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 Post subject: Filariasis-an eradicable disease with your cooperation
 Post Posted: Thu Jul 21, 2005 1:26 pm 
Filariasis-an eradicable disease with your cooperation

Professor Mirani Weerasooriya Filariasis Research Unit, University of Ruhuna

Filariasis is an eradicable disease!

An important message for all of you living in the Western, Southern and North western Provinces!

The Mass Drug Administration this year in the National Programme for the Elimination of Lymphatic Filariasis is scheduled to be conducted by the Ministry of Health on July 24, 2005.

Filariasis or popularly known as Barava is one of the four mosquito borne diseases seen in Sri Lanka. This chronic disease causes severe disfiguration in man. Unlike the other three mosquito borne diseases viz malaria, dengue and Japanese encephalitis it does not cause death in man. It was known as a neglected disease of the poor and till recently less attention was paid by the authorities to this disease.

Due to the severe disfigurement and genital lesions patients were stigmatised from the society and some remained unmarried and some others were unwilling to find partners from the diseased families.

The Southern, Western and North western provinces have been identified as the endemic provinces where filariasis is endemic in Sri Lanka. If we fail to eradicate the disease there is a possibility of it spreading to other provinces.

Filariasis is caused by a parasitic worm called Wuchereria bancrofti the adult of which lives in the lymphatic system of the human body and is carried from one person to another by mosquitoes.

In Sri Lanka only one mosquito species called Culex quinquefasciatus is the vector. These are grayish brown mosquitoes abundant in and around of our houses and biting viciously in the night. Infact it is known as the common house mosquito.

The adult worms can be inside someone's body without his knowing or feeling it. Majority of the people about 95% after contracting the disease will remain symptom less. Most adult worms live up to five to six years but some worms may live even longer. It takes about a year before the adult worms start producing tiny larvae and several years later they cause effects like hydrocele and elephantiasis. These tiny larvae are released into the blood stream. In filarial patients in Sri Lanka this occurs at night.

The damage to the body builds up slowly and when the swelling of the legs, arms and genitals gets bigger it will lead to inability to work, social isolation and shame. Elephantiasis or "Ali kakul" occurs when the limbs are repeatedly invaded by the bacterial and fungal infections.

The disease is transmitted by the people who are having these tiny larvae in their blood. The patients having elephantiasis or hydroceles will not transmit the disease and attempts to isolate them from the society is meaningless. The tiny larvae will reach the peripheral circulation during the night and in Sri Lanka the peak arrival occurs during midnight between l0 pm to 2 am.

The diagnosis of the disease has to be performed by examining blood taken at night due to this reason. It is practically difficult to conduct mass blood surveys at this hour of the night and further it will not be possible to identify all the infected populations. Although there are very sensitive and specific diagnostic techniques available at present we are not in a position to use them in mass surveys due to the high cost.

Considering all the above facts and also due to the advances in the diagnosis and treatment the World Health Organization has initiated a Global Programme for the Elimination of Filariasis.

Oval albendazole tablets

The goal of this programme is to eradicate filariasis by year 2020 by two strategies. First by treating the whole endemic population with a single dose of combination of two drugs. Second is by controlling morbidity, that is by managing and taking care of those who already have the disease.

In the Mass Drug administration (MDA)we use two kinds of drugs and both these drugs are well known and safe drugs. Once given as a combination their effect of killing the filarial worms has been well demonstrated.

The first drug diethylcarbamazine or popularly known as DEC has been in use for more than sixty years. It is also a very safe drug which does not react with most of the other drugs. The second drug albendazole is a well known drug given for intestinal worms. When administered with DEC for filariasis people will benefit from this bonus effect on these worms.

In this treatment programme an adult will receive 300mg of DEC (three round large 100mg tablets or six round small 50mg tablets) and 400mg of albendazole (one oval tablet). The children below twelve years will receive DEC 150mg and 400mg of albendazole.

In Sri Lanka this programme was implemented in the three endemic provinces covering eight districts. They are Colombo, Gampaha and Kalutara in the Western province, Galle, Matara and Hambantota in the Southern province and Kurunegala and Puttalam in the North Western province.

The first round of Mass Drug Administration covering all three provinces was conducted in July 2002. The second round was done on July 27, 2003 and the third on 8th August 2004. This year the fourth round will be conducted on Sunday the July 24.

The entire requirement of albendazole for the programme has been donated by the producers Glaxo SmithKline to all the endemic countries through the World Health Organization. The cost of the 400mg albendazole tablet is around Rs 80. The DEC is manufactured locally by the Sri Lankan Government.

Accordingly an individual will receive drugs worth of more than Rs 100. This donation will be given for five rounds of distribution and at present we are left with two more rounds. To achieve success of this programme a country should have more than 80% coverage of drugs.

If all of us do not make every effort to make this event successful we will loose a golden opportunity given to us to eradicate a chronic disease from Sri Lanka. Most of us do not realize the value of this opportunity offered free to us. These drugs should not be given to children below two years, pregnant mothers, mothers breast feeding children less than two years and severely debilitated patients. All the others are expected to consume these drugs.

There is no harm caused by patients having diabetes, asthma, common cold, chest infections, epilepsy and heart disease taking these harmless drugs. As mentioned earlier there are no interactions with most of the other drugs.

The occurrence of adverse reactions due to DEC are also minimal. In the last MDA programme I found that only a negligible 3% had mild adverse effects. These mild side effects were limited to mild headaches, nausea, dizziness or mild attacks of fever.

All these disappeared even without any medication. There were many myths circulating among the public like causing sub fertility to males or of many dangerous side effects.

If one had developed any of these mild side effects on earlier occasions our advice is to take the drugs after dinner. It is always advisable to take the drugs after a meal.

After the "Filariasis Day" on the 24th these drugs will be available from identified centres. These may be the Family Health Worker or the Midwife's office, office of Medical Officer of Health (MOH), a religious institution, a school or Grama Niladhari' s office in your respective areas. These will be announced.

On the July 24, this year the distributing personnel will visit your homes. Most of them are experienced individuals trained by the MOHs but they will not be able to spend much time on each individual. They will not be able to explain all these details to householders as they have to cover a certain number of houses within a day.

The purpose of this brief article is to educate all of you readers prior to this drug delivery programme. We believe that all the readers are now confident about this programme and the drugs distribution. If all of us cooperate and comply with this effort we might be able to bring down the transmission to very low levels.

As mentioned earlier, this programme will be implemented by the Ministry of Health. My research team from the Filariasis Research Unit of Faculty of Medicine, University of Ruhuna did the independent evaluation of the past MDA programmes. In 2003 in all eight districts we found that nearly79% received these drugs mainly through the volunteers. A 9% did not swallow the drugs.

The distribution in Hambantota, Kalutara and Kurunegala districts were very successful. Well known endemic Colombo, Galle and Matara districts were far below the expected 80%. The distribution and consumption in urban areas were poor compared to rural areas.

In 2004 we evaluated the three Municipalities in Colombo, Galle and Matara.

In Galle a record 86% and 78% in Matara had received the drugs and most of them had consumed them in the night after meals. The worst distribution was in Colombo Municipality with only 55 % receiving the drugs and 49% consuming them. Another purpose of this article is mainly to gain attention of the affluent Colombo population for their cooperation for this programme and to rid them of any unnecessary fears about these freely distributed drugs.

I appeal to all of you to expect the volunteers’ arrival on July 24, and to convey this message to all people known to you. A special request for you is to kindly inform your servants, watchers and security staff to watch out for drugdeliverers and to have the dogs tied in your homes that day. I earnestly request your kind cooperation for this all important service we are about to perform.

Finally your cooperation in the compliance with these drugs and carrying this very important message will greatly help us to eradicate this chronic disease from our country.

In summary

On July 24, "Filariasis Day" please remain at your homes waiting for the arrival of volunteer distributing personnel.

Please consume the drugs without fail.

If you do not receive the drugs on that day, visit a distribution centre and obtain your drugs within the next two weeks.

Even if you did not receive drugs on previous occasions please take the drugs this time.

Convey this message to everybody.

Finally I wish you all a life free from the dreaded filariasis.

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