The World Health Organization (WHO) has recently issued a new guideline document for the treatment of lymphatic filariasis.
Background Information:
Lymphatic filariasis, commonly known as elephantiasis, is a neglected tropical disease. Infection occurs when filarial parasites are transmitted to humans through mosquitoes. Infection is usually acquired in childhood causing hidden damage to the lymphatic system.
The painful and profoundly disfiguring visible manifestations of the disease, lymphoedema, elephantiasis and scrotal swelling occur later in life and can lead to permanent disability. These patients are not only physically disabled, but suffer mental, social and financial losses contributing to stigma and poverty.
Key Messages:
856 million people in 52 countries worldwide remain threatened by lymphatic filariasis (LF) and require preventive chemotherapy to stop the spread of this parasitic infection.
In 2000 over 120 million people were infected, with about 40 million disfigured and incapacitated by the disease.
Lymphatic filariasis can be eliminated by stopping the spread of infection through preventive chemotherapy with safe medicine combinations, repeated annually for at least 5 years. 6.7 billion treatments have been delivered to stop the spread of infection since 2000.
499 million people no longer require preventive chemotherapy due to successful implementation of WHO strategies.
A basic, recommended package of care can alleviate suffering and prevent further disability among persons living with disease caused by lymphatic filariasis.
Elimination of lymphatic filariasis is possible by stopping the spread of the infection through preventive chemotherapy. The WHO recommended preventive chemotherapy strategy for LF elimination is mass drug administration (MDA).
MDA involves a combined dose of 2 medicines given annually to an entire at-risk population in the following way: albendazole (400 mg) together with either ivermectin (150-200 mcg/kg) or with diethylcarbamazine citrate (DEC) (6 mg/kg).
Why the new Guideline?
The target for global elimination of lymphatic filariasis is 2020. Although MDA has been successful in reducing the burden of disease,
- 22 of 52 (42%) countries remain endemic and require MDA but have not started MDA in all of their endemic implementation units [IUs]. Because at least five effective MDA rounds are needed, achieving the elimination target in these countries by 2020 is unlikely.
- Additionally, countries with IUs that have already achieved five effective MDA rounds are grappling with assessment results that reveal suboptimal responses to current MDA regimens.
Given the current status of Global Programme to Eliminate Lymphatic Filariasis (GPELF) countries, achieving global elimination of LF by 2020 is no longer technically feasible using the existing regimens.
The new guideline is specific to LF MDA, and does not address other public health interventions for LF.
The new guideline:
The treatment, known as IDA, involves a combination of ivermectin, diethylcarbamazine citrate and albendazole.
Useful Links:
Link to the WHO news release:
http://who.int/neglected_diseases/news/WHO_recommends_triple_medicine_therapy_for_LF_elimination/en/
Link to the WHO Guideline document:
http://who.int/lymphatic_filariasis/resources/9789241550161/en/
Link to WHO fact sheet on lymphatic filariasis (updated October 2017):
http://who.int/mediacentre/factsheets/fs102/en/
Link to WHO Global Programme to Eliminate Lymphatic Filariasis Strategic Plan 2010-2020 (English) [PDF]:
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