Kala Azar elimination deadline sees red again in India

The disease is endemic to Bihar and Jharkhand currently

New Delhi, July 26, 2018: India has missed the 2017 deadline for elimination of Kala Azar (black fever) as announced by the finance minister in his Budget speech last year. The endemic blocks have increased from 61 to 68 in 17 districts of Bihar and Jharkhand. Further, a little-known skin condition called Post Kala Azar Dermal Leishmaniasis (PKDL) — a red flag for transmission of KA — has been growing steadily over the past few years.

Visceral leishmaniasis (VL), also known as Kala Azar, is a worldwide protozoal vector-borne disease, endemic in 76 countries. The annual incidence is estimated to be 250,000 to 300,000 cases, with over 90 per cent of those cases occurring in India, Bangladesh, Sudan, South Sudan, Ethiopia and Brazil, where it often affects the poorest populations in those countries. Leishmaniasis can be contracted from the bite of an infected sand fly.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “Kala-azar is a slow progressing indigenous disease caused by a protozoan parasite of genus Leishmania. In India, Leishmania donovani is the only parasite causing this disease and it primarily infects reticuloendothelial system. It may also be found in abundance in the bone marrow, spleen and liver.Post Kala-azar Dermal Leishmaniasis (PKDL) is a condition when Leishmania donovaniinvades skin cells, resides and develops there and manifests as dermal lesions. Some of the kalaazar cases manifest as PKDL after a few years of treatment. Recently, it is believed that PKDL may appear without passing through visceral stage. However, adequate data is yet to be generated on the course of PKDL manifestation.”

Initially, leishmania parasites cause skin sores or ulcers at the site of sand fly bites. Once the disease progresses, it attacks the immune system. Kala azar presents after two to eight months, with more generalized symptoms including prolonged fever and weakness.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, “India’s first target for the elimination of kala azar was set for 2010, then 2015 and later 2017. The development and use of a liposomal amphotericin drug in 2014 became something of a “game changer”. When administered intravenously, the drug can cure the disease in a day. While the drug has made a big difference in controlling infection, social conditions like poverty and neglect that help the disease spread remain.”

Some tips from HCFI

• Wear clothing that covers as much skin as possible. Long pants, long-sleeved shirts tucked into pants, and high socks are recommended.
• Use insect repellent on any exposed skin and on the ends of your pants and sleeves. The most effective insect repellants contain DEET.
• Spray indoor sleeping areas with insecticide.
• Sleep on the higher floors of a building. The insects are poor fliers.
• Avoid the outdoors between dusk and dawn. This is when sand flies are most active.
• Use screens and air conditioning indoors when possible. Using fans might make it more difficult for the insects to fly.
• Use a bed net tucked into your mattress. Sand flies are much smaller than mosquitos, so you need a tightly woven net. Spray the net with insecticide containing pyrethroid if possible.