Abstract
Starting from 1989 Italy experienced an increase of visceral leishmaniasis (VL) cases over a baseline of 10 to 30 cases reported annually. The number of cases peaked in 2000 and 2004 with more than 200 cases/year, and subsequently declined to reach on average one third of the 2000 peak value in the period after 2010. A retrospective analysis from 1982 to 2012 showed that the multi-annual epidemic consisted of major components including (i) an outbreak involving infants and immunocompetent adults in parts of the Campania region (southern peninsular Italy) and that appears to have declined naturally, (ii) a second outbreak affecting human immunodeficiency virus (HIV)-infected individuals throughout the country, that declined owing to the use of highly active antiretroviral therapies (HAART), (iii) a generalised increase of VL cases in immunocompetent individuals and patients affected by associated conditions other than HIV from endemic regions of peninsular and insular Italy (other than Campania), which was due to a geographical spreading of VL foci, with no major case-clusters or outbreak features. A minor component consisted in the appearance of a few autochthonous cases in formerly non-endemic areas, starting from the early 1990s. Epidemic determinants and reasons for VL decline in the Campania region remain largely unexplained, despite the information available on canine reservoir and phlebotomine vectors in Italy.
Highlights
Visceral leishmaniasis (VL) is a protozoan disease transmitted by phlebotomine sandflies and caused by members of the Leishmania donovani complex
Under/ late reporting may occur from some provinces or when VL is diagnosed in patients suffering from associated conditions such as human immunodeficiency virus (HIV) co-infection, or organ transplant
At country-wide level, leishmaniasis epidemics may consist of an increase of disease cases over the expected baseline in the general population throughout the territory, or represent the additive outcome of different outbreaks occurring in particular areas and/ or affecting specific groups of individuals
Summary
Visceral leishmaniasis (VL) is a protozoan disease transmitted by phlebotomine sandflies and caused by members of the Leishmania donovani complex. Zoonotic VL, a disease caused by L. infantum for which domestic dogs act as the main reservoir hosts, exhibits a typical pattern characterised by isolated or small localised clusters of cases (usually less than 10), with large epidemics uncommon in the Mediterranean area [6]. The first documented outbreak of zoonotic VL occurred within the 1971 to 1972 period, near Bologna, Italy, with 60 clinical cases (13 deaths) diagnosed from villages where only a total of four cases had been documented in the previous 50 years [7]. Determinants of this outbreak have remained unexplained. Very recently (2010–2012) another localised VL outbreak with more than 100 cases has occurred near Madrid, Spain, where major determinants have been identified in environmental changes and the unusual role of hares as reservoir hosts [10]
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