Clinical and epidemiological studies of Visceral Leishmaniasis in Bihar, India

LE声明：内脏利什曼病(VL)是一种寄生虫病，如果不治疗是致命的。几百个 印度次大陆有数千人受到影响。大多数人很穷，依靠公共资金或 慈善救治。疾病控制的基础是早期诊断和治疗，以及控制沙蝇 传播疾病的物质。到目前为止，控制努力只给了暂时的缓解，周期性的反弹 重大流行病。这是因为我们对疾病动态的理解存在差距。 变速箱。这项研究旨在确定这些因素，并评估新的诊断方法和疫苗。 通过对寄生虫进行基因组测序而产生的候选者。这项研究将提供新的 使区域政府能够在2015年前实现疾病控制目标的知识和工具。 项目描述：VL在印度的分销情况参差不齐。疾病传播的决定因素 对村级和户级的了解还不够深入。亚临床感染被认为起着重要作用。 在疾病传播方面，但亚临床感染的标志物尚未得到验证。我们不能完全 理解为什么只有一小部分感染者会发展为临床疾病。为了获得更好的 为了了解疾病的动态和传播，这项研究将进行(1)详尽的人群调查 连续两年对50,000人进行调查，使用家庭访谈、CIS技术、远程 遥感数据和多层次建模，以确定能够更好地确定目标的生态风险标记物 控制干预措施；(2)嵌套病例对照研究，以记录可改变的危险因素(例如 家庭和个人VL的营养)和风险标记(临床、遗传、免疫学)，以及 两轮年度血清调查，使我们能够记录事件利什曼感染，和为期3年的 对全面发展的VL的文件的纵向跟踪；(3)对现有的(rK39-ELISA， 针对标准Western印迹和定性kDNA的感染的直接凝集试验(LST)标记 (4)新的杜氏利什曼原虫的评价。 复杂的特定基因)标记使用定性和定量的聚合酶链式反应、酶联免疫吸附试验和T细胞分析；以及(5) 新候选疫苗在患者和地方病对照中的免疫概况。结果将为政策提供信息 印度次大陆的疾病控制和实践，并增加了全球对VL疾病的了解。

Lay statement: Visceral leishmaniasis (VL) is a parasitic disease that is fatal if untreated. Several hundred thousand people are affected in the Indian subcontinent. Most are poor and depend on public funds or charity for treatment. Disease control is based on early diagnosis and treatment, and control of sandflies that transmit disease. Control efforts to date have given only temporary reprieve, with periodic rebound of major epidemics. This is because there are gaps in our understanding of the dynamics of disease transmission. This study is designed to identify these factors, and to evaluate novel diagnostics and vaccine candidates that have arisen through genomic sequencing of the parasite. The study will provide new knowledge and tools to allow regional governments to achieve their aim of disease control by 2015. Project description: VL in India is patchy in distribution. The determinants of disease transmission at a village and household level are not well understood. Subclinical infection is thought to play a significant role in disease transmission, but markers of subclinical infection have yet to be validated. We don't fully understand why only a small proportion of infected subjects develop clinical disease. To gain a better understanding of disease dynamics and transmission, this study will undertake (1) an exhaustive population survey of 50,000 persons for two consecutive years using household interviews, CIS technology, remote sensing data and multi-level modelling, to identify the ecological risk markers that will permit better targeting of control interventions; (2) a nested case control study to document the modifiable risk factors (e.g. nutritional) and risk markers (clinical, genetic, immunological) for VL at household and individual level, with two annual rounds of sero-survey allowing us to document incident leishmanial infections, and a 3-year longitudinal follow-up to document development of full blown VL; (3) evaluation of existing (rK39 ELISA, Direct Agglutination Test, LST) markers of infection against standard Western blot and qualitative kDNA PCR and new Quantiferon assays for T cell responses; (4) evaluation of novel (Leishmania donovani- complex specific genes) markers using qualitative and quantitative PCR, ELISA and T-cell assays; and (5) immune profiling of novel vaccine candidate in patients and endemic controls. The results will inform policy and practice for disease control in the Indian sub-continant, and add to global understanding of VL disease.