Elimination of lymphatic filariasis still a challenge

August 22, 2019 12:48 am | Updated 12:48 am IST - Afshan Yasmeen

Vector-borne diseases have gained significance in recent years with several States reporting a surge in malaria, dengue, chikungunya, etc., year after year. While there is awareness about these, not many know that lymphatic filariasis is another preventable vector-borne disease that needs to be tackled effectively to meet the Health Ministry’s target of eliminating it in India by 2020.

Although the compliance rate (consumption of drugs) has gone up from 35% to 65% over the years, the need of the hour is to achieve 80%, according to doctors involved in chalking out elimination strategies. A lack of an integrated approach with multi-sectoral involvement in tackling the disease has added to the problem, they said.

Presently, India has 256 endemic districts across 16 States and five Union Territories including nine endemic districts in Karnataka. According to Indian Council of Medical Research (ICMR), India still has over 2.3 crore people suffering with lifelong disability due to lymphatic filariasis (LF).

MDA began in 2004

In 2004, the Government of India launched the National Programme for Elimination of LF with the adoption of the globally-recognised Mass Drug Administration (MDA), using a combination of two drugs – diethylcarbamazine (DEC) and Albendazole (ABZ). As many as 15 rounds of MDA have been taken up in Karnataka so far.

Although, LF has been a low priority among public health issues in the country and comprises only a minute portion of the overall health budget, over the years, India has made steady progress under its national elimination program. Infection levels in the community have been reduced below the threshold level in 100 districts, which accounts for nearly 39% of the total districts, N.K. Ganguly, former ICMR director general, told The Hindu.

Present scenario

Tackling the elimination of LF on a war footing, in June 2018, India renewed its commitment towards achieving the global LF elimination goal of 2020 with the launch of Accelerated Plan for Elimination of LF (APELF).

Under APELF, the government introduced the WHO-recommended Triple Drug Therapy (TDT) also known as Ivermectin, DEC and ABZ (IDA) that is more effective than the previous two-drug regime. With this, India became the first country in the South-East region to rollout IDA, said Dr. Ganguly.

“Despite these efforts, greater emphasis needs to be placed in employing strategies tackling the source of the disease – preventing mosquitoes to human transmission,” Dr. Ganguly said.

What is lymphatic filariasis?

Lymphatic filariasis, commonly known as elephantiasis, is a neglected tropical disease. Infection occurs when filarial parasites are transmitted to humans through mosquitoes. Infection is usually acquired in childhood causing hidden damage to the lymphatic system. The painful and disfiguring visible manifestations of the disease, lymphoedema, elephantiasis and scrotal swelling (hydrocele) occur later in life and can lead to permanent disability. These patients are not only physically disabled, but suffer mental, social and financial losses contributing to stigma and poverty.

TDT to be rolled out in Yadgir in November

The State Health Department is all set to roll out the Triple Drug Therapy (TDT) in Yadgir in the second week of November, said S. Sajjan Shetty, State Joint Director, NVBDCP.

Of the nine endemic districts — Bagalkote, Bidar, Vijayapura, Uttara Kannada, Kalaburgi, Yadgir, Raichur, Dakshina Kannada and Udupi — the threshold level of less than one microfilaria rate has been achieved in Uttar Kannada, Udupi, Dakshina Kannada and parts of Raichur, Vijayapura and Bagalkote, he said.

Pointing out that the State has 14,200 chronic cases of LF, Dr. Shetty said, “While the disease load has come down over the years in the endemic districts, Yadgir continues to remain a challenge. We will roll out the TDT here in the second week of November to accelerate elimination efforts.”

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