Filariasis in India

1. RECENT ADVANCES IN FILARIASIS
DR. PRAGYAN PARAMITA PARIJA
DEPT. OF COMMUNITY MEDICINE
VMMC & SAFDARJUNG HOSPITAL, NEWDELHI

2. OUTLINE OF THE PRESENTATION:
• INTRODUCTION
• MICROBIOLOGY
• LIFECYCLE
• NEWER CONCEPT OF
PATHOGENESIS
• CLINICAL FEATURES
• DIAGNOSTICS
• GLOBAL SCENARIO
• INDIAN SCENARIO
• NFCP
• ELF
• ISSUES AND CHALLENGES
• ROADMAP
• VACCINES
• MATHEMATICAL MODELS
• REFERENCES

3. INTRODUCTION:
• Filariasis has been a major public health problem in India next only to malaria.
• The disease was recorded in India as early as 6th century B.C. by the famous
Indian physician, Susruta in his book Susruta Samhita.
• In 7th century A.D., Madhavakara described signs and symptoms of the disease in
his treatise 'Madhava Nidhana' which hold good even today.
• In 1709, Clarke called elephantoid legs in Cochin as Malabar legs.
• The discovery of microfilariae (mf) in the peripheral blood was made first
by Lewis in 1872 in Kolkata. *NVBDCP

4. • Lymphatic filariasis is the world’s second leading cause of long-term
disability.
• Indigenous cases have been reported from about 250 districts in 20
states/Union Territories.
• Cases of filariasis have been recorded from Andhra Pradesh, Assam,
Bihar, Chhattisgarh, Goa, Jharkhand, Karnataka, Gujarat, Kerala,
Madhya Pradesh, Maharashtra, Odisha, Tamil Nadu, Uttar Pradesh,
West Bengal, Pondicherry, Andaman & Nicobar Islands, Daman & Diu,
Dadra & Nagar Haveli and Lakshadweep.

5. FILARIA ENDEMIC DISTRICTS: Endemic district 250
(in 20 States/UTs)
Population: 600 Million *NVBDCP 2015
ENDEMIC
Non endemic

6. LANDMARKS:
YEAR
1949-1954 PILOT PROJECT IN ODISHA FOR FILARIASIS
1955 NATIONAL FILARIA CONTROL PROGRAMME(FOCUSSING
ON URBAN AREAS)
1994 NFCP EXTENDS TOWARDS RURAL AREA
1996 MDA WITH DEC PILOT IN 13 DIST
1997 WORLD HEALTH ASSEMBLY CALLING FOR ELIMINATION
OF LF AS PUBLIC HEALTH PROBLEM BY 2020
2000 GPELF FACILITATE INITIATION OF PROGRAMMES IN
ENDEMIC COUNTRIES INCLUDING INDIA
2000-2005 A LARGE TRIAL ON FEASIBILTY AND IMAPCT OF DEC+ALB
IN SELECTED DISTRICTS (ICMR)
2002 NATIONAL HEALTH POLICY GOAL ELIMINATE LF BY 2015
2003 MERGED WITH NVBDCP
2012-2017 12th FIVE YEAR PLAN( ROAD MAP FOR ELIMINATION OF
LF)

7. MICROBIOLOGY:
• In India, 99.4% of the cases are caused by the species - Wuchereria
bancrofti whereas Brugia malayi is responsible for 0.6% of the
problem.
• Species variants have been characterized on Microfilarial periodicity
and vector susceptibility.
• Persons having circulating Mf are healthy.. transmit disease.
Persons having chronic filarial are severely disease .. no longer transmit

8. SPECIES TRANSMITTED BY Mf FOUND IN
PERIPHERAL BLOOD
REGIONS
Nocturnally periodic W.
bancrofti
Culex quinquefasciatus
(dirty water)
Only during night widely
Diurnally sub-periodic W.
bancrofti
Ochlerotatus(Finlaya) niveus
( swampy saline water
bodies)
At any time, but high
count during day time
Small foci in Nicobar
Islands
Nocturnal periodic B.
malayi
Mansonia species
(floating hydrophytes in
freshwater bodies)
Only during night central coastal part of
Kerala, and small isolated
foci in six other States

9. LIFE CYCLE:

10. Newer concept in pathogenesis of filariais
• A newer concept in filariasis pathogenesis is the role of a filaria
endosymbiont Wolbachia sp.
• All filariae of medical significance except for Loa loa harbour this
endosymbiont
• Wolbachia sp. has been found to be essential for adult worm viability,
fertility and normal larval development

11. • PCR assays using 16s rDNA of Wolbachia sp. is being considered as a
diagnostic test for filariasis
• A new chemotherapeutic strategy targeting the endosymbionts with
tetracycline class of compounds is being envisaged for the treatment of
filariasis.

12. CLINICAL FEATURES:
Asymptomatic
Acute:
Adenolymphangitis :
Acute dermato-adeno-lymphangitis (ADLA)
Acute filarial lymphangitis (AFL)
Acute epididymo-orchitis and funiculitis:

13. Chronic:
Limbs: Lymphoedema of the extremities
Grade I lymphoedema: Mostly pitting oedema; spontaneously
reversible on elevation
Grade II lymphoedema: Mostly non-pitting oedema; not
spontaneously reversible on elevation
Grade III lymphoedema (elephantiasis): Gross increase in volume in a
grade II lymphoedema with dermatosclerosis and papillomatous lesions

14. Genito-urinary Involvement
• Hydrocele
• Chylocele
• Lymphoedema of the scrotum and penis
• Lymph scrotum
Chyluria
Occult filariasis and tropical filariasis eosinophilia

15. Diagnostic methods
 Demonstration of parasites:-
• Definitive diagnosis: Demonstration of the mf. in peripheral
blood.
• Peripheral Blood: 2-3drops of blood by finger prick between
8:30 PM – 12 PM
1) Direct wet mount: serpentine movement
2) Giemsa stained thick film smear
3) Counting chamber method
4) Concentration of blood or other body fluid: By knott’s method
or membrane filtration technique or quantitative buffy coat
method
5) DEC provocation test

16. Newer diagnostic methods
• Immunodiagnosis:
a) Antigen detection:
Immuno chromatographic test: Detected with monoclonal antibody AD12.1
Recently filarial streak test also available
ELISA: Uses monoclonal antibody against Og4C3 antigen which is a heat stable CFA
b) Antibody detection: Detection of anti-filarial immunoglobulin IgG4 antibody
3 recombinant antigens - Bm14, WbSXP and BmR1

17. • Molecular Diagnosis
• Ultrasonography
• Lymphoscintigraphy
• Xenomonitoring:
Dissection and examination of female vector mosquitoes for filarial
larvae

18. Target detected Field Assay Confirmatory Assay (Laboratory
based)
Microfilariae Blood film PCR
Filarial antigen ICT Og4C3 ELISA
Antifilarial antibody Brugia rapid test Bm14 ELISA

19. Global scenario:
• About 1400 million people in 73 countries are at risk of Lymphatic Filariasis (Asia,
Africa, the Western Pacific, Caribbean and South America).
• Over 120 million people are currently infected globally,
• 40 million disfigured
• 25 million genital disease
• 15 million lymphoedema.
• South East Asia Region of WHO has the highest disease burden with 9 out of 11
member countries in the region being endemic for the disease. Out of this, about
600 million are at risk in India.

20. • Currently 73 countries are considered endemic for filariasis.
• 6 of these (Cambodia, The Cook Islands, Maldives, Niue, Sri Lanka and
Vanuatu) were acknowledged as achieving elimination of LF as a public
health problem.
• 13 more countries under surveillance to demonstrate that elimination has
been achieved.
• Preventive chemotherapy is still required in 54 countries but has not been
delivered to all endemic areas as of the end of 2015.
• Enhanced strategies are now required in about 29 countries to achieve
elimination targets and stop treatment by 2020.

21. • Global strategy is based on two components-
Interruption of transmission through large-scale annual treatment of
all eligible people in an area or region where infection is present
increased morbidity management and disability prevention activities
to alleviate suffering due to disabilities

22. INDIAN SCENARIO:
• Government of India launched nationwide MDA in 2004 in endemic areas.
• In 2004, only 202 districts could be covered.
• Scaled up in 2007 all the 250 (now 255 due to bifurcation)
• Co-administration of DEC with Albendazole by National Task Force under
DGHS in 2006.
• coverage during MDA has improved from 73% in 2004 to 89% in 2015
• Overall reduction of microfilaria rate from 1.2% in 2004 to 0.3% in 2015.

23. Trend of Average Microfilaria rates (%)
Sl. No.
States/U
Ts
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
1
Andhra
Pradesh
0.71 0.62 0.50 0.36 0.40 0.51 0.39 0.23 0.19 0.17 0.22 0.07
2 Telangana 1.18 1.19 1.21 0.17 0.35 0.33 0.27 0.17 0.21 0.42 0.31 0.52
3 Assam ND 0.04 0.19 1.46 0.88 0.81 1.06 0.17 0.19 0.15 0.04 0.01
4 Bihar 1.50 2.15 1.38 0.68 ND 1.07 0.94 ND 1.03 ND 0.88 0.56
5
Chhattisga
rh
ND 1.96 ND 0.63 0.45 0.54 0.40 0.10 0.10 0.14 0.20 0.14
6 Goa 0.11 0.04 0.02 0.08 0.01 0.00 0.01 0.00 0.01 0 0 0
7 Gujarat 0.22 0.84 0.84 0.42 0.83 0.92 0.46 0.52 0.24 0.31 0.97 0.13
8 Jharkhand ND 0.84 1.40 1.34 1.10 1.11 0.82 0.63 0.61 ND 0.04 0.36
9 Karnataka 1.87 0.84 0.69 1.15 1.07 0.93 0.89 0.83 0.65 0.78 1.19 0.60
10 Kerala 0.68 0.50 0.67 0.65 0.29 0.39 0.17 0.14 0.21 0.15 0.11 0.10
11
Madhya
Pradesh
0.83 0.40 0.38 0.70 0.36 0.40 0.19 0.23 0.09 0.09 0.31 0.28
12
Maharasht
ra
1.13 1.45 1.13 0.83 0.35 0.46 0.53 0.51 0.43 0.46 0.53 0.23
13 Orissa 2.60 2.37 1.11 0.99 0.74 0.69 0.40 0.43 0.34 0.34 0.77 0.38
14
Tamil
Nadu
0.04 0.38 0.39 0.29 0.15 0.12 0.07 0.09 0.17 ND 0.11 0.11
15
Uttar
Pradesh
1.77 1.01 0.81 0.32 0.41 ND 0.28 0.24 0.38 0.18 0.17 0.07
16
West
Bengal
4.74 4.10 2.72 2.83 0.89 0.48 0.44 0.55 0.70 1.01 0.79 0.64
17
A&N
Islands
1.40 0.09 0.15 0.34 0.19 0.46 0.10 0.12 0.17 0.14 0.14
18
D & N
Haveli
1.96 2.01 2.91 3.47 1.82 1.23 0.95 1.79 0.71 0.54 0.54 0.42
19
Daman &
Diu
0.47 0.14 0.27 0.09 0.07 0.07 0.06 0.07 0.08 0.25 0.05 0.03
20
Lakshadwe
ep
1.19 0.09 0.07 0.02 0.27 0.00 0.00 ND ND ND ND 0
21
Pondicherr
y
0.42 0.50 0.15 0.06 0.03 0.00 0.00 0.00 MDA Stopped
National
Average
1.24 1.02 0.97 0.64 0.52 0.65 0.41 0.37 0.43 0.30 0.44 0.26

25. Morbidity Management
Sl No. States/UTs 2004 round 2005 round 2006 round 2007 round 2008 round 2009 round 2010 round 2011 round 2012 round 2013 round 2014 round 2015 round
1
Andhra
Pradesh
85.34 84.48 90.43 89.46 93.28 93.96 92.77 92.48 93.84 92.34 92.34 89.01
2 Telangana 83.73 84.03 88.19 88.51 89.49 87.97 91.99 93.23 92.36 93.70 90.02 90.41
3 Assam 25.42 42.94 67.33 78.32 82.16 ND 82.72 78.10 81.19 78.67 90.66
MDA
stopped
4 Bihar 81.64 77.82 79.77 77.23 ND 77.91 78.61 ND 86.38 ND 86.25 89.03
5 Chhattisgarh 84.17 82.80 ND 93.65 91.30 91.53 92.99 90.06 ND 89.18 87.61 90.54
6 Goa 97.92 95.33 97.17 97.83 96.44 95.37 94.63 96.21 MDA stopped
7 Gujarat 45.47 97.78 69.60 92.11 93.25 97.63 98.33 97.66 99.04 99.38 98.42 97.51
8 Jharkhand 42.25 74.16 72.75 79.03 84.62 85.99 63.64 86.53 84.36 ND 75.22 87.56
9 Karnataka 85.22 89.31 90.20 89.67 90.53 89.30 91.46 91.81 93.84 93.70 76.71 88.41
10 Kerala 86.10 90.15 ND 92.19 93.67 77.81 81.91 89.62 80.90 73.33 82.29 82.08
11
Madhya
Pradesh
73.74 79.29 88.01 88.48 90.14 87.59 90.74 89.27 87.88 87.89 91.45 91.13
12 Maharashtra 78.68 86.48 90.15 89.53 91.05 89.51 89.38 89.28 89.24 91.00 93.58 93.15
13 Orissa 90.11 90.29 88.93 88.47 89.67 89.66 90.63 90.55 ND 91.10 88.39 91.82
14 Tamil Nadu 95.18 ND ND 77.22 88.80 94.13 ND 93.58 94.76(4 dist.)
MDA
stopped
97.26
MDA
stopped
15
Uttar
Pradesh
66.40 73.72 77.57 81.44 82.47 ND 80.68 80.45 83.15 70.69 83.40 88.16
16 West Bengal 39.58 54.01 ND 78.66 77.89 86.93 ND 79.23 84.83 86.95 83.16 84.39
17 A & N Islands 85.85 88.31 93.17 98.73 94.10 91.40 77.12 90.15 90.06 88.93 95.94 96.08
18
D & Nagar
Haveli
91.13 98.26 94.93 94.16 96.67 95.84 96.20 98.51 96.88 95.83 96.15 92.81
19 Daman & Diu 94.96 73.23 87.17 93.27 91.85 91.56 92.04 90.89 MDA stopped
20
Lakshadwee
p
79.99 84.60 83.16 81.81 82.63 83.86 80.09 73.94 ND 94.22 ND
MDA
stopped
21 Pondicherry 94.76 96.63 ND 96.30 97.01 96.02 96.92 97.14 MDA stopped
Total 72.42 76.65 81.86 82.91 86.42 86.69 84.44 87.97 86.82 81.80 85.80 88.96

26. National Filaria Control Programme (NFCP)
• Pilot project in Orissa from 1949 to 1954.
• NFCP was launched in 1955
Objective:
• Delimiting the problem
• To undertake control measures in endemic areas and to train personnel to
man the programme
[mass DEC administration, antilarval measures in urban areas and indoor
residual spray in rural areas]

27. • In 1962, the strategy revised [side effect of DEC and
resistance to insecticides by the vectors]
• In 1978, the operational component was merged with
Urban Malaria Scheme.
• In 1997, India became a signatory to WHO for global
elimination of Lymphatic Filariasis and the target for
global elimination is by 2020.
• In 2003-04, it was merged with NVBDCP.

28. Population protected under NFCP and the setup
as on 01/03/2002

29. • Survey unit: initial survey in endemic districts- Prevalence, vector, type of
infection
• Control unit: anti larval measures, monitor breeding places
• Filaria clinic: population survey, treatment of cases and carriers
• Operational component under NVBDCP
• Research and training activity under NCDC
• 3 regional filaria training and research centre under NCDC( banaras,
Calicut, Rajahmundri)

30. Strategy
Recurrent antilarval measures at weekly intervals.
• Environmental methods[source reduction: filling ditches, pits, low
lying areas, deweeding, desilting, etc.]
• Biological control: larvivorous fish.
• Antiparasitic: ‘Detection' and ‘Treatment' of microfilaria carriers and
disease person with DEC.

31. Revised Strategy
• Annual Mass Drug Administration:
single dose of DEC [pilot project covering 41 million population in 1996-97 and
extended to 74 million population]
1.Interruption of transmission of filariasis: Annual MDA for 5 years or more to the
population except:
• Children below 2 years
• Pregnant women
• Seriously ill persons
(DEC + Albendazole in selected distt & DEC in other distt)

32. 2.Morbidity Management:
• Home based management of lymphedema cases and
• Upscaling of hydrocele operations in the identified CHCs / District
hospitals/ medical colleges.

33. Global Programme to Eliminate
Lymphatic Filariasis (GPELF)
GOAL: global elimination by 2020
1. MDA: To stop the spread of infection:
interrupting transmission through MDA
2. MMDP: To reduce human suffering caused by the
disease: managing morbidity and preventing
disability (MMDP)

34. Basis of the strategies for the elimination of lymphatic filariasis
• Man is the main reservoir of infection in India
• Better understanding of the disease dynamics
• Parasite exhibits genetic diversity
• Long latent period
• Drugs : DEC and albendazole
o safe and are already in clinical practice
o Single annual dose of anti-filarial drugs can suppress microfilaria levels for periods as
long as one year

35. • Diagnostics – antigenemia and antibody tests
• Over 85% coverage of the population for at least 5 years could effectively
interrupt transmission
• MDA is operationally feasible to carry out with the support of community
volunteers
• Side effects can easily be managed
• community participation.

36. ELF PROGRAMME:
• a. Goal: Elimination of Lymphatic Filariasis by 2015 as envisaged in
National Health Policy (2002)
• b. Target:
To cover all eligible population living in all (presently 255) Lymphatic
filariasis endemic districts during MDA.
To line list the cases of lymphoedema and hydrocele in all the
districts
Augment home based morbidity management
Hydrocele operations in identified district hospitals/CHCs.

37. • c. Objective:
Progressively reducing and ultimately interrupting the transmission
of Lymphatic Filariasis (LF).
Preventing and reducing disability amongst affected persons through
disability alleviation and morbidity management.

38. ELF STRATEGIES:
A. Mapping- the geographical distribution of disease
B. Mass drug administration (MDA)- for 5 years or more to reduce the
number of parasites in the blood to levels that will prevent
mosquito vectors from transmitting infection
C. Post-MDA surveillance- after MDA is discontinued
D. Verification of elimination of transmission

39. A. MAPPING:
• Historical records
• Rapid method by key informant interview
• Physical examination of the individuals by the health workers
• Microfilaraemia survey
• Detection of infective stage larvae in the vector
Line listing is the principal method to enlist all the diseased individuals in the
given community

40. Line listing:
Enquired from
• community heads
• key informers
• opinion leaders.
[other person in the family or in the neighbourhood]
• compiled at village/subcentre/PHC/District/State levels including
similar compilation in urban areas.

41. LINE LISTING OF FILARIA PATIENTS
STATE_______________DISTRICT______________PHC_______
SUBCENTRE__________NAME OF HEALTH WORKER_______________
SL.
NO
NAME AGE SEX NAME OF
HOF $
ADRESS
POPULATION DISEASE AFFECTED PART TIME OF
STARTIN
G
DISFIGUR
EMENT
PERIOD OF
STAY IN
DISTRICT
DATE
OF
SURV
EY
LEG HAND SCROTUM BRE
AST
OT
HER
S

42. FLASH CARD FOR LINE LISTING

43. 2.MDA ACTIVITIES:
• PRE MDA ACTIVITIES:
1. Projection of DEC and Albendazole Requirements:
• Indent = Current year requirements – previous year drugs in hand
• Indent for the current year through the state programme officer and communicated to the
Directorate of NVBDCP.
• This indent should also be accompanied with “Utilization Certificate” (UC) for the fund provided
by NVBDCP. The drugs must be received by the state at least three months before the scheduled
date of MDA.
DEC(100mg TAB) TOTAL POPL * 2.5
ALBENDAZOLE(400 mg TAB) TOTAL POPL * 1

44. • 2.INTERSECTORAL COORDINATION: STAC , STF
• 3. TRAINING OF PARAMEDICAL STAFFS
• 4. SELECTION AND TRAINING OF DRUG DISTRIBUTORS
• 5. IEC/BCC:
• 6.ENUMERATION OF HOUSEHOLDS:
• 7. MICROFILARIA SURVEY: 4 Sentinel + 4 Random sites
500 slides from each site= 4000 slides
1 month prior to MDA

45. State task force(STF):
• 1. Minister of Health & FW – Chairperson
• 2. Chief Secretary - Vice Chairperson
• 3. Addl. Chief Secretary - Member
• 4. Health Secretary – Member
• 5. NRHM State Mission Director - Member
• 6. Secretary (Finance) - Member
• 7. Secretary (Tribal) - Member
• 8. Secretary (ICDS) - Member
• 9. Secretary (Social Welfare) - Member
• 10. Secretary (Irrigation) - Member
• 11. Secretary (Rural Development/ Panchayat Raj) - Member
• 12. Secretary (Agriculture) - Member
• 13. Secretary (Local Health Govt.) - Member
• 14. Secretary (Industry) - Member
• 15. Secretary (Forest) - Member
• 16. Secretary (Information) - Member
• 17. Secretary (Education) - Member
• 18. Director General of Health Services (State)/ Director of Health Services -
Member
• 19. Regional Director (H&FW), Govt. of India – Member
• 20. State Programme Coordinator, NRHM – Member
• 21. State Programme Officer (Mal. & Fil. or VBD) - Member Secretary
State technical advisory committee(STAC)
• 1. Director General/Director of Health Services (State)
Chairperson
• 2. Director of Medical Education & Research – Member
• 3. Director of Indian System of Medicine – Member
• 4. Director, State Health Education Bureau – Member
• 5. Prof. & HoD Pharmacology - Member
• 6. Prof. & HoD Medicine - Member
• 7. Prof. & HoD PSM – Member
• 8. Prof. & HoD Paediatrics – Member
• 9. Prof. & HoD Microbiology – Member
• 10. Regional Director (H&FW), GoI - Member
• 11. President, Indian Medical Association, State Branch -
Member
• 12. Nodal State Programme Manager (NRHM) - Member
• 13. State Programme Officer (Mal & Fil or VBD) -
Member-Secretary

46. ACTIVITIES DURING MDA:
• Drug administration on fixed day: “supervised drug administration by
door to door visit supplemented with drug administration at booths
and groups” preferably on a single day.
• Two-day mopping up operations.
• Supervision of drug distribution
• Side effects management
DRUG DOSAGE SCHEDULE
AGE IN
YEARS
STREAMLINE DOSE
DEC(100mg
TAB)
ALBENDAZOLE(
400mg TAB)
<2 0 0
2-5 1 1
6-14 2 1
>= 15 3 1

47. • Transmission Assessment Survey (TAS)
For documenting that the prevalence of lymphatic filariasis among 6–7
year old children is below a predetermined threshold.
It provides the evidence base that MDA can be stopped and to assure
that programme has achieved elimination goal.

48. Eligibility criteria for TAS:
Sl.no component criteria
1 At least five rounds of MDA completed All intervention units (IU)
2 The epidemiological drug coverage
(programme coverage) at each round
At least or more than 65% in each round
3 Sentinel sites The prevalence of mf is <1% or that of Antigen is ,2%
at all sentinel sites
4 Spot-check sites The prevalence of mf is <1% or that of Antigen is ,2%
at all sentinel sites

49. C. POST MDA SURVILLANCE
• A successful Transmission Assessment Survey (TAS) in a particular
Evaluation Unit (EU) leads to the stoppage of MDA there.
• Even after MDA has stopped, the LF elimination programme will
continue for a further period of at least four years.

50. Surveillance:
• Periodic survey
• Ongoing surveillance:
1. Entomological data collection: 4 sentinel sites(3 rural+ 1 urban) + 4
random sites.
A minimum of three collections at an interval of 10 days shall be carried
out in each site once a year during October-November each year and
four indices are to be calculated as follows:

51. No. of female
C. quinquefasciatus collected
Ten Man-hour Vector density = --------------------------------------------- X 10
No. of man-hour spent for mosquito collection
No. of mosquitoes +ve
for any stage (L1/L2/L3 states) of the parasite
Infection rate (%) = ----------------------------------------------------------- X 100
No. of female vector mosquitoes dissected

52. No. of mosquito +ve for infective larvae (L3)
Infectivity rate (%) = -------------------------------------------------------- X 100
No. of female vector mosquitoes dissected
No. of infective larvae (L3) found
Mean mosquito infectivity = --------------------------------------------------
No. of infective mosquitoes

53. • 2. Mf survey in 5-9 years children: Time of collection of blood slides‟ (8.30 PM to
12.00 mid-night)
Mf survey will be done in the same 8 selected sites during October-
November each year. A minimum of 50 blood slides are to be collected from each
site.
cross-checking of all positive slides and 5% of negative slides from each site, have
to be maintained strictly.
• 3. Intensification of morbidity management:
• 4. Vector control : IVM
• 5 Screening of migratory population:

55. MMDP:
Goal:
• To alleviate suffering in people with ADLA, lymphedema, and
hydrocele
• To improve quality of life.
Aim:
• To provide access to the recommended basic care for every person
with these manifestations in areas endemic for lymphatic filariasis.

57. ISSUES AND CHALLENGES:
• Drug delivery and high treatment coverage to bring desired impact
• Social Mobilization will improve programme performance
• Phasing out of MDA after validation for which availability of ICT is limiting factor.
• MMDP should be fully integrated into the health system.
• Timely preparation and implementation of Micro-Plan
• Continued training and sensitization of State and District level officer
• Timely availability of DEC
• Timely available ICT
• Timely conducting MDA

58. ROAD MAP:
• Year 2015-16
Out of 255 districts, it is expected that by end of 2014-15, 88 districts would have
completed TAS.
Out of remaining 167 districts, 86 will observe MDA and 81 prepared for TAS.
Post MDA surveillance
Review meeting of performance in hard core districts conducted.
Districts already stopped MDA after conducting TAS------for second TAS.

59. Year 2016-17
• MDA will be observed only in few districts not passing TAS.
• TAS of 2016-17 will be completed by end of April-June 2017 in 100 districts
as minimum 6 months gap will be required after last MDA.
• More districts will go for second/third TAS
• Lymphoedema Management will continue at PHCs/CHCs
• Hydrocele operations at identified CHC/district hospital.
• Survey in Non endemic districts
• Post MDA surveillance will continue

60. “Hathipaon Mukt Bharat” ( Filaria Free India)
campaign: launched in 2012
• Global network in partnership with Sabin institute runs an initiative called END7
that aims to eliminate 7 most common neglected tropical diseases by 2020.
(BRAND AMBASSADOR OF NTD IS ABHISHEK BACHCHAN)
• It is the only international advocacy campaign dedicated to raising the awareness,
political will and funding towards end.
• It also enjoys support from WHO and Bill & Melinda gates Foundation.
www.globalnetwork.org

61. VACCINES
There is currently no vaccine available.
Potential vaccine Targets are:-
• Irradiated third stage larva(L3)
• Excretory secretory antigen
• Glutathione S transferase of the filarial worm
For B. malayi
• DNA vaccine containing genes encoding paramyosin, HSP, intermediate
filament and the serodiagnostic Ag BM14 are being explored
*Veerapathran A et al.Evaluation of Wuchereria bancrofti GST as a Vaccine
Candidate for Lymphatic Filariasis. 2009;PLoS Negl Trop Dis 3(6): e457.

62. MATHEMATICAL MODELS:
• Two mathematical simulation models have been developed for tracking
the dynamics of lymphatic filariasis (LF) transmission and control:-
• EPIFIL (population based, deterministic)
• LYMFASIM (individual based, stochastic)
• Both models have been used to predict the long-term impact of control
programmes (mass chemotherapy/vector control) and assess the
prospects of elimination

63. oEPIFIL assumes that transmission will cease to occur when the
microfilarial (mf)-prevalence drops below 0.5% following MDA
oLYMFASIM considers the likelihood of reaching zero prevalence within 40
years after the start of MDA
• When similar assumptions were used, the predictions by both models
were similar in terms of required coverage and duration of MDA.

64. • These models need to be improved upon to account for factors like :-
• Drug factors-
- mode of action of drugs (e.g. direct effects vs immune mediated effects)
- Possible emergence of drug resistance
- changes in efficacy after repeated treatment
• Parasite-related factors – quantification of its reproductive biology
• Different epidemiological settings

66. REFERENCES:
• www.who.int/lymphatic_filariasis/en/
• www.nvbdcp.gov.in_doc_guidelines
• http://www.who.int/neglected_diseases/en/
• www.globalnetwork.org
• Chan MS, Srividya A, Norman RA, Pani SP, Ramaiah KD, Vanamail P, et
al. EPIFIL: A dynamic model of infection and disease in lymphatic
filariasis. Am J Trop Med Hyg 1998;59:606-14
• Veerapathran A et al.Evaluation of Wuchereria bancrofti GST as a
Vaccine Candidate for Lymphatic Filariasis. 2009;PLoS Negl Trop Dis
3(6): e457.

67. • Norman RA, Chan MS, Srividya A, Pani SP, Ramaiah KD, Vanamail P, et
al. EPIFIL: The development of an age-structured model for describing
the transmission dynamics and control of lymphatic filariasis.
Epidemiol Infect 2000;124:529-41.
• Plaisier AP, Subramanian S, Das PK, Souza W, Lapa T, Furtado AF, et al.
The LYMFASIM simulation program for modeling lymphatic filariasis
and its control. Met Inf Med 1998;37:97-108
• Sabesan S, Vanamail P, Raju K, Jambulingam P. Lymphatic filariasis in
India: Epidemiology and control measures. J Postgrad Med
2010;56:232-8