ELIMINATION OF LYMPHATIC FILARIASIS

Elimination of Lymphatic Filariasis in India

In 1997, WHO and its Member States made a commitment to eliminate Lymphatic Filariasis (LF) as public health problem by 2020 through World Health Assembly Resolution WHA 50.29. The National Health Policy (2002) has set the goal of Elimination of Lymphatic Filariasis in India by 2015. Later extended to 2021. Subsequent to that Global Alliance to Eliminate Lymphatic Filariasis (GAELF) has been formed in 2000.

Twin pillar strategies of Mass Drug Administration (MDA) for interruption of transmission i.e. no new case and Morbidity Management and Disability Prevention (MMDP) for catering the disease afflicted patients were adopted for elimination.

Mass Drug Administration (MDA)

• MDA started as mass campaign from 2004.
• Initially with single dose of DEC only.
• In the year of 2007 with DEC + Albendazole co-administration
• Form 2018 Triple Drug Therapy (IDA) i.e. DEC + Albendazole + Ivermectin is launched initially in five selected districts. Since elimination target is approaching first all the left out districts which are yet to achieve elimination will be brought under IDA.

Twin Pillar Strategy for Elimination of Lymphatic Filariasis

• Annual Mass Drug Administration (MDA) of single dose of DEC (Diethylcarbamazine citrate) and Albendazole for 5 years or more to the eligible population (except pregnant women, children below 2 years of age and seriously ill persons) to interrupt transmission of the disease.

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

Progress and Achievement

• In pursuit of the goals, the Government of India launched nationwide MDA in 2004 in endemic areas as well as home based morbidity management, scaling up hydrocelectomies in hospitals and CHCs.
• During the year 2004, only 202 districts could be covered with coverage rate of 72.6%. The number of districts was upscaled and in 2007 all the 250 (now 256 due to bifurcation) known LF endemic districts were brought under MDA. 257 districts (1 district included in 2019) have been brought under MDA where about 650 million population are at risk of Lymphatic Filariasis in the country. Out of that about 500 million populations is eligible for MDA.
• Accelerated Plan which include Triple Drug Therapy (IDA) was launched in the Global Alliance Elimination of Lymphatic Filariasis (GAELF) meeting held during 13^th to 15^th June 2018 by Hon’ble Union Health Minister and Hon’ble Minister of State.
• Meeting for Dissemination of the Accelerated Plan for Elimination of Lymphatic Filariasis and Program Progress Review held at New Delhi.
• The population coverage during MDA has improved from 73% in 2004 to 87.33% in 2019 (Prov.)
• MDA has been observed in 151 districts, during 2019. The MoH&FW has approved the Triple Drug Therapy (IDA) implementation programme in selective five districts named Arwal (Bihar), Simdega (Jharkhand), Varanasi (Uttar Pradesh), Nagpur (Maharashtra) and Yadgir (Karnataka) which has successfully implemented in these districts. Eleven more districts of Uttar Pradesh have implemented IDA during December, 2019. One district Tapi in Gujarat has implementing IDA in Jan. 2020.
• Eleven more districts of Uttar Pradesh have implemented IDA during December, 2019. 2^nd round of IDA was observed in Arwal district in Bihar on 7^th 2019 and Tapi in Gujarat implemented IDA in Jan. 2020.
• Intensive social mobilization during MDA, have been carried out by various States/ UTs involving political/ opinion leaders, decision makers, local leaders and community.
• For high level advocay - United to Eliminate Lymphatic National Symposium Filariasis held on 30th October 2019 at Pravasi Bharatiya Kendra, New Delhi inaugurated by Hon’ble Union Health Minister.

Milestones of ELF

• In 1997, The World Health Assembly adopted resolution WHA 50.29, for Elimination of Lymphatic Filariasis as a global public health problem by 2020.
• In 2002, National Health Policy set a goal for ELF in India by 2015 (further extended to 2017). It implies that LF ceases to be a public health problem when microfilaria rate is <1% and the children born after initiation of MDA are free from circulating antigenemia.
• In 2004, Elimination of Lymphatic Filariasis (ELF) programme was launched covering 202 endemic districts in 20 States/UTs.
• Subsequently scaled up to cover all the 257 endemic districts in 21 States/UTs targeting a population of about 650 million.
• In 2013 validation started through Transmission Assessment Survey (TAS).
• The policy decision to implement global strategy of co-administration of DEC with Albendazole during MDA was approved by National Task Force on Elimination of Lymphatic Filariasis under the Chairmanship of DGHS in 2006.
• Accelerated Plan for Elimination of Lymphatic Filariasis 2018 launched in 10 Global Alliance Elimination of Lymphatic Filariasis (GAELF) on 13th June, 2018.
• Triple Drug Therapy (IDA) has been successfully implemented in 5 districts namely Arwal (Bihar) and Simdega (Jharkhand), Nagpur (Maharashtra), Varanasi (Uttar Pradesh), Yadgiri (Karnataka) on 20^th December 2018, 10^th January 2019, 20^th January, 2019, 20^th February, 2019 and 13^th November, 2019 respectively.
• GoI has revised the financial norms for Morbidity Management Kits from Rs. 150/- to Rs. 500/- per kit in last MSG meeting held in February 2019.
• Proposal for enhancement of budget under ELF programme approved by EPC for consideration of MSG.

List of Triple Drug Therapy (IDA) Districts:

Validation through Transmission Assessment Survey (TAS)Lf-Workshop-TAS

• After completion of 5 effective round of MDA followed mf survey in the IUs which achieve <1% mf validation by TAS to as certain the circulation antigenimia in the community. 
• In TAS school children of 1^st and 2^nd Standard by 30 cluster sample methodology are to measure circulating antigenimia. When the enrolment students are more than 75% for school survey enrollment.
• TAS started in the year of 2013 and the year wise TAS cleared districts given below in the Table:
  

Morbidity Management and Disability Alleviation

• Morbidity Management is another pillar of strategy for ELF and states/UTs were advised on up-scaling home based morbidity management of Lymphoedema cases and Hydrocele operations. The process involved updating the line-listing of Lymphoedema & Hydrocele cases in the districts. Demonstration and training on simple foot hygiene to affected persons and motivate them for self practice.
  
  
• Since 2004, the states/UTs have reported 148877 (2018)  hydrocele operations. Different states have initiated management of Lymphodema cases through demonstrating home based foot hygiene method to patients at local levels.

Guidelines Available (for More Click here)

• Accelerated Plan for Elimination of Lymphatic Filariasis 2018
• National Guidelines for Transmission Assessment Survey for Elimination of Lymphatic Filariasis India- 2013-14 - Draft
• National Roadmap for Elimination of Lymphatic Filariasis (ELF)
• Guidelines for Drug Distributors in Elimination of Lymphatic Filariasis