Patna: The campaign against lymphatic filariasis (LF) – a neglected tropical disease – faced a setback in Bihar following reports of children falling ill after taking the medication during a Mass Drug Administration (MDA) drive in schools. This led to reluctance among the population to participate in the MDA. However, sources in administration denied widespread halting of the campaign, asserting it was limited to one district.
Authorities also reaffirmed the safety of the drugs for consumption. In fact, experts suggest that if the drug is causing certain side effects, it indicates that its effectiveness has begun. Dr. Parmeshwar Prasad, Additional Director and State Program Officer for filariasis, stressed, “Instances of nausea, dizziness, or weakness after taking medicines are actually positive signs, indicating the elimination of microfilaria worms in the body. There are no concerns regarding the efficacy or quality of the drug.”
Why are children falling sick and why Bihar?
Instances of illness resulting from drug side effects have predominantly been reported from various districts in Bihar. Dr. Bhupendra Tripathi, Country Lead for the Elimination Programme of Neglected Tropical Diseases at the Bill & Melinda Gates Foundation, cited two main reasons behind these occurrences in an interview with Health on Air. “Firstly, Bihar has a high rate of microfilaria, and when individuals ingest the drugs, these parasites die, leading to self-limiting symptoms. Secondly, taking the medication on an empty stomach can cause some acidity, which is easily manageable. No severe adverse events have been reported thus far,” he explained.
Microfilaria occurs when small immature worms of certain parasites, known as filariae, are present in the bloodstream of infected individuals. This represents the initial stage of the disease, which can be eradicated through drug administration. However, once the worms mature into adults, the effectiveness of medications diminishes.
“Children may experience distress if they eat medicine on an empty stomach. Our health workers are trained to communicate this to the parents. Slight discomfort may arise, but it means that the medicine is working,” said Birendra Prasad, Gopalganj Civil Surgeon.
Despite numerous government campaigns aimed at mobilizing and raising awareness about the MDA drive, occasional gaps in communication can lead to such hysteria and panic. “Most vaccines or preventive drugs have mild side-effects which is normal. And the proper way of taking medicine is an important piece of information for the parents. Actually, it’s a key message given to all the health workers but a few miss communicating this properly,” said Dr. Tripathi.
Referring to the media’s influence in reporting such stories, he stated, “This is a situation of mass hysteria fuelled by media influence. We’ve noticed similar patterns during previous vaccination campaigns,” he explained.
Bihar holds the highest endemicity of filariasis, standing at over 17%, followed by Kerala with 15.7% and Uttar Pradesh with 14.6%. Filariasis ranks as India’s second most common mosquito-borne parasitic disease after malaria.
A total of 2,193 children reportedly fell ill after taking filariasis medicines in Bihar following the campaign’s launch on February 10th, with complaints including headaches, stomach aches, and vomiting. However, they were discharged after medical examination, with no fatalities or severe illnesses reported.
The nationwide MDA campaign for lymphatic filariasis elimination commenced on February 10th, covering 92 districts across 11 states for two weeks. Participating states, including Bihar, achieved significant coverage last year, with Bihar reaching 74.33% coverage against the total population.
The simplest and the most effective treatment pathway for this disease is MDA. This method has successfully eliminated LF as a public health problem in 18 out of 72 endemic countries like 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. India has committed to eliminating the disease by 2027.
What is LF?
Lymphatic filariasis is caused by tiny roundworm parasites called nematodes, specifically from the Filariodidea family. There are three main types of these worms:
- Wuchereria bancrofti, responsible for most cases (about 90%)
- Brugia malayi, causing the majority of the remaining cases
- Brugia timori, which also contributes to the disease.
These worms live in the lymphatic vessels, disrupting normal lymphatic system function. They can survive for about 6 to 8 years and produce millions of immature larvae called microfilariae during their lifespan. These microfilariae circulate in the bloodstream.
Mosquitoes become infected with microfilariae when they feed on the blood of an infected person. Inside the mosquito, the microfilariae mature into larvae capable of infecting humans. When infected mosquitoes bite people, they deposit these mature larvae onto the skin, allowing them to enter the body. The larvae then migrate to the lymphatic vessels, where they grow into adult worms, continuing the transmission cycle.
Different types of mosquitoes, such as Culex in urban and semi-urban areas, Anopheles in rural areas, and Aedes on endemic islands in the Pacific, transmit lymphatic filariasis.
What drugs are administered to combat the disease?
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:
- In areas where LF co-occurs with another disease called loiasis, the recommended MDA regimen is albendazole (400 mg) administered twice a year.
- For countries grappling with LF and onchocerciasis, the WHO recommends MDA with ivermectin (based on body weight) in combination with albendazole (400 mg).
- In countries without onchocerciasis, the prescribed MDA regimen includes diethylcarbamazine citrate (DEC) (6 mg/kg) and albendazole (400 mg).
- 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).
(With inputs from Santosh Singh)
