Spatio-temporal relative risks and priority areas for visceral leishmaniasis control in Brazil, between 2001 and 2020.

Visceral leishmaniasis (VL) is a pressing public health problem in Brazil. The proper implementation of disease control programs in priority areas is a challenge for healthcare managers. The present study aimed to analyze the spatio-temporal distribution and identify high risk areas of VL occurrence in the Brazilian territory. We analyzed data regarding new cases with confirmed diagnosis of VL in Brazilian municipalities, from 2001 to 2020, extracted from the Brazilian Information System for Notifiable Diseases. The Local Index of Spatial Autocorrelation (LISA) was used to identify contiguous areas with high incidence rates in different periods of the temporal series. Clusters of high spatio-temporal relative risks were identified using the scan statistics. The accumulated incidence rate in the analyzed period was 33.53 cases per 100,000 inhabitants. The number of municipalities that reported cases showed an upward trend from 2001 onward, although there was a decrease in 2019 and 2020. According to LISA, the number of municipalities considered a priority increased in Brazil and in most states. Priority municipalities were predominantly concentrated in the states of Tocantins, Maranhão, Piauí, and Mato Grosso do Sul, in addition to more specific areas of Pará, Ceará, Piauí, Alagoas, Pernambuco, Bahia, São Paulo, Minas Gerais, and Roraima. The spatio-temporal clusters of high-risk areas varied throughout the time series and were relatively higher in the North and Northeast regions. Recent high-risk areas were found in Roraima and municipalities in northeastern states. VL expanded territorially in Brazil in the 21st century. However, there is still a considerable spatial concentration of cases. The areas identified in the present study should be prioritized for disease control actions.

Immunoprophylaxis using polypeptide chimera vaccines plus adjuvant system promote Th1 response controlling the spleen parasitism in hamster model of visceral leishmaniasis.

In recent years, several advances have been observed in vaccinology especially for neglected tropical diseases (NTDs). One of the tools employed is epitope prediction by immunoinformatic approaches that reduce the time and cost to develop a vaccine. In this scenario, immunoinformatics is being more often used to develop vaccines for NTDs, in particular visceral leishmaniasis (VL) which is proven not to have an effective vaccine yet. Based on that, in a previous study, two predicted T-cell multi-epitope chimera vaccines were experimentally validated in BALB/c mice to evaluate the immunogenicity, central and effector memory and protection against VL. Considering the results obtained in the mouse model, we assessed the immune response of these chimeras inMesocricetus auratushamster, which displays, experimentally, similar pathological status to human and dog VL disease. Our findings indicate that both chimeras lead to a dominant Th1 response profile, inducing a strong cellular response by increasing the production of IFN-γ and TNF-α cytokines associated with a decrease in IL-10. Also, the chimeras reduced the spleen parasite load and the weight a correlation between protector immunological mechanisms and consistent reduction of the parasitic load was observed. Our results demonstrate that both chimeras were immunogenic and corroborate with findings in the mouse model. Therefore, we reinforce the use of the hamster as a pre-clinical model in vaccination trials for canine and human VL and the importance of immunoinformatic to identify epitopes to design vaccines for this important neglected disease.

Digital strategies for health education on leishmaniasis / Estrategias digitales de educación en salud sobre leishmaniasis

La leishmaniasis es una enfermedad desatendida y endémica en localidades remotas de Perú, y existe evidencia de un alto índice de inexperiencia por parte del personal de salud que labora en zonas endémicas; asociada al diagnóstico, tratamiento y desconocimiento de protocolos nacionales e internacionales respecto a la enfermedad; lo que se traduce en un incremento de eventos adversos o una cura incompleta para los pacientes. Por otro lado, la pandemia por COVID-19, ha originado interrupción en los sistemas educativos, estimulando la aplicación de enfoques educativos a distancia. Se elaboró un programa académico de educación superior bajo la modalidad virtual, dirigido a profesionales sanitarios que laboran en áreas de riesgo o endémicas de leishmania, en el marco del eLearning, empleando tecnologías de información y comunicación (TIC) como herramientas para el aprendizaje; y se aplicó la metodología MEDESME en la planificación de herramientas digitales educativas. El producto incluyó la ficha académica del programa "leishmaniasis tegumentaria y visceral", diversos recursos de autoaprendizaje y estrategias de evaluación digitales. La aplicación del programa educativo permitiría capacitar y actualizar conocimientos a los profesionales de la salud y, en consecuencia, optimizar el diagnóstico, tratamiento y seguimiento de los pacientes afectados por las distintas manifestaciones de la leishmaniasis(AU)

Leishmaniasis is a neglected and endemic disease in remote locations in Peru, and there is evidence of a high rate of inexperience on the part of health personnel working in endemic areas; associated with the diagnosis, treatment and ignorance of national and international protocols regarding the disease; which translates into an increase in adverse events or an incomplete cure for patients. On the other hand, the COVID-19 pandemic has caused disruption in educational systems, stimulating the application of distance educational approaches. An academic program of higher education was developed under the virtual modality, aimed at health professionals who work in risky or endemic areas of leishmania, within the framework of eLearning, using information and communication technologies (ICT) as tools for learning; and the MEDESME methodology was applied in the planning of educational digital tools. The product included the academic record of the program "integumentary and visceral leishmaniasis", various self-study resources and digital assessment strategies. The application of the educational program would allow health professionals to be trained and updated and, consequently, to optimize the diagnosis, treatment and follow-up of patients affected by the different manifestations of leishmaniasis(AU)

Impact of IRS: Four-years of entomological surveillance of the Indian Visceral Leishmaniases elimination programme.

BACKGROUND: In 2005, Bangladesh, India and Nepal agreed to eliminate visceral leishmaniasis (VL) as a public health problem. The approach to this was through improved case detection and treatment, and controlling transmission by the sand fly vector Phlebotomus argentipes, with indoor residual spraying (IRS) of insecticide. Initially, India applied DDT with stirrup pumps for IRS, however, this did not reduce transmission. After 2015 onwards, the pyrethroid alpha-cypermethrin was applied with compression pumps, and entomological surveillance was initiated in 2016. METHODS: Eight sentinel sites were established in the Indian states of Bihar, Jharkhand and West Bengal. IRS coverage was monitored by household survey, quality of insecticide application was measured by HPLC, presence and abundance of the VL vector was monitored by CDC light traps, insecticide resistance was measured with WHO diagnostic assays and case incidence was determined from the VL case register KAMIS. RESULTS: Complete treatment of houses with IRS increased across all sites from 57% in 2016 to 70% of houses in 2019, rising to >80% if partial house IRS coverage is included (except West Bengal). The quality of insecticide application has improved compared to previous studies, average doses of insecticide on filters papers ranged from 1.52 times the target dose of 25mg/m2 alpha-cypermethrin in 2019 to 1.67 times in 2018. Resistance to DDT has continued to increase, but the vector was not resistant to carbamates, organophosphates or pyrethroids. The annual and seasonal abundance of P. argentipes declined between 2016 to 2019 with an overall infection rate of 0.03%. This was associated with a decline in VL incidence for the blocks represented by the sentinel sites from 1.16 per 10,000 population in 2016 to 0.51 per 10,000 in 2019. CONCLUSION: Through effective case detection and management reducing the infection reservoirs for P. argentipes in the human population combined with IRS keeping P. argentipes abundance and infectivity low has reduced VL transmission. This combination of effective case management and vector control has now brought India within reach of the VL elimination targets.

Modelling the impact of COVID-19-related programme interruptions on visceral leishmaniasis in India.

BACKGROUND: In March 2020, India declared a nationwide lockdown to control the spread of coronavirus disease 2019. As a result, control efforts against visceral leishmaniasis (VL) were interrupted. METHODS: Using an established age-structured deterministic VL transmission model, we predicted the impact of a 6- to 24-month programme interruption on the timeline towards achieving the VL elimination target as well as on the increase of VL cases. We also explored the potential impact of a mitigation strategy after the interruption. RESULTS: Delays towards the elimination target are estimated to range between 0 and 9 y. Highly endemic settings where control efforts have been ongoing for 5-8 y are most affected by an interruption, for which we identified a mitigation strategy to be most relevant. However, more importantly, all settings can expect an increase in the number of VL cases. This increase is substantial even for settings with a limited expected delay in achieving the elimination target. CONCLUSIONS: Besides implementing mitigation strategies, it is of great importance to try and keep the duration of the interruption as short as possible to prevent new individuals from becoming infected with VL and continue the efforts towards VL elimination as a public health problem in India.