LymphaticFilariasis (LF) is the second most common vector borne parasitic disease aftermalaria. It affects over 120 million people in 73 countries in tropics andsub-tropics of Asia, Africa, the Western Pacific, and parts of Caribbean andSouth America, while one billion are at risk. According to World HealthOrganization (WHO), filariasis is the second most common cause of disabilityafter mental illness.1,2 One third of the people with LF live inIndia.
Filariasis has been a major public health problem in India with indigenouscases reported from about 250 districts in 20 states/Union territories. LFis one of the diseases enlisted under Global neglected tropical disease. WHOlaunched Global Programme to Eliminate Lymphatic Filariasis (GPELF) in 2000,with the target to eliminate Filariasis by 2020.3 The national health policy (2017) envisageselimination of LF by year 2017 which is defined as “cessation of lymphaticfilariasis as a public health problem when the number of microfilaria carriersin the community is less than 1% and children born after initiation ofelimination of lymphatic filariasis are free from circulating antigenaemia thatis presence of adult filarial worm in human body”.4Annual mass drug administration (MDA) of single dose of Albendazole and Diethylcarbamazine (DEC) for five years or more for the eligible population to stopthe spread of transmission of LF was launched in 2004. Implementation of MDArequires cooperation and coordination of activities by service providers, localhealth officials and more importantly the communities. MDA programme after 4-6rounds with high coverage of ?80% is expected to reach the elimination stagewhere the prevalence of infection falls below 1%.5 Most LF infectedpeople may have no symptoms and are found to be apparently healthy.
But the LFparasite can be transmitted from these asymptomatic people to healthy peoplethrough mosquitoes. Duringthe year 2004, only 202 districts were covered with a coverage rate of 72.42%.MDA coverage increased gradually from 72.42% in 2004 to 88.96% in 2014.
6 India’s filarial controlprogram has scaled up MDA over the past several years for the treatment of the590 million Indians living at risk of infection.7 Whena sizeable portion of population fails to comply with MDA, apotential reservoir for the parasite is left untreated, leading torecrudescence of the microfilaraemia (mf) and thus hampering the program’ssuccess.8 For interrupting transmission, MDA compliance must exceed65–75%, with five to six rounds of treatment9, however, compliancehas remained relatively low in most of the endemic areas.10,11,12Amongthe LF endemic regions, Odisha, has been recognized as one of the most highlyendemic and remains as such.13,14,15 Microfilaria rate was 2.
6% in2004 in Odisha which was reduced to 0.38% in 2015 after introduction of MDA.16But still 12 years after the commencement of MDA it has not achieved desiredresults with LF still plaguing the state as a formidable public healthchallenge.