Crucial to maintain success of 'elimination'

It is crucial to maintain the success of the ‘elimination’ status of Lymphatic Filariasis (LF) and prevent its resurgence through diligent control measures, the WHO Representative to Sri Lanka, Dr. Jacob Kumaresan told

Of the 11 countries which form the WHO South-East Asia Region, nine are endemic for LF and two are non-endemic. While Bhutan and the Democratic People’s Republic of Korea are non-endemic, Sri Lanka, Bangladesh, India, Maldives, Indonesia, Myanmar, Nepal, Thailand and Timor-Leste are endemic.

Tracing Sri Lanka’s public health epidemiological transition from infectious or communicable diseases (CDs) to non-communicable diseases (NCDs), Dr. Kumaresan says that there has been good control of CDs, several of which are currently in the stages of elimination and eradication. What is causing major problems are NCDs.

Before dealing with Neglected Tropical Diseases (NTDs) that Sri Lanka is confronted with, he defines them as a diverse group of CDs that prevail in tropical and sub-tropical conditions. These NTDs are found in 149 countries, affecting more than a billion people.

While costing the economies of developing countries billions of dollars annually, NTDs mainly affect impoverished populations, living without adequate sanitation and in close contact with infectious vectors and domestic animals and livestock, he points out.

The major NTDs confronting Sri Lanka are LF, dengue, malaria, leprosy and rabies, it is learnt.

Dr. Kumaresan explains the technicalities of ‘control’, ‘elimination’ and ‘eradication’. Control means that even though disease transmission is going on in the country, the burden is not so high to cause concern, like tuberculosis (TB), in which sphere Sri Lanka is “doing quite well”, as it is detecting cases early and treating them quickly.

Elimination denotes the achievement of very low levels of disease transmission in the country. But achieving zero transmission is not feasible due to the continued existence of the bacteria, virus or parasite in the environment. Here he cites the presence of the parasite and the vector mosquito in the envi- ronment in both LF and malaria.

Eradication, meanwhile, means getting rid of the whole problem like in the case of small pox.

Picking out malaria, Dr. Kumaresan stresses the need for continued vigilance. Sri Lanka had been very close to the elimination of malaria in the 1960s, but complacence resulted in a spike of cases once again. Almost 50 years later, since 2012 there have been no indigenous cases of malaria, only imported ones. “This is fantastic.”

The challenges that Sri Lanka faces in the future with regard to LF, meanwhile, would be managing the few remaining ‘hotspots’, monitoring and detection of the non-primary but abundant parasite and not allowing the focus on LF to be distracted by dengue.

With the WHO’s 2020 Roadmap on NTDs on the table, Dr. Kumaresan says that many of these diseases can be controlled by the end of the decade. However, this cannot be done alone. There is ‘power in partnerships’ and different stakeholders including the affected people themselves should get-together to overcome NTDs.