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Successful Control of Lymphatic Filariasis in the Republic of Korea

Hyeng-Il Cheun1, Yoon Kong2, Shin-Hyeong Cho1, Jong-Soo Lee1, Jong-Yil Chai3, Joo-Shil Lee4, Jong-Koo Lee5, Tong-Soo Kim1,†
The Korean Journal of Parasitology 2009;47(4):323-335.
Published online: December 1, 2009

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Corresponding author (tongsookim@inha.ac.kr)

†Present address: Department of Parasitology, Inha University School of Medicine, Incheon 400-712, Korea.

• Received: June 11, 2009   • Revised: September 25, 2009   • Accepted: October 6, 2009

Copyright © 2009 by The Korean Society for Parasitology

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Successful Control of Lymphatic Filariasis in the Republic of Korea
Korean J Parasitol. 2009;47(4):323-335.   Published online December 1, 2009
DOI: https://doi.org/10.3347/kjp.2009.47.4.323
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Successful Control of Lymphatic Filariasis in the Republic of Korea
Korean J Parasitol. 2009;47(4):323-335.   Published online December 1, 2009
DOI: https://doi.org/10.3347/kjp.2009.47.4.323
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Successful Control of Lymphatic Filariasis in the Republic of Korea
Image Image
Fig. 1 Endemic and surveyed areas of lymphatic filariasis in Korea, 2002-2006.
Fig. 2 Korea: one century of progress in lymphatic filariasis. There are some notable milestones-from first authentic case of lymphatic filariasis in 1927 to elimination of lymphatic filariasis in 2008.

Fig. 1

Fig. 2

Successful Control of Lymphatic Filariasis in the Republic of Korea
Former name Current name
Cheju-do (Island) Jeju-do
Cheju do
Cheju Do
Cheju Island
Cheju-do
Yongju (-gun) Yeongju-gun
Yong-ju
Yong-ju Kun
Yongju
Yongju-gun
Heugsan-do (Island) Heuksan-do
Kyongsang-Puk-do Gyeongsangbuk-do
Chung Nam Chungcheongnam-do
Chung Nam Province
Ronsan Nonsan
Puyo Buyeo
1927 Scientific identification of first authentic case of lymphatic filariasis in Korea.
1929-1930 First epidemiological survey was carried out in Chungcheongnam-do and Jeju-do.
1930-1940 Analysis of the clinical manifestations observed in Korean patients. The episodic febrile attacks accompanied by acute lymphadenitis and lymphangitis are the clinical manifestations characteristic to the early stage of lymphatic filariasis. The recurrent febrile attacks and the repeated occurrence of lymphangitis seemed to be important factors that may consequently result in elephantiasis in some of the infected cases. Enlargement of lymph nodes was also found in some cases; large in size, not hard, rather rubbery in consistency and movable. The most commonly affected site is the inguinal lymph nodes. No case of lymphangitis of the spermatic cord or lymph-scrotum was recognized in lymphatic filariasis patients in Korea. Clinical signs such as chyluria, haematochyluria or chylous effusions were not usually observed, but elephantiasis of the extremities was frequently observed. The episode of recurrent febrile attack, lymphangitis, and elephantiasis are the most important clinical signs of lymphatic filariasis found in Korea.
1943 Microfilaria affected with patients in Korea was firstly identified as Brugia malayi, not Wuchereria bancrofti.
1951 Survey in southern region of Korea and Jeju-do revealed 12.1% of positive rate for microfilaria (604 cases/5,000 examinee). The highest positive rate in Jeju-do reached 26.6%. All the affected species were identified as Brugia malayi.
1953 Launching of nationwide epidemiological survey. There were 3 major endemic foci of the lymphatic filariasis in Korea, including the northeastern part of Gyeongsangbuk-do, the western coastal areas of Jeollanam-do and Jeju-do.
1964 Start mass chemotherapy with diethylcarbamazine in endemic areas. Identification of Aedes togoi as a vector mosquito for Brugia malayi filariasis on Jeju-do.
1973 Introduction of low dosage regimen with diethylcarbamazine. Administration of low dosages daily or with a gradual increase of daily dosages after several days of initial administration, totaling 36 mg/kg in a full course.
1974 Identification of Anopheles sinensis as a vector mosquito responsible for local transmission of Brugia malayi in inland areas of Korea.
1980 Epidemiological surveys in Jeju-do, where the lymphatic filariasis was most endemic, revealed that the microfilaria positive rate reduced to a significantly low level of 0.5% following mass and selective treatments. In inland Korea, there has also been marked decrease of microfilaremia from 12.4% in 1973 to 2.2% in 1980.
1986 The epidemiological surveys in 4 villages of Jeju-do showed 0.3% of microfilaria positive rate in their peripheral blood smears.
In inland Korea, microfilaria positive case was not detected. A group of remote islands of Jeollanam-do, including Daeheuksan-do of Heuksan-myeon (Sinan-gun), which is located off the southwestern part of the Korean peninsula, were newly found to be endemic areas of Brugia malayi filariasis. Surveys in these areas demonstrated relatively high microfilaria rate among inhabitants with 10.6% on the average out of a total of 1,862 persons examined in the 21 villages of the 11 small islands from 1985 to 1987. The average microfilaria count for 198 positive cases were 33.4/120 μl night blood.
1988 Analysis of the relationship between the nocturnal periodicity of microfilariae of Brugia malayi in the peripheral blood and the blood sucking time of the vector mosquitoes. The lowest microfilaria count was seemed between 11 : 00 am and 3 : 00 pm. It gradually increased in the evening, with a significant increase at night around 9 : 00 pm and reached a plateau around 1 : 00 am (1.6 microfilariae/μl). The highest microfilaremia was observed during 11 : 00 pm-5 : 00 am (1.1-1.4 microfilariae/μl). The mosquitoes showed a typical nocturnal activity. Their peak human biting time was between 1 : 00-3 : 00 am.
1992-2000 The infected people in Sinan-gun were treated with diethylcarbamazine from 1986 to 1992 with the low dosage schedule. In 2000, epidemiological survey revealed 1.4% of positive rate. A total of 6 persons were treated with a single dose of albendazole and ivermectin, which resulted in successful treatment. In 2003, no positive case was found in these areas.
2002-2005 Accomplishment of a new programme for elimination filariasis in Korea. Microfilaria surveys were done in 3 endemic areas of Jeju-do, Jeollanam-do including Sinan-gun and Gyeongsangbuk-do. No case was found to be positive with microfilaria by microscopic examination (0 case/9,426 examinee). World Health Organization (WHO) advisory members visited in 2005 for evaluation of the programme.
2006 A seroepidemiological survey was carried out for 3,049 school children aged 10-13, in areas where Brugia malayi filariasis had been prevalent. No case was positively reacted. This result may further reflect that the transmission of filariasis in the Republic of Korea has already probably terminated more than 3 decades ago.
2007 Final national documentation of “The Elimination of Lymphatic Filariasis in Korea” was reported to the WHO Western Pacific Region Office (WPRO) and reviewed by the Regional Programme Review Group of the Regional Office for the Western Pacific of the WHO and subsequently by the WHO’s Technical Advisory Group for the Elimination of Lymphatic Filariasis (TAG-ELF).
2008 Declaration of free filariasis from Korea. WHO concluded the Republic of Korea has achieved elimination of lymphatic filariasis as a public health problem.
Year 1973
1980
1987
Village No. exam. No. posit. (%) No. exam. No. posit. (%) No. exam. No. posit. (%) Baranggol 61 11 (18) 34 2 (5.9) 34 0 (0) Ganuni 66 4 (6.1) - - 48 0 (0) Guitonggol 41 3 (7.3) 30 0 (0) 33 0 (0) Alseonggol 86 15 (17.4) 72 3 (4.2) 50 0 (0) Jangjagol 91 5 (5.5) 65 0 (0) 38 0 (0) Saehae 276 39 (14.1) 169 3 (1.8) 125 0 (0) Total 621 77 (12.4) 370 8 (2.2) 328 0 (0) Year 1963-1965
1968-1970
1971-1973
1978
1982-1984
1985-1989
Village No. exam. No. posit. (%) No. exam. No. posit. (%) No. exam. No. posit. (%) No. exam. No. posit. (%) No. exam. No. posit. (%) No. exam. No. posit. (%) Namwon-eup 317 59 (18.6) 1,301 326 (25.1) 5,415 257 (4.7) 312 18 (5.8) 1,133 22 (1.9) 1,448 8 (0.5) Pyoseon-myeon 162 22 (13.6) 800 174 (21.8) 3,289 119 (3.6) 365 20 (5.5) 488 13 (2.7) 172 1 (0.6) Seongsan-eup 201 7 (3.5) 0 0 (0) 4,980 168 (3.4) 0 0 (0) 1,892 17 (0.9) 115 4 (3.5) Andeok-myeon 150 12 (8) 0 0 (0) 0 0 (0) 0 0 (0) 0 0 (0) 241 0 (0) Daejeong-eup 0 0 (0) 1,239 60 (4.8) 0 0 (0) 360 0 (0) 0 0 (0) 65 0 (0) Total 830 100 (12) 3,340 560 (16.8) 13,684 544 (4) 1,037 38 (3.7) 3,513 52 (1.5) 2,041 13 (0.6) Year 1963-1968
1985-1989
Village No. exam. No. posit. (%) No. exam. No. posit. (%) Aewol-eup 63 10 (15.9) 117 1 (0.9) Hallim-eup 542 96 (17.7) 136 0 (0) Gujwa-eup 174 3 (1.7) 165 1 (0.6) Hangyeong-myeon 201 2 (1.0) 0 0 (0) Jocheon-eup 119 1 (0.8) 147 0 (0) Chuja-myeon 199 20 (10.1) 513 9 (1.8) Total 1,298 132 (10.2) 1078 11 (1.0) Island Year 1986-1992
2000
Village No. exam. No. posit. (%) No. exam. No. posit. (%) Daeheuksan-do Jin-ri 2gu 90 2 (2.2) 73 0 (0) Bi-ri 60 10 (16.7) 46 0 (0) Sa-ri 55 5 (9.1) 76 2 (2.6) Sim-ri 78 9 (11.5) 44 4 (9.1) Ma-ri 51 11 (21.6) 27 0 (0) Gonchon-ri 48 10 (20.8) 24 0 (0) Subtotal 382 47 (12.3) 290 6 (2.1) Daedun-do Su-ri 124 15 (12.1) - - Domok-ri 61 7 (11.5) - - O-ri 84 7 (8.3) - - Subtotal 269 29 (10.8) - - Hong-do Hongdo 1gu 162 12 (7.4) - - Hongdo 2gu 142 15 (10.6) 37 0 (0) subtotal 304 27 (8.9) 37 0 (0) Gageo-do Gageo 1gu 235 7 (3) - - Gageo 2gu 44 4 (9.1) - - Gageo 3gu 43 2 (4.7) - - Subtotal 322 13 (4) - - Daejang-do Jangdo-ri 67 15 (22.4) 45 0 (0) Yeongsan-do Yeongsan-ri 45 9 (20) 45 0 (0) Damul-do Damul-ri 125 9 (7.2) 49 0 (0) Sangtae-do Sangtaedo-ri 83 18 (21.7) - - Jungtae-do Jungtaedo-ri 56 10 (17.9) - - Hatae-do Hataedo-ri 100 15 (15) - - Manjae-do Manjaedo-ri 109 6 (5.5) - - Ui-do Ui 1gu 79 0 (0) - - Ui 2gu 49 0 (0) - - Seosoui-do Ui 3gu (Seori) 37 0 (0) - - Subtotal 750 82 (15.7) 139 0 (0) Total 2,027 198 (9.8) 466 6 (1.3)

※ Former names are shown in “References”.


Table 1. Transition of microfilaria rates in inhabitants of Yeongju-si, Gyeongsangbuk-do in 1973, 1980, and 1987

References: Kim, 1994 [28]; Kim et al., 1977 [54], 1980 [30]; Lee et al., 1987 [33],1992 [36].

Table 2. Decrease of microfilaria rates in Namjeju-gun, Jeju-do from 1963 to 1989

References: Kim et al., 1968 [46]; Lee, 1985 [31]; Lee, 1986 [32], 1987 [33], 1988 [34], 1989 [35]; Lee et al., 1964 [16]; Moon, 1968 [44]; Paik et al., 1988 [29]; Seo et al., 1965 [27], 1968 [19]; Seo and Lee 1973 [24]; Seo and Whang, 1974 [41]; Soh et al., 1966 [45].

Table 3. Decrease of microfilaria rates in Bukjeju-gun, Jeju-do in 1963 to 1989

References: Kim et al., 1968 [46]; Lee et al., 1964 [16]; Lee et al., 1985 [31], 1986 [32], 1987 [33], 1988 [34], 1989 [35]; Moon, 1968 [44]; Paik, 1986 [42]; Paik et al., 1988 [29]; Seo et al., 1965 [17], 1968 [19].

Table 4. Decrease of microfilaria rates on the islands in Sinan-gun, Jeollanam-do from 1986 to 2000

References: Chai et al., 2003 [38]; Lee et al., 1986 [32], 1987 [33], 1988 [34], 1989 [35]; Lee et al., 1992 [36]; Yong et al.,1988 [49]; Kim, 1994 [28].

Table 1.

Table 2.

Table 3.

Table 4.

PHD : Parasites, Hosts and Diseases

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