WHO's Leishmaniasis Press Release

[hartlg at who.ch]

     Press Release WHO/24
     13 February 1998
     
     
     DRAMATIC UPSURGE IN VISCERAL LEISHMANIASIS CASES IN THE HORN OF AFRICA
     
     
        There has been a dramatic upsurge in cases of visceral 
     leishmaniasis (VL) in Ethiopia, Eritrea and Sudan in the last months 
     of 1997 and the beginning of 1998. 
     
        In Sudan, over 2 500 confirmed cases were registered in one 
     treatment centre in Gedaref State (eastern Sudan) from October to 
     December 1997, out of a total of 4 400 cases registered for the whole 
     of 1997 in the same treatment centre which is run by Medecins sans 
     Frontieres (MSF) Holland. This represents an increase of 439% compared 
     to the same period in 1996. Eritrea and Ethiopia have also reported a 
     sharp increase in cases during 1997, and the Tigray health bureau (in 
     Ethiopia) has issued an urgent request to the World Health 
     Organization (WHO) for serological facilities and drugs.
     
        "Visceral leishmaniasis has become an emergency health problem in 
     Eritrea, Ethiopia and Sudan, where it has been endemic for years. The 
     high mortality rate in this outbreak is mainly due to the absence of 
     diagnostic facilities and the non-availability of first-line drugs at 
     local level," said Dr Ralph Henderson, Assistant Director-General of 
     WHO.
     
        In the absence of treatment, the mortality rate is close to 100% 
     from the disease in these areas, while, with treatment, it is normally 
     under 10% (with deaths mainly due to associated diseases).
     
        The current outbreak is also being exacerbated by the massive 
     population migration among these three countries (due to the 
     traditional seasonal migration of workers and the resettlement of 
     returnees and refugees in highly endemic areas). Although a simple 
     diagnostic test and an effective first-line, specific treatment exist, 
     these are not available for the majority of people suffering from the 
     disease. In this area of Africa, approximately 65% of VL cases are 
     found in children less than 15 years old. Malnourished children, who 
     often suffer simultaneously from associated diseases such as 
     tuberculosis, respiratory and/or intestinal infections, are 
     particularly vulnerable.
     
        The Ministry of Health of Sudan has requested the urgent assistance 
     of WHO in combatting this disease. Although MSF Holland have been 
     active in addressing the outbreak in Sudan, stocks of the first-line 
     drugs (Pentavalent antimonials) risk being exhausted soon. WHO's 
     Divisions of Control of Tropical Diseases (CTD), Emergency and 
     Humanitarian Assistance (EHA), and Emerging and other Communicable 
     Diseases Surveillance and Control (EMC), in coordination with the 
     corresponding WHO Regional and Country Offices, and MSF Holland, are 
     working together to launch an immediate response to this multi-country 
     epidemic emergency. The response will include the establishment of 
     diagnostic facilities in decentralized laboratories and remote areas, 
     the provision of first-line drugs, and distribution of 
     insecticide-impregnated bednets.
     
        The leishmaniases are a widespread group of parasitic diseases, 
     transmitted by the female phlebotomine sandfly, and have a broad range 
     of clinical manifestations. VL, also known as kala azar, is the most 
     severe form of the disease, with an almost 100% mortality rate if left 
     untreated. It is characterized by irregular bouts of fever, 
     substantial weight loss, swelling of the spleen and liver, and 
     anaemia.
     
        Leishmaniases are now endemic in 88 countries on five continents - 
     Africa, Asia, Europe, North America and South America - with a total 
     of 350 million people at risk. Five-hundred thousand new cases of VL 
     occur every year. Currently, it is believed that 12 million cases of 
     all forms of the disease exist worldwide. Only approximately one-third 
     of new cases are ever officially declared.