At the beginning of October, the island nation of Kiribati announced that it had eliminated lymphatic filariasis. By 2021, Union Health Minister Dr Harsh Vardhan has pledged that India will do the same.
What is lymphatic filariasis?
Lymphatic filariasis, or elephantiasis, is a neglected tropical disease (NTD) that attacks the lymphatic system. It is caused by the transmission of filarial parasites, transmitted to humans via mosquitoes. Three parasites – Wuchereria bancrofti, Brugia malayi, and Brugia timori – cause lymphatic filariasis. The parasites are roundworms belonging to the Filarioidea family. Wuchereria bancrofti is responsible for ninety percent of cases.
Infection with the condition can be acute, asymptomatic, or chronic. The chronic condition of lymphatic filariasis witnesses the body’s tissue swelling (lymphoedema) or thickening (elephantiasis, hence the condition’s synonym). Tissue swelling and thickening often affects the breasts and genitals and can lead to physical deformity. The condition can also cause damage to the lymphatic system, kidneys, and immune system.
Acute attacks of lymphatic filariasis result in short-term effects. These include fever, lymphadenitis (enlargement of the lymph nodes), lymphangitis (inflammation of the lymphatic channel), funiculitis (inflammation of the spermatic cord, vessels, nerves and ducts associated with the testicles), and epididymitis (inflammation of the epididymis, located at the back of the testicle and responsible for storing and transporting sperm).
Lymphatic filariasis has a debilitative, negative impact on the individual, who will not only face the health complications of the disease but also will often face ostracisation due to the stigma attached their visible physical effects. The World Health Organization (WHO) “encourages Member States to eliminate lymphatic filariasis as a public health problem” and enacted a Global Programme to Eliminate Lymphatic Filariasis in 2000, a two-pronged approach consisting as follows: “stopping the spread of infection through large-scale annual treatment of all eligible people in an area or region where infection is present; and alleviating the suffering caused by lymphatic filariasis through provision of the recommended basic package of care.”
Lymphatic filariasis in India
650 million Indians across 21 states and union territories are at risk of lymphatic filariasis. Infection levels have been reduced to below the threshold level for further transmission in almost 37 percent of districts. However, active transmission persists in 160 districts.
India has recently reaffirmed its commitment to tackle the disease. Earlier this week, Dr Vardhan inaugurated a National Symposium with the theme of ‘United to Eliminate Lymphatic Filariasis’ in New Delhi, which he described on Twitter as “a platform for sharing of experiences between states and planning for the expected final steps for India to move into what is hoped to be the final phase of elimination efforts for [lymphatic filariasis] in India.”
The symposium, Vardhan added, “brought together diverse stakeholders including public health experts, partners and donors, research [organisations], [and] pharmaceutical companies to deliberate on building a common vision towards achieving the elimination of [lymphatic filariasis] by 2021.”
The elimination strategy
India’s strategy for tackling lymphatic filariasis follows the WHO’s model, involving a mass-drug administration (MDA) programme in endemic areas. This programme, to commence in November 2019 across high-burden states, will benefit 106 million Indians across ten states and union territories according to National Vector Borne Disease Control Programme (NVBDCP) director Dr Neeraj Dhingra. MDA consists of drug regimens provided to at-risk populations, with the exact regimen tailored according to whether an area is co-endemic with other filarial diseases such as loiasis and onchocerciasis.
In addition to the MDA programme, Neeraj said that a WHO-recommended triple drug therapy approach would be rolled out across sixteen districts in Bihar, Gujarat, Karnataka, Maharashtra, and Uttar Pradesh with the goal of “[accelerating] the pace of elimination of the disease in the country.” Already four districts have been reached with the approach, reaching 8.07 million people in four districts of Bihar, Jharkhand, Maharashtra, and Uttar Pradesh. Vardhan said that “rapid implementation of the [triple drug therapy] policy made us the first country in the South-East region to introduce this new preventive drug regimen.”
At the symposium, Vardhan signed a pledge to reaffirm India’s commitment towards elimination of lymphatic filariasis. “I signed this pledge to take every step towards eliminating LF by 2021,” he tweeted. “A nostalgic moment which reminded me of the mass campaign against polio I led in the early [1990s]. Our efforts to make India polio-free is an evidence of our resolve.”