Background In 2005, Bangladesh, India and Nepal agreed to eliminate visceral leishmaniasis (VL) as a public health problem. The approach to this was through improved case detection and treatment, and controlling transmission by the sand fly vector Phlebotomus argentipes, with indoor residual spraying (IRS) of insecticide. Initially, India applied DDT with stirrup pumps for IRS, however, this did not reduce transmission. After 2015 onwards, the pyrethroid alpha-cypermethrin was applied with compression pumps, and entomological surveillance was initiated in 2016. Methods Eight sentinel sites were established in the Indian states of Bihar, Jharkhand and West Bengal. IRS coverage was monitored by household survey, quality of insecticide application was measured by HPLC, presence and abundance of the VL vector was monitored by CDC light traps, insecticide resistance was measured with WHO diagnostic assays and case incidence was determined from the VL case register KAMIS. Results Complete treatment of houses with IRS increased across all sites from 57% in 2016 to 70% of houses in 2019, rising to >80% if partial house IRS coverage is included (except West Bengal). The quality of insecticide application has improved compared to previous studies, average doses of insecticide on filters papers ranged from 1.52 times the target dose of 25mg/m2 alpha-cypermethrin in 2019 to 1.67 times in 2018. Resistance to DDT has continued to increase, but the vector was not resistant to carbamates, organophosphates or pyrethroids. The annual and seasonal abundance of P. argentipes declined between 2016 to 2019 with an overall infection rate of 0.03%. This was associated with a decline in VL incidence for the blocks represented by the sentinel sites from 1.16 per 10,000 population in 2016 to 0.51 per 10,000 in 2019. Conclusion Through effective case detection and management reducing the infection reservoirs for P. argentipes in the human population combined with IRS keeping P. argentipes abundance and infectivity low has reduced VL transmission. This combination of effective case management and vector control has now brought India within reach of the VL elimination targets.

BackgroundVisceral leishmaniasis (VL) is on the verge of being eliminated as a public health problem in the Indian subcontinent. Although Post-kala-azar dermal leishmaniasis (PKDL) is recognized as an important reservoir of transmission, we hypothesized that VL patients co-infected with Human Immunodeficiency Virus (HIV) may also be important reservoirs of sustained leishmania transmission. We therefore investigated to what extent cases of PKDL or VL-HIV are associated with VL incidence at the village level in Bihar, India.MethodsVL, VL-HIV, and PKDL case data from six districts within the highly VL-endemic state of Bihar, India were collected through the Kala-Azar Management Information System for the years 2014–2019. Multivariate analysis was done using negative binomial regression controlling for year as a fixed effect and block (subdistrict) as a random effect.FindingsPresence of VL-HIV+ and PKDL cases were both associated with a more than twofold increase in VL incidence at village level, with Incidence Rate Ratios (IRR) of 2.16 (95% CI 1.81–2.58) and 2.37 (95% CI 2.01–2.81) for VL-HIV+ and PKDL cases respectively. A sensitivity analysis showed the strength of the association to be similar in each of the six included subdistricts.ConclusionsThese findings indicate the importance of VL-HIV+ patients as infectious reservoirs for Leishmania, and suggest that they represent a threat equivalent to PKDL patients towards the VL elimination initiative on the Indian subcontinent, therefore warranting a similar focus.

With rapid urbanization and large-scale development activities going on in Indian cities, a large population is displaced, which need to be resettled. Although shelter is provided, but the Project Affected People (PAP) are often neglected, they don't have access to promotive and preventive health services such as immunization, family planning services and general health checkup. This is the cost of development; such displaced groups have to pay. Immunization is often cited as being one of the greatest public health achievements of the 20 th century which has resulted in dramatic decrease in morbidity and mortality due to vaccine preventable diseases. 1 However, effective protection against these diseases requires 90-95% immunization coverage. 2 Immunization coverage refers to information on the proportion of children who have received specific vaccines or are up to date with the recommended vaccine schedule. This information is essential for planning immunization programs, identifying the vulnerable groups that require ABSTRACT Background: With the rapid urbanization and numerous infrastructure projects going on in cities, large number populations are affected by these development projects. Such Projects Affected People (PAP) is resettled in colonies where critical health services are often lacking. Immunization is one such preventive and promotive health services, which is often cited as one of the greatest public health achievement of 20 th century and has resulted in dramatic decrease in morbidity and mortality due to vaccine preventable diseases. However, effective protection against these vaccine preventable diseases requires 90-95% immunization coverage. This study was conducted to assess the immunization coverage in PAP resettlement area of urban slum in Mumbai and associated responsible factors. Methods: Immunization coverage was assessed with the help of the WHO's 30cluster sampling method with a sample size of 210 children in the 12-23 months age group. Results: 90% children were completely immunized. The immunization coverage was highest for BCG (98.1%) and least for measles (90%). The most common reason for noncompliance was child's illness at the time of scheduled vaccine dose. Conclusions: The Universal Immunization Programme (UIP) goal of 85% immunization coverage can be achieved by community based awareness activities, supplemented by patient friendly immunization services at the health centre.

Background Visceral leishmaniasis (VL) in patients living with Human-Immunodeficiency-Virus (HIV) presents an increasingly important patient cohort in areas where both infections are endemic. Evidence for treatment is sparce, with no high-quality studies from the Indian sub-continent. Methods This is a randomised open label, parallel arm phase-3 trial conducted within a single hospital in Patna, India. 150 patients aged ≥18 years with serologically confirmed HIV and parasitologically confirmed VL were randomly allocated to one of two treatment arms, either a total 40mg/kg intravenous liposomal amphotericin B(AmBisome) administered in 8 equal doses over 24-days, or a total 30mg/kg intravenous liposomal amphotericin B(AmBisome) administered in 6 equal doses given concomitantly with a total 1.4g oral miltefosine administered through two daily doses of 50mg over 14-days. The primary outcome was ITT relapse-free-survival at day-210, defined as absence of signs and symptoms of VL, or if symptomatic negative parasitological investigations. Findings Among 243 patients assessed for eligibility, 150 were recruited between 2 ndJanuary 2017 and 5 thApril 2018, with no loss-to-follow-up. Relapse free survival at day-210 was 85%, (64/75; 95%CI 77-100) in the monotherapy arm, and 96%, (72/75;95%CI 90-100) in the combination arm. 19%(28/150) were infected with concurrent tuberculosis, divided equally between arms. Excluding those with concurrent tuberculosis, relapse free survival at day-210 was 90%, (55/61;95%CI 82-100) in the monotherapy and 97%, (59/61;95%CI 91-100) in the combination therapy arm. Serious adverse events were uncommon and similar in each arm. Conclusions Combination therapy appears to be safe, well tolerated and effective, and halves treatment duration of current recommendations.