Visceral leishmaniasis control in Brazil: time to re-evaluate DDT?

Abstract

Controlling visceral leishmaniasis in Brazil has proven difficult for several reasons, including: 1) limitations in diagnosis and treatment, 2) the failure of the dog culling program, and 3) the short-term residual effect of pyrethroids against the main phlebotomine vectorLutzomyia longipalpis. The disease has become more widespread during the last three decades and it now occurs in 21 of the 26 Brazilian states plus the Federal District, and even affects several state capitals and large cities. Although DDT has many environmental drawbacks and possible toxicity to animals, several countries still use this chemical in their public health programs due to its long-lasting effect. Therefore, this study aims to re-evaluate the use of DDT to control zoonotic visceral leishmaniasis.

Lutzomyia longipalpis urbanisation and control

“…longipalpis could provide important evidence contributing to the better understanding of this process. On this basis, after analysing the "pros and cons", Marcondes and Costa (2013) recently launched a very restrained proposal about the return to the use of DDT for the control of Lu. longipalpis , mainly because of its long residual action .…”

Decentralized control of human visceral leishmaniasis in endemic urban areas of Brazil: a literature review

“…In the last 20 years, despite the known underestimation of cases, Brazil registered a marked increase in the incidence of visceral leishmaniasis [ 27 ]. Whilst in the 1980s, HVL was considered a rural disease, HVL has spread throughout municipalities with 7 % of municipalities being endemic in 1985; 18 % in 1990; 30 % in 1996 and, in 2014, endemicity was reported in 21 of the 26 Brazilian states plus the Federal District [ 30 ] and its control in urban areas constitutes a challenge [ 31 ]. In the 1980s, an average of 1500 cases was reported each year in Brazil, and between 2000 and 2009, the average increased to 3480 cases annually, an increase of 132 % [ 32 ].…”