India to scale-up triple-drug therapy to eliminate elephantiasis

The use of triple-drug therapy for elephantiasis will be scaled up in a phased manner from next month to accelerate elimination of the tropical disease, the government said on Wednesday. The parasitic infection, known as lymphatic filariasis, is spread by mosquitoes and contracted in childhood, often before the age of five.

Health partners and stakeholders need to actively work on cross-sector collaboration to tackle the disease, Union Health Minister Harsh Vardhan said as he signed the ‘Call to Action to Eliminate Lymphatic Filariasis by 2021’ on Wednesday.

National Vector Borne Disease Control Programme (NVBDCP) Director Neeraj Dhingra said, the three-drug regimen will be scaled up in 16 districts in five “high burden” states of Uttar Pradesh, Bihar, Gujarat, Karnataka and Maharashtra.

This is being done to speed up elimination of the disease, he said. The treatment involves a combination of three drugs ivermectin, diethylcarbamazine citrate and albendazole.

Ten states and Union territories, including the high-burden states, will implement on a large scale the mass drug administration campaign starting in November. The campaign aims to benefit around 106 million people, Dhingra said.

In lymphatic filariasis, the parasites are thread-like worms called filariae that damage the lymphatic system and the associated tissues.

The minister also called for proper planning, commitment and societal involvement to achieve the goal of eliminating elephantiasis in the next two years.

“I would like to draw your attention to the neglected tropical diseases (NTDs), which are a group of debilitating infectious diseases that impact over 1.5 billion people globally and hold back the poorest communities from reaching their full potential.

“India is committed to eliminate two of these NTDs – lymphatic filariasis (hathipaon) and visceral leishmaniases (kala-azar) that put the future of our children at high risk,” Vardhan said.

He also inaugurated a day-long national symposium on the theme ‘United to Eliminate Lymphatic Filariasis’.

“While we have taken significant steps to ensure more people are not affected by these NTDs, what we need now is a common vision driven towards achieving the elimination of the disease.

“This, however, will only be possible if we foster greater collaboration and commitment by all stakeholders, including global public health experts, national and state representatives, partners and donors,” Vardhan said.

Union Health secretary Preeti Sudan and other delegates also signed the ‘Call to Action to Eliminate Lymphatic Filariasis by 2021’.

Elephantiatis is usually contracted in childhood, often before the age of five.

The global programme to eliminate lymphatic filariasis by the WHO was launched in 2000 and it had a twin pillar strategy — prevention through mass drug administration using combination of two anti-filarial drugs (DEC and albendazole) and providing morbidity management and disability prevention services, a health ministry official said.

India, with a 650 million population at risk, has made steady progress under the national programme by reducing the infection levels in the community below the threshold level in 96 districts, which accounts for nearly 37 per cent of the total districts,.

The challenge however, persists in the remaining 160 districts that continue to sustain active transmission, the official said.

Despite attaining high reported coverage in these districts with multiple annual rounds of mass drug administration over the years, actual consumption of medicines remains low due to low awareness about the benefits of medicines at the community-level leading to non-adherence to treatment, the official said.

The accelerated plan for elimination of lymphatic filariasis was launched in 2018 and by February, the WHO’s alternative three drug treatment was rolled out across four districts – Arwal in Bihar, Simdega in Jharkhand, Nagpur in Maharashtra and Varanasi in Uttar Pradesh.

The official said 8.07 million people out of 10.7 million vulnerable people were benefitted with the medicines.