Elimination of lymphatic filariasis

What is lymphatic filariasis (LF)?
Lymphatic filariasis (LF) is a parasitic disease, commonly known as elephantiasis. • It is caused by thread like worms known as filarial parasite. • The adult worms (male and female) settle in lymph nodes and the female worm gives birth to millions of young ones known as microfilariae (mf). Microfilaria in the blood of man

Directorate of National Vector
Disease Control Programme,
Directorate General of Health
Services, Ministry of Health and
Family Welfare, Government of
• Generally no symptoms are seen Vector Control Research Centre,
initially, but the lymphatic system is (Indian Council of Medical
• With no symptoms initially, the persons with mf are not recognized and they continue to transmit the parasite to the community.

• The persons infected with the parasite Why should every one take DEC and
may experience frequent acute albendazole tablets during Mass
attacks of adenolymphangitis when Drug Administration (MDA)?
they may have symptoms of fever, pain and redness in the affected body • People living in filaria endemic areas, who look healthy, may be • After 6 to 8 years of infection, clinical carrying mf in their blood without symptoms such as swollen legs or any recognizable symptoms at the enlarged lymph nodes/lymph vessels or hydrocele may appear • Finding the infected persons at this • These chronic manifestations become stage and giving them alone irreversible as the lymphatic system treatment is tedious. has already been damaged. • Both DEC and albendazole are safe and even non-infected can How is LF transmitted?
• DEC kills mf and albendazole • Filarial parasite species in India lives normally clears intestinal worms only in man. The adult worm which is an added benefit. When produces microfilaria which circulates both the drugs are given to-gether, in the peripheral blood system of the it has effect on adult worm and infected people. When the mosquito therefore the parasites will be feeds on the infected person, it destroyed preventing the infected ingests the microfilaria. person from developing disease • When every individual in the community takes drugs under MDA, microfilaria will be cleared and not present in the blood for the mosquitoes to transmit. • MDA repeated annually over 5-6 years may interrupt transmission. This eventually leading to future • The ingested microfilaria grows and generation being free of this within 12 days it reaches a stage when it can infect another human Who should take the drugs?
• When the mosquito with infective stage larva bites another person, the • Everybody in the community, parasite enters and reaches the except pregnant women, children lymphatic system. below two years of age and persons who are very sick from How to prevent infection?
• Administration of single dose of When should people take DEC
antifilarial drugs to the entire tablets?
community (mass drug administration), yearly once for 5-6 • DEC tablets should be taken once in a year on the identified day of Diethylcarbamazine (DEC) and MDA (National Filaria Day). albendazole are the drugs used for mass drug administration • The tablets should be taken after • Protection from mosquito bites food. If the tablets are taken on

empty stomach, it may cause should list who should get the drugs stomach discomfort. and then mobilize their participation. Training will be provided to all the drug How many tablets should one
distributors by the Medical Officer of the consume?
PHC and VHN on MDA 15 days prior to • The dose for different age groups is indicated below: Pre MDA activities:

Enumeration and motivation of the community by making at least two visits zole (400
First visit: (Household enumeration)
• Visit every house in your assigned area with in 15 days prior to the • Identify yourself as an active member of the community and display your Identity card

Are there any side effects of drugs?
• DEC and albendazole are safe drugs,
which are in use for the last 50 years around the world. • People, who look healthy but have parasite in their blood, may experience some side (therapeutic) effects due to the killing of parasites following drug consumption • One or combination of the following • Enquire about the details of the side effects may be experienced by a household and record: small proportion of population especially microfilaria carriers: o Name, age and gender of the every member in the • Inform the family members about the MDA programme and clarify o Rash and itching occasionally These side effects are self limiting, usually disappear or subside within a Second visit: (Interpersonal contact)
day without any medication. • Make house to house visit What should Drug Distributors do?
• Meet all the available members • Explain to them: The ultimate goal of the drug distributor is to administer drugs to the assigned o The problem due to LF in the area and socio-economic population. Therefore the drug distributor

o Methods of prevention of LF • Approach every individual in the o Importance of MDA o Possible side effects • Select the correct dose of DEC o Health and economic benefit of based on the age of the person Co-administer DEC with Date and time of drug • Ensure that the individual is o Ensure that all family members consuming the drugs in your are available at the time of MDA presence (supervised administration) • Record the absentees and their time of availability • Advise to approach the Sub- centre/PHC if any inconvenience is faced
• Make daily visits to your assigned area for two days following MDA to cover the absentees o Request them to eat and be • If any case with side effects are ready for drug consumption come across, provide them with Identify suitable time for contacting symptomatic treatment and delivering drug If any case requires hospital Distribute IEC materials admission, report to the VHN/rapid MDA activities:
• Consolidate your record on the number of people covered daily Checklist of items to be carried:
Data consolidation and reporting;
o Sufficient number of tablets • Consolidate the data on : including paracetomol For a population of 250
o The total population Approximately 700 tablets of DEC
Number of people administered with drugs 275 tablets of albendazole
o Number of people reported IEC materials
with side effects Type of side effects o IEC materials such as hand bills/bit notices No. of people required o Family register – updated o Flash cards on elephantiasis to o Number of tablets received explain to the community • Return the family register along Drug administration:
with drugs in balance to the VHN Visit the house at the agreed time Identify all the eligible individuals for administering drugs Tips for improving coverage & drug
• Also inform that the mass drug compliance during MDA
administration with DEC and albendazole alone will not cure the • Ensure that messages on the date of chronic complications such as MDA are displayed through lymphoedema and hydrocele. posters/banners in your area and • If there are patients in the family, premises of public places. they should be advised to • The local community leaders should approach the health care facilities be informed and involved in MDA. in your locality • Explain to people about filariasis and • Hydrocele can be surgically how it spread and clear their doubts. operated in the Government • Inform people about the disabilities Hospitals free of charge. Enlist the caused by LF and its impact on hydrocele cases and motivate economic productivity and income. them to avail the factiities. • Educate people about its risk and • Identify and involve individuals in social stigma especially in case of the village who will campaign for MDA. Provide them with adequate • Inform people about the importance of prevention through consuming DEC and albendazole tablets on the day of OUR VISION : FUTURE GENERATION
• Inform people that they may not know that they are infected from this disease and if they do not take DEC tablets, the manifestations may appear later in the form of swelling of legs/ enlargement of lymph nodes/lymph vessels or hydrocele. • Explain that once swelling appears, it is difficult or impossible to reverse. It may remain as a permanent disability causing social stigma, hampering the daily activities, quality of life and also be a financial burden. • If the whole community takes DEC tablets once a year for 5-6 years, the microfilariae in the infected persons HELP TO KEEP THIS SMILE ALIVE
will be killed and the disease progression will be halted. The spread of filariasis will be stopped as mosquitoes cannot pick up the infection and we can make the next generation free from filariasis. • Explain also that unless everybody takes the drug, the disease will continue to spread. • Killing of microfilariae by the drugs may cause some the side effects among a small proportion of people • Tablets should not be taken on empty

Source: http://iapsm.org/pdf/Guidelines/national-vector-borne-disease-control-programme/Guidelines%20for%20Drug%20Distrubutors%20%20in%20Elimination%20of%20Lymphatic%20Filariasis.pdf


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