Filariasis Control Program

› Lymphatic filariasis can progress to elephantiasis, a swelling and thickening of body tissues from
accumulation of fluid. The skin may look thick, pebbly, and dark.

› Filariasis is caused by different species of microscopic parasitic * roundworms that are passed to
people through the bites of insects, most commonly mosquitoes. Several strains * of these
worms, known as filariae (fih-LAIR-e-e), can infect humans, including Wuchereria bancrofti
(vooker-E-re-ah ban-CROFT-e). There are also different types of filariasis itself, including
cutaneous (kyoo-TAY-nee-us) or skin-related, body cavity, and lymphatic * infections. In the
cutaneous disease, the worms live in the layers of the skin; in body cavity filariasis, they inhabit
certain body openings and surrounding tissue; and in the lymphatic form of infection, they
invade the vessels of the lymphatic system and the lymph nodes.

› Lymphatic filariasis, which can progress to a condition called elephantiasis is the most serious
form of the disease. It begins when an infected female mosquito injects worm larvae into a
person's blood while feeding. The larvae travel to the lymphatic vessels, where they grow into
adult worms. As adults, the worms can survive and reproduce for up to 7 years. The gradual
buildup of worms in the vessels hinders the lymphatic system's ability to fight infection, and
causes lymph fluid to collect—typically in the arms, legs, breasts, and male genitals—leading to
swelling and disfigurement.

› Filariasis is most common in tropical and subtropical regions, including parts of Africa, the
western Pacific, Asia (especially India), and Central and South America. In these areas, the
number of cases of filariasis continues to rise. It is estimated that more than 120 million people
worldwide have the lymphatic form of illness today, and approximately 40 million of them have
been disabled or disfigured by the disease. Although contracting filariasis is not a risk in the
United States, some recent immigrants may have it, and people who have traveled to other
countries can contract the disease as well. Missionaries and Peace Corps volunteers are
considered to be most at risk.

› The disease does not spread from direct person-to-person contact. Instead, it is transmitted by
the bite of a mosquito. When one of these insect bites someone who is infected, it takes in the
parasites along with its meal of blood. The mosquito then can pass those parasites on to the
next person it bites. Usually, someone must be bitten many times, typically over a long period,
to develop symptoms of filariasis.

› The lymphatic form of filariasis usually produces fever, swollen or painful lymph nodes in the
neck and groin, pain in the testicles and swelling in the limbs or genitals. Males and the male
urinary and genital systems are particularly likely to be affected. In elephantiasis, a severe form
of chronic * lymphatic filariasis, the blocked flow of lymph causes one or both legs to swell
significantly. Over time, the skin on the leg also can change, taking on a rough texture so that it
resembles the skin of an elephant. Although elephantiasis is unusual, up to half of all men with
lymphatic filariasis may show serious symptoms, such as swelling of the scrotum. In some cases,
people may have no obvious symptoms, but they still may have serious damage to the kidneys
and lymphatic system.

› Knowing that the person lives in or has spent time in a country where filariasis poses a risk can
help a doctor diagnose the disease. The doctor may also take skin and blood samples from the
patient to look for signs of the parasite.

› Ideally, treatment begins as soon as possible after the patient becomes infected. Prompt
treatment may not be possible, however, because the disease can be difficult to detect in its
early stages. When the diagnosis is made, treatment may include:

1. medication to kill the young worms in the bloodstream and stop the parasite's life cycle
(although the medicine cannot kill adult worms)
2. exercising and moving swollen limbs to improve lymph flow
3. bed rest and compression bandages to treat swelling
4. medications to lessen swelling and discomfort
 5. hospitalization and intravenous (IV) antibiotics for secondary infections that might
appear because the damaged lymphatic system is less able to assist in defending the
body against infectious agents
6. surgical treatment for deformities, such as enlarged limbs and scrotum, sometimes with
several procedures and skin grafts to correct cases of disfigurement.

› Filariasis can last a lifetime, and without treatment it can worsen. The disease can lead to
permanent disfigurement and damage to the lymphatic system and kidneys, secondary
infections, hardening and thickening of the skin, and sexual and psychological problems. In
countries where the disease is common, a serious social stigma often accompanies it.

› The Mass treatment has been going on province wide in 2003 targeting the eligible population
(2 yrs old, 7 above) since its pilot study in 2000 using the combination drug Diethylcarbamazine
Citrate and albendazole.

› In support to the program, an administrative Order declaring “November as Filariasis Mass

Treatment Month was signed by the Secretary of Health on July 2004 and was disseminated to
all endemic regions.

BASELINE DATA

› Prevalence Rate (1997): 9.7% per 1,000 population

› Endemic in 44 provinces however, 7 provinces have reached elimination level namely: Southern
Leyte, Sorsogon, Biliran, Bukidnon, Romblon, Agusan del Sur & Dinagat Island.

TARGET POPULATION / CLIENTS / BENEFICIARIES

› Individuals, families and communities living in endemic municipalities in 43 provinces in 11

regions.

INTERVENTION OF DOH

Vision: Healthy and productive individuals and families for Filariasis-free Philippines

Mission: Elimination of Filariasis as a public health problem thru a comprehensive approach and
universal access to quality health services

Goal: To eliminate Lymphatic Filariasis as a public health problem in Philippines by year 2017

General Objective: To decrease Prevalence Rate of Filariasis in endemic municipalities to

<1/1000 population.

Specific Objectives:

The National Filariasis Elimination Program specifically aims to:

1. Reduce the prevalence rate to elimination level of <1%

2. Perform mass treatment in all established endemic areas

3. Develop a filariasis disability prevention program in established endemic areas

4. Continue surveillance of established endemic areas 5 years after mass treatment

PROGRAM STRATEGIES

1. Endemic Mapping

2. Capacity Building

3. Mass Treatment (integrated with other existing parasitic programs)

4. Support Control

5. Monitoring and Supervision

6. Evaluation
7. National Certification

8. International Certification

MANAGEMENT BEING USED

1. Selective Treatment- treating individuals found to be positive for microfilariae in nocturnal

blood examination

Drug: Diethylcarbamazine Citrate

Dosage: 6mg/kg body weight in 3 divided doses for 12 consecutive days (usually given
after meals)

2. Mass Treatment- giving the drugs to all population from aged 12 years and above in all
established endemic areas

Drug: Diethylcarbamazine Citrate (single dose based on 6mg/kg body weight plus
Albendazole 400 mg given single dose once annually to people 12 years and above living in
established endemic areas.

3. Disablility Prevention- thru home-based or community-based care for lymphedema &

elephanthiasis cases. Surgical management for hydrocele patients.