Lymphatic lymphatic filariasis as a public health problem when

Lymphatic
Filariasis (LF) is the second most common vector borne parasitic disease after
malaria. It affects over 120 million people in 73 countries in tropics and
sub-tropics of Asia, Africa, the Western Pacific, and parts of Caribbean and
South America, while one billion are at risk. According to World Health
Organization (WHO), filariasis is the second most common cause of disability
after mental illness.1,2 One third of the people with LF live in
India. Filariasis has been a major public health problem in India with indigenous
cases reported from about 250 districts in 20 states/Union territories.  

LF
is one of the diseases enlisted under Global neglected tropical disease. WHO
launched Global Programme to Eliminate Lymphatic Filariasis (GPELF) in 2000,
with the target to eliminate Filariasis by 2020.3 The national health policy (2017) envisages
elimination of LF by year 2017 which is defined as “cessation of lymphatic
filariasis as a public health problem when the number of microfilaria carriers
in the community is less than 1% and children born after initiation of
elimination of lymphatic filariasis are free from circulating antigenaemia that
is presence of adult filarial worm in human body”.4
Annual mass drug administration (MDA) of single dose of Albendazole and Diethyl
carbamazine (DEC) for five years or more for the eligible population to stop
the spread of transmission of LF was launched in 2004. Implementation of MDA
requires cooperation and coordination of activities by service providers, local
health officials and more importantly the communities. MDA programme after 4-6
rounds with high coverage of ?80% is expected to reach the elimination stage
where the prevalence of infection falls below 1%.5 Most LF infected
people may have no symptoms and are found to be apparently healthy. But the LF
parasite can be transmitted from these asymptomatic people to healthy people
through mosquitoes.

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During
the 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 control
program has scaled up MDA over the past several years for the treatment of the
590 million Indians living at risk of infection.7

When
a sizeable portion of   population fails to comply with MDA, a
potential reservoir for the parasite is left untreated, leading to
recrudescence of the microfilaraemia (mf) and thus hampering the program’s
success.8 For interrupting transmission, MDA compliance must exceed
65–75%, with five to six rounds of treatment9, however, compliance
has remained relatively low in most of the endemic areas.10,11,12

Among
the LF endemic regions, Odisha, has been recognized as one of the most highly
endemic and remains as such.13,14,15 Microfilaria rate was 2.6% in
2004 in Odisha which was reduced to 0.38% in 2015 after introduction of MDA.16
But still 12 years after the commencement of MDA it has not achieved desired
results with LF still plaguing the state as a formidable public health
challenge.