Diethylcarbamazine Research Articles

Role of National Filaria Control Programme (NFCP) Units in Elimination of Lymphatic Filariasis in Uttar Pradesh, India

All 51 lymphatic filariasis (LF) endemic districts of eastern Uttar Pradesh are being targeted for elimination of lymphatic filariasis (ELF) and accordingly, mass drug administration (MDA) had to be observed for consecutive five years by administering only Di-ethyl Carbamazine Citrate (DEC) once in a year. However, the human resource deployed in the state under NFCP is not optimally involved and utilised for the purpose. Instead, one more drug albendazole (400 mg) was added along with DEC and was administered to all age groups above 2 years of age since 2008 to have an effect on the adult worm too together with mf and therefore, the parasite was destroyed preventing the infected person from developing clinical manifestation. This had to be assessed by conducting a transmission assessment survey (TAS) thrice at an interval of two years.Out of 51 filaria endemic districts of the state, 42 districts have been subjected to TAS since 2015, of which only one district, i.e. Rampur, has cleared TAS-1, TAS-2 and TAS-3 and is under post MDA surveillance. 09 districts were subjected to TAS-1 twice, but could not clear the TAS-1 level, while 09 other districts could not qualify to proceed further for TAS-1. The state is yet to achieve the elimination of LF and has to conduct more MDA rounds beyond the scheduled five rounds required for the elimination of the disease. The various reasons for not achieving the target in programme implementation have been raised in the present paper.

Current perspective of new anti-Wolbachial and direct-acting macrofilaricidal drugs as treatment strategies for human filariasis.

Filarial diseases like lymphatic filariasis and onchocerciasis belong to the Neglected Tropical Diseases and remain a public health problem in endemic countries. Lymphatic filariasis and onchocerciasis can lead to stigmatizing pathologies and present a socio-economic burden for affected people and their endemic countries. Current treatment recommendations by the WHO include mass drug administration with ivermectin for the treatment of onchocerciasis and a combination of ivermectin, albendazole and diethylcarbamazine (DEC) for the treatment of lymphatic filariasis in areas that are not co-endemic for onchocerciasis or loiasis. Limitations of these treatment strategies are due to potential severe adverse events in onchocerciasis and loiasis patients following DEC or ivermectin treatment, respectively, the lack of a macrofilaricidal efficacy of those drugs and the risk of drug resistance development. Thus, to achieve the elimination of transmission of onchocerciasis and the elimination of lymphatic filariasis as a public health problem by 2030, the WHO defined in its roadmap that new alternative treatment strategies with macrofilaricidal compounds are required. Within a collaboration of the non-profit organizations Drugs for Neglected Diseases initiative (DNDi), the Bill & Melinda Gates Foundation, and partners from academia and industry, several new promising macrofilaricidal drug candidates were identified, which will be discussed in this review.

Introduction of Triple-Drug Therapy for Accelerating Lymphatic Filariasis Elimination in India: Lessons Learned.

ABSTRACT.There are 670 million people at risk of contracting lymphatic filariasis (LF) in India, which bears 40% of the global burden of the disease. The National Program to Eliminate LF was launched in 2004 first with a single-drug therapy—diethylcarbamazine (DEC), followed by a two-drug therapy—DEC + albendazole (DA). In 2017, following successful drug trials, World Health Organization endorsed a new triple-drug therapy to fight LF using ivermectin with DEC and albendazole (IDA). 1 In June 2018, India made new commitments to accelerate their program to eliminate LF and initiated the new IDA protocol in five districts in the country. This article looks at the experience of India in the roll out of the new drug protocol and shares their preparations, successes, challenges, and lessons learned.

Development water in oil nanoemulsion of diethylcarbamazine for enhanced the characteristics for lymphatic targeting: A proof of concept study

As an antifilariasis drug, oral administration of diethylcarbamazine (DEC) could not effectively deliver the drug to the lymphatic system. Hydrophobic formulation with a particle size of <100 nm could improve the delivery of drug. Accordingly, we developed water in oil nanoemulsion encapsulating DEC. The nanoemulsion was less than 100 nm with negative charge, showing its suitability for lymphatic targeting. The nanoemulsion could sustain the release of DEC and improve the retention in intestinal tissue in comparison with DEC solution. Importantly, this approach did not cause any hemolysis in in vitro study and any irritation in in vivo study.

Breast filariasis presenting fibroadenoma like nodules: a rare diagnosis.

India has still not eradicated filariasis, which is still endemic throughout the country. This study focuses on the breast asanon-typicalbut notuncommonsite of breast diseasecharacterizedby nematodescausingobstructionof lymphatic vesselscaused by filariasis. The case described herein involves a 26-year-old married female who presented with a subcutaneous nodule in her left breast. Clinical interrogation of this case as part of the pathological diagnosis, phlebotomy was performed by venepuncture in order to examine peripheral blood smears under a microscope. Nonetheless, the peripheral blood smear did not show microfilariae of the disease. Furthermore, fine needle aspiration cytology was also performed to identify possible things for the study. It was diagnosed that the fine-needle aspiration cytology smears of various lesions indicate the lump carried microfilariae. Conclusively the lymphatic swelling was confirmed to be caused by Wuchereria bancrofti in fine-needle aspiration cytology examination without evidence in peripheral blood smears. It was shown that the subject had filariasis, and the patient responded well to daily treatment with diethylcarbamazine citrate for 42days.

Tropical Pulmonary Eosinophilia Masquerading as Interstitial Lung Disease: An Interesting Case Report with Review of Literature

Tropical Pulmonary Eosinophilia (TPE) is a form of occult filariasis characterised clinically by paroxysms of nocturnal cough, wheezing and dyspnoea . It is due to hyper-responsive pulmonary reaction to trapped microfilaria inside the lung tissue. Though it is common in endemic areas, it is frequently misdiagnosed mostly as bronchial asthma or tuberculosis and the patient continues to suffer without being treated appropriately. A 36-year-old male, who presented with fever, cough and shortness of breath for a period of 6 months was misdiagnosed as Interstitial Lung Disease (ILD) and was put on antifibrotic agents without any relief of symptoms. He was thoroughly investigated with routine haematological tests, Absolute Eosinophil Count (AEC), X-ray of chest, High Resolution Computed Tomography (HRCT) thorax including bronchoalveolar lavage and was diagnosed as Tropical Pulmonary Eosinophilia (TPE). Diethyl Carbamazine citrate (DEC) was initiated and patient had satisfactory recovery. So in endemic areas the possibility of TPE should always be kept in mind while evaluating cases presenting with chronic cough, dyspnea and wheezing even if the radiological imaging may mimic ILD.

Lymphatic filariasis elimination in the Dominican Republic: History, progress, and remaining steps.

Lymphatic filariasis (LF) is a mosquito-transmitted parasitic disease that is a leading cause of disability globally. The island of Hispaniola, which the Dominican Republic shares with Haiti, accounts for approximately 90% of LF cases in the Americas region. In 1998, the Dominican Ministry of Public Health created the Program to Eliminate Lymphatic Filariasis (PELF) with the goal of eliminating LF transmission by 2020. Baseline mapping revealed 19 (12% of total) endemic municipalities clustered into three geographic foci (Southwest, La Ciénaga and East), with a total at-risk population of 262,395 people. Beginning in 2002, PELF sequentially implemented mass drug administration (MDA) in these foci using albendazole and diethylcarbamazine (DEC). In total, 1,174,050 treatments were given over three to five annual rounds of house-to-house MDA per focus with a median coverage of 81.7% (range 67.4%–92.2%). By 2018, LF antigen prevalence was less than 2% in all foci, thus meeting criteria to stop MDA and begin post-treatment surveillance (PTS). This success has been achieved against a shifting landscape of limited domestic funding, competing domestic public health priorities, and sporadic external donor support. Remaining steps include the need to scale-up morbidity management and disability prevention services for LF and to continue PTS until LF transmission is interrupted across Hispaniola.

Population Pharmacokinetics of Diethylcarbamazine in Patients with Lymphatic Filariasis and Healthy Individuals.

Diethylcarbamazine (DEC) is a drug of choice to treat lymphatic filariasis (LF) either used alone or in combination as mass drug administration (MDA) preventive strategies. The objective of this study was to develop a population pharmacokinetics (PK) model for DEC in subjects infected with lymphatic filariasis (LF) compared to healthy individuals, and to evaluate the effect of covariates on the volume of distribution (V/F) and oral clearance (CL/F) of DEC. This was an open-label cohort study of treatment-naive Wuchereria bancrofti-infected (n = 32) and uninfected (n = 24) adults residing in the Agboville District of Côte d'Ivoire. The population pharmacokinetics model for DEC was built using Phoenix NLME 8.0 software. The covariates included in the model-building process were age, gender, body weight, infection status, creatinine clearance (CLCR), and aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels. A total of 56 adults were enrolled in the study, and a total of 728 samples were obtained over 168 h. A one-compartment linear pharmacokinetics model with first-order absorption with an absorption lag time (Tlag) best described the data. After determining the pharmacokinetics (PK) parameters of DEC, body weight and gender were found to be the significant covariates for DEC V/F. The final population pharmacokinetics model adequately described the pharmacokinetics of DEC in the studied population. Model-based simulation indicated that the body weight significantly impacted the exposure in both the male and female populations. This analysis may further support the drug-drug interaction model development of DEC with different coadministered drugs or agents in disease control programs. (This study is registered at clinicaltrials.gov under identifier NCT02845713.).

Efektivitas Pengobatan Massal Filariasis Setelah Empat Tahun Pengobatan Massal di Desa Ploso, Demak, Jawa Tengah

TThe filariasis elimination program is carried out through mass treatment with Diethylcarbamazine Citrate (DEC) and albendazole once a year for five years. Filariasis mass treatment, which was carried out for five years, aims to reduce the prevalence rate of microfilaria &lt; 1%. Evaluation of community treatment needs to be done, one of which is the Finger Blood Preparation (SDJ) and Polymerase Chain Reaction (PCR) methods. The purpose of this research was to know the effectiveness of mass treatment of filariasis after four years in Karang Ploso Village, Demak, Indonesia. This study is a descriptive study with a cross-sectional approach with a sample of 350 people. The study variables were an examination of SDJ microfilariae, PCR molecular examination, and interviews about filariasis knowledge. The examination methods used were SDJ and PCR. The data analysis used was univariate, microfilaria rate. The results of SDJ and PCR examinations were not found microfilariae, so that the Mf rate was 0%. As many as 97.4% of people adhered to taking medication, 91.1% of people had moderate knowledge of filariasis, 98.3% had an average experience of the Mass Drug Administration (MDA). The Mf rate results by SDJ and PCR in Demak after the fourth filariasis treatment program in 2019 was 0%. There was a decrease in SDJ results from 2016-2019, namely 1% to 0% in 2019.

Safety and Tolerability of Mass Diethylcarbamazine and Albendazole Administration for the Elimination of Lymphatic Filariasis in Kenya: An Active Surveillance Study

Preventive chemotherapy with diethylcarbamazine citrate (DEC) and albendazole (ALB) is the core intervention strategy to eliminate lymphatic filariasis (LF). We conducted a large-scale prospective active safety surveillance study to identify the incidence, type, severity, and risk factors for adverse events (AEs) following mass drug administration (MDA) of single-dose DEC and ALB in 10,010 participants from Kilifi County, Kenya. AEs were actively monitored and graded at 24 h, 48 h, and on day 7 Post-MDA. Out of 10,010 enrolled study participants, 1621 participants reported a total of 3102 AEs during a seven-day follow-up. The cumulative incidence of AEs was 16.2% (95% CI, 15.5–16.9%). The proportion of participants who experienced one, two, or ≥three types of AEs was 9.2%, 4.6%, 2.4%, respectively. AEs were mild (87.3%), moderate (12.4%), and severe (0.3%) and resolved within 72 h. The five most common AEs were dizziness (5.9%), headache (5.6%), loss of appetite (3.3%), fever (2.9%), and drowsiness (2.6%). Older age, taking concurrent medications, ≥three tablets of DEC, and type of meal taken before MDA were significant predictors of AEs. One in six participants experienced systemic mild-to-moderate severity grading and transient AEs. DEC and ALB co-administration for the elimination of LF is generally safe and well-tolerated.

A multicenter, community-based, mixed methods assessment of the acceptability of a triple drug regimen for elimination of lymphatic filariasis.

BackgroundMany countries will not reach elimination targets for lymphatic filariasis in 2020 using the two-drug treatment regimen (diethylcarbamazine citrate [DEC] and albendazole [DA]). A cluster-randomized, community-based safety study performed in Fiji, Haiti, India, Indonesia and Papua New Guinea tested the safety and efficacy of a new regimen of ivermectin, DEC and albendazole (IDA).Methodology/Principal findingsTo assess acceptability of IDA and DA, a mixed methods study was embedded within this community-based safety study. The study objective was to assess the acceptability of IDA versus DA. Community surveys were performed in each country with randomly selected participants (>14 years) from the safety study participant list in both DA and IDA arms. In depth interviews (IDI) and focus group discussions (FGD) assessed acceptability-related themes. In 1919 individuals, distribution of sex, microfilariae (Mf) presence and circulating filarial antigenemia (CFA), adverse events (AE) and age were similar across arms. A composite acceptability score summed the values from nine indicators (range 9–36). The median (22.5) score indicated threshold of acceptability. There was no difference in scores for IDA and DA regimens. Mean acceptability scores across both treatment arms were: Fiji 33.7 (95% CI: 33.1–34.3); Papua New Guinea 32.9 (95% CI: 31.9–33.8); Indonesia 30.6 (95% CI: 29.8–31.3); Haiti 28.6 (95% CI: 27.8–29.4); India 26.8 (95% CI: 25.6–28) (P<0.001). AE, Mf or CFA were not associated with acceptability. Qualitative research (27 FGD; 42 IDI) highlighted professionalism and appreciation for AE support. No major concerns were detected about number of tablets. Increased uptake of LF treatment by individuals who had never complied with MDA was observed.Conclusions/SignificanceIDA and DA regimens for LF elimination were highly and equally acceptable in individuals participating in the community-based safety study in Fiji, Haiti, India, Indonesia, and Papua New Guinea. Country variation in acceptability was significant. Acceptability of the professionalism of the treatment delivery was highlighted.

Tri-Model Therapy: Combining Macrocyclic Lactone, Piperazine Derivative and Herbal Preparation in Treating Humpsore in Cattle.

Stephanofilariasis or humpsore is a chronic parasitic dermatitis of cattle. Various treatment regimens were attempted in the past but were found to be partially effective. Here, we claim a successful treatment regime using an FDA-approved macrocyclic lactone, a piperazine derivative, and an herbal preparation. Twenty-four cattle (18 affected and 6 unaffected) were selected and divided into Gr 1: positive control (infected without treatment; n = 6), Gr 2: treatment group (infected with treatment with ivermectin; n = 6), Gr 3: treatment group (infected with treatment with tri-model therapy including ivermectin, diethylcarbamazine citrate, and an herbal ointment, n = 6), and Gr 4: negative control (non-infected animals; n = 6). In Gr 2 and Gr 3, treatment to the ailing animals were given for 30 days. Lesion was significantly reduced in day 15 of post-treatment and completely healed on day 30 of post-treatment in Gr 3. Tri-model therapy recorded significant improvement in the surface area of the sore as compared to ivermectin administration alone. Antioxidants were increased and malondialdehyde (MDA) and cortisol concentrations were decreased significantly (p < 0.05) in Gr 3 than in untreated control group at day 14, 21 and 28. Histopathological changes in infected animals were characterized by parakeratotic hyperkeratosis along with presence of nucleated keratinocytes. There were infiltrations of polymorphonuclear cells specially eosinophils along with a few monomorphonuclear cells. Microfilarial organism was observed beneath the epidermis, which was surrounded by fibrocytes and infiltrated cells. In the tri-model-treated animal after recovery, the skin revived a normal architecture. Therefore, tri-model therapy has the potential to cure humpsore.

Control and elimination of lymphatic filariasis in Oceania: Prevalence, geographical distribution, mass drug administration, and surveillance in Samoa, 1998-2017.

Lymphatic filariasis (LF) is a major public health problem globally and in the Pacific Region. The Global Programme to Eliminate LF has made great progress but LF is persistent and resurgent in some Pacific countries and territories. Samoa remains endemic for LF despite elimination efforts through multiple two-drug mass drug administrations (MDA) since 1965, including renewed elimination efforts started in 1999 under the Pacific Programme for Elimination of LF (PacELF). Despite eight rounds of national and two rounds of subnational MDA under PacELF, Samoa failed transmission assessment surveys (TAS) in all three evaluation units in 2017. In 2018, Samoa was the first to distribute countrywide triple-drug MDA using ivermectin, diethylcarbamazine (DEC), and albendazole. This paper provides a review of MDAs and historical survey results from 1998 to 2017 in Samoa and highlights lessons learnt from LF elimination efforts, including challenges and potential ways to overcome them to successfully achieve elimination.

Evaluation of Mass Drug Administration with Albendazole against Lymphatic Filariasis in Bidar district, Karnataka

Introduction: Lymphatic Filariasis is one of the most debilitating and disfiguring disease and is a major public health problem in India. Government of India had set the goal of elimination of disease by 2015 and Mass Drug Administration (MDA) is recognized as the main strategy to achieve it. Albendazole in combination with Diethyl carbamazine proved to have both long-term effectiveness in decreasing microfilaraemia and adult filarial worm antigen levels. Objective of Study: To estimate coverage and compliance to Mass Drug Administration (MDA) with Albendazole in Bidar District. Materials and Methods: A cross sectional evaluation survey was conducted in the month of September 2016 in Bidar district using multi-stage cluster sampling technique. A total of 744 subjects were interviewed and information about intake of Albendazole was collected in a predesigned questionnaire after taking an informed consent. Data thus obtained were entered and analyzed using Epi info software version 3.5.4. Results: The coverage, compliance and effective compliance to Albendazole as a part of MDA in Bidar district were 82.5%, 72.2% and 59.6% respectively. Among those who have received, only 39.3% have taken Albendazole by DOTS (Directly observed treatment). Conclusion: The present study demonstrates poor compliance to Albendazole during MDA campaign in Bidar district, emphasizing the need to emphasize on DOT method of drug administration for better compliance. Keywords: Albendazole, Compliance, Filariasis, Mass drug administration.

A community survey of coverage and adverse events following country-wide triple-drug mass drug administration for lymphatic filariasis elimination, Samoa 2018.

The Global Programme to Eliminate Lymphatic Filariasis has made considerable progress but is experiencing challenges in meeting targets in some countries. Recent World Health Organization guidelines have recommended two rounds of triple-drug therapy with ivermectin, diethylcarbamazine (DEC), and albendazole (IDA), in areas where mass drug administration (MDA) results with two drugs (DEC and albendazole) have been suboptimal, as is the case in Samoa. In August 2018, Samoa was the first country in the world to implement countrywide triple-drug MDA. This paper aims to describe Samoa’s experience with program coverage and adverse events (AEs) in the first round of triple-drug MDA. We conducted a large cross-sectional community survey to assess MDA awareness, reach, compliance, coverage and AEs in September/October 2018, 7–11 weeks after the first round of triple-drug MDA. In our sample of 4420 people aged ≥2 years (2.2% of the population), age-adjusted estimates indicated that 89.0% of the eligible population were offered MDA, 83.9% of the eligible population took MDA (program coverage), and 80.2% of the total population took MDA (epidemiological coverage). Overall, 83.8% (2986/3563) reported that they did not feel unwell at all after taking MDA. Mild AEs (feeling unwell but able to do normal everyday things) were reported by 13.3% (476/3563) and moderate or severe AEs (feeling unwell and being unable to do normal everyday activities such as going to work or school) by 2.9% (103/3563) of participants. This study following the 2018 triple-drug MDA in Samoa demonstrated a high reported program awareness and reach of 90.8% and 89.0%, respectively. Age-adjusted program coverage of 83.9% of the total population showed that MDA was well accepted and well tolerated by the community.

Heterogeneous response of Wuchereria bancrofti-infected persons to diethylcarbamazine (DEC) and its implications for the Global Programme to Eliminate Lymphatic Filariasis (GPELF).

DEC or ivermectin (IVM) in combination with albendazole (ALB) has been the recommended strategy of the Global Programme to Eliminate Lymphatic Filariasis (GPELF) since 2000. Despite effective population coverage (> 65%) with several rounds of MDA with DEC or combination of DEC plus ALB, microfilariae persist in few individuals and they continue to be the source of infection for transmitting LF. We report an individual's variability in response to DEC by defining the response as complete absence of microfilaria (mf) (post-treatment mf count = 0) and non-response as presence of mf (post-treatment mf count ≥ 1). We analyzed follow-up data on individual's response to treatment from two randomized clinical trials in which 46 microfilaremic individuals were treated with single-dose DEC (6 mg/kg body weight). They were classified into low, medium, and high mf density categories based on their pre-treatment mf counts. Of the 46 individuals, 65.2% have not responded throughout the 12-month post-treatment period. Application of a logistic regression model with fixed (age, gender, mf density, post-treatment time, and their interactions) and random (individual's response over time) effects indicated that treatment response is independent of age, gender, and time. The overall treatment response increases in low and decreases in high mf density categories. Furthermore, the estimates for the random coefficients model showed that there is a greater variability in response between individuals over post-treatment time. The results substantiate that individual variation in response to DEC exists which indicate the importance of studying the parasite as well as host genetic factors associated with DEC action.

Assessing Coverage and Compliance of Mass Drug Administration under Elimination of Lymphatic Filariasis Program in Malda District, West Bengal

Background: Lymphatic filariasis, commonly known as elephantiasis, is a neglected tropical disease. Evaluation of mass drug administration (MDA) is done internally by the health authorities and externally by independent agencies. This paper reports the findings of evaluation of MDA conducted in Malda district of West Bengal state in May-June 2015. Objectives: To assess the Coverage &amp; Compliance rates of MDA against lymphatic filariasis and to study the factors influencing non-coverage and non-compliance in Malda district. Materials &amp; Methods: A Community based cross-sectional study was conducted in three selected rural blocks and one municipality. Family was the unit of sampling in the current MDA coverage survey. 30 families in each of four clusters were taken as samples. Cluster sampling technique was adopted. The data was collected in a pre-designed semi-structured proforma from 120 households. Results: 564 eligible population 120 families were studied and 50.53% of them were males. Predominant respondents were male (92%) with average age 40.7 years. The Diethylcarbamazine citrate plus Albendazole coverage rate was 95% and the compliance rate was 71.6%. The major reason for non–compliance was due to fear of side effects amounting to 58%. Only 4 persons reported adverse effects after drug consumption. Conclusion: Though distribution was high, many people were not consuming drugs. Consumption was not properly supervised and there was misconception prevailed among workers about time of consumption. A high level of motivation and commitment from the drug distributors with adequate training is required for ensuring a high coverage and compliance rates. Supervision should be strengthened to improve consumption and misconception should be eliminated through training.

Green Synthesis of Agar/Gelatin Based Superabsorbent (BGCP) Through Gamma Radiation Cross-Linking Polymerization for Castoff as Sustained Drug Delivery Device and in Soil Treatment for Improved Water Retention

In this paper, agar/gelatin and acrylic acid-co-vinyl acetate (monomer chains) based superabsorbent, fabricated using gamma radiations as an initiator and N-N′ dimethylene bisacrylamide as a crosslinker, has been investigated for its swelling behaviour (Max. Ps = 8010) in distilled water as a function of time, temperature and pH. The hydrogel has further been applied for sustained delivery of diethyl carbamazine citrate under three pH conditions at 37 °C. It has been found to show non-Fickian type mechanism as the drug release showed diffusion coefficient less than 0.50 for all the pH conditions. The gel characteristic constant ‘n’ was found to be: 0.910 at 9.2 pH, 0.832 at 7.0 pH and 0.768 at 2.2 pH with their corresponding ‘k’: 0.175, 0.242 and 0.413, respectively. The initial diffusion coefficient has been found to show greater values than late diffusion coefficient confirming greater release at the early stages of the drug release than that in the late stages. Also to apply BGCP in soil treatment its moisture retention capacity has been studied using three different soil models. BGCP was found to retain moisture under clay, mix and sand soil models for 57 days, 42 days and 32 days, respectively. Under bio-composting method of biodegradation sample was found to be 91% degraded after 70 days.

Mass Drug Administration (MDA) for Lymphatic Filariasis Elimination in Uttar Pradesh, India: Issues, Gaps &amp; Challenges

Uttar Pradesh is the largest state of India and is comprised of 75 revenue districts. 51 districts of eastern Uttar Pradesh are endemic for LF and are under Elimination of Lymphatic Filariasis (ELF). In order to ensure elimination of the disease from the people, the mass drug administration (MDA) is being observed in these 51 districts since 2004 by ensuring administration of drug Di-ethyl Carbamazine Citrate (DEC) alone once in a year according to the age excluding children &lt;2years, pregnant women and seriously ill persons. Thereafter, 400 mg albendazole to &gt;2 years age group was added with DEC since 2008. When both the drugs are administered together, the effect is on the adult worm too and therefore the parasite will be destroyed preventing the infected person from developing clinical manifestation. NVBDCP guidelines envisages that administration of drug to the 65% of the total population or 85% of the targeted population for five consecutive years will bring down the microfilarimia to &lt;1% among the population, ultimately leading to the elimination of the disease after conducting Transmission Assessment Survey (TAS) thrice at an interval of two years among the virgin/protected group of children i.e. 6-7 years. The Transmission Assessment Survey (TAS) is conducted after ensuring &lt;1% microfilariamia in 10 additional sites selected randomly.The state could subject only one district Rampur under post MDA surveillance, which cleared TAS-1 &amp; TAS-2. The other districts subjected for TAS during 2016, 2017, 2018 &amp; 2019 but could not qualify for conducting TAS in additional m.f. survey as microfilariamia during 2016, 2017, &amp; 2018 was found &gt;1% and during 2019, the antigenemia was found &gt;2% in 13 districts. The possible gaps, issues and challenges at various levels of the programme implementation have been discussed in the present paper, the rectification of which may lead the state for achieving the goal of elimination of the disease.

Enhancement of Anti-allergic Effect of Diethylcarbamazine Citrate in Asthmatic Mouse Model: Testing of Anti-drug Antibodies and Quercetin.

Diethylcarbamazine citrate (DEC) is known as an effective treatment for bronchial asthma because of its ability to reduce eosinophil trafficking to the lung tissue. The current study aimed to potentiate the anti-allergic effect of the drug by passive immunization of the asthmatic model with anti-DEC antibody or prior treatment with quercetin (Qur). Eight mice groups were categorized into control, the model of lung asthma, treated with DEC, passively immunized with anti(α)-bovine serum albumin Ab, anti-DEC Ab, prior exposure to 10, 20, or 40 mg Qur/Kg. b.wt. Both eosinophil peroxidase (EPO) and eotaxin2 in the lung tissues were performed. Serum levels of cytokines, bronchoalveolar lavage fluid (BALF) IgE, rabbit anti-bovine serum albumin (anti-BSA), and DEC IgG in lung tissue homogenates were assayed by ELISA. Regarding the effect of anti-DEC Ab and Qur on DEC-induced recovery of histopathological alterations showed that the Ova group had peri-bronchial hyperplasia, mononuclear leukocyte infiltration, thickening in the wall of alveoli, and congested blood vessels. However, the reduction of inflammatory cells and thickened alveolar walls was dependent on the Qur dose. Qur40 enhanced the anti-allergic effect of DEC. Moreover, the present data revealed high levels of Th2 cytokines (IL-4 and IL-5) and IgE in the Ova group. An increased leukocyte infiltration/thickening of the alveolar wall and lung tissue EPO/eotaxin2 were also observed. Qur-40 could show an enhancement effect on DEC for the reduction of IL-4, IL-5, IgE, EPO, and eotaxin 2. Consequently, the IFN-γ/IL-4 ratio was increased. Qur at 40 mg/Kg could be recommended to enhance the DEC effect suggesting a novel approach for treatment.