Lymphatic Filariasis Elimination in Kerala: A Success Story
National Filaria Control Programme has been running in the country since the year 1955 with the strategy of parasite detection, treatment and vector control mainly in urban areas. In the year 1997, the fiftieth World Health Assembly Resolution listed Lymphatic Filariasis (LF) for elimination by 2020 which now has been aligned with Sustainable Development Goal to be achieved by 2030. India also started its campaign to eliminate LF in 2004. The main strategy of the elimination programme is the Annual Mass Drug Administration (MDA) to progressively reduce and ultimately interrupt LF transmission. The other pillar of the strategy is morbidity management and disability prevention. Kerala state also started its LF elimination campaign in 11 endemic districts out of a total of 14 districts. The average population coverage during MDA in Kerala was reported to be more than 90% from 2004 to 2013, however, drug compliance during independent assessment was reported to be 40%-60% which improved in subsequent years due to a multipronged approach. The main reason of low consumption was the fear of side effects and the same was resolved through massive IEC activities highlighting its benefits compared to side effects, which are mostly self-limiting. The innovative strategic approach of extending the MDA period from 3 days to 3 weeks was undertaken to ensure that all the target population was covered. The results have been encouraging as compliance improved to above 65% and many districts have been validated for having achieved the elimination threshold through successfully clearing transmission assessment survey (TAS).
How to cite this article:
Meenakshy V, Anju Viswan K, Sharma SN, Baruah K, Srivastava PK. Lymphatic Filariasis Elimination in Kerala: A Success Story. J Commun Dis. 2023;55(1):91-97.
Ives E. A voyage from England to India. London: Dilly; 1773. [Google Scholar]
Clark J. Observations on the diseases in long voyages to hot countries, and particularly on those which prevail in the East Indies. London: Wilson and Nicol; 1775. [Google Scholar]
Aiya VN. The Travancore State Manual. Trivandrum. Vol. II. Travancore Government Press; 1906. 570 p. [Google Scholar]
Innes CA. Malabar Gazetteer. Vol. I and II. Kerala Gazette Department; 1908.
Menon CA. The Cochin State Manual; 1911.
Iyengar MO. Studies on the epidemiology of filariasis in Travancore. Ind Med Res Mem. No. 30. 1938. 179 p. [Google Scholar]
Krishnaswami AK, Raghavan NG, Singh J. Filariasis in Travancore-Cochin state. I. Ernakulam and Mattancherri. Indian J Malariol. 1956 Sep;10(3):219-38. [PubMed] [Google Scholar]
Singh J, Krishnaswami AK, Raghavan NG. Filariasis in Travancore-Cochin State. II. Shertallai Taluk. Indian J Malariol. 1956 Dec;10(4):317-25. [PubMed] [Google Scholar]
Government of Kerala. Filariasis in Kerala. Trivandrum: Government Press; 1961. 27 p.
Sharma RS, Biswas H, Saxena NB. Operational Manual on National Filaria Control Programme. Delhi: National Malaria Eradication Programme; 1995. 152 p.
Fiftieth World Health Assembly. Elimination of lymphatic filariasis as a public health problem. Resolution of the World Health Assembly; 1997. p. 27-8. [Google Scholar]
Ottesen EA, Duke BO, Karam M, Behbehani K. Strategies and tools for the control/elimination of lymphatic filariasis. Bull World Health Organ. 1997;75(6):491-503. [PubMed] [Google Scholar]
Ottessen EA. The global programme to eliminate lymphatic filariasis. Trop Med Int Health. 2000;5(9):591-4. [PubMed] [Google Scholar]
National Vector Borne Disease Control Programme. Operational Guidelines on Elimination of lymphatic filariasis, India. Directorate of National Vector Borne Disease Control; 2005.
National Vector Borne Disease Control Programme. Guidelines on elimination of lymphatic filariasis, India; 2009.
Biswas G, Raina VK, Rao CK. Revised strategy for the control of lymphatic filariasis in India, New Delhi. Delhi: National Institute of Communicable diseases and National Malaria Eradication Program; 1996.
Srivastava PK, Dhillon GP. Elimination of lymphatic filariasis in India â€“ a successful endeavour. J Indian Med Assoc. 2008;106(10):673-4, 676-7. [Google Scholar]
Srivastava PK, Dhariwal AC, Bhattacharjee J. Status of lymphatic filariasis in India. Health Action. 2013:19.
Srivastava PK, Bhattacharjee J, Dhariwal AC, Krishnamoorthy K, Dash AP. Elimination of lymphatic filariasis - current status and way ahead. J Commun Dis. 2014;46(2):85-94. [Google Scholar]
Dhariwal AC, Srivastava PK, Bhattacharjee J. Elimination of lymphatic filariasis in India: an update. J Indian Med Assoc. 2015;113(12):189-90.
DHS, Kerala (2008-2014). NVBDCP Reports. Forthcoming.
World Health Organization. Monitoring and epidemiological assessment of the programme to eliminate lymphatic filariasis at implementation unit level. 2005.
World Health Organization. Global programme to eliminate lymphatic filariasis: monitoring and epidemiological assessment of mass drug administrationâ€“TAS. 2011.
National Vector Borne Disease Control Programme [Internet]. Elimination of lymphatic filariasis. National Guidelines for Transmission Assessment Survey; 2013 [cited 2023 Jan 12]. Available from: https://nvbdcp.gov.in/WriteReadData/l892s/TAS-National-Guidelines-2013-14.pdf
Srivastava PK, Sharma SN, Bhattacharjee J, Dhariwal AC, Krishnamoorthy K. A tool for monitoring epidemiological impact of Mass Drug Administration (MDA) in the elimination of lymphatic filariasis- an Indian experience. J Commun Dis. 2014;46(2):1-6.
World Health Organization. Lymphatic filariasis: progress of disability prevention activities. Wkly Epidemiol Rec. 2004;79:417-24. [PubMed] [Google Scholar]
Srivastava PK, Dhariwal AC. Progress towards morbidity management under elimination of lymphatic filariasis programme in India. J Indian Med Assoc. 2010;108(12):854-62. [Google Scholar]
Regu K, Ali MK, Rajendran R, Koya SM, Ganesh B, Dhariwal AC, Lal S. Mass drug administration against lymphatic filariasis: experiences from Kozhikode district of Kerala State. J Commun Dis. 2006;38(4):333-8. [PubMed] [Google Scholar]
Showkath AM, Regu K, Rajendran R, Mohanan MK, Ganesh B. Awareness of health personnel about lymphatic filarisis and mass drug administration in Kerala state. J Commun Dis. 2008;40:37-40. [PubMed] [Google Scholar]
Srivastava PK, Krishnamoorthy K, Govenkar S, Perni S, Delvi S, Subramanain S, Dhariwal AC, Bhattacharjee J, Dash AP. Elimination of lymphatic filariasis in Goa: first successful Transmission Assessment Survey in India. J Commun Dis. 2014;46(2):7-16.
World Health Organization. Expert committee on filariasis (Wuchereria and Brugia infections). Technical Report Series No. 233. 1962. 49 p.
World Health Organization [Internet]. Lymphatic filariasis: practical entomology. A handbook for National Elimination Programmes; 2013 [cited 2023 Jan 12]. Available from: http://apps.who.int/iris/bitstream/10665/87989/1/9789241505642_eng.pdf?ua=1
Reuben R, Rajendran R, Sunish IP, Mani TR, Tewari SC, Hiryian J, Gajanana A. Annual single-dose diethylcarbamazine plus ivermectin for control of bancroftian filariasis: comparative efficacy with and without vector control. Ann Trop Med Parasitol. 2001;95(4):361-78. [PubMed] [Google Scholar]
Krishnamoorthy K, Rajendran R, Sunish IP, Reuben R. Cost-effectiveness of the use of vector control and mass drug administration, separately or in combination, against lymphatic filariasis. Ann Trop Med Parasitol. 2002;96(2):S77-90. [PubMed] [Google Scholar]
Copyright (c) 2023 Authors
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.