SmithKline Beecham and The World Health Organization to Collaborate in Seeking to Eliminate One of the World’s Greatest Scourges — Lymphatic Filariasis (Elephantiasis)

Released in London and Washington D.C.

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Interviews available with SmithKline Beecham and World Health Organization technical experts in Washington, D.C. on Friday, January 23. To schedule time, please call (703) 820-2244.

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January 26, 1998 — In a new worldwide program, SmithKline Beecham (SB) and the World Health Organization (WHO) will work together to eliminate lymphatic filariasis, one of the world’s most disfiguring and disabling tropical diseases, which affects 120 million people in 73 countries. More than one billion people, or about 20 percent of the world’s population, are now vulnerable to this infection caused by parasitic worms. Announcement of the program was made at the WHO Executive Board now meeting in Geneva.

The disease often leads to elephantiasis, the huge enlargement of the arms, legs and genital organs which causes profound physical and psychological disability. Efforts to eliminate the carrier of the parasite, the mosquito, have failed. The best opportunity for eliminating lymphatic filariasis is through medicines used to break the endless cycle of infections between the mosquitoes and humans.

New research has determined that albendazole, a SmithKline Beecham drug which has already become a standard treatment worldwide to combat intestinal parasites, is 99 percent effective against the parasite that causes lymphatic filariasis when simultaneously administered with other anti-parasitic drugs.

“We will donate albendazole free of charge for this program to WHO for use in every country that needs it until this dreadful disease is eliminated as a public health problem,” says Jan Leschly, Chief Executive for SmithKline Beecham.

“We expect to see a dramatic decline in lymphatic filariasis within five to six years after the program gets underway later this year,” Mr. Leschly adds. “The entire program will run for at least 20 years, longer if necessary.”

“This will be one of the largest global disease elimination programs ever undertaken by public health authorities,” says Dr. Hiroshi Nakajima, WHO Director-General. “Lymphatic filariasis is one of the major causes of individual disability and associated socio-economic burden in the world. We are delighted that SmithKline Beecham has generously agreed to collaborate with WHO and its Division of Control of Tropical Diseases in this important initiative.”

“Because of the drug regimen needed to interrupt the parasite’s life cycle — one dose yearly for 4-5 years to all people in infected areas — SmithKline Beecham’s commitment to donating sufficient albendazole to this program will require several billion doses,” says Dr. James Hill, Director and Senior Vice President for Corporate Affairs. “But SmithKline Beecham will do more than just donate the drug. We will also offer program assistance and health education. We want to make sure that this disease will be totally eliminated as a public health problem. Our employees in target countries will offer additional support.”

“The donation by SmithKline Beecham is being made at a particularly opportune time,” emphasizes Dr. Kazem Behbehani, Director of WHO’s Division of Control of Tropical Diseases. “The necessary tools and strategies for diagnosing and treating this infection have been developed only recently but, indeed, have proven so effective that we can now envision not just control of this ancient scourge but even its elimination by the year 2020.”

The disease elimination program will involve close collaboration with ministers of health of participating nations. “Egypt welcomes this important expression of concern and partnership between WHO and SmithKline Beecham, a public-private sector initiative that promises to stimulate enormous progress in our efforts to eliminate lymphatic filariasis globally,” says Professor I. Sallam, Minister of Health and Population, Egypt.

Adds Nimal Siripala de Silva, Minister of Health and Indigenous Medicine, Sri Lanka, “We will now move forward to finalize Sri Lanka’s plans for a dynamic national filariasis elimination campaign in collaboration with this partnership. A large number of voluntary workers and community-based organizations will assist the health authorities in supporting this project that is so important to national health.”

“This program complements our much broader approach to improve the health of the communities where we work,” adds Dr. Hill. “Ultimately it is our aim, through our products, services and community partnership programs, to enrich the health of everyone in the world. This collaboration with the World Health Organization allows us to directly improve the health of at least one-fifth of the world’s population and this program will spearhead our healthcare focus within global communities into the new millennium. We welcome other companies and organizations to join us in this program.”

SmithKline Beecham is one of the world’s leading healthcare companies. It discovers, develops, manufactures and markets pharmaceuticals, vaccines, diagnostics, over-the-counter medicines and health-related consumer products, and provides a wide range of healthcare services.

Background Information on the Disease

In tropical and subtropical areas of Africa, Asia and the Americas where lymphatic filariasis is well-established, the prevalence of infection is continuing to increase. The 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.

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.

Some 43 million people worldwide have outwardly visible symptoms of the disease. The remainder of those infected, nearly 76 million people, appear healthy, but internally, their bodies are being damaged, often severely and irreversibly.

The thread-like, parasitic filial worms Wuchereria bancrofti and Brugia malayi that cause lymphatic filariasis live almost exclusively in humans. These worms lodge in the lymphatic system, the network of nodes and vessels that maintain the delicate fluid balance between the tissues and blood, and are an essential component for the body’s immune defense system. They live for 4-6 years, producing millions of immature microfilariae, minute larvae, that circulate in the blood.

The disease is transmitted by mosquitoes that bite infected humans and pick up the microfilariae. These develop into the infective stage in a process that usually takes 7-14 days. The larvae then migrate to the mosquitoes biting mouth parts, ready for inoculation into the bloodstream of the next unsuspecting individual, thus completing the cycle.

The appearance of the disease itself in humans is still something of an enigma to scientists. Though the infection is generally acquired early in childhood, the disease may take years to express itself. Indeed, many people never acquire the outward clinical manifestations of their infections.

The asymptomatic form of infection is characterized by the presence in the blood of thousands or millions of larval parasites (microfilariae) and adult worms located in the lymphatic system. While there may be no clinical symptoms, however, studies have now disclosed that such victims, outwardly healthy, actually have hidden lymphatic pathology and kidney damage as well.

The worst symptoms of the chronic disease generally appear in adults, and in men more often than in 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, the vulva, 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.

Acute episodes of local inflammation involving skin, lymph nodes and lymphatic vessels often accompany the chronic lymphedema or elephantiasis. Some of these are caused by the body’s immune response to the parasite, but most are the result of the bacterial infection of skin where normal defenses have been partially lost due to underlying lymphatic damage. Careful cleansing can be extremely helpful in healing the infected surface areas and in both slowing and, even more remarkably, reversing much of the overt damage that has occurred already.

In endemic areas, chronic and acute manifestations of filariasis tend to develop more often and sooner in refugees or newcomers than in local populations continually exposed to infection. Lymphedema may develop within six months and elephantiasis as quickly as a year after arrival.

This profoundly disabling disease has serious psychological and social consequences, particularly sexual dysfunction and social ostracism of men and women. Young women often can never marry or are subsequently rejected by their spouses.

The best previous regimen against the disease was a single, annual dose of either diethlycarbamazine (DEC) or ivermectin. When either DEC or ivermectin is administered at the same time as SmithKline Beecham’s albendazole, however, very significant enhancement of efficacy is observed.

A second major benefit of albendazole is that, at the same time it is attacking the lymphatic filariasis parasite, it will also cure infections with gastro-intestinal parasites, including the hookworm, which is a particularly severe problem across the world, especially Africa. These multiple effects of treatment not only enhance people’s receptiveness to taking the medications each year (thereby improving program effectiveness); but they also lead to direct physical benefits, with children showing improved weight gain and cognitive development after successful treatment of their intestinal parasites. Thus, the collaborative program between SB and WHO to eliminate lymphatic filariasis globally promises to have a public health impact extending even beyond that anticipated from eliminating one of the oldest, most debilitating parasitic diseases of mankind.

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