Visceral Leishmaniasis in Bihar State, India

TMRC计划的目的是建立一个专注于理解的卓越中心 杜氏利什曼原虫引起的内脏利什曼病(VL)的所有方面 印度的消除疾病倡议，旨在将临床疾病的发病率降低到非常低的水平。许多 关于完全阻断多诺瓦尼乳杆菌传播的可行性，未知因素依然存在， 尤其是在十分之一的感染导致临床疾病的情况下。科学小组的意图 计划这一应用程序是为了产生一个知识体系和一个准备好的调查团队 对于疾病的任何死灰复燃，可能是在该国新的流行地区。 我们提出了三个研究项目，重点是传播和持续的参数 印度的L.donovani。项目1将使用以前供资期间建立的方法进行监测 和VL的监测，并使用全球代谢组学分析来确定无症状的 感染，并将其放在肠道微生物群的背景下，并将其与其他NTD合并感染作为风险 为晋级VL而战。项目2将监测抗药性种群的出现。 白纹伊蚊(Phlebotomus Argentipe)的沙蝇媒介，并考察了媒介的潜在因素 杜氏钩端螺旋体从人或动物宿主的能力和传播性。项目3将 检查潜在的免疫因素，对比症状性与无症状性VL。 多诺瓦尼感染，包括系统性和局部性的皮肤感染。《健康与人口》 在本供资期间启动的监测系统将监测 比哈尔邦选定人口的人口统计和健康状况。因此，该计划将 全面检查维护和维护基础的外在和内在宿主因素 VL在印度比哈尔邦的持续传播。 TMRC计划的目标是：(1)保持和进一步发展TMRC作为VL中心 在印度朝着疾病目标迈进的过程中解决知识差距的卓越 消除；(2)发现促进疾病的环境和昆虫学因素 在种群中的持久性；(3)发现决定人类免疫因素是否 感染者会出现无症状或有症状的结局；(4)改变HDSS 转化为前瞻性计划，为未来疾病暴发、治疗或 地方性传染病的免疫预防。 研究团队包括一个由多学科研究人员组成的小组，他们分享了培训 下一代印度VL专家。这个团队组成了一支强大的团队，能够打动我们 以了解这种媒介传播疾病传播的动态变化。

The purpose of this TMRC program is to establish a Center of Excellence focused on understanding all aspects of Visceral Leishmaniasis (VL) due to Leishmania donovani in the current phase of the VL elimination initiative in India, that aims to reduce incidence of clinical disease to a very low level. Many unknowns persist with regard to the feasibility of totally interrupting L. donovani transmission, especially as only 1 out of 10 infections leads to clinical disease. The intent of the scientific group planning this application is to generate a body of knowledge and an investigative team that is ready for any resurgence of the disease, possibly in new endemic areas of the country. We propose three research projects focused on the parameters of transmission and persistence of L.donovani in India. Project 1 will use methods established in prior funding periods for surveillance and monitoring of VL, and use global metabolomics profiling to identify biomarkers of asymptomatic infection, and put this in the context of the gut microbiome and co-infection with other NTDs as risks for progression to VL. Project 2 will monitor the emergence of insecticide resistant populations of Phlebotomus argentipes, the sand fly vector for VL, and examine factors underlying vector competence and the transmissibility of L. donovani from human or animal reservoirs. Project 3 will examine immune factors underlying and contrasting symptomatic VL versus asymptomatic L. donovani infection, both systemically and localized in the skin. The Health and Demographic Surveillance System (HDSS) that was initiated in the current funding period will monitor the demographics and health status of selected populations in Bihar State. Thus, the program will comprehensively examine the extrinsic and intrinsic host factors that underlie the maintenance and continued transmission of VL in Bihar State, India. Aims of the TMRC program are: (1) To maintain and further develop the TMRC as a VL Center of Excellence that addresses knowledge gaps as India progresses toward the goal of disease elimination; (2) To discover environmental and entomological factors that promote disease persistence in the population; (3) To discover human immune factors that determine whether an infected person will develop an asymptomatic or symptomatic outcome; (4) To transform the HDSS into a forward-looking program that is ready for future studies of disease outbreaks, treatment, or immunoprophylaxis of endemic infectious diseases. The research team includes a multi-disciplinary group of investigators sharing the ambition to train the next generation of Indian VL experts. Together the group constitutes a strong team able to move us toward understanding the changing dynamics of transmission of this vector borne disease.