Characterization and speculations on the urbanization of visceral leishmaniasis in Brazil

Abstract

Abstract

How effective is dog culling in controlling zoonotic visceral leishmaniasis? a critical evaluation of the science, politics and ethics behind this public health policy

“…Given that there is no hard evidence on how much dogs contribute towards human infection, or on the effect of insecticides, particularly organochlorines, and there are no analyses of the operational obstacles to control measures used in large-scale urban environments, and since the biological, social or ecological events that led to urbanization and the spread of leishmaniasis are absolutely unknown 36 , investment in research that addresses these problems must be a priority. Finding vaccines seems to be an immediate challenge.…”

“…The present phenomenon of large scale urbanization started in 1981, when epidemics hit Teresina and then São Luis, in the mid-north, spread throughout the country to the west and south, affecting several states, including São Paulo and Rio Grande do Sul, and larger cities, such as Belo Horizonte and the capital, Brasilia (Figure 2). Moreover, the total number of cases in the country nearly doubled despite all efforts of control 36,37 . The annual cumulative incidence rate increased more discretely, but the mortality rate rose significantly despite medical advances and the development of specific guidelines for the most serious presentation of this disease 38,39 .…”

“…One would be the fragility of knowledge concerning the control of leishmaniasis, as revealed in the systematic review 9 . Another is the territorial expansion of the disease and increase in incidence and mortality 36,37 , which generates expectations and pressures on decision makers. Third, the lack of alternatives with recognized effects regarding zoonotic visceral leishmaniasis, which, in the face of political pressure may push the decision-makers to take irrational attitudes.…”

Seroprevalence and risk factors for canine visceral leishmaniasis in the endemic area of Dias D'Ávila, State of Bahia, Brazil

“…VL, also known as kala-azar, is an important zoonosis in Brazil 4 . L. chagasi is the agent responsible for more than 2300 clinical cases of HVL in Brazil every year 2,5 , and the prevalence of CVL in endemic areas has been shown to be between 1.9 and 25% 3,6 .…”

Vaccines for the Leishmaniases: Proposals for a Research Agenda

“…Political and socioeconomic changes may have an even more important role than global warming on the changing epidemiology of the leishmaniases, as has been argued for tick-borne diseases in Europe [4]. Indeed, in the last 20 years in Brazil, the epidemiological pattern of VL has changed from a sporadic disease of rural areas to one occurring in peri-urban epidemics that affect all socioeconomic strata, and with a trend towards increasing mortality [5]. The European Centre for Disease Prevention and Control lists the leishmaniases among the ten vector-borne diseases that have the greatest potential to affect European inhabitants [6].…”