Can visceral leishmaniasis be eliminated from Asia?

Area of Science:

• Tropical medicine
• Public health
• Epidemiology

Background:

• Visceral leishmaniasis (VL) poses a significant public health threat in the Indian subcontinent, with an estimated 200 million people at risk.
• Current reported cases (25,000-40,000 annually) are gross underestimates, with recent studies suggesting a burden of 420,000 cases.
• Existing policies for VL vector control interventions show gaps and weaknesses.

Purpose of the Study:

• To highlight the critical need for accurate data on VL burden for effective elimination program planning.
• To emphasize the importance of integrated vector management strategies.
• To underscore the necessity of accessible healthcare and targeted interventions for vulnerable populations.

Main Methods:

• Analysis of data on VL burden and risk populations in the Indian subcontinent.
• Review of chemical and environmental vector control studies, including indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs).
• Evaluation of diagnostic tools like the rK39 strip test and treatment options such as miltefosine.

Main Results:

• VL is significantly under-reported, with actual cases potentially reaching 420,000 against a backdrop of 200 million at-risk individuals.
• Indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs) are effective in reducing sandfly densities.
• Active case detection and community-level feasibility assessments for oral treatments are vital.

Conclusions:

• Elimination of visceral leishmaniasis in the Indian subcontinent is achievable through evidence-based policies, integrated vector management, and accessible healthcare.
• Key strategies include early diagnosis, complete treatment, robust surveillance, social mobilization, and continued research.
• Addressing the needs of the poorest and marginalized groups is paramount for successful elimination efforts.