Summary

This personal view examines the challenges and the relevance of mass drug administration (MDA) in urban areas. The authors suggest that MDA might not be essential to interrupt the transmission of lymphatic filariasis in urban areas in west Africa. Evidence shows that transmission levels are low and that effective MDA is difficult to implement, with assessments suggesting that specific control measures against filariasis in such dynamic settings is not an effective use of limited resources.

Instead, the authors recommend that: 1) individuals who have clinical disease or who test positive for Wucheria bancrofti infection in surveillance activities should be offered antifilarial drugs through a passive surveillance approach, as well as morbidity management for their needs; 2) more precise studies are done, so that MDA in urban areas is considered if sustainable transmission is found to be ongoing.