[leish-l] Leishmaniasis in Afghanistan - Update

[Fred R. Opperdoes]

LEISHMANIASIS - AFGHANISTAN (06)
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Date: 28 Jun 2002
From: ProMED-mail <promed at promedmail.org>
Source: World Health Organization (WHO)
(http://www.who.int/disease-outbreak-news/)


Leishmaniasis in Afghanistan - Update
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PRESS RELEASE ISSUED BY WHO 28 JUNE 2002
AFGHANISTAN: WHO APPEALS FOR US$ 1.2 MILLION TO
TACKLE LARGEST SINGLE EPIDEMIC OF DISFIGURING DISEASE

Relatively small investment by international community could prevent misery
for 200 000 in Kabul alone

Displaced people and international staff most at risk

Largest single outbreak of the disease in the world

Decades of civil war in Afghanistan have not only destroyed much of the
country's infrastructure. Neglected but treatable diseases have taken hold
throughout this long history of conflict and defeated the efforts of doctors
and clinics to bring them under control.

One of the most serious examples is a disfiguring disease known by various
names including Kandahar sore (scientific name: cutaneous leishmaniasis).
This is a condition caused by a parasite transmitted by insect bites, that
leads to disfiguring facial injuries and long-term disability. As a result,
those affected are often stigmatized.

Women and children are particularly affected and in some cases women may be
treated as outcasts by their communities. In some areas, the disease is so
widespread that it is known as "Little Sister" because it is almost a part
of the family. But in Kabul today there is an opportunity to bring it under
control and end the suffering endured by so many people.

Two hundred thousand people are believed to be infected with this parasite
in Kabul alone. Due to their lower levels of resistance to the disease,
returning refugees and other displaced persons in Kabul are at higher risk
of infection. International staff working in Afghanistan also face a
substantially higher risk.

The World Health Organization, together with the government of Afghanistan
and a number of international NGOs, is launching an urgent appeal for funds
to bring this serious outbreak under control. This is one case where a
remarkably small amount of money could make an enormous difference.

"A little over one million [U.S.] dollars is all we need to fund a 2-year
programme that would have a huge, long-term impact on this disfiguring
disease once and for all," said Dr Gro Harlem Brundtland, Director-General
of the WHO.  "But we need to act now: if this opportunity is missed, there
will be a severe increase in the number of cases next year."

It is vital that this emergency response is launched as soon as possible.
Because this form of leishmaniasis is passed from person to person via the
bite of a sandfly, the infection can spread rapidly in a concentrated
population, particularly among the poor. The sandflies breed quickly in
unsanitary conditions.  After biting an infected person, the sandflies
spread the disease each time they bite.

Transmission occurs from May to October, but new cases may not emerge for
another several months because of the long incubation period of the disease.
However, it is vital to interrupt transmission in order to avoid a sharp
increase in the number of cases over the next year. A rapid response now
also allows a long-term control plan to be put in place, to prevent this
disease from taking an even stronger hold in Afghanistan.

The WHO emergency plan involves a rapid intervention combining preventive
and curative measures with drugs for mass treatment, insecticide impregnated
bednets for individual protection, social mobilization, and health education
to ensure that this disabling disease of poverty can be brought under
control.

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