Lymphatic filariasis (LF), often known as elephantiasis, is a devastating parasitic worm infection spread by mosquitoes that affects 120 million people in 55 countries around the world.
The disease is one of the world’s leading causes of disability and the economic cost of working days lost as a result of LF runs into billions of dollars.
LF threatens almost one sixth of the world’s population, yet few people outside the affected countries have ever heard of it. LF is found in the tropical and sub-tropical areas of Africa, Asia, the Pacific, the Middle East and the Americas.
When a mosquito bites someone already infected with lymphatic filariasis, the mosquito ingests microscopic worms (microfilariae), which then circulate in the mosquito's blood. These develop into infective larvae, which later migrate to the mosquito’s mouth ready to enter the bloodstream of the next person to be bitten.
Once a person is infected, the larvae develop into adult worms and lodge in the lymphatic system (a network of vessels that regulate the body’s fluid and is part of the immune system) causing inflammation and damage. Over time this can result in chronic swelling of the limbs (lymphoedema), male genitals (hydrocele) and breasts. The condition also leads to a vicious cycle of feverish acute attacks as the body attempts to fight the disease.
Adult worms typically live in humans for about six years, during which time they produce millions of immature worms (microfilaria). The microfilaria circulate in the blood waiting for the next biting mosquito to ingest, continuing the cycle. Many people are not aware they have the disease until years after the initial infection. Around half of those affected do not have any symptoms but they may still have active infection in their bodies.
Although the disease is not life threatening, infected individuals with physical symptoms are usually affected during their most productive years. The disability and the incapacitating acute attacks leave them unable to work, which can lead to a life of poverty. Added to this, those affected are often stigmatised. They can be considered undesirable for marriage, normally an essential source of security.
Top photo: Healthy children playing in the streets of Karaikal in Tamil Nadu, India - one of the areas where lymphatic filariasis is being targeted.
Above: With a compromised lymphatic system, the body is less able to resist common skin infections, and simple cuts become badly infected. In the photo Adama Zoundi finds the spirit to share a joke with Mme Kabre (Ministry of Health, Burkina Faso) whilst she washes his infected foot. Adama is part of a newly established group of LF patients who meet regularly to share their experiences and to support each other. Ouagadougou, Burkina Faso.
Managing lymphatic filariasis
Lymphatic filariasis can be prevented with two pills which kill the parasitic worms. However, for those who have developed the condition, with the exception of men with hydrocele, the lymphoedema, tissue damage and the compromised immune system cannot be reversed.
Regular washing is essential to minimise skin deterioration, although this can be a challenge for many patients who don't have easy access to clean water. Recognising and treating the condition early is essential.
Below: Regularly washing limbs affected by lymphatic filariasis plays a key role in minimising skin infections which can otherwise spiral out of control.
Above left: Sultan Nuoni grew up unaware of what was causing his legs to swell from the age of twelve. He tried to continue at school, but the pain and the intense fevers forced him to leave. Today, his condition is managed, but the physical effects and the lack of education means he finds it impossible to find regular employment. Morogoro, Tanzania.
Above right: Usha fell ill when she was 13 years old and her leg started swelling. She wanted to study maths but quit school in the 9th grade because she was being teased. Her condition made it difficult to find suitors for her, so she never married. Lymphatic filariasis has meant that Usha has missed out on a lot in life. She now runs the family house for her nephew and his wife, but continues to suffer pain and fever associated with the disease.
Above: Finding work which reduces the risk of injury and infection to the affected limbs helps LF patients maintain a sustainable income. Miftahudin chose to work as a local tailor in Pekalongan City, Indonesia.
Above: Degbe Ablavi is a woman most busy mothers can identify with. Here she finally sits down after an exhausting day. In the morning she collected water, then carried her maize and cassava to the local miller for grinding. In the afternoon she worked in the family's yam field before sweeping the yard and preparing dinner for the family in the evening. All the while she allowed us to follow her and her daughter, Sitchope, to take pictures. Now, all that's left to do is tidy the kitchen, clean the cooker (main picture - right) and put Sitchope to bed before the sun goes down. Degbe has lived with LF since 2005. Agbati, southern Togo.
Above: Darai Lal-Bahadur, an LF patient, returns home with a little food for his livestock of two - a buffalo and a cow - his main source of income. In addition to struggling with LF, Darai also broke all fingers in both hands due to an accident when he was younger. (The running cows do not belong to Darai, and they didn't knock him over.) Jagir Goan, Salyantar, Nepal.
Below: A scene replicated around the world - Silvi Degbe's son hangs around the family kitchen waiting for his dinner. Silvi, who has lived with LF since 1993, works as a corn saleswoman. Tsave, southern Togo.
Eliminating lymphatic filariasis
For centuries lymphatic filariasis, like many tropical diseases, was misunderstood and neglected with little hope of treatment or prevention. This has now changed and there is real hope for both the control of the disease and for those afflicted by it.
In early 1998 GSK announced a collaboration with the World Health Organization (WHO) to spearhead a global effort to eliminate LF. This has evolved into a major public-private partnership known as the Global Alliance to Eliminate Lymphatic Filariasis. GSK's commitment to the project includes the provision of its anti-parasitic medicine, albendazole, to every country that needs it until LF is eliminated as well as resources for a wide range of supporting activities. The goal is to have consigned lymphatic filariasis to history by 2020.
Below left: In order to rid the world of lymphatic filariasis, affected communities need to be educated about the disease and motivated to take the drugs to stop it. This requires dedicated local teams working remotely in countries often experiencing funding shortages, conflict issues and battling other chronic diseases.
The picture shows a drug administration team encouraging a young boy to take medicine in order to combat lymphatic filariasis. The yellow measuring stick is used as an effective guide for calculating the required dose for each person and is much quicker than weighing or assessing a person's age, which may not always be known.
Above right: Bhagwati Thapa typifies the spirit of many LF patients who opened their homes and shared their stories to help us document lymphatic filariasis. In the photo Bhagwati is inviting us to stay for tea - which we gladly accepted. Bungmati, Nepal.
GSK (GlaxoSmithKline): One of the world's leading science-led healthcare companies headquartered in the UK and operating in over 100 countries.
In early 1998 GSK announced a collaboration with the World Health Organization (WHO) to spearhead a global effort to eliminate lymphatic filariasis. This has evolved into a major public-private partnership known as the Global Alliance to Eliminate Lymphatic Filariasis.
GSK's commitment to the project includes the provision of its anti-parasitic medicine, albendazole, to every country that needs it until LF is eliminated as well as resources for a wide range of supporting activities.
The project required photography to illustrate LF, how the disease is managed and the initiative to eliminate it.
What was delivered
A portfolio of images from three continents showing the impact LF has on those who suffer from this debilitating disease, the challenges faced by some of the teams working to eliminate it, and the clear benefits elimination brings
How it is being used
Published globally online and in print by GSK and partners - including WHO, African and Central Asian health ministries, academia and global advocacy groups - the pictures helped to inform potential partners, the general public and those at risk about the devastating effects of LF and the international effort to combat it.
The pictures were also exhibited at the Carter Centre in Atlanta as part of GSK's 10th anniversary of the drive to eliminate LF. The event brought together leaders in global health to discuss disease elimination prospects - past, present and future.
Since January 2015, some of the pictures have formed part of a major exhibition at the American Museum of Natural History in New York. Presented in collaboration with the Carter Centre, the exhibition 'Countdown to Zero: Defeating Disease' is on display until January 2017.
Lymphatic filariasis (LF) remains one of the seven diseases deemed eradicable by the International Task Force for Disease Eradication, along with polio, mumps, rubella, pork tapeworm, Guinea worm disease, and measles.