seminar on new filaria

8/2/2019 SEMINAR on New Filaria

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SEMINAR ON

NATIONAL FILARIA CONTROL

PROGRAMME

(NFCP)

PRESENTED BY

ARUN.JV


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INTRODUCTION

Filariasis has been a major public health

problem in India next only to malaria. The

disease was recorded in India as early as 6th

century B.C. by the famous Indian physician,

Susruta in his book Susruta Samhita. In

7thcentury A.D., Madhavakara described signs

and symptoms of the disease in his treatiseMadhava Nidhana which hold good even

today.


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INTRODUCTION cont

In 1709, Clarke called elephantoid legs in Cochin as

Malabar legs.

The discovery of microfilariae (MF) in the peripheral

blood was made first by Lewis in 1872 in Calcutta(Kolkata).


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FILARIASIS

Filariasis is caused by several round, coiled and thread-

like parasitic worms belonging to the family filaridea.

These parasites after getting deposited on skin penetrate

on their own or through the opening created by mosquitobites to reach the lymphatic system. The disease is caused

by the nematode worm, either Wuchereria

bancrofti orBrugia malayi and transmitted by ubiquitous

mosquito species Culexquinquefasciatus and Mansonia annulifera/M.uniformisrespectively.


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FILARIASIS

Brugian filariasis

Bancroftian filariasis


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FILARIA VECTORS

Culex quinquefasciatus transmits filariasis in

India. Culex breeds in polluted water. Common

breeding sites are wet pit latrines, septic tanks,barrow pits, cess pools, drains, disused wells,

paddy fields, etc.


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TRANSMISSION OF LYMPHATIC

FILARIASIS

The adult produces millions of very small

immature larvae known as microfilariae, which

circulate in the peripheral blood with markednocturnal periodicity. The worms usually live

and produce microfilariae for 5-8 years.


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In India, 99.4% of the cases are caused by the

species - Wuchereria bancrofti whereas Brugia

malayi is responsible for 0.6% of the problem.


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Wuchereria bancrofti Brugia malayi


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MAGNITUDE OF DISEASE

Indigenous cases have been reported from about250 districts in 20 states/Union Territories.

Cases of filariasis have been recorded from

Andhra Pradesh, Assam, Bihar, Chhattisgarh, Goa,Jharkhand, Karnataka, Gujarat, Kerala, Madhya

Pradesh, Maharashtra, Orissa, Tamil Nadu, Uttar

Pradesh, West Bengal, Pondicherry, Andaman &

Nicobar Islands, Daman & Diu, Dadra & NagarHaveli and Lakshadweep.


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B. malayi is prevalent in the states of Kerala, Tamil Nadu, AndhraPradesh, Orissa, Madhya Pradesh, Assam and West Bengal.

The single largest tract of this infection lies along the west coast of

Kerala, comprising the districts of Trichur, Ernakulum, Alleppey,

Quilon and Trivandrum, stretching over an area of 1800 sq km. Theinfection in the other six states is confined to a few villages. 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

forB. malayi infection four decades back


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ECONOMIC LOSS :

About 1.2 billion man-days are lost due to

filariasis every year leading to an economicloss of Rs. 3500 crore


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NATIONAL FILARIA CONTROL

PROGRAMME

National filarial control programme was

started in 1955.

After pilot project in Orissa from 1949 to1954, the National Filaria Control Programme

(NFCP) was launched in the country in 1955

with the objective of delimiting the problem, to

undertake control measures in endemic areas and

to train personnel to manage the programme.


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Pilot project in Orissa:

mass drug administration with

diethylcarbamazine (DEC)

recurrent antilarval measures Residual insecticidal spray as anti-adult

measure.


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Recommendations of assessment

committee.

(a) proper environmental sanitation

(b) antilarval measures by the application of oil.

U d h NFCP h f ll i i i i b i


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Under the NFCP the following avtivities are being

undertaken

Delimitation of the programme in unsurveyed

areas.

Adoption of antilarval and anti-mosquitomeasures.

Detect and treat positive cases of filariasis.

Install underground drainage system to preventmosquito breeding.


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4 rural research cum training centres were

established,one each in Andhra

Pradesh,Maharashtra,Madhya Pradesh ,and in uttar

Pradesh3 regional research cum training centres situated at

Calicut ,Rajahamudry(AP) and Varanasi(UP) under the

National Institute of communicable diseases ,Delhi.

At the state level 12 headquarters bureaux arefunctioning.


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National filarial control programme is being

implemented through 206 filaria control units

,199 filaria clinics and 27 survey units primarilyin filarial endemic urban towns.In rural areas

anti filarial medicines and morbidity

management through primary health care system.


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NATIONAL GOAL

The National Health Policy 2002 aims

at Elimination of LymphaticFilariasis by 2015.


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The elimination is defined aslymphatic

filariasis ceases to be public health problem,

when the number of microfilaria carriers is lessthan 1 percent and the children born after

initiation of ELF are free from circulating

antigenaemia(presence of adult filarial worm inhuman body)


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Central Assistance

During Fourth Five Year Plan the NFCP was 100 per centcentrally sponsored programme. But in Fifth Five Year Plan,only material and equipment were supplied by the Centrefrom its share and the entire operational cost was borne bythe States.

However, from 1978 onward the Central assistance wasfurther reduced by sharing the cost of material andequipment on 50:50 basis.

Up to Seventh Five Year Plan the NFCP budget was separateand the same was merged with budget of Urban MalariaScheme during Eighth Five Year Plan continuing the sharingthe cost of material and equipment on 50:50 basis.


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FILARIA CONTROL STRATERGY

Vector control through anti larval operations

Source reduction

Detection and treatment of microfilariacarriers

Morbidity management

IEC

i i d i l l


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Anti-mosquito and anti-larval

measures :

Anti-larval measures with temephos in prescribed dosagein water storage tanks every week and application ofMineral larvidcidal oils on water surface are practiced.

The larvicide under use includetemephos, Fenthion andMLO. The selection of breeding places for treatment with aparticular larvicide is done judiciously.

Recurrent antilarval measures at weekly intervals.

Environmental methods including source reduction byfilling ditches, pits, low lying areas, deweeding, desilting,

etc. Biological control of mosquito breeding through larvivorous

fish.

Home based management of


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Home based management of

lymphedema cases and upscaling of

hydrocele operations The line listing of lymphedema and hydrocelecases were initiated till 2004 by door to door

survey in filarial endemic districts.Initiation

has also been taken to demonstrate thesimple washing of foot to maintain hygiene for

prevention of secondary bacterial and fungal

infection in chronic lymph edema cases,sothat the patients get relief from frequent

acute attacks.


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Mass drug administration (MDA)

DEC dosage schedule: The DEC dosage adopted

in the programme is 6mg/kg body wt. per day

for 12 days.

The strategy for achieving the goal of eliminationis by Annual Mass Drug Administration of DEC for

5 years or more to the population excluding

children below two years, pregnant women andseriously ill persons in affected areas to interrupt

transmission of disease.


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During 2008 around 121 million population in

selected districts of Tamil

Nadu,Karnataka,Kerala and Andhra Pradesh

were covered with co administration of singledose of DEC+Albendazole.Rest the districts

were covered with DEC alone.The MDA

coverage was 82.75% in 2007 and 85.9% in2008.


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Objectives of MDA

To review the progress of activities of singledose DEC mass administration in the selecteddistricts.

To make independent assessment of theprogramme implementation with respect toprocess and outcome indicators.

To recommend midcourse corrections andsuggest necessary steps for further course ofaction.

Th B i P i i l f R i d


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The Basic Principle of Revised

Strategy for the Single Dose Mass DEC

Administration

Interruption of disease transmission

Treatment of problems associated withlymphoedema (disability prevention and

control)


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One of the main reasons for "non-compliance"

to the MDA programme is the occurrence of

side-effects reported by consumers. DEC is

reported to be safe, and does not produce anychronic toxicity.


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Medicated salt regimens in India

The DEC medicated salt project with 0.2%

concentration was concluded at Karaikal;

Pondicherry which gave significant reduction in

microfilaraemia.


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B.malayi control

The pilot project under the auspices of NICD in

Kerala has revealed that the vectors of

B.malayi are amenable to indoor residual

spray of HCH at a dose of 0.2 g/m2 per round,three rounds a year. Integrated vector control

approach for control of this infection was

being implemented by VCRC Pondicherry inCherthala of Alapuzhadistrict, Kerala.


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National Filaria Control Programme in

kerala

Filariasis is prevalent in the entire coastal belt and insome pockets of Kerala. About 6.3 million people areexposed to the risk Filarisis and 2.8 million people areprotected by NFCP.The programme was launched in the State during1955-56. Now it is implemented through 16 NFCPunits, 2 Filaria Survey Units and the Filaria controlworks at Cherthala. Attached to the Filaria Units, 11Filaria clinics are functioning. The Filaria Survey Unit at

Thrissur was shifted to Thiruvananthapuram in May 95and continues to function as main central unit atValiyathura in Thiruvananthapuram.


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Activities

Control Mosquito larvicidal spraying

operation, pistia removal and anti parasitic

(DEC) treatment.

Assessment Entomological and parasitological

(filaria survey)


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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 theState level


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Achievements of National Filaria Control

Programme

Year Persons Examined

Cases detected

Hydrocele Operations

MF Disease

200102 971658 13142 2374 1642

2002

03 1003222 13848 2527 2666

200304 1055505 13292 1396 2287

200405 1086526 10311 1776 4232

2005

06 1045770 8270 1024 3615

20062007 925331 5588 623 3056

20072008 1049923 4705 655 4250

200809 up to May 194855 825 216 133

A k h t d l th i i bj ti d


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A workshop to develop the vision, objectives and

strategies for the approach paper

to the twelfth five year plan

The filaria elimination strategies were also discussed.

Kerala should aim to eliminate filariasis through activecase detection and

through effective implementation of MDA campaign.

Rehabilitation of patients including surgery andartificial aids should also be done effectively.

An effective waste management and source reduction

for mosquito is a necessary condition for reduction of incidence of communicable

diseases.


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Expected Community Participation

Involvement of Panchayats in successful

indoor residual insecticide spray is an essential

aspect of the programme.

Panchayats/villages/local bodies/villageheads/BDOs/MahilaMandals, religious groups

etc. are to be informed about the spray

schedule at least before a fortnight.


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Role of NGOs

Non Governmental Organizations (NGOs), CommunityBased Organisations (CBOs), Faith Based Organisations(FBOs) can play an important role in LF elimination.

These organisations should be invited to discussions

when the annual strategic plan is prepared, so thatthey can identify areas of interest for theirparticipation, which could be incorporated in thenational plan.

A list of NGOs, DBOs, FBOs and enterprising Panchayatswith the possible areas of partnership should beprepared.


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Mapping of areas through morbidity surveys.

Social Mobilization for drug compliance.

Supporting mass drug administration and

management of adverse reactions.

Morbidity Management at community level


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MID-COURSE CORRECTIONS

A geographically identified risk area or PHC should be madean intervention unit.

Vector control should be a component in the LF eliminationcampaign. It is not wise to depend only on MDA.

A single strip of two tablets, one each of DEC and Alb inblister pack could be used in the programme.

Programme managers should be encouraged to adopt theprinciple of 'directly-observed treatment'.

DEC-fortified salt and vector control as an adjunct should

be introduced in all residual foci, including the areas whereother intervention measures are weak.

An intensive information, education, communication andadvocacy campaign involving professional bodies is crucial.

NURSES ROLE


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NURSES ROLE

Active detection of cases through surveys.the co-ordinated effort of peripheral level workers has to beensured.

Supply of DEC tablets as per the government policiesand explaining the benefits.Removing the

misconception of the people regarding adverse effectsof DEC is essential.

Health education and promotion of IEC activities aboutthe disease,vector control,environmentalsanitation,removing social stigma of disease etc

Ensuring adequate treatment for identified cases.

Co-ordinating the efforts of NGOs and non voluntaryorganizations in filarial control activities.


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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. Now, the wholeworld is looking at the progress of the LF

elimination programme in India as the

population living at risk of infection is high,and hence the height of its achievement will

greatly have a bearing at the global level.


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seminar on new filaria

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