Bancroftian filariasis: The lymphatic vessels of the male genitalia are most commonly affected in bancroftianfilariasis. by the famous Indian physician.INTRODUCTION Filariasis has been a major public health problem in India next only to malaria. epididymitis and orchitis. In 1709. Madhavakara described signs and symptoms of the disease in his treatise „MadhavaNidhana‟ which hold good even today. Genital lesions or chyluria (milky colour urine) do not occur in brugianfilariasis. Lymphatic filariasis is estimated to be one of the leading causes of disability worldwide. elephantiasis and chyluria. Susruta in his book „SusrutaSamhita‟. elephantiasis involves the leg below the knee but occasionally it affects the arm below the elbow. Due to damaged lymphatic system. the whole arm. The infection lasts for several days and usually heals spontaneously. The disease manifests often in bizarre swelling of legs. either Wuchereriabancrofti or Brugiamalayi and transmitted by ubiquitous mosquito species Culex quinquefasciatus andMansonia annulifera/M. Patients may be bed-ridden for several days and normal routine activities become difficult. The disease was recorded in India as early as 6th century B. the scrotum.C. most commonly affecting one inguinal lymph node at a time. The swelling involves the whole leg. and hydrocele and is the cause of a great deal of social stigma. Hydrocele is the most common sign of chronic bancroftianfilariasis. These parasites after getting deposited on skin penetrate on their own or through the opening created by mosquito bites to reach the lymphatic system.uniformis respectively. Characteristically. producing episodicfuniculitis (inflammation of the spermatic cord). .D. patients with lymphoedema have frequent attacks of infection causing high fever and severe pain. In 7thcentury A. coiled and thread-like parasitic worms belonging to the family filaridea. FILARIASIS Filariasis is caused by several round. The disease is caused by the nematode worm. Brugian filariasis: Lymphadenitis (swollen and painful lymphnode) occurs episodically. The discovery of microfilariae (MF) in the peripheral blood was made first by Lewis in 1872 in Calcutta (Kolkata). Such attacks not only cause acute physical suffering but also directly impede the earning capacity of the individual. Clarke called elephantoid legs in Cochin as ‘Malabar legs’.. followed by lymphoedema. the vulva or the breast. Elimination of the disease is an important tool for poverty alleviation and economic development.

The adult parasites are usually found in the lymphatic system of man. disused wells. the life cycle of the parasite is relatively long. which circulate in the peripheral blood with marked nocturnal periodicity. Common breeding sites are wet pit latrines. TRANSMISSION OF LYMPHATIC FILARIASIS The adult produces millions of very small immature larvae known as microfilariae. The infective larvae transmitted by mosquito do not .e. which find their way into blood circulation. Lymphatic filariasis is transmitted through mosquito bites.000 microfilariae per day. septic tanks. 99. Culex breeds in polluted water. barrow pits. The parasite cycle in the mosquito begins when the microfilariae are picked up by the vector mosquitoes during their feeding on the infected person (microfilaria carrier). the infective larvae are deposited at the site of mosquito bite from where the infective larvae get into lymphatic system. etc.6% of the problem. The worms usually live and produce microfilariae for 5-8 years. In contrast to malaria parasite. LIFE CYCLE OF FILARIA PARASITE Man is the definitive host i. paddy fields. When the infective mosquito feeds on other human host. In filariasis. the infective larvae develop into adult male and female worms.4% of the cases are caused by the species Wuchereriabancrofti whereas Brugiamalayi is responsible for 0. In the human host. In India. drains. The microfilaria in mosquito develops into three stages and under optimum conditions of temperature and humidity. The life span of microfilaria is not exactly known which preferably may survive up to a couple of months. the duration of the cycle in the mosquito (extrinsic incubation period) is about 10-14 days. The persons having circulating microfilariae are outwardly healthy but transmit the infection to others through mosquitoes. it does not multiply in the mosquito vector. They give birth to as many as 50. cess pools.FILARIA VECTORS Culex quinque fasciatus transmits filariasis in India. The adult worms survive for about 5-8 years or sometimes as long as 15 years or more. where the mature adult male and female parasites mate and produce microfilariae whereas the mosquito is the intermediate host.

Nagaland. Punjab. Delhi and Uttaranchal and North-Eastern States namely Sikkim. Assam and West Bengal. Cases of filariasis have been recorded from Andhra Pradesh. comprising the districts of Trichur. Assam. Orissa.multiply in the human host. Himachal Pradesh. stretching over an area of 1800 sq km. Quilon and Trivandrum. BURDEN OF DISEASE : Lymphatic filaria is prevalent in 18 states and union territories. Dadra & Nagar Haveli and Lakshadweep. B. Kerala. The single largest tract of this infection lies along the west coast of Kerala. Karnataka. Tamil Nadu. Daman & Diu. Prolonged exposure is required to develop patent infection in man. Madhya Pradesh. Tamil Nadu. Goa. Pondicherry.UP. Andaman & Nicobar Islands. Orissa. The infection in the other six states is confined to a few villages. Haryana. Bancroftianfilariasis is widely distributed while brugianfilariasis caused by Brugiamalayi is restricted to 6 states . Uttar Pradesh. MAGNITUDE OF DISEASE Indigenous cases have been reported from about 250 districts in 20 states/Union Territories. There are about 454 million people (75. The disease is endemic in 250 districts in 20 states and UT‟s. Jharkhand. Gujarat. The North-Western States/UTs namely Jammu & Kashmir. West Bengal. Mizoram. The WHO has estimated that 600 million people are at risk of infection in South east Asia and 60 million are actually infected in the region (WHO). Therefore. malayi is prevalent in the states of Kerala. Manipur and Tripura are known to be free from indigenously acquired filarial infection. The incubation interval is one year or more. Madhya Pradesh. Kerala.6%) at the risk of infection with 48 million (80%) infected with parasite are contributed only by India. Tamil Nadu. Bihar. Bihar. Chhattisgarh. the parasite never causes epidemics. Surveys undertaken recently in Kerala and a few villages in other states revealed either a reduction of foci or complete elimination of the parasite as well as the vector(s) in many villages which were known to be endemic for B. Orissa. Ernakulum. Arunachal Pradesh. Rajasthan. Andhra Pradesh. Andhra Pradesh. malayi infection four decades back .According to recent estimates about 600 million people are exposed to the risk of infection. Maharashtra. Alleppey. Meghalaya. Chandigarh. and Gujarat.

Whenever the disease was found the survey and control units were established.2 billion man-days are lost due to filariasis every year leading to an economic loss of Rs. The emphasis was shifted to reduce the problem of filariasis and stop the transmission through intensive antilarval and anti-parasitic measures.ECONOMIC LOSS : About 1.It was found that the insect vector culexfatigens has become resistant to all the available insecticides. Detect and treat positive cases of filariasis. namely    mass drug administration with diethylcarbamazine (DEC) recurrent antilarval measures Residual insecticidal spray as anti-adult measure. The pilot study revealed that each of the above methods had its own drawback but a project using all the three methods concurrently was appropriate for the control of filariasis.An assessment committee was appointed in 1961 to note the progress made against malaria. After pilot project in Orissa from 1949 to 1954. to undertake control measures in endemic areas and to train personnel to manage the programme. Adoption of antilarval and anti-mosquito measures. Pilot project in Orissa: The first pilot project for the control of bancroftianfilariasis was undertaken in a group of villages in Orissa from 1949 to 1954 through the conventional methods. Recommendationsof assessment committee. Under the NFCP the following avtivities are being undertaken     Delimitation of the programme in unsurveyed areas. . 3500 crore. NATIONAL FILARIA CONTROL PROGRAMME National filarial control programme was started in 1955. This has an implication for the nurses working in the community to educate the people on promotion of good environmental hygiene. Install underground drainage system to prevent mosquito breeding. the National Filaria Control Programme (NFCP) was launched in the country in 1955 with the objective of delimiting the problem. (a)proper environmental sanitation (b)antilarval measures by the application of oil.

In June1978 . FILARIA CONTROL STRATERGY      Vector control through anti larval operations Source reduction Detection and treatment of microfilaria carriers Morbidity management IEC .In rural areas anti filarial medicines and morbidity management through primary health care system.The training and research components . from 1978 onward the Central assistance was further reduced by sharing the cost of material and equipment on 50:50 each in Andhra Pradesh.the operational component of NFCP was merged with the urban malaria scheme for maximum utilization of available resources.  At the state level 12 headquarters bureaux are functioning.National institute of Communicable diseases .Delhi. However.when the number of microfilaria carriers is less than 1 percent and the children born after initiation of ELF are free from circulating antigenaemia(presence of adult filarial worm in human body) Central Assistance: During Fourth Five Year Plan the NFCP was 100 per cent centrally sponsored programme. only material and equipment were supplied by the Centre from its share and the entire operational cost was borne by the States. 4 rural research cum training centres were established.Rajahamudry(AP) and Varanasi(UP) under the National Institute of communicable diseases . Up to Seventh Five Year Plan the NFCP budget was separate and the same was merged with budget of Urban Malaria Scheme during Eighth Five Year Plan continuing the sharing the cost of material and equipment on 50:50 basis. The elimination is defined as “lymphatic filariasis ceases to be public health problem . NATIONAL GOAL The National Health Policy 2002 aims at Elimination of Lymphatic Filariasis by 2015.199filaria clinics and 27 survey units primarily in filarial endemic urban towns. The organophosphorus compounds like temephos and fenthion and drugs are supplied by the Centre.Maharashtra.Delhi.and in uttar Pradesh  3 regional research cum training centres situated atCalicut . National filarial control programme is being implemented through 206 filaria control units .however continue to be with the Director .Madhya Pradesh . But in Fifth Five Year Plan.

The survey is done in 4 sentinal and 4 random sites collecting total 4000 slides (500 from each site).  Home based management of lymphedema cases and upscaling of hydrocele operations in identified CHC’s /district hospitals/medical colleges. The larvicide under use includetemephos. low lying areas. etc.  Mass drug administration (MDA) DEC dosage schedule: The DEC dosage adopted in the programme is 6mg/kg body wt.There is definite evidence of microfilaria reduction in the MDA districts. Recurrent anti–larval measures at weekly intervals. The selection of breeding places for treatment with a particular larvicide is done judiciously.Anti-mosquito and anti-larval measures :      Anti-larval measures with temephos in prescribed dosage in water storage tanks every week and application of Mineral larvidcidal oils on water surface are practiced. Environmental methods including source reduction by filling ditches. pregnant women and seriously ill persons in affected areas to interrupt transmission of disease.However the coverage of population with MDA should be above 80% persistently for 5-6 years. . that the patients get relief from frequent acute attacks. Biological control of mosquito breeding through larvivorous fish. Fenthion and MLO. desilting.which would reduce microfilaria load in the community and there by interrupt the transmission. pits. The strategy for achieving the goal of elimination is by Annual Mass Drug Administration of DEC for 5 years or more to the population excluding children below two years. The microfilaria survey in all the implementation units is being done through night blood survey before MDA. Home based management of cases who already have the disease and hydrocelectomy operations in identified CHCs and hospitals. The line listing of lymphedema and hydrocele cases were initiated till 2004 by door to door survey in filarial endemic districts. per day for 12 days.Initiation has also been taken to demonstrate the simple washing of foot to maintain hygiene for prevention of secondary bacterial and fungal infection in chronic lymph edema cases.

Osmanabad. Sindhudurga. Latur. To recommend mid–course corrections and suggest necessary steps for further course of action. during Jun 2004. Godia.children below 2 years of age and seriously ill persons)to interrupt transmission of disease. To review the progress of activities of single dose DEC mass administration in the selected districts.Rest the districts were covered with DEC alone. pregnant women and seriously ill persons in affected areas to interrupt transmission of disease. During 2008 around 121 million population in selected districts of Tamil Nadu. Four newly added districts for the campaign are Ratnagiri.Karnataka. The drug is safe and effective for human lymphatic filariasis.9% in 2008. Gadchiroli. Nagpur. Bhandara. &Nanded. Yeotmal.The MDA coverage was 82.Kerala and Andhra Pradesh were covered with co administration of single dose of DEC+Albendazole.during 2004 the Govt. To achieve elimination of lymphatic filariasis. iii. This strategy is to be continued for 5 years or more to the population excluding children below two years. Interruption of disease transmission and Treatment of problems associated with lymphoedema (disability prevention and control) Parasite control with DEC is often relatively cheap when compared with vector control. Thane. of India launched annual MDA with single dose of DEC tablets in addition to scaling-up home based foot care and hydrocele operation. Wardha. To make independent assessment of the programme implementation with respect to process and outcome indicators.Annual Mass Drug Administration with single dose of DEC was taken up as a pilot project covering 14 endemic districts of Maharashtra State viz. The Basic Principle of Revised Strategy for the Single Dose Mass DEC Administration i.68 Crore population in 18 districts for the year 2005. There is basic difference between individual . ii. & Akola. Jalgaon.58 Crore selected population was covered under MDA in 2004 and extended to 2. Chandrapur. Nandurbar.  Annual mass drug administration (MDA) of single dose of antifilaria drug for 5 years or more to the eligible population (except pregnant woman.The co-administration of DEC+Albendazole has been upscaled to cover population at risk. ii. 1. Objectives of MDA i. Solapur.75% in 2007 and 85. Amaravati.

Once the mutual confidence is built–up. communication and advocacy campaign involving professional bodies will be highly useful to achieve the desired community compliance. on the other hand. In the first case. the symptoms are usually nonspecific and self-limiting. and does not produce any chronic toxicity. it is usually the patient who is in need of help and therefore he or she is more likely to comply with the treatment. particularly if mF counts are high. . DEC is reported to be safe. The success of the strategy also depends on the speed of control measures put forth in order to prevent parasite becoming re–established within a stipulated period of time. However.and community treatment of filariasis. During a large–scale treatment programme. One of the main reasons for "non-compliance" to the MDA programme is the occurrence of sideeffects reported by consumers. In a community. people harboring filarial infection are likely to experience side-effects as a consequence of the interaction between the drug and the parasite. In others. the communication with people becomes easy and the treatment objectives and nature of possible reactions would be explained to them. There is no evidence yet that this message has reached the community at large. education. only a small proportion of the population is suffering from acute clinical filariasis at any one time and therefore a few people feel the need for help. the key to success is the ability of the peripheral (village/subCentre) level team involved in MDA to communicate effectively with the community. An intensive information. The people's awareness on MDA widely varies between different community settings.

DEC pilot project was taken up during 1989 in selected villages of Kalakuchi Health District of Tamil Nadu. 2 Filaria Survey Units and the Filaria control works at Cherthala. The programme was launched in the State during 1955-56.2 g/m2 per round. Kerala. The DEC medicated salt project with 0. Attached to the Filaria Units.000 during 1976-77 which reduced MF rate by 80% and circulating MF by about 90%. comprising a population of 25. Control Mosquito larvicidal spraying operation. Integrated vector control approach for control of this infection was being implemented by VCRC Pondicherry in Cherthala of Alapuzhadistrict. the distribution of 0. Activities: A. B.Medicated salt regimens in India: Based on the encouraging results obtained in pilot trials in the Uttar Pradesh and Andhra Pradesh. pistia removal and anti parasitic (DEC) treatment.malayi control: The pilot project under the auspices of NICD in Kerala has revealed that the vectors of B. Pondicherry which gave significant reduction in microfilaraemia. 11 Filaria clinics are functioning. National Filaria Control Programme in kerala Filariasis is prevalent in the entire coastal belt and in some pockets of Kerala. three rounds a year. Now it is implemented through 16 NFCP units.1% DEC medicated salt to general public for one year was implemented in Lakshadweep. Assessment Entomological and parasitological (filaria survey) Monitoring Agency The State Headquarters Bureau of Filariasis under the Assistant Director (Filaria) attached to the Directorate of Health Services is monitoring and assessing the work at the State level.2% concentration was concluded at Karaikal. About 6.8 million people are protected by NFCP. Achievements of National Filaria Control Programme Filaria Cases(kerala) Year 2001–02 2002–03 Persons Examined 971658 1003222 Cases detected MF 13142 13848 Disease 2374 2527 Hydrocele Operations 1642 2666 . B. The Filaria Survey Unit at Thrissur was shifted to Thiruvananthapuram in May 95 and continues to function as main central unit at Valiyathura in Thiruvananthapuram.3 million people are exposed to the risk Filarisis and 2.malayi are amenable to indoor residual spray of HCH at a dose of 0.

Expected Community Participation Involvement of Panchayats in successful indoor residual insecticide spray is an essential aspect of the programme. This advance information must be mopped up by surveillance workers/Malaria inspectors/DMOs so as to facilitate the villagers to extend full co–operation in getting actual spray inside of human dwelling with the objective of full coverage of targeted population.  An effective waste management and source reduction for mosquito is a necessary condition for reduction of incidence of communicable diseases.2003–04 2004–05 2005–06 2006–2007 2007–2008 2008–09 up to May 1055505 1086526 1045770 925331 1049923 194855 13292 10311 8270 5588 4705 825 1396 1776 1024 623 655 216 2287 4232 3615 3056 4250 133 A workshop to develop the vision. religious groups etc. The group considered the lack of an effective public health act a major lacuna in the control of communicable disease.  Kerala should aim to eliminate filariasis through active case detection and through effective implementation of MDA campaign. objectives and strategies for the approach paper to the twelfth five year plan was held at the on 15th September 2011 at the State Health Resource Centre. The filaria elimination strategies were also discussed. Panchayats/villages/local bodies/village heads/BDOs/MahilaMandals. . Thycaud. are to be informed about the spray schedule at least before a fortnight. Ayurveda and Homeopathy have to take up identified hotspots and establish that interventions using the strategies in their stream of medicine have brought down incidence. Thiruvananthapuram. Kerala has to become serious about control of plastics as plastic waste has become the single most important location of waste water where mosquito breeds.  Rehabilitation of patients including surgery and artificial aids should also be done effectively. Kerala should have an effective public health act soon.

2.Role of NGOs 1. Vector control should be a component in the LF elimination campaign. Private medical practitioners can also be motivated through the professional organizations. These organisations should be invited to discussions when the annual strategic plan is prepared. Faith Based Organisations (FBOs) can play an important role in LF elimination. which could be incorporated in the national plan. especially in urban areas. A single strip of two tablets. one each of DEC and Alb in blister pack could be used in the programme. A list of NGOs. ii. The possible areas of partnership for an active role of voluntary organisations for Elimination of Lymphatic Filariasis (ELF) in India are identified in the following three specific areas i. Non Governmental Organizations (NGOs). Morbidity Management at community level. Large industries provide health services to their employees and their families and sometimes also provide health services to the industrial township or rural area where they are located. Social Mobilization for drug compliance. Community Based Organisations (CBOs). The private health sector represents a substantial resource. iii. . These organizations can also identify areas in which the support of private physicians could best be utilised in mass drug administration and in morbidity (disability) management. Supporting mass drug administration and management of adverse reactions. An inventory of private establishments will enhance planning for drug distribution. DBOs. The following mid-course corrections are suggested which would facilitate the present control/elimination strategy:    A geographically identified risk area or PHC should be made an intervention unit. Mapping of areas through morbidity surveys. so that they can identify areas of interest for their participation. It is not wise to depend only on MDA. 3. industrial houses and private educational institutions are also important groups for organizing mass treatment campaigns for their employees. The private sector. FBOs and enterprising Panchayats with the possible areas of partnership should be prepared. iv.

BIBLIOGRAPHY Book 1.Park.BT “Text book of community health Nursing”2ndedition.2ndedition. Supply of DEC tablets as per the government policies and explaining the benefits.the co-ordinated effort of peripheral level workers has to be ensured.kk “Textbook of community health nursing”2ndedition.removing social stigma of disease etc Ensuring adequate treatment for identified cases.Elseiver publishers.K “Parks Textbook of preventive and social medicine”. Health education and promotion of IEC activities about the disease.Removing the misconception of the people regarding adverse effects of DEC is essential.pp.Lucita Mary “Nursing:Practice and public health administration”.21stedition. NURSES ROLE      Active detection of cases through surveys. the whole world is looking at the progress of the LF elimination programme in India as the population living at risk of infection is high.pp-262-325 3. CONCLUSION Elimination of filariasis using annual MDA is one of the most economical and beneficial disease control strategies undertaken so far in public health programmes.Jaypee publishers.pp321-330 4.   Programme managers should be encouraged to adopt the principle of 'directly-observed treatment'. including the areas where other intervention measures are weak. Co-ordinating the efforts of NGO‟s and non voluntary organizations in filarial control activities. Now.Basavanthappa. DEC-fortified salt and vector control as an adjunct should be introduced in all residual foci.vector control. and hence the height of its achievement will greatly have a bearing at the global level.Banarsidas Bhanotpublishers.Gulani. communication and advocacy campaign involving professional bodies is crucial.environmental sanitation.814-818 2. education. An intensive information.Kumar publishers Pp 256-262 . www.nrhm.arogyakeralam.Net reference .

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