REVISED STRATEGY FOR ELIMINATION OF LYMPHATIC FILARIASIS IN INDIA
Dr. Manoranjan Jha, MD (Ped)*
Senior Medical Officer, Regional Office for Health & FW., Govt. of India, Patna. *
Filariasis has been a major public health problem in India next only to malaria. In India Wucheria bancrofti, the causative organism for filaria transmitted by the ubiquitous vector, Culex quinquefasciatus has been the most predominant infection contributing to about 99% of the problem in the country.

Man is the definitive host i.e., where the adult male and female matured parasites mate and produce microfilariae whereas the intermediate host. The adult parasites are usually found in the lymphatic system of man. They give birth to as many as 50,000 microfilariae per day, which find their way into blood circulation.

When the infective mosquito feeds on other human host, the infective larvae are deposited at the site of mosquito bite from where the infective larvae get into lymphatic system. In the human host, the infective larvae develop into adult male and female worms. The adult worms survive for about 5-8 years or sometimes as long as 15 years or more. The reservoir or source of infection in a person with circulating microfilaria in peripheral blood. The microfilaria carriers are usually without any recognizable symptoms of illness. The individuals with advanced disease often turnout to be negative for microfilaria.

The transmission of filariasis can only be interrupted either through effective control of vector species of mosquitoes or Mass Drug Administration of DEC, a drug effective against the circulating microfilaria in the blood of infected persons. It is usually effective in killing microfilaria and probably some of the adult worms; and reduces the parasite load in the human reservoir.

National Health Policy (2002) Goal: To eliminate lymphatic filariasis from India by year 2015.
  • To reduce and eliminate transmission of lymphatic filariasis by annual Mass Drug Administration of Diethylcarbamazine Citrate (DEC-6 mg/kg body wt.) - aiming at interruption of disease transmission
  • To reduce and prevent morbidity in affected persons - aiming at disability prevention and control of the disease
  • To strengthen the existing health care services and also to undertake effective and timely IEC/BCC activities to mobilize the people and
  • Continuation of existing control measures in NFCP towns to supplement the above

Parasite control with DEC is often relatively cheap when compared with vector control. The drug is safe and effective for human lymphatic filariasis. Instead of 12-day drug regime with DEC, it has been observed that a single day treatment once as year was found equally effective in reducing the transmission. There is basic difference between individual and community treatment of filariasis. In the first case, it is usually the patient who is in need of help and therefore he or she is more likely to comply with the treatment. In a community on the other hand, only a small proportion of the population is suffering from acute clinical filariasis at any one time and therefore a few people feel the need for help.

The disease has been eliminated in countries like Japan, Taiwan, South Korea and Solomon Islands and markedly reduced filarial infection in China with similar strategies and together we can and we will eliminate this public health menace from our country also by sustained efforts of all concerned.
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