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PLoS Negl Trop Dis. 2015 Aug 7;9(8):e0003966. doi: 10.1371/journal.pntd.0003966. eCollection 2015.

Transmission of Leishmania donovani in the Hills of Eastern Nepal, an Outbreak Investigation in Okhaldhunga and Bhojpur Districts.

Author information

1
Department of Public Heath, Institute of Tropical Medicine, Antwerp, Belgium.
2
Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
3
Department of Microbiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
4
Epidemiology and Disease Control Division, Ministry of Health and Population (MOHP), Kathmandu, Nepal.
5
Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
6
Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium.
7
Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium.
8
Department of Control of Neglected Tropical Diseases, World Health Organization (WHO), Geneva, Switzerland.

Abstract

BACKGROUND:

In the Indian subcontinent, Visceral leishmaniasis is endemic in a geographical area coinciding with the Lower Gangetic Plain, at low altitude. VL occurring in residents of hill districts is therefore often considered the result of Leishmania donovani infection during travel. Early 2014 we conducted an outbreak investigation in Okhaldhunga and Bhojpur districts in the Nepal hills where increasing number of VL cases have been reported.

METHODOLOGY/PRINCIPAL FINDINGS:

A house-to-house survey in six villages documented retrospectively 35 cases of Visceral Leishmaniasis (VL). Anti-Leishmania antibodies were found in 22/23 past-VL cases, in 40/416 (9.6%) persons without VL and in 12/155 (7.7%) domestic animals. An age- and sex- matched case-control study showed that exposure to known VL-endemic regions was no risk factor for VL, but having a VL case in the neighbourhood was. SSU-rDNA PCR for Leishmania sp. was positive in 24 (5%) of the human, in 18 (12%) of the animal samples and in 16 (14%) bloodfed female Phlebotomus argentipes sand flies. L. donovani was confirmed in two asymptomatic individuals and in one sand fly through hsp70-based sequencing.

CONCLUSIONS/SIGNIFICANCE:

This is epidemiological and entomological evidence for ongoing local transmission of L. donovani in villages at an altitude above 600 meters in Nepal, in districts considered hitherto non-endemic for VL. The VL Elimination Initiative in Nepal should therefore consider extending its surveillance and control activities in order to assure VL elimination, and the risk map for VL should be redesigned.

PMID:
26252494
PMCID:
PMC4529159
DOI:
10.1371/journal.pntd.0003966
[Indexed for MEDLINE]
Free PMC Article

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