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Fears over mass administration of anti-filariasis drug

By Roy Mathew

THIRUVANANTHAPURAM, JUNE 6 . The Government's move for mass administration of diethyl carbamazine to fight lymphatic filariasis has raised several questions and concerns that are yet to be answered by the Health Department.

The department is following the recommendation of the World Health Organisation (WHO) and the Central Government in this regard and is going ahead with plans to administer the drug to 26 million people in 11 districts, most of whom are not even carriers of the disease.

The major policy question that arises out of the move is whether the department could not have looked into alternatives and the special conditions prevalent in the State before adopting the national programme.

The department has sufficient machinery to reach out to people actually suffering from filariasis and treat them. If past programmes to reach all have failed, it was for want of proper mobilisation of the machinery. Kerala is facing the threat of recurrence of Dengue fever and malaria, and resources could have been pooled for vector control.

The State would spend at least Rs. 5.7 crores (at the current year's estimates) over the next five years with the avowed objective of eradicating filariasis. However, studies and past experience have shown that mass administration of the drug alone would not suffice. Vector control is essential. Even with that, it is doubtful whether the objective could be achieved. What can be achieved for sure is only a reduction in the density of microfilaria among the population, which can hopefully bring down the level of transmission of the disease. The WHO's target for elimination of the disease worldwide is 2020 and India hopes to achieve the same by 2015.

According to official sources, there are more than 8,000 cases of lymphatic filariasis in the State. Fresh incidence indicates the failure of the National Filariasis Control Programme and the public health care system to reach out to the vulnerable population.

Jothydev Kesavadev, Assistant Professor of the Thiruvananthapuram Medical College, said the situation in Kerala was different from other States. The State had a high proportion of elderly population to whom the drug could not be administered. The proportion of diabetic patients among the population too was high with many picking up the disease at an early age. The educated populace of the State would identify the adverse effects of the medicine, and this would affect the programme.

Concerns have also been raised over the risks associated with the mass administration of the drug by doctors and voluntary groups.

Dr. Kesavadev said the WHO would not have recommended mass administration of the drug in a developed country. "In a developed country, its approach would be different. It appeared that the WHO is willing to take a few casualties in less developed countries for eradication of lymphatic filariasis."

He said the drug could cause severe anaphylactic shock that could be fatal in patients with high levels of microfilaria in the blood stream. Allergic reaction occurs on account of the toxins released by the microfilaria killed by the medicine. The drug is administered to patients with absolute eosinophyl count of more than 2,000 cells per cubic millimetre under steroid cover. This was the consensus medical opinion, and that meant the drug should be administered under medical supervision after a blood test.

According to documentation available with Medline (Online Medical Information System), the risks of taking the medicine should be weighed against the good it would do and this is a decision "you and your doctor will make". It also says that mothers who take the medicine and who wish to breastfeed should discuss this with their doctor. Care should be taken to see that its administration does not conflict with other medicines one is taking. There is also a warning against double doses. The Health Department has virtually not taken any precaution to avoid mishaps occurring from volunteers, many of who are drawn from Kudumbasree units, administering the medicine.

C.R. Soman, of the Health Action by People, says that mass administration of the drug in endemic areas will be justified when benefits overweigh the risks. The drug was in use for years and fears about side-effects are imaginary. However, administration of the drug to the whole population is not advisable.

The biggest question about the programme, Dr. Soman adds, will be compliance. Many people are unlikely to follow the medical instructions. Transmission of the parasite cannot be interrupted by drug administration as long as mosquitoes are around.

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