Fight against filaria: Adverse events, refusal to take drug hampers drive in Bihar
All 38 districts of Bihar, which was endemic to lymphatic filariasis, reported 1.25 lakh cases of lymphedema (swelling of limbs) and hydrocele (swelling in the scrotum) in 2020-21.
Instances of refusal to consume anti-filarial drugs following reports of adverse drug reactions (ADRs) have hampered Bihar’s mass drug administration (MDA) campaign in 11 districts where the 17-day drive, covering a target population of 4.5 crore, began on September 20, officials said on Monday.
As many as 3,910 instances of ADRs, out of the total 39,78,581 anti-filarial drugs administered, had been reported till Sunday, some even leading to law and order problems, officials familiar with the matter said.
This had a cascading effect, as 7,433 people have so far refused to take diethylcarbamazine citrate (DEC) and albendazole, combination drugs to treat parasites and worm infestations, during the second round of MDA this year, the officials said.
At 1035, Patna reported the highest ADRs and 4218 refusals, as per government data.
Despite an insignificant overall 0.09% ADRs and 0.18% refusals so far in the last five days, the state health department has written to the Centre to replace some batches of the DEC tablet, after they turned into powder form and tasted bitter, said the officials quoted above.
“We wrote to the Centre on the next day of commencement of MDA to replace the DEC tablets that had turned bitter after turning into powder form. We have been following up with the Centre every day for the new stock of drugs. The Centre had supplied us these drugs in May this year,” said a senior officer in the health department.
At the same time, government officials tried to dispel rumours of any serious after-effect in the adverse events reported till Sunday.
“Some instances of nausea, giddiness or weakness after consuming DEC is a positive sign, which indicates the killing of microfialria worms in human body. There is no problem whatsoever with the efficacy or the quality of the drug,” said Dr Parmeshwar Prasad, additional director and state programme officer, filariasis.
Some DEC tablets, he said, had turned bitter because they had broken into powder form due to their hygroscopic nature, which was the ability of the drug to absorb water or moisture from its surroundings.
“Adverse events mostly happen after consumption of anti-fialrial drugs due to killing of heavy number of microfialria, if a person in infected with filarial parasite,” said Dr Rajesh Pandey, state coordinator (neglected tropical diseases) of WHO, which is helping the state government in the health sector.
All 38 districts of Bihar, which was endemic to lymphatic filariasis, reported 1.25 lakh cases of lymphedema (swelling of limbs) and hydrocele (swelling in the scrotum) in 2020-21.
“Around 80% hydrocele cases are due to lymphatic filariasis in endemic areas,” said Dr Pandey.
As part of MDA, DEC tablet and albendazole, will be administered through booths at health centres and schools and through door-to-door visits in seven districts of Bhojpur, Buxar, Madhubani, Nalanda, Nawada, Purnia and Patna. Health workers will also administer Ivermectin (to treat certain parasitic roundworm infections)to beneficiaries in four districts of Darbhanga, Lakhisarai, Rohtas and Samastipur, having higher infectivity rate, said Dr Prasad.
The first round, covering 24 districts, was undertaken in February. Araria, Madhepura and Kishanganj districts have been left out of the MDA round this time as they have less than 1% microfilariae (MF) rate, which is parasitological identification of microfilariae in the blood.
Lymphatic filariasis (LF) is a severely disabling, mosquito-borne infectious disease, causing elephantiasis (abnormal swelling of limb or other body part) and hydrocele (inflammation of the scrotum). It may irreversibly damage the lymphatic system in people of all age groups, leading to abnormal swelling in body parts. Those affected by filaria, such as hydrocele, lymphedema (swelling of limbs), and chyluria (milky white urine), often have to bear a significant social burden, affecting their livelihoods and capacity to work.