Neglected tropical diseases

South-East Asia poised to defeat visceral leishmaniasis (kala-azar)

19 October 2015 | Geneva −− Three countries of WHO’s South-East Asia Region – Bangladesh, India and Nepal – are poised to eliminate visceral leishmaniasis (kala-azar) as a public health problem. The number of cases has reduced by 53%, from a high of 182 000 cases during 2005–2008 to 85 000 cases during 2011–2014. The 10 209 new cases reported in 2014 represents a 75% decrease from 2005 when the Kala-Azar Elimination Programme was launched.

Achieving a drop of 85% in mortality is impressive,” said Dr Daniel Argaw Dagne, Head of the Leishmaniasis Control Programme at WHO’s Department of Control of Neglected Tropical Diseases. “What is more impressive is that Nepal, having eliminated kala-azar at district level, has been able to sustain the gain for the past 2 years. Bangladesh has achieved the elimination target in over 90% of endemic sub-districts (upazillas), while India has achieved elimination in some 70% sub-districts (blocks) for 2 consecutive years”.

The target of the Programme in South-East Asia is to reduce the incidence of the disease to less than one case per 10 000 population at sub-district level (upazilla in Bangladesh; block in India) and at district level (in Nepal).

In India alone the reported number of new cases has reduced by 72% and the number of deaths by 85% since 2011. In 2014, fewer than 10 000 cases were reported for the first time in 40 years. Improved access to free diagnosis and treatment and support from accredited social health activists1 have contributed to this success.

In Bangladesh, active community involvement and support from village volunteers in case searches and collaboration with existing programmes such as the Leprosy Elimination Programme have enhanced case detection and contributed to the decline in the number of cases and deaths. In 2014, 650 new cases were reported – one of the lowest in the past 20 years – with a mortality rate below 1%

These achievements were made possible by the efforts of governments and key development partners in implementing a control strategy based on early diagnosis and case management, integrated vector management, disease surveillance through passive and active case detection, social mobilization, partnerships and capacity-building.

Medicines previously used to treat patients were either too costly or too toxic or limited in terms of their efficacy,” said Dr Argaw Dagne. “In 2010 the WHO Expert Committee on Leishmaniasis recommended a single injection of liposomal amphotericin B, which has now been adopted by Bangladesh, India and Nepal as first-line treatment. This new therapeutic regimen is safe, effective and provided free of charge.

Liposomal amphotericin B is manufactured by Gilead, a US-based pharmaceutical company. A donation agreement signed with WHO ensures that the medicine is procured and distributed free of charge to endemic countries, enabling them to roll out implementation of single-dose treatment with the support of partners such as DFID, DNDi, KalaCORE and MSF.

The coverage and quality of insecticide residual spraying operations for vector control have also improved thanks to follow up and support from communities and partners. Care India and the Bill & Melinda Gates Foundation are supporting vector control and improving the health information system, particularly in India.

Besides coordinating the delivery of medicines, WHO continues to provide technical policy guidance and capacity-building. It also supports governments to coordinate and harmonize the efforts of various partners assisting the elimination programme. Sustainability of the Programme relies on country ownership and leadership in endemic countries.

Epidemiological information on leishmaniasis is available at WHO Leishmaniasis and from the Global and Regional Health Observatories web sites.

The disease

An estimated 300–500 000 cases of visceral leishmaniasis and over 20 000 deaths occur annually. More than 147 million people living in the South-East Asia Region are at risk. The disease prevails among poor people in marginalized communities. It attacks the internal organs and can be fatal if left untreated as it affects the vital organs of the body. Symptoms include irregular bouts of fever, weight loss, enlargement of the spleen and liver, and anaemia. All patients diagnosed with visceral leishmaniasis require prompt and complete medical treatment.

1ASHAs are women who live in the community and receive performance-based incentives for overseeing maternal and other health-related issues in their village.

Viscerial leishmaniasis in the WHO South East Asia region, 2000−2015