Authors

S Sundar¹;  ¹ Banaras Hindu University, India

Discussion

Visceral leishmaniasis (VL), also known as Kala-azar, is the most severe form of leishmaniasis. VL epidemics have been known for several centuries in India. However, the current epidemic began in the early 1970s, with estimated annual incidences of several hundred thousand. Unfortunately, drug resistance to pentavalent antimonials in Bihar has limited the effectiveness of treatment options. In the year 2000, amphotericin B deoxycholate was recommended as a substitute; however, the lack of infrastructure in public health facilities made it difficult to implement. In 2002, oral miltefosine was licensed for the treatment of VL in India after a high cure rate in the pivotal phase 3 trial. In 2005, the Kala-azar Elimination Program (KAEP) was launched jointly in India, Nepal, and Bangladesh with early diagnosis using the rK39 strip test and treatment with miltefosine for four weeks, residual insecticide spray, and public awareness. The selection of miltefosine was based on its high cure rate and the ease of using an oral drug in the field. However, after nearly seven years of use, poor compliance was common due to the 28-day long treatment and reports of declining efficacy. Finally, the Regional Technical Advisory Group recommended a change in treatment. In 2010, a single dose of Liposomal Amphotericin B (10mg/Kg) demonstrated very high efficacy, leading to its approval by the WHO in the same year. In 2013, treatment was changed, leading to a significant impact on the incidence of VL. After ten years of its use, the elimination target has been achieved in India and Bangladesh. In October 2023, Bangladesh was declared by the WHO to have eliminated the disease. In India, all 633 blocks have been declared to have reached the elimination target. However, the status has to be maintained for three consecutive years for WHO certification.