Date Published: July 30, 2015
Publisher: Public Library of Science
Author(s): Madhusmita Bal, Prakash K. Sahu, Nityananda Mandal, Ashok K. Satapathy, Manoranjan Ranjit, Shatanu K. Kar, Carlos Franco-Paredes. http://doi.org/10.1371/journal.pntd.0003955
Abstract: BackgroundGlobal Program to Eliminate Lymphatic Filariasis (GPELF) launched by WHO aims to eliminate the disease by 2020. To achieve the goal annual mass drug administration (MDA) with diethylcarbamazine (DEC) plus albendazole (ABZ) has been introduced in all endemic countries. The current policy however excludes pregnant mothers and children below two years of age from MDA. Since pregnancy and early childhood are critical periods in determining the disease outcome in older age, the present study was undertaken to find out the influence of maternal filarial infection at the time of pregnancy on the susceptibility outcome of children born in a community after implementation of MDA for the first time.Methodology and Principal FindingsThe participants in this cohort consists of pregnant mothers and their subsequently born children living in eight adjacent villages endemic for filarial infections, in Khurda District, Odisha, India, where MDA has reduced microfilariae (Mf) rate from 12% to 0.34%. Infection status of mother and their children were assessed by detection of Mf as well as circulating filarial antigen (CFA) assay. The present study reveals a high rate of acquiring filarial infection by the children born to infected mother than uninfected mothers even though Mf rate has come down to < 1% after implementation of ten rounds of MDA.SignificanceTo attain the target of eliminating lymphatic filariasis the current MDA programme should give emphasis on covering the women of child bearing age. Our study recommends incorporating supervised MDA to Adolescent Reproductive and Sexual Health Programme (ARSH) to make the adolescent girls free from infection by the time of pregnancy so as to achieve the goal.
Partial Text: Lymphatic filariasis (LF) is the second leading cause of chronic disability worldwide. According to recent estimate around 120 million people have been infected with LF in 73 countries and more than 1.1 billion (20% of the world’s population) are at risk of acquiring infection . Two-thirds of the endemic population resides in South-East Asia and one-third lives in India . Out of 30 states in India, seven states namely Andhra Pradesh, Bihar, Kerala, Odisha, Uttar Pradesh, Tamil Nadu, and West Bengal contribute over 86% of Mf and 97% of disease cases in the country .
An overview of the enrolment and follow up of participants is presented in Fig 1. A total number of 179 pregnant women admitted to O& G clinic for delivery from July 2009 to July 2011were selected for the study. Of them 21 (11.7%) mothers were excluded because of complication during delivery or infant death or unwillingness. None of the mothers have been enrolled more than once. Finally 158 mother-new born pairs were enrolled for the study. Amongst them 24% of the mothers have multiparity status. As would appear from the baseline characteristics about 45% of the mothers were positive for CFA (GM: 1925, range: 630–16596) and 11.8% for Mf (3–210 per 60μl blood). The transplacental transfer of CFA from mother to cord was detected in 15.8% of the infected mother, while none of the cord blood was found to be positive for Mf.
For the first time our study has shown the impact of in- utero exposure to filarial infection on susceptibility outcome in early childhood during their natural exposure to filariasis in a MDA ongoing area, where the Mf rate has come down to below threshold level. This study further reveals that though a proportion of infected mothers have cleared infection during follow-up period due to ongoing MDA, yet children born to them acquire infection similarly as the children born to mothers who have not cleared the infection.