helminth infections including those caused by STHs, aims at reducing morbidity through periodical administration of anthelminthic drugs either alone or in combination. The Expanded Programme on Immunization is one of the most widely implemented health programmes in the world and has well established access to children and women. The present study investigated the cost of the provision of anthelminthic drugs during existing immunisation campaigns. In Lao PDR, use of this integrated approach compared with implementation of the vertical deworming campaign alone allowed a reduction of the individual cost of deworming by 10 times (from US$0.23 in the vertical deworming campaign to US$0.03 in the integrated campaign). When drug cost was excluded, the cost of deworming an individual was US$0.007, implying that deworming 100 children would cost less than US$1 if drug donation was in place. The burden posed on health workers by the integration process was perceived as minimal and manageable. Moreover, delivery of anthelminthic drugs during immunisation campaigns enabled campaign teams to observe drug intake directly, which assured safety. These findings prove that integration is an opportunity to maximise health benefits through the delivery of multiple health products and the attainment of high coverage.

Objectives: To describe the epidemiology of mumps and examine potential factors underlying the recent increase in the incidence of mumps in Australia. Design, setting and participants: Analytical descriptive study, for all Australian states and territories, of mumps notifications (1994-2007); hospitalisations for mumps (1994-2005); and mumps seroprevalence in a nationally representative sample of 2787 subjects (1997). Main outcome measures: Incidence of notifications and hospitalisations for mumps; seropositivity by birth cohort. Results: Notified mumps cases increased from 60 in 2002 to 231 in 2005 and 512 in 2007. Between 1994 and 2005, there were 605 hospitalisations for mumps. Mumps seropositivity in all states and territories in 1997 was high (range, 87.1%-94.3%). The predominant age group affected by mumps shifted to adults over time: between 2005 and 2007, 41% of cases occurred among people aged 20-29 years. Cases were concentrated among the birth cohort of 1978 to 1982, who had higher rates of notifications and hospitalisations for mumps and a lower seropositivity rate (92% [95% Cl, 89%-94%]) than other birth cohorts. Conclusions: The birth cohort of 1978 to 1982 was too old to reliably receive a second dose of measles-mumps-rubella (MMR) vaccine in the 1998 Australian Measles Control Campaign and too young to have had mumps infection. Renewed efforts to maximise two-dose MMR coverage are important for prevention of mumps and measles in young adults.

To estimate the prevalence and incidence of dementia in Northern Territory Indigenous and non-Indigenous populations.Four data sources were used to identify clients with a diagnosis of dementia, from 1 January 2008 to 31 December 2011. The data sources included hospital admissions, aged care services, primary care and death registration. A capture-recapture method was used to estimate prevalence and incidence, including both diagnosed and unknown cases.Prevalence and incidence of dementia among the NT Indigenous and non-Indigenous populations.In 2011, the estimated prevalence in the NT Indigenous population aged 45 years and over was 3.7 per 100, and 1.1 per 100 in the corresponding NT non-Indigenous population. The age-adjusted prevalence for the NT Indigenous population was 6.5 per 100, compared with the NT non-Indigenous prevalence of 2.6 per 100, which was similar to the national rate. The prevalence rate ratios of NT Indigenous to NT non-Indigenous men and women, respectively, were: 6.5 and 5.5 for the 45-64-years age group, 4.0 and 4.1 for those aged 65-74 years and 2.1 and 1.9 for those aged 75 years and over. The age-adjusted incidence among the NT Indigenous population aged 45 years and over (27.3 per 1000 person-years) was higher than that among the NT non-Indigenous population (10.7 per 1000 person-years).The NT Indigenous population has a much higher prevalence and incidence of dementia and younger onset of disease compared with their non-Indigenous counterparts. The results highlight the urgent need for interventions to moderate the emerging impact of dementia in the Australian Indigenous population.