Lymphatic filariasis

Prevention and Control

 Arthropod-borne Diseases
➢ Malaria (ICD-B54)
➢ Filariasis (ICP-B74.9)
➢ Dengue (ICD-A90)
➢ Chikungunya Fever (ICD-A92.0)
➢ Leishmaniasis (ICD-B55.9)
➢ Plague (ICD-A20.9)
➢ Yellow Fever (ICD-A95.9)
➢ Japanese Encephalitis (ICD-A83.0)
➢ Sandfly Fever (ICD-A93.1) (Pappataci Fever)
➢ Kyasanur Forest Disease (ICD-A98.2)
 INTRODUCTION
▪ Helminths(worms) : A worm classified as a parasite.
▪ Parasite means disease-causing organisms that lives on or in a human body &
derive nourishment from its host).
▪ Their eggs enter the body through skin, mouth & anus.

TYPES OF HELMINTHS

Nemathelminths Platyhelminths
(round bodies worms) (flat bodied worms)
 Nemathelminths
(nematodes)
Platyhelminths
Different types
They are of two types
➢ Roundworms
➢ Hookworms
1)Trematodes (flukes)- liver,
➢ Whipworms
intestinal, lung and Blood
➢ Threadworms
flukes (schistosomes)
➢ Pinworms
➢ Filarias
2) Cestodes (tapeworms)
➢ Onchocerca
➢ Guinea worms
Trematodes
 Helminths and helminthiasis
DEFINITION
➢ Anthelmintics are drugs that either kill (vermicide) or expel (vermifuge)
infesting helminths.
➢ Helminthiasis is more common in developing countries with poorer
personal and environmental hygiene.
➢ Infections with helminths, or parasite worms affect more than two billion
people worldwide.
 Filariasis
➢ Not fatal but important public health problem because considerable
suffering, deformity and disability.
➢ Social stigma: swelling of elephantiasis produce disfiguration, resulting in
matrimonial handicap and inferiority complex.
➢ Physical disabilities due to obstructional defects (e. g swelling of genitals
and legs or chylous ascites) result in loss of manpower. An example is the
coir industry in Kerala.
 Global prevalence
➢ Filariasis is a global problem.
➢ Major social and economic scourge in the tropics and subtropics of Africa, Asia,
Western Pacific and parts of the Americas, affecting over 73 countries.
➢ W. bancrofti (95 %); others: Brugia malayi in South-East Asia and B. timori in
Indonesia.
➢ Lymphatic filariasis is a public health problem in India. The disease is endemic all
over India, except in Jammu and Kashmir, Himachal Pradesh, Punjab, Haryana,
Delhi, Chandigarh, Rajasthan, Nagaland, Manipur, Tripura, Meghalaya, Sikkim,
Arunachal Pradesh, Mizoram, and Dadra and Nagar Haveli.
➢ However, surveys carried out during the past two decades indicate that areas
previously known to be free from filariasis are showing evidence of low degrees of
transmission.
➢ Heavily infected areas are found in Uttar Pradesh, Bihar, Jharkhand, Andhra
Pradesh, Orissa, Tamil Nadu, Kerala and Gujarat.
 Epidemiology
➢ Communicable disease --increasing in extent in India, because drainage
facilities are not keeping pace with the rapidly increasing water supply in
towns and villages.
➢ Spreading to areas previously free from the disease. E. g Palghat town,
Kerala (prevalence rates of 0 , 4.3 and 5.3 percent in 1950, 1960 and 1966
respectively)
➢ Majority infections remain symptomless and thus potent source for the
spread of infection.
➢ Sri Lanka-- 32 percent subjects were found to remain symptomless carriers.
 Identification
➢ Filarial infection ---presence of filarial parasites of any stage and sex in the human
host.
➢ At present, the detection of microfilaria is the only definite method for
demonstrating infection. Around 90 percent of MF carriers are asymptomatic.
➢ Filarial disease -- presence of clinical manifestations, i.e. acute
adenolymphangititis, epididymoorchitis, lymphedema, hydrocele, etc.
➢ In epidemiological practice these manifestations (irrespective of patent
microfilaremia) are assumed to be of filarial origin in endemic areas.
➢ A host of other clinical entities have been reported to be caused by filarial
infections.
➢ Of these, glomerulonephritis, arthritis and endomyocardial fibrosis are probably of
practical importance.
 Identification
➢ Acute adenolymphangititis- recurrent attacks of fever associated with
inflammation of the lymph nodes and or lymph vessels
➢ Epididymo orchitis-- inflammation of the epididymis and/or testicle (testis). In
adults, epididymo-orchitis is usually due to infection, most commonly from a urine
infection or a sexually transmitted infection.
➢ Lymphedema- increased collection of lymphatic fluid in the body, causing swelling
➢ Hydrocele- fluid collection within the tunica vaginalis of the scrotum
➢ Endomyocardial fibrosis- fibrosis of the apical endocardium of the right ventricle
(RV), left ventricle (LV), or both- usually in tropical and subtropical poverty regions
 Lymphatic filariasis- causes
➢ Defined as infection with three closely related nematode worms –
➢ Wuchereria bancrofti, Brugia malayi and Brugia timori
➢ All three infections are transmitted to man by the bites of infective mosquitoes.
➢ All three parasites have basically similar life cycles in man
➢ Adult worms living in lymphatic vessels
➢ Their offspring (microfilariae MF)--circulate in peripheral blood and are available
to infect mosquito vectors when they come to feed.
➢ The disease manifestations range from none to both acute and chronic
manifestations such as lymphangitis, lymphadenitis, elephantiasis of genitals, legs
and arms or as a hypersensitivity state such as tropical pulmonary eosinophilia or
as an atypical form such as filarial arthritis.
➢ The first 3
worms are
responsible for
lymphatic
filariasis
➢ Others for
"non-lymphatic
filariasis".
➢ The parasites
causing non-
lymphatic
filariasis are
not found in
India.
 Transmission
In humans the source of infection is a person with circulating Mf in
peripheral blood. In filarial disease (late obstructive stages) Mf are not
found in the blood.
 Factors
➢ Host factors
➢ Man is a natural host.
➢ (a) AGE: All ages are susceptible to infection. Infection rates rise with age up to the
age of 20-30 years and then level off.
➢ (b) SEX : In most endemic areas the Mf rate is higher in men.
➢ (c) MIGRATION : The movement of people from one place to another has led to
the extension of filariasis into areas previously non-endemic.
➢ (d) IMMUNITY : Man may develop resistance to infection only after many years of
exposure.
➢ (e) SOCIAL FACTORS : Lymphatic filariasis is often associated with urbanization,
industrialization, migration of people, illiteracy, poverty and poor sanitation.
 Factors
➢ Environmental factors
➢ (a) CLIMATE : important factor in the epidemiology of filariasis. It influences the
breeding of mosquitoes, their longevity and also determines the development of
the parasite in the insect vector. The maximum prevalence of Culex
quinquefasciatus (previously known as C. fatigans) was observed when the
temperature was between 22 to 38 deg. C and optimum longevity when the
relative humidity was 70 per cent,
➢ (b) DRAINAGE: Lymphatic filariasis is associated with bad drainage. The vectors
breed profusely in polluted water,
➢ (c) TOWN PLANNING : Inadequate sewage disposal and lack of town planning have
aggravated the problem of filariasis in India by increasing the facilities for the
breeding of C. quinquefasciatus (C. fatigans). The common breeding places are
cesspools, soakage pits, ill-maintained drains, septic tanks, open ditches, burrow
pits, etc.
 Incubation period
➢ The time interval between inoculation of infective larvae and the first appearance
of detectable Mf is known as "prepatent period".
➢ Direct information on the duration of the prepatent period is lacking.
➢ The time interval from invasion of infective larvae to the development of clinical
manifestations is known as the "clinical incubation period".
➢ This period, most commonly, is 8 to 16 months. This period may, however, be
longer.
 Clinical manifestations
➢ Only a small proportion of infected individuals exhibit clinical signs.
➢ The disease manifestations can be divided into two distinct clinical types :
➢ (a) lymphatic filariasis caused by the parasite in the lymphatic system, and (b)
occult filariasis caused by an immune hyper-responsiveness of the human host
(e.g., tropical pulmonary eosinophilia).
➢ 1. LYMPHATIC FILARIASIS:
➢ (i) Asymptomatic amicrofilaraemia
➢ (ii) Asymptomatic microfilaraemia
➢ (iii) Stage of acute manifestations
➢ (iv) Stage of chronic obstructive lesions
 Clinical manifestations
➢ 1. LYMPHATIC FILARIASIS:
i. Asymptomatic amicrofilaraemia: In all endemic areas a proportion of population
does not show Mf or clinical manifestations of the disease, not possible to
determine whether persons in this group have detectable infections or whether they
are free from infection.
ii. Asymptomatic microfilaraemia: considerable proportion of people are
asymptomatic, although their blood is positive for Mf. They may remain without any
symptoms for months - in some instances for years.
iii. Stage of acute manifestations: first months and years there are recurrent episodes
of acute inflammation in lymph glands and vessels. The clinical manifestations
comprise filarial fever, lymphangitis, lymphadenitis, lymphoedema of the various
parts of the body and of epididymo-orchitis in the male.
iv. Stage of chronic obstructive lesions: The chronic stage usually develops 10-15 years
from the onset of the first acute attack. This phase is due to fibrosis and obstruction
of lymphatic vessels causing permanent structural changes.
 Bancroftian filariasis vs Brugian filariasis
➢ Chronic Bancroftian filariasis ➢ Brugian filariasis
➢ Main clinical features ➢ Generally similar to Bancroftian
➢ hydrocele, elephantiasis and filariasis, but strangely the
chyluria. genitalia are rarely involved,
except in areas where Brugian
➢ Elephantiasis may affect the legs, filariasis occurs together with
scrotum, arms, penis, vulva and Bancroftian filariasis.
breasts, usually in that order of
decreasing frequency.
➢ The prevalence of chyluria is
usually very low.
 Clinical manifestations
➢ 2. OCCULT FILARIASIS
➢ Occult/ cryptic filariasis –filarial infections with no classical clinical
manifestations
➢ Mf are not found in the blood.
➢ Occult filariasis is believed to result from a hypersensitivity reaction to
filarial antigens derived from Mf.
➢ The best known example is tropical pulmonary eosinophilia.
 Lymphoedema management
➢ The prevention and management of disability caused by LF is public health issue
➢ Guidelines developed by WHO to manage acute dermato-lymphangioadenitis (ADLA)
➢ 1. TREATMENT FOR UNCOMPLICATED ADLA
a. Give analgesic such as paracetamol (1 g given 3 – 4 times a day);
b. Give oral antibiotic such as amoxicillin (1.5 g in 3 divided doses or oral penicillin) for at least 8
days. In case of allergy to penicillin, oral erythromycin (1 g, given 3 times a day) can be used;
c. Clean the limb with antiseptic;
d. Check for any wounds, cuts, abscesses and interdigital infection (especially between the
toes). Clean with antiseptic, if any present. If local superficial skin infection is found give
antibiotic cream, apply antifungal cream if interdigital infection is present;
e. Give advice about prevention of chronic lymphoedema caused by lymphatic filariasis;
f. Do not give antifilarial medicine.
g. Home management includes drinking plenty of water, rest, elevation of the limb, wriggling
the toes, cooling the limb with cold water and washing the limb if the patient can do it; and
h. Follow-up after 2 days at home. If situation does not improve, then refer the patient to
physician.
 Treatment
• First line
• Diethylcarbamazine
• Second line
• Ivermectin
• Albendazole
 CONTROL MEASURES
➢ The current strategy of filariasis control is based on :
➢ 1. Chemotherapy
➢ 2. Vector control
➢ Many years of experience with DEC chemotherapy has shown that, even after the
full regimen of treatment, some microfilariae still persist in the body. Due to this
and other reasons (e.g., toxic effects), it has not been possible to prevent the
spread of filariasis by the administration of DEC alone. Chemotherapy must,
therefore, be supplemented by an effective vector control program, if the disease
transmission has to be effectively prevented.
 1. Chemotherapy
➢ a. Diethylcarbamazine
➢ Diethylcarbamazine (DEC) is both safe and effective.
➢ Bancroftian filariasis:
➢ Most accepted dose: 6 mg/kg body weight per day orally for 12 days, given preferably in divided
doses after meals.
➢ This amounts to a total of 72 mg of DEC per kg of body weight as a full treatment.
➢ Brugian filariasis:
➢ 3 to 6 mg/kg body weight per day, up to a total dose of 36-72 mg DEC/kg body weight as a full
treatment.
➢ DEC is rapidly absorbed after oral administration, reaching peak blood levels in 1 - 2 hours.
➢ It is also rapidly excreted - the blood half-life is only 2 - 3 hours in alkaline urine and about 10-20
hours in acid urine.
➢ DEC causes rapid disappearance of Mf from the circulation.
➢ It is effective in killing Mf .
➢ The effect of the drug on the adult worm is uncertain.
➢ It has probably no effect on the infective stage larvae.
 1. Chemotherapy
➢ The administration of DEC can be carried out in various ways :
➢ (i) Mass therapy: Give DEC to everyone in community whether they have
microfilaraemia, disease manifestations or no signs of infection except children
under 2 years, pregnant women and seriously ill patients.
➢ The dose recommended is 6 mg/kg body weight.
➢ In some countries it is used alone and some countries with albendazole or
ivermectin.
➢ Mass therapy is indicated in highly endemic areas
 1. Chemotherapy
➢ (ii) Selective treatment
➢ DEC is given only to those who are Mf positive.
➢ It is generally accepted that selective treatment may be more suitable in areas of low endemicity
than in highly endemic
➢ areas.
➢ In India the current strategy is based on detection and treatment of human carriers and filaria
cases.
➢ The recommended dose in the Indian programme is 6 mg DEC per kg of body weight daily for 12
doses, to be completed in 2 weeks (i.e., 6 days in a week).
➢ (iii) DEC-medicated salt
➢ Special form of mass treatment using very low doses of the drug over a long period of time.
➢ Common salt medicated with 1-4 g of DEC per kg has been used for filariasis control in some
endemic areas of W. bancrofti and B. malayi, particularly after an initial reduction in prevalence
has been achieved by mass or selective treatment of Mf carriers.
➢ Treatment should be continued for at least 6 to 9 months.
➢ In the Lakshadweep islands, this regimen has been shown to be safe, cheap and effective.
 1. Chemotherapy
➢ b. Ivermectin
➢ Ivermectin is a semisynthetic macrolide antibiotic with a broad spectrum of
activity against a variety of nematodes and ectoparasites.
➢ The dose is 150-200 ng/kg of body weight
➢ Ivermectin is not used in India.
➢ It is used in the region of Africa.
➢ There is no drug toxicity in normal persons.
➢ However, in microfilaraemic patients there may be a variety of reactions as a
result of inflammatory response triggered by the cleared and dying microfilariae.
 1. Chemotherapy
➢ c. Filaria control in the community
➢ There are three reasons why filariasis never causes explosive epidemics :
➢ (a) the parasite does not multiply in the insect vector,
➢ (b) the infective larvae do not multiply in the human host, and
➢ (c) the life cycle of the parasite is relatively long, 15 years or more.
➢ These factors favour the success of control programme.
 2. Vector control
➢ Where mass treatment with DEC is impracticable, the control of filariasis must
depend upon vector control.
➢ Vector control may also be beneficial when used in conjunction with mass
treatment.
➢ The most important element in vector control is the reduction of the target
mosquito population in order to stop or reduce transmission quickly.
➢ The techniques for controlling mosquitoes:
➢ I. Antilarval measures:
➢ II. Anti-adult measures
➢ III. Personal prophylaxis
 2. Vector control
➢ I. Antilarval measures: elimination of breeding places by providing adequate
sanitation and underground waste-water disposal system. The current approach in
India is to restrict the antilarval measures to urban areas, because it is
operationally difficult and very costly to cover the vast rural areas of the country.
➢ (1) CHEMICAL CONTROL :
➢ (a) Mosquito larvicidal oil : Mosquito larvicidal oil (MLO) is active against all
preadult stages. It is being replaced by pyrethrum oil, temephos and fenthion.
➢ (b) Pyrosene oil-E : pyrethrum-based emulsifiable larvicide. The emulsion
concentrate contains 0.1 to 0.2 per cent pyrethrins by weight and is required to be
diluted with water before use. The emulsion is diluted in the ratio of 1:4,
➢ (c) Organophosphorus larvicides : During the past 10 years, organophosphorus
larvicides (e.g., temephos, fenthion) have been widely used with successful
results. Resistance is issue- once in a week in breeding places
 2. Vector control
➢ (2) REMOVAL OF PISTIA PLANT :
➢ In the case of Mansonia mosquitoes, breeding is best controlled by removing the
supporting aquatic vegetation such as the pistia plant from all water collections
and converting the ponds to fish or lotus culture.
➢ Alternatively, certain herbicides such as phenoxylene 30 or Shell Weed Killer D
may be used for destroying the aquatic vegetation.
➢ (3) MINOR ENVIRONMENTAL MEASURES :
➢ Larvicidal operations are complemented by minor engineering operations such as
filling up of ditches and cesspools, drainage of stagnant water, adequate
maintenance of septic tanks and soakage pits, etc. Environmental management is
the most efficient approach to the problem of controlling mosquito breeding.
 2. Vector control
➢ II. Anti-adult measures
➢ The vector mosquitoes of filariasis have become resistant to DDT, HCH and
dieldrin.
➢ The use of these compounds for indoor residual spraying, tried earlier, has been
discontinued.
➢ Pyrethrum, as a space spray, still holds promise.
➢ It is useful as a temporary means of personal protection, but has no practical value
in present-day vector control programmes.
➢ III. Personal prophylaxis
➢ The most effective preventive measure is avoidance of mosquito bites (reduction
of man-mosquito contact) by using mosquito nets.
➢ Screening of houses can substantially reduce transmission, but it is expensive.
 Integrated vector control
➢ None of the above vector control measures applied alone is likely to bring about
sustained control of filariasis vectors.
➢ An integrated or combined approach is needed to control filariasis using all the
above strategies and approaches in optimum combination.
➢ In filariasis four major breakthroughs have occurred.
➢ The first of these is the development of safe, single dose, annual drug treatment.
➢ Trials have proved that a single dose of DEC is very effective even two years after
treatment.
➢ A single dose of ivermectin has proved to be equally effective.
➢ A combination of single dose of both drugs reduced microfilaraemia more than 95
per cent, 2 years after treatment.
 FILARIA SURVEY
➢ 2 types
➢ routine survey or survey for evaluation
➢ The NICD (National Institute of Communicable Diseases, Delhi) standard is to examine 5 – 7 per cent of the
population for routine surveys, and at least 20 per cent for evaluation studies.
➢ The sample must be random, representative and cover all ages and both sexes.
➢ Statistical advice should be obtained when surveys are being planned.
➢ A standardized schedule for conducting filaria surveys is given in a WHO Expert Committee Report on
Filariasis.
➢ A filaria survey comprises the following
➢ 1. MASS BLOOD SURVEY: (i) The thick film, (ii) Membrane filter concentration (MFC) methods, (iii) DEC
provocation test
➢ 2. CLINICAL SURVEY: menifestations
➢ 3. SEROLOGICAL TEST: detect antibodies to Mf and adults using immunofluorescent and complement-fixing
techniques
➢ 4. XENODIAGNOSIS: The mosquitoes are allowed to feed on the patient, and then dissected 2 weeks later
➢ 5. ENTOMOLOGICAL SURVEY: This comprises of general mosquito collection from houses, dissection of
female vector species for detection of developmental forms of the parasite,
 Diagnosis
➢ Serological tests to detect antibodies to Mf and adults using
immunofluorescent and complement-fixing techniques cannot distinguish
between past and present infection, and heavy and light parasite loads in
the human hosts
 Advances in Diagnosis
➢ Very sensitive antigen based diagnostic methods were refined and standardized
and made available commercially
➢ Antibody based diagnostic methods were also developed.
➢ BinaxNOW Filariasis - the only immune-chromatographic test commercially
available for Bancroftian filariasis infection.
➢ New point-of-care rapid diagnostic test -Filariasis Test Strip (FTS) - is designed to
detect in human blood the antigen (Ag) of W. bancrofti, globally the predominant
parasite.
➢ The FTS has been evaluated in different countries and is now being used in
mapping, monitoring and evaluation activities (WHO, 2017).
➢ A new combination of drugs is shown to be highly effective against LF infection in
comparison to the current recommended regimen.
➢ WHO has recently recommended use of triple drug therapy in certain situations,
which is likely to expedite elimination of LF (WHO, 2017).
 Prevention and control
• India initiatives
• WHO programs
 The Global Programme to Eliminate LF
• The WHO launched GPELF in 2000.
• The strategy of GPELF 2 pillars:
• (i) to stop the spread of infection
(interrupting transmission)
• (ii) to alleviate the suffering among
people affected with chronic
disease (preventing and controlling
morbidity)
• The recommended strategy to
interrupt transmission of LF is
annual single dose mass drug
administration (MDA) in all
districts and areas endemic for LF.
 The Global Programme to Eliminate LF
• The drugs used in MDA program are a combination of DEC (6 mg/kg body weight) +
ALB (400 mg) in endemic areas free from onchocerciasis prevalence.
• The strategy recommended to alleviate suffering in chronic disease affected people
is Morbidity management and disability prevention (MMDP) through self-care
among lymphoedema patients that principally includes limb hygiene measures and
surgical intervention for hydrocele.
• Five to 6 rounds of annual MDA are required to interrupt transmission of LF. Each
round of MDA should be ‘effective’ i.e. at least 65% treatment coverage should be
accomplished.
• After MDA, the evidence for interruption of transmission is generated through
implementation of the first transmission assessment survey (TAS 1) among children
of 6-7 year age in each district.
• If the number of infected children found in TAS 1 is less than the threshold number
(which is approximately 2% Ag or Ab prevalence), then the MDA is stopped.
• After stopping the MDA, post-MDA surveillance is initiated. This consists of two
more rounds of TAS (TAS 2 and TAS 3).
NATIONAL FILARIA CONTROL PROGRAMME
➢ After pilot project in Orissa from 1949 to 1954, the National Filaria Control
Programme (NFCP) was launched in the country in 1955 with the objective
of delimiting the problem, to undertake control measures in endemic areas
and to train personnel to man the programme.

NATIONAL FILARIA CONTROL PROGRAMME

 NFCP Strategy
➢ Recurrent anti-larval measures at weekly intervals.
➢ Environmental methods including source reduction by filling ditches, pits,
low lying areas, deweeding, desilting, etc.
➢ Biological control of mosquito breeding through larvivorous fish.
➢ Anti-parasitic measures through 'detection' and 'treatment' of microfilaria
carriers and disease person with DEC by Filaria Clinics in towns covered
under the programme.
 Government initiatives
• LYMPHATIC FILARIASIS
• Accelerated Plan for Elimination of Lymphatic Filariasis 2018
• National Guidelines for Transmission Assessment Survey for Elimination of Lymphatic Filariasis
India- 2013-14 - Draft
• National Roadamp for Elimination of Lymphatic Filariasis (ELF)
• Guidelines for Drug Distributors in Elimination of Lymphatic Filariasis
• Guidelines on Filariasis Control in India and its Elimination (2009)
• Guidelines for elimination of Filariasis (2004)
Surveys (TAS) to
Define Endpoints
for Lymphatic
Filariasis Mass
Drug
Administration
• The National Filaria Control Programme (1955-2000) operated only in few
selected towns and cities and met with limited success.
• The Global programme to eliminate lymphatic filariasis, launched in 2000,
provided a great opportunity to India and several other affected countries to
effectively combat the disease.
• It envisages elimination of the disease through a two-pillar strategy
• (i) preventive chemotherapy in the form of annual mass drug administration
(MDA) to interrupt transmission of the disease
• (ii) morbidity management and disability prevention measures to alleviate
suffering among people affected with chronic disease condition.
 India initiatives
• 1996-1997: steps to eliminate LF (pilot project was launched in 7 districts)- annual
single dose MDA (DEC alone), was started in in 1996-1997 in 13 districts of 7 states.
• This enabled the national program to understand the logistics and operational
aspects of the program.
• 2002 - project extended to 31 districts in and DEC+ALB combination therapy was
implemented in some of the districts.
• 2004- national program was launched, covering 202 districts in 20 states UTs.
• The program had envisaged the target date of 2015 to eliminate LF.
• Subsequently, the program was further scaled up to include all 256 districts and
treat the entire population of endemic districts. Since 2007, the programme has
been implementing DEC+ALB combination therapy in all districts.
• During the last 12 years, the programme achieved good progress in some states.
 2018
• Starting from 2018 - the national program plans to implement an accelerated
plan to give a new impetus to the ongoing activities and achieve the goal of LF
elimination by 2020, in accordance with WHO regional strategic frame work
for control/elimination of Neglected Tropical Diseases (NTDs) and WHO NTD
goals and timeline.
• The plan is built upon the national guidelines for elimination of LF (2009) and
seeks to introduce newer intervention strategies and improve implementation
of MDA and Monitoring & Evaluation and surveillance strategies.
• The plan envisages
• (i) constitution of a high level inter-ministerial committee to monitor the
progress of the program
• (ii) strengthening of advocacy and social mobilization
 2018
• (iii) confirmatory mapping of uncertain areas using mini-Transmission Assessment Survey
• (iv) improved advocacy, social mobilization, training and supervision in all programme
activities
• (v) implementation of enhanced MDA with emphasis on micro-planning and directly
observed treatment, supported by adequate human and financial resources and
supplementary intervention measures
• (v) introduction of newer initiatives in districts with persistent transmission and/or poor
implementation of MDA
• (vi) strengthening of monitoring and evaluation and surveillance system (vii) robust
assessment of chronic disease burden
• (viii) development and implementation of plans for delivery of minimum package of care
for all chronic disease patients
• (ix) improved data collection and data reporting and consolidation of data and data
management using integrated NTD database.
• The accelerated plan aims to improve the effectiveness of MDA, interrupt transmission in
all LF endemic districts, increase access to recommended minimum package of care in all
areas with known patients by 2020.