Impact of the visceral leishmaniasis elimination initiative on Leishmania donovani transmission in Nepal: a 10-year repeat survey

Cloots, Kristien; Uranw, Surendra; Ostyn, Bart; Bhattarai, Narayan; Rutte, Epke A. Le; Khanal, Basudha; Picado, Albert; Chappuis, François; Hasker, Epco; Karki, Prahlad; Rijal, Suman; Boelaert, Marleen

doi:10.1016/s2214-109x(19)30536-4

Cited by 35 publications

(25 citation statements)

References 15 publications

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“…It is still not clear whether those seropositive healthy individuals in endemic areas were truly infected with parasites or whether the serology test results were just false-positive results due to cross reactivity or a manifestation of a prior infection that has been cleared. A recent study does show a substantial decline in seropositivity rates in Nepal, consistent with an observed decline in incidence of the disease [ 73 ]. Furthermore, Leishmania DNA has been detected by PCR in peripheral blood of persons with asymptomatic infection in India, Nepal, Italy and Brazil, [ 66 , 74 – 76 ].…”

Section: Introductionsupporting

confidence: 71%

Xenodiagnosis to address key questions in visceral leishmaniasis control and elimination

et al. 2020

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Visceral leishmaniasis (VL) remains an important public health issue worldwide causing substantial morbidity and mortality. The Indian subcontinent accounted for up to 90% of the global VL burden in the past but made significant progress during recent years and is now moving towards elimination. However, to achieve and sustain elimination of VL, knowledge gaps on infection reservoirs and transmission need to be addressed urgently. Xenodiagnosis is the most direct way for testing the infectiousness of hosts to the vectors and can be used to investigate the dynamics and epidemiology of Leishmania donovani transmission. There are, however, several logistic and ethical issues with xenodiagnosis that need to be addressed before its application on human subjects. In the current Review, we discuss the critical knowledge gaps in VL transmission and the role of xenodiagnosis in disease transmission dynamics along with its technical challenges. Establishment of state of the art xenodiagnosis facilities is essential for the generation of much needed evidence in the VL elimination initiative.

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Section: Introductionsupporting

confidence: 71%

Xenodiagnosis to address key questions in visceral leishmaniasis control and elimination

et al. 2020

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“…The DAT detects anti- Leishmania antibodies that could be circulating from a previously cleared asymptomatic infection. However, a recent study found that DAT titers could be a useful tool to monitor transmission in an elimination setting during repeat surveys [14]. Where qPCR requires more laboratory infrastructure, the Leishmania antigen ELISA and LAMP are relatively simple techniques suitable for use in resource poor settings.…”

Section: Discussionmentioning

confidence: 99%

“…The rK39 enzyme-linked immunosorbent assay (ELISA), rK39 rapid diagnostic test (RDT) and the DAT measure the presence of anti -Leishmania antibodies [11-14], These antibodies have been found to persist for months or years after infection, with patients in the VL endemic region of Muzaffarpur, India found positive by rK39 RDT (39.0%) and DAT (53.0%) ≥ 15 years post treatment [15]. Therefore, a clinical history is required to determine if a positive result is due to active or previous infection, or a previous asymptomatic infection that will not progress to disease.…”

Section: Introductionmentioning

confidence: 99%

Detection of asymptomatic Leishmania infection in Bangladesh by novel antigen and antibody diagnostic tools shows strong association with PKDL patients

Owen

Hossain

Ghosh

et al. 2020

Preprint

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Background: Asymptomatic Leishmania infections outnumber clinical infections on the Indian sub-continent (ISC) where disease reservoirs are anthroponotic. Diagnostics which detect active asymptomatic infection, which are suitable for monitoring and surveillance, may be of benefit to the visceral leishmaniasis (VL) elimination campaign on the ISC. Methodology/Principal Findings: Quantitative polymerase chain reaction (qPCR), loop mediated isothermal amplification (LAMP), the direct agglutination test (DAT), and the Leishmania antigen ELISA were carried out on blood and urine samples collected from 720 household and neighbouring contacts of 276 VL and post kala-azar dermal leishmaniasis (PKDL) index cases, with no symptoms or history of VL and PKDL, in endemic regions of Bangladesh between September 2016 and March 2018. Of the 720 contacts of index cases, asymptomatic infection was detected in 69 (9.6%) participants by a combination of qPCR (1.0%), LAMP (2.1%), DAT (3.9%), and Leishmania antigen ELISA (3.3%). Only 1 (0.1%) participant was detected positive by all 4 diagnostic tests. Poor agreement between tests was calculated using Cohen's kappa statistics, however the Leishmania antigen ELISA and DAT in combination capture all participants positive by more than one test. We find strong evidence for association between the index case being a PKDL case (OR 1.94, p = 0.009), specifically macular PKDL (OR 2.12, p = 0.004) and being positive for at least one of the four tests. Conclusions/Significance: Leishmania antigen ELISA detects active asymptomatic infection, requires a non-invasive sample, and therefore may be of benefit for monitoring transmission and surveillance in an elimination setting in combination with serology. Development of an antigen detection test in RDT format would be of benefit to the elimination campaign.

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“…WHO has, therefore, not yet been able to validate the achievement of visceral leishmaniasis elimination as a public health problem in Nepal. 9 The strategy for VL control broadly included three main activities: interruption of transmission by reducing vector population through indoor residual insecticides; early diagnosis and complete treatment of VL cases and health education program for community awareness. These strategies are in line with the WHO strategies for elimination of VL.…”

Section: Kala-azar Elimination Program In Nepalmentioning

confidence: 99%

An Overview of Kala-azar Elimination Program in Nepal

Uranw

2019

Jnl. BP Koirala Inst. Health Sci.

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Impact of the visceral leishmaniasis elimination initiative on Leishmania donovani transmission in Nepal: a 10-year repeat survey

Cited by 35 publications

References 15 publications

Xenodiagnosis to address key questions in visceral leishmaniasis control and elimination

Xenodiagnosis to address key questions in visceral leishmaniasis control and elimination

Detection of asymptomatic Leishmania infection in Bangladesh by novel antigen and antibody diagnostic tools shows strong association with PKDL patients

An Overview of Kala-azar Elimination Program in Nepal

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