Epidemiology of

LYMPHATIC FILARIASIS
 Introduction
• Lymphatic filariasis, commonly known as
elephantiasis, is a painful and profoundly
disfiguring disease.
• all ages are affected.
• Acquired during childhood
• its visible manifestations may occur later in life,
causing temporary or permanent disability.
• In endemic countries, lymphatic filariasis has a
major social and economic impact.
 Problem statement
Global disease affecting 73 countries mainly in
tropic and sub tropic Africa, Asia, south pacific
countries.
• 1.4 billions are at risk
• 120 millions are affected
• 40 millions are overtly affected (apparent)
disease
National Health Policy “Elimination of Lymphatic
filariasis by 2015”
 The term “lymphatic filariasis” covers
infection with three closely related
parasites.(nematode worms)

These parasites are transmitted to man through

mosquito bites.(culex,mansonia, anapheles)
 Indian scenario

• UP,AP,TN,KL,
GJ,BIHAR,ODISHA,JAHAR
KHAND.(250 DISTRICTS
IN 20 STATES)
• 600 MILLION AT RISK
• 8 LACS CASES OF
LYMPHOEDEMA,
• 4 LACS CASES OF
HYDROCELE
 EPIDEMIOLOGICAL DETERMINANTS
Agent
There are 8 species of microfilarial parasites that are
specific to man. Out of which only three cause
lymphatic filariasis.
1. Wuchereria bancrofti
2. Brugia malayi
3. Brugia malayi

Periodicity
• Nocturnal periodicity
• The maximum MF larva in blood is reported
between 10.00pm and 2.00am
EPIDEMIOLOGICAL DETERMINANTS
life cycle
 Host factor
Man is the Definitive host…(i.e where the parasite
reaches maturity and reproduces sexually, if
possible).
Age- All age are susceptible, infection rate high in 20-
30 years of age, MF declines in middle and old age
Sex- High in male
Immigration causes extension of filariasis.
Immunity- Man may develop resistance to infection
only after many years of exposure
Social factor- urbanization, industrialzation, poor
sanitation, poverty.
 Environmental factor
• Climate Vectors of filariasis
• Drainage It is a mosquito borne disease
• Town planning Mosquito is the Secondary
or intermediate host -
harbors the sexually
immature parasite and is
required by the parasite to
undergo development and
complete its life cycle.
• Culex- bancrofti
• Mansonia- brugia
• Anopheles-brugia
Mode of transmission
• Bite of infected mosquito
• Parasite is deposited near punctured skin or
punctured the skin on its own and finally
reaches lymphatic system

Incubation period
The period between exposure and onset of
clinical symptoms is called 'incubation period‘-
8-16 months or longer.
 Clinical manifestation LF
Stages of acute manifestation-
1. may have no symptoms.
2. episodes of acute inflammation of lymphatic
vessels (lymphangitis)
3. high temperatures,
4. shaking chills,
5. body aches, and swollen lymph nodes.
6. Edema but the accumulation typically resolves
after the other symptoms are gone.
7. acute inflammation of the genitalia leading, in
males, to inflammation, pain and swelling of the
testes (orchitis), The scrotum may become
abnormally swollen and painful.
stages of chronic obstructive lesion usually develop
10-15 years after first onset, permanent fibrosis
and obstruction of lymphatic vessels

Lymphangitis, lymphadenitis, elephantiasis of

genitals and limbs, pulmonary eosinophilia,
arthritis.

Though its not fatal it leaves temporary or

permanent disability.
• Lymphoedema management;
1. Early detection of cases
2. Skin care by washing and drying
3. Preventing and treating entry lesions
4. Limb elevation and exercising
• Hydrocele management
Case detection,
diagnosis,
Surgery.
 Filarial surveyexamine 5-7 % of
population for routine survey,
• A filarial survey comprises the following FIVE
elements
1. Mass blood survey- The thick film, Membrane filter
concentration (MFC) methods and DEC
provocation test

2. Clinical survey- people are examined for

manifestation of LF
3.Serological test - detecting antibodies of MF in human
bodies.
 Parasitological indices:
1. Microfilaria Rate: % of persons showing Mf in their
peripheral blood in a sampled population;
2. Filarial Endemicity Rate: % of persons examined
showing microfilariae in blood, or disease manifestation or
both;
3. Microfilarial Density: No. of Mf per unit volume of
blood in samples from individual persons ;
4. Average Infestation Rate: Average number of Mf per
positive slide.
 Entomological indices:
1. Vector density per 10 man – hours cathc;

2. % of mosquitoes positive for all stages of

development

3. % of mosquitoes positive for infective larvae

4. types of breeding places.

 Lymphatic Filariasis Elimination Goal
Filarial control in the community
The Government of India is signatory to the World
Health Assembly Resolution in 1997 for Global
Elimination of Lymphatic Filariasis. The National
Health Policy (2002) envisages elimination of
lymphatic filariasis in India by 2015.

I. Mass drug administration

II. Selective treatment
III. DEC- medicated salt
 MASS DRUG ADMINISTRATION

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.
 challenges and options of MDA
• the identification of target area/community
really under 'risk' of infection,

• drug dosage/distribution,

• community compliance, and need for site-

specific approach in strategies
 Integrated vector control
1. A single dose of DEC or Ivermectin are proved
to be equally effective
2. Intensive local hygiene of affected limb with or
with out antibiotic and anti fungal creams.
3. DEC medicated salt , to eleminating filariasis
from community.
4. Development of insecticide spray, polystyrene
beads to seal latrines and over head water tank
to eliminate the breed of culex mosquitoes.
1. ANTI-LARVAL MEASURES -elimination of
breeding places by providing adequate
sanitation and under ground waste water
disposal system.
a) Chemical control- mosquito larvicidal oil
(MLO),pyrosene oil.
b) Removal of pistia plant
c) Minor environmental measures
 contd
2. Anti-adult mosquito measures
Pyrethrum as a space spray
(Mosquitoes became resistant to Indoor Residual spray
with DDT ).

3. Personal prophylaxis
Bed nets and screening of houses can reduce
transmission but very expensive.
• Apply insect repellent to uncovered skin.
• Sleep under a mosquito net.
• If possible, stay indoors between dusk and dawn.
• Take an annual dose of medicine that kills the worms circulating in the blood.
• When outdoors, wear long pants and long-sleeved shirts to protect against
mosquito bites.
Secondary control
• Diagnosis
• Treatment of filarial disease
• Treatment of complications

Tertiary control
Rehabilitation
Thank you