The epidemic of visceral leishmaniasis in Western Upper Nile, Southern Sudan: Course and impact from 1984 to 1994
The epidemic of visceral leishmaniasis in Western Upper Nile, Southern Sudan: Course and impact from 1984 to 1994
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DOI：
10.1093/ije/25.4.862
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发表时间：
1996-08-01
影响因子：
7.7
通讯作者：
Sondorp, E
中科院分区：
文献类型：
--
作者：
Seaman, J;Mercer, AJ;Sondorp, E
背景。尽管内脏利什曼病 (VL) 在苏丹南部部分地区流行，但直到 1989 年确认流行后，内脏利什曼病 (VL) 才在西上尼罗河 (WUN) 出现。多种情况的结合为在主要由没有免疫力的努尔人和丁卡人组成的人群中传播创造了条件。 1983 年重新开始的内战是一个主要原因，并继续阻碍治疗、数据收集和控制措施的提供。方法。自 1989 年在 WUN 建立第一家治疗 VL 的诊所以来，通过对村庄和患者进行的七次回顾性调查收集了有关流行病和死亡率的数据。成年人接受了关于幸存家庭成员和自疫情爆发以来死亡的人的采访。此处使用调查死亡率来估计 VL 死亡率和高于预期水平的“超额死亡率”。结果。调查发现，所有年龄段的死亡率都很高，自 1984 年疫情爆发以来，总体死亡率为 38-57%，受影响最严重的地区高达 70%。两种估计方法都表明，疫区约 28 万人中，约 10 万人死亡可能是由 VL 造成的。结论。这种持续的流行病表明，VL 在爆发时可导致高死亡率，感染率高得惊人。人口流动是传播的主要因素，营养状况不佳可能增加了临床感染的风险。尽管已经有超过 17 000 人在 WUN 的诊所成功接受了 VL 治疗，但该疾病很可能在那里流行。
Background. Although endemic in parts of southern Sudan, visceral leishmaniasis (VL) had not been reported in Western Upper Nile (WUN) until an epidemic was confirmed in 1989. A combination of circumstances created conditions for transmission among a population of mainly Nuer and Dinka people who had no immunity. The civil war which restarted in 1983 has been a major contributing cause and continues to hinder provision of treatment, data collection and control measures.Methods. Since the first of three clinics to treat VL was established in WUN in 1989, data on the epidemic and mortality have been collected in seven retrospective surveys of villages and among patients. Adults were interviewed about surviving family members and those who had died since the epidemic came. Survey death rates are used here to estimate mortality from VL and 'excess mortality' above expected levels.Results. The surveys found high mortality at all ages and suggest an overall death rate of 38-57% since the epidemic started in 1984, and up to 70% in the most affected areas. Both methods of estimation suggest that around 100 000 deaths, among about 280 000 people in the epidemic area, might be attributable to VL.Conclusions. This continuing epidemic has shown that VL can cause high mortality in an outbreak with astonishingly high infection rates. Population movement has been a major factor in transmission and poor nutritional status has probably contributed to the risk of clinical infection. Although over 17 000 people have been successfully treated for VL at the clinics in WUN, the disease is likely to become endemic there.