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Understanding the transmission dynamics of Leishmania donovani to provide robust evidence for interventions to eliminate visceral leishmaniasis in Bihar, India


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Cameron, Mary M., Acosta Serrano, Alvaro ORCID:, Bern, Caryn, Boelaert, Marleen, den Boer, Margriet, Burza, Sakib, Chapman, Lloyd A. C., Chaskopoulou, Alexandra, Coleman, Michael ORCID:, Courtenay, Orin, Croft, Simon, Das, Pradeep, Dilger, Erin, Foster, Geraldine ORCID:, Garlapati, Rajesh, Haines, Lee ORCID:, Harris, Angela, Hemingway, Janet ORCID:, Hollingsworth, T. Déirdre, Jervis, Sarah, Medley, Graham, Miles, Michael, Paine, Mark ORCID:, Picado, Albert, Poché, Richard, Ready, Paul, Rogers, Matthew, Rowland, Mark, Sundar, Shyam, de Vlas, Sake J. and Weetman, David ORCID: (2016) 'Understanding the transmission dynamics of Leishmania donovani to provide robust evidence for interventions to eliminate visceral leishmaniasis in Bihar, India'. Parasites & Vectors, Vol 9, Issue 1.

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Visceral Leishmaniasis (VL) is a neglected vector-borne disease. In India, it is transmitted to humans by Leishmania
donovani-infected Phlebotomus argentipes sand flies. In 2005, VL was targeted for elimination by the governments of India,
Nepal and Bangladesh by 2015. The elimination strategy consists of rapid case detection, treatment of VL cases and
vector control using indoor residual spraying (IRS). However, to achieve sustained elimination of VL, an appropriate post
elimination surveillance programme should be designed, and crucial knowledge gaps in vector bionomics, human
infection and transmission need to be addressed. This review examines the outstanding knowledge gaps, specifically in
the context of Bihar State, India.
The knowledge gaps in vector bionomics that will be of immediate benefit to current control operations include better
estimates of human biting rates and natural infection rates of P. argentipes, with L. donovani, and how these vary spatially,
temporally and in response to IRS. The relative importance of indoor and outdoor transmission, and how P. argentipes
disperse, are also unknown. With respect to human transmission it is important to use a range of diagnostic tools to
distinguish individuals in endemic communities into those who: 1) are to going to progress to clinical VL, 2) are immune/
refractory to infection and 3) have had past exposure to sand flies.
It is crucial to keep in mind that close to elimination, and post-elimination, VL cases will become infrequent, so it is vital to
define what the surveillance programme should target and how it should be designed to prevent resurgence. Therefore,
a better understanding of the transmission dynamics of VL, in particular of how rates of infection in humans and sand
flies vary as functions of each other, is required to guide VL elimination efforts and ensure sustained elimination in the
Indian subcontinent. By collecting contemporary entomological and human data in the same geographical locations,
more precise epidemiological models can be produced. The suite of data collected can also be used to inform the
national programme if supplementary vector control tools, in addition to IRS, are required to address the issues of people
sleeping outside

Item Type: Article
Subjects: QX Parasitology > Protozoa > QX 70 Mastigophora. (e.g., Giardia. Trichomonas. Trypanosoma. Leishmania)
WA Public Health > Preventive Medicine > WA 110 Prevention and control of communicable diseases. Transmission of infectious diseases
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 715 Visceral leishmaniasis
Faculty: Department: Biological Sciences > Vector Biology Department
Biological Sciences > Department of Tropical Disease Biology
Digital Object Identifer (DOI):
Depositing User: Samantha Sheldrake
Date Deposited: 28 Jan 2016 14:55
Last Modified: 27 Sep 2019 15:29


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