Strengthening Visceral Leishmaniasis Diagnosis Capacity to Improve Access to Care in Kenya: The Example of Marsabit County

BackgroundVisceral leishmaniasis (VL), also known as kala-azar, is a neglected tropical disease (NTD) that is fatal if not treated early. The WHO targets the elimination of VL as a public health problem in its 2030 NTD road map. However, improving access to VL diagnosis and treatment remains a major challenge in many VL-endemic countries. Kenya is endemic for VL and is among the top 6 high-disease burden countries in the world.MethodsFIND, through its activities in improving the diagnosis of VL and supporting the elimination of the disease in Kenya, has worked with various county ministries of health (MOH) and central MOH over the last couple of years. FIND’s activities in Marsabit county started in 2018. In this work, we present the implementation of activities and the impacts in Marsabit county. We reviewed the data for 2017 and 2019 outbreaks (before and after the implementation of FIND’s activities) and assessed the importance of improving access and community sensitization to VL diagnosis. We assessed the contribution of each facility to the total distance traveled from a perspective of location optimization.ResultsThere was a sharp increase in the number of people tested in the 2017 outbreak compared to the 2019 outbreak. In 2017, 437 people were tested compared to 2,338 in 2019. The county reported 234 and 688 VL cases in 2017 and 2019, respectively. The data revealed a shift in the demographic structures of cases toward the younger population (mean age in 2017 was 17.6 years and 15.3 years in 2019), with more female cases reported in 2019 compared to 2017. In 2017, 44.4% were 10 years of age or under. In 2019, the proportion 10 years or below was 52.2%. The addition of two new diagnosis facilities in 2018 resulted in a decrease in the distance traveled by confirmed VL cases from 28.1 km in 2017 to 10.8 km in 2019. Assessing the impact of facility placement indicated the most optimal facilities to provide VL diagnostic services and minimize the distance traveled by patients. Adding new facilities reduces the travel distance until a point where the addition of a new facility provides no additional impact.ConclusionThe results from this study indicate the need to carefully consider the placement of health facilities in improving access to VL diagnosis and treatment and could serve as an investment case in deciding when to stop adding new facilities in a particular setting. Extending the activities in Kenya to other VL-endemic countries in East Africa will contribute significantly toward the elimination of the disease, addressing the needs of marginalized populations and leaving no one behind.

A Stochastic Model for Kala-azar Transmission Dynamics in Libo Kemkem, Ethiopia

The objective of this paper is to analyse and demonstrate the dynamics of Kala-azar infected group using stochastic model, particularly using simple SIR model with python script over time. The model is used under a closed population with N = 100, transmission rate coefficient β = 0.09, recovery rate γ = 0.03 and initial condition I(0) = 1. In the paper it is discussed how the Kala-azar infected group behaves through simple SIR model. The paper is completed with stochastic SIR model simulation result and shows stochasticity of the dynamics of Kala-azar infected population over time. Fig. 2 below depicts continuous fluctuations which tells us the disease evolves with stochastic nature and shows random process.Subject: Infectious Disease, Global Health, Health Informatics and Statistical and Computational Physics

Impact on Vector-Borne Diseases in COVID-19 Pandemic: Evidence from a District in Jharkhand, India

The study is aimed to assess the effect of COVID-19 pandemic and non-pharmaceutical interventions (NPI) like banning mass gatherings (Lockdown) etc on vector borne diseases. This study can throw some light on the epidemiology of all vector-borne diseases under surveillance during this COVID-19 pandemic. This study is done in Dumka district, Jharkhand. Method- A cross-sectional study was conducted in 10 Blocks of Dumka District. Sampling technique used in this study was convenience sampling. Study of six month was conducted for vector-borne diseases from January 2021– June 2021.To know the epidemiology of vector-borne disease before and after COVID-19 pandemic, data from the year 2019 and 2020 was used for data analysis. Result – During the six months study period between January 2021-June 2021, maximum number of cases found in Dumka District was Kala-azar followed by Lymphatic Filariasis and then Malaria. There was sharp decrease in number of vector-borne disease cases. After data analysis between the year 2019 and 2020 reduction of cases was seen in Kala-azar (15.3%), Lymphatic Filariasis (8.9%) and maximum reduction of cases was seen Malaria (98.1%). Conclusion – A drastic reduction in reported cases of vector-borne diseases was noticed. To better understand the reason behind the changes in vector-borne disease prevalence a consistent and vigilant surveillance is required. Keywords: COVID-19, Vector-borne diseases, non-pharmaceutical interventions.

Descripción de un caso clínico de Leishmaniasis canina

<p>La leishmaniasis es una enfermedad parasítica ocasionada por un protozoario del género Leishmania, propagada a través de la picadura de insectos contagiados de la familia Phlebotomidae. Conforme menciona la Organización Mundial de la Salud, se cree que su incidencia aumenta conforme pasan los años. La afección es de tipo zoonótica. La patología y epidemiología de leishmaniasis puede mostrarse dependiendo de la especie del parásito, de las tipologías ecológicas de las zonas en donde se transmite y de la exposición anterior y presente ante el parásito. Por ello se presentará una forma visceral conocida como kala azar teniendo una alta mortalidad al no tratarla, ya que posee la capacidad de provocar brotes que conlleven a la muerte, caracterizada por la presencia de sucesos anormales de pirexia, disminución de peso, anemia y hepato-esplenomegalia. Una de las formas más frecuentes es la leishmaniasis cutánea, que provoca úlceras a nivel de la piel, las que son causantes de incapacidad grave; la leishmaniasis mucocutánea induce la pérdida parcial o total de las mucosas del área de la nariz, boca y garganta. Se han hallado casos de leishmaniasis en la mayoría de los países, tanto en regiones subtropicales como tropicales o de climas mediterráneos, ya que la presencia de la familia Phlebotomidae es alta. Con relación a los diagnósticos empleados para la identificación de leishmaniasis, se aplican técnicas morfológicas o técnicas de detección antigénica.<br /><br /><br /></p>

IgG3 and IL10 are effective biomarkers for monitoring therapeutic effectiveness in Post Kala-Azar Dermal Leishmaniasis

Background The assessment of chemotherapeutic responses in Post Kala-azar Dermal Leishmaniasis (PKDL), especially its macular form is challenging, emphasizing the necessity for ‘test of cure’ tools. This study explored the diagnostic and prognostic potential of IgG subclasses and associated cytokines for monitoring the effectiveness of chemotherapy in PKDL. Methods Participants included PKDL cases at (a) disease presentation, (b) immediately at the end of treatment (12 weeks for Miltefosine or 3 weeks for Liposomal Amphotericin B, LAmB and (c) at any time point 6 months later, for estimating anti-leishmanial immunoglobulin (Ig, IgG, IgM, IgG1, IgG2 and IgG3) and cytokines (IL-10, IL-6). Results In PKDL, Ig levels were elevated, with IgG3 and IL-10 being the major contributors. Miltefosine decreased both markers substantially and this decrease was sustained for at least six months. In contrast, LAmB failed to decrease IgG3 and IL-10, as even after six months, their levels remained unchanged or even increased. Conclusions In PKDL, IgG3 and IL-10 proved to be effective predictors of responsiveness to chemotherapy and may be considered as a non invasive alternative for longitudinal monitoring.

Op-Ed---- Public Health as I see it- India &LMICs1

Op-Ed---- Public Health as I see it- India &amp;LMICs1 The concepts of public health, one of the broad and vast scientific streams, is not getting required attention and support in India and other LMICs (low and middle income countries) like the western countries and HICs (high income countries) even in this covid-19 pandemic era. There are several reasons for this difference in public health encouragement between LMICs and HIC, the most significant factors are policies, lack of awareness and resources such as institutes, funds etc. Added to this the policy and decision makers seem to be ignorant about the significance of public health in reducing the burden of disease and health expenses at mass level. The field of public health will be more significant &amp; useful if divided into Medical and Non-Medical branches as it incorporates scholars and experts of different fields and this division will increase significance, utility as well as efficiency of public health scholars. At present it is a mixture of scholars of different backgrounds and the title Master of Public Health seems quite inappropriate title for scholars’ of non-health field backgrounds called Master (of public health) with a simple 2 year course. Moreover the non-medical graduates will find difficulty in getting primary data related to health sciences and vice versa is also true for medical graduates and scholars. For example the non medical scholars doing research on Kala-azar don’t have enough knowledge of kala-azar to interpret the findings like spleen size, life cycle of vector, modes of transmission etc. and vice versa is also true for medical graduates. Since the preparedness and efficiency of these scholars depends on the education they receive and how effectively they use it, the training and work field should be designed as isolated fields to make the scholars’ real master instead of making jack of all trades Master of nothing. This is one of the reasons why the scholars of public health are not getting good jobs, enough attention and reputation. Added to this the credibility and reliability of public health experts can be endangered by practice of using secondary data in research largely derived from medical graduates. Hence it’s better if the public health experts department with proper division is established to reap the maximum benefits from scholars of different fields. Public health consists of experts from different fields and services which can be utilized in cases of emergency and critical support. Their abilities can be utilized while managing existing cases of non-communicable diseases like diabetes, hypertension, heart ailments, routine ante-natal care, accidents, as well as communicable disease like covid-19 if we have a clear role to be played by public health scholars. For example let the management public health expert do the management works while let medical public health experts find out the formula to deal with covid-19 as medical public health experts. Of course everyone will have importance and at the same time expertise in their respective field which can be utilized as team work to deal with various healths related issues. The significance of doctors, nurses, technicians and other hospital-based staff have been noticed and praised during this covid-19 era but still the public health experts are not getting enough attention, why? Taking example of covid-19, Public health experts may not be able to provide sophisticated complex treatments but their role in preventing, identification of cases, contact tracing, quarantine and isolation monitoring, referrals, logistic management etc. would prove helpful and significant to deal with the situation. Their ability would depend on their training about the infection and its identification, transmission, diagnostics and treatment support. India has a three-tier public health system for provision of primary (HSC, APHC, and PHC), secondary (provided by SDH, CHC, and DH specialist on referral from primary care provider) and tertiary (medical college hospitals etc. highly specialized medical care) care. All these centers must have public health experts well qualified and trained to reduce the burden of disease as well as OOPE (out of pocket expenditure) at mass level. India and other LMICs must focus now on preparing the qualified, skilled public health soldiers in order to reduce the burden of disease and health care expenses which are interfering with the nation's development.1. DR PIYUSH KUMAR, M.B.B.S., EMOC (FOGSI), PGDPHM,SENIOR MEDICAL OFFICER, HEALTH DEPARTMENT, [email protected] Mobile-+919955301119/7677833752,GOVERNMENT OF BIHAR

Multisystem diseases and infections

Differential diagnosis of fevers?, Fever without localizing features?, Sepsis?, Cancer?, General rules of cancer management?, Rheumatoid arthritis?, Osteoarthritis?, Systemic lupus erythematosus?, Typhoid and paratyphoid fevers?, Rickettsioses?, Bartonella?, Ehrlichia?, Coxiella?, Relapsing fevers?, Leptospirosis?, Brucellosis?, Plague?, Melioidosis?, Anthrax?, African trypanosomiasis?, American trypanosomiasis?, Visceral leishmaniasis (kala-azar)?, Infectious mononucleosis?, Measles?, Arboviruses and zoonotic haemorrhagic fever viruses , Ebola and Marburg virus diseases, Crimean-Congo haemorrhagic fever, Rift Valley fever, Lassa fever, Hantavirus infections, Severe fever and thrombocytopenia, Zika virus, Japanese encephalitis , Dengue virus, Yellow fever, West Nile virus , Kyasanur Forest Disease, Chikungunya, Ross River fever, O'nyong nyong

Human leishmaniasis vaccines: Use cases, target population and potential global demand

The development of vaccines against one or all forms of human leishmaniasis remains hampered by a paucity of investment, at least in part resulting from the lack of well-evidenced and agreed estimates of vaccine demand. Starting from the definition of 4 main use cases (prevention of visceral leishmaniasis, prevention of cutaneous leishmaniasis, prevention of post-kala-azar dermal leishmaniasis and treatment of post-kala-azar dermal leishmaniasis), we have estimated the size of each target population, focusing on those endemic countries where incidence levels are sufficiently high to justify decisions to adopt a vaccine. We assumed a dual vaccine delivery strategy, including a wide age-range catch-up campaign before the start of routine immunisation. Vaccine characteristics and delivery parameters reflective of a target product profile and the likely duration of the clinical development effort were considered in forecasting the demand for each of the four indications. Over a period of 10 years, this demand is forecasted to range from 300–830 million doses for a vaccine preventing visceral leishmaniasis and 557–1400 million doses for a vaccine preventing cutaneous leishmaniasis under the different scenarios we simulated. In a scenario with an effective prophylactic visceral leishmaniasis vaccine, demand for use to prevent or treat post-kala-azar dermal leishmaniasis would be more limited (over the 10 years ~160,000 doses for prevention and ~7,000 doses for treatment). Demand would rise to exceed 330,000 doses, however, in the absence of an effective vaccine for visceral leishmaniasis. Because of the sizeable demand and potential for public health impact, a single-indication prophylactic vaccine for visceral or cutaneous leishmaniasis, and even more so a cross-protective prophylactic vaccine could attract the interest of commercial developers. Continuous refinement of these first-of-their kind estimates and confirmation of country willingness and ability to pay will be paramount to inform the decisions of policy makers and developers in relation to a leishmaniasis vaccine. Positive decisions can provide a much-needed contribution towards the achievement of global leishmaniasis control.

Evaluation of molecular assays to detect Leishmania donovani in Phlebotomus argentipes fed on post-kala-azar dermal leishmaniasis patients

Background Post-kala-azar dermal leishmaniasis (PKDL) caused by Leishmania donovani (LD) is a skin disorder that often appears after treatment of visceral leishmaniasis (VL) patients. PKDL patients are potential reservoirs of LD parasites, which can initiate a new epidemic of anthroponotic VL. Therefore, host infectiousness to its sand fly vector is a critical factor for transmission, and its accurate estimation can facilitate control strategies. At present, conventional microscopy serves as the reference method to detect parasites in its vector. However, low sensitivity of microscopy can be a limiting factor. Methods In this study, real-time quantitative PCR (LD-qPCR) and recombinase polymerase amplification (LD-RPA) assays were evaluated against microscopy for the detection of LD DNA extracted from live sand flies five days after controlled feeding on PKDL cases. Results The sensitivity of LD-qPCR and LD-RPA assays were found to be 96.43 and 100%, respectively, against microscopy for the selected fed sand flies (n = 28), and an absolute specificity of both molecular tools for apparently unfed sand flies (n = 30). While the proportion of infectious cases among 47 PKDL patients was estimated as 46.81% as defined by microscopic detection of LD in at least one fed sand fly per case, LD-RPA assay evaluation of only the microscopy negative sand flies fed to those 47 PKDL cases estimated an even greater proportion of infectious cases (51.06%). In overall estimation of the infectious cases in retrospective manner, discordance in positivity rate was observed (p < 0.05) between LD-RPA (59.57%) assay and microscopy (46.81%), while LD-RPA had slightly better positivity rate than LD-qPCR (55.32%) as well. Conclusions Considering the sensitivity, cost, detection time, and field applicability, RPA assay can be considered as a promising single molecular detection tool for investigations pertaining to LD infections in sand flies and/or host infectiousness in PKDL, while it can also be useful in confirmation of microscopy negative sand fly samples. Graphical abstract