Separating fact from fiction: Debunking myths about lymphatic filariasis

Lymphatic filariasis, often referred to as "elephantiasis," is a debilitating parasitic disease that affects millions of people worldwide and is caused by mosquito bites. Despite being a debilitating disease, it is one that can be easily eliminated if all residing in endemic areas consume anti-filarial medication, once a year, continuously for 5 years.

Globally, 18 countries have achieved the elimination of Lymphatic Filariasis (LF) including our neighbors Sri Lanka and Bangladesh. Though in India, many people in affected areas still refuse to take preventive, anti-filarial medication during the Mass Drug Administration (MDA) rounds. These medicines are completely safe to consume and help not only with LF, but also with the removal of intestinal worms, prevent scabies, lice and hookworm infections. The government of India has set the target of 2027 for the elimination of LF as a public health issue from India, and to this end, specific states that are endemic for LF undertake MDA rounds, where the anti-filarial medicines are administered to eligible populations, completely free of cost. However, despite these efforts not everyone consumes the medicines, risking us missing the elimination deadline.

There are some common myths and misconceptions that prevent individuals from accepting anti-filarial medication. Common reasons for refusal include fear of side effects, concerns about interactions with other medications, the belief that they are not at risk of filariasis, lack of trust in the medicines, a lack of complete information about the drugs, and various misconceptions such as the belief that anti-filarial drugs are not suitable for the elderly. Additionally, some individuals may perceive the medication regimen as too complex or time-consuming.

Let's debunk some common myths and set the record straight

Some people may believe that lymphatic filariasis is a genetic disease, but this is not the case. The disease is caused by parasitic worms transmitted through mosquito bites, and there is no genetic predisposition. Often, the cases of LF found in the same family are a result of proximity leading to the transmission of the filarial parasite via mosquitoes. This myth contributes to the low-risk perception that communities have about the threat that filaria can pose to them and their families. LF is a disease that can manifest in any individual no matter how old, young, rich or poor.

Another such myth is that this is a disease that can only affect those living in poverty. While due to their living conditions and limited access to healthcare, they may be more prone to the disease, this illness can impact anyone, regardless of their socioeconomic situation. With urban infrastructural changes, water stagnation and mosquito-breeding, even those living in urban settings can contract LF If a family’s sole earner refuses anti-filarial medication, they risk lifelong disability and financial hardship, as they may become unable to work due to conditions like lymphedema or hydrocele.
Due to low levels of awareness about the transmission of LF, there are some people who carry the misconception that this disease can spread via physical contact with a patient. This is categorically false, as LF spreads only via the bite of an infected mosquito.

Many people hesitate to take anti-filarial drugs due to concerns about potential side effects. This year through the February MDA round alone, over 13,00,00,000 (thirteen crore) people consumed anti-filarial medicines safely and with no incidents requiring major medical interventions. Side effects such as acidity may occur in a small percentage of the population consuming the medication if it is consumed on an empty stomach. Similarly, some individuals may experience itching as a side effect, which occurs due to the microfilaria in the body reacting to the medicines and getting destroyed. It is important to understand that experiencing mild side effects often indicates that the drugs are working effectively. The medicines given during the MDA rounds are commonly used in the health sector for several other treatments as well and can also be obtained from private doctors or through chemists on presenting the required prescription.

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The drugs do not affect reproductive organs, are safe for children, can be beneficial for allergies, and are compatible with surgery and other medications. Additionally, they can be taken along with any ongoing treatment for mild illnesses. The only people who should not take the drugs are children below the age of 2, pregnant women and those with critical illnesses.

Advance stages of LF, aside from Hydrocele which can be operated upon, can be extremely hard to manage but early diagnosis and treatment with anti-filarial drugs can prevent the disease from progressing and causing severe complications. It's important to seek medical attention if you experience symptoms such as swollen limbs, genitals, or lymph nodes.

While there is no cure for the lymphedema caused by LF, the Ministry of Ayush is making great efforts to work with experts on researching and implementing better disease management methodologies. To implement integrated medicine for filarial lymphedema, the Institute of Applied Dermatology (IAD) is working with the governments of Bihar, Uttar Pradesh, and the Ministry of AYUSH, Government of India. IAD’s approach combines modern medicine treatments (Allopathy), Ayurveda and Yoga to treat lymphedema and other chronic skin diseases. IAD has established four regional filariasis treatment sub-centres in endemic districts of Lucknow and Varanasi in UP and Begusarai and Patna in Bihar.
By employing grassroots-level approaches to address refusals, facilitating social mobilization through self-help groups and patient networks, and promoting inter-sectoral convergence, the Indian government has significantly advanced elimination efforts. Similar efforts by the government have proven to be instrumental the elimination of Kala Azar and with dedicated implementation and education I am sure we can eliminate LF from our country once and for all as well, ensuring a healthier India for everyone.


(Dr. Bhupendra Tripathi, Deputy Director - Infectious Diseases and Vaccine Delivery, Bill and Melinda Gates Foundation)