‘The future is in your hands, prevent filaria today’

‘The future is in your hands, prevent filaria today’ – doctor urges

Oct 08, 2017 News

By Sharmain Grainger

Even in a world as modern as ours, tauntings and harsh stares are still among the difficulties faced by some people who manifest signs and symptoms of lymphatic filariasis [commonly called filaria].

Dr. Allena Hercules

Although information about this disease, which could have very debilitating outcomes, is very much in the public domain, stigma and discrimination has not become a thing of the past.
But according to Dr. Allena Hercules, a Government Medical Officer [GMO], who for the past few months has been working within the Vector Control Services Unit of the Ministry of Public Health, persons should be slow to discriminate when it comes to filaria. This is in light of the fact, she explained, that anyone could be vulnerable to the disease.
She explained that although persons could be infected with the parasite that causes the disease, they may not manifest signs and symptoms until years later – sometimes as many as two decades later.
She disclosed that persons can be easily infected if they are bitten by a mosquito that had previously bitten someone already infected with the parasite.
According to the World Health Organisation [WHO], filaria is a painful and profoundly disfiguring disease which is caused by parasites classified as nematodes or roundworms of the family Filariodidea.
WHO has given credence to reports of discrimination by pointing out that since filaria is known to impair the lymphatic system, it can lead to the abnormal enlargement of body parts, causing pain and severe disability that attracts social stigma.
“The common sign is swelling and you can have swelling to the lower limbs [commonly referred to as big foot], the arms, breast and the scrotum in males. There can also be other general symptoms such as fever and pain in the infected area.
“Persons can even manifest chyluria [a milky urine],” explained Dr. Hercules.
According to the medical practitioner, chyluria is a rare condition in which lymphatic fluid leaks into the kidneys and turns the urine milky white.

Swelling of the feet is a common symptom of filaria.

Although filaria is not known to be fatal, but rather a silent disease that could severely debilitate the anatomy overtime, Dr. Hercules said that it is important to guard against it.
Here in Guyana, she noted that the disease is transmitted by the Culex mosquitoes which are known to thrive in stagnant water.
“We have been encouraging people to get rid of any collection of water that has been stagnant for a prolonged period of time. We have also been encouraging people to keep the drains in their environment clean,” said Dr. Hercules.
But since people will not always be able to control the presence of mosquitoes in their environment, she also revealed that wearing light coloured garments that cover most of the body could also help to reduce the incidence of mosquito bites. Added to this, the use of repellents, and sleeping under bed nets could be helpful.
WHO has explained that “mosquitoes are infected with microfilariae [the parasite] by ingesting blood when biting an infected host.”
“When infected mosquitoes bite people, mature parasite larvae are deposited on the skin from where they can enter the body. The larvae then migrate to the lymphatic vessels where they develop into adult worms, thus continuing a cycle of transmission,” WHO has outlined.
Given the simplicity of the transmission and the fact that there is no cure, once signs and symptoms are manifested, Dr. Hercules stressed the need for persons to take advantage of the treatment being readily availed by the Public Health Ministry through a recently launched campaign.
“If you already have the parasite inside of you and you use the tablets that we are offering, they can kill them and prevent the advancement of the disease,” Dr. Hercules related.
She noted that while campaigns were conducted in the past, they were not effective since the target of about 65 percent of the population was not met. As such the Ministry, with the support of its technical partner, the Pan American Health Organisation/World Health Organisation [PAHO/WHO], has been able to devise a new plan to achieve its goal to reach a wide cross-section of the population.
PAHO/WHO, according to Dr. Hercules, has donated the requisite supply of tablets to help combat the spread of the disease.
“This year we are not only doing house to house visits, we are going into schools, we are going into work places and we are going to fix points or places where there are likely to be a large gathering of people during the waking hours. From past experience we found that from going to households alone we were not able to reach a large percentage of the population,” Dr. Hercules admitted.
With the renewed efforts, she noted that the Ministry anticipates improved results.
Even persons who were reached during previous campaigns are eligible for tablets during this campaign too. Dr. Hercules said that persons are entitled to two types of tablets – 400 milligram DEC or Diethylcarbamazine and 100 milligram albendazole.
From age two to five, one DEC and one albendazole are tablets will be administered, from age six -14, two DEC and one albendazole tablets will be administered and for those 15 and older, three DEC and one albendazole tablets will be administered, she revealed.
Based on the age range of individuals, they will be required to take further doses, once annually for the next four years as well.
“Even though we may not be able to capture 100 percent of the population we will be happy once we get 65 percent or more because that would mean that our campaign would have been successful,” said Dr. Hercules.
She is appealing to members of the public to “take the tablets” when they encounter Pill Distributors who are have been trained to administer the filarial tablets.
“Encourage each other to take the tablet because if you take your tablet and someone else refuse to take theirs, you are still at risk of being re-infected…the tablets do not give a life-time immunity,” she cautioned.
She added, “Once everybody take their pills, we are certain that the adult worms will die and we are certain that we will help to arrest the spread of the disease.”
But there may be some within the population who may not be able to take the pills at the time of distribution. These individuals, according to Dr. Hercules, include pregnant women, children below the age of two and those who are seriously ill. However, once the status of these individuals change during the following years, they will be offered the tablets as well.
Even persons already manifesting the disease are not left in the cold. According to Dr. Hercules, the Vector Control Services Unit, located within the compound of the Georgetown Public Hospital Corporation currently conducts a central clinic for persons with filaria.
There, she noted, that patients with the disease are managed, not only to ensure that they do not further transmit the disease, but to help ease, as far as possible, the complications associated with the disease.
“We have methods to help prevent the swelling from advancing and those patients will also receive treatment in terms of tablets just in case they have worms living in them,” Dr. Hercules said.
But according to her, sometimes the stigma and discrimination faced by some patients can be even worse than their infliction.
“Some of our patients have told us stories of people looking at them and their family members with scorn. The reaction of some people you can’t always explain it; some people do not have the level of knowledge to assess these issues and so they react in a manner that is unwarranted,” considered Dr. Hercules.
She added, “I have heard that sometimes patients, because of their conditions are not even allowed into some public transportation.” This state of affairs, she noted, oftentimes force patients to seek to disguise their infliction [swelling], most times by wearing oversized clothing.
Even as she condemned attempts to stigmatise those with filaria, Dr. Hercules reminded of the importance for “everyone to take the pills. You should take the opportunity now to choose prevention than to lament in the future. The future is in your hands, prevent filaria today,” she urged.