Friday, November 13, 2009

Mass drug prophylaxis against filariasis

To eliminate lymphatic filariasis, the Kerala State Government Health Department has launched a  mass drug administration (MDA) programme  in 11 districts in the State on Novemeber 11,2009.
A lot of confusion is there in the minds of many among the public about the need and possible side effects of this mass drug administration.

Why this mass anti-filarial drug administration in healthy persons?

Let me try to clarify.

What is Lymphatic filariasis?

Lymphatic filariasis is a parasitic disease caused by microscopic, thread-like worms. The adult worms only live in the human lymph system. The lymph system maintains the body's fluid balance and fights infections. Lymphatic filariasis is spread from person to person by mosquitoes.

People with the disease can suffer from lymphedema and elephantiasis and in men, swelling of the scrotum, called hydrocele. Lymphatic filariasis is a leading cause of permanent disability worldwide

Disease burden

Although lymphatic filariasis very rarely causes death, it is a major cause of clinical suffering, disability and handicap. More than 1.3 billion people in 83 countries and territories (Map) — approximately 18% of the world's population — live in areas at risk of infection with lymphatic filarial parasites. Approximately one third of those at risk live in India, one third in Africa and the remainder in Asia, the Pacific and the Americas.
It is estimated that around 120 million people in tropical and subtropical areas of the world are infected. Almost 25 million men suffer from genital disease (most commonly hydrocoele); an estimated 15 million people — the majority of them women — have lymphoedema or elephantiasis of the leg.

Indian Situation

Filariasis is endemic in 19 States/union territories in India. Estimates based on surveys by Filariasis Survey Units suggested that: about 454 million people (120 million in urban areas) are living in known endemic areas; there are 29 million filariasis cases in the country and 22 million micro-filaria carriers.

The magnitude of infection in children has become much better understood in recent years; indeed, most infections appear to be acquired in childhood, with a long period of subclinical asymtomatic period  that progresses to the characteristic, clinical manifestations of adults.

Global Programme to Eliminate Lymphatic Filariasis

 In 1997, as a result of advances in the diagnosis and treatment of lymphatic filariasis (LF), the disease was classed as one of six infectious diseases considered to be “eradicable” or “potentially eradicable”. Consequently, the World Health Assembly adopted resolution 50.29, calling for elimination of the disease as a global public health problem.
Elimination strategy

The strategy proposed by WHO to achieve the goal of elimination comprises two components:
1.interruption of transmission of filarial infection in all endemic countries through drastic reduction of microfilariae prevalence levels;

2.prevention and alleviation of disability and suffering in individuals already affected by LF.

Interruption of transmission of infection can only be achieved if the entire population at risk is covered by mass drug administration (MDA) for a period long enough to ensure a reduction in the level of microfilariae in the blood to a point where transmission can no longer be sustained.
That's why mass administration of anti filarial drugs are advised in healthy individuals living in areas of risk.

The following recommended drug regimens must be administered once a year for at
least 5 years, with a coverage of at least 65% of the total at-risk population:

a.6 mg/kg diethylcarbamazine citrate (DEC) + 400 mg albendazole; or

b.150 µg/kg ivermectin + 400 mg albendazole (in the case of co-endemicity with onchocerciasis).

c.A third option is to follow a treatment regimen using DEC-fortified cooking salt daily for a period of 12 months.

As a part of this programme 11 Districts in Kerala has started the second round of MDA this Novemeber using DEC and Albendazole.

Side effects of the drugs.

There has been reports in the media about children becoming sick after taking the tablets. Is this true? Is it serious?

Both DEC and Albendazole is best taken in full stomach. Many temporary side effects can be prevented by taking care to eat well before ingesting the medicines.
Side effects due to these medicines are rare, not serious and lasts for few minutes to hours only.
Most common side effects are dizziness,nausea,vomiting,headache and fatigue. Some may develop fever and skin rashes which may indicate succesful elimination of microfilaria.

Children below 2 years and elderly people above 65 are not required to take the drugs.
All others are advised to take the drugs.

 Let us try to eliminate the dreaded elephantiasis from our community.


Bindhu Unny said...

Thanks for the valuable info. :)

Anonymous said...

:) Timely post..

Let me share my thoughts.. there was awareness campaigns in regard with this tablets,and tablets were given to us,all families by health workers..But my MIL insisted that nobody should take this tablet as she has never taken or given her kids,this tablet.. I argued that we all are normal human beings and are prone to have this disease.Her response was "Let the disease come to me,then i will deal with it,moreover,they are distributing non branded tablets,which are age-old it is better not to invite troub;e by eating waste-tablets"..The next day,theer was news of kids and people having side effects due to the tablets and my MIL was very happy that she was proved right.. :) I don't know who is right and who is wrong,but there are concerns over the tablet and of the many many people i know,nobody dares to take it..

The image provided is distubingg :(

Charakan said...

Welcome Bindu Unny. I thought there was lot of confusion due to serious lack of information among public

Charakan said...

Nimmy, One of the medicine is Albendazole,the tablet routinely given for de worming. I am sure most of us have taken it atleast once before. The other is DEC which is also routinely prescribed for eosinophillia. One in 100 can get some dizziness or vomiting especially if taken in empty stomach. So when you are giving medicines to lakhs of ppl thousands can get this mild side effects.Media is scaring ppl.

kochuthresiamma p .j said...

usefu;post. a few queries:
is it true that whites have racial immunity to this disease?
a person affected by it(the picture you have posted for eg) - can he be cured? can his leg come back to normal or near normal?

Charakan said...

KPJ,Sorry for the delay in response.I forgot.
As far as I know caucasian population do not have any racial immunity. They live in regions whose climate is not suitable for transmission of the infection.Nations found to be endemic tend to be tropical or subtropical due to the optimal habitat for the vectors[mosquitos]. Ambient humidity is also necessary for the survival of the infective larva stage of the microfilariae. I have just added a map of the World to show the countries which are affected.

Can elephantiasis,the grossly deformed body parts be cured?
Treatment of bacterial and fungal super infections and good hygiene can produce siginificant changes in the appearence. Many have tried surgical and physiotherapy procedures with varying success and failures.
The affected part is unlikely to become normal but we can aim for a near normal result.

ashgtx said...

What's this 3+1 regimen for prophylaxis?

Charakan said...

ashgtx, welcome to this blog.I am not sure what is 3 + 1 prophylaxis. May be it means 3 tablets of DEC and 1 tablet of Albendazole given together.

ashgtx said...

Yes I got three DEC tablets and one albendazole tablet. The DEC tablets are supposed to be taken at night on three consecutive days right?

Charakan said...

ashgtx, as per the Govt directive all 3 DEC Tablets have to be taken at a time. But I will advise taking it in one day 8 hours apart.Albendazole can be taken along with that too all after eating some food.

SanthoshV said...

The next campaign is coming. I have two doubts. Last year one girl died after taking drug from school due to albendazole reaction at thrissur . Nobody warn about it before . Secondly the drugs used for programme seems sub standard . There is no explanation or campaign from authorities.

Charakan said...

Santhosh, Welcome here. Did the girl really died due to Albendazole? Was any post mortem done?
As you know Albendazole is the most routinely prescribed drug for worm infestation and almost all kids must have taken it once or more in their life time.
I not aware that the drugs supplied are of poor quality. If so a concerted attempt must be doen to ensure good quality drugs are supplied.

Mathew said...

hello, i recently had a viral fever ..... so the hospital took my blood from my vain in the afternoon to check for infection... so if i have adult worms in my blood ... is there any chance they would have found out ??

if i go to a lab to take a blood test at night .... is there any special kind of test to find these worms or just the normal blood test will reveal whether i have adult worms in my body ?

and if i already have adult worms in my body will the medicine only prevent the spread of worms to other person or will it also cure me from having elephantiasis in future?

vinz said...


I am from Kochi Kerala. I have been bitten by mosquitoes abt 5 days ago and have 6 bumps on my hand and 2 on my legs. The bumps are purple in color, severly itchy, and sometimes experience pain similar to pin prick. Also some watery liquid oozes out from small bubbles on top of the bump. Is this a symptom of filariasis? I have just recovered from an TB and dont want to fall ill again. A bit paranoid, I know. But pls guide me.

Arun.N.M. said...

Vinz, better to get examined by a Dr. Also you can take the blood test for filariasis too.

Arun.N.M. said...

Mathew, u need to do the specific test for Filariasis to find out presence microfilaria. Treatment kills only the microfilaria, not adult worm.

Mathew said...

thank you for the quick response sir, just one more doubt . what's the name of the blood test for filariasis? .. i'm a little paranoid because one of my new neighbors have this disease. so if i have adult worms in my blood, then it's certain that i'm going to get filariasis in future right ?

two days ago the health workers gave 4 tablets .i still haven't taken the tablets because i have doubts about the quality of the tablets

Arun.N.M. said...

Mathew, test name is 'Peripheral smear for microfilaria".