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Naylor-Leyland G, Collin SM, Gatluak F, den Boer M, Alves F, Mullahzada AW, Ritmeijer K. Correction: The increasing incidence of visceral leishmaniasis relapse in South Sudan: A retrospective analysis of field patient data from 2001-2018. PLoS Negl Trop Dis 2024; 18:e0011952. [PMID: 38346002 PMCID: PMC10861048 DOI: 10.1371/journal.pntd.0011952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pntd.0010696.].
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Jibreel T, Khogali A, Jiménez M, Raiyed A, Dakein O, Alsharif B, Khalid NM, Osman OF, Nour BYM, Mohamed GH, Molina R, Vidal-López A, Díaz-Regañón R, den Boer M, Alvar J, Courtenay O, Elnaiem DE. Host preference and human blood index of Phlebotomus orientalis, an exophilic sand fly vector of visceral leishmaniasis in eastern Sudan. Med Vet Entomol 2023; 37:782-792. [PMID: 37540228 DOI: 10.1111/mve.12683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/10/2023] [Indexed: 08/05/2023]
Abstract
Visceral leishmaniasis (VL, kala azar), caused by Leishmania donovani, transmitted by Phlebotomus orientalis, is a serious systemic disease that causes high morbidity and mortality rates in Sudan and other parts of East Africa and the world. Despite progress in understanding the epidemiology of the disease in East Africa, little is known about the host preference of P. orientalis in kala azar endemic villages of Sudan, which have some of the highest VL incidence rates in the world. The present study used host choice experiments and blood-meal identification approaches to determine the host preference of P. orientalis in kala azar endemic villages in Gedarif state, eastern Sudan. In the host choice experiment, tent traps were used to compare the attractiveness of cows, donkeys, sheep and goats for host-seeking P. orientalis. In the blood-meal identification study, blood-fed P. orientalis females, captured inside houses and peri-domestic habitats, were subjected to molecular typing using cytochrome b gene (cyt b) amplification and sequence analysis. Cows and donkeys were the most attractive to blood-seeking P. orientalis, followed by goats. Similarly, the blood-meal analysis of P. orientalis showed that the vector preferentially feeds on cows, followed by donkeys, humans and goats. The human blood index of P. orientalis was 19.4% (42/216), indicating a high zoophilic habit of the vector, both inside and outside the houses. Although the order of host preference varied by location, it was clear that cows are the most preferred host of P. orientalis in the area. Results are discussed in relation to the role of domestic/livestock animals in VL zoopotentiation and zooprophylaxis. Inference is made on the potential impact of insecticide treatment of cows in control of the vector and the transmission of VL in Sudan and other parts of East Africa.
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Affiliation(s)
- Tayseer Jibreel
- Blue Nile National Institute for Communicable Diseases, University of Gezira, Wad Medani, Sudan
| | - Altayeb Khogali
- Blue Nile National Institute for Communicable Diseases, University of Gezira, Wad Medani, Sudan
| | - Maribel Jiménez
- Laboratorio de Entomología Médica, Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Adeel Raiyed
- Department of Zoology, Faculty of Science, University of Khartoum, Khartoum, Sudan
| | - Osman Dakein
- Kala azar Research Centre, Faculty of Medicine and Health Sciences, University of Gedarif, Gedarif, Sudan
| | - Bashir Alsharif
- Medical Entomology Department, Federal Ministry of Health, Khartoum, Sudan
| | | | - Omran F Osman
- Department of Zoology, Faculty of Science, University of Khartoum, Khartoum, Sudan
| | - Bakri Y M Nour
- Department of Medical Parasitology, Faculty of Medical Laboratory Sciences, University of Gezira, Wad Medani, Sudan
| | - Gamal Hassan Mohamed
- Department of Biostatistics, Epidemiology and Scientific Computing, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Ricardo Molina
- Laboratorio de Entomología Médica, Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Ana Vidal-López
- Laboratorio de Entomología Médica, Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Ramón Díaz-Regañón
- Laboratorio de Entomología Médica, Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Orin Courtenay
- Zeeman Institute and School of Life Sciences, University of Warwick, Coventry, UK
| | - Dia-Eldin Elnaiem
- Department of Natural Sciences, University of Maryland Eastern Shore, Princess Anne, Maryland, USA
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Naylor-Leyland G, Collin SM, Gatluak F, den Boer M, Alves F, Mullahzada AW, Ritmeijer K. The increasing incidence of visceral leishmaniasis relapse in South Sudan: A retrospective analysis of field patient data from 2001-2018. PLoS Negl Trop Dis 2022; 16:e0010696. [PMID: 35981057 PMCID: PMC9426874 DOI: 10.1371/journal.pntd.0010696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 08/30/2022] [Accepted: 07/23/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Visceral Leishmaniasis (VL) is endemic in South Sudan, manifesting periodically in major outbreaks. Provision of treatment during endemic periods and as an emergency response is impeded by instability and conflict. Médecins Sans Frontières (MSF) has provided health care in South Sudan since the late 1980's, including treatment for 67,000 VL patients. In recent years, MSF monitoring data have indicated increasing numbers of VL relapse cases. A retrospective analysis of these data was performed in order to provide insight into the possible causes of this increase. METHODOLOGY/PRINCIPAL FINDINGS Programme monitoring data from the MSF hospital in Lankien, Jonglei State, South Sudan, for the period 2001-2018 were analysed to detect trends in VL relapse as a proportion of all VL cases presenting to MSF treatment centres. Routinely collected patient-level data from relapse and primary VL cases treated at all MSF sites in South Sudan over the same period were analysed to describe patient characteristics and treatments received. VL relapse as a proportion of all VL cases increased by 6.5% per annum (95% CI 0.3% to 13.0%, p = 0.04), from 5.2% during 2001-2003 to 14.4% during 2016-2018. Primary VL and VL relapse patients had similar age, sex and anthropometric characteristics, the latter indicating high indices of undernutrition which were relatively constant over time. Clinical factors (Hb, spleen size, and VL severity score) also did not vary substantially over time. SSG/PM was the main treatment regimen from 2001-2018, used in 68.7% of primary and 70.9% of relapse VL cases; AmBisome was introduced in 2013, received by 22.5% of primary VL and 32.6% of VL relapse cases from 2013-2018. CONCLUSION Increasing incidence of VL relapse in South Sudan does not appear to be explained by changes in patient characteristics or other factors. Our data are concerning and may indicate an emergence of treatment-resistant parasite strains, decreasing the effectiveness of treatment regimens. This warrants further investigation as a causal factor. New chemical entities that will enable safe and highly effective short-course oral treatments for VL are urgently needed.
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Affiliation(s)
| | - Simon M. Collin
- UK Health Security Agency (UKHSA), London, United Kingdom
- Departamento de Medicina Social, Universidade Federal do Espírito Santo, Vitória, Brazil
| | | | | | - Fabiana Alves
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
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Alvar J, den Boer M, Dagne DA. Towards the elimination of visceral leishmaniasis as a public health problem in east Africa: reflections on an enhanced control strategy and a call for action. The Lancet Global Health 2021; 9:e1763-e1769. [PMID: 34798033 PMCID: PMC8609279 DOI: 10.1016/s2214-109x(21)00392-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 08/04/2021] [Accepted: 08/16/2021] [Indexed: 11/25/2022] Open
Abstract
East Africa is the world region most affected by visceral leishmaniasis, accounting for 45% of cases globally that were reported to WHO in 2018, with an annual incidence that is only slightly decreasing. Unlike southeast Asia, east Africa does not have a regional approach to achieving elimination of visceral leishmaniasis as a public health problem. The goal of the WHO 2021–30 Neglected Tropical Diseases road map is to reduce mortality caused by the disease to less than 1%. To achieve this goal in east Africa, it will be necessary to roll out diagnosis and treatment at the primary health-care level and implement evidence-based personal protection methods and measures to reduce human–vector contact. Investment and collaboration to develop the necessary tools are scarce. In this Health Policy paper, we propose a strategic framework for a coordinated regional approach in east Africa for the elimination of visceral leishmaniasis as a public health problem.
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Dahl EH, Hamdan HM, Mabrouk L, Matendechero SH, Mengistie TB, Elhag MS, Lado M, Adera C, Atia AA, Potet J, den Boer M, Ritmeijer K, Alvar J, Alves F, Alcoba G. Control of visceral leishmaniasis in East Africa: fragile progress, new threats. BMJ Glob Health 2021; 6:bmjgh-2021-006835. [PMID: 34413075 PMCID: PMC8365799 DOI: 10.1136/bmjgh-2021-006835] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/13/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Elin Hoffmann Dahl
- Infectious Diseases Medical Advisor, MSF Access Campaign, Médecins Sans Frontières, Geneva, Switzerland
| | | | - Lexson Mabrouk
- Director Communicable Diseases, Neglected Tropical Diseases, Ministry of Health, Juba, South Sudan
| | | | - Tesfahun Bishaw Mengistie
- Neglected Tropical Diseases Team Officer, Diseases Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Mousab Siddig Elhag
- Neglected Tropical Diseases Advisor, Federal Ministry of Health, Khartoum, Sudan
| | - Mounir Lado
- Country Director, IMA World Health, Juba, South Sudan
| | - Cherinet Adera
- Visceral Leishmaniasis Technical Advisor, ASCEND (Accelerating Sustainable Control and Elimination of Neglected Tropical Diseases) / Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Atia Abdalla Atia
- Country Lead, ASCEND (Accelerating Sustainable Control and Elimination of Neglected Tropical Diseases), Khartoum, Sudan
| | - Julien Potet
- Neglected Diseases Policy Advisor, MSF Access Campaign, Médecins Sans Frontières, Geneva, Switzerland
| | - Margriet den Boer
- Neglected Tropical Diseases advisor, Médecins Sans Frontières, London, UK
| | - Koert Ritmeijer
- Coordinator Neglected Tropical Diseases, Médecins Sans Frontières, Amsterdam, The Netherlands
| | - Jorge Alvar
- Senior Leishmaniasis Adviser, Drugs for Neglected Diseases Initiative, Geneva, Switzerland
| | - Fabiana Alves
- Head of Visceral Leishmaniasis Disease, Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Gabriel Alcoba
- Leader of Neglected Tropical Diseases Working Group, Médecins Sans Frontières, Geneva, Switzerland
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Kämink S, Masih B, Ali N, Ullah A, Khan SJ, Ashraf S, Pylypenko T, Grobusch MP, Fernhout J, den Boer M, Ritmeijer K. Effectiveness of miltefosine in cutaneous leishmaniasis caused by Leishmania tropica in Pakistan after antimonial treatment failure or contraindications to first line therapy-A retrospective analysis. PLoS Negl Trop Dis 2021; 15:e0008988. [PMID: 33507944 PMCID: PMC7872246 DOI: 10.1371/journal.pntd.0008988] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 02/09/2021] [Accepted: 11/17/2020] [Indexed: 12/15/2022] Open
Abstract
Background Cutaneous leishmaniasis (CL) is a neglected tropical skin disease, caused by Leishmania protozoa. In Pakistan, where CL caused by L. tropica is highly endemic, therapy with pentavalent antimonials is the standard of care, but has significant toxicity when used in systemic therapy, while are no evidence-based safer alternative treatment options for L. tropica. The efficacy of oral miltefosine has not been studied in CL caused by L. tropica. We evaluated effectiveness and tolerability of miltefosine in patients with previous treatment failure or with contraindications to systemic antimonial treatment. Methods A retrospective review was conducted of a cohort of CL patients who were treated with a 28-day course of miltefosine between December 2017 and August 2019, in urban Quetta, Pakistan, an area endemic for L. tropica. Descriptive analyses were performed, and effectiveness was assessed by initial response after treatment, and final cure at routine follow up visits, six weeks to three months post-treatment. Tolerability was assessed by routinely reported adverse events. Results Of the 76 CL patients in the cohort, 42 (55%) had contraindications to systemic antimonial treatment, and 34 (45%) had failure or relapse after antimonial treatment. Twelve patients defaulted during treatment and 12 patients were lost to follow up. In the remaining 52 patients, final cure rate was 77% (40/52). In those with contraindications to systemic antimonial treatment the final cure rate was 83% (24/29) and in the failure and relapse group 70% (16/23). Twenty-eight patients (40.0%) reported 39 mild to moderate adverse events with the main complaints being nausea (41.0%), general malaise (25.6%), and stomach pain (12.8%). Conclusion Results indicate that miltefosine is an effective second line treatment in CL in areas endemic for L. tropica. Prospective studies with systematic follow up are needed to obtain definitive evidence of effectiveness and tolerability, including identification of risk factors for miltefosine treatment failure. Cutaneous Leishmaniasis (CL) is a neglected tropical skin disease, which globally affects an estimated 0.6 to 1 million people. The skin disease is caused by the protozoa Leishmania and is transmitted by phlebotomine sandflies in Old World CL (OWCL). In Pakistan, CL is highly endemic, especially in the provinces Balochistan and Khyber Pashtunkwa, where L. tropica is the main causative species. In this context, untreated CL often leads to stigmatisation and severe (psycho)social suffering, due to the disfiguring ulcerating wounds and scars. The mainstay treatment is with pentavalent antimonials, and evidence for efficacy of alternative treatments for L. tropica is lacking. Médecins sans Frontières (MSF) has specialised treatment centres in Balochistan (Quetta and Kuchlak), where in December 2017 miltefosine was introduced for patients who did not respond to, or had contraindications for antimonials. In this study, we showed favourable outcomes of miltefosine as second-line treatment for these CL patients.
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Affiliation(s)
- Suzette Kämink
- Médecins Sans Frontières, Quetta, Pakistan
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, location AMC, Amsterdam Public Health, Amsterdam Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | | | - Noor Ali
- Médecins Sans Frontières, Quetta, Pakistan
| | - Aman Ullah
- Médecins Sans Frontières, Quetta, Pakistan
| | | | - Shakil Ashraf
- Mohtarma Shaheed Benazir Bhutto General Hospital,Quetta, Pakistan
| | | | - Martin P. Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, location AMC, Amsterdam Public Health, Amsterdam Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
| | - Jena Fernhout
- Médecins Sans Frontières, Amsterdam, the Netherlands
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Elnaiem DE, Khogali A, Alsharif B, Dakein O, Jibreel T, Hassan M, Edries HH, Elhadi H, Elnur B, Osman OF, Boer MD, Alvar J, Khalid NM. Understanding sand fly sampling methods: sticky traps are attraction-based and not interceptive sampling tools of Phlebotomus orientalis. Parasit Vectors 2020; 13:389. [PMID: 32736588 PMCID: PMC7393830 DOI: 10.1186/s13071-020-04249-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 07/20/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Sticky traps are generally viewed as interceptive sand fly sampling methods; although no previous experimental evidence has supported this assumption. In this study, we tested this assumption experimentally for Phlebotomus orientalis, the principal vector of visceral leishmaniasis in East Africa, and propose an explanation for the highly male-biased collection of sticky traps. METHODS A number of field experiments were carried out in March-June 2016-2019, in Gedarif state, eastern Sudan. In the first experiment, we compared numbers of P. orientalis caught on sticky traps made of black, red, transparent, white, yellow, green and blue A4 size papers set simultaneously at different lunar light conditions. In the second and third experiments, we compared numbers of P. orientalis captured on sticky traps placed side-by-side horizontally or vertically on the ground, or horizontally on a 15 cm height stool. We also witnessed mating behaviour of sand flies following their landing on un-sticky papers placed on the ground. RESULTS Phlebotomus orientalis showed significant attraction to white, yellow and transparent traps, with negligible numbers caught on the black and the red traps. Similarly, significantly higher numbers of P. orientalis were attracted to the horizontal traps, resulting in an 8-fold increase in sand fly trapping efficacy as compared to the vertical traps. Placing the traps on the stools resulted in significant reduction in this attraction. In contrast to the sticky traps that captured only very few females; we found that when male sand flies land on un-sticky white paper they successfully lure females and copulate with them. CONCLUSIONS We demonstrate that, for P. orientalis, sticky traps are more attractant-based than interception-based sampling tools. Further, our findings support the notion that males of this sand fly species likely utilize the bright surface of the trap papers to perform mating rituals that attract the females for copulation. However, pre-mature death in the sticky oil hampers the completion of these rituals, and thus results in failure to attract the females. These findings inform our understanding of P. orientalis behaviour and have important implications for optimization of sticky trap design for vector surveillance purposes.
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Affiliation(s)
- Dia-Eldin Elnaiem
- Department of Natural Sciences, University of Maryland Eastern Shore, Princess Anne, MD, 21853, USA.
| | - Altayeb Khogali
- Blue Nile Health Institute for Communicable Diseases, Gezira University, Wad Medani, Sudan
| | - Bashir Alsharif
- Medical Entomology Department, Federal Ministry of Health, Khartoum, Sudan
| | - Osman Dakein
- Department of Zoology, Faculty of Science, University of Khartoum, Khartoum, Sudan.,Kalar azar Research Centre, Faculty of Medicine and Health Sciences, University of Gedarif, Gedarif, Sudan
| | - Tayseer Jibreel
- Blue Nile Health Institute for Communicable Diseases, Gezira University, Wad Medani, Sudan
| | | | - Hassan H Edries
- Blue Nile Health Institute for Communicable Diseases, Gezira University, Wad Medani, Sudan
| | - Hanan Elhadi
- Kalar azar Research Centre, Faculty of Medicine and Health Sciences, University of Gedarif, Gedarif, Sudan
| | - Bakri Elnur
- Blue Nile Health Institute for Communicable Diseases, Gezira University, Wad Medani, Sudan
| | - Omran F Osman
- Department of Zoology, Faculty of Science, University of Khartoum, Khartoum, Sudan
| | | | - Jorge Alvar
- Drugs for Neglected Diseases Initiative, Geneva, Switzerland
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Sunyoto T, Potet J, den Boer M, Ritmeijer K, Postigo JAR, Ravinetto R, Alves F, Picado A, Boelaert M. Exploring global and country-level barriers to an effective supply of leishmaniasis medicines and diagnostics in eastern Africa: a qualitative study. BMJ Open 2019; 9:e029141. [PMID: 31152044 PMCID: PMC6549606 DOI: 10.1136/bmjopen-2019-029141] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/14/2019] [Accepted: 04/18/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To understand stakeholders' perceptions of the access barriers to quality-assured diagnostics and medicines for leishmaniasis in the high-burden region of eastern Africa, and to identify key bottlenecks to improve the supply of commodities for neglected tropical diseases. DESIGN Desk reviews and qualitative in-depth interview study with purposive sampling. METHODS A landscape analysis through literature and desk review was performed. Next, 29 representatives from international organisations, non-governmental agencies, national control programmes from six countries (Ethiopia, Kenya, Somalia, South Sudan, Sudan and Uganda) and manufacturers were interviewed between May and July 2018. Participants were selected purposively and expanded through a snowballing technique.Data analysis was aided by NVivo, applying the framework method as a part of the thematic content analysis approach. RESULTS The barriers along the visceral leishmaniasis (VL) supply chain were identified as emerging themes, grouped across supply chain activities and health systems component(s). Stakeholders expressed the perception of progress, but bottlenecks persist. VL medicines, in general, lack multisource production capacity and with small market volume, expansion of suppliers is difficult. Procurement is plagued by forecasting difficulties, complex regulatory policies and procedures, and distribution challenges. Weak communication and coordination across different levels resulted in shortages and loss of trust among different actors. Cross-cutting issues spanned from limited political and resource commitment due to low awareness and limited in-country capacity. However, study respondents were optimistic to pursue several remedies, most importantly to build bridges between supply and demand sides through continued dialogue and collaborations. Diagnostics supply has mostly been overlooked; thus, improved investment in this area is needed. CONCLUSIONS Addressing supply barriers in eastern Africa requires consistent, specific efforts at the global and national levels, progressing from current partnerships and agreements. Priority actions include pooled procurement, improved forecast, and increased commitment and resources. Sustainability remains an elusive goal, yet to be integrated into discussions moving forward.
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Affiliation(s)
- Temmy Sunyoto
- Public Health Department, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Julien Potet
- Medical Department, Médecins Sans Frontières Access Campaign, Paris, France
| | - Margriet den Boer
- Medical Department, Artsen zonder Grenzen, Amsterdam, The Netherlands
| | - Koert Ritmeijer
- Medical Department, Artsen zonder Grenzen, Amsterdam, The Netherlands
| | - Jose A R Postigo
- Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - Raffaella Ravinetto
- Public Health Department, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Fabiana Alves
- VL Clinical Program, Drugs for Neglected Disease Initiative, Geneva, Switzerland
| | - Albert Picado
- Instituto de Salud Global Barcelona, Barcelona, Spain
- Neglected Tropical Diseases Department, FIND, Geneva, Switzerland
| | - Marleen Boelaert
- Public Health Department, Institute of Tropical Medicine, Antwerpen, Belgium
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Coulborn RM, Gebrehiwot TG, Schneider M, Gerstl S, Adera C, Herrero M, Porten K, den Boer M, Ritmeijer K, Alvar J, Hassen A, Mulugeta A. Barriers to access to visceral leishmaniasis diagnosis and care among seasonal mobile workers in Western Tigray, Northern Ethiopia: A qualitative study. PLoS Negl Trop Dis 2018; 12:e0006778. [PMID: 30408042 PMCID: PMC6224040 DOI: 10.1371/journal.pntd.0006778] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 08/23/2018] [Indexed: 12/13/2022] Open
Abstract
Background Ethiopia bears a high burden of visceral leishmaniasis (VL). Early access to VL diagnosis and care improves clinical prognosis and reduces transmission from infected humans; however, significant obstacles exist. The approximate 250,000 seasonal mobile workers (MW) employed annually in northwestern Ethiopia may be particularly disadvantaged and at risk of VL acquisition and death. Our study aimed to assess barriers, and recommend interventions to increase access, to VL diagnosis and care among MWs. Methodology/Principal findings In 2017, 50 interviews and 11 focus group discussions were conducted with MWs, mobile residents, VL patients and caretakers, community leaders and healthcare workers in Kafta Humera District, Tigray. Participants reported high vulnerability to VL among MWs and residents engaged in transitory work. Multiple visits to health facilities were consistently needed to access VL diagnosis. Inadequate healthcare worker training, diagnostic test kit unavailability at the primary healthcare level, lack of VL awareness, insufficient finances for care-seeking and prioritization of income-generating activities were significant barriers to diagnosis and care. Social (decision-making and financial) support strongly and positively influenced care-seeking; workers unable to receive salary advances, compensation for partial work, or peer assistance for contract completion were particularly disadvantaged. Participants recommended the government/stakeholders intervene to ensure: MWs access to bed-nets, food, shelter, water, and healthcare at farms or sick leave; decentralization of diagnostic tests to primary healthcare facilities; surplus medications/staff during the peak season; improved referral/feedback/reporting/training within the health system; free comprehensive healthcare for all VL-related services; and community health education. Conclusions/Significance Contrary to what health policy for VL dictates in this endemic setting, study participants reported very poor access to diagnosis and, consequently, significantly delayed access to treatment. Interventions tailored to the socio-economic and health needs of MWs (and other persons suffering from VL) are urgently needed to reduce health disparities and the VL burden. Ethiopia bears a high burden of visceral leishmaniasis (VL)—a neglected tropical disease transmitted through the bite of a sand fly that disproportionately affects vulnerable populations. Without treatment, VL progresses, causing increasingly severe symptoms and ultimately death within two years, in most cases. Early access to VL diagnosis and care improves clinical prognosis and reduces transmission from infected humans; however, significant obstacles exist. To our knowledge, our study is the first in Ethiopia to use qualitative methods to assess barriers to VL diagnosis and care among seasonal mobile workers. Strikingly, we found that contrary to what health policy for VL dictates in this endemic setting, study participants reported very poor access to diagnosis and, consequently, significantly delayed access to treatment. Our findings have important public health and policy implications. Specifically, our results offer strategies that may increase access to VL diagnosis and care, allowing for earlier treatment and better prognoses for VL patients, and reducing the potential health disparities and the overall burden of VL.
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Affiliation(s)
| | | | | | | | | | - Mercè Herrero
- KalaCORE, London, United Kingdom
- World Health Organization, Geneva, Switzerland
| | | | - Margriet den Boer
- KalaCORE, London, United Kingdom
- Médecins Sans Frontières, London, United Kingdom
| | | | - Jorge Alvar
- Drugs for Neglected Diseases Initiative, Geneva, Switzerland
| | - Abrahim Hassen
- Department of Health Promotion and Disease Prevention, Tigray Regional Health Bureau, Tigray, Ethiopia
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den Boer M, Das AK, Akhter F, Burza S, Ramesh V, Ahmed BN, Zijlstra EE, Ritmeijer K. Safety and Effectiveness of Short-Course AmBisome in the Treatment of Post–Kala-Azar Dermal Leishmaniasis: A Prospective Cohort Study in Bangladesh. Clin Infect Dis 2018; 67:667-675. [DOI: 10.1093/cid/ciy172] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/14/2018] [Indexed: 12/31/2022] Open
Affiliation(s)
| | | | | | | | - V Ramesh
- Safdarjang Hospital, New Delhi, India
| | - Be-Nazir Ahmed
- Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
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Sunyoto T, Adam GK, Atia AM, Hamid Y, Babiker RA, Abdelrahman N, Vander Kelen C, Ritmeijer K, Alcoba G, den Boer M, Picado A, Boelaert M. " Kala-Azar is a Dishonest Disease": Community Perspectives on Access Barriers to Visceral Leishmaniasis (Kala-Azar) Diagnosis and Care in Southern Gadarif, Sudan. Am J Trop Med Hyg 2018; 98:1091-1101. [PMID: 29488462 PMCID: PMC5928836 DOI: 10.4269/ajtmh.17-0872] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Early diagnosis and treatment is the principal strategy to control visceral leishmaniasis (VL), or kala-azar in East Africa. As VL strikes remote rural, sparsely populated areas, kala-azar care might not be accessed optimally or timely. We conducted a qualitative study to explore access barriers in a longstanding kala-azar endemic area in southern Gadarif, Sudan. Former kala-azar patients or caretakers, community leaders, and health-care providers were purposively sampled and thematic data analysis was used. Our study participants revealed the multitude of difficulties faced when seeking care. The disease is well known in the area, yet misconceptions about causes and transmission persist. The care-seeking itineraries were not always straightforward: “shopping around” for treatments are common, partly linked to difficulties in diagnosing kala-azar. Kala-azar is perceived to be “hiding,” requiring multiple tests and other diseases must be treated first. Negative perceptions on quality of care in the public hospitals prevail, with the unavailability of drugs or staff as the main concern. Delay to seek care remains predominantly linked to economic constraint: albeit treatment is for free, patients have to pay out of pocket for everything else, pushing families further into poverty. Despite increased efforts to tackle the disease over the years, access to quality kala-azar care in this rural Sudanese context remains problematic. The barriers explored in this study are a compelling reminder of the need to boost efforts to address these barriers.
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Affiliation(s)
- Temmy Sunyoto
- Institute of Tropical Medicine, Antwerp, Belgium.,Médecins Sans Frontières Campaign for Access to Medicines, Geneva, Switzerland
| | - Gamal K Adam
- Faculty of Medicine, Kala-Azar Research Center, University of Gadarif, Al Qadarif, Sudan
| | - Atia M Atia
- Faculty of Medicine, Kala-Azar Research Center, University of Gadarif, Al Qadarif, Sudan
| | - Yassin Hamid
- Faculty of Medicine, Kala-Azar Research Center, University of Gadarif, Al Qadarif, Sudan
| | - Rabie Ali Babiker
- Faculty of Medicine, Kala-Azar Research Center, University of Gadarif, Al Qadarif, Sudan
| | - Nugdalla Abdelrahman
- Faculty of Medicine, Kala-Azar Research Center, University of Gadarif, Al Qadarif, Sudan
| | | | | | | | - Margriet den Boer
- KalaCORE Consortium, London, United Kingdom.,Médecins Sans Frontières, Amsterdam, The Netherlands
| | - Albert Picado
- ISGlobal, Barcelona Institute of Global Health, Barcelona, Spain
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Rahman R, Goyal V, Haque R, Jamil K, Faiz A, Samad R, Ellis S, Balasegaram M, den Boer M, Rijal S, Strub-Wourgaft N, Alves F, Alvar J, Sharma B. Safety and efficacy of short course combination regimens with AmBisome, miltefosine and paromomycin for the treatment of visceral leishmaniasis (VL) in Bangladesh. PLoS Negl Trop Dis 2017; 11:e0005635. [PMID: 28558062 PMCID: PMC5466346 DOI: 10.1371/journal.pntd.0005635] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 06/09/2017] [Accepted: 05/10/2017] [Indexed: 01/24/2023] Open
Abstract
Background AmBisome therapy for VL has an excellent efficacy and safety profile and has been adopted as a first-line regimen in Bangladesh. Second-line treatment options are limited and should preferably be given in short course combinations in order to prevent the development of resistant strains. Combination regimens including AmBisome, paromomycin and miltefosine have proved to be safe and effective in the treatment of VL in India. In the present study, the safety and efficacy of these same combinations were assessed in field conditions in Bangladesh. Methods The safety and efficacy of three combination regimens: a 5 mg/kg single dose of AmBisome + 7 subsequent days of miltefosine (2.5 mg/kg/day), a 5 mg/kg single dose of AmBisome + 10 subsequent days of paromomycin (15 mg/kg/day) and 10 days of paromomycin (15 mg/kg/day) + miltefosine (2.5 mg/kg/day), were compared with a standard regimen of AmBisome 15 mg/kg given in 5 mg/kg doses on days 1, 3 and 5. This was a phase III open label, individually randomized clinical trial. Patients from 5 to 60 years with uncomplicated primary VL were recruited from the Community Based Medical College Bangladesh (CBMC,B) and the Upazila Health Complexes of Trishal, Bhaluka and Fulbaria (all located in Mymensingh district), and randomly assigned to one of the treatments. The objective was to assess safety and definitive cure at 6 months after treatment. Results 601 patients recruited between July 2010 and September 2013 received either AmBisome monotherapy (n = 158), AmBisome + paromomycin (n = 159), AmBisome + miltefosine (n = 142) or paromomycin + miltefosine (n = 142). At 6 months post- treatment, final cure rates for the intention-to-treat population were 98.1% (95%CI 96.0–100) for AmBisome monotherapy, 99.4% (95%CI 98.2–100) for the AmBisome + paromomycin arm, 94.4% (95%CI 90.6–98.2) for the AmBisome + miltefosine arm, and 97.9% (95%CI 95.5–100) for paromomycin + miltefosine arm. There were 12 serious adverse events in the study in 11 patients that included 3 non-study drug related deaths. There were no relapses or PKDL up to 6 months follow-up. All treatments were well tolerated with no unexpected side effects. Adverse events were most frequent during treatment with miltefosine + paromomycin, three serious adverse events related to the treatment occurred in this arm, all of which resolved. Conclusion None of the combinations were inferior to AmBisome in both the intention-to-treat and per-protocol populations. All the combinations demonstrated excellent overall efficacy, were well tolerated and safe, and could be deployed under field conditions in Bangladesh. The trial was conducted by the International Centre for Diarrhoeal Disease Research (ICDDR,B) and the Shaheed Suhrawardy Medical College (ShSMC), Dhaka, in collaboration with the trial sites and sponsored by the Drugs for Neglected Diseases initiative (DNDi). Trial registration ClinicalTrials.gov NCT01122771 Treatment is one of the key strategies for visceral leishmaniasis control and elimination. Historically a number of monotherapy drugs for VL treatment were used in Bangladesh, including pentavalent antimonials, amphotericin B deoxycholate (AmB), and miltefosine (MF). With the limited number of drugs available, it was necessary to preserve existing drugs and also to develop shorter and safer treatment regimens. At the time the study was initiated, miltefosine monotherapy was a recommended first-line treatment in Bangladesh. The present study aimed to provide safety and efficacy data for three short-course combination regimens including AmBisome, miltefosine and paromomycin when rolled out in field conditions in Bangladesh, and to compare these to AmBisome monotherapy. All combinations proved non-inferior to AmBisome monotherapy and were safe and well tolerated. This study was implemented in field conditions at Upazila level with treatment provided by government doctors, providing further evidence for scaling up new regimens in national program contexts within the public health sector.
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Affiliation(s)
- Ridwanur Rahman
- Shaheed Suhrawardy Medical College (ShSMC), University of Dhaka, Dhaka, Bangladesh
| | - Vishal Goyal
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
- * E-mail:
| | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research (ICDDR,B), Dhaka, Bangladesh
| | - Kazi Jamil
- Kuwait institute for Scientific Research, Environment and Life Sciences Research centre, Food and Nutrition Program formerly ICDDR,B, Dhaka, Bangladesh
| | - Abul Faiz
- Dev Care Foundation, Dhaka, Bangladesh and Retired Ministry of Health, Government official Dhaka, Bangladesh
| | | | - Sally Ellis
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | | | | | - Suman Rijal
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | | | - Fabiana Alves
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | - Jorge Alvar
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | - Bhawna Sharma
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
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Cameron MM, Acosta-Serrano A, Bern C, Boelaert M, den Boer M, Burza S, Chapman LAC, Chaskopoulou A, Coleman M, Courtenay O, Croft S, Das P, Dilger E, Foster G, Garlapati R, Haines L, Harris A, Hemingway J, Hollingsworth TD, Jervis S, Medley G, Miles M, Paine M, Picado A, Poché R, Ready P, Rogers M, Rowland M, Sundar S, de Vlas SJ, Weetman D. Understanding the transmission dynamics of Leishmania donovani to provide robust evidence for interventions to eliminate visceral leishmaniasis in Bihar, India. Parasit Vectors 2016; 9:25. [PMID: 26812963 PMCID: PMC4729074 DOI: 10.1186/s13071-016-1309-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 01/15/2016] [Indexed: 12/31/2022] Open
Abstract
Visceral Leishmaniasis (VL) is a neglected vector-borne disease. In India, it is transmitted to humans by Leishmania donovani-infected Phlebotomus argentipes sand flies. In 2005, VL was targeted for elimination by the governments of India, Nepal and Bangladesh by 2015. The elimination strategy consists of rapid case detection, treatment of VL cases and vector control using indoor residual spraying (IRS). However, to achieve sustained elimination of VL, an appropriate post elimination surveillance programme should be designed, and crucial knowledge gaps in vector bionomics, human infection and transmission need to be addressed. This review examines the outstanding knowledge gaps, specifically in the context of Bihar State, India.The knowledge gaps in vector bionomics that will be of immediate benefit to current control operations include better estimates of human biting rates and natural infection rates of P. argentipes, with L. donovani, and how these vary spatially, temporally and in response to IRS. The relative importance of indoor and outdoor transmission, and how P. argentipes disperse, are also unknown. With respect to human transmission it is important to use a range of diagnostic tools to distinguish individuals in endemic communities into those who: 1) are to going to progress to clinical VL, 2) are immune/refractory to infection and 3) have had past exposure to sand flies.It is crucial to keep in mind that close to elimination, and post-elimination, VL cases will become infrequent, so it is vital to define what the surveillance programme should target and how it should be designed to prevent resurgence. Therefore, a better understanding of the transmission dynamics of VL, in particular of how rates of infection in humans and sand flies vary as functions of each other, is required to guide VL elimination efforts and ensure sustained elimination in the Indian subcontinent. By collecting contemporary entomological and human data in the same geographical locations, more precise epidemiological models can be produced. The suite of data collected can also be used to inform the national programme if supplementary vector control tools, in addition to IRS, are required to address the issues of people sleeping outside.
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Affiliation(s)
- Mary M Cameron
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | | | - Caryn Bern
- UCSF School of Medicine, 550 16th Street, San Francisco, 94158, CA, USA.
| | | | | | - Sakib Burza
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | | | - Alexandra Chaskopoulou
- European Biological Control Laboratory, USDA-ARS, Tsimiski 43 Street, Thessaloniki, 54623, Greece.
| | - Michael Coleman
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | - Orin Courtenay
- University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, UK.
| | - Simon Croft
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Pradeep Das
- Rajendra Memorial Research Institute of Medical Sciences, Patna, India.
| | - Erin Dilger
- University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, UK.
| | - Geraldine Foster
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | | | - Lee Haines
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | | | - Janet Hemingway
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | | | - Sarah Jervis
- University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, UK.
| | - Graham Medley
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Michael Miles
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Mark Paine
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | - Albert Picado
- FIND, Campus Biotech, Chemin des Mines 9, 1202, Geneva, Switzerland.
| | - Richard Poché
- Genesis Laboratories, Inc., Wellington, CO, 80549, USA.
| | - Paul Ready
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Matthew Rogers
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Mark Rowland
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Shyam Sundar
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India.
| | - Sake J de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
| | - David Weetman
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
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Gadisa E, Tsegaw T, Abera A, Elnaiem DE, den Boer M, Aseffa A, Jorge A. Eco-epidemiology of visceral leishmaniasis in Ethiopia. Parasit Vectors 2015; 8:381. [PMID: 26187584 PMCID: PMC4506599 DOI: 10.1186/s13071-015-0987-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 07/05/2015] [Indexed: 12/25/2022] Open
Abstract
Visceral leishmaniasis (VL, Kala-azar) is one of the growing public health challenges in Ethiopia with over 3.2 million people at risk and estimated up to 4000 new cases per year. Historically, VL was known as the diseases of the lowlanders; in the lower and upper Kola agro-ecological zones of Ethiopia. The 2005–07 out breaks in highlands of Libo Kemkem and Fogera, in the Woina Degas, that affected thousands and claimed the life of hundreds misdiagnosed as drug resistance malaria marked that VL is no more the problem of the lowlanders. The Kola (lower and upper) and the Woina Dega are the most productive agroecological zones, supporting both the ongoing and planned expansions of large or small scale agriculture and/or agriculture based industries. Thus, the (re)emergence of VL is not only a public health and social problem but also have a direct implication on the country’s economy and further development. Thus is high time for its control and/or elimination. Yet, the available data seem incomplete to plan for a cost-effective and efficient VL control strategy: there is a need to update data on vector behaviour in specific ecosystems and the roles of domestic animals need to be ascertained. The effectiveness and social acceptability of available vector control tools need be evaluated. There is a need for identifying animal reservoir(s), or establish the absence of zoonosis in Ethiopia. The planning of prevention of (re)emergence and spread of VL to areas adjacent to endemic foci need be supported with information from spatio-temporal mapping. In affected communities, available data showed that their knowledge about VL is generally very low. Thus, well designed studies to identify risk factors, as well as better tools for social mobilization with the understanding of their knowledge, aptitude and practice towards VL are necessary.
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Affiliation(s)
| | - Teshome Tsegaw
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Adugna Abera
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Dia-Eldin Elnaiem
- Department of Natural Sciences, University of Maryland Eastern Shore (for KalaCORE consortium), 1Backbone Rd, Princess Anne, MD, 21853, USA
| | | | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Alvar Jorge
- Visceral Leishmaniasis Program, Drugs for Neglected Diseases Initiative (DNDi), Addis Ababa, Ethiopia
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15
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Marking U, den Boer M, Das AK, Ahmed EM, Rollason V, Ahmed BN, Davidson RN, Ritmeijer K. Hypokalaemia-induced rhabdomyolysis after treatment of post-Kala-azar dermal Leishmaniasis (PKDL) with high-dose AmBisome in Bangladesh-a case report. PLoS Negl Trop Dis 2014; 8:e2864. [PMID: 24922279 PMCID: PMC4055542 DOI: 10.1371/journal.pntd.0002864] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
| | | | | | | | - Victoria Rollason
- Division of Clinical Pharmacology and Toxicology, University Hospitals of Geneva, Geneva, Switzerland
| | - Be-Nazir Ahmed
- Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Robert N Davidson
- Department of Infection and Tropical Medicine, Northwick Park Hospital, Harrow, United Kingdom
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16
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Yangzom T, Cruz I, Bern C, Argaw D, den Boer M, Vélez ID, Bhattacharya SK, Molina R, Alvar J. Endemic transmission of visceral leishmaniasis in Bhutan. Am J Trop Med Hyg 2012; 87:1028-37. [PMID: 23091191 DOI: 10.4269/ajtmh.2012.12-0211] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Visceral leishmaniasis was first reported in Bhutan in 2006. We conducted studies of the parasite, possible vectors and reservoirs, and leishmanin skin test and risk factor surveys in three villages. Nineteen cases were reported from seven districts. Parasite typing yielded two novel microsatellite sequences, both related to Indian L. donovani. In one case village, 40 (18.5%) of 216 participants had positive leishmanin skin test results, compared with 3 (4.2%) of 72 in the other case village and 0 of 108 in the control village. Positive results were strongly associated with the village and increasing age. None of the tested dogs were infected. Eighteen sand flies were collected, 13 Phlebotomus species and 5 Sergentomyia species; polymerase chain reaction for leishmanial DNA was negative. This assessment suggests that endemic visceral leishmaniasis transmission has occurred in diverse locations in Bhutan. Surveillance, case investigations, and further parasite, vector, and reservoir studies are needed. The potential protective impact of bed nets should be evaluated.
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Affiliation(s)
- Thinley Yangzom
- JDWNR-Hospital and Vector Borne Diseases Control Programme, Timphu, Bhutan.
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Alvar J, Vélez ID, Bern C, Herrero M, Desjeux P, Cano J, Jannin J, Boer MD. Leishmaniasis Worldwide and Global Estimates of Its Incidence. PLoS One 2012. [DOI: '10.1371/journal.pone.0035671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Abstract
Paromomycin is an aminoglycoside that is active against Gram-negative and many Gram-positive bacteria as well as some protozoa and cestodes. It is out of use as an antibiotic but was licensed in 2007 in India as an effective, well tolerated and affordable treatment for visceral leishmaniasis (VL) at a dose of 11 mg/kg (base) for 21 days. Currently, the non-profit group Drugs for Neglected Diseases Initiative is conducting studies on paromomycin (as monotherapy and in combination) in VL in Africa, and the Institute for OneWorld Health is conducting a Phase IV study in India. Paromomycin in combination with sodium stibogluconate has proven to be effective in African and Indian VL and improves survival in African VL. To prevent the emergence of drug-resistant leishmaniasis in areas of anthroponotic transmission (India and Africa), paromomycin should be used as part of combination therapy for VL. Further trials testing different combinations are much needed. In addition, the distribution of paromomycin (like other drugs for leishmaniasis) should be well regulated and preferably restricted to the public sector. These strategies should ensure the longevity of paromomycin as a useful drug for VL.
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Affiliation(s)
- Robert N Davidson
- Department of Infection and Tropical Medicine, Lister Unit, Northwick Park Hospital, Harrow, Middlesex, UK.
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Bern C, Adler-Moore J, Berenguer J, Boelaert M, den Boer M, Davidson RN, Figueras C, Gradoni L, Kafetzis DA, Ritmeijer K, Rosenthal E, Royce C, Russo R, Sundar S, Alvar J. Liposomal amphotericin B for the treatment of visceral leishmaniasis. Clin Infect Dis 2006; 43:917-24. [PMID: 16941377 DOI: 10.1086/507530] [Citation(s) in RCA: 221] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2005] [Accepted: 01/18/2006] [Indexed: 11/03/2022] Open
Abstract
During the past decade, liposomal amphotericin B has been used with increasing frequency to treat visceral leishmaniasis (VL). The World Health Organization convened a workshop to review current knowledge and to develop guidelines for liposomal amphotericin B use for VL. In Europe, liposomal amphotericin B is widely used to treat VL. In Africa and Asia, the VL disease burden is high and drug access is poor; liposomal amphotericin B is available only through preferential pricing for nonprofit groups in East Africa. Clinical trials and experience demonstrate high efficacy and low toxicity for liposomal amphotericin B (total dose, 20 mg/kg) in immunocompetent patients with VL. Combination trials in areas with antileishmanial drug resistance, and treatment and secondary prophylaxis trials in VL-human immunodeficiency virus-coinfected patients, are important to safeguard the current armamentarium and to optimize regimens. The public health community should work to broaden access to preferential liposomal amphotericin B pricing by public sector VL treatment programs.
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Affiliation(s)
- Caryn Bern
- Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Ritmeijer K, Dejenie A, Assefa Y, Hundie TB, Mesure J, Boots G, den Boer M, Davidson RN. A Comparison of Miltefosine and Sodium Stibogluconate for Treatment of Visceral Leishmaniasis in an Ethiopian Population with High Prevalence of HIV Infection. Clin Infect Dis 2006; 43:357-64. [PMID: 16804852 DOI: 10.1086/505217] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2006] [Accepted: 03/24/2006] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Antimonials are the mainstay of visceral leishmaniasis (VL) treatment in Africa. The increasing incidence of human immunodeficiency virus (HIV) coinfection requires alternative safe and effective drug regimens. Oral miltefosine has been proven to be safe and effective in the treatment of Indian VL but has not been studied in Africa or in persons with HIV and VL coinfection. METHODS We compared the efficacy of miltefosine and sodium stibogluconate (SSG) in the treatment of VL in persons in Ethiopia. A total of 580 men with parasitologically and/or serologically confirmed VL were randomized to receive either oral miltefosine (100 mg per day for 28 days) or intramuscular SSG (20 mg/kg per day for 30 days). RESULTS The initial cure rate was 88% in both treatment groups. Mortality during treatment was 2% in the miltefosine group, compared with 10% in the SSG group. Initial treatment failure was 8% in the miltefosine group, compared with 1% in the SSG group. Among the 375 patients (65%) who agreed to HIV testing, HIV seroprevalence was 29%. Among patients not infected with HIV, initial cure, mortality, and initial treatment failure rates were not significantly different (94% vs. 95%, 1% vs. 3%, and 5% vs. 1% for the miltefosine and SSG groups, respectively). Initial treatment failure with miltefosine occurred in 18% of HIV-coinfected patients, compared with treatment failure in 5% of non-HIV-infected patients. At 6 months after treatment, 174 (60%) of the 290 miltefosine recipients and 189 (65%) of the 290 SSG recipients experienced cure; 30 (10%) of 290 in the miltefosine group and 7 (2%) of 290 in the SSG group experienced relapse, and the mortality rate was 6% in the miltefosine group, compared with 12% in the SSG group. HIV-infected patients had higher rates of relapse (16 [25%] of 63 patients), compared with non-HIV-infected patients (5 [5%] of 131). CONCLUSIONS Treatment with miltefosine is equally effective as standard SSG treatment in non-HIV-infected men with VL. Among HIV-coinfected patients, miltefosine is safer but less effective than SSG.
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Affiliation(s)
- Koert Ritmeijer
- Médecins Sans Frontières-Holland, Amsterdam, The Netherlands.
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Abstract
This review summarizes the current developments in therapy for visceral leishmaniasis. With the recent introduction of new drugs, the main limits in reducing deaths from visceral leishmaniasis are difficulty in diagnosis in the field and health inequality--patients lack of access to treatment. No new drugs are currently in the early stages of development. There are good reasons for the use of combination therapy; to prevent further development of resistance against the limited therapeutic options available.
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Affiliation(s)
- Margriet den Boer
- Campaign for Access to Essential Medicines, Médecins Sans Frontières, Rue Lausanne 78 CP 116 CH-1211, Geneva 21, Switzerland.
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