Lymphatic Filariasis "Elephantiasis" a Parasitic Disease

Lymphatic Filariasis is a Parasitic Disease, commonly known as elephantiasis is a disfiguring and disabling disease, usually acquired in childhood. It is caused by wire worms called filarial parasites. Adult worms (male and female) settle in the lymph nodes and the female worm gives birth to millions of young people called Microfilariae (mf).

Important facts

1. Lymphatic filariasis weakens the lymphatic system and leads to abnormal dilation of body parts, causing pain, severe disability and social stigma.
2. 893 million people in 49 countries worldwide are at risk of lymphatic filariasis and preventive chemotherapy is needed to stop the spread of this parasitic infection.
3. In 2000, more than 120 million people were infected, and about 40 million were infected.
4. Lymphatic filariasis can be eliminated by preventing the spread of infection through preventive chemotherapy with a combination of safe medications that are repeated annually. More than 7.7 billion treatments have been provided to stop the spread of infection since 2000.
5. Successful implementation of WHO strategies means that 597 million people do not need preventive chemotherapy.
6. A basic, recommended package of care can reduce suffering and prevent further disability in people living with the disease caused by lymphatic filariasis.

Symptoms

1. Asymptomatic
2. Kidney damage
3. Proteinuria and hematuria
4. Infected people maintain transmission of the disease
5. Swollen and painful limbs (lymphedema or elephantiasis)
6. Genital disease, hydrocele in humans is also common in endemic areas.
7. High fever and severe pain

Cause

The disease is caused by three species of threadlike nematode worms, called worms - Wuchereria bancrofti, Brugia malayi and Brugia timori.

Transmission

Filarial parasite species in India only live in humans. The adult worm produces microfilariae which circulate in the peripheral blood system of infected people. When the mosquito feeds on the infected person, it ingests the microfilariae.

National filaria control program

Following the pilot project in Orissa from 1949 to 1954, the National Filaria Control Program (NACP) was launched in the country in 1956 with the aim of eradicating the problem, taking control measures in endemic areas and train staff to manage the program. The main control measures were the massive administration of CED, anti-larval measures in urban areas and residual indoor spraying in rural areas.

Strategy

1. Repeated anti-larval measures at weekly intervals.
2. Environmental methods, including reduction at source by filling ditches, pits, low areas, de-watering, sand removal, etc.
3. Biological control of mosquitoes by breeding larvivorous fish.
4. Pest control measures through “detection” and “treatment” of microfilaria carriers and patients with CED by Filaria clinics in the cities covered by the program.

Elimination of lymphatic filariasis in India

In 1997, WHO and its Member States committed to eliminating lymphatic filariasis (LF) as a public health problem by 2020 by resolution WHA 50.29 of the World Health Assembly. The national health policy (2002) set the objective of eliminating lymphatic filariasis in India by 2015, then later until 2021. 

Following this Global Alliance for the Elimination of Lymphatic Filariasis (GAELF) , was formed in 2000. Two-pillar strategies for mass drug administration (Marketing Authorization) for interruption of transmission, ie no new cases and management of morbidity and prevention of disabilities (MMDP) for the restoration of patients with the disease have only been adopted for elimination.

Mass Drug Administration (MDA)

MDA started as a mass campaign from 2004. Initially with a single dose of DEC only. In 2007 with the DEC + Albendazole co-administration. The 2018 Triple Drug Therapy (IDA) form, i.e. DEC + Albendazole + Ivermectin, is initially launched in five selected districts. Since the elimination target is approaching first, all districts left behind that have not yet been eliminated will be submitted to IDA.

Two-pillar strategy for the elimination of lymphatic filariasis

1. Annual mass administration (MDA) of a single dose of DEC (diethylcarbamazine citrate) and albendazole for 5 years or more to the eligible population (except pregnant women, children under 2 years of age and the seriously ill ) to interrupt the transmission of the disease.
2. Home management of lymphedema cases and extension of hydrocele operations in the CHCs / district hospitals / medical schools identified.

Global program to eliminate lymphatic filariasis

In 1997, WHO classified lymphatic filariasis, along with five other infectious diseases, as eradicable or potentially eradicable.That same year, the World Health Organization adopted a resolution, WHA 50.29, which called on member states to take action to eliminate lymphatic vapors as a public health concern. In response to this call, WHO launched the Global Program to Eliminate Lymphatic Filariasis (GPELF) in 2000. The elimination strategy has two components:

1. Stopping the spread of the infection (interrupting transmission)
2. Relieve the suffering of affected populations (control morbidity).

Prevention

1. Administration of a single dose of anti-filarial drugs to the whole community administration, yearly once for 5-6 years.
2. Diethylcarbazazine (DEC) and albendazole are widely used drugs for drug administration.
3. Protection from mosquito bites

References

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