Triple therapy regimen recommended to help Guyana meet 2020 MDA goal

Nov 15, 2018 News

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Guyana, through its health sector, was in 2017 able to reach the accepted target of 65 percent coverage of its filaria Mass Drug Administration [MDA] programme for the first time in its history. However, word out of the Public Health Ministry is that at least four additional consecutive years will be required to achieve eligibility of the current regimen of two drugs – Diethylcarbamazine [DEC] and Albendazole.
This is according to information released for public consumption by the Ministry’s Head of Public Relations/Health Promotion Unit, Mr. Terrence Esseboom, who pointed out that “the only option left if Guyana is to meet its 2020 goal is to intensify our efforts with the introduction of a proven alternative drug regimen of triple therapy in 2019”.
But the alternative may be within hand reach. This is in light of the fact that the Pan American Health Organisation/World Health Organisation [PAHO/WHO] has recommended Triple Therapy, using Ivermectin in conjunction with DEC and Albendazole [IDA]. This regimen, it is believed, would require only two additional years of mass administration, that is, 2019 and 2020.
According to Esseboom, “this would place Guyana within the narrowing window of opportunity to meet its 2020 goal of interruption of transmission of filaria.
Filaria or lymphatic filariasis is a debilitating, stigmatising and impoverishing disease that affects over 36 million people globally. Because of this dilemma, hundreds of millions of dollars are lost annually due to ill health. “Persons with Elephantiasis [big foot] or Hydrocele [enlarged scrotum] also suffer socially from stigmatisation and discrimination in the job market.
In 2000, WHO launched the Global Programme to Eliminate Lymphatic Filariasis [GPELF] to achieve global elimination of filaria as a public health problem by 2020.
Moreover, a comprehensive programme includes MDA annually for five consecutive years, with a minimum of 65 percent coverage of endemic populations; morbidity management; the prevention of disabilities and integrated vector control.
Currently, MDA is taking place in 66 of the 72 countries where microfilaria has been found to be endemic. Of these countries, 20 are now in the post-MDA phase where they are being monitored to ensure elimination has been achieved.
However, Esseboom noted that here in the Americas, Trinidad, Suriname and Costa Rica have been removed from the WHO list of endemic countries, while Guyana, Brazil, Dominica Republic and Haiti are all actively working towards eligibility for elimination status. At present, reports suggest that Brazil and the Dominican Republic are about to complete their rounds of MDA and are preparing for transmission assessments.
Esseboom noted that “the fact that this is easily preventable does not overshadow the fact that a person who already shows chronic signs of the infection cannot be cured.”
He said that since the late 1800s, cases of filaria infection have been recorded by the local Ministry of Public Health. He noted that studies have shown that the main vector implicated in the spread of lymphatic filaria in Guyana is the Culex Quinquefasciatus mosquito.
This mosquito is found by vector control personnel in all 10 regions of Guyana and is the only known vector that transmits this disease in the Americas. When the mosquito bites an infected person, it ingests the microfilariae, which then mature to the stage of larvae in the mosquito. The larvae are deposited on the skin of someone the mosquito bites, after which it makes it way to the lymphatic vessels where they mature into the adult worm before multiplying hundred fold and releasing microfilariae into the blood stream.
“It therefore follows that wherever infected individuals and vector mosquitoes exist, the likelihood of disease spread is great,” said Esseboom, who revealed that part of the Ministry’s response to the country being endemic to filaria, includes raising public awareness of the joint responsibility for vector control and mass treatment of at risk individuals.
This, Esseboom said, includes the clearing of drains, ensuring proper disposal of tyres and garbage. Also the use of mosquito nets, mesh on houses, insecticides, fumigation, larvicides, early closure of windows and the covering of limbs in the evening, all help to reduce the likelihood of mosquito bites, and by extension, transmission of infection.
The senior ministry functionary noted, however, that “these measures are not stand alone and should be coupled with the destruction of microfilariae in the blood of persons who many times are unaware that they have been infected until it is too late.” It is for this reason that the MDA programme has been utilised as an imperative measure to combat the spread of filaria.

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