India misses Kala-Azar elimination deadlines

Two deadlines already missed to eliminate the killer disease, the Government is now hit with a sudden spurt in cases of Post Kala-azar Dermal Leishmaniasis (PKDL), a condition in which kala-azar parasites are found in skin. The Government has missed two Kala-azar elimination deadlines, first in 2015 and then in 2017.

A senior Union Health Ministry official conceded that the Kala-Azar  Elimination  Programme  will not be effective until PKDL is eliminated. PKDL develops in some of the Kala-azar patients usually 1-2 years or more following recovery of Kala-azar; less commonly without suffering from Kala-azar.

Rattled by the increase in the PKDL cases, the Ministry has recently doubled the incentive to Rs 4000 to encourage the PKDL patients to come forward to avail treatment. Incentives of ASHA workers have also been raised from Rs 300 to Rs 500 for per notified Kala-azar cases, the official added.

According to the Government data, PKDL cases increased from 655 in 2015 to 1,657 in 2016 and 1949 last year. It was just 421 cases in 2014. In PKDL, skin lesions appear which houses the Kala-Azar parasite, Leishmania donovani.

Because PKDL patients are not ill and the disease may run a chronic course with limited discomfort, many do not report to health facilities or report late. Only up to 25 per cent of patients seek medical treatment for cosmetic reasons. This is concerning because of the possible risk in transmission, said the official.

Also because, the PKDL is not life-threatening, it is difficult to diagnose and treat than Kala-Azar and represents a sustained infection reservoir.

The median 21-month delay between Kala-Azar and PKDL is also consistent with earlier findings and suggests that the PKDL echo epidemic will continue for several more years, the officer added.

Currently, Kala-Azar  is endemic in 54 districts of the country — 33 districts of Bihar reports more than 70 per cent cases — 11 in West Bengal, four in Jharkhand and six in eastern UP. It is also sporadically found in other states. While PKDL is on increase, Kala-Azar cases and deaths have declined over the years.

Visceral leishmaniasis (VL), also known as Kala Azar, is a worldwide protozoal vector-borne disease, endemic in 76 countries. The annual incidence is estimated to be 250,000 to 300,000 cases, with over 90 per cent of those cases occurring in India, Bangladesh, Sudan, South Sudan, Ethiopia and Brazil, where it often affects the poorest populations in those countries. VL is the second largest cause of parasitic death after malaria.