The epidemic you don’t know about
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NEW DELHI: It is now pretty certain. India will miss the target date of stamping out or lymphatic filariasis, one of two diseases that it was hoping to eliminate by 2020.
The national health policy had aimed at eliminating filariasis by 2015. The deadline was extended to 2017 and now has been shifted to 2020.
Filariasis, called hathipaon locally, can cause limbs, usually the leg, knee downwards, to swell enormously, or hydrocele (swelling of the scrotum), causing disfigurement and disability.
Transmitted through mosquito bite, filariasis is estimated to be endemic in over 250 districts in 20 states, putting 650 million people at risk.
Mass drug administration (MDA) in endemic districts ensuring coverage of over 65% population is the global strategy to eliminate the disease. It is caused by various coiled and thread-like parasitic worms.
In India, 99.4% of the cases are caused by the species Wuchereria bancrofti with the other species Brugia malayi responsible for just 0.6%. The worms produce about 50,000 microfilariae (minute larvae) that enter a person’s blood stream — and get passed on when a mosquito bites an infected person.
Persons with microfilariae in their blood can appear healthy but are infectious. Those with chronic filarial swellings cannot further spread the infection. The larvae develop into adult worms that can live upto 5-8 years and more in humans. They damage the lymphatic system though no symptoms may show for years.
Since 2004, the health ministry has been carrying out mass drug administration as part of the Hathipaon Mukt Bharat Filaria Free India
) programme for preventive medication. This involves giving at least 65% of the population in endemic districts two drugs: tablets of diethylcarbamazine citrate and albendazole once a year for five years. Children below two years, pregnant women and seriously-ill people are not eligible for these drugs. Read more at:
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Progress
China and the Republic of Korea were declared to have eliminated lymphatic filariasis as a public health problem in 2007 and 2008, respectively. Of 73 countries listed by WHO as being endemic for lymphatic filariasis, 18 countries have completed interventions and are conducting surveillance to validate elimination. An additional 22 countries had delivered MDA in all endemic areas and are also on track to achieve elimination. The remaining 33 countries have not been able to achieve 100% geographical coverage; 10 of these have yet to initiate preventive chemotherapy or submit evidence that MDA is not required.
Mass treatment is ongoing in 45 countries. Ten countries have not started treatment or submitted evidence indicating treatment is not required.
NEW DELHI: It is now pretty certain. India will miss the target date of stamping out or lymphatic filariasis, one of two diseases that it was hoping to eliminate by 2020.
The national health policy had aimed at eliminating filariasis by 2015. The deadline was extended to 2017 and now has been shifted to 2020.
Filariasis, called hathipaon locally, can cause limbs, usually the leg, knee downwards, to swell enormously, or hydrocele (swelling of the scrotum), causing disfigurement and disability.
Transmitted through mosquito bite, filariasis is estimated to be endemic in over 250 districts in 20 states, putting 650 million people at risk.
Mass drug administration (MDA) in endemic districts ensuring coverage of over 65% population is the global strategy to eliminate the disease. It is caused by various coiled and thread-like parasitic worms.
In India, 99.4% of the cases are caused by the species Wuchereria bancrofti with the other species Brugia malayi responsible for just 0.6%. The worms produce about 50,000 microfilariae (minute larvae) that enter a person’s blood stream — and get passed on when a mosquito bites an infected person.
Persons with microfilariae in their blood can appear healthy but are infectious. Those with chronic filarial swellings cannot further spread the infection. The larvae develop into adult worms that can live upto 5-8 years and more in humans. They damage the lymphatic system though no symptoms may show for years.
Since 2004, the health ministry has been carrying out mass drug administration as part of the Hathipaon Mukt Bharat Filaria Free India
After five years of MDA and 65% coverage, a transmission assessment survey is conducted to see if the district qualifies for stoppage of mass drug administration. India stopped the MDA in 96 of the 256 districts last year. But many of the 96 districts failed a treatment assessment survey by external evaluators.
Another challenge is that the surveillance that identified the 256 endemic districts is now outdated. A fresh survey could push up the number of endemic districts to over 300. This would require an overhaul of programme strategy and consequently, the chances of meeting the 2020 target are slim. “It’s a challenge to get people to take as many as four tablets simultaneously, especially when they have no symptoms. Health workers must ensure the person consumes the tablets right then. This doesn’t always happen,” explained a senior official in the national filariasis elimination programme.
Since DEC is given by body weight, the rough calculation is about one DEC tablet for those between 2-5 years, two tablets for those aged 6-14 years and 3 tablets for adults or those above 15 years. This is in addition to the albendazole tablet.
The new three-drug combination, IDA, which involves adding tablets of Ivermectin to the DEC and albendazole tablets, has been shown to reduce microfilariae by 99% with the first dose itself. The two-drug regimen (DE and albendazole) reduces the disease by 60-80% and hence requires five rounds. The new drug regimen is expected to help clear the infection faster as IDA would require just two rounds.
But Ivermectin dosage is bodyweight dependent, which could mean adding 2-4 tablets to the existing drug regimen depending on the person’s body weight. That could be an additional challenge to the programme, the success of which hinges on community compliance (ensuring people take the medicine) and coverage (ensuring medicines reach at least 65% of the population).
Though WHO gives India albendazole free, it has to buy 70% of the required DE, 30% is free. Government will now have to find the funds to buy Ivermectin and meet the cost of expanding the programme. Budget approvals for the same are still in the pipeline.
Is this costing us medals in sports
Are children being held back from excelling in sports because of the damage to their lymphatic system caused by the filarial worm? A study of 102 students in a filaria-endemic district in Odisha seems to suggest that is so and has also shown that treatment can reverse the damage.
For the study, children aged 5-18 in Odisha’s Khordha district were screened for filariasis caused by Wuchereria bancrofti — the species behind 99.4% of filaria infections in India. Though infection usually occurs early in childhood in endemic areas, the clinical signs appear later.
The study looked for prevalence of damage to the lymphatic system in children who did not show any outward or clinical signs and tried to determine how well they responded to treatment. It tested the efficacy of DEC and albendazole once or twice a year in clearing the infection and reversing lymphatic damage.
It found that though changes to lymphatic vessels occurred early in the infection, treatment could reverse these in most cases.
Of the children included in the study, 80% showed no symptoms but over 40% showed damaged lymphatic system. This indicates that it’s highly likely that these children won’t have the strength and stamina required to excel in sports,” explained a filariasis expert, adding that the study had strengthened evidence of the benefits of treatment even for children who showed no symptoms. He said treatment could boost chances of producing better sports people for the country.
The study was funded by the Bill and Melinda Gates Foundation and published in PLOS journal in October this year
Rs 1000 Pension to Filaria Patients
Hyderabad | Feb 10, 2018 12:00 AM
Hon'ble Chief Minister Sri K. Chandrashekar Rao has decided to give Rs. 1000 pension per month to the patients suffering from lymphatic filariasis (Filaria). The CM announced that 47,000 people who are suffering from lymphatic filariasis will be given the pensions from coming financial year and allocation will be made in the Budget for the purpose. The CM has also decided to offer medical diagnostic tests to the people in the state at the government’s cost with the village as a unit as the government believes in the dictum that prevention is better than cure. The CM has instructed the officials concerned to prepare an action plan to utilise the services of medical employees and staff at the village level at the optimal level. The CM, who has decided to enhance the salaries of the ASHA workers, also announced the enhancement of salaries of the Second ANMs. The CM suggested that the Telangana state should become role model in the Public Health in the country.
The Chief Minister held a review meeting on Medical and Health at Pragathi Bhavan here on Friday. Chief Advisor to the Government, Sri Rajiv Sharma, Principal secretaries Sri S Narsing Rao, Ms Shanti Kumari, Medical and Health Director Ms Vakati Karuna, Public Health Director Ms Lalitha Kumari, Special Secretary in CMO, Sri Rajasekhara Reddy, Mission Bhagiratha Vice Chairman Sri Vemula Prashanth Reddy, Government Whip Sri Palla Rajeswara Reddy, MLA Sri Sanjeev Rao, MLC Sri Karne Prabhakar, Corporation Chairman Sri Seri Subhash Reddy, Sri Gadari Bala Mallu and others participated.
Recently, Minister Sri Tummala Nageswara Rao, MP Ms Kalvakuntla Kavitha represented to the CM that in the constituencies they are representing many people are suffering with filarial and are not been able to even walk. They need to be supported by the government, they said. They wanted the government to take steps to prevent spread of the disease and help to those suffering with filarial. They have also put pressure on the officials concerned. With their initiative, there is a momentum in the government. The CM held a review meeting on the matter, as there are also people suffering from filaria in his own constituency. In the review meeting, it is discussed about the preventive steps to be taken against filarial. In order to help the patients, the CM has decided to give Rs. 1000 per month as pension to them. He has also instructed the officials to arrange for the medicines and treatment to the patients. The CM also instructed the officials, “Assess what is the number of filarial patients in the State. Conduct a comprehensive survey and go to villages and collect the data. All DM & HO 's should conduct an extensive survey the filarial cases.”
Medical diagnostic tests for every village, everyone
The CM said in countries like the US everyone goes for diagnostic tests on a regular basis. “Similarly, in Telangana state also people should be educated to go in for the diagnostic tests regularly. Those having awareness and money will go for the diagnostic tests but for the poor living in the villages and rural areas will visit the hospitals when they are ill and never go for any diagnostic tests. Hence it is becoming difficult to identify the disease in the primary stages. Early detection will help to cure the disease. But in many cases, it is detected when the disease is at the final stage. This should not happen henceforth. The government will conduct the tests for everyone in every village on a regular basis. Collect the blood samples and conduct tests for all the diseases. Design a beautiful health checkup scheme. Once the illness is detected treat the patient at the government costs and supply medicines. Money is not a constraint; the government is ready to spend any amount. The government has no other priority item on its agenda other than protecting health of the poor people. Besides conducting the diagnostic tests, take all measures to prevent spread of the disease and people from acquiring diseases,” the CM said.
The CM said in countries like the US everyone goes for diagnostic tests on a regular basis. “Similarly, in Telangana state also people should be educated to go in for the diagnostic tests regularly. Those having awareness and money will go for the diagnostic tests but for the poor living in the villages and rural areas will visit the hospitals when they are ill and never go for any diagnostic tests. Hence it is becoming difficult to identify the disease in the primary stages. Early detection will help to cure the disease. But in many cases, it is detected when the disease is at the final stage. This should not happen henceforth. The government will conduct the tests for everyone in every village on a regular basis. Collect the blood samples and conduct tests for all the diseases. Design a beautiful health checkup scheme. Once the illness is detected treat the patient at the government costs and supply medicines. Money is not a constraint; the government is ready to spend any amount. The government has no other priority item on its agenda other than protecting health of the poor people. Besides conducting the diagnostic tests, take all measures to prevent spread of the disease and people from acquiring diseases,” the CM said.
“After formation of Telangana state, the Public Health system changed. The government hospitals have also been bettered. The Centre also praised the programmes and schemes launched by the state government. The services rendered by doctors, staff and employees are highly appreciated by all. Due to the efforts put in by doctors, deaths due to dengue and Malaria have come down. This spirit and initiative should continue. Health and medical care should reach the doorstep of the Poor in the rural areas. They should be extended medical and health care locally. Several categories of doctors and staff are working in the rural areas. Converge the whole capacity of a department of health and take all preventive steps. Prepare an action plan for this. We have increased salaries of ASHA workers and we are ready to increase them again. Workers will be recognised as Village Health Assistants. We will also increase salaries of the second ANMs. We will utilise their services more fruitful way. We will increase facilities in the PHCs. The aim and objective is to make the Telangana state as number one in Public health in the country. Make the Telangana state Health system better than the neighbouring Tamil Nadu state. Our future thrust will be through health and education,” the CM said.
KCR Kits not for private hospitals
“KCR Kits has created a tremendous impact and is being implemented successfully. Unnecessary operations have come down. Despite overburden, doctors and staff and extending their services. The doctors’ role is highly appreciated. We will give them incentives. There are representations with a request to implement KCR Kits to the private hospitals and the government is not in favour of it. We will increase faculties in the government hospitals and increase the staff. We will improve the government hospitals and there is no question of extending KCR Kits programme to the private hospitals,” the CM categorically said.
District wise Lymphatic Filariasis (Filaria) cases in the State (As on December, 2017)
1. Jagtial - 6463
2. Siddipet - 5199
3. Suraypet - 4587
4. Kamareddy - 3342
5. Khammam - 2886
6. Rajanna Sircilla - 2350
7. Jangaon - 2189
8. Karimnagar - 1892
9. Nizamabad - 1847
10. Vikarabad - 1823
11. Warangal (Rural) - 1777
12. Mahabubbad - 1682
13. Nalgonda - 1567
14. Sangareddy - 1464
15. Yadadri Bhuvanagiri - 1410
16. Warangal (Urban) - 1051
17. Medak - 1047
18. Peddapally - 913
19. Adilabad - 673
20. Mahabubnagar - 644
21. Kumuram Bheem Asifabad - 479
22. Nirmal - 292
23. Mancherial - 274
24. Jayashankar Bhupalpaly - 174
25. Bhadradri Kothagudem - 142
26. Nagarkurnool - 112
27. Medchal - 71
28. Rangareddy - 55
29. Gadwal - 39
30. Wanaparthy - 32
31. Hyderabad - 0
TOTAL - 46476
2. Siddipet - 5199
3. Suraypet - 4587
4. Kamareddy - 3342
5. Khammam - 2886
6. Rajanna Sircilla - 2350
7. Jangaon - 2189
8. Karimnagar - 1892
9. Nizamabad - 1847
10. Vikarabad - 1823
11. Warangal (Rural) - 1777
12. Mahabubbad - 1682
13. Nalgonda - 1567
14. Sangareddy - 1464
15. Yadadri Bhuvanagiri - 1410
16. Warangal (Urban) - 1051
17. Medak - 1047
18. Peddapally - 913
19. Adilabad - 673
20. Mahabubnagar - 644
21. Kumuram Bheem Asifabad - 479
22. Nirmal - 292
23. Mancherial - 274
24. Jayashankar Bhupalpaly - 174
25. Bhadradri Kothagudem - 142
26. Nagarkurnool - 112
27. Medchal - 71
28. Rangareddy - 55
29. Gadwal - 39
30. Wanaparthy - 32
31. Hyderabad - 0
TOTAL - 46476
- LYMPHATIC FILARIASIS
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