Surveillance of leishmaniasis in the WHO European Region

Abstract

Introduction Leishmaniasis is a neglected tropical disease (NTD), which is endemic in large parts of the world. Leishmania infantum is the etiological agent of canine leishmaniasis (CanL[1]) in Europe, with dogs as the major reservoir of the parasite for humans and other mammalian hosts. This zoonotic Leishmania species is responsible for the majority of human cutaneous leishmaniasis (CL) and visceral leishmaniasis (VL) cases in the WHO European Region (EUR). Here, the disease mainly occurs around the Mediterranean basin as well as in Caucasus and Central Asia. Surveillance is key to better estimate the burden of leishmaniasis in EUR and take appropriate action to control the diseases. Methods WHO supports countries in their fight against the burden of leishmaniasis. This includes the collection, analysis and publication of data to monitor the disease. Every year, WHO collects the number of new autochthonous and imported cases, both for CL and VL. These indicators, along with the endemicity status of each Member State, are published in the Global Health Observatory (GHO). Since 2014, WHO has strengthened data collection in 25 priority countries worldwide, 3 belonging to EUR (Georgia, Spain and Turkey). For these countries, WHO publishes detailed country profiles annually on leishmaniasis burden and control. These data are also entered in the WHO integrated data platform, based on DHIS2, which aims at strengthening data collection, use and dissemination, both at national and global levels. Results Twenty-five Member States of EUR (47%) are classified as CL-endemic and 27 (51%) are classified as VL-endemic in the GHO. Of these countries, 12 reported cases of CL and 14 reported cases of VL in 2015 and/or 2016. A total of 2815 autochthonous and 1180 imported CL cases were reported in EUR in 2016, which corresponds to 1.6% and 84.6% of cases reported globally, respectively. Moreover, a total of 303 autochthonous and 38 imported VL cases have been reported from EUR in 2016, which corresponds to 1.5% and 66.7% of cases reported globally respectively. Since 2016, six additional countries from EUR have been reporting detailed data to enable the publication of country profiles. As a result, nine detailed country profiles from EUR Member States were published for 2015 and 2016. They are publically available at http://www.who.int/leishmaniasis/burden/endemic-priority-alphabetical/en/Affected countries in EUR also met in 2017 at a meeting in Sofia, Bulgaria, to exchange data and develop future control strategies. Since then, Armenia has made efforts to strengthen their surveillance system and the DHIS2 platform was customized to fit the nationally collected data of individual cases. Conclusions Cutaneous and visceral leishmaniasis are endemic in wide areas of the WHO European Region, with a large population at risk of disability and death. As the main Leishmania species involved is zoonotic, One Health considerations linking up human and veterinary public health and control efforts are required. WHO supports Member States in strengthening leishmaniasis surveillance, e.g. through standardizing indicators and facilitating reporting, in order to better estimate burden and take appropriate action to tackle the disease as stated in the United Nations’ Sustainable Development Goals to end the epidemic of neglected tropical diseases.