Kala Azar/ Black Fever/Dumdum Fever (Visceral Leishmaniasis): Causes, Symptoms, and Treatment

23 Feb 2024

Context: 

Recently, India hit a target towards eliminating Kala Azar as reported less than one case per 10,000 population across all blocks in 2023. 

Decline in Kala Azar Cases in India

  • Data from the National Vector Borne Disease Control Programme (NVBDCP) showed that there were 595 cases & 4 deaths of Kala Azar reported nationwide compared to 891 cases & three deaths in 2022.
National Vector Borne Diseases Control Programme (NVBDCP)

  • It is an umbrella programme for the prevention and control of vector-borne diseases namely Malaria, Japanese Encephalitis, Dengue, Chikungunya, Kala-azar and Lymphatic Filariasis
  • Out of them three diseases namely, Malaria, Lymphatic Filariasis and Kala-azar are targeted for elimination.

About Kala Azar

  • It is a neglected tropical disease affecting almost 100 countries including India.
  • Caused by: infection with Leishmania parasites. (Leishmania donovani in India)
Neglected Tropical Disease(NTDs): 

  • They are ‘neglected’ because they are almost absent from the global health agenda
  • NTDs are a diverse group of conditions caused by various pathogens (including viruses, bacteria, parasites, fungi and toxins).
  • Geographical Distribution: These diseases disproportionately affect low-income populations residing in developing regions across Africa, Asia, and the Americas. 
  • WHO recognizes more than 20 NTDS: Chagas disease; dengue and chikungunya; dracunculiasis; leishmaniasis; leprosy; lymphatic filariasis; chromoblastomycosis and rabies;  soil-transmitted helminthiases; snakebite envenoming; trachoma; and yaws etc. 
  • Global Impact: It is prevalent in 149 countries and impacting over 1.5 billion individuals, including more than 450 million children. 
  • WHO Roadmap goal for NTDs 2021-2030.
  • Types of leishmaniasis: 
    • Visceral leishmaniasis affects multiple organs and is the most serious disease. 
    • Cutaneous leishmaniasis causes skin sores and is the most common form. 
    • Mucocutaneous Leishmaniasis, which causes skin and mucosal lesions. 
  • Spread through sandfly bites. 
  • Kala Azar Symptoms: Fever, weight loss and swelling of the spleen or liver. 
  • Fatality : 95%, if left untreated.
  • Kala Azar Treatment:
    • Administration of  injectable liposomal amphotericin B
    • For PKDL (Post Kala-Azar Dermal Leishmaniasis) : Oral Miltefosine.
  • Strategies Adopted to Eliminate Kala Azar in India: 3 key interventions
Post Kala-azar Dermal Leishmaniasis (PKDL): It  develops when Leishmania donovani infiltrates and proliferates within skin cells, leading to the formation of skin lesions. While PKDL generally arises subsequent to kala-azar treatment.
    • Spraying: Rigorous indoor residual spraying effort aimed at curbing sandfly breeding sites.
    • Wall Plastering: Application of a special soil (Gerrard Soil) on walls, preventing sand flies from nesting.
    • Treatment Compliance: Mobilization of ASHA (Accredited Social Health Activist) network to ensure completion of treatment PKDL patients.

Government Efforts To Eliminate Kala Azar

  • World Health Organisation (WHO) Targets: Under Neglected Tropical Diseases Roadmap,target for Eliminating Kala-azar by 2030. 
  • Government Initiatives: 
    • The Government of India initiated Kala-azar control programme in the endemic states in 1990-91
    • National Health Policy and Revised Targets: The National Health Policy of 2002 initially aimed for Kala-azar elimination by 2010, later revising it to 2015, 2017, and 2020
    • Collaborative Partnerships and Oversight: Between Bill & Melinda Gates Foundation (BMGF), the National Centre for Disease Control (NCDC), and the World Health Organization (WHO) to achieve Kala-azar elimination. 
  • Major Development:  
    • In October 2023, Bangladesh became the first country in the world officially validated by WHO for eliminating Kala Azar as a Public health concern.
  • In India
    • Elimination status: Less than one case per 10,000 Progress:
    • More than 98 % decline in cases of Kala-azar (2007 to 2022) in India. 
    • Kala Azar Endemic states: 633 blocks mainly in four Bihar, Jharkhand, West Bengal & Uttar Pradesh. 
    • Uttar Pradesh & West Bengal states have achieved their targets.
Also Read: World’s First Vaccine For Chikungunya Approved

News Source: IE

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