FILARIASIS CONTROL PROGRAMME-INDIA

FILARIASIS CONTROL PROGRAMME-INDIA

1. LYMPHATIC FILARIASIS  DR. MAHESWARI JAIKUMAR

2. NATIONAL FILARIA CONTROL PROGRAMME (NFCP) IN INDIA

3. Filariasis is caused by several round, coiled and thread-like parasitic worms belonging to the family filariea.These parasites after getting deposited on skin penetrate on their own or through the opening created by mosquito bites to reach the lymphatic system.

4. The disease is caused by the nematode worm, either  Wuchereria bancrofti  or  Brugia malayi   Is transmitted by ubiquitous mosquitospecies Culex   quinquefasciatus  &  Mansonia   annulifera / M.uniformis   respectively .

5. BRUGIAN FILARIASIS: Lymphadenitis (swollen and painful lymphnode ) occurs episodically, most commonly affecting one inguinal lymph node at a time. The infection lasts for several days and usually heals spontaneously. The frequency of episodes may vary from 1-2 attacks per year to several attacks per month.

6. Sometimes lymphadenitis is followed by a characteristic retrograde lymphangitis . The infection may spread to the surrounding tissues, and occasionally involves the whole thigh or entire limb. The infected lymph node may become an abscess, ulcerate, and heal with  fibrotic scarring.

7. The acute clinical course with its complications may last from several weeks to 3 months. Characteristically, elephantiasis involves the leg below the knee but occasionally it affects the arm below the elbow. Genital lesions or chyluria (milky colour urine) do not occur in brugian filariasis . 

8. BANCROFTIAN FILARIASIS: The lymphatic vessels of the male genitalia are most commonly affected in bancroftian filariasis , producing episodic funiculitis (inflammation of the spermatic cord), epididymitis and orchitis . Adenolymphangitis of the extremities is less common.  Hydrocele is the most common sign of chronic bancroftian filariasis , followed by lymphoedema , elephantiasis and chyluria .

9. LYMPHATIC FILARIASIS (LF)

10. commonly known as elephantiasis is a disfiguring and disabling disease, usually acquired in childhood. In the early stages, there are either no symptoms or non-specific symptoms.  Although there are no outward symptoms, the lymphatic system is damaged. This stage can last for several years. Infected persons sustain the transmission of the disease.

11. Due to damaged lymphatic system, patients with lymphoedema have frequent attacks of infection causing high fever and severe pain. Patients may be bed-ridden for several days and normal routine activities become difficult.  Such attacks not only cause acute physical suffering but also directly impede the earning capacity of the individual .

12. FILARIA VECTORS

13. C.quinquefasciatus  is the vector of  W.bancrofti  in the mainland.  C.quinquefasciatus  breeds in association with human habitations and is the domestic pest mosquitoes, preferring polluted waters, such as sewage and sullage water collections including cess pools, cess pits, drains and septic tanks.

14. The eggs are laid in rafts containing 150-40 eggs each depending on quality and quantity of blood meal taken. At the optimum temperature of 250 C to 300 C, the eggs hatch within 24 to 48 hours.

15. TRANSMISSION OF LYMPHATIC FILARIASIS The adult produces millions of very small immature larvae known as microfilariae , which circulate in the peripheral blood with marked nocturnal periodicity. The worms usually live and produce microfilariae for 5-8 years.

16. ADULT FILARIAL WORMS (MACROFILARIAE) INHABITING LYMPHATIC SYSTEM OF MAN

17. Lymphatic filariasis is transmitted through mosquito bites.  The persons having circulating microfilariae are outwardly healthy but transmit the infection to others through mosquitoes. The persons with chronic filarial swellings suffer severely from the disease but no longer transmit the infection.

18. LIFE CYCLE OF FILARIA PARASITE

19. MAGNITUDE OF DISEASE Cases of filariasis have been recorded from Andhra Pradesh, Assam, Bihar, Chhattisgarh, Goa, Jharkhand, Karnataka, Gujarat, Kerala, Madhya Pradesh, Maharashtra, Orissa, Tamil Nadu, Uttar Pradesh, West Bengal, Pondicherry, Andaman & Nicobar Islands, Daman & Diu, Dadra & Nagar Haveli and Lakshadweep.

20. FILARIA ENDEMIC DISTRICTS  

21. NATIONAL FILARIA CONTROL PROGRAMME (NFCP)

22. After pilot project in Orissa from 1949 to 1954, the National Filaria Control Programme (NFCP) was launched in the country in 1955 with the objective of delimiting the problem, to undertake control measures in endemic areas and to train personnel to man the programme.

23. The main control measures were mass DEC administration, antilarval measures in urban areas and indoor residual spray in rural areas. The NFCP set-up and population protected are given in the table below:

24. STRATEGY Recurrent anti-larval measures at weekly intervals. Environmental methods including source reduction by filling ditches, pits, low lying areas, deweeding , desilting , etc.

25. Biological control of mosquito breeding through larvivorous fish. Anti-parasitic measures through 'detection' and 'treatment' of microfilaria carriers and disease person with DEC by Filaria Clinics in towns covered under the programme.

26. REVISED STRATEGY   Annual Mass Drug Administration with single dose of DEC was taken up as a pilot project covering 41 million population in 1996-97 and extended to 74 million population.

27. This strategy was to be continued for 5 years or more to the population excluding children below two years, pregnant women and seriously ill persons in affected areas to interrupt transmission of disease.

28. MORBIDITY MANAGEMENT  

29. Home based management of lymphoedema cases and  - up-scaling of hydrocele operations in the identified CHCs / District hospitals/ medical colleges.

30. NATIONAL GOAL The National Health Policy 2002 aims at Elimination of Lymphatic Filariasis by 2015.

31. STRATEGY FOR ELIMINCATION OF LYMPHATIC FILARIASIS The strategy for achieving the goal of elimination is by Annual Mass Drug Administration of Anti Filarial Drugs ( DEC+Albendazole ) for 5 years or more to the population excluding children below two years, pregnant women and seriously ill persons in affected areas to interrupt transmission of disease.

32. Home based management of cases who already have the disease and hydrocelectomy operations in identified CHCs and hospitals.

33. MDA - 2004 Mass Drug Administration of single dose of DEC was launched as National Filaria Day (NFD) on 5th June 2004 by Dr. A. Ramadoss , Hon'ble Union Minister for Health & Family Welfare in Thane district in Maharashtra . Smt. P. Lakshmi , Hon'ble Union Minister of State for Health & Family Welfare initiated the MDA in Raibareilly district in Uttar Pradesh.