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Rocha R, Conceição C, Gonçalves L, Maia C. Knowledge and practices regarding leishmaniasis in Portugal - Comparison between blood donors and health students/professionals. One Health 2024; 18:100697. [PMID: 38463613 PMCID: PMC10924195 DOI: 10.1016/j.onehlt.2024.100697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/27/2024] [Indexed: 03/12/2024] Open
Abstract
Objective To compare the current knowledge and practices regarding leishmaniasis among blood donors and health students and professionals, in Portugal. Material and methods Data were collected through the application of two questionnaires (one online and one in paper) with similar questions in two distinct cross-sectional independent studies, each targeting one of the groups. Descriptive statistics and hypothesis testing were performed using IBM® SPSS® Statistics. Results In total, 3763 blood donors, 254 students and 232 professionals were included in the comparative analysis. Over 95% of students and professionals, but only around 70% of blood donors had previously heard of leishmaniasis. Over 90% of participants in each group admitted leishmaniasis affected animals, but only in the professional group over 90% were aware of human leishmaniasis. Conclusions Even though canine leishmaniasis is recognized by many blood donors and by most students and professionals, awareness of the disease in humans is less common, highlighting the importance of promoting an approach to this infection through a One Health lens.
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Affiliation(s)
- Rafael Rocha
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira N°100, 1349-008 Lisboa, Portugal
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, IHMT, UNL, Rua da Junqueira N°100, Lisboa 1349-008, Portugal
| | - Cláudia Conceição
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira N°100, 1349-008 Lisboa, Portugal
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, IHMT, UNL, Rua da Junqueira N°100, Lisboa 1349-008, Portugal
| | - Luzia Gonçalves
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira N°100, 1349-008 Lisboa, Portugal
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, IHMT, UNL, Rua da Junqueira N°100, Lisboa 1349-008, Portugal
- Centro de Estatística e Aplicações da Universidade de Lisboa, Faculdade de Ciências da Universidade de Lisboa, Campo Grande, Lisboa 1749-016, Portugal
- Z-Stat4life, Espaço Cowork Baldaya, Palácio Baldaya, Estrada de Benfica N° 701ª, Lisboa 1549-011, Portugal
| | - Carla Maia
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira N°100, 1349-008 Lisboa, Portugal
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, IHMT, UNL, Rua da Junqueira N°100, Lisboa 1349-008, Portugal
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Rocha R, Conceição C, Gonçalves L, Maia C. Knowledge, perceptions and practices of health students and professionals regarding leishmaniasis in Portugal: a cross-sectional study. Parasit Vectors 2023; 16:381. [PMID: 37880779 PMCID: PMC10598964 DOI: 10.1186/s13071-023-05982-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/24/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Control of leishmaniasis in the Mediterranean Basin relies on the active contributions from researchers in the fields of animal, human and environmental health. The application of knowledge, perceptions and practices (KPP) questionnaires to health students and professionals in Europe could be fundamental to identify and explore gaps in KPP, highlighting the diversity of conceptions related to this disease between students and professionals active in (One) Health. The objective of this study was to characterize and compare the current knowledge, perceptions and practices regarding leishmaniasis among subgroups of students and health professionals in Portugal through the application of an online questionnaire. METHODS A cross-sectional study targeted the population of health students and professionals in Portugal, including students in medicine, veterinary medicine and environmental health, physicians, veterinarians and environmental health technicians. Potential participants were approached by email via universities and professional societies and organizations and provided with the link to access the online questionnaire. Answers to the self-administered sociodemographic and KPP questionnaire were collected between July and December 2022. Individual KPP scores were calculated by summing grades defined for each question. Logistic regression models were used to search for potential associations, and the results were expressed at estimated crude and adjusted odds ratios with 95% confidence intervals. RESULTS In total, 486 participants were included in this study: 254 students and 232 professionals. Overall, 75% of the participants reported having heard of both human and animal leishmaniasis, and > 80% reported hearing about the disease during their course work (although this was significantly lower among those in the field of environmental health). Around 90% of participants identified the pathogenic agent as a parasite, and an arthropod bite was identified as the main route of transmission by > 95%. Animal leishmaniasis was considered to be diagnosed in Portugal by 87% of participants and human leishmaniasis by only 69%. The main barriers pointed out by professionals to the control of leishmaniasis were: lack of knowledge in the general population, failures in the early diagnosis and treatment of diseased animals, absence/inefficacy of vector control programs and lack of knowledge in human health professionals. Median knowledge and perception scores were higher among professionals in the animal health field and higher in professionals than in students. Median practice scores were not significantly different between groups and subgroups. The multivariate analysis revealed that a longer period of study (for students) and having seen cases of leishmaniasis (for physicians) were associated with above-mentioned median knowledge score. CONCLUSIONS Most health students and professionals are knowledgeable about the cause and transmission route of leishmaniasis. However, recognition of the disease as autochthonous in humans is less common, highlighting the importance of promoting an approach to this infection through a One-Health lens. A national structured plan to control leishmaniasis could overcome some of the barriers pointed out by professionals, namely by implementing systematic phlebotomine surveillance and integrated reporting of animal and human cases of disease.
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Affiliation(s)
- Rafael Rocha
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Institute of Hygiene and Tropical Medicine (IHMT), NOVA University Lisbon (UNL), Lisbon, Portugal
| | - Cláudia Conceição
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Institute of Hygiene and Tropical Medicine (IHMT), NOVA University Lisbon (UNL), Lisbon, Portugal
| | - Luzia Gonçalves
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Institute of Hygiene and Tropical Medicine (IHMT), NOVA University Lisbon (UNL), Lisbon, Portugal
- Centro de Estatística e Aplicações da Universidade de Lisboa (UL), Lisbon, Portugal
- Z-Stat4life, Lisbon, Portugal
| | - Carla Maia
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal.
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Institute of Hygiene and Tropical Medicine (IHMT), NOVA University Lisbon (UNL), Lisbon, Portugal.
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Rocha R, Gonçalves L, Conceição C, Andrade P, Cristóvão JM, Condeço J, Delgado B, Caeiro C, Kuzmenko T, Vasconcelos E, Escoval MA, Rey C, Guz M, Norte C, Aldeia C, Cruz D, Maia C. Prevalence of asymptomatic Leishmania infection and knowledge, perceptions, and practices in blood donors in mainland Portugal. Parasit Vectors 2023; 16:357. [PMID: 37817278 PMCID: PMC10563231 DOI: 10.1186/s13071-023-05980-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/24/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Asymptomatic infection is the most common outcome of exposure to Leishmania parasites. In the Mediterranean region, where Leishmania infantum is endemic, studies on the prevalence of asymptomatic infection have often relied on serological testing in blood donors. In Spain, regional studies have shown seroprevalence in blood donors between 1 and 8%; in Portugal, values of 0 and 2% were suggested by two localized studies, in different populations. The purpose of this study was (i) to estimate the prevalence of asymptomatic Leishmania infection in blood donors in mainland Portugal, and (ii) to study the association between the detection of antibodies to Leishmania and sociodemographic factors, and also the knowledge, perceptions and practices (KPP) of the blood donors regarding leishmaniasis. METHODS A cross-sectional study targeted the population of people who donated blood in mainland Portugal. Participants, distributed proportionally by municipality and aged between 18 and 65 years, were selected randomly in 347 blood collection points between February and June 2022, and completed a sociodemographic and a KPP questionnaire. Detection of anti-Leishmania antibodies in serum was performed using an ELISA commercial kit. Individual KPP scores were calculated by adding grades defined for each question. RESULTS Globally, 201/3763 samples were positive. The estimated national true seroprevalence was 4.8% (95% CI 4.1-5.5%). The proportion of positive results was significantly different between NUTS (Nomenclature of Territorial Units for Statistics) regions. Models suggested that seropositivity was significantly higher in male sex, people older than 25 years, or residing in the Centro NUTS2 region, but not in dog owners nor people with lower KPP scores. Overall, 72.3% of participants had previously heard of leishmaniasis and, in multivariate analysis, a higher Knowledge score was associated with age 25-40 years, female sex, ownership of dogs, and higher education. CONCLUSIONS Global estimated true seroprevalence (4.8%) was similar to previous regional studies in blood donors in neighboring Spain. Higher seroprevalence values in the NUTS2 Centro region were consistent with incidence data from humans and seroprevalence studies in dogs. On the other hand, the low values in the Alentejo and the high values in the northern subregions may be the result of geographical shifts in parasite circulation due to climate change and should prompt localized and integrated, vector, canine, and human research, following a One Health approach.
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Affiliation(s)
- Rafael Rocha
- Instituto de Higiene E Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, IHMT, UNL, Lisbon, Portugal
| | - Luzia Gonçalves
- Instituto de Higiene E Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, IHMT, UNL, Lisbon, Portugal
- Centro de Estatística E Aplicações da Universidade de Lisboa (UL), Lisbon, Portugal
- , Z-Stat4life, Lisbon, Portugal
| | - Cláudia Conceição
- Instituto de Higiene E Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, IHMT, UNL, Lisbon, Portugal
| | - Patrícia Andrade
- Instituto de Higiene E Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal
| | - José Manuel Cristóvão
- Instituto de Higiene E Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, IHMT, UNL, Lisbon, Portugal
| | - Jorge Condeço
- Instituto Português Do Sangue E da Transplantação, Lisbon, Portugal
| | - Beatriz Delgado
- Instituto Português Do Sangue E da Transplantação, Lisbon, Portugal
| | - Cristina Caeiro
- Instituto Português Do Sangue E da Transplantação, Lisbon, Portugal
| | - Tetyana Kuzmenko
- Instituto Português Do Sangue E da Transplantação, Lisbon, Portugal
| | | | | | - Carmen Rey
- Centro Hospitalar Universitário Do Algarve, Portimão, Portugal
| | - Madalina Guz
- Hospital do Espírito Santo de Évora, Évora, Portugal
| | - Cláudia Norte
- Unidade Local de Saúde Do Baixo Alentejo, Beja, Portugal
| | - Carlos Aldeia
- Unidade Local de Saúde Do Litoral Alentejano, Santiago Do Cacém, Portugal
| | - Diego Cruz
- Unidade Local de Saúde Do Norte Alentejano, Elvas, Portugal
| | - Carla Maia
- Instituto de Higiene E Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal.
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, IHMT, UNL, Lisbon, Portugal.
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Pal B, Kumari S, Kaur M, Wadhwa P, Murti K, Kumar R, Pandey K, Siddiqui NA, Dhingra S, Padmakar S. Barriers to the effective management and prevention of post kala-azar dermal leishmaniasis (PKDL) in the Indian subcontinent. Med J Armed Forces India 2023; 79:500-505. [PMID: 37719909 PMCID: PMC10499647 DOI: 10.1016/j.mjafi.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/26/2023] [Indexed: 09/19/2023] Open
Abstract
Post kala-azar dermal leishmaniasis (PKDL) is a skin disease that usually occurs among individuals with a past history of visceral leishmaniasis (VL). PKDL cases act as a reservoir of parasites and may play a significant role in disease transmission. Hence, prompt detection and complete treatment of PKDL cases are crucial for the control and elimination of VL. The purpose of this review was to highlight the barriers to effective control and prevention of VL/PKDL as well as potential solutions in India. Main obstacles are lack of knowledge about the disease and its vector, poor treatment-seeking behaviours, ineffective vector control measures, lack of confirmatory diagnostics in endemic areas, limited drug choices, treatment noncompliance among patients, drug resistance, and a lack of an adequate number of trained personnel in the health system. Therefore, in order to control and successfully eliminate VL in the Indian subcontinent, early detection of PKDL cases, improved diagnosis and treatment, raising awareness, and effective vector control mechanisms are necessary.
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Affiliation(s)
- Biplab Pal
- Assistant Professor, School of Pharmaceutical Science, Lovely Professional University, Punjab, India
| | - Sweta Kumari
- Assistant Professor, School of Pharmaceutical Science, Lovely Professional University, Punjab, India
| | - Manpreet Kaur
- Student, School of Pharmaceutical Science, Lovely Professional University, Punjab, India
| | - Pankaj Wadhwa
- Associate Professor, School of Pharmaceutical Science, Lovely Professional University, Punjab, India
| | - Krishna Murti
- Assistant Professor (Pharmacy Practice), National Institute of Pharmaceutical Education and Research, Hajipur, Bihar, India
| | - Rishikesh Kumar
- Consultant (Biostatistics), Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, India
| | - Krishna Pandey
- Director, Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, India
| | - Niyamat Ali Siddiqui
- Scientist E, (Biostatistics), Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, India
| | - Sameer Dhingra
- Associate Professor (Pharmacy Practice), National Institute of Pharmaceutical Education and Research, Hajipur, Bihar, India
| | - Somanaboina Padmakar
- PhD Scholar, School of Pharmaceutical Science, Lovely Professional University, Punjab, India
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Berhanu A, Dugassa S, Maru M, Animut A, Erko B, Hailu A, Gebresilassie A. Cutaneous leishmaniasis in Kutaber District, Ethiopia: Prevalence, sand fly fauna and community knowledge, attitude and practices. Heliyon 2023; 9:e18286. [PMID: 37520994 PMCID: PMC10382297 DOI: 10.1016/j.heliyon.2023.e18286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 08/01/2023] Open
Abstract
Background Cutaneous leishmaniasis (CL) affects 25% of the population living in the highlands of Ethiopia. CL intervention has not decreased the number of leishmaniasis patients. A cross-sectional study was conducted to determine CL prevalence, community's knowledge, attitude and practices (KAP), and the sand fly fauna in Kutaber district, northeast Ethiopia. Methods A retrospective, community-based cross-sectional study was conducted in Boru Meda Hospital from December 2014-March 2021 to study CL prevalence of Kutaber district. A Pre-tested, well-structured questionnaire was used to collect data on the participants' socio-demographic characteristics, KAP towards CL and knowledge about sand fly vectors. Chi-square test and logistic regression analysis were used in the study, and data were analyzed using SPSS version 23 (p < 0.05). Results A total of 10,002 (14.02%), of which 71,325 samples were confirmed as positive for CL. The infection rate of CL in females (7.1%) was a little bit higher than males (7.0%). More cases were recorded among 15-29 age category. The study also revealed that 77.1% of the respondents had poor knowledge about CL treatment, prevention, clinical presentation and disease transmission. Farmers tended to have poorer knowledge about sand flies than non-workers and students (32.7 vs. 35 and 44.1%; P = 0.049). Housewives had poorer knowledge about sand flies than farmers and workers (22.2 vs. 32.7 and 33.3%; P = 0.023). Phlebotomus longipes comprised the highest composition (80%) of the sand fly species identified in Kutaber district. Conclusions The data showed that the community had poor knowledge about CL, vector, and transmission mode. CL preventive measures were prevalent, implying the need to raise CL awareness. Phlebotomus longipes was identified as the most dominant sand fly species which accounted for CL. The findings can be used in developing an effective control strategy to reduce CL transmission in the study area and elsewhere in Ethiopia.
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Affiliation(s)
- Abib Berhanu
- Addis Ababa University, College of Natural and Computational Sciences, Department of Zoological Sciences, Insect Science Stream, Addis Ababa, Ethiopia
| | - Sisay Dugassa
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Ethiopia
| | - Minwuyelet Maru
- Health Research and Technology Transfer Directorate, Amhara Public Health Institute, Dessie Branch, Ethiopia
| | - Abebe Animut
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Ethiopia
| | - Berhanu Erko
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Ethiopia
| | - Asrat Hailu
- College of Health Sciences, Addis Ababa University, Ethiopia
| | - Araya Gebresilassie
- Addis Ababa University, College of Natural and Computational Sciences, Department of Zoological Sciences, Insect Science Stream, Addis Ababa, Ethiopia
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Anisuzzaman, Hossain MS, Hatta T, Labony SS, Kwofie KD, Kawada H, Tsuji N, Alim MA. Food- and vector-borne parasitic zoonoses: Global burden and impacts. ADVANCES IN PARASITOLOGY 2023; 120:87-136. [PMID: 36948728 DOI: 10.1016/bs.apar.2023.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Around 25% of the global population suffer from one or more parasitic infections, of which food- and vector-borne parasitic zoonotic diseases are a major concern. Additionally, zoonoses and communicable diseases, common to man and animals, are drawing increased attention worldwide. Significant changes in climatic conditions, cropping pattern, demography, food habits, increasing international travel, marketing and trade, deforestation, and urbanization play vital roles in the emergence and re-emergence of parasitic zoonoses. Although it is likely to be underestimated, the collective burden of food- and vector-borne parasitic diseases accounts for ∼60 million disability-adjusted life years (DALYs). Out of 20 neglected tropical diseases (NTDs) listed by the World Health Organization (WHO) and the Centres for Disease Control and Prevention (CDC), 13 diseases are of parasitic origin. There are about 200 zoonotic diseases of which the WHO listed eight as neglected zoonotic diseases (NZDs) in the year 2013. Out of these eight NZDs, four diseases, namely cysticercosis, hydatidosis, leishmaniasis, and trypanosomiasis, are caused by parasites. In this review, we discuss the global burden and impacts of food- and vector-borne zoonotic parasitic diseases.
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Affiliation(s)
- Anisuzzaman
- Department of Parasitology, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh, Bangladesh.
| | - Md Shahadat Hossain
- Department of Parasitology, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Takeshi Hatta
- Department of Parasitology and Tropical Medicine, Kitasato University School of Medicine, Minami, Sagamihara, Kanagawa, Japan
| | - Sharmin Shahid Labony
- Department of Parasitology, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Kofi Dadzie Kwofie
- Department of Parasitology and Tropical Medicine, Kitasato University School of Medicine, Minami, Sagamihara, Kanagawa, Japan; Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Hayato Kawada
- Department of Parasitology and Tropical Medicine, Kitasato University School of Medicine, Minami, Sagamihara, Kanagawa, Japan
| | - Naotoshi Tsuji
- Department of Parasitology and Tropical Medicine, Kitasato University School of Medicine, Minami, Sagamihara, Kanagawa, Japan.
| | - Md Abdul Alim
- Department of Parasitology, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh, Bangladesh
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Retraction: Awareness of residents about kala-azar and its related practices in two endemic areas of Bangladesh. PLoS One 2022; 17:e0270656. [PMID: 35737683 PMCID: PMC9223389 DOI: 10.1371/journal.pone.0270656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Parkash V, Kaye PM, Layton AM, Lacey CJ. Vaccines against leishmaniasis: using controlled human infection models to accelerate development. Expert Rev Vaccines 2021; 20:1407-1418. [PMID: 34664543 PMCID: PMC9835556 DOI: 10.1080/14760584.2021.1991795] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 10/07/2021] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Leishmaniasis is a neglected tropical disease that is defined by the World Health Organization as vaccine preventable. Although several new candidate vaccines are in development, no vaccine has successfully reached the market for human use. Several species of Leishmania cause human disease and have co-evolved with their respective sand fly vectors. These unique relationships have implications for initiation of infection and vaccine development. An approach to vaccine development for many infectious diseases is the use of controlled human infection models (CHIMs). AREAS COVERED We describe the history and recent development of experimental and deliberate infection using Leishmania in humans and the rationale for developing a new sand fly-initiated CHIM to progress leishmaniasis vaccine development. Examples from other infectious diseases are discussed in the context of the development of a new leishmaniasis CHIM. We also reflect upon the manufacture of the challenge agent, practical considerations, safety, ethics, and regulatory issues. EXPERT OPINION A new cutaneous Leishmania CHIM is being developed to enable testing of vaccines in the development pipeline. Questions remain about the use of such CHIMs to determine effectiveness of vaccines against visceral leishmaniasis. However, such a CHIM will be invaluable in expediting time to market for vaccines.
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Affiliation(s)
- Vivak Parkash
- York Biomedical Research Institute, Hull York Medical School, University of York, York, UK
- Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals Nhs Foundation Trust, Sheffield, UK
| | - Paul M. Kaye
- York Biomedical Research Institute, Hull York Medical School, University of York, York, UK
| | - Alison M Layton
- York Biomedical Research Institute, Hull York Medical School, University of York, York, UK
| | - Charles J Lacey
- York Biomedical Research Institute, Hull York Medical School, University of York, York, UK
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Rahman KM, Olsen A, Harley D, Samarawickrema IVM, Butler CD, Zahid K, Sumon SA, Mondal D, Luby SP, Sleigh AC. Early diagnosis of kala-azar in Bangladesh: Findings from a population based mixed methods research informing the post-elimination era. Parasitol Int 2021; 85:102421. [PMID: 34280530 DOI: 10.1016/j.parint.2021.102421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 06/21/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Global annual reports of visceral leishmaniasis or kala-azar ("black fever") reduced from 200,000 cases in 2012 to 23,804 in 2015. India, Bangladesh and Nepal reported 80% of the global cases in 2012, but 39% in 2015. We sought to identify major amenable barriers to early diagnosis of kala-azar in peripheral areas of Mymensingh district, an area of Bangladesh that was highly endemic for kala-azar. METHODS We conducted sequential exploratory mixed methods research. Qualitative data were first derived from in-depth interviews and focus group discussions among 29 patients diagnosed with kala-azar, their families, and neighbours. Preliminary results from qualitative analysis were used to design a structured questionnaire, which was administered to collect data on the processes leading to the diagnosis of kala-azar from 102 patients. Qualitative and quantitative data were integrated consistent with the chronology for kala-azar patients seeking care. The study was conducted from September 2011 to May 2012 in Fulbaria and Gaffargaon sub-districts of Mymensingh. RESULTS The median delay from fever onset to confirmatory diagnosis of kala-azar was 60 days, with 38% of the cases diagnosed within 30 days. Public health facilities and Gaffargaon sub-district achieved high proportions of early diagnosis. Individual barriers to early diagnosis were low awareness of symptoms and treatment facilities, poverty, and traditional beliefs. Other factors were the remoteness of health care centres, wet season transport difficulty, mis-diagnosis as typhoid, limited availability of rK-39 testing at the community level, and the inclusion of splenomegaly in the case definition. CONCLUSIONS Targeted community awareness campaigns appropriate for underprivileged communities will increase care seeking and consequently diagnosis. Improved diagnostic guidelines and a strong referral chain for kala-azar will accelerate diagnosis. These steps will contribute significantly to the National Kala-azar Elimination Program of Bangladesh, especially during the post-elimination era.
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Affiliation(s)
- Kazi Mizanur Rahman
- North Coast Public Health Unit, New South Wales Health, Lismore, NSW, Australia; The University of Sydney, University Centre for Rural Health, Lismore, NSW, Australia.
| | - Anna Olsen
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
| | - David Harley
- UQ Centre for Clinical Research, Royal Brisbane and Women's Hospital Campus, Herston, QLD, Australia
| | | | - Colin D Butler
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, ACT, Australia; Faculty of Health, University of Canberra, Canberra, ACT, Australia; College of Humanities, Arts and Social Sciences, Flinders University, Australia
| | - Khandaker Zahid
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shariful Amin Sumon
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Dinesh Mondal
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Stephen P Luby
- Center for Innovation in Global Health, Stanford University, Stanford, CA, USA
| | - Adrian C Sleigh
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
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Knowledge and attitude towards cutaneous leishmaniasis among rural endemic communities in Shara'b district, Taiz, southwestern Yemen. BMC Infect Dis 2021; 21:269. [PMID: 33731042 PMCID: PMC7968254 DOI: 10.1186/s12879-021-05965-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 03/08/2021] [Indexed: 01/29/2023] Open
Abstract
Background Cutaneous leishmaniasis (CL), a neglected tropical disease, represents a significant public health problem in many endemic countries including Yemen. The ongoing armed conflict that started in March 2015 has had a negative impact on the entire healthcare system as well as on infectious disease control programmes. Therefore, this cross-sectional study aimed to assess knowledge and attitude towards CL among rural endemic communities in southwestern Yemen. Methods Five hundred households in five areas of Shara’b district of Taiz governorate were randomly selected to participate in a quantitative survey. A pretested structured questionnaire was used to collect data on the sociodemographic characteristics of the participants, their knowledge and attitude towards CL and their knowledge on the sand fly vector. Results The analysis was conducted on a final sample of 466 individuals (62.7% males and 37.3% females) aged between 18 and 70 years. Among the participants, 21.5% were non-educated while 39.7 and 20.8% had completed secondary school and tertiary education, respectively. Although the participants were aware of CL, about three quarters (77.7%) of them had poor overall knowledge about disease transmission, clinical presentation, treatment, and prevention. Interestingly, approximately half of the participants (49.1%) were able to differentiate sand flies from other flies and mosquitoes. However, only 14.8% of the participants knew about the role of the phlebotomine sand fly in the transmission of CL. Only 36.6% believed that CL can be prevented and 49.6% had a negative attitude towards the disease. Univariate and multivariate analyses showed that age and gender were the significant determinants of knowledge about CL and the sand fly vector among the studied population. Conclusion A poor level of knowledge about the different epidemiological aspects of CL was found among rural CL-endemic communities in Taiz. This factor, together with the major collapse of the healthcare infrastructure due to the ongoing civil war in Yemen, may be contributing to the continued endemicity of CL in the governorate. It is therefore recommended that health education on CL transmission and prevention should be provided to the targeted communities. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-05965-4.
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