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HEALTH: Silent Disease Finds a Voice

Sanjay Suri

LONDON, Mar 16 2004 (IPS) - Filariasis has been the forgotten condition in what has emerged as a kind of snobbery among diseases, with global attention focused on HIV/AIDS, TB and malaria. But new drugs offer new hope to a billion people at risk of getting filariasis.

One of the world’s most disfiguring and disabling tropical diseases, filariasis has been tackled more effectively in the last four years than ever before, David Molyneux from the Liverpool School of Tropical Medicine told IPS Monday. A World Health Organisation (WHO) programme has already provided remarkable benefits for the populations of at least 37 endemic countries.

"It has been neglected partly because people don’t get it when they travel," Molyneux said. "One mosquito bite won’t kill you. But this is the second most disabling disease after mental illness."

The disease can lead to the huge enlargement and disfigurement of the arms, legs and genital organs known as elephantiasis.

The worst symptoms of the chronic disease generally appear in adults and in men more often than women. In endemic communities, some 10-50 percent of men suffer from genital damage, especially hydrocoele (fluid-filled balloon-like enlargement of the sacs around the testes) and elephantiasis of the penis and scrotum.

Elephantiasis of the entire leg, the entire arm, or the breast – swelling up to three times normal size – can affect up to 10 percent of men and women in these communities. The psychological and social stigmata associated with the disease are immense, including sexual dysfunction and social ostracism of men and women. Young women and men often can never marry or are subsequently rejected.

"But now we know we can eliminate the disease, we know how to," Molyneux said. A simple two-drug treatment once a year of all people at risk has proved. The fight against this disease needs additional funding of about 100 million dollars, he said. "That is small compared to the global fund to fight HIV, TB and malaria which talks of billions of dollars."

That fund could finance the fight also against this disease because the treatment for filariasis was also found to bring a whole range of unexpected benefits, Molyneux said. Its side benefits meant elimination of intestinal parasites that affect up to a billion children. Treatment also helps fight anaemia, which can be a cause of mortality among those suffering from malaria. "This treatment will bring benefits also for malaria control," Molyneux said.

The highest number of people affected and at risk are in Nigeria, India and Indonesia, but filariasis is endemic in 80 countries, including most of the least developed countries, Molyneux said. So far 120 million people have been treated, he said. "Considering that in 1999-2000 nobody was being given this effective treatment, these figures are remarkable."

Approximately one-third of people infected with the disease live in India; one third are in Africa and most of the remainder are in Southeast Asia, the Pacific and the Americas.

Given the needed funding the billion people at risk could all be protected from the disease by 2015, Molyneux said.

About 120 million people are already infected, and these too could be treated. The people given preventive treatment so far are not necessarily the infected people. Treatment for the condition means that everyone in an exposed area needs to be covered, much in the manner of administering of the polio vaccine.

Two of the drugs to counter filariasis are being donated by their manufacturers – albendazole by GlaxoSmithKline and Mectizan (ivermectin) by Merck & Co., Inc. Administration of treatment costs no more than 10 cents to two dollars per person for the full five-year course.

The elimination of filariasis is expected to provide tremendous economic advantages in affected areas, according to a statement by The Global Alliance to Eliminate Lymphatic Filariasis.

"Economists estimate that people protected from the effects of LF could be expected to contribute billions more dollars to the economies of endemic regions throughout their lifetimes than they would have had they been stricken by the disease," it says.

"In India alone, the economic losses resulting from decreased productivity and lost work days are estimated to be in the order of one billion dollars annually."

In tropical and subtropical areas of Africa, Asia and the Americas where lymphatic filariasis is highly endemic, the prevalence of infection is continuing to increase, the alliance says in its note.

"A primary cause of this increase is the rapid and unplanned growth of cities, which creates numerous breeding sites for the mosquitoes that transmit the disease."

But the growth of disease is being countered now by the faster growth of treatment.