Kala-Azar Outbreak in Libo Kemkem, Ethiopia: Epidemiologic and Parasitologic Assessment

Department for the Control of Neglected Tropical Diseases (CDS/NTD/IDM), Leishmaniasis Control Program, World Health Organization, 20 Avenue Appia, CH-1211 Geneva, Switzerland.
The American journal of tropical medicine and hygiene (Impact Factor: 2.7). 09/2007; 77(2):275-82.
Source: PubMed


In May 2005, visceral leishmaniasis (VL) was recognized for the first time in Libo Kemkem, Ethiopia. In October 2005, a rapid assessment was conducted using data from 492 patients with VL treated in the district health center and a household survey of 584 residents of four villages. One subdistrict accounted for 71% of early cases, but the incidence and number of affected subdistricts increased progressively throughout 2004-2005. In household-based data, we identified 9 treated VL cases, 12 current untreated cases, and 19 deaths attributable to VL (cumulative incidence, 7%). Thirty percent of participants were leishmanin skin test positive (men, 34%; women, 26%; P = 0.06). VL was more common in men than women (9.7% versus 4.5%, P < 0.05), possibly reflecting male outdoor sleeping habits. Molecular typing in splenic aspirates showed L. infantum (six) and L. donovani (one). Local transmission resulted from multiple introductions, is now well established, and will be difficult to eradicate.

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    • "Although it is impossible to rule out the possibility of outdoor biting, this might indicate the increasing risk of domestication of VL transmission in this focus[67]. In addition to the soil (black cotton soil)[14,47], vegetation type (Acacia-Balanites vegetation)[39,68], presence of termite hills[36,37]and mass movement of people[22,23,32,69], different behavioural, household and environmental factors have been implicated as risk factors for either asymptomatic Leishmania infection or clinical VL. Studies done in the Libo Kemkem and Fogera areas documented increasing age (per year), being male, sleeping outside at any time of the year, past history of VL in the family, living in a straw roofed house and whether the family owned sheep as risks for Leishmania infection[70]. "

    Full-text · Article · Jan 2015 · Parasites & Vectors
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    • "Malnutrition and immune suppression, such as HIV co-infection, frequently result in clinical disease (WHO, 2010). In Ethiopia, VL is mostly endemic in the lowland areas but has recently spread into the highlands, particularly in northwest Ethiopia (Libo-Kemkem and Fogera districts) (Alvar et al., 2007). This disease is transmitted by the bite of phlebotomine sand flies (Diptera: Psychodidae). "
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    ABSTRACT: Phlebotomus orientalis is the most likely vector of Leishmania donovani causing visceral leishmaniasis in northwest Ethiopia. Understanding of sand fly night activities is very essential to design appropriate sand fly control methods in order to reduce Leishmania infection. The aim of this study was to determine the nocturnal activity of Phlebotomus species. This study was conducted for six consecutive months from January to June 2013 in Adebay village where visceral leishmaniasis is endemic. Sandflies were collected using CDC Light traps changed at one hour interval, in periphery village (peridomestic area) and farm field. The traps were activated from 18:00 to 7:00 hours. Overall, 5,902 sandflies were collected. Eight Phlebotomus species representing four subgenera were indentified: Phlebotomus (Larroussius) orientalis, P.(Phlebotmus) papatasi, P.(Phlebotmus) bergeroti, P. (Phlebotomus)duboscqi, P. (Paraphlebotomus) alexanderi, P. (Anaphlebotomus) rodhani and other two Parvidens species(P. lesleyae and P. heischi). Among eight species of sand flies collected P.orientalis were the most predominant species followed by P. papatasi and P. lesleyae. The result indicated that female and male P.orientalis showed similar activity pattern (19:00-05:00hrs). Both sexes were active throughout the night (19:00-06:00 hours), reaching a peak between 01:00 and 03:00hrs (mean density of 16.46 females/trap/hour/night; and 33.83 males/trap/hour/night). Male P. papatasi were the dominant having two peaks, an early smaller peak between 21:00-22:00 hrs and a larger second one around midnight (24:00-02:00 hrs). Females displayed similar activity patterns, with an early peak at 21:00-22:00 and a late smaller peak at 02:00-03:00 hours. Hourly collections of P.orientalis and P. papatasi, the corresponding temperatures revealed no significant correlations. In conclusion, P.orientalis and P. papatasi remained active throughout the night. High risk of VL transmissions is likely concentrated during the peak hours and local inhabitants could reduce the risk of infection by using appropriate personal protective measures such as repellents and bed nets.
    Full-text · Article · Jan 2015
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    • ": Physical map of the study area and nearby districts: Alvar et al. 2007 [18] "
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    ABSTRACT: Background: Visceral leishmaniasis (VL) is a systemic disease caused by the Leishmania donovani complex. It is one of the fatal diseases if left untreated. In Ethiopia, there are many VL endemic foci. The aim of this study was to determine the trends of VL in the study area. Methodology: A retrospective study was conducted at Addis Zemen health center from September 2005 to August 2011. Data were collected from laboratory registration book and entered and analyzed by using SPSS version 20 software and P value of ≤0.05 was considered statistically significant. Result: A total of 7161 VL suspected cases were reported in the study area. The overall prevalence of VL was 2801 (39.1%). Of the 2801 VL positive cases, the highest annual prevalence, 988 (46.8%), was reported in 2005 but the trend gradually decreases. Majority of the VL confirmed cases were in the age groups of 5-14 years and males were more affected. Conclusion: The prevalence of VL in the study area was high in early 2005 but, gradually, the trend has been decreased and it becomes one of VL endemic foci in Ethiopia.
    Full-text · Article · Mar 2014
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