Lymphatic filariasis in India

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Prominence and Spread of a disease in India

Lymphatic filariasis in India refers to the presence of the disease lymphatic filariasis in India and the social response to the disease. In India, 99% of infections come from a type of mosquito spreading a type of worm through a mosquito bite.[1] The treatment plan provides 400 million people in India with medication to eliminate the parasite.[2] About 50 million people in India were carrying the worm as of the early 2010s, which is 40% of all the cases in the world.[3] In collaboration with other countries around the world, India is participating in a global effort to eradicate lymphatic filariasis. If the worm is eliminated from India then the disease could be permanently eradicated.[4][5] In October 2019 the Union health minister Harsh Vardhan said that India's current plan is on schedule to eradicate filariasis by 2021.[6]

To treat, prevent, and eliminate the disease, the Indian government provides mass drug administration (MDA) to achieve mass deworming. The treatment is a few pills taken once a year for five years. The medication provided is diethylcarbamazine.[citation needed] For the treatment to work 60-80% of people in large regions must take this yearly treatment for several years.

## Treatment

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Treatment is done through a public health initiative in which most people in regions with the parasite take treatment. The treatment is a mass drug administration to cause mass deworming. In India the worm only lives in humans, so if everyone takes treatment, and everyone is cured, then the worm will be permanently eradicated. India participates in the global eradication program to eliminate the worm worldwide.[citation needed]

Health education for the public is an essential part of the campaign.[2] Hundreds of millions of people in affected communities have to agree to take the drugs once a year.[2] In a 2015 public health campaign called Hathipaon Mukt Bharat shows how the disease causes large feet, says the medicine is safe, and tells people to take it.[2]

The treatment program varies in different places in India. Various reports describe the variation, such as for Assam[7] and Andhra Pradesh.[8]

Most people who take treatment have no negative effects or only mild adverse events which resolve without further treatment.[9] A bigger problem than any side effects of treatment is people having fear of taking treatment, which leads them to refuse to take medicine.[9] Various studies have examined why people in various Indian regions neglect to take the drugs.[10]

## Vector

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99% of infections in India happen when the mosquito Culex quinquefasciatus spreads the worm Wuchereria bancrofti through a mosquito bite.[1] Because the cause of this disease can be a different worm and parasite in different countries, each country has its own plan for control and treatment.[11]

The typical prevention for filariasis is through the use of medication.[12] However, in some areas, using the pesticide spinosad to eliminate mosquitoes is helpful to prevent the spread.[12]

To eliminate the disease neither humans nor mosquitoes should have the parasite.[13] The usual way to determine whether filariasis is eliminated from an area is to test humans for the parasite.[13] In some special cases India uses molecular xenomonitoring to examine captured mosquitoes and determine if they carry the parasite.[13]

## Epidemiology

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By 2006 there were 20 million people infected and with symptoms, 30 million people infected but asymptomatic, and 470 million people who were at potential risk.[1] In 2005 95% of the cases in India were in Andhra Pradesh, Bihar, Gujarat, Kerala, Maharashtra, Orissa, Tamil Nadu, Uttar Pradesh and West Bengal.[14]

India has 40% of the world's lymphatic filariasis (LF) cases.[15] For patients, one of the major costs of treating the disease is that of being unable to work for some time.[15] A year 2000 survey reported that about half the people in India were at risk of contracting LF.[16] Men and women are equally susceptible to this disease, but in the past, there have been barriers to women accessing treatment.[17] An estimate from the year 2000 reported that filariasis in India caused an annual economic loss of ₹5000 crore (US$1,000,000,000).[15]

## Society and culture

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The Sushruta Samhita, an Ayurvedic Indian text, described filariasis in the 6th century BCE.[1] The disease is timeless and present throughout Indian history. Indian physicians in the 500s wrote about the disease.[18] In the 1500s the European explorer Jan Huyghen van Linschoten visited Goa and wrote about people with filariasis symptoms there.[18]

In 1955 the Indian government established the National Filaria Control Programme (NFCP) as a project to limit the spread of the disease.[19][1] By 1959 that organization proposed various plans for controlling or eliminating the disease.[20] Infections spread out of control from 1955 until 1995 in which time the number of cases increased several fold.[1] Reasons for the disease's expansion included increased urban population and a rapidly changing country which exposed people to new circumstances with mosquitoes.[21]

Various people in Delhi present a 2018 plan for eliminating LF with government support of J.P. Nadda

In 1997 India joined a World Health Assembly resolution to eliminate LF by 2020.[19] In India to achieve this goal healthcare must be very accessible to almost everyone at risk for the disease.[22] The Indian government originally planned to eliminate the disease by 2015, then shifted the date to 2017, then to 2020.[23] Various media outlets have discussed how India might meet the goal or what it should happen next if more time is required.[24][25][26]

In 2015 the Indian government launched a health campaign called Hathipaon Mukt Bharat (Filaria Free India) to encourage public participation in eliminating LF.[27][28] In the program everyone in an area with the disease takes pill medicine once a year for five years.[23] The drug is diethylcarbamazine citrate and albendazole and is in the form of about four pills which people take all at once.[23]

## Research

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Public health researchers have applied machine learning techniques to improve public health monitoring for filariasis in India.[29]

A 2019 report identified dogs in Kerala who have another worm which can cause filariasis, Brugia malayi.[30] This worm is not known to infect people in India.[30] If necessary tests are ready to identify the dogs carrying the disease.[30]

## References

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1. ^ a b c d e f Agrawal, VK; Sashindran, VK (October 2006). "Lymphatic Filariasis in India : Problems, Challenges and New Initiatives". Medical Journal Armed Forces India. 62 (4): 359–362\. doi:10.1016/S0377-1237(06)80109-7. PMC 5034168. PMID 27688542.
2. ^ a b c d Bagcchi, Sanjeet (April 2015). "India tackles lymphatic filariasis". The Lancet Infectious Diseases. 15 (4): 380. doi:10.1016/S1473-3099(15)70116-7. PMID 25809895.
3. ^ Hoti, S (January 2012). "Filariasis of uncommon nature in India". Tropical Parasitology. 2 (1): 2–3\. doi:10.4103/2229-5070.97230. PMC 3593514. PMID 23509678.
4. ^ Ganguly, NK (9 January 2018). "The final lap towards elimination of Lymphatic Filariasis". Business Line.
5. ^ Senthilingam, Meera (24 April 2015). "Every last worm: Eliminating Elephantiasis in India". CNN.
6. ^ Sharma, Neetu Chandra (30 October 2019). "India to eliminate Lymphatic Filariasis by 2021: Harsh Vardhan". Livemint.
7. ^ Khan, AbdulMabood (2018). "Lymphatic filariasis elimination programme in Assam, India, needs change in mass drug administration strategy to target the focus of infection". Indian Journal of Medical Research. 147 (1): 7–10\. doi:10.4103/ijmr.IJMR_1843_16. PMC 5967220. PMID 29749354.
8. ^ Upadhyayula, Suryanaryana Murty; Mutheneni, Srinivasa Rao; Kadiri, Madhusudhan Rao; Kumaraswamy, Sriram; Nagalla, Balakrishna; Noor, Abdisalan Mohamed (19 March 2012). "A Cohort Study of Lymphatic Filariasis on Socio Economic Conditions in Andhra Pradesh, India". PLOS ONE. 7 (3): e33779. Bibcode:2012PLoSO...733779U. doi:10.1371/journal.pone.0033779. PMC 3307764. PMID 22442721.
9. ^ a b Kuttiatt, VS; Somani, RK; Swaminathan, S; Krishnamoorthy, K; Weil, GJ; Purushothaman, J (January 2020). "Frequency and Clinical Significance of Localized Adverse Events following Mass Drug Administration for Lymphatic Filariasis in an Endemic Area in South India". The American Journal of Tropical Medicine and Hygiene. 102 (1): 96–99\. doi:10.4269/ajtmh.19-0532. PMC 6947773. PMID 31769393.
10. ^ Banerjee, S; Bandyopadhyay, K; Khan, MF; Akkilagunta, S; Selvaraj, K; Tripathy, JP; Solanki, R; Kushwaha, AS; Deshmukh, P (September 2019). "Coverage of mass drug administration for elimination of lymphatic filariasis in urban Nagpur, Central India: A mixed method study". Journal of Family Medicine and Primary Care. 8 (9): 3009–3014\. doi:10.4103/jfmpc.jfmpc_503_19. PMC 6820416. PMID 31681683.
11. ^ Erickson, Sara M.; Thomsen, Edward K.; Keven, John B.; Vincent, Naomi; Koimbu, Gussy; Siba, Peter M.; Christensen, Bruce M.; Reimer, Lisa J.; Valenzuela, Jesus G. (12 September 2013). "Mosquito-Parasite Interactions Can Shape Filariasis Transmission Dynamics and Impact Elimination Programs". PLOS Neglected Tropical Diseases. 7 (9): e2433. doi:10.1371/journal.pntd.0002433. PMC 3772046. PMID 24069488.
12. ^ a b Sadanandane, C; Gunasekaran, K; Boopathi Doss, PS; Jambulingam, P (January 2018). "Field evaluation of the biolarvicide, spinosad 20 per cent emulsifiable concentrate in comparison to its 12 per cent suspension concentrate formulation against Culex quinquefasciatus, the vector of bancroftian filariasis in India". The Indian Journal of Medical Research. 147 (1): 32–40\. doi:10.4103/ijmr.IJMR_1369_15. PMC 5967213. PMID 29749358.
13. ^ a b c Subramanian, S; Jambulingam, P; Krishnamoorthy, K; Sivagnaname, N; Sadanandane, C; Vasuki, V; Palaniswamy, C; Vijayakumar, B; Srividya, A; Raju, HKK (January 2020). "Molecular xenomonitoring as a post-MDA surveillance tool for global programme to eliminate lymphatic filariasis: Field validation in an evaluation unit in India". PLOS Neglected Tropical Diseases. 14 (1): e0007862. doi:10.1371/journal.pntd.0007862. PMC 7001988. PMID 31978060.
14. ^ Pani, SP; Kumaraswami, V; Das, LK (2005). "Epidemiology of lymphatic filariasis with special reference to urogenital-manifestations". Indian Journal of Urology. 21 (1): 44. doi:10.4103/0970-1591.19551.
15. ^ a b c Ramaiah, Kapa D; Das, Pradeep K; Michael, Edwin; Guyatt, Helen L (June 2000). "The Economic Burden of Lymphatic Filariasis in India". Parasitology Today. 16 (6): 251–253\. doi:10.1016/S0169-4758(00)01643-4. PMID 10827432.
16. ^ Sabesan, S.; Palaniyandi, M.; Das, P. K.; Michael, E. (3 Jul 2000). "Mapping of lymphatic filariasis in India". Annals of Tropical Medicine & Parasitology. 94 (6): 591–606\. doi:10.1080/00034983.2000.11813582. PMID 11064761. S2CID 35526107.
17. ^ Bandyopadhyay, Lalita (May 1996). "Lymphatic filariasis and the women of India". Social Science & Medicine. 42 (10): 1401–1410\. doi:10.1016/0277-9536(95)00288-X. PMID 8735896.
18. ^ a b Gordon, CA; Jones, MK; McManus, DP (4 June 2018). "The History of Bancroftian Lymphatic Filariasis in Australasia and Oceania: Is There a Threat of Re-Occurrence in Mainland Australia?". Tropical Medicine and Infectious Disease. 3 (2): 58. doi:10.3390/tropicalmed3020058. PMC 6073764. PMID 30274454.
19. ^ a b Sabesan, S; Vanamail, P; Raju, KH.K; Raju, P (2010). "Lymphatic filariasis in India: Epidemiology and control measures". Journal of Postgraduate Medicine. 56 (3): 232–8\. doi:10.4103/0022-3859.68650. PMID 20739779.
20. ^ Beye, H. K.; Wright, W. H. (1959). "The National Filaria Control Program (NFCP) of India: investigative challenges". Bulletin of the National Society of India for Malaria and Other Mosquito-Borne Diseases. 7 (2). Indian Society for Malaria and Other Communicable Diseases: 45–52.
21. ^ Ramaiah, KD (1993). "A rational approach to the control of filariasis in India". The National Medical Journal of India. 6 (3): 114–6\. PMID 8329989.
22. ^ Agrawal, VK; Sashindran, VK (October 2006). "Lymphatic Filariasis in India : Problems, Challenges and New Initiatives". Medical Journal Armed Forces India. 62 (4): 359–362\. doi:10.1016/S0377-1237(06)80109-7. PMC 5034168. PMID 27688542.
23. ^ a b c TNN (17 November 2017). "filariasis in india: The epidemic you don't know about". The Times of India.
24. ^ TNN (17 November 2017). "Filariasis in india: The epidemic you don't know about". The Times of India. The Times Group.
25. ^ Basu, Snigdha (8 March 2018). "Not Stigma But Awareness A Hurdle To Eliminate Lymphatic Filariasis By 2020". NDTV.
26. ^ Rath, Nibedita; Dash, Sambit (22 August 2017). "India Is Set To Fail Its Target Of Eradicating Filariasis By 2020". HuffPost India. AOL.
27. ^ Bagcchi, Sanjeet (April 2015). "India tackles lymphatic filariasis". The Lancet Infectious Diseases. 15 (4): 380. doi:10.1016/S1473-3099(15)70116-7. PMID 25809895.
28. ^ McNeil, Donald G. (2 March 2015). "India Begins Campaign to Eliminate Elephantiasis". The New York Times.
29. ^ Kondeti, PK; Ravi, K; Mutheneni, SR; Kadiri, MR; Kumaraswamy, S; Vadlamani, R; Upadhyayula, SM (2 September 2019). "Applications of machine learning techniques to predict filariasis using socio-economic factors". Epidemiology and Infection. 147: e260. doi:10.1017/S0950268819001481. PMC 6805759. PMID 31475670.
30. ^ a b c Sadarama, PV; Chirayath, D; Pillai, UN; Unny, NM; Lakshmanan, B; Sunanda, C (December 2019). "Canine Brugia malayi microfilarial excretory/secretory protein-based antibody assay for the diagnosis of brugian filariasis in dogs". Journal of Parasitic Diseases. 43 (4): 549–553\. doi:10.1007/s12639-019-01125-3. PMC 6841868. PMID 31749523.

## Further consideration

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* Das, PK; Pani, SP; Krishnamoorthy, K (June 2002), "Prospects of eliminating lymphatic filariasis in India" (PDF), ICMR Bulletin, New Delhi: Indian Council of Medical Research
* Kazmin, Amy (2017). "The race to zero: how to eliminate an ancient disease". Financial Times.