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What happened, where and when?
Lymphatic Filariasis is caused by a chronic mosquito-borne parasitic infection, which can lead to swelling of the extremities, hydroceles, and testicular masses. The disease is usually transmitted by Culex pipiens, type of mosquito found in congested or dirty water. In 2016, the Maldives became the first country in the region to be certified as having eliminated the disease as a public health problem. However, the Maldives frequently faces spikes of mosquito-borne diseases, such as dengue and chikungunya, during the annual rainy monsoons.
During a health screening event for migrants held in Kulhudhuffushi City, a northern province of the Maldives, from 1-2 December 2023, a total of 25 positive cases of Lymphatic Filariasis were identified. Following this, health screening activities were also carried out in the Greater Male' Area, the capital, resulting in the identification of an additional seven cases. All positive cases identified so far are among migrants. The Health Protection Agency (HPA) reports that the source of the disease is likely from individuals who have traveled to the Maldives from regions where the disease is endemic, specifically identifying Bahar, Uttar Pradesh, Gopalganj, and Tamil Nadu in India, as well as Comilla in Bangladesh, as the likely sources.
In total, 683 individuals (155 Maldivians in Kulhudhuffushi City and 528 migrants from Kulhudhuffushi City and Greater Male' Area) have been screened by health authorities. Out of the 683 screenings, 594 individuals were from Kulhudhuffushi City and 89 from the Greater Male' Area. So far, the disease has only been identified among migrants, with no local positive cases. The Ministry of Health (MOH) and the HPA are working with the WHO to formulate a screening strategy to better understand the extent of the spread. They are currently operating under the assumption that all positive cases identified thus far are imported from regions where Lymphatic Filariasis is endemic, with no local cases identified.
The MOH and the HPA have requested support from the Maldivian Red Crescent (MRC) to assist in scaling up health screening efforts to establish the scale of the disease across the country. MOH confirms that the immediate approach is to carry out mass drug administration (MDA) for the at-risk population. Based on the initial findings, the Ministry of Health and the HPA are scaling up health screening for Lymphatic Filariasis in wider cities across the Maldives, with a particular focus on migrant communities. MRC has been requested to support prevention and community engagement efforts, especially with vulnerable groups such as migrant communities. According to the 2022 Census Report, there are 132,493 expatriate workers living in the Maldives, with an estimated (unconfirmed) 35,000+ undocumented migrants. MRC is also requested to provide immediate support in the procurement of screening kits and medication required for infected individuals. As part of the interventions, the government aims to target city-level islands, ongoing construction sites across the country, and migrant accommodation blocks, as the current assumption is that the outbreak is within the migrant communities.
Update as of 20 May 2024:
A national screening effort led by the HPA of the Maldives took place from February to April 2024. During this effort, 375 migrants in the community tested positive for Lymphatic Filariasis. Additionally, HPA reports that mandatory testing for Lymphatic Filariasis in the visa medical examinations for foreign workers in the country detected over 80 positive cases. Furthermore, HPA reports that the agency only has medication for about 100 patients (IDA, DA iS available for more, but ivermectin is less) on hand and is dependent on the MRC's support for the immediate procurement needed to implement the mass drug administration (MDA) targeted at migrants from endemic countries residing in the Maldives.