Hotspots in India are slums where residual lymphatic filariasis gathers. The most endemic states of India are Uttar Pradesh and Bihar.
Second, we are adding color to the ordinarily white tablets to help differentiate pills for people who cannot read. Third, we are individually labeling the medicine and providing informative literature inside the cartons to include drug purpose, instructions, and possible side effects, in the appropriate languages (English and Hindi).
MDA is a key strategy in fighting against LF, approved globally to prevent lymphatic filariasis in endemic areas and requiring administration to all the susceptible population in the community once or twice a year. MDA decreases transmission rates and prevents progression from subclinical to clinical disease and worse morbidity.11 In the past, the primary drug DEC, or else drugs ALB and DEC combined were used for this purpose. In 2017, new recommendations11 for eliminating the disease were published by the World Health Organization (WHO) and funded by the US Agency for International Development (USAID). Depending on special criteria and on co-endemic loiasis or onchocerciasis, there are four recommended treatments: annual triple therapy of ALB, DEC, and IVM (a combination used in most of India); annual dual therapy of ALB and IVM; annual dual therapy of DEC and IVM; or biannual ALB alone.
Bend Biomedical is working on an acceptance and effectiveness study to evaluate single-drug blister packs vs loose pills for LF PC in an urban subdistrict with slum areas. The new formulation will be used in selected areas, and using a control arm, the coverage of MDA with the new formulation will be compared to the same for the conventional formulation. Further it will also be interesting to examine the number of people who have never been treated who agree to be treated precisely because of the blister packs. The models tell us that if the proportion of non-compliant (never treated) declines, treatment will be more effective. The existing drug formulation for LF MDA consists of pills in bottles: IVM 3 mg at 200 mcg/kg (or height), DEC 100 mg at 6 mg/kg (or age), and ALB 400 mg. The trial formula is the same, but the tablets are in single-drug blister packs. All bottled drugs during routine MDA rounds in the control arm will come from the name-brand free-drug manufacturers: MSD, Eisai, and GSK. Households will be selected for each arm, and eligible participants will receive one or the other formula. The number of compliant patients in each arm and mean microfilariae Mf% using night blood survey and filarial test strips after treatment will be compared.
Use of IVM for LF is contraindicated in areas co-endemic for loiasis and is used restrictively for onchocerciasis based on potential serious adverse events in loiasis patients.11 DEC is also contraindicated in areas co-endemic for onchocerciasis and loiasis.11
Onchocerciasis and loiasis are not endemic in India.12,13 However the slum areas selected for blister packs must be eligible for ALB, DEC, and IVM triple therapy for lymphatic filariasis. The Government of India will issue locations for implementation. Healthcare workers will screen for neurocysticercosis and seizures during MDA.
DEC is a harsh drug especially in children. Care needs to be taken with allergy, itching, and swelling (especially of the eyes). In some, this may be life-threatening. This is more common in people with allergic challenges. Having plans for steroids and antihistamines available will always be recommended by us to GOI.
Note that the most pills any patient should receive in India is 8 pills for a tall adult: 1 ALB, 3 DEC, and 4 IVM.
ALB: Albendazole; DEC: Diethylcarbamazine citrate; ELF: Elimination of Lymphatic Filariasis; GOI: Government of India; IDA: Ivermectin with diethylcarbamazine and albendazole; IVM: Ivermectin; MDA: Mass drug administration; Mf%: Proportion microfilaremic; NLEP: National Leprosy Eradication Programme; NTEP: National Tuberculosis Elimination Programme; NVBDCP: National Vector Borne Disease Control Programme; USAID: United States Agency for International Development; WHO: World Health Organization.
2Filaria endemic districts. National Vector Borne Disease Control Programme. Available from: https:// nvbdcp.gov.in/index4.php?lang=1&level=0&linkid=453&lid=3733. [cited 2021 Feb 6].
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13Shivalingaiah PR, Veerabhadraiah P, et al. Onchocerciasis in the Orbital Region: An Unexpected Guest From Tropics. Int J Head Neck Surg 2018;9(4):137–139.