Treatment and prevention
The primary goal of treating affected communities is to eliminate microfilariae from the blood of infected individuals in order to interrupt transmission of infection by mosquitoes. Studies have shown that > 5 years of MDA with preventive chemotherapy reduces microfilariae from the bloodstream and prevents the spread of microfilariae to mosquitoes. Preventive chemotherapy involves a combined dose of two medicines given annually to an entire at-risk population as follows: albendazole (400 mg) plus ivermectin (150–200 μg/kg) or diethylcarbamazine citrate (DEC) (6 mg/kg). MDA with albendazole (400 mg) alone should be given preferably twice per year to stop the spread of lymphatic filariasis in areas where Loa loa is present.
All people with filariasis who have microfilaraemia or a positive antigen test should receive antifilarial drug treatment to eliminate microfilariae. Unfortunately, the medicines available have limited effect on adult worms. Infected patients can be treated with one of the following regimens:
- a single dose of a combination of albendazole (400 mg) with ivermectin (150–200 μg/kg) in areas where onchocerciasis is co-endemic; in areas where onchocerciasis is non co-endemic, either
- a single dose of a combination albendazole (400 mg) plus diethylcarbamazine (6 mg/kg) or
- DEC (6 mg/kg) alone for 12 days.
Managing morbidity and preventing disability
Management of morbidity and disability prevention (MMDP) in lymphatic filariasis require a broad strategy involving both secondary and tertiary prevention. Secondary prevention includes simple hygiene measures, such as basic skin care and exercise, to prevent ADL and progression of lymphoedema to elephantiasis. For management of hydrocoele, surgery may be appropriate. Tertiary prevention includes psychological and socioeconomic support for people with disabling conditions to ensure that they have equal access to rehabilitation services and opportunities for health, education and income. Activities beyond medical care and rehabilitation include promoting positive attitudes towards people with disabilities, preventing the causes of disabilities, providing education and training, supporting local initiatives, and supporting micro- and macro-income-generating schemes. The activities can also include education of families and communities to help patients with lymphatic filariasis to fulfil their roles in society. Thus, vocational training and appropriate psychological support may be necessary to overcome the depression and economic loss associated with the disease. MMDP must be continued in endemic communities after MDA has stopped and after validation, as chronically affected patients are likely to remain in these communities.
Avoidance of mosquito bites through personal protection measures or community-level vector control and participation in MDA is the best option to prevent lymphatic filariasis.