Two decades of filariasis in India: Insights into prevalence, diagnostic challenges, and strategies for elimination by 2027.

Lymphatic filariasis (LF) remains endemic in India, with the National Centre for Vector Borne Disease Control targeting elimination by 2027 through mass drug administration and other control tools. We reviewed 157 studies on filariasis in India (2001-2023) via PubMed, Embase, and Scopus databases. We did futher screening using Covidence and Cochrane's tools and analyzed data using GraphPad Prism and R. From 1,488,432 examined subjects (1,486,508 humans and 1924 canines), 22,938 humans were positive for LF, 26 were confirmed cases for human dirofilariasis, and 228 canines had filarial infections. Puducherry showed the highest LF prevalence (∼43%) while Kerala reported significant canine dirofilariasis (∼22%). Atypical symptoms (e.g., breast filariasis) and diagnostic gaps (e.g., lack of filaria-specific tests) complicated management, with coinfections (e.g., with Leishmania, Plasmodium) further challenging treatment. Enhanced surveillance in non-endemic states, improved diagnostics, and a One Health approach integrating human, animal, and vector data will be critical for meeting LF elimination.