Abstract
Lymphatic Filariasis Elimination: Concern for Introducing Vector Control
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Lymphatic Filariasis (LF), has been targeted for elimination by the resolution of the World Health Assembly (WHA) in 1997. The global programme to eliminate lymphatic filariasis (GPELF) launched in 2000 has been adopted in all endemic countries with Mass Drug Administration (MDA) to interrupt infection transmission and with basis home-based morbidity care to LF patients. MDA involves administering a single annual dose of drug(s) to the entire at-risk population for at least five-six years, with 65% or more coverage. Morbidity management and disability prevention (MMDP) recommended care package helps in reducing the sufferings from the morbidities of lymphedema and hydrocele. India launched elimination campaign of annual MDA to all endemic states/UTs in 2004, starting with 202 districts, subsequently scaled up to 256 districts in next 3-4 years and then to 345 districts.
Boudh, a high endemic LF districts in Odisha in India was covered under MDA since 2004. Boush district cleared all three Transmission Assessment Surveys (TAS) as per WHO meeting the criteria of minimum 5-6 rounds of MDA, drug coverage of more than 65% against total population and evidence of microfilaria prevalence less than 1% in each of sentinel and random sites. The district has taken care of lymphedema and hydrocele patients as per LF elimination strategies. Under the LF elimination programme, there is no focused vector control measures except larval control in certain towns and collateral benefits by use of LLINs distributed for malaria prevention. Vector control was not emphasized in the beginning of the programme even in GPELF due to its cost effectiveness and feasibility which has recently been included as third pillar to sustain the gains achieved and monitor the prevalence of infection among vector mosquitoes. India has also launched accelerated programme with five pronged strategies including vector control. The presence of microfilaria even in low concentration detected during TAS raises concern whether such parasitic presence can be considered as endpoint for elimination or the infection can re-emerge and establish infection at in the district at long run. Appropriate studies including immunological component are required to explore solutions to the above apprehension.
Keywords: Lymphedema, Hydrocele, Endemic districts, Malaria prevention
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