MASS DRUG ADMINISTRATION CAMPAIGN FOR LYMPHATIC FILARIASIS ELIMINATION

In February 2024, The Union Minister of State for Health and Family Welfare has launched the first phase of the Bi-annual Nationwide Mass Drug Administration (MDA) campaign aimed at eliminating Lymphatic Filariasis (LF).

Campaign Objective

1. 1. The campaign seeks to check disease transmission by providing free preventive medications to residents living in areas affected by Lymphatic Filariasis (LF).
   2. It aims to cover 92 districts across 11 states during its initial phase.

Understanding Lymphatic Filariasis

1. Overview:

1. Lymphatic filariasis is also known as elephantiasis
2. It is a neglected tropical disease caused by filarial parasites transmitted through mosquitoes.
3. It is a Vector-Borne Disease.

2. Lymphatic Filariasis Disease Incidences:

1. Over 882 million people in 44 countries worldwide remain threatened by lymphatic filariasis and require preventive chemotherapy to stop the spread of this parasitic infection.
2. India, particularly, faces a significant LF burden with 345 endemic districts across 20 states and union territories.
3. In India, 75% of MDA districts belong to Bihar, Jharkhand, Uttar Pradesh, Odisha, and Telangana.
4. LF affects more the urban poor and various rural segments of the population.

3. Impact:

1. LF starts typically during childhood and persists into adulthood, leading to irreversible chronic health conditions.
2. Besides physical health implications, LF contributes to stigma, mental distress, social marginalization, and economic hardships, increase poverty within affected communities.

4. Cause and Transmission:

   1. Parasitic Infection:

      1. Lymphatic filariasis is caused by tiny parasites known as nematodes (roundworms) from the Filariodidea family. These worms are thread-like in shape.
      2. There are three main types of these filarial worms:
         1. Wuchereria bancrofti (responsible for around 90% of cases)
         2. Brugia malayi (causing most of the remaining cases) and
         3. Brugia timori

   2. Transmission Cycle:

      1. Adult worms live in the lymphatic vessels, where they produce tiny larvae called microfilariae. These microfilariae circulate in the blood.
      2. Mosquitoes get infected when they bite an infected person, and they then transmit the larvae to humans when they bite, continuing the cycle of transmission.

5. Symptoms and Complications:

   1. Asymptomatic and Chronic Conditions: Most infections don't show any symptoms, but in chronic cases, it can lead to conditions like:
      1. Lymphoedema (swelling of limbs)
      2. Elephantiasis (thickening of skin and tissues)
      3. Hydrocele (swelling of the scrotum), causing physical and psychological distress.
   2. Acute Episodes: Chronic conditions often come with acute inflammatory episodes, resulting in severe symptoms and reduced productivity among those affected.

6. Approaches to Treatment and Prevention:

   1. Preventive Chemotherapy: The recommended strategy by the World Health Organization (WHO) is Mass Drug Administration (MDA) with annual doses of medicines to the at-risk population to eliminate lymphatic filariasis.
   2. MDA Regimens: Different drug regimens are suggested based on the presence of other filarial diseases in the area. The goal is to reduce the density of microfilariae and stop transmission.
   3. Morbidity Management: Surgery, hygiene measures, and medical care play vital roles in managing chronic symptoms and stopping disease progression.
   4. Vector Control: Strategies like mosquito control are essential supplements to reduce transmission and support preventive chemotherapy efforts.

7. WHO's Response and Objectives:

   1. Global Programme to Eliminate Lymphatic Filariasis (GPELF):
      1. GPELF, initiated in 2000, aims to eradicate lymphatic filariasis through preventive chemotherapy and managing associated morbidity.
      2. In the new NTD Road Map (2021–2030), GPELF aims for the following goals by 2020:
         • Validation: The aim is for 80% of countries with endemic cases (58 in total) to confirm the elimination of the disease and maintain low infection rates after Mass Drug Administration (MDA).
         • Surveillance: All countries with endemic cases (72 in total) should establish surveillance systems to prevent the resurgence of the disease.
         • MDA Reduction: The objective is to reduce the population needing Mass Drug Administration (MDA) to zero.
   2. WHO’s strategy is based on 2 key components:
      1. stopping the spread of infection through large-scale annual treatment of all eligible people in an area or region where infection is present; and
      2. Alleviating the suffering caused by lymphatic filariasis through provision of the recommended essential package of care.
   3. India's Efforts:
      1. A Five-pronged Strategy: - India has introduced a new plan to speed up efforts to get rid of Lymphatic Filariasis. The Health and Family Welfare Minister launched a five-step strategy to eliminate the disease by 2027. The five pillars are as follows:
         1. Multi-drug administration (MDA) Campaign twice a year synchronized with National Deworming Day (10th Feb and 10th August)
         2. Early diagnosis and treatment; engagement of medical colleges for strengthening Morbidity management and disability (MMDP) services
         3. Integrated Vector Control with multi sectoral coordinated efforts
         4. For inter sectoral convergence with allied departments and ministries
         5. Leveraging existing digital platforms for LF and exploring alternate diagnostics
      2. India's Commitment: India is dedicated to eliminating Lymphatic Filariasis by 2027, three years ahead of the global target.
      3. A Team Effort: India is adopting this collaborative method through Jan Bhagidaari and the Whole of Government and Whole of Society approach.

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