WHO Report on Global Surveillance of Epidemic-prone Infectious Diseases - Leishmaniasis
Leishmania/HIV co-infection in south-western Europe
- Since 1990, cases of co-infection have been reported from 31 countries worldwide (Map 10.1). Most cases have been reported in south-western Europe; where the surveillance system was first implemented and where most of the surveillance centres are located.
- While the total number of cases reported from this area in the period 1990 until June 1998 was 1440, almost 50% have been reported in the last two-and-a-half years (717 cases between 1996 - June 1998). This may represent better reporting as awareness builds up in the area, rather than an increasing trend in infection. However, if the trend continues to rise, it may be advisable to formulate preventive measures, such as the use of bed nets in south-western Europe by HIV positive campers.
- On average, all four countries reported more cases of Leishmania/HIV co-infection per year during the last two-and-a-half years, as compared to the period 1990-1995. In Portugal the number of cases reported to WHO between 1996 and June 1998 has gone up seven-fold as compared to the six-year period before (Fig. 10.1).
- On average the number of cases of Leishmania/HIV co-infection reported during the last two-and-a-half years has increased relative to the number of reported AIDS cases in the same period (Fig. 10.1).
- In south-western Europe Leishmania/HIV co-infection is highest in adult males. Over 55% of the cases in this area have been reported to occur in the age group from 31 to 40 years. Over 83% of the reported cases are male (8).
- Over 70% of the cases of Leishmania/HIV co-infection reported from south-western Europe is among intravenous drug users (Fig. 10.2).A comparison between probable mode of transmission for Leishmania/ HIV co-infection and AIDS, indicates that in all four countries a higher proportion of reported co-infection cases was transmitted by intravenous drug use than HIV infections, as reflected in AIDS cases (Fig. 10.2). This finding was statistically significant for all countries, except for Portugal. This is consistent with the fact that Leishmania/HIV co-infection can be transmitted by the use of contaminated needles.
- In Spain, 6% of the cases of co-infection has as probable mode of transmission the transfusion of blood or blood products as opposed to only 1% in the AIDS cases (Fig. 10.2).
Fig. 10.1 Average number of AIDS cases and Leishmania/HIV co-infection cases per year, reported to WHO, south-western Europe, 1990- June 1998
Fig. 10.2 Percentage distribution of reported cases of Leishmania/HIV co-infection* and AIDS**, according to probable mode of HIV transmission, south-western Europe, 1997-1999
Mode of probable transmission for Leishmania/HIV co-infection is based on
the HIV transmission for 1990-1998.
Mode of probable transmission for AIDS is based on 1998.
Fig. 3.2 Number of cases of plague reported to WHO 1954-1997-Viet Nam excluded