Visceral leishmaniasis elimination targets in India, strategies for preventing resurgence

ABSTRACT

Introduction: Visceral leishmaniasis (VL) is a fatal parasitic disease caused by a parasite belonging to the Leishmania donovani complex and transmitted by infected female Phlebotomous argentipes sand flies. The VL elimination strategy in the Indian subcontinent (ISC), which has a current goal of reducing the incidence of VL to below 1/10,000 of population by the year 2020, consists of rapid detection and treatment of VL to reduce the number of human reservoirs as well as vector control using indoor residual spraying (IRS). However, as the incidence of VL declines toward the elimination goal, greater targeting of control methods will be required to ensure appropriate early action to prevent the resurgence of VL.

Area covered: We discuss the current progress and challenges in the VL elimination program and strategies to be employed to ensure sustained elimination of VL.

Expert commentary: The VL elimination initiative has saved many human lives; however, for VL elimination to become a reality in a sustained way, an intense effort is needed, as substantial numbers of endemic subdistricts (primary health centers (PHCs) blocks level) are yet to reach the elimination target. In addition to effective epidemiological surveillance, appropriate diagnostic and treatment services for VL at PHCs will be needed to ensure long-term sustainability and prevent reemergence of VL.

KEYWORDS:

• Visceral leishmaniasis
• elimination
• surveillance
• resurgence

Authors Contributions

OPS, JC and SS conceived the idea, participated in writing and critical revision of draft.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was supported by the National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (TMRC [Tropical Medicine Research Centers]  grant number U19AI074321) and grants from the Bill & Melinda Gates Foundation (OPP 1117011).