Am. J. Trop. Med. Hyg., 66(5), 2002, pp.

560–565
Copyright © 2002 by The American Society of Tropical Medicine and Hygiene

HIGH PREVALENCE OF BRUGIA TIMORI INFECTION IN THE HIGHLAND OF

ALOR ISLAND, INDONESIA
TANIAWATI SUPALI, HERRY WIBOWO, PAUL RÜCKERT, KERSTIN FISCHER, IS S. ISMID, PURNOMO,
YENNY DJUARDI, AND PETER FISCHER
Department of Parasitology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia: German Agency for Technical
Co-operation (GTZ), Kupang, Indonesia; Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; U.S. Naval Medical
Research Unit No. 2, Jakarta, Indonesia

Abstract. To identify areas endemic for Brugia timori infection, a field survey was carried out in 2001 on Alor, East
Nusa Tenggara Timor, Indonesia. Elephantiasis was reported on this island by villagers as a major health problem.
Bancroftian filariasis was detected in four villages in the coastal area, whereas B. timori was identified in four rice-
farming villages. No mixed infections with both species were found. In the highland village Mainang (elevation ⳱ 880
m), 586 individuals were examined for B. timori infection and 157 (27%) microfilaria carriers were detected. The
prevalence of microfilaremic individuals standardized by sex and age was 25%. The geometric mean microfilarial density
of microfilaremic individuals was 138 microfilariae/ml. Among teenagers and adults, males tended to have a higher
microfilarial prevalence than females. Microfilaria prevalence increased with age and a maximum was observed in the
fifth decade of life. In infected individuals, the microfilarial density increased rapidly and high levels were observed in
those individuals 11−20 years old. The highest microfilaria density was found in a 27-year-old woman (6,028 microfi-
lariae/ml). Brugia timori on Alor was nocturnally periodic, but in patients with high parasite loads, a small number of
microfilariae was also detected in the day blood. The disease rate was high and many persons reported a history of acute
filarial attacks. Seventy-seven (13%) individuals showed lymphedema of the leg that occasionally presented severe
elephantiasis. No hydrocele or genital lymphedema were observed. This study showed that B. timori infection is not
restricted to the lowland and indicated that it might have a wider distribution in the lesser Sunda archipelago than
previously assumed.

INTRODUCTION fore, more detailed information about distribution and epide-

Three species of filarial parasites are the causative agents of
lymphatic filariasis: Wuchereria bancrofti, Brugia malayi, and
Brugia timori. Although the lymphatic filarial parasites have
many biologic and epidemiologic features in common, the
level of knowledge about their prevalence is different. It is
estimated that 115 million people are infected with W. ban-
crofti and 13 million with B. malayi, but no detailed estima-
tions about the prevalence of B. timori are available.1,2 Be-
cause the distribution of B. timori is limited to some islands of
the lesser Sunda archipelago, a low prevalence is suspected
and B. malayi and B. timori infections are often summarized
for prevalence estimations. Detailed knowledge of the distri-
bution of B. timori is scarce. The Timor filaria was originally
reported from East Timor.3 It was later detected on Sumba
island and more detailed studies were performed on Flores,
where the species B. timori was officially described.4,5
It was reported that B. timori occurs also on Alor island.4,6
A prevalence of B. timori microfilaremic individuals of 10%
was observed in Welai village in the coastal area of Alor, but
B. timori was not found in a nearby village at an elevation of
500 m.6 Both villages are close to the district capital Kalabahi
in the northwestern part of Alor, and the distribution of B.
timori in the remaining, more remote part of the island is still
unknown. On Flores island B. timori occurs also in the coastal
areas and not in the highlands; therefore, it was concluded
that it is a typical lowland species.6,7 So far B. timori has been
reported to be co-endemic only with W. bancrofti, but not
with B. malayi.4 Lymphatic filariasis has been targeted by the
World Health Organization for elimination as a public health
problem by the year 2020 because recent advances in diag-
nosis and chemotherapy of W. bancrofti and B. malayi infec-
tions have resulted in new and promising control strategies.8
However, it remains to be determined whether these new
concepts can be adapted to control B. timori infection. There-
miology of this parasite is required to establish sustainable
control programs.
In the present study, we identified for the first time villages
highly endemic for B. timori in the highland at an elevation of
880 m. We provide a parasitologic and clinical description of
the population in one endemic village on Alor. In this village,
B. timori is responsible for various clinical signs, most promi-
nently, lymphedema and elephantiasis of the lower leg. The
results of the study present baseline data for a control pro-
gram of B. timori filariasis on Alor island.
MATERIALS AND METHODS
Study area. Alor island is located north of Timor in the
province Nusa Tenggara Timor (Figure 1A). The island has
approximately 164,000 inhabitants and is one of the poorest
areas in Indonesia. To identify areas endemic for filariasis,
eight villages situated between the co-ordinates 124°20’E and
124°40’E and 8°10’S and 8°20’S were examined (Figure 1B):
Wolwal and Lola villages (southwestern Alor, elevation ⳱
120 m), Kokar village (northwestern Alor, elevation ⳱ 10 m),
Alila village (northwestern Alor, elevation ⳱ 100), Mainang
village (northwestern Alor, elevation ⳱ 880 m); Pailelang
village (southwestern Alor, elevation ⳱ 10 m), Fanating vil-
lage (northwestern Alor, elevation ⳱ 20 m), and Alemba
village (northwestern Alor, elevation ⳱ 100 m). The highland
village of Mainang was selected for a more detailed survey.
This village can be reached using a four-wheel-drive car by a
1.5-hour drive (30 km) from Kalabahi, the district capital of
Alor. The temperature varies between 18°C at night and
28−30°C during the day and the climate is humid. The short
wet season begins at the end of October continuing through
March and the long dry season extends from April to Octo-
ber. The village is located in a swampy valley and houses are
scattered over a large area. Several fields are located some

560
 B. TIMORI ON ALOR ISLAND
FIGURE 1. A, Map of Indonesia showing the location of Alor
island in the province of East Nusa Tenggara Timor. B, Map of Alor
showing the villages examined, the district capital Kalabahi, and the
most important mountains (triangles, elevation in meters) on the
island.
distance from the village and a number of farmers stay over-
night in their fields during the week. Rice is the main crop in
Mainang. Nevertheless, many dams in the rice paddies were
destroyed 10 years ago. This created numerous ponds of vari-
ous sizes that are excellent breeding sites for Anopheles mos-
quitoes. In addition to filariasis, villagers claim that malaria is
the major health problem in the area. Intestinal helminths are
common, especially Ascaris lumbricoides and hookworms. A
few people in the study area received diethylcarbamazine
(DEC) before 1990. However, during the last 10 years no
filariasis treatment was performed. In 2001, no DEC was
available in the pharmacies of the district capital.
Survey. The study was carried out from March to May 2001.
To identify endemic villages, people were called by their local
health workers to a central place, usually the Puskesmas
health center. Sex, age, and name were noted for each vol-
unteer and after a brief clinical examination finger prick
blood was collected between 7:00 PM and 11:00 PM. The par-
ticipants of the detailed survey in Mainang originated from
three different residential quarters of the village: Welai Sela-
tan, Malaipea and Tominuku. To determine the eligible popu-
lation, a house-to-house survey was carried out in these quar-
ters. All individuals more than four years of age were asked to
participate in the study. Inhabitants from Welai Selatan and
Malaipea came voluntarily to the health center. To exclude a
bias due to self-selection, all inhabitants of Tominuku who
were present in the village on the survey day were asked
individually to take part in the study. Almost all of these
selected persons participated the survey. Other individuals
from this village who heard about the survey and asked for an
examination were examined but excluded from the study
population. Informed consent was obtained from all persons
participating in the survey. The study was approved by the
Indonesian Ministry of Health and the University of Indone-
sia in Jakarta. Following registration, the individuals were
examined by experienced physicians for clinical signs of lym-
phatic filariasis, including enlarged or tender superficial in-
guinal and femoral lymph nodes, acute lymphadenitis and
lymphangitis of the extremities, scars at the sites of previously
561
ruptured lymph nodes or vessels, and lymphedema of the
extremities. All individuals were asked for signs of urogenital
disease and genitalia were examined when histories suggested
the presence of hydrocele or scrotal elephantiasis. Lymphe-
dema of the limbs was classified from grade 1 (pitting, revers-
ible lymphedema) to grade 4 (elephantiasis, non-pitting
edema with fibrotic and verrucous skin changes).9 In addition,
the participants were asked for a history of clinical signs that
may be related to lymphatic filariasis or malaria. All microfi-
laremic individuals, some randomly selected amicrofilaremic
persons, and all persons with lymphedema, including those
with elephantiasis, were asked for day blood collection on the
next morning between 10:00 AM and noon. During this op-
portunity, patients with lymphedma were introduced to hy-
gienic methods to use on their affected legs and other proce-
dures that may help stop the progression of the disease. Fol-
lowing the survey, treatment using a combination of a single
dose of DEC (6 mg/kg of body weight) and of albendazole
(400 mg) was offered to all infected individuals.
Assessment of microfilariae. For the identification of en-
demic areas, finger prick blood was collected between 7:00 PM
and 11:00 PM and a Giemsa-stained thick blood smear was
examined microscopically for the presence of microfilariae
(mf). Brugia timori mf were identified according to the de-
scription of Purnomo and others.10 To confirm the periodicity
of B. timori, finger prick blood (30 ␮L) was collected from
two infected individuals every two hours for 24 hours and
examined for mf. For more accurate estimation of mf densi-
ties, 1 mL of venous blood was filtered using 5-␮m polycar-
bonate filters (Millipore, Eschborn, Germany). The Giemsa-
stained filters were examined using a ×100 magnification and
mf were counted.
Data analysis. Epi-Info version 6.01 (Centers for Disease
Control and Prevention, Atlanta, GA) was used for documen-
tation and analysis of the data. The geometric mean was used
as an index of the mf density within a study group. Data on
distribution and density of mf were compared using the chi-
square test and the Mann-Whitney U test.
RESULTS
Identification of areas endemic for B. timori. Eight villages
in the western part of Alor island were briefly screened for
the presence of mf and for clinical signs of lymphatic filariasis.
A total of 1,075 individuals were examined. Twenty-seven B.
timori mf-positive persons in four inland villages were de-
tected by examination of finger prick night blood (Table 1).
Seventy-two W. bancrofti mf-positive persons in four coastal
villages were detected found by membrane filtration of 1 mL
night blood. The prevalence of Bancroftian filariasis was low
(1−3%) in the villages on the northwestern coast of Alor, and
only three patients with clinical signs were observed. Patients
with lymphedema of different grades or elephantiasis were
observed almost exclusively in the rice-farming villages en-
demic for B. timori. Male patients with hydrocele or genital
lymphedema were recorded only in the areas endemic for W.
bancrofti. The youngest man affected was 20 years old. In
these villages, people worked in dry-field agriculture or as
fishermen. However, since the participants were not ran-
domly selected, a bias due to self-selection cannot be ex-
cluded. Mixed infections of B. timori and W. bancrofti were
not found.
562 SUPALI AND OTHERS

TABLE 1
Identification of villages endemic for lymphatic filariasis by examination of thick smears of capillary night blood for the presence of microfilariae
(mf) on Alor island, Indonesia*

No. (%) mf positive

No. of patients with leg No. of male patients with scrotal
Village No. of persons examined Brugia timori Wuchereria bancrofti lymphedema (%) hydrocele/lymphedema (%)

Mainang 83 11 (13) 0 12 (14) 0

Pailelang 89 5 (6) 0 11 (12) 0
Fanating 176 4 (2) 0 6 (4) 0
Alemba 99 7 (7) 0 2 (2) 0
Wolwal* 229 0 35 (15) 0 9 (8)
Lola* 167 0 32 (19) 0 23 (29)
Kokar* 136 0 2 (1) 0 1 (2)
Alila* 96 0 3 (3) 1 (1) 1 (2)
Total 1,075 27 (3) 72 (7) 32 (3) 34 (6)
* These villages were examined by filtration of 1 ml of night blood.

Microfilaria rates. The B. timori-endemic village of Main-
ang in the highlands of Alor was selected for a more detailed
study. A total of 1,582 individuals lived in Mainang and 37%
(586 persons) of the population was examined. No children
less than five years old were included in the study. There was
no difference in the sex and age distribution of the examined
individuals in Mainang. More females were studied than
males, and 50% of the eligible females and 27% of the eligible
males were included in the study. This was because some men
stayed overnight in their fields and could not participate in
the survey. Confounding factors due to self-selection were
possible only in Welai Selatan and Malaipea, but not in
Tominuku where participants were recruited directly from
their homes. However, there was no significant difference in
prevalence of microfilaremic individuals and patients with
clinical signs in three sections of Mainang (Table 2). There-
fore, these three sections were analyzed as a homogeneous
group.
The highest rate of microfilaremic men and women was
found in those 40−50 years of age (50% for men and 38% for
women) (Figure 2). However, even in those 5−10 years of age,
18% of the children were mf positive. There was no sex dif-
ference in prevalence of microfilaremic individuals in this age
group of children (P ⳱ 0.8266). In older children and adults,
a significantly higher percentage of males was mf positive
(35% vs. 23%, P ⳱ 0.0022). The prevalences of microfila-
remic individuals standardized by sex and age were 25% and
23% if children less than five years old were assumed to be mf
negative. The geometric mean number of microfilariae per
millililter of blood was 118 mf/ml in males and 160 mf/ml in
females. This trend of women having higher microfilarial den-
sities than men was not statistically significant (P ⳱ 0.2380).
Microfilaria densities in microfilaremic individuals reached a
peak in both sexes between 10 and 19 years of age (Figure 3).
The highest microfilarial density observed was 6,028 mf/ml in
a 27-year-old women with grade 1 leg lymphedema. Fourteen
percent of the microfilaremic individuals had microfilarial
loads of 1−10 mf/ml, 26% had loads of 11−100 mf/ml, 37%
had loads of 101−1,000 mf/ml and 23% had loads greater than
1,000 mf/ml.
Microfilariae in day blood. When the day blood of mf-
positive individuals was examined for mf, it was observed that
62% of the individuals had circulating microfilariae. There
was a positive correlation between microfilarial density in
night blood and in day blood (rs⳱ 0.38, FG ⳱ 67, P < 0.002).
Among 28 individuals with microfilarial densities greater than
400 mf/ml in night blood, 27 (96%) also had mf-positive day
blood. The microfilarial densities in day blood were low: 57%
of the microfilaremic individuals had 1−10 mf/ml, 39% had
11−100 mf/ml, and 4% had greater than 100 mf/ml. Therefore,
we briefly examined the periodicity of B. timori on Alor is-
land in a patient with greater than 400 mf/ml in night blood
and in another patient with 100 mf/ml in night blood. Between
8:00 AM and 4:00 PM, 4.8% and 3.3% of the total number of
detected microfilariae were found in the peripheral blood of
these two patients, respectively. The peak of microfilarial
density was observed in one patient between 2:00 AM and 4:00
AM and in the other patient between 8:00 PM and 10:00 PM.

TABLE 2
Prevalence of Brugia timori microfilaremic individuals and persons
with lymphedema in the three sections of Mainang village, Alor
island, Indonesia*

No. examined No. mf positive (%) No. with lymphedema (%)

Male Female Male Female Male Female

Welai Selatan 88 120 30 (34) 23 (19) 14 (16) 21 (18)

Malaipea 87 112 27 (31) 24 (21) 11 (13) 14 (13) FIGURE 2. Prevalence of microfilariae-positive individuals in
Tominuku 65 114 23 (35) 30 (26) 4 (6) 14 (12) Mainang, Alor by age and sex. Microfilariae (mf) were detected by
Mainang 240 346 80 (33) 77 (22) 28 (12) 49 (14) filtration of 1 mL of night blood. The number of individuals examined
(total) is indicated on top of each column (n ⳱ 586). Black bars show males
* Microfilariae (mf) were detected by filtration of 1 ml of night blood. and hatched bars show females.
 B. TIMORI ON ALOR ISLAND
FIGURE 3. Geometric mean microfilarial densities in infected per-
sons in Mainang, Alor by age and sex. Microfilariae (mf) were de-
tected by filtration of 1 mL of night blood. Black bars show males and
hatched bars show females (n ⳱ 586).
These results confirmed the nocturnal periodicity of B. timori,
but showed that in individuals with high parasite loads a small
number of microfilariae can be also found in day blood.
Prevalence of clinical signs in Mainang. The most promi-
nent clinical sign of lymphatic filariasis in Mainang was
lymphedema (grades 1−3) of the leg; 35% of the affected
patients had elephantiasis (grade 4 lymphedema). Twenty-
nine (12%) males and 49 (16%) females had lymphedema,
but this difference was not significant (P ⳱ 0.466). The dis-
tribution of the grades of lymphedema was similar in both
genders. The prevalence of individuals with lymphedema
standardized by sex and age was 12%. Lymphedema of
grades 1−3 was first observed in individuals 10−15 years old
and elephantiasis was first observed in patients greater than
15 years old (Figure 4). Ninety percent of the individuals with
lymphedema were amicrofilaremic. The geometric mean mi-
crofilarial density of the eight microfilaremic individuals with
lymphedema was 311 mf/ml (range ⳱ 1−6,028 mf/ml). Both
legs were affected in approximately 40% of the cases. Only
one older woman had lymphedema of the right arm (grade 2).
In all other cases, lymphedema was limited to the leg, mostly
below the knee. Hydrocele in men and lymphedema of the
genitals were not observed. About 33% of the examined in-
dividuals reported a history of acute filarial attacks. Malaria
was reported to be highly endemic in the area and most par-
ticipants were not able to differentiate filarial fever from ma-
FIGURE 4. Prevalence of individuals with lymphedema (grades
1−3) or elephantiasis (grade 4) of the leg in Mainang, Alor by age and
sex. Black bars show males and hatched bars show females (n ⳱ 586).
563
laria. Therefore, data on acute filarial fever were not analyzed
in detail. During the survey, no patients with acute filarial
fever and acute lymphadenitis or lymphangitis were observed.
Filarial scars were observed in 12 (2%) of the individuals
examined. The overall prevalence of B. timori filariasis in
individuals with microfilaremia and/or obvious clinical signs
of filariasis was 39%.
DISCUSSION
The results of the present study show that lymphatic fila-
riasis is highly endemic on Alor island. Wuchereria bancrofti
was endemic only in the coastal, rice field−free areas, whereas
B. timori was found in areas with extensive rice culture. The
ecotype for B. timori was characterized as foothills along a
riverine valley with irrigated rice fields.11,12 This character-
ization is supported by the results of the present study. Since
B. timori infection was prevalent also at an elevation of 880 m,
it is suggested that it is not restricted to lowland areas, but is
linked to rice fields. Anopheles barbirostris is the only known
vector for B. timori .13 In a preliminary study, local A. bar-
birostris mosquitoes were found by polymerase chain reaction
(PCR) pool screening to be infected with B. timori (Fischer
and Supali T, unpublished data), published data), but because
it is not a homogeneous species, the vector strain remains
to be further characterized by molecular methods. However,
A. barbirostris is a typical rice field−breeding species and is
responsible for transmission of brugian filariasis in many
areas in East Asia.7 In contrast, A. subpictus was reported to
be the most important vector of W. bancrofti on Flores,
an island near Alor.14,15 The distribution of members of
the A. subpictus complex is more variable than that of A.
barbirostris, and certain cytospecies are known to occur only
in coastal areas and breed in brackish water. Highland
areas with an elevation more than 500 m predominate on
most of the islands of the lesser Sunda archipelago, and it is
likely that B. timori occurs in all rice-farming areas in this
region where A. barbirostris is abundant. No reports of a
co-endemicity of B. timori and B. malayi have been pub-
lished, and it can be hypothesized that B. timori replaces
B. malayi in this region.
We found a standardized prevalence of mf carriers of 25%
in Mainang. Previous studies on Alor also reported high
prevalences of B. timori infection, but the exact sampling
strategy, disease rates, and standardized prevalences were not
provided.4,6 Dennis and others detected on Flores a preva-
lence of mf carriers of 25% in a defined community of 201
persons.11 No significant differences in sex and age distribu-
tion of microfilaremic individuals were found in this village.
In our study, men tended to be mf positive more often and a
positive correlation was observed between the prevalence of
microfilaremic individuals and the age. A similar observation
was made by Partono and others on Flores, but due to the
small sample size these differences were not statistically sig-
nificant.12 Many studies on W. bancrofti and B. malayi infec-
tion provide evidence that a positive correlation between mf
prevalence and age exists and it is not unusual for filariasis
that men are infected more often than women.16 It can be
assumed that B. timori has an epidemiologic pattern similar to
the other lymphatic filarial parasites.
Although B. timori was confirmed to be nocturnally peri-
odic, the presented results indicate that persons with mf den-
564 SUPALI AND OTHERS
sities greater than 400 mf/ml of night blood can be identified
by the filtration of day blood with a sensitivity of 96%. For the
identification of endemic areas with high parasite loads, this
might be an alternative to the night blood collection. How-
ever, for areas with low endemicity and low infection density,
as well as for the monitoring of intervention programs, the
parasitologic examination of day blood for microfilariae is not
suitable. More sensitive methods, such as the PCR, need to be
used for this purpose.17
In the opinion of villagers in Mainang, the development of
leg edema was due to extensive work in rice fields. In accor-
dance with this belief, in rice field-free areas, where Bancrof-
tian filariasis was endemic, almost no edema of the leg was
observed. It is now well known that external bacterial super-
infections contribute to the pathology of lymphatic filaria-
sis.18 Therefore, working in irrigated rice fields may be a risk
factor in the development of elephantiasis of the leg in indi-
viduals infected with B. timori. Although individuals with
open lesions and advanced lymphedema try to avoid contact
with water because of the pain, they are forced to continue to
work in their rice paddies for economic reasons. Further stud-
ies are needed to elucidate the risk factors for the develop-
ment of lymphedema in individuals living in areas endemic
for B. timori. However, the prevalence of lymphedema in
Mainang was in agreement with results of two studies on
Flores, which reported B. timori microfilaremia rates of ap-
proximately 25% and lymphedema rates ranging between
11% and 15%.11,12
Dennis and others found that elephantiasis due to B. timori
most often developed during the third decade of life.11 This
observation is supported by our results, but we found that
lymphedema up to grade 3 was common even in teenagers
and may lead to serious social and economic consequences at
an early age. In a sample of 42 previously uninfected immi-
grants to an area endemic for B. timori, nine individuals were
reported to have developed lymphedema or elephantiasis
within two years following settlement.19 Although the devel-
opment of lymphedema may be faster in individuals who have
not been previously exposed to B. timori, this observation is
in agreement with our data that show that lymphedema due
to infection with B. timori often affects teenagers and younger
adults. The high prevalence of microfilaremic individuals and
persons with clinical signs such as lymphedema in Mainang
shows that B. timori filariasis is still an important local public
health problem.
As of the year 2000, approximately 3.9 million people lived
in Nusa Tenggara Timor and approximately 0.75 million
people lived in East Timor.20 These people are at risk of
lymphatic filariasis due to W. bancrofti and B. timori. The
prevalence of B. timori on Timor appeared to be low,3 but it
likely that on the other islands its prevalence may reach val-
ues similar to those reported for Mainang in the present
study. Although it may be premature to estimate the global
number of B. timori infections based on the available data, it
probably does not exceed 800,000 persons. In comparison
with W. bancrofti and B. malayi, this number is relatively
small and may be controlled more easily.
A few decades ago B. timori filariasis was successfully con-
trolled in a small community of 202 individuals on Flores
island by mass administration of DEC (5 mg/kg of body
weight) for 10 consecutive days.21 However, a dramatic ad-
vance in the control of W. bancrofti and B. malayi infections
was achieved by the observation that a single dose of DEC (6
mg/kg) has similar effects as the same dose of DEC given
daily for two weeks.8,22,23 Community-based treatment using
a single, annual, or semi-annual dose of DEC is considered to
be more feasible compared with a 10-day or two-week treat-
ment course. It is still not known if this single-dose treatment
strategy is also safe and effective in the control of B. timori
infection. So far, no animal reservoir for B. timori has been
identified. The distribution of B. timori is restricted to a few
islands and anopheline mosquitoes are the only known vec-
tors. It has already been discussed that filarial parasites trans-
mitted by anopheline mosquitoes can be more easily con-
trolled than culicine-transmitted infections.24 For these rea-
sons, the prospects for the elimination of B. timori filariasis
may be more promising compared with the elimination of
filariasis due to B. malayi and W. bancrofti in many other
regions.
The present study showed that B. timori filariasis is abun-
dant in the highlands of the lesser Sunda archipelago and that
this infection is still a public health issue of local importance.
Further studies are needed to show if B. timori infection can
be controlled by the new treatment strategies for the control
and elimination of lymphatic filariasis proposed by the World
Health Organization.
Acknowledgments: We thank Dr. Paul Manoempil, Sudiman, Dr.
Lani Harijanti, Simone Klüber, and the district health workers for
their help during the field survey. We are grateful to all inhabitants of
Mainang and the other villages examined who participated in the
study. We also thank Professor Bernhard Fleischer for his encour-
agement and Professor W. Büttner for critically reading the manu-
script.
Financial support: This investigation was supported by the UNDP/
World Bank/WHO Special Program for Research and Training in
Tropical Diseases (TDR). Peter Fischer was supported by the Schol-
arship Program ‘Infectiology’ of the German ‘Bundesministerium für
Forschung und Technologie (BMBF)’.
Authors’ addresses: Taniawati Supali, Herry Wibowo, Is S. Ismid,
and Yenny Djuardi, Department of Parasitology, Faculty of Medi-
cine, Salewba 6, University of Indonesia, Jakarta 10430, Indonesia.
Paul Rückert, German Agency for Technical Co-operation (GTZ),
Jalan Wolter Robert Monginsidi II/2, PO Box 1217, Walikota Baru,
Kupang 85000, Indonesia. Kerstin Fischer and Peter Fischer, Bern-
hard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Strasse
74, D-20359 Hamburg, Germany. Purnomo, U.S. Naval Medical Re-
search Unit No. 2, Jakarta, Indonesia.
Reprint requests: Peter Fischer, Bernhard Nocht Institute for Tropi-
cal Medicine, Bernhard-Nocht-Strasse 74, D-20359 Hamburg, Ger-
many, E-mail: Pfischer@bni.uni-hamburg.de.
REFERENCES
1. Michael E, Bundy DAP, Grenfell BT, 1996. Re-assessing the
global prevalence and distribution of lymphatic filariasis. Para-
sitology 112: 409−428.
2. Michael E, Bundy DAP, 1997. Global mapping of lymphatic fil-
ariasis. Parasitol Today 13: 472–476.
3. David HL, Edeson JFB, 1965. Filariasis in Portuguese Timor,
with observation on a new microfilaria found in man. Ann
Trop Med Parasitol 59: 193–204.
4. Joesoef A, Cross JH, 1978. Distribution and prevalence of cases
of microfilaraemia in Indonesia. Southeast Asian J Trop Med
Public Health 9: 480–488.
5. Partono F, Dennis DT, Atmosoedjono S, Oemijati S, Cross JH,
1977. Brugia timori sp. n. (nematoda: filarioidea) from Flores
Island, Indonesia. J Parasitol 63: 540–546.
6. Joesoef A, Dennis DT, 1980. Intestinal and blood parasites of
 B. TIMORI ON ALOR ISLAND
man on Alor Island Southeast Indonesia. Southeast Asian J
Trop Med Public Health 11: 43–47.
7. World Health Organization, 1992. Lymphatic filariasis: the dis-
ease and its control. World Health Organ Tech Rep Ser 821.
8. Ottesen EA, Duke BO, Karam M, Bebehani K, 1997. Strategies
and tools for the control/elimination of lymphatic filariasis.
Bull World Health Organ 75: 491–503.
9. Kumaraswami V, 2000. The clinical manifestations of lymphatic
filariasis. Nutman TB, ed., Lymphatic Filariasis. London: Im-
perial College Press, 103−125.
10. Purnomo, Dennis DT, Partono F, 1977. The microfilaria of Bru-
gia timori (Partono et al. 1977 ⳱ Timor microfilaria, David
and Edeson, 1964): morphologic description with comparison
to Brugia malayi of Indonesia. J Parasitol 63: 1001–1006.
11. Dennis DT, Partono F, Atmosoedjono PS, Saroso JS, 1976.
Timor filariasis: epidemiologic and clinical features in a de-
fined community. Am J Trop Med Hyg 25: 797–802.
12. Partono F, Pribadi PW, Soewarta A, 1978. Epidemiological and
clinical features of Brugia timori in a newly established village.
Karakuak, West Flores, Indonesia. Am J Trop Med Hyg 27:
910–915.
13. Atmosoedjono S, Partono F, Dennis DT, Purnomo, 1977. Anoph-
eles barbirostris (Diptera: Culicidae) as a vector of the timor
filaria on Flores Island: preliminary observations. J Med En-
tomol 13: 611–613.
14. Hoedojo, Partono F, Atmosoedjono S, Purnomo, Teren T, 1980.
A study on vectors of bancroftian filariasis in West Flores,
Indonesia. Southeast Asian J Trop Med Public Health 11: 399–
404.
15. Lee VH, Atmosoedjono S, Dennis DT, Suhaepi A, Suwarta A,
1983. The anopheline (Diptera: Culicidae) vectors of malaria
and bancroftian filariasis in Flores Island, Indonesia. J Med
Entomol 20: 577–578.
16. Michael E, 2000. The population dynamics and epidemiology of
565
lymphatic filariasis. Nutman TB, ed., Lymphatic Filariasis.
London: Imperial College Press, 41−81.
17. Fischer P, Supali T, Wibowo H, Bonow I, Williams SA, 2000.
Detection of DNA of nocturnally periodic Brugia malayi in
night and day blood samples by a polymerase chain
reaction−ELISA-based method using an internal control
DNA. Am J Trop Med Hyg 62: 291–296.
18. Dreyer G, Piessens WE, 2000. Worms and microorganisms can
cause lymphatic disease in residents of filariasis-endemic areas.
Nutman TB, ed., Lymphatic Filariasis. London: Imperial Col-
lege Press, 245−264
19. Partono F, Purnomo, 1978. Clinical features of Timorian filariasis
among immigrants to an endemic area in West Flores, Indo-
nesia. Southeast Asian J Trop Med Public Health. 9: 338–
343.
20. Statistiks BP, (Statistics Indonesisa), Republic of Indonesia, 2000,
http://www.bps.go.id.
21. Partono F, Maizels RM, Purnomo, 1989. Towards a filariasis-free
community: evaluation of filariasis control over an eleven year
period in Flores, Indonesia. Trans R Soc Trop Med Hyg 83:
821–826.
22. Dreyer G, Coutinho A, Miranda D, Noroes J, Rizzo JA, Galindo
E, Rocha A, Medeiros Z, Andrade LD, Santos A, Figueredo-
Silva J, Ottesen EA, 1995. Treatment of bancroftian filariasis
in Recife, Brazil: a two-year comparative study of the efficacy
of single treatments with ivermectin or diethylcarbamazine.
Trans R Soc Trop Med Hyg 89: 98–102.
23. Shenoy RK, George LM, John A, Suma TK, Kumaraswami V,
1998. Treatment of microfilaraemia in asymptomatic brugian
filariasis: the efficacy and safety of the combination of single
doses of ivermectin and diethylcarbamazine. Ann Trop Med
Parasitol 92: 579–585.
24. Webber RH, 1992. Can anopheline-transmitted filariasis be
eradicated? J Trop Med Hyg 94: 241–244.