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Filaria

Eliminating Elephantiasis by 2020

Highlights

  • New model of therapy for elephantiasis using three drugs developed.
  • A combination of the three drug therapy treats the disease rapidly and WHO hopes to eliminate lymphatic elephantiasis by 2020.
  • The three drugs are ivermectin, diethylcarbamazine and albendazole and drug companies Merck, GlaxoSmithKline and Eisai have pledged to provide free drugs.

Research team from The
University of Warwick have identified a method by which a debilitating disease
called elephantiasis
could be potentially eliminated by 2020. This brings in a lot of hope for more
than 1 billion people who live under the threat of developing this disease,
which can greatly affect the quality of life lead.

The Head of The
Neglected Tropical Diseases Modelling Consortium, Dr. Deirdre Hollingsworth and
an International consortium studied the recent advances in therapy for
elephantiasis and came up with a model where three drugs could be
used to treat elephantiasis rapidly.

‘The new model of drug therapy involving ivermectin, diethylcarbamazine and albendazole drugs to treat elephantiasis should reach remote high risk areas for complete elimination.’


Elephantiasis

Elephantiasis is also
called lymphatic
filariasis, and is caused by parasitic
worms. Mosquitoes are vectors
for the disease. This disease condition is characterized by gross enlargement
of a part of the body, especially the limbs. The external genitals are other
areas that are commonly affected.
The lymphatic system
includes a network of tubular channels that are called the lymph vessels. These
vessels drain a thin watery fluid called the lymph from various parts of the
body and when such a lymph node is blocked, the lymph begins to accumulate,
resulting in the characteristic symptom of the disease.

The enlargement of the
body part that occurs can be painful and can be disfiguring, sometimes even
leading to permanent damage. This could result in the individual feeling
socially stigmatized apart from the monetary and physical strain on the
individual.

Countries at High Risk

80% of the disease is
found in countries like India, Indonesia and Myanmar, Angola, Democratic
Republic of Congo, Nigeria, Mozambique, Cameroon, Cote D’Ivoire and The United
Republic of Tanzania.

  • 1 billion people are at high risk
  • People in over 54 countries are at some risk of being infected
  • In the year 2000, 120 million were infected and 40 million disfigured

They are caused by three
parasitic worms, Wuchereria bancrofti,
Brugia malayi, Brugia timori
. Adult worms get lodged in the lymphatic
system and live for 6 to 8 years. During the lifetime of the worms they produce
a large number of microfilaria that circulates in the blood. When the mosquito feeds
on the blood of the affected human, they take in the immature larvae and inject
the larvae when they feed on the blood of another human.

The current treatment
methodology for lymphatic filariasis involves many rounds of drugs. However,
the current study includes a combination of three drugs,
ivermectin, diethylcarbamazine and albendazole that are found to be more effective
and treat the disease rapidly.
These require only two to three rounds of
administration as against the previous drug regimen that was administered for
multiple rounds.

Pledge to Eradicate Lymphatic Filariasis

The World Health
Organization (WHO) is working towards eliminating the disease by year 2020.
Three drug companies have pledged their support and offered to provide free
drugs to eliminate the disease – Merck, GlaxoSmithKline and Eisai.

The use of triple drugs
in treating the disease is far more effective and rapid when compared with a
single drug approach.
However, the researchers are a little apprehensive
about how effective the distribution and the use of the drug would be. People
seldom stick to drug regimens when the disease is rare.

The study researchers
used mathematical models to try and determine how effective the drug therapy
would be to eliminate the disease. Three different models developed in three
different Universities – The University of Warwick, Notre Dame University and
The Erasmus Medical Centre. All three models concurred that the three drug
strategy would be most effective in curbing the spread of the disease. The
use of multiple drugs will lower the infection load faster, a much needed
support for people in countries with poor resources.

Dr. Hollingsworth who is
based in The University of Warwick’s Mathematic Institute and School of Life
Sciences stated that the effectiveness of the treatment was dependent on being
able to reach the most inaccessible people. This will truly aid in lowering
incidence of the disease.

The first author of the
study, Dr. Mike Irvine from the University of British Columbia says that the
important aspect of elimination campaigns is to find an effective treatment
method that will lower the risk of the disease within a few years, long drawn
treatment modules will not be effective.

“The multi-modelling study could aid the
Indian policy makers to decide on the need for introducing the triple drug
regimen in the ‘hard-core’ districts to accelerate lymphatic filariasis
elimination in India” said Dr. Swaminathan Subramanian, from the Vector Control
Research Centre (ICMR).

Elephantiasis due to
lymphatic filariasis is a debilitating disease with a strong social stigma
attached to it. The efforts taken by the medical fraternity in eliminating this
disease condition will aid in removing a dreaded condition that has physically
deformed millions till date.

References :

  1. Lymphatic filariasis – (http://www.who.int/mediacentre/factsheets/fs102/en/)
  2. Elephantiasis – (https://rarediseases.org/rare-diseases/elephantiasis/)
  3. Michael A Irvine, Wilma A Stolk, Morgan E Smith, Swaminathan Subramanian, Brajendra K Singh, Gary J Weil, Edwin Michael, T Deirdre Hollingsworth. Effectiveness of a triple-drug regimen for global elimination of lymphatic filariasis: a modelling study. The Lancet Infectious Diseases, 2016; DOI: 10.1016/S1473-3099(16)30467-4

Source: Medindia

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