Abstract
.We compared the efficacy of three intervention packages for active case detection (ACD) of visceral leishmaniasis (VL)/post–kala-azar dermal leishmaniasis (PKDL) combined with sandfly control around an index case. The packages were 1) no kala-azar transmission activity involving indoor residual spraying (IRS) with deltamethrin, peri-domestic deployment of larvicide with temephos, and house-to-house search for cases; 2) fever camp (FC) plus durable wall lining (DWL) with deltamethrin; and 3) FC plus insecticide (deltamethrin) impregnated bed-nets (ITN) around an index case. Fever camp includes 1-day campaign at the village level to screen and diagnose VL, PKDL, leprosy, malaria, and tuberculosis among residents with chronic fever or skin disease. Efficacy was measured through yield of new cases, vector density reduction, and mortality at 1, 3, 6, 9, and 12 months following intervention. Fever camp + DWL was the most efficacious intervention package with 0.5 case detected per intervention, 79% reduction in vector density (incidence rate ratio [IRR] = 0.21, P = 0.010), and 95.1% (95% confidence interval: 93.4%, 96.8%) sandfly mortality at 12 months. No kala-azar transmission activity was efficacious for vector control (74% vector reduction, IRR = 0.26, P < 0.0001 at 9 months; and 84% sandfly mortality at 3 months), but not for case detection (0 case per intervention). Fever camp + ITN was efficacious in detection of VL/PKDL cases (0.43 case per intervention), but its efficacy for vector control was inconsistent. We recommend index case–based FC for ACD combined with DWL or IRS plus larvicide for sandfly control during the consolidation and maintenance phases of the VL elimination program of the Indian subcontinent.
Highlights
Visceral leishmaniasis (VL), known as kala-azar, is a vector-borne disease transmitted by the female sandfly Phlebotomus argentipes
Fever camp + DWL was the most efficacious intervention package with 0.5 case detected per intervention, 79% reduction in vector density, and 95.1% (95% confidence interval: 93.4%, 96.8%) sandfly mortality at 12 months
CI = confidence interval; NKTA = no kala-azar transmission activity; fever camps (FCs) + DWL = fever camp and installation of durable wall lining; FC + ITN = fever camp and insecticide-treated net. * P-value for test of mean differences between intervention and control arms. † Crude estimated effect in female P. argentipes sandfly counts attributed by the intervention compared with the control arm
Summary
Visceral leishmaniasis (VL), known as kala-azar, is a vector-borne disease transmitted by the female sandfly Phlebotomus argentipes. In 2006, in Bangladesh the estimated annual incidence was 12,000–24,000 cases with a case fatality rate of 1%;1 about 130 upazilas of 45 districts reported VL cases at the beginning of the century.[2] the VL burden in Bangladesh has declined as a result of the huge efforts of the National Kalaazar Elimination Program (NKEP)[3] and the country achieved its target in 2016 (personal communication with Director, Communicable Disease Control, Directorate General of Health Services, Government of Bangladesh). The current practice of the national program in Bangladesh is the recently introduced “no kala-azar transmission activity (NKTA).”[7] The NKTA includes house-to-house search for VL and PKDL cases, IRS, and the use of larvicides in suspected vector breeding places in 60 houses around the house of a recently reported VL case (index case) (Figure 1).[7] its yield and effectiveness for detecting VL cases and reducing sandfly density have not been properly quantified and compared with other alternatives.
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