New Delhi- In the eastern part of India, it is possible to come across the unedifying sight of people with large swollen legs or necks. Commonly known as elephantiasis or Haathi Paanv, it is also known by its medical term as Lymphatic Filaria (LF). It is a persistent health concern that affects millions in developing countries. In its efforts to help achieve the global target of LF elimination by 2030, India’s Ministry of Health and Family Welfare has initiated a nationwide bi-annual Mass Drug Administration campaign. The ambitious goal is to achieve complete elimination of LF by 2027, three years ahead of the global target.

LF, a mosquito-borne tropical disease, entails a complex life cycle involving the transmission of larvae through mosquito bites. These larvae eventually develop into adult worms residing in the lymphatic system, causing debilitating swelling in various body parts, including limbs, genitalia, and even breasts. While there are effective drugs to combat the larvae, there currently exists no treatment for adult worms.

However, a simple yet effective approach, Mass Drug Administration (MDA), has successfully eliminated LF as a public health problem in 18 out of 72 endemic countries namely Cambodia, the Cook Islands, Egypt, Kiribati, Maldives, Malawi, Marshall Islands, Niue, Palau, Sri Lanka, Thailand, Togo, Tonga, Vanuatu, Viet Nam, Wallis and Futuna, and Yemen.

In an interview to Health on Air,  Dr. Bhupendra Tripathi, Country Lead for Neglected Tropical Diseases at the Bill & Melinda Gates Foundation, while explaining why only MDA can eradicate this disease, he said, “Similar to polio vaccination campaigns, providing these drugs to all eligible individuals can eliminate this disease,”

 The MDA program has been in operation in India since 2004, but its success is dependent on reaching those who have not previously participated. “The health department can provide medicines, but it’s the public’s responsibility to consume them. Typically, people take medication when they feel ill, but LF symptoms can take 15 to 20 years to appear after infection. This lack of visible signs often leads people to neglect drug consumption, assuming they are healthy, leading them to avoid medication,” he added.

Dr. Tripathi emphasizes the vital role of educating and raising awareness within communities about the disease and its treatment- stressing the importance of consistently following prescribed drug regimens. This is where the significant contributions of community radios, local NGOs, and grassroots health workers becomes indispensable. Dr. Tripathi underscores the pivotal role of community radios as powerful instruments for disseminating vital information about LF.

The choice of medicines for preventing LF through  MDA depends on whether LF coexists with other similar diseases. The World Health Organization (WHO) recommends the following MDA regimens:

1. In areas where LF co-occurs with another disease called loiasis, the recommended MDA regimen is albendazole (400 mg) administered twice a year.

2. For countries grappling with LF and onchocerciasis, the WHO recommends MDA with ivermectin (based on body weight) in combination with albendazole (400 mg).

3. In countries without onchocerciasis, the prescribed MDA regimen includes diethylcarbamazine citrate (DEC) (6 mg/kg) and albendazole (400 mg).

4. In countries without onchocerciasis, and subject to specific programmatic conditions, the recommended MDA regimen comprises ivermectin (based on body weight), diethylcarbamazine citrate (DEC) (6 mg/kg), and albendazole (400 mg).

The success of Mass Drug Administration depends on the effectiveness of the chosen regimen and the coverage, which refers to the proportion of the total population that takes the medicines. MDA, using the two-medicine regimen, has been effective in interrupting the transmission cycle when carried out annually for a minimum of 4-6 years with adequate coverage of the entire at-risk population. In some unique settings, salt fortified with DEC has also been employed to halt LF transmission.

All these measures accompanied by an aware community can end this disease whose symptoms may lie dormant for years, but when they emerge in a person then it can just be too late to treat them.