Natural history of a visceral leishmaniasis outbreak in highland Ethiopia.

In May 2005, visceral leishmaniasis (VL) was recognized for the first time in Libo Kemken, Ethiopia, a highland region where only few cases had been reported before. We analyzed records of VL patients treated from May 25, 2005 to December 13, 2007 by the only VL treatment center in the area, maintained by Médecins Sans Frontières-Ethiopia, Operational Center Barcelona-Athens. The median age was 18 years; 77.6% were male. The overall case fatality rate was 4%, but adults 45 years or older were five times as likely to die as 5-29 year olds. Other factors associated with increased mortality included HIV infection, edema, severe malnutrition, pneumonia, tuberculosis, and vomiting. The VL epidemic expanded rapidly over a several-year period, culminating in an epidemic peak in the last third of 2005, spread over two districts, and transformed into a sustained endemic situation by 2007.

[1]  J. Alvar,et al.  Risk factors for visceral leishmaniasis in a new epidemic site in Amhara Region, Ethiopia. , 2009, The American journal of tropical medicine and hygiene.

[2]  C. Nishida,et al.  Development of a WHO growth reference for school-aged children and adolescents. , 2007, Bulletin of the World Health Organization.

[3]  J. Alvar,et al.  Kala-azar outbreak in Libo Kemkem, Ethiopia: epidemiologic and parasitologic assessment. , 2007, The American journal of tropical medicine and hygiene.

[4]  T. Alamirew,et al.  Preliminary entomological observations in a highland area of Amhara region, northern Ethiopia, with epidemic visceral leishmaniasis , 2007, Annals of tropical medicine and parasitology.

[5]  R. Davidson,et al.  A comparison of miltefosine and sodium stibogluconate for treatment of visceral leishmaniasis in an Ethiopian population with high prevalence of HIV infection. , 2006, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[6]  C. Davies,et al.  Conflict and kala-azar: determinants of adverse outcomes of kala-azar among patients in southern Sudan. , 2004, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[7]  M. de Onís,et al.  Rationale for Developing a New International Growth Reference , 2004, Food and nutrition bulletin.

[8]  C. Victora,et al.  The WHO Multicentre Growth Reference Study: planning, study design, and methodology. , 2004, Food and nutrition bulletin.

[9]  Jean M. Long,et al.  Visceral leishmaniasis and HIV in Tigray, Ethiopia , 2003, Tropical medicine & international health : TM & IH.

[10]  G. Werneck,et al.  Prognostic Factors for Death from Visceral Leishmaniasis in Teresina, Brazil , 2003, Infection.

[11]  L. Oskam,et al.  Evaluation of the direct agglutination test (DAT) using freeze-dried antigen for the detection of anti-Leishmania antibodies in stored sera from various patient groups in Ethiopia. , 1999, Transactions of the Royal Society of Tropical Medicine and Hygiene.

[12]  B. Mengesha,et al.  Kala-azar among labour migrants in Metema-Humera region of Ethiopia. , 1978, Tropical and geographical medicine.

[13]  R. Bray,et al.  Kala-azar in Ethiopia: Epidemiological studies in a highland valley. , 1973, Ethiopian medical journal.

[14]  Joke Voogt,et al.  Study design and methodology , 2008 .