As countries progress towards elimination goals of diseases targeted by preventive chemotherapy, there is a need for robust survey methods and diagnostic tools to determine when transmission is low enough that it is safe to stop mass drug administration (MDA) and whether transmission remains suppressed after MDA has been stopped. After MDA has been stopped for a number of years and no recrudescence of transmission has been detected, there is a need for continued surveillance to alert ministries of health whether the disease has reemerged.

Stopping programs

• For onchocerciasis, there is a need to establish a measurable threshold for stopping MDA.
• For lymphatic filariasis, there is a need to determine when and how to follow up on antigen-positive children identified during surveys that take place three to five years after MDA has been stopped.
• For trachoma, there is a need to pilot a pre-trachoma impact survey (pre-TIS) to determine whether a district is ready to conduct TIS.

Post-MDA surveillance

• There is a need to validate and incorporate geostatistical and model-based tools into post-validation surveillance strategies
• There is a need to integrate post-MDA surveillance into the healthcare system and integrate surveillance with other diseases