Lymphatic filariasis in India explained

Lymphatic filariasis in India refers to the presence of the disease lymphatic filariasis in India and the social response to the disease. In India, 99% of infections come from a type of mosquito spreading a type of worm through a mosquito bite. The treatment plan provides 400 million people in India with medication to eliminate the parasite. About 50 million people in India were carrying the worm as of the early 2010s, which is 40% of all the cases in the world.[1] In collaboration with other countries around the world, India is participating in a global effort to eradicate lymphatic filariasis. If the worm is eliminated from India then the disease could be permanently eradicated.[2] [3] In October 2019 the Union health minister Harsh Vardhan said that India's current plan is on schedule to eradicate filariasis by 2021.[4]

To treat, prevent, and eliminate the disease, the Indian government provides mass drug administration (MDA) to achieve mass deworming. The treatment is a few pills taken once a year for five years. The medication provided is diethylcarbamazine. For the treatment to work 60-80% of people in large regions must take this yearly treatment for several years.

Treatment

Treatment is done through a public health initiative in which most people in regions with the parasite take treatment. The treatment is a mass drug administration to cause mass deworming. In India the worm only lives in humans, so if everyone takes treatment, and everyone is cured, then the worm will be permanently eradicated. India participates in the global eradication program to eliminate the worm worldwide.

Health education for the public is an essential part of the campaign.[5] Hundreds of millions of people in affected communities have to agree to take the drugs once a year.[5] In a 2015 public health campaign called Hathipaon Mukt Bharat shows how the disease causes large feet, says the medicine is safe, and tells people to take it.[5]

The treatment program varies in different places in India. Various reports describe the variation, such as for Assam[6] and Andhra Pradesh.[7]

Most people who take treatment have no negative effects or only mild adverse events which resolve without further treatment.[8] A bigger problem than any side effects of treatment is people having fear of taking treatment, which leads them to refuse to take medicine.[8] Various studies have examined why people in various Indian regions neglect to take the drugs.[9]

Vector

99% of infections in India happen when the mosquito Culex quinquefasciatus spreads the worm Wuchereria bancrofti through a mosquito bite.[10] Because the cause of this disease can be a different worm and parasite in different countries, each country has its own plan for control and treatment.[11]

The typical prevention for filariasis is through the use of medication.[12] However, in some areas, using the pesticide spinosad to eliminate mosquitoes is helpful to prevent the spread.[12]

To eliminate the disease neither humans nor mosquitoes should have the parasite.[13] The usual way to determine whether filariasis is eliminated from an area is to test humans for the parasite.[13] In some special cases India uses molecular xenomonitoring to examine captured mosquitoes and determine if they carry the parasite.[13]

Epidemiology

By 2006 there were 20 million people infected and with symptoms, 30 million people infected but asymptomatic, and 470 million people who were at potential risk. In 2005 95% of the cases in India were in Andhra Pradesh, Bihar, Gujarat, Kerala, Maharashtra, Orissa, Tamil Nadu, Uttar Pradesh and West Bengal.[14]

India has 40% of the world's lymphatic filariasis (LF) cases.[15] For patients, one of the major costs of treating the disease is that of being unable to work for some time. A year 2000 survey reported that about half the people in India were at risk of contracting LF.[16] Men and women are equally susceptible to this disease, but in the past, there have been barriers to women accessing treatment.[17] An estimate from the year 2000 reported that filariasis in India caused an annual economic loss of ₹5000 crore .

Society and culture

The Sushruta Samhita, an Ayurvedic Indian text, described filariasis in the 6th century BCE.[10] The disease is timeless and present throughout Indian history. Indian physicians in the 500s wrote about the disease.[18] In the 1500s the European explorer Jan Huyghen van Linschoten visited Goa and wrote about people with filariasis symptoms there.[18]

In 1955 the Indian government established the National Filaria Control Programme (NFCP) as a project to limit the spread of the disease.[19] [10] By 1959 that organization proposed various plans for controlling or eliminating the disease.[20] Infections spread out of control from 1955 until 1995 in which time the number of cases increased several fold.[10] Reasons for the disease's expansion included increased urban population and a rapidly changing country which exposed people to new circumstances with mosquitoes.[21]

In 1997 India joined a World Health Assembly resolution to eliminate LF by 2020. In India to achieve this goal healthcare must be very accessible to almost everyone at risk for the disease.[22] The Indian government originally planned to eliminate the disease by 2015, then shifted the date to 2017, then to 2020.[23] Various media outlets have discussed how India might meet the goal or what it should happen next if more time is required.[24] [25] [26]

In 2015 the Indian government launched a health campaign called Hathipaon Mukt Bharat (Filaria Free India) to encourage public participation in eliminating LF.[27] [28] In the program everyone in an area with the disease takes pill medicine once a year for five years. The drug is diethylcarbamazine citrate and albendazole and is in the form of about four pills which people take all at once.

Research

Public health researchers have applied machine learning techniques to improve public health monitoring for filariasis in India.[29]

A 2019 report identified dogs in Kerala who have another worm which can cause filariasis, Brugia malayi.[30] This worm is not known to infect people in India.[30] If necessary tests are ready to identify the dogs carrying the disease.[30]

Further consideration

Notes and References

  1. Hoti . S . Filariasis of uncommon nature in India. . Tropical Parasitology . January 2012 . 2 . 1 . 2–3 . 10.4103/2229-5070.97230 . 23509678. 3593514 . free .
  2. Web site: Ganguly . NK . The final lap towards elimination of Lymphatic Filariasis . . en . 9 January 2018.
  3. Web site: Senthilingam . Meera . Every last worm: Eliminating Elephantiasis in India . CNN . 24 April 2015.
  4. Web site: Sharma . Neetu Chandra . India to eliminate Lymphatic Filariasis by 2021: Harsh Vardhan . . en . 30 October 2019.
  5. Bagcchi . Sanjeet . India tackles lymphatic filariasis . The Lancet Infectious Diseases . April 2015 . 15 . 4 . 380 . 10.1016/S1473-3099(15)70116-7. 25809895 .
  6. Khan . AbdulMabood . Lymphatic filariasis elimination programme in Assam, India, needs change in mass drug administration strategy to target the focus of infection . Indian Journal of Medical Research . 2018 . 147 . 1 . 7–10 . 10.4103/ijmr.IJMR_1843_16. 29749354 . 5967220 . free .
  7. Upadhyayula . Suryanaryana Murty . Mutheneni . Srinivasa Rao . Kadiri . Madhusudhan Rao . Kumaraswamy . Sriram . Nagalla . Balakrishna . Noor . Abdisalan Mohamed . A Cohort Study of Lymphatic Filariasis on Socio Economic Conditions in Andhra Pradesh, India . PLOS ONE . 19 March 2012 . 7 . 3 . e33779 . 10.1371/journal.pone.0033779. 22442721 . 3307764 . 2012PLoSO...733779U . free .
  8. Kuttiatt . VS . Somani . RK . Swaminathan . S . Krishnamoorthy . K . Weil . GJ . Purushothaman . J . Frequency and Clinical Significance of Localized Adverse Events following Mass Drug Administration for Lymphatic Filariasis in an Endemic Area in South India. . The American Journal of Tropical Medicine and Hygiene . January 2020 . 102 . 1 . 96–99 . 10.4269/ajtmh.19-0532 . 31769393. 6947773 .
  9. Banerjee . S . Bandyopadhyay . K . Khan . MF . Akkilagunta . S . Selvaraj . K . Tripathy . JP . Solanki . R . Kushwaha . AS . Deshmukh . P . Coverage of mass drug administration for elimination of lymphatic filariasis in urban Nagpur, Central India: A mixed method study. . Journal of Family Medicine and Primary Care . September 2019 . 8 . 9 . 3009–3014 . 10.4103/jfmpc.jfmpc_503_19 . 31681683. 6820416 . free .
  10. Agrawal . VK . Sashindran . VK . Lymphatic Filariasis in India : Problems, Challenges and New Initiatives . . October 2006 . 62 . 4 . 359–362 . 10.1016/S0377-1237(06)80109-7. 27688542 . 5034168 .
  11. Erickson . Sara M. . Thomsen . Edward K. . Keven . John B. . Vincent . Naomi . Koimbu . Gussy . Siba . Peter M. . Christensen . Bruce M. . Reimer . Lisa J. . Valenzuela . Jesus G. . Mosquito-Parasite Interactions Can Shape Filariasis Transmission Dynamics and Impact Elimination Programs . PLOS Neglected Tropical Diseases . 12 September 2013 . 7 . 9 . e2433 . 10.1371/journal.pntd.0002433. 24069488 . 3772046 . free .
  12. Sadanandane . C . Gunasekaran . K . Boopathi Doss . PS . Jambulingam . P . Field evaluation of the biolarvicide, spinosad 20 per cent emulsifiable concentrate in comparison to its 12 per cent suspension concentrate formulation against Culex quinquefasciatus, the vector of bancroftian filariasis in India. . The Indian Journal of Medical Research . January 2018 . 147 . 1 . 32–40 . 10.4103/ijmr.IJMR_1369_15 . 29749358. 5967213 . free .
  13. Subramanian . S . Jambulingam . P . Krishnamoorthy . K . Sivagnaname . N . Sadanandane . C . Vasuki . V . Palaniswamy . C . Vijayakumar . B . Srividya . A . Raju . HKK . Molecular xenomonitoring as a post-MDA surveillance tool for global programme to eliminate lymphatic filariasis: Field validation in an evaluation unit in India. . PLOS Neglected Tropical Diseases . January 2020 . 14 . 1 . e0007862 . 10.1371/journal.pntd.0007862 . 31978060. 7001988 . free .
  14. Pani. SP. Kumaraswami. V. Das. LK. 2005. Epidemiology of lymphatic filariasis with special reference to urogenital-manifestations. Indian Journal of Urology. 21. 1. 44. 10.4103/0970-1591.19551. free.
  15. Ramaiah . Kapa D . Das . Pradeep K . Michael . Edwin . Guyatt . Helen L . The Economic Burden of Lymphatic Filariasis in India . Parasitology Today . June 2000 . 16 . 6 . 251–253 . 10.1016/S0169-4758(00)01643-4. 10827432 .
  16. Sabesan . S. . Palaniyandi . M. . Das . P. K. . Michael . E. . Mapping of lymphatic filariasis in India . Annals of Tropical Medicine & Parasitology . 3 Jul 2000 . 94 . 6 . 591–606 . 10.1080/00034983.2000.11813582. 11064761 . 35526107 .
  17. Bandyopadhyay . Lalita . Lymphatic filariasis and the women of India . Social Science & Medicine . May 1996 . 42 . 10 . 1401–1410 . 10.1016/0277-9536(95)00288-X. 8735896 .
  18. Gordon . CA . Jones . MK . McManus . DP . The History of Bancroftian Lymphatic Filariasis in Australasia and Oceania: Is There a Threat of Re-Occurrence in Mainland Australia? . Tropical Medicine and Infectious Disease . 4 June 2018 . 3 . 2 . 58 . 10.3390/tropicalmed3020058 . 30274454. 6073764 . free .
  19. Sabesan . S . Vanamail . P . Raju . KH.K . Raju . P . Lymphatic filariasis in India: Epidemiology and control measures . Journal of Postgraduate Medicine . 2010 . 56 . 3 . 232–8 . 10.4103/0022-3859.68650. 20739779 . free .
  20. Beye . H. K. . Wright . W. H. . The National Filaria Control Program (NFCP) of India: investigative challenges. . Bulletin of the National Society of India for Malaria and Other Mosquito-Borne Diseases . 1959 . 7 . 2 . 45–52 . Indian Society for Malaria and Other Communicable Diseases.
  21. Ramaiah . KD . A rational approach to the control of filariasis in India. . The National Medical Journal of India . 1993 . 6 . 3 . 114–6 . 8329989.
  22. Agrawal. VK. Sashindran. VK. October 2006. Lymphatic Filariasis in India : Problems, Challenges and New Initiatives. Medical Journal Armed Forces India. 62. 4. 359–362. 10.1016/S0377-1237(06)80109-7. 5034168. 27688542.
  23. Web site: filariasis in india: The epidemic you don't know about. TNN. 17 November 2017. The Times of India. en.
  24. News: TNN. Filariasis in india: The epidemic you don't know about. 17 November 2017. The Times of India. The Times Group. en.
  25. News: Basu. Snigdha. Not Stigma But Awareness A Hurdle To Eliminate Lymphatic Filariasis By 2020. 8 March 2018. NDTV.
  26. Web site: India Is Set To Fail Its Target Of Eradicating Filariasis By 2020. Rath. Nibedita. Dash. Sambit. 22 August 2017. HuffPost India. AOL. en.
  27. Bagcchi. Sanjeet. April 2015. India tackles lymphatic filariasis. The Lancet Infectious Diseases. 15. 4. 380. 10.1016/S1473-3099(15)70116-7. 25809895.
  28. Web site: McNeil . Donald G. . India Begins Campaign to Eliminate Elephantiasis . The New York Times . 2 March 2015.
  29. Kondeti . PK . Ravi . K . Mutheneni . SR . Kadiri . MR . Kumaraswamy . S . Vadlamani . R . Upadhyayula . SM . Applications of machine learning techniques to predict filariasis using socio-economic factors. . Epidemiology and Infection . 2 September 2019 . 147 . e260 . 10.1017/S0950268819001481 . 31475670. 6805759 .
  30. Sadarama . PV . Chirayath . D . Pillai . UN . Unny . NM . Lakshmanan . B . Sunanda . C . Canine Brugia malayi microfilarial excretory/secretory protein-based antibody assay for the diagnosis of brugian filariasis in dogs. . Journal of Parasitic Diseases . December 2019 . 43 . 4 . 549–553 . 10.1007/s12639-019-01125-3 . 31749523. 6841868 .

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