WHEN my son came from school a few weeks ago and asked me about the disease that turns people into elephants, I had to scratch my head. I tried to dissuade him but he was insistent.
Their teacher had told them, that people were turning into elephants in Ndola and he needed to be vaccinated against it to protect himself. Not long after that, the word Elephantiasis started appearing in the newspapers, billboards, the local community radio and television. So I put two and two together.
The pronunciation of the word was a severe challenge for many television and radio announcers and so was the spelling.
Too many letters repeat themselves, what with double ‘es’, double ‘as’, double ‘is’ and double ‘ss’. It steered up a lot of controversy on the basis for this campaign about a disease no one had ever even heard of, nor could they pronounce or spell properly.
In my case, it had been many years ago, in medical schools when I had learnt about Elephantiasis. In those days we were told it was a disease, mostly confined to West Africa. So I decided to go first to the Ministry of Health website for an update. I must admit I was concerned enough to dust my medical books and look up Elephantiasis.
1. What causes Elephantiasis?
Elephantiasis is one among a group of diseases caused by a group of parasites called Filarial worms. These worms get into the body and grow in different organs of the body causing malfunctions of those body systems. Elephantiasis is the common name for the conditions, but the more medical term is Onchocerciasis.
The term Elephantiasis is derived from the advanced form of the disease when the patient has abnormally enlarge limbs, like those of an elephant.
The Filiarial parasite that is the cause of this condition is called Wulcelaria Bancrofti. The worm is carried by the female mosquito from infected people into the blood stream of uninfected people. This is very similar to the way malaria, which is far more common, is transmitted.
The mosquitoes that carry the parasite are the Culex mosquito, as well as the Anopheles mosquito (which also carries malaria).These worms grow in the body and lodge themselves in the lymphatic channels. The lymphatic channels, are like blood vessels, except they carry a clear fluid called lymph.
Lymph is a clear body fluid that is filtered through lymphatic defense stations (lymph nodes).These channels carry any fluid that is too thick to be carried by the blood vessel system. It cleans out any unhealthy germs, or worms through a series of lymph nodes in the body. Eventually, when the lymph fluid has been processed it is returned to the blood stream through the large veins in the neck.  The filarial worms grow and divide in these channels, until over time they block them. The worms can stay in the body for many years without showing any signs of disease.
2.  How can someone know that they have Elephantiasis?
A person may not know that they have been infected by the worm for many years, until the lymphatic system stops working properly. This process of damage to the lymphatic channels can take anywhere between 10 to 15 years.
Slowly the lymphatic channels begin to narrow, until they are completely blocked. When they are blocked, excess body fluid begins to spill over in the body. This makes the skin thick and woody hard. Then the skin also becomes itchy and prone to other skin infections.
The fluid accumulates beneath the skin in the loose packing and supporting tissues of the body. This makes legs and thighs in particular, take on the round full appearance of an elephant’s leg. The leg (the part between the knee and the ankle), enlarges to become almost the same size as the thigh (the part between the hip and the knee).
This gives the rounded appearance of the elephant leg, from which the disease gets its name. Usually the disease involves only one side. The constant irritation of the skin, leads to the limb also becoming darker in colour. In the male patient, the scrotum (the male bags) also fill up with fluid and become large, like huge balloons. These two problems make walking very difficult for the patient, making the patient to stay indoors.
The patient will start wearing shorts, because the normal trousers will no longer fit. The question that is often asked is, why does this problem mostly affect the legs and not the rest of the body? The answer is that, the disease can affect any part of the body where lymphatic channels are found.
However the lower parts of the body tend to have more fluid accumulating because of their position. This means that they are more easily affected by any damage to the vessels that pick up fluid. In fact any low lying structure is easily affected by this blockage of the lymphatic channels. This includes the female breasts, which can become enlarged and pendulous, as well as the male organ, the penis. The lymphatic stations (lymph nodes), in particular those around the groin area (the region between the thigh and the abdomen), also enlarge and become hard.
3.Why has it become common now?
This disease has always been common in the tropics. The areas which have high temperatures and have a high humidity, are good breeding ground for the mosquito. This includes the areas of Sub-saharan Africa, South America and Asia. However over the years this condition has been seen in higher levels in parts of West, Central and East Africa.
With the improvement in travel, and increase in trade among regions within Africa, it can well be appreciated how the disease may have spread. In addition the World Health Organisation (WHO) encourages countries within these regions to be vigilant in looking out for any increase in these types of diseases (an approach called active surveillance). Therefore, any small rise in the level of this disease is a cause for action to prevent a further increase.
So levels of 5 to10 per cent of the population on the Copperbelt, are an indication that it is possible to eliminate this disease altogether in the population if an active intervention undertaken.
4.How can I be protected?
Like many new medical interventions which involve large groups, people are always hesitant. I thought this was only peculiar to Zambia, until I worked in the United Kingdom (UK). I was surprised to find a group in London that was actively campaigning against measles vaccination in the West London Borough (the council region).
So naturally any new vaccination or mass treatment strategy is bound to face opposition. This is particularly so when it involves administration of a medical intervention to children and women. If it involves an injection, the opposition is doubly so.
Since the worm can grow unobserved for many years, the strategy is to give drugs that kill the worm in the body before it causes the damage to the lymph vessels. The strategy which is recommended by the WHO, which is also being used in Zambia, is periodic mass treatment.
This means that you interrupt the life cycle, of the worm in the body by treating at-risk populations every once a year for a period of 4 to 6 years. If this is done, it will both reduce the number of cases of the disease in the community and the risk of spread in the community.
In selected towns on the Copperbelt, this mass administration of two drugs has been done (Albendazole and Diethylcarbamazine are what were being administered).
Many people have been concerned that these drugs may have side effects. However these drugs are not new or experimental drugs. These drugs have been used routinely for many years in the treatment of many other childhood worm infections. Some people who have taken these drugs have experienced mild side effects, as may happen with any drugs given to a large number of people. Some of these include dizziness, nausea, vomiting and abdominal upsets. However the large majority have had no major effects.
Elephantiasis is difficult to treat once it is in an advanced stage. It is disfiguring and makes it difficult for a person affected to continue working.
Therefore it is a wise decision to try as much as possible to prevent the disease from affecting you and your family.
The use of Insecticide Treated Nets (ITNs), indoor residual spraying, burying stagnant pools around the house and taking the recommended drugs, will all help protect you from this disease.