Towards elimination of visceral leishmaniasis in the Indian subcontinent—Translating research to practice to public health

Abstract

BackgroundThe decade following the Regional Strategic Framework for Visceral Leishmaniasis (VL) elimination in 2005 has shown compelling progress in the reduction of VL burden in the Indian subcontinent. The Special Programme for Research and Training in Tropical Diseases (TDR), hosted by the World Health Organization (WHO) and other stakeholders, has coordinated and financed research for the development of new innovative tools and strategies to support the regional VL elimination initiative. This paper describes the process of the TDR’s engagement and contribution to this initiative.Methodology/principal findingsMultiple databases were searched to identify 152 scientific papers and reports with WHO funding or authorship affiliation around the following 3 framework strategies: detection of new cases, morbidity reduction, and prevention of infection. TDR has played a critical role in the evaluation and subsequent use of the 39-aminoacid–recombinant kinesin antigen (rK39) rapid diagnostic test (RDT) as a confirmatory test for VL in the national program. TDR has supported the clinical research and development of miltefosine and single-dose liposomal amphotericin B as a first-line treatment against VL. TDR has engaged with in-country researchers, national programme managers, and partners to generate evidence-based interventions for early detection and treatment of VL patients. TDR evaluated the quality, community acceptance, and cost effectiveness of indoor residual spraying, insecticide-treated bed nets, insecticide-impregnated durable wall linings, insecticidal paint, and environmental management as tools for integrated vector management in reducing sandfly density.Conclusions/significanceTDR’s engagement with country policy makers, scientists, and clinicians in the development of effective diagnosis, treatment, case detection, and vector control represents an important example of TDR’s stewardship toward the elimination of VL in the Indian subcontinent.

An immunoinformatic approach driven by experimental proteomics: in silico design of a subunit candidate vaccine targeting secretory proteins of Leishmania donovani amastigotes

“…With a chance of case fatality of 100% in an inadequate treatment scenario, over 90% of VL cases occur in relatively poor communities of Bangladesh, India, Sudan, South Sudan, Ethiopia and Brazil [1]. The VL elimination program known as Kala-azar Elimination Programme (KEP) has contributed to a remarkable decline in the incidence of VL over recent years in the Indian subcontinent and now it is approaching the maintenance phase of VL elimination [2]. However, sustained elimination cannot be possible without proper and prevailing immunity development in the endemic population against Leishmania parasites in the post-elimination era due to the chance of reservoir mediated re-emergence of the disease [3].…”

Molecular Diagnosis of Visceral Leishmaniasis

“…A major challenge in the clinical management of VL is the weakness of health systems at primary care levels in many affected countries with multiple challenges and numerous constraints [8, 20]. Despite multiple techniques for confirming VL cases being available, they are all still far from being ideal.…”

“…90% of VL cases occur in three geographical regions: i) South East Asia: India (especially Bihar), Bangladesh, Nepal; ii) Latin America: mainly North Eastern Brazil; iii) East Africa: Sudan, Ethiopia, Kenya, Uganda and Somalia [4, 5][6, 7]. In the Indian Subcontinent, VL is now being reported in 54 districts in India, 16 upazila in Bangladesh, and 12 districts in Nepal [8]. In Europe, VL is endemic in nine countries and account for less than 2% of the global burden [9].…”

Leishmaniasis: current challenges and prospects for elimination with special focus on the South Asian region

“…Post-kala azar dermal leishmaniasis (PKDL) is also an intriguing clinical scenario described in India and occurs in 5-10% of VL cases following apparent cure of VL (and sometimes with no history of preceding VL). PKDL patients presents with macular papular skin lesions and are speculated to act as reservoirs for VL transmission (due to the parasite-rich nature of the skin lesions) (Ready, 2014), although such significance of PKDL remains debatable (Le Rutte et al, 2016; Hirve et al, 2017). …”

“…A more recent initiative led the WHO to define a road map for prevention, control, elimination, and eradication of 17 NTDs, including VL, as a step toward achieving the Sustainable Development Goals (World Health Organization., 2012b). These efforts included the extension of support to enable better access to drugs and related interventions, and monitor progress towards VL elimination by 2020 with all stake holder involvement (Hirve et al , 2017). …”