Control of bancroftian filariasis by common salt medicated with diethylcarbamazine in Liehyu District (Little Kinmen), Kinmen (Quemoy) Islands, Republic of China

SummaryA diethylcarbamazine (DEC)-fortified salt intervention programme was implemented between 1982 and 1986 in Karaikal district, Union territory of Pondicherry, south India, to control Culex transmitted bancroftian filariasis. The intervention reduced the microfilaria (Mf) rate from 4.49% to 0.08%. showed an overall Mf rate of 0.46% in the high-risk urban areas and 0.18% in the rural areas; none of the sampled children was positive for Ag. All detected Mf carriers were >20 years old. The age of the youngest Mf carrier was 30 years in urban and 21 years in rural areas, which suggests that transmission was interrupted and there was no incidence of new Mf case after cessation of DEC salt programme. Eleven of 15 urban and 15 of 17 villages were totally free from microfilaraemia. Nevertheless, three of 15 surveyed urban localities and two of 17 villages showed >1% Mf rate. Thus, it seems that (i) postintervention very low levels of microfilaraemia can continue as long as 20 years; (ii) 0.60-0.70% Mf rate is a safe level and at this level recrudescence of infection may not occur; (iii) there can be isolated localities with >1% Mf rate and their detection for further intervention measures could be challenging in larger control ⁄ elimination programmes and (iv) the residual infection mostly gets concentrated in the adult population, in underdeveloped urban areas and in historically highly endemic or large endemic rural areas. These groups and areas should be targeted with rigorous intervention measures such as mass drug administration to eliminate the residual infection.

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“…1989; Subramanyam Reddy & Venkateswaralu 1996). The reduction was similar to that observed in other studies (Fan et al. 1975a,b,c; Rao et al.…”

Section: Discussionsupporting

confidence: 92%

Prolonged persistence of residualWuchereria bancroftiinfection after cessation of diethylcarbamazine-fortified salt programme

Ramaiah

Thiruvengadam²,

Vanamail

et al. 2009

Tropical Medicine &Amp; International Health

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“…The results of these trials in India and elsewhere proved to be very encouraging and mf density dropped by more than 90 per cent and mf disappeared from the blood in 31 to 98 per cent of the infected population 43 44 45 46 47 48 . Similar effects have been obtained from medium scale trials, covering population in the range between 1000 and 7000 49 50 51 52 53 54 and one large scale trial covering a whole endemic province with a population of over two million in China where the problem was as serious as in India 54 . The mf prevalence declined by 96 to 98 per cent and mf density by 87 to 99 per cent.…”

Section: How Do We Approach This Issue Vis-a-vis Psupporting

confidence: 66%

Diurnally subperiodic filariasis among the Nicobarese of Nicobar district - epidemiology, vector dynamics & prospects of elimination

Shriram

Krishnamoorthy

Vijayachari

2015

Indian Journal of Medical Research

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In India diurnally subperiodic filariasis (DspWB) is prevalent only in the Nicobar district of Andaman and Nicobar Islands. Studies undertaken at different points of time indicate that this form of filariasis is restricted to a small region in Nancowry group of islands where it is transmitted by mosquito Downsiomyia nivea, a day biting mosquito. Studies on prevalence, distribution, and assessment of endemicity status, vector incrimination, bioecology, host seeking behaviour, population dynamics of the vector, transmission dynamics and clinical epidemiology indicate the prevalence and persistence of this infection in the Nancowry group of islands with perennial transmission. There was no control programme in these islands, until the National programme to eliminate filariasis was launched in 2004. Eight rounds of annual mass drug administration (MDA) with diethyl carbamazine (DEC) + albendazole have been completed. Despite this, microfilaria prevalence remains at above one per cent, the level identified for initiating transmission assessment survey to decide on continuation of MDA further. This necessitates adjunct measures to the ongoing MDA programme in these islands. The vector control options could be an adjunct measure, but the vector is a forest dweller with a unique bio-ecology, therefore, not a technically feasible option. Use of DEC fortified salt for six months to one year could hasten the process of elimination. Although administration of DEC-fortified salt is simple, rapid, safe, and cost-effective, challenges are to be tackled for evolving operationally realistic strategy. Such a strategy requires commitment of all sections of the society, a distribution mechanism that ensures the use of DEC-fortified salt in the Nancowry islands. Here we discuss the plan of action to serve the indigenous communities and operationalizing DEC fortified salt strategy through an inter-sectoral approach involving multiple stakeholders.

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“…Mass chemotherapy with DEC in salt has been tried fairly extensively in bancroftian filariasis (Hawking and Marques, 1967;Davis and Bailey, 1969;Basu et al, 1971;Sen et al, 1974;Fan et al, 1975). It would appear to offer an effective and practical method of control that can rapidly and substantially reduce transmission (Fan et al, 1975). However, no form of mass chemotherapy of onchocerciasis has so far been acceptable because of the adverse reactions.…”

Section: Non-pulsed Ocular and Systemic Delivery Of Decmentioning

confidence: 99%

Effects of various concentrations of diethylcarbamazine citrate applied as eye drops in ocular onchocerciasis, and the possibilities of improved therapy from continuous non-pulsed delivery.

Jones¹,

Anderson²,

Fuglsang³

1978

British Journal of Ophthalmology

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SUMMARY Diethylcarbamazine was given as eye drops in varying concentrations in a half-log dilution series from 1 0 to 0O0001 % to patients with ocular onchocerciasis. Migration of microfilariae into the cornea, followed by their straightening and disintegration, wvas observed with delivery rates as low as 0-1 ,ug/hour. Dose-related adverse inflammatory reactions, including the development of globular limbal infiltrates with itching and redness, were seen with delivery rates as low as 06 ,ug/hour, but substantial inflammatory reactions, including severe vasculitis, were seen only with delivery rates of or above 1 0 [Lg/hour. This suggests that it should be possible to achieve beneficial clearing of the microfilarial load, without adverse reactions, by continuous non-pulsed delivery of the drug. Technology exists for such delivery, either directly into the eye or systemically by a transdermal system that could give 3 to 7 days' treatment from each application. The observations reported suggest that after preliminary clearing of the microfilarial load by carefully controlled delivery of DEC it may be possible to maintain therapy by less strictly controlled delivery in DEC-medicated salt, or to use treatment with suramin, without incurring substantial adverse reactions, such as a deterioration in vision in cases in which the optic nerve is already compromised. Continuous non-pulsed DEC delivery systems could have a place in the management of onchocercal sclerosing keratitis. The unique opportunities for using the ocular model to define the requirements for beneficial non-damaging therapy with DEC should be explored in further field trials.Diethylcarbamazine citrate (DEC) is the most effective microfilaricide available for treating ocular or other forms of onchocerciasis. It is therefore potentially of great public health importance in the prevention of blindness from onchocerciasis and for treating certain other filarial diseases, but it is a very difficult drug to handle in cases of severe ocular onchocerciasis (Anderson et al., 1976a). It has low toxicity for animals and man, but serious adverse systemic reactions can occur when it is given orally by ordinary therapeutic schedules to heavily parasitised patients. These reactions include itching, papular and exfoliative skin eruptions, arthralgia, vertigo, collapse (Fuglsang and Anderson, 1974;Duke et al., 1976;Bryceson et al., 1977), and even death (Oomen, 1969;Anderson et al., 1976a).

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Control of bancroftian filariasis by common salt medicated with diethylcarbamazine in Liehyu District (Little Kinmen), Kinmen (Quemoy) Islands, Republic of China

Cited by 14 publications

References 0 publications

Prolonged persistence of residualWuchereria bancroftiinfection after cessation of diethylcarbamazine-fortified salt programme

Prolonged persistence of residualWuchereria bancroftiinfection after cessation of diethylcarbamazine-fortified salt programme

Diurnally subperiodic filariasis among the Nicobarese of Nicobar district - epidemiology, vector dynamics & prospects of elimination

Effects of various concentrations of diethylcarbamazine citrate applied as eye drops in ocular onchocerciasis, and the possibilities of improved therapy from continuous non-pulsed delivery.

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