Future strategies to be elaborated in order to tackle one of the world's most disfiguring diseases
2 May 2002 - A disfiguring disease that can affect everything from a person's sex life to his or her ability to work can be eliminated simply and effectively. All it takes is a dose of two drugs once a year for five years. The tiny worms that spread the disease are killed and prevented from passing on the infection.
That is the good news about lymphatic filariasis, which will be discussed in New Delhi by Ministers from at least seven of the most affected countries on Thursday and Friday, 2-3 May 2002. The Ministers are in India for a meeting bringing together the World Health Organization (WHO) and its partners in the Global Alliance for the Elimination of Lymphatic Filariasis. Together, they will be assessing recent successes and deciding on future strategies to end this scourge once and for all.
"The Global Alliance for the Elimination of Lymphatic Filariasis is a reflection of what partnerships should be about. It is action oriented and outcomes driven," said Dr Gro Harlem Brundtland, Director-General of the World Health Organization. "Most of all, the role of the partners does not stop at providing resources but goes beyond to help endemic countries to advance self-sustainable lymphatic filariasis elimination programmes."
The Chief Executive Officer of GlaxoSmithKline, Jean-Pierre Garnier, noted in New Delhi that the company has just delivered its one hundred millionth treatment donation of one of the drugs used in the elimination program. Says Garnier: "This confirms our commitment to one the most promising programs and one of the largest drug donations in the world."
Lymphatic filariasis is a disease that today maims and disfigures people in shocking numbers. At least 120 million people around the world have already been affected and 40 million of them have suffered serious incapacity or disability due to the thousands of worms that build up inside the body, causing swelling of the limbs and genitals and internal damage to organs and the lymphatic system.
Lymphatic filariasis, or LF, is sometimes known as elephantiasis because of the huge swellings it can produce in the more advanced stages of disease. Whole arms or whole legs can be affected, as can genitals. The affected area swells as it fills with fluid, which the body is unable to regulate because of the parasitic worms collected in and damaging the lymphatic system.
Lymphatic filariasis does not kill the body, but it can kill a person economically and socially and leave them ostracised by their own community. People with advanced cases of LF often find it difficult to find work; if they are single, it is almost impossible to find a partner; if they are married, their husband or wife may leave them.
"Lymphatic filariasis is one of the top priorities of the government," Pierre Tapfoba, Minister of Health and Development of Burkina Faso. "With more resources we could accelerate the elimination of LF in the country."
Regular annual doses of two drugs can completely prevent the disease being passed on by killing or affecting the parasites in an infected person and killing their microscopic offspring. Then there is no infection for a mosquito to pick up and pass on to others.
The idea is to treat the entire 'at risk' population, which means about one billion people worldwide, for a period long enough to ensure that levels of microfilariae in the blood remain below those necessary to sustain transmission. Annual doses of two drugs are needed for approximately four to six years, which is the reproductive lifespan of the parasite.
People who are already suffering the effects of lymphatic filariasis will not be completely cured by the drugs, but there are relatively simple measures they too can take to ease the effects of the parasites. Careful washing of the infected area can prevent the most severe effects of the disease. Researchers now know that the most extreme symptoms of lymphatic filariasis are largely due to secondary bacterial or fungal infections, which can be prevented with good hygiene.
While careful hygiene can help those who already have the disease, the main priority of the Global Programme to Eliminate Lymphatic Filariasis is to prevent the disease being passed from one person to another.
LF is a mosquito-borne disease. As the parasites grow in an infected person, they shed thousands of minute worms called microfilariae into the person's bloodstream. The worms are immature, but ready to be passed on in the next stage of their life cycle.
If a mosquito bites an infected person, it will absorb the microfilariae as it ingests their blood. The process of development then begins until the tiny parasites are ready to infect another person. They then move within the mosquito's body to the area close to its mouth. Next time the mosquito bites someone the microscopic worms are deposited on the skin. They can then pass through the skin and into the bloodstream, where they begin to mature and spread inside the victim's body.
Recent successes include the largest single drug administration ever done for LF, in Tamil Nadu State, India, where on one day, 28 million people were given the vital drugs to interrupt the spread of the disease. Another recent drug administration, in Zanzibar, covered 800000 people. In 2001, a further 26 million people worldwide were treated.
This is what can be done - and it can be done easily and effectively using existing technologies. However, it requires a huge amount of social and political will and requires the mobilization of large numbers of people in affected communities around the world. It can be done - now the challenge is to do it, in every country where people's lives are destroyed by lymphatic filariasis.