Filariasis In India Research Articles

Burden of dengue, leishmaniasis and lymphatic filariasis in India and its states from 1990-2019: Analysis from the Global Burden of Disease study (GBD 2019).

Vector-borne diseases such as dengue, leishmaniasis, and lymphatic filariasis, constitute significant sources of illness, disability, and mortality among the poor and vulnerable in many countries around the world, including India. Based on the global burden of diseases, injuries, and risk factors study 2019, we analyse the burden of dengue, leishmaniasis, and lymphatic filariasis, in India from 1990 to 2019. Over this period, there was a reduction in the burden of lymphatic filariasis and leishmaniasis. Notably, dengue emerged as the most common vector-borne disease, exhibiting high fatality rate above 15 years of age and the highest DALY within 15-49 age group. Additionally, dengue cases surged substantially between 1990 and 2019. Leishmaniasis related mortality and DALY declined in the year 2019 compared to the year 1990, with high mortality and DALY in the 0-49-year-old age group. For lymphatic filariasis, DALY was more pronounce among those in the 15-49-year age group, which underwent reduction in 2019. Males had a higher burden in other vector-borne diseases than females, although females had a slightly elevated dengue burden. These findings highlight the evolving epidemiological trends related to vector-borne diseases in India, over the last three decades and underline the critical significance of sustained efforts for the elimination and control of vector-borne diseases.

Diethylcarbamazine citrate-fortified salt for lymphatic filariasis elimination in India.

Lymphatic filariasis (LF) is a vector-borne neglected tropical disease, causing permanent disability. The disease is debilitating and widespread, leading to tremendous productivity and economic loss. The Government of India (GOI) prioritized the elimination of LF through the annual mass drug administration (MDA) programme in 2004 and continued with a single dose of diethylcarbamazine citrate (DEC), 6 mg/kg of body weight, plus albendazole annually over a period of 5-6 years. The GOI had set the target to achieve LF elimination by 2015 and now by 2030. The progress so far has been suboptimal. Much remains to be done as about 84 per cent of the total 328 endemic districts are still under MDA. The major challenge in implementing MDA is poor compliance. It is necessary to have a feasible alternative strategy addressing the above challenge to achieve the desired goal of LF elimination. At this juncture, a well-researched approach, i.e. the use of DEC-fortified salt, also advocated by the World Health Organization, as a unique form of MDA, is proposed. As per this strategy, a low dose of DEC (0.2% w/w) is added to the cooking salt at the manufacturing facility of iodized salt and consumed by the LF-endemic communities for about two years. Many examples of successful use of this strategy for LF elimination in small- and large-scale trials have been documented in India and several other endemic countries in the world. Implementing DEC-iodine-fortified salt is a safe, less expensive, more efficient and prompt approach for achieving the elimination of LF in India. Adverse effects are none or minor and self-limiting. The DEC-fortified salt strategy can easily piggyback on the existing countrywide deployment of iodized salt under the National Iodine Deficiency Disorders Control Programme (NIDDCP), which has achieved a great success in reducing iodine-deficiency disorders such as hypothyroidism. This existing robust programme can be leveraged to launch DEC-fortified salt for the community. If implemented appropriately, this strategy will ensure the complete cessation of LF transmission within two years from its introduction. If the said strategy is implemented in 2022, it is expected that India will be able to achieve the LF elimination by 2024, much before the global target of 2030.

An open label, block randomized, community study of the safety and efficacy of co-administered ivermectin, diethylcarbamazine plus albendazole vs. diethylcarbamazine plus albendazole for lymphatic filariasis in India.

Better drug regimens for mass drug administration (MDA) could accelerate the Global Programme to Eliminate Lymphatic Filariasis (LF). This community study was designed to compare the safety and efficacy of MDA with IDA (ivermectin, diethylcarbamazine and albendazole) or DA (diethylcarbamazine and albendazole) in India. This two-armed, open-labelled, block randomised, community study was conducted in LF endemic villages in Yadgir district, Karnataka, India. Consenting participants ≥5 years of age were tested for circulating filarial antigenemia (CFA) and microfilaremia (Mf) before treatment with a single oral dose of IDA or DA. Adverse events (AEs) were monitored actively for two days and passively for five more days. Persons with positive CFA or Mf tests at baseline were retested 12-months post-treatment to assess treatment efficacy. Baseline CFA and Mf-rates were 26.4% and 6.9% in IDA and 24.5% and 6.4% in DA villages respectively. 4758 and 4160 participants received IDA and DA. Most AEs were mild after both treatments; fewer than 0.1% of participants experienced AEs with severity > grade 1. No serious AEs were observed. Fever, headache and dizziness were the most common AEs. AE rates were slightly higher after IDA than DA (8.3% vs. 6.4%, P<0.01). AEs were more frequent in females and Mf-positives after either treatment, but significantly more frequent after IDA (40.5% vs 20.2%, P < 0.001). IDA was more effective for clearing Mf than DA (84% vs. 61.8%, P < 0.001). Geometric mean Mf counts per 60μl in retested Mf-positives decreased by 96.4% from 11.8 after IDA and by 90.0% from 9.5 after DA. Neither treatment was effective for clearing CFA. IDA had an acceptable safety profile and was more effective for clearing Mf than DA. With adequate compliance and medical support to manage AEs, IDA has the potential to accelerate LF elimination in India. Clinical Trial Registry of India (CTRI No/2016/10/007399).

Lymphatic Filariasis in India: A Journey towards Elimination

The journey towards elimination of Lymphatic Filariasis (ELF) in India started with the deliberations in a meeting held at Delhi in 1996 recommending for pilot project of Mass Drug Administration (MDA) with DEC. Global Programme to Eliminate Lymphatic Filariasis (GPELF was launched in 2000 subsequent to World Health Assembly (WHA) resolution in 1997 making India as signatory. ELF campaign was launched on 5th June, 2004 with annual MDA in endemic districts. However, all the endemic districts could not initiate MDA due to logistics and preparedness issues, thus the journey initially experienced challenges of hurried start. Serious Adverse Events (SAE) and poor compliance were reported from many states which were tackled through advocacy and capacity building of health workers and community volunteers. MDA was managed with staggering of dates in different states and strong supervision helped in improving drug compliance. The improved reported drug coverage resulted in decline of microfilaria prevalence in many districts except some districts. India’s significant progress was recognised internationally as approximately 200 of 650 million population at risk of Lymphatic Filariasis (LF) was made free of risk by 2017 by passing Transmission Assessment Survey (TAS) though some districts could not clear TAS. Efforts to improve drug compliance were intensified and to achieve goal faster, MDA with three drug Ivermectin, DEC and Albendazole has been initiated in addition to ascertaining the current status of LF endemicity in non-MDA districts. Based on experience of long journey towards ELF with mix of success and challenges, it is suggested to intensify ELF in a mission mode with priority.

Economic Costs and Benefits of Community-Based Lymphedema-Management Programs for Lymphatic Filariasis in India.

.Lymphatic filariasis (LF) is endemic in 72 countries; 15 million persons live with chronic filarial lymphedema. It can be a disabling condition, frequently painful, leading to reduced mobility, social exclusion, and depression. The Global Program to Eliminate Lymphatic Filariasis aims to stop new infections and care for affected persons, but morbidity management has been initiated in only 38 countries. We examine economic costs and benefits of alleviating chronic lymphedema and its effects through simple limb care. We use economic and epidemiological data from 12 Indian states in which 99% of Indians with filariasis reside. Using census data, we calculate the age distribution of filarial lymphedema and predict the burden of morbidity of infected persons. We estimate lifetime medical costs and lost earnings due to lymphedema and acute dermatolymphangioadenitis (ADLA) with and without community-based limb-care programs. Programs of community-based limb care in all Indian endemic areas would reduce costs of disability by 52%, saving a per person average of US$2,721, equivalent to 703 workdays. Per-person savings are 185 times the program’s per-person cost. Chronic lymphedema and ADLA impose a substantial physical and economic burden in filariasis-endemic areas. Low-cost programs for lymphedema management based on limb washing and topical medication are effective in reducing the number of ADLA episodes and stopping progression of disabling lymphedema. With reduced disability, people can work longer hours per day, more days per year, and in more strenuous, higher paying jobs, resulting in important economic benefits to themselves, their families, and their communities.

Frequency and Clinical Significance of Localized Adverse Events following Mass Drug Administration for Lymphatic Filariasis in an Endemic Area in South India.

Fear of adverse events (AEs) negatively affects compliance to mass drug administration (MDA) for lymphatic filariasis (LF) elimination program. Systemic AEs are believed to occur because of killing of microfilariae, whereas localized soft tissue reactions might be due to the death of adult worms following therapy. Most AEs are mild and self-limited. However, localized AEs are sometimes more significant and of concern to participants. Here, we describe localized AEs that were noted during a large community study that evaluated the safety of a triple-drug regimen (ivermectin, diethylcarbamazine, and albendazole) for the treatment of LF in India. We have also discussed the importance of timely detection and careful management of AEs for preserving community confidence in MDA.

Cost of care and its impact on households due to lymphatic filariasis: Analysis of a national sample survey in India.

India is an endemic country for lymphatic filariasis (LF). There are no current estimates of the expenditure being borne by LF patients in case of outpatient care or hospitalisation and its impact on households. This study aimed to estimate the household out-of-pocket (OOP) expenditure due to hospitalization or outpatient care as a result of LF in India. Secondary analysis of nationally representative data for India collected by the National Sample Survey Organization in 2014 was performed, reporting on health service utilization and health care related OOP expenditure by income quintiles and by type of health facility (public or private). The median household OOP expenditure from hospitalization and outpatient care due to LF was US$ 178 and US$ 04, respectively; and was more than two times higher among the richest group compared to the poorest. There was a significantly higher proportion of households affected by catastrophic costs among the rich (30%) compared to the poor households (18%) due to hospitalization. Median private sector OOP hospitalization expenditure was nearly four times higher than the public sector. Less than one-fourth of outpatient visits (22%) were in the public sector. The median expenditure on medicines and indirect cost were US$ 32 (IQR: 17-84) and US$ 23 (IQR: 9-59), respectively in case of hospitalization due to LF; while in case of outpatient care these were US$ 1.5 (IQR: 0-5.8) and US$ 1.5 (IQR: 0-4), respectively. Households with LF incur huge cost of patient care, particularly those in the lowest income group and those seeking care in the private sector.

Chyluria-a review of literature and a modified sclerotherapy regimen.

Chyluria, described as passage of milky white urine, has been recognized as a urological manifestation of the lymphatic system due to abnormal connection between the blocked and dilated lymphatics and the renal pelvicaliceal systems. We report the case of a 36-year-old female from an endemic area of filariasis in India who presented with chyluria. In addition to medical therapy, intermittent sclerotherapy of renal pelvis with 0.2% povidone iodine was carried out with a dose schedule different from the ones in practice earlier. The idea of intermittent sclerotherapy was to create pyelolymphatic and pyelosinus reflux so as to sclerose the communicating channel between the lymphatic and urinary systems. This method proved to be curative for the patient and she was relieved from her 8-year-old problem and subsequently remained asymptomatic.

Sustained Release of Nanoformulation of Diethyl Carbamazine (Dec) for Filariasis – a Review

Lymphatic filariasis (LF), is a mosquito vector-borne disease and a major public health problem in the tropical countries. The annual mass drug administration (MDA) in India was studied in 1996-97. It was introduced with single dose of Diethylcarbamazine and was investigated as a pilot project covering 41millon population. The study was extended to 77million population by 2002. The MDA is one of the strategies to eliminate LF in India. Liposomes, polymeric and solid lipid nanoparticles are the most promising nanopharmaceuticals which are easy to formulate, cheaper and can bring prolific consequences for filariasis management.

Field evaluation of the biolarvicide, spinosad 20 per cent emulsifiable concentrate in comparison to its 12 per cent suspension concentrate formulation against Culex quinquefasciatus, the vector of bancroftian filariasis in India.

Background & objectives:Biolarvicides may offer alternatives to chemical larvicides as these are known to be safe to environment and selective against the target species. However, only a limited number of biolarvicides have been approved for mosquito larval control. In the current study, a new formulation of spinosad, 20 per cent emulsifiable concentrate (EC) was tested for its efficacy against Culex quinquefasciatus, in comparison to its 12 per cent suspension concentrate (SC).Methods:Spinosad 20 per cent EC was tested against Cx. quinquefasciatus immature at 25, 50, 100 and 150 mg active ingredient (ai)/m[2] in cesspits, drains and abandoned wells in comparison with spinosad 12 per cent SC at the optimum field application dosage of 50 mg ai/m[2].Results:The 20 per cent EC caused 90-100 per cent reduction of pupal density for 7-14 days in cesspits, 10-17 days in drains and 14-30 days in abandoned wells at all dosages tested. At lower dosages of 25 and 50 mg ai/m[2], >90 per cent reduction of pupal density was observed for one week in cesspits and street drains and for two weeks in abandoned wells. The effective duration of control provided by the higher dosages, 100 and 150 mg ai/m[2] was 1.4 to 2 times greater than the lower dosages, 25 and 50 mg ai/m[2].Interpretation & conclusions:The findings showed that the spinosad 20 per cent EC can be used for larval control against Cx. quinquefasciatus, at the dosage of 25 mg ai/m[2] at weekly interval in cesspits and drains and at fortnightly interval in abandoned wells. Spinosad 20 per cent EC could be one of the options to be considered for larval control under integrated vector management.

Phylogenetic study based on 28S rRNA gene sequencing of Wuchereria bancrofti isolated from the filaria endemic areas of Bankura district, West Bengal, India.

Lymphatic filariasis is one of the major public health concern in India, and Bankura district of West Bengal is one of the main filaria prone area of the country. Wuchereria bancrofti is the causative organism and Culex quinquefasciatus is the main vector of lymphatic filariasis in India. In the present study, infection and infectivity rate of filarial vector C. quinquefasciatus were determined. The molecular characterization, DNA fingerprinting and phylogenetic analysis of W. bancrofti was done. In the study area, overall vector infection and infectivity rates were 4.83 and 0.97%, respectively. The infection and infectivity rate were found to be higher in rainy season and lower in summer season. The AT and GC content of W. bancrofti SNC Bankura (Accession No. JF930705) were 55.59 and 44.41%, respectively. The phylogenetic tree was prepared following neighbour joining, maximum parsimony, minimum evolutionary and UPGMA methods. The study revealed that W. bancrofti SNC Bankura (JF930705) showed 100% similarity with W. bancrofti (Accession No. EU370161). The cluster containing, W. bancrofti SNC Bankura (JF930705) and W. bancrofti (EU370161) branched with Brugia pahangi (M15309) with 62% bootstrap value. W. bancrofti SNC Bankura (JF930705), W. bancrofti (EU370161) and B. pahangi (M15309) branched with Dirofilaria immitis (AF188120) with 78% bootstrap value.

Are we nearly there yet? Coverage and compliance of mass drug administration for lymphatic filariasis elimination.

Lymphatic filariasis has been targeted for elimination by 2020, and a threshold of 65% coverage of mass drug administration (MDA) has been adopted by the Global Programme to Eliminate Lymphatic Filariasis (GPELF). A recent review by Babu and Babu of 36 studies of MDA for lymphatic filariasis in India found that coverage, defined as receipt of tablets, ranged from 48.8 to 98.8%, while compliance, defined as actual ingestion of tablets, was 22% lower on average. Moreover, the denominator for these coverage figures is the eligible, rather than total, population. By contrast, the 65% threshold, in the original modelling study, refers to ingestion of tablets in the total population. This corresponds to GPELF's use of ‘epidemiological drug coverage’ as a trigger for the Transmission Assessment Surveys (TAS), which indicate whether to proceed to post-MDA surveillance. The existence of less strict definitions of ‘coverage’ should not lead to premature TAS that could impair MDA's sustainability.

GIS for rapid epidemiological mapping and health-care management with special reference to filariasis in India

This study was carried out to apply geographic information systems (GIS) technology for rapid epidemiological mapping and health-care management of filariasis in India. GIS has essentially become important role in epidemiological mapping, disease monitoring and health information management in India. It has been customized inbuilt facilities to store, retrieve, analysis, and mapping of horizontal and vertical structure of the disease epidemiological information. This study aimed on the application of GIS for rapid epidemiological mapping of disease occurrences, infection rate, age group, sex, disease transmission, site specification of the patients, host availability of the parasite or virus loads, and so on. It was used to state the horizontal and vertical structure of the diseases, history of the disease, etc. with reference to space and times. GIS is not only used to mapping the geographical distributions of disease prevalence (communicable and noncommunicable diseases), but also been used to analyze the spatial trend of the disease transmission and the spatial modeling of environmental aspects of disease occurrences, above and beyond. GIS has been used to updating and mapping the disease epidemiological information and perhaps, it was used for disease surveillance, mapping disease transmission risk and for spatial modeling. And hence, it has also become essential tool in mapping the epidemiological information, disease surveillance, health monitoring, surveying, sampling design, disease control programs, predicting the disease transmission, and most importantly, it has become the important decision-making tool in public health disease surveillance and monitoring disease control programs, site selection of health services, health information systems toward and tool for providing a datum of guidelines for decision making and planning toward the achievements of health-care management in India successfully.

Microfilaria in Fine Needle Aspiration Cytology Smear of Mixed Parotid Tumor - A Case Report

Filariasis is a major public health disease in India especially at coastal areas of Andhra Pradesh, India. Microfilaria is some time seen as an incidental finding during fine needle aspiration cytology smear (FNAC). But it is very rare to find microfilaria in cytological smears of parotid lesions. This is unique finding not reported till to date at our institute. Microfilaria is seen mainly in peripheral blood smear. Wuchereria bancrofti is the most common parasite which causes lymphatic filariasis in India. Here we reported a case in which microfilaria is seen in cytological smears of parotid lesion, first time at our institute of Gandhi Medical College, Telangana, India.

Coverage of, and compliance with, mass drug administration under the programme to eliminate lymphatic filariasis in India: a systematic review.

India's mass drug administration (MDA) programme to eliminate lymphatic filariasis (PELF) covers all 250 endemic districts, but compliance with treatment is not adequate for the programme to succeed in eradicating this neglected tropical disease. The objective of our study was to systematically review published studies on the coverage of and compliance with MDA under the PELF in India. We searched several databases-PubMed/Medline, Google Scholar, CINAHL/EBSCO, Web of Knowledge (including Web of Science) and OVID-and by applying selection criteria identified a total of 36 papers to include in the review. Overall MDA coverage rates varied between 48.8% and 98.8%, while compliance rates ranged from 20.8% to 93.7%. The coverage-compliance gap is large in many MDA programmes. The effective level of compliance, ≥65%, was reported in only 10 of a total of 31 MDAs (5 of 20 MDAs in rural areas and 2 of 12 MDAs in urban areas). The review has identified a gap between coverage and compliance, and potentially correctable causes of this gap. These causes need to be addressed if the Indian programme is to advance towards elimination of lymphatic filariasis.

English

Filariasis caused by the nematode Wuchereria Bancrofti is a public health and socioeconomic problem in tropical and sub-tropical countries. The clinical manifestations depend upon the course of infection in the human host and the worm load. It is a rarity to document filarial worms in histopathology from the testes. We present a giant filarial scrotum of size 30 kg in weight. INTRODUCTION: Lymphatic filariasis is a major health problem in India with a large number of patients tending to be asymptomatic. Genital filariasis in India more commonly presents as a secondary vaginal hydrocele with an associated epididymo-orchitis. CASE REPORT: A 40y/M, from jhalda, farmer by occupation. No history of trauma associated. c/o: Scrotal swelling for 8yrs.patient gave history of progressive increase in the size of swelling from football size to present size. During initial period of disease patient sometimes had rise in body temperature, malaise and tenderness in the swelling but with progression of disease the all symptoms vanished. O/E: swelling is 38into 34cm in size, ovoid in shape, you can get above the swelling. The swelling was non-reducible. Coughing impulse is absent. Skin above the swelling was wrinkled, Penis was buried. Cord was thickened, testis not palpable. Swelling was oval in shape hard in consistency, non-tender, with no rise in local temperature, no translucency; reducibility. USG: suggest Filarial scrotal tumour With the patient in a modified lithotomy position, we excised the lymphedematous mass with a U-shaped incision. The neo-scrotum was made by anterior and posterior flaps. Both testes have been preserved. Reduction scrotoplasty has been done. A romovac drain was put in pouches prepared for the testicles. Postoperative period was uneventful mass was send for histopathological examination. Patient was followed for 6 month for recurrence.

Epidemiological assessment of eight rounds of mass drug administration for lymphatic filariasis in India: implications for monitoring and evaluation.

BackgroundMonitoring and evaluation guidelines of the programme to eliminate lymphatic filariasis require impact assessments in at least one sentinel and one spot-check site in each implementation unit (IU). Transmission assessment surveys (TAS) that assess antigenaemia (Ag) in children in IUs that have completed at least five rounds of mass drug administration (MDA) each with >65% coverage and with microfilaria (Mf) levels <1% in the monitored sites form the basis for stopping the MDA. Despite its rigour, this multi-step process is likely to miss sites with transmission potential (‘hotspots’) and its statistical assumptions for sampling and threshold levels for decision-making have not been validated. We addressed these issues in a large-scale epidemiological study in two primary health centres in Thanjavur district, India, endemic for bancroftian filariasis that had undergone eight rounds of MDA.Methodology/Principal FindingsThe prevalence and intensity of Mf (per 60 µl blood) were 0.2% and 0.004 respectively in the survey that covered >70% of 50,363 population. The corresponding values for Ag were 2.3% and 17.3 Ag-units respectively. Ag-prevalence ranged from 0.7 to 0.9%, in children (2–10 years) and 2.7 to 3.0% in adults. Although the Mf-levels in the survey and the sentinel/spot check sites were <1% and Ag-level was <2% in children, we identified 7 “residual” (Mf-prevalence ≥1%, irrespective of Ag-status in children) and 17 “transmission” (at least one Ag-positive child born during the MDA period) hotspots. Antigenaemic persons were clustered both at household and site levels. We identified an Ag-prevalence of ∼1% in children (equivalent to 0.4% community Mf-prevalence) as a possible threshold value for stopping MDA.Conclusions/SignificanceExistence of ‘hotspots’ and spatial clustering of infections in the study area indicate the need for developing good surveillance strategies for detecting ‘hotspots’, adopting evidence-based sampling strategies and evaluation unit size for TAS.

A double-blind controlled field trial of doxycycline and albendazole in combination for the treatment of bancroftian filariasis in India

In a placebo controlled field trial, the effects of doxycycline (200mg/day) for 23 days followed by doxycycline (200mg/day) in combination with albendazole (ABZ) (400mg/day) for 7 days on depletion of Wolbachia endobacteria from Wuchereria bancrofti and microfilaricidal activity were studied in 68 patients (34 males and 34 females) from West Bengal, India. The drugs in combination (i.e., doxycycline+ABZ) provided the best efficacy by totally eliminating the circulating microfilaria (mf) (in 42% cases) on day 365 with (99.8%, P<0.05) suppression even on day 365 post-treatment compared to both exclusive doxycycline (69%, P<0.05) and ABZ (89%, P<0.05) groups. Thus, our results have established that a 30-day course of doxycycline in combination with a 7-day course of ABZ is sufficient to ensure long-term reduction in mf level by depleting Wolbachia from worm tissues. Doxycycline combined with ABZ led to a greater reduction in mf density in blood at 4 months (post-treatment) in comparison to doxycycline or ABZ alone. There were significant differences between the three treatments after 12 months (post-treatment). Further, the impact of a 7-day regimen of ABZ was surprisingly good in reducing mf compared to doxycycline-alone group. Adverse reactions were mild. A 30-day course of doxycycline and ABZ in combination is a safe and well-tolerated treatment for lymphatic filariasis with significant activity against microfilaremia.

Diurnally subperiodic filariasis in India—prospects of elimination: precept to action?

The elimination of lymphatic filariasis in the Andaman and Nicobar Islands provides unique opportunities and challenges at the same time. Since these islands are remote, are sparsely populated, and have poor transport networks, mass drug administration programs are likely to be difficult to implement. Diurnally subperiodic Wuchereria bancrofti vectored by Downsiomyia nivea was considered for the scope of vector control options. Considering the bioecology of this mosquito, vector control including personal protection measures may not be feasible. However, since these islands are covered by separate administrative machinery which also plays an important role in regulating the food supply, the use of diethylcarbamazine (DEC)-fortified salt as a tool for the interruption of transmission is appealing. DEC-fortified salt has been successfully pilot tested in India and elsewhere, operationally used by China for eliminating lymphatic filariasis. Administration of DEC-fortified salt though simple, rapid, safe, and cost-effective, challenges are to be tackled for translating this precept into action by evolving operationally feasible strategy. Although the use of DEC-fortified salt is conceptually simple, it requires commitment of all sections of the society, an elaborate distribution mechanism that ensures the use of DEC-fortified salt only in the endemic communities, and a vigorous monitoring mechanism. Here, we examine the inbuilt administrative mechanisms to serve the tribal people, health infrastructure, and public distribution system and discuss the prospects of putting in place an operationally feasible strategy for its elimination.

High prevalence of Wuchereria bancrofti infection as detected by immunochromatographic card testing in five districts of Orissa, India, previously considered to be non-endemic

India accounts for over one-third of the world's burden of lymphatic filariasis (LF). Although most coastal districts of Orissa state (eastern India) are LF-endemic, the western districts of Orissa are considered non-endemic. During a large-scale insecticide-treated bed net/microfinance trial, we tested one randomly selected adult (age 15-60 years) for LF from a random sample of microfinance-member households in five districts of western Orissa, using immunochromatographic card testing (ICT). Overall, 354 (adjusted prevalence 21%, 95%CI 17-25%) of 1563 persons were ICT positive, with district-wide prevalence rates ranging from 15-32%. This finding was not explained by immigration, as only 3% of subjects had ever lived in previously known LF-endemic districts. These results therefore suggest ongoing autochthonous transmission in districts where LF control programs are not operational. Our results highlight the importance of broad, systematic surveillance for LF in India and call for the implementation of LF control programs in our study districts.