A pilot project was rolled out in Nagpur as of January 20 to issue the World Health Organization’s (WHO) recommended triple-drug therapy for lymphatic filariasis – also known as elephantiasis.
The state of Maharashtra is one of six states in India classed as endemic for the disease. It is hoped that if the pilot project is successful in Nagpur, the treatment will be made available across these six states to aid in speeding up the elimination of the disease.
Roundworms and lymph systems
Classed as a neglected tropical disease, elephantiasis derived its more widely known name from the excessive swelling and growths commonly found in an infected patients legs, making them almost resemble that of an elephant.
The technical name of the disease — lymphatic filariasis — is taken from the name of the filarial parasites, a type of roundworm, responsible for causing the disease. These parasites are transmitted to humans through mosquitoes and primarily affect young children.
Symptoms may not be apparent during childhood, though permanent damage to the immune system may occur. This is due to adult parasitic worms burrowing into lymph glands, disrupting normal function. Adult worms are capable of producing millions of larvae across their lifetime which can pass via the bloodstream to infect more of the lymph system.
Elephantiasis, a relatively well known, yet neglected disease
The disease is well known due to its highly recognisable chronic symptoms. In addition to the swollen legs, tissue hardening can occur, contributing to the resemblance to the skin of an elephant. Genital and breast swelling may also occur.
Due to the highly visible nature of the symptoms, coupled with its capacity to be infectious, those suffering from the condition are often ostracised within their communities. This aspect can cause further issues regarding the mental health of the individual affected, as well as reduce potential for job opportunities resulting in many being unable to afford medical bills.
The majority of infections are, however, asymptomatic, showing no external signs of infection at all. These asymptomatic infections still cause damage to the lymphatic system and the kidneys, and alter the body’s immune system. This makes the asymptomatic cases potentially far more damaging to elimination efforts, as they still contribute to passing on the infection while remaining all but untraceable.
Will the new treatment regimen make a difference?
The triple therapy comes as an addition to the currently used double therapy, as opposed to a different treatment regimen entirely. Originally, only Di-ethylcarbamazine Citrate and Albendazole were used. The WHO has added one more drug — Ivermectin — which has increased the cost of treatment, but increases the speed at which the treatment takes effect considerably.
The treatment operates by clearing the blood of microfilariae — the larvae of the roundworm causing the disease. By doing so, mosquitoes do not take in parasites when feeding on infected individuals, and so do not pass on the disease to other people. While the treatment regimen will not cure the individual, it is a vital step in reducing transmission and therefore moving close to elimination.
The currently used strategy is to administer the new three drug therapy to as many people in the endemic areas as possible. In doing so, it is hoped that asymptomatic cases are medicated and transmission rates will be significantly reduced. “We managed to cover nearly 85% population in the endemic areas. If people have these drugs, the disease can be prevented,” said Dr. Japtap, a doctor working on the mass administration campaign.
The situation in India
“Over forty percent of worldwide cases are found in India and for this we have to work together so that we can achieve the goal of eradicating this disease,” said Dr Rashmi Shukla, WHO India’s national programme officer for neglected tropical diseases.
Since 2004 a two drug therapy has been in place in India. Experts such as Dr Nupur Roy, additional director of the National Vector Borne Disease Control Programme believes that with the addition of the three drug therapy, it is within the realm of possibility that India attains the global eradication deadline by 2020.
However, this may be an optimistic view of the situation. Some estimate disease figures in India as high as being over 31 million people with over 29 million suffer from disability associated with the disease.
Efforts to curb the spread of the disease are hindered by the aforementioned asymptomatic cases of the disease. However, even those who are aware that they have the infection are often unwilling to seek treatment as it would reveal their disease status, exposing them to social stigma. Others are unwilling to take the medication during the mass administration drives as they believe they are uninfected, which may not be the case due to the asymptomatic form of the disease.