Diseases & National Health Programme
Mass prophylaxis is not used in (DNB June 09)
Mass drug administration is not given in scabies although all the close contacts of the patient like the family members who might be sharing the same bedding, towels, clothes etc must be treated simultaneously so that the local transmission of the disease stops.
For all other conditions given in the options, mass drug administration is a well established strategy for disease control.
Mass Drug Administration for Malaria
a. WHO is currently emphasizing malaria control/eradication of which the drug treatment is an important component. Under the revised strategy, mass drug administration has been recommended in highly endemic areas (API more than 5 per 1,000 population) as the best method of curbing the transmission, with extensive antimosquito measures to follow. While drugs may provide a temporary relief, the ultimate solution lies in the interruption of transmission.
Mass prophylaxis in children under 5 years old is no longer recommended for the following reasons:
i. experience shows that it is impossible to achieve continuous suppression in a significant proportion of the population;
ii. it may interfere with the development of protective immunity;
iii. it may accelerate the development of drug resistance;
iv. it uses scarce resources that may be better used for treatment;
v. it might increase the risk of retinopathy occurring during the lifetime of the individual. In these circumstances, it is preferable to provide curative treatment whenever and wherever it is required, ideally through a primary health care system that provides prompt diagnosis and adequate treatment.
b. Filaria control in the community:
a. There are three reasons why filariasis never causes explosive epidemics: A. the parasite does not multiply in the insect vector, B.the infective larvae do not multiply in the human host, and C. the life cycle of the parasite is relatively long, 15 years or more. These factors favour the success of control programme . Pg. 249
b. DEC is still the only drug available for chemotherapeutic control of filariasis. The administration of DEC can be carried out in various ways:
c. Mass therapy: In this approach, DEC is given to almost everyone in the community irrespective of whether they have microfilaraemia, disease manifestations or no signs of infection. It is generally accepted that mass therapy is indicated in highly endemic areas.
i. Mass treatment control projects using DEC have markedly reduced prevalence of W. bancrofti in many of the Pacific islands. On the other hand, the result of mass chemotherapy in India during 1958-60 has met with little success.
ii. This was due to poor population compliance. For mass chemotherapy to be accepted, a good rapport must be established with the community before the treatment begins.
iii. This requires intensive health education of the general public. Mass chemotherapy approach was abandoned in India.
Mass treatment for Trachoma Pg: 282: A prevalence of more than 5 per cent severe and moderate trachoma in children under 10 years is an indication for mass or blanket treatment. The treatment consists of the application twice daily of tetracycline 1 per cent ointment to all children, for 5 consecutive days each month or once daily for 10 days each month for 6 consecutive months, or for 60 consecutive days. An alternative antibiotic is erythromycin.