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This July, Tonga eliminated lymphatic filariasis. Lymphatic filariasis is a mosquito-borne illness that attacks the lymphatic system. The Tonga Ministry of Health used a combination of large-scale treatment to control transmission and disability prevention activities to eliminate lymphatic filariasis.

Lymphatic filariasis is caused by a parasitic infection when filarial parasites are transmitted to humans and can become infectious through the bite of a mosquito. Most lymphatic filariasis cases are asymptomatic. While there are no external signs of infection, the parasites can damage the lymphatic system, kidneys and immune system. Eventually, the disease can become chronic and cause tissue swelling and skin or tissue thickening. This affects the limbs and genitalia.

Chronic infections of lymphatic filariasis cause severe disfigurement, pain and disability. This can cause people to lose their jobs and income. In addition, the social stigma associated with the disfigurement can lead to depression and anxiety.

Lymphatic filariasis has been prevalent in Tonga since the 20th century, and it has taken decades of work to eliminate the disease. In the 1950s the prevalence rate of lymphatic filariasis in Tonga was close to 50 percent. The disease incidence steadily decreased in the 1970s and 1980s as the Ministry of Health administered mass drugs throughout the country. Doctors administered two doses of medicine annually to the at-risk population. This drug reduces the amount of parasite in the bloodstream of an infected person, which prevents the spread of the parasite by mosquitoes. For these drugs to be successful in eliminating a disease they must be administered to the same population every year or four to six years. These treatments reached a coverage ranging between 81 percent and 92 percent.

Tonga’s efforts were so successful due to the continuous and focused work of their Ministry of Health. In addition, there was strong financial support from other donors and partners who contributed drugs and educational resources. Tongan communities also played a significant role in the reduction of the disease; they were willing to take the drugs and work through different treatment programs for disabilities.

The incidence of lymphatic filariasis in Tonga is now less than one percent. Over the last five years, several independent experts analyzed the incidence of the disease through three transmission assessment surveys. Tonga must continue these surveys for the next five to ten years to ensure that the disease is not reintroduced.

Sarah Denning

Photo: Flickr

India's Largest Public Health CampaignIn 2014, the Indian Ministry of Health and Family Welfare paired with the Global Network for Neglected Tropical Diseases to create a communication campaign aimed at the prevention of Lymphatic Filariasis.

The video for India’s largest public health campaign by the Mass Drug Administration to eliminate Lymphatic Filariasis (LF) begins with a trail of oversized footprints attracting a group of curious spectators. The growing crowd follows the giant tracks to find their owner and the intent investigation of the crowd captures the matched attention of viewers off-screen.

Lymphatic Filariasis, commonly known as elephantiasis, is a disfiguring and debilitating neglected tropical disease that puts three in five people in India at risk of infection. While prevention of the disease is fairly simple — a pill once every year — public participation in the government’s drug distribution programs was low.

In 2002, India set a goal to eliminate preventable diseases by 2015. Their current campaign plan began in 2004. Although the Filaria has not yet been eliminated in India, significant progress has been made since India’s largest public health campaign began.

The video leads the villagers to a man with LF, who stresses the ease of prevention and emphasizes that contracting the disease can happen to anyone. The narrative is largely positive with the patient himself acting as a champion for awareness and change. Distributed widely in ten different languages on television and online, the public service announcement reached over 300 million people.

The number of people reached by the MDA increased from 72 percent in 2004, to 89 percent in 2015. Subsequently, the microfilaria rate decreased from 1.2 percent in 2004 to 0.26 percent in 2015, according to India’s National Vector Borne Disease Control Program (NVBDCP).

As of May 2016, 72 districts (each with an approximate population of 164 million) completed the Transmission Assessment Survey for LF and were qualified to stop the MDA program, said the NVBDCP. India’s dedication and success in decreasing LF likely increased global attention on Lymphatic Filariasis and other neglected tropical diseases. On June 3, the World Health Organization reported that LF was eliminated in Sri Lanka and Maldives.

With the largest Mass Drug Administration in the world, the Indian government continues its efforts to eliminate Lymphatic Filariasis by distributing LF preventative medication to 460 million people in 17 Indian states.

Erica Rawles

Photo: Flickr

5 Most Common Neglected Tropical Diseases
Neglected tropical diseases (NTDs) affect 1 billion people, or one out of every six individuals, every year. Half a million people die from NTD related effects, the majority of whom are impoverished children, women and persons with disability. Although methods of prevention and treatment are available, these diseases remain extremely common in parts of Africa, Asia, Latin America and the Caribbean.

The following list of NTDs represents approximately 90% of the global NTD burden, along with methods of treatment and prevention.

1. Onchocerciasis

Also known as “river blindness,” this disease is transmitted via black flies carrying the onchocerca volvulus parasite. The parasite causes debilitating itching and upon reaching the eyes, visual impairment and eventually blindness. It is the second leading cause of infection-induced blindness, behind Trachoma, with 37 million people infected with the disease.

A single, annual dose of Mectizan controls the disease and relieves symptoms. Some countries in Latin America successfully eliminated disease transmission after administering the drug for twenty years which lends hope to its possible elimination in the African continent.

2. Trachoma

One of the oldest infectious diseases known to mankind and the leading source of global blindness, is caused by the bacterium Chlamydia trachomatis. Eye-seeking flies transmit the disease from an infected person’s eye discharge to uninfected hosts.

Repeated infections result in a scarred interior eyelid thereby forcing eyelashes to turn inward thus scratching the cornea, all of which is followed by blindness. It affects about 21.4 million people, of whom 1.2 million are blind.

It is hyperendemic in remote poor rural areas of Africa, Central and South America, Australia and the Middle East.
The World Health Organization (WHO) recommends the SAFE strategy (Surgery, Antibiotic treatment, Face washing and Environmental changes) to limit its spread.

3. Schistosomiasis

Or, snail fever, is a parasitic disease transmitted by freshwater snails to bathing or swimming humans. Urniary schistosomiasis progressively damages the bladder, ureters and kidneys. Intestinal schistosomiasis enlarges the liver and spleen, damages the intestines and creates hypertension of the abdominal blood vessels. It affects 200 million people, and in children can impair growth and cognitive development.

A single dose of praziquantel with repeated community distribution treats and controls the disease.

4. Soil-transmitted helminthes

Affects more than 880 million children around the world. The intestinal worms may result in diarrhea, abdominal pain, anemia, general malaise and severe infection can impair growth and cognitive development.

Improved sanitation, health education and the periodic administration of anthelminthics to at-risk groups limits the rate of transmission.

5. Lymphatic filariasis (LF)

Also known as elephantiasis, is a mosquito-borne disease which results in painful swelling of the limbs and genitals. Over 120 million people are currently infected and nearly 1.4 billion people are at risk in 73 countries.

The WHO recommends yearly large-scale Mectizan and albendazole doses for four to six years to interrupt transmission.

This information was compiled from the Neglected Tropical Disease NGDO Network, World Health Organization and the Center for Disease Control.

Emily Bajet

Sources: Neglected Tropical Diseases (NGDO) Network, WHO, WHO Programmes, Center for Disease Control and Prevention(CDC)
Photo: Bullion Street

elephantiasis_in_haiti
Lymphatic filariasis (LF), a condition known as “elephantiasis” that can lead to the severe and debilitating swelling of the arm or the leg, is considered one of the most disabling diseases for those affected. In Haiti, the condition is present in 118 of 135 communities, which leaves 88% of the country as a potential risk zone. It is classed as a “neglected tropical disease;” although it has long disappeared from industrialized countries, it remains a severe threat for those living in developing regions of the world.

Mass Drug Administration (MDA) was achieved on a national level in Haiti in 2012, with many of the endemic regions having taken part in the program for at least four years. The LF infection can be prevented and treated with a combination of medicines – a single dose of Albendazole and Diethylcarbamazine Citrate – that cost about 50 cents per person each year. The World Health Organization recommends that the drugs are taken for five years in order to stop transmission of the disease, but acknowledges that it is just as important to address the emotional effects of the infection, as it is the physical.

Haiti’s MDA program is now up for assessment; while the project has been successful in reducing transmission, applying the concept to Haiti has been challenging. Extreme poverty, periodic social unrest, and depleted health system infrastructure have persisted as roadblocks to the program. Now, a more holistic approach is being taken by the disability charity, CBM. In partnership with the University of Notre Dame and Hospital St. Croix, CBM is addressing the unmet need of those who already have LF; by setting up self-help groups, they are empowering patients through self-care education, and psychological and emotional support. These clubs meet twice a month and participants receive information about self-care, hygiene and basic limb care. All members receive a hygiene kit, which includes alcohol swabs and antiseptic soaps to clean their feet.

The CBM program combines global heath research and education and puts the two elements into practice; not only does it help prevent LF, but it provides care for those affected by it. Community programs, such as the one provided by CBM, addresses issues other than the physical disability, by promoting inclusion and tackling the stigma for people suffering from clinical manifestations of LF. This comprehensive partnership complements the MDA program and is a crucial mechanism in the fight to address, prevent, and eliminate elephantiasis in Haiti.

– Chloe Isacke

Sources: The Guardian, The Root
Photo: Management Sciences for Health

Chagas-Disease-parasite

The World Health Organization (WHO) wants to draw attention to diseases that have typically been neglected and underreported. Referring to treatment for schistosomiasis, Dr. Margaret Chan, Director-General of the World Health Organization, stated, “We can blanket this part of the world [Africa] with medicines that rid every schoolchild of worms and eggs, parasites that interfere with their learning, impair cognitive development, and compromise their nutritional status.” These are ten parasitic diseases WHO classifies as neglected.

1. Chagas Disease is transmitted through a triatomine bug’s sting, or by contact between the bug’s infected feces and open wounds or mucous membranes. In its chronic phase, parasites embed in tissue such as heart or digestive muscle. Symptoms include a purplish bruise, a fever lasting several weeks, headache, abdominal pain, cough, rash, diarrhea, chest pain, heart failure, and less commonly seizures or paralysis. There is no vaccine available, but insecticide treatments, bed nets, and good hygiene practices can prevent contraction.

2. Dracunculiasis, or “Guinea-worm disease” is caused by the ingestion of contaminated water. Over about a year, the parasite painfully migrates through tissues, eventually emerging from a painful blister formed on infected persons’ feet. Often relief is sought by immersing the body in cold pond water. Unfortunately, this causes the female worm to release thousands more larvae into the water. When a person drinks the contaminated water, the larvae migrate through their intestinal wall and the process begins again. There are no drugs available to prevent or heal the disease. Patients frequently remain sick for several months, although it is rarely fatal.

3. Echinococcosis develops in humans by ingestion of Echinococcus granulosus eggs, primarily through contact with infected dogs or by consuming contaminated food or water. If left untreated, Echinococcosis has a high fatality rate in humans.

 4. Foodborne Trematodiases are a group of parasitic infections caused by unsanitary food preparation or defecation of infected animals in fresh-water sources. The infections that make up Foodborne Trematodiases are Clonorchiasis, Fascioliasis, Opisthorchiasis and Paragonamiasis. Symptoms include fever, abdominal pain, chest pain, bacterial infections, nausea, skin rashes, and in some cases fatal forms of bile duct cancer.

 5. Human African Trypanosomiasis, or “Sleeping Sickness” is transmitted by the bite of a tsetse fly. The disease affects mostly poor populations living in rural areas of Africa. If left untreated, Sleeping Sickness is usually fatal.

6. Lymphatic filariasis, or elephantiasis, is a painful disease that causes disability and disfigurement. Infection usually occurs in childhood, while visible symptoms don’t appear until adulthood. Filarial infection can cause fluid retention, fever, and genital disease. Nearly all infected persons suffer lymphatic damage and nearly half suffer kidney damage.

7. Onchocerciasis, or “River Blindness” is transmitted through the bites of infected blackflies. Infection leads to blindness, skin rashes, lesions, intense itching, and skin discoloration. Insecticide treatment of blackfly breeding sites can prevent the spread of onchocerciasis, and there is a drug available to treat symptoms and reduce transmission potential.

8. Schistosomiasis is transmitted through contact with larvae infested water. It affects nearly 240 million people worldwide in areas without potable water or sanitation, causing chronic sickness. Anthelminthic drugs now offer some control of schistosomiasis in marginalized communities.

9. Soil-transmitted Helminth infections are transmitted by roundworm, whipworm, or hookworm eggs present in soil where sanitation is poor. It is estimated that over 880 million children need treatment for these parasitic infections which can cause diarrhea, abdominal pain, weakness, intestinal bleeding, loss of appetite, reduction in absorption of micronutrients, intestinal obstruction, rectal prolapsed, and diarrhea.

10. Cysticercosis is an intestinal infection of adult tapeworms that can develop in a number of tissues. Those located in the central nervous system are known to be the most frequent preventable cause of epilepsy in the developing world.

– Dana Johnson

Source: WHO, WHO Speeches
Photo: ABC News