Lymphatic filariasis power point presentation

Management and treatment

1. Lymphatic Filariasis Presenter: Dr. Soppimath Anusha Moderator: Dr. Blessy Babu 1

2. ⁠Evolution of lymphatic filariasis control programme in India 2

3. Evolution Filaria control in India : First pilot project – Odisha - 1949 – 1954 Three strategies used: i . Five day mass Diethylcarbamazine (DEC) therapy ii. Indoor residual spray in rural areas iii. Anti-larval measures in urban areas 3

4. Govt of India launched - 1955 – National Filaria Control Programme under National Institute of Communicable Diseases Objectives : i . To delimit the problem ii. To undertake large scale pilot iii. To train the professional and ancillary personnel required for the programme Strategies : Mass therapy at a dose of 4 mg/kg body weight for five consecutive days Three rounds of indoor residual spray in rural areas Weekly anti-larval measures in urban areas 4

5. Reviews and assessment: 1961 Recurrent anti-larva measures New control units Adequate waste disposal 1971 Detection and treatment Newer areas to be given priority 1982 100% centre sponsored Integration with Primary Health Centres Post of District Filaria Officer Filaria unit – minimum of 20,000 people Research unit under NCID 1995 Eradication of burgia malayi infection Integrated vector control Antigen and DNA based detection of microfilaria Delimitation surveys 5

6. Pilot project for Mass Drug Administration GOI – 13 districts – 1996 Andhra Pradesh , Kerala, Tamil Nadu, West Bengal, Uttar Pradesh, Odisha and Bihar Single dose - Diethylcarbamazine (DEC) was administered – National Filaria Day 2002 – 31 districts - DEC and Albendazole implemented in some districts 2004 : National campaign of Mass Drug Administration (MDA) with DEC - launched in 202 districts. 2006 : Recommended DEC+Albendazole in country. 2007: MDA programme was further scaled up to cover all 256 districts 2013: Validation started through Transmission Assessment Survey (TAS) 2016: Integration with NDD campaign (Feb & Aug) 6

7. Accelerated plan to eliminate LF Goal : Elimination of lymphatic filariasis (LF) as a public health problem by 2020 Actions: 1. Enhance advocacy 2. Implement confirmatory mapping in uncertain areas Mini TAS – 9-13 years school children – Antigen prevalence 3. Communication and social mobilization Sanitation practices, hygiene, capacity building for drug administrators Communication at all levels 7

8. 4. Enhanced MDA in all districts 2004 – 2017 – 256 endemic districts covered At least 5 rounds (DEC + ALB) over 5 years Minimum coverage 65% If after 6 rounds – high prevalence – operational problems NVBDCP monitors and supervises MDA implementation PHCs manage ADRs - Contact person – Directly observed treatment strategy 8

9. 5. Innovative preventive chemotherapy strategies and supplementary measures BCC/IEC Triple drug therapy - Ivermectin + DEC + ALB DEC medicated salt Collaboration with National Deworming Programme 6.Strengthen monitoring and surveillance Transmission Assessment Surveys – 6-7 year olds Assessment of Microfilaria prevalence – since 2017 – Filaria Test Strips – Ag testing Conducted by Evaluation units - <20lakh population If TAS1 – then TAS 2 and TAS 3 9

10. 7. Identify people with chronic disease Line listing Morbidity management and disability prevention 8. Quality care Minimum package care - acute episodes, management of lymphedema, Prevention of acute attacks and providing surgery for hydrocele District health Administration 9. Quality data management 10

11. Five Pronged Strategy 11

12. Mass Drug Administration Approach – House to house , Booth, Group Pre-MDA – training, IEC/BCC activities, microfilaria survey During MDA – drug administration on fixed day, mopping –up operation, management of side effects of drugs, supervision Dosage : single dose of DEC - 6mg per kg single dose of albendazole - 400 mg irrespective age and weight Post MDA- Review, report 12

13. Morbidity management and disability prevention Lymphoedema management – washing, prevention and cure of entry lesions, elevation of foot, exercise, proper footwear, management of acute attacks Surgical management of hydrocele due to LF – PHCs – diagnose cases needing surgical intervention – CHCs – hydrocelectomy 13

14. 2004 : National campaign of Mass Drug Administration (MDA) with DEC - launched in 202 districts. 2006 : NTF recommended DEC+Albendazole in country. 2007 : MDA programme was further scaled up to cover all 256 districts WHO increased donation of Albendazole Medical colleges and ICMR/NCDC involved to assess Financial allocation increased to Rs. 50-60 cr per annum IEC/BCC intensified under overall NHM 2013 : Validation started through Transmission Assessment Survey (TAS) 2016 : Integration with NDD campaign (Feb & Aug) 2018 : 10 th  GALEF meeting held & launched Accelerated Plan of Elimination of Lymphatic Filariasis (APELF) 2018 : Triple Drug Therapy (IDA) i.e. DEC + Albendazole + Ivermectin in scheduled districts in phase wise manner. 2019 : Revision of financial norms for morbidity management of Lymphoedema Patient from Rs. 150 to Rs. 500 2020 -  Expansion of IDA (Domestic procurement of Ivermectin) 2021 –  Introduction of Block Level Strategy 2022 -  LF Symposium held on 13th January 2023 with launch of Strategic Action Plan and Mega launch of bi-annual MDA 14