The lost hope of elimination of Kala-azar (visceral leishmaniasis) by 2010 and cyclic occurrence of its outbreak in India, blame falls on vector control practices or co-infection with human immunodeficiency virus or therapeutic modalities?
The lost hope of elimination of Kala-azar (visceral leishmaniasis) by 2010 and cyclic occurrence of its outbreak in India, blame falls on vector control practices or co-infection with human immunodeficiency virus or therapeutic modalities?
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DOI：
10.4103/2229-5070.129143
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发表时间：
2014-01
影响因子：
--
通讯作者：
Muniaraj M
中科院分区：
文献类型：
--
作者：
Muniaraj M
黑热病/内脏利什曼病在印度次大陆流行区每15年流行一次。尽管印度政府、世界卫生组织和东南亚区域办事处作出了最大努力，但到2010年在印度消灭黑热病的目标仍然落空。本综述的主要目的是阐明黑热病消灭计划失败的可能原因，并提出可能的补救措施，以实现未来的目标。自1977年以来，印度记录的VL病例和死亡的年度数量绘制在一张图表上，以了解时间趋势是否与病媒控制做法的变化或与人类免疫缺陷病毒（HIV）的合并感染或用于治疗VL的治疗方式有关。当停药后DDT的作用减弱时，VL病例突然发作。衰落的有效性与VL病例数量的增加明显相关。治疗方式被认为是高度相关的VL死亡率与VL发病率。一线和二线药物疗效的下降以及新药和联合用药的引入是VL死亡率上升和唐斯的原因。自1993年以来，VL死亡率不断下降，但病例从2003年至2007年开始增加，最近又从2010年至2011年再次增加。这表明所采用的病媒控制做法存在严重缺陷。HIV合并感染的程度与研究期间VL病例或死亡的数量/趋势没有任何相关性。结论是，通过严格的媒介控制措施，可以减少VL病例，并通过应用适当的治疗策略，可以降低VL死亡率。HIV-VL合并感染似乎并不处于令人担忧的阶段。
The Kala-azar/visceral leishmaniasis (VL) turns epidemic form once in every 15 years in the endemic regions of Indian subcontinent. The goal of elimination of Kala-azar from India by 2010 was lost despite paramount efforts taken by the Government of India and World Health Organization and Regional Office for South East Asia. The main objective of this review was to elucidate the possible reason for the failure of Kala-azar elimination program and to suggest possible remedial measures to achieve the goal in future. The annual numbers of VL cases and deaths recorded in India since 1977 were plotted on a graph, to see if the temporal trends could be associated with changes in the vector control practices or co-infection with human immunodeficiency virus (HIV) or therapeutic modalities used against VL. The VL cases flares up whenever the effect of dichlorodiphenyltrichloroethane (DDT) diminished after the withdrawal of spray. The fading effectiveness was clearly correlated with an increasing number of VL cases. Therapeutic modalities were found to be highly correlating with VL mortality not with VL morbidity. The diminishing efficacy of first and second line drugs and the introduction of new drugs and drugs combination were responsible for ups and downs in the VL mortality. The VL mortality is constantly declining since 1993, but cases started increasing from 2003 to 2007 and then recently again from 2010 to 2011. This shows a serious lacuna in the vector control practices applied. The extent of HIV co-infection did not show any correlation with number/trend of VL cases or death over the study period. It is concluded that, by strict vector control practices, the VL cases can be reduced and by applying proper therapeutic strategies, the VL mortality can be reduced. HIV-VL co-infection does not seem to be in a worried stage.