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<br><br><div><div id="SkyDrivePlaceholder"></div><hr id="stopSpelling"><br><div class="ecxgmail_quote">From: <b class="ecxgmail_sendername">ProMED-mail</b> <span dir="ltr"><<a href="mailto:promed@promed.isid.harvard.edu">promed@promed.isid.harvard.edu</a>></span><br>
Date: 2011/11/11<br>Subject: PRO/AH/EDR> Leishmaniasis, visceral - South Sudan (JO, UN)<br>To: <a href="mailto:promed-ahead-edr@promedmail.org">promed-ahead-edr@promedmail.org</a><br><br><br>LEISHMANIASIS, VISCERAL - SOUTH SUDAN (JONGLEI, UPPER NILE)<br>
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A ProMED-mail post<br>
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<br>
Date: Thu 10 Nov 2011<br>
Source: NaTHNaC [edited]<br>
<<a href="http://www.nathnac.org/pro/clinical_updates/leishmaniasis_ssudan_041111.htm" target="_blank">http://www.nathnac.org/pro/clinical_updates/leishmaniasis_ssudan_041111.htm</a>><br>
<br>
<br>
Visceral leishmaniasis in the Republic of South Sudan<br>
-----------------------------------------------------<br>
In September 2009, an outbreak of visceral leishmaniasis was reported<br>
in the states of Upper Nile and Jonglei which are now part of the<br>
newly formed country of the Republic of South Sudan. Since this time<br>
the outbreak has continued with increased numbers of cases and has<br>
spread to the states of Eastern Equatoria and Unity [1].<br>
<br>
As of 28 October 2011, more than 18 000 cases and 720 deaths have been<br>
reported since the outbreak began. A total of 7827 cases have been<br>
reported in 2011 which is an increase over 2010 case numbers [1,2].<br>
<br>
The World Health Organization (WHO) estimates that the number of<br>
deaths is likely to be under-reported due to the lack of a cohesive<br>
infrastructure and the prevalence of remote communities [2]. This is<br>
further complicated by thousands of people returning from northern<br>
Sudan to settle in endemic areas of the Republic of South Sudan.<br>
Insecurity in the affected states restricts access to health care and<br>
treatment, and malnutrition, poor housing, mosquito net shortages, and<br>
environmental changes escalate the problem [1]. There is concern that<br>
thousands of lives will be at risk during the peak transmission season<br>
through December [1].<br>
<br>
WHO is supporting the Republic of South Sudan's health authorities<br>
through provision of drugs, laboratory diagnosis, training of health<br>
staff, and by developing an integrated management strategy to guide<br>
vector control [1].<br>
<br>
In order to ensure that treatment sites receive essential supplies<br>
during the rainy season, when roads are impassable, boats are being<br>
made available to facilitate movement of medical supplies [1].<br>
<br>
Visceral leishmaniasis<br>
----------------------<br>
Visceral leishmaniasis is caused by parasitic protozoa of the genus<br>
Leishmania. The parasite is transmitted via the bite of infected<br>
sandflies. In advanced infection, symptoms include: fever, weight<br>
loss, enlargement of the liver and spleen, anaemia if not treated.<br>
Visceral leishmaniasis has a mortality rate of 95 percent [1].<br>
<br>
Advice for travelers<br>
---------------------<br>
Travelers to and persons returning to live in the Republic of South<br>
Sudan should follow good insect bite avoidance, particularly between<br>
dusk and dawn. Sandflies are small enough to pass through standard<br>
mosquito nets. However, mosquito nets impregnated with permethrin are<br>
usually effective. There no vaccine against any type of<br>
leishmaniasis.<br>
<br>
References<br>
----------<br>
1. World Health Organization Republic of South Sudan. Thousands of<br>
South Sudan people suffer from kala azar epidemic as cases rise. World<br>
Health Organization 28 October 2011. [Accessed 4 November 2011].<br>
Available at:<br>
<<a href="http://www.who.int/hac/crises/sdn/releases/28october2011/en/" target="_blank">http://www.who.int/hac/crises/sdn/releases/28october2011/en/</a>><br>
2. United Nations News Centre. Deadly outbreak of kala-azar continues<br>
in South Sudan, UN agency says. 28 October 2010, [Accessed 4 November<br>
2011]. Available at:<br>
<<a href="http://www.un.org/apps/news/story.asp?NewsID=40232&Cr=South+Sudan&Cr1" target="_blank">http://www.un.org/apps/news/story.asp?NewsID=40232&Cr=South+Sudan&Cr1</a>><br>
<br>
--<br>
Communicated by:<br>
ProMED-mail from HealthMap alerts<br>
<<a href="mailto:promed@promedmail.org">promed@promedmail.org</a>><br>
<br>
[Sudan, including Southern Sudan, is endemic of leishmaniasis.<br>
Leishmaniasis is spread by sandflies. The main reservoir is dogs and<br>
the main vectors are _Phlebotomus papatasi_ and _P. orientalis_<br>
(Dereure J et al. Visceral leishmaniasis in eastern Sudan: parasite<br>
identification in humans and dogs; host-parasite relationships.<br>
Microbes Infect. 2003;5:1103-8).<br>
<br>
Leishmaniasis is a chronic infection with a high mortality in<br>
untreated cases. Malnutrition is a main contributing factor to<br>
clinical disease. Leishmaniasis is also a HIV related disease, but HIV<br>
infection rates are low in South Sudan (Rai RK et al. Prioritizing<br>
Maternal and Child Health in Independent South Sudan. Matern Child<br>
Health J. 2011 Sep 30. [Epub ahead of print]). HealthMap location:<br>
<<a href="http://healthmap.org/r/1qzq" target="_blank">http://healthmap.org/r/1qzq</a>> - Mod.EP]<br>
<br>
[see also:<br>
2009<br>
----<br>
Leishmaniasis - Sudan: (southern) : 20091107.3851<br>
2003<br>
----<br>
Leishmaniasis - Sudan (03) 20031228.3152<br>
2002<br>
----<br>
Leishmaniasis - Sudan (02) 20021117.5835<br>
Leishmaniasis - Sudan 20021110.5767<br>
Early warning network (EWARN) - Sudan (south) 20020126.3399<br>
2000<br>
----<br>
Leishmaniasis, visceral - Kenya (Wajir) 20000625.1048<br>
Leishmaniasis, visceral - Kenya (Wajir) (02) 20000626.1053<br>
Leishmaniasis, visceral - Kenya (Wajir) (03) 20000705.1113<br>
Leishmaniasis, visceral - Kenya (Wajir) (04) 20000714.1165<br>
Leishmaniasis, visceral - Kenya (Wajir) (05) 20000825.1421<br>
Leishmaniasis, visceral - Kenya (Wajir) (06) 20000828.1439<br>
1997<br>
----<br>
Leishmania/HIV co-infections 19970222.0427]<br>
.................................................sb/ep/dk<br>
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