Reducing the spread of elephantiasis

From Sciencedaily:
"Now, a new review of existing research suggests that enriching a community’s salt with a drug could treat and prevent the condition without any adverse effects.
But it remains a challenge to get governments to enrich their salt with the drug, diethylcarbamazine, or DEC.
“Biologically and medically, it’s a great tool. Operationally and socially, it’s a challenge to put it into place,” said Eric Ottesen, M.D., director of the Lymphatic Filariasis Support Center in Decatur, Ga. Ottesen was not involved with the research but is familiar with the review’s findings.
To gauge the effectiveness of enriching salt with DEC, researcher Srividya Adinarayanan of the Vector Control Research Center in Pondicherry, India, and her colleagues examined 21 studies in a new systematic review.
The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews like this one draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
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Drug treatments are fairly effective at getting rid of adult worms and very good at killing off the baby worms, which transmit the disease to other people through mosquitoes. But when tens of millions of people are infected, it can be difficult to provide care to individuals.
Enter the drug DEC, which kills the baby worms, known as microfilariae. Since the drug only works if people take it repeatedly, some health officials have put it in salt supplies so people could get a regular dose.
According to the reviewers, the studies suggest that DEC-medicated salt is effective at reducing transmission of the disease if maintained for at least six months. They added that the salt treatment can eliminate transmission entirely if used over a long period of time.
The reviewers also suggest that a very low dose of DEC over an extended period — perhaps six months — is better than bigger doses given at once.
A couple of caveats exist. For one, the reviewers say that widespread use of DEC could lead to resistance to the drug, although there’s been little research into this possibility. The reviewers add that “political and administrative commitment and community motivation is a necessity for community programs to be successful.”
Indeed, while China has eliminated filariasis with the help of DEC, regulatory hurdles have prevented many countries from enriching their salt despite research suggesting that DEC is effective, Ottesen said."