[leish-l] LEISHMANIASIS - INDIA (BIHAR)

[Richard Ashford]

Perhaps the most interesting aspect of the Times of India article is the 
timing.  Just why should it have appeared at this time?

In reality, there has been a continual incidence of kala azar in North 
Bihar since at least 1980, including Vaishali district.  The numbers of 
reported cases have fluctuated greatly but since a large proportion of 
cases are treated privately and not reported it is hard to know whether the 
fluctuation has anything to do with actual numbers.

There is in place, officially, a plan to eliminate kala azar in the near 
future.

It is important to distinguish true kala azar from the situation in 
northwest India and Pakistan, where the parasite is L. infantum and there 
is a dog-based reservoir of infection.  The increasing resistance of kala 
azar to SAG is an excellent indication that there is little if any 
non-anthroponotic transmission.

Dick Ashford

--On 27 May 2004 06:43 +0200 "Fred R. Opperdoes" <opperdoes at bchm.ucl.ac.be> 
wrote:

> Date: Wed, 26 May 2004 18:36:49 -0400 (EDT)
> From: ProMED-mail <promed at promed.isid.harvard.edu>
> Subject: PRO/EDR> Leishmaniasis - India (Bihar) (02)
>
> LEISHMANIASIS - INDIA (BIHAR) (02)
> **********************
> A ProMED-mail post
> <http://www.promedmail.org>
> ProMED-mail, a program of the
> International Society for Infectious Diseases
> <http://www.isid.org>
>
> Date: 26 May 2004
> From: ProMED-mail <promed at promedmail.org>
> Source: Times of India 25 May 2004 [edited]
> <http://timesofindia.indiatimes.com/cms.dll/articleshow?msid=697940>
>
>
> Bihar rural areas in grip of kala-azar (visceral leishmaniasis)
> - ---------------
> The entire rural area of Vaishali district has been suffering from the
> deadly kala-azar disease for the last 2 months, and more than a dozen
> villagers including children have died.
>
> However, according to official figures, only 3 persons have died of
> kala-azar, while 298 are still affected in different areas. Officially, it
> was admitted that as many as 157 patients with kala-azar were provided
> medical treatment, while 138 patients are still undergoing treatment at
> different primary health centres in the district.
>
> Reports reaching the district headquarters from different blocks present
> an alarming picture. Sources said that Mahua, Raghopur, Mahnar, Lalganj,
> Goraul, Sahdeibujurag, Vaishali, Bidupur and Jandaha blocks are badly in
> the grip of the kala-azar epidemic. This was confirmed officially as well.
>
> Since 1989, Vaishali district has been gripped by kala-azar, but no
> concrete measures have been undertaken to eliminate the sand-fly, which is
> the carrier of the disease. The most stirring fact is that kala-azar
> [affects] 2 to 3 persons daily on an average in different affected areas,
> but health officials have not confirmed [this figure]. The medicine for
> kala-azar, sodium antimony, is not available at primary health centres,
> which officials deny. According to health officials, the chief malaria
> officer had provided 300 vials of kala-azar medicine on 26 Feb 2004, but
> it fell short of demand. There has been a shortage of the life-saving
> drug for kala-azar since 5 May 2004 in the district.
>
> During the current financial year, INR 3 million [approx. USD 66 000] was
> provided to the department concerned but was returned unused. In 2003, INR
> 11 66 260 [approx. USD 26 000] was received for kala-azar elimination, but
> only INR 75 643 [USD 1670] could be utilised, said official sources. The
> scarcity of DDT has also added to the kala-azar menace. The district
> magistrate H R Srinivas said he was personally monitoring the situation
> and preventive steps were being taken.
>
> [Byline: Rajesh K Thakur]
>
> - --
> ProMED-mail
> <promed at promedmail.org>
>
> [ProMED has previously published on the apparent increase in visceral
> leishmaniasis in Bihar State, and readers are referred to our comment of
> 27 Jan 2004 on possible reservoirs and vectors [Leishmaniasis - Pakistan
> (Sind) (02) 20040127.0324]. There is little doubt that there is an
> increasing number of cases, and we would appreciate a comment from the
> health authorities on the situation. - Mod.EP]
>
> [see also:
> Leishmaniasis - Pakistan & India: background   20040201.0392
> Leishmaniasis - Pakistan (Sind) (02) 20040127.0324
> Leishmaniasis - India (Andhra Pradesh) 20040124.0288
> Leishmaniasis - India (Bihar) 20040114.0156
> 2002
> - ----
> Leishmania - Pakistan ex Afghanistan 20020213.3556
> Leishmaniasis - Afghanistan (03) 20020515.4212
> 2000
> - ----
> Leishmaniasis - India (Calcutta) (02) 20001026.1858
> Leishmaniasis - Nepal (02) 20000731.1266
> 1998
> - ----
> Kala-azar - Nepal 19980425.0781
> 1997
> - ----
> Leishmaniasis - Nepal (02) 19970927.2042]
> ...................mpp/ep/pg/mpp
>
>
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R.W. Ashford
Consultant Biologist
Professor (Retired) of Parasite and Vector Biology
c/o Liverpool School of Tropical Medicine
Liverpool L3 5QA
Tel: +44 151 632 2714
Fax: +44 151 705 3371
e-mail: ashford at liv.ac.uk