AbstractObjectiveThe purpose of this study was to describe the epidemiology ofvisceral leishmaniasis in Georgia and to define new control measures.IntroductionVisceral leishmaniasis (VL) is a zoonotic, protozoal infection thatis endemic in Georgia, which commonly affects young children.In recent years, the incidence of VL has increased sharply and thegeographic distribution has increased. Recently, VL moved to highlypopulated areas as new foci appeared from 2010-2015, during which,610 laboratory confirmed cases of VL were registered in Georgia.The majority of cases were found in East Georgia (94.2%) and 5.8%of cases in West Georgia (representing new foci of VL in Georgia).MethodsBlood samples from 2,100 individuals suspected to have VL weretested using the rk39 based VL rapid diagnostic test, an enzyme-linkedimmunosorbent assay (ELISA). Also, 1,575 randomly selected dogs(stray and pet) and 77 wild canids were tested for VL using the sameELISA. Confirmed human cases were followed up for 9-12 months.ResultsThe most affected age group was 0-5 years (72.2%). Of thepatients, 13.9% were HIV positive and lethal outcomes were observedin 2.1%of patients. Mortality was associated with delayed diagnosisand HIV co-infection. Relapse developed in 6.4% of cases. AmongHIV positive patients, secondary prophylaxis was conducted withliposomal amphotericin B, which decreased the number of relapses by76% in 12-24 month follow-ups. A high incidence of VL in humanswas associated with a high prevalence of leishmaniasis in stray anddomestic dogs. Leishmania antibodies were found in 23.7% of strayand domestic dogs and 2.6% of wild animals screened in Tbilisi.ConclusionsOverall, the VL situation in Georgia is concerning and new controlmeasures are needed. Our study revealed a high prevalence of VLin humans and dogs in East Georgia. Early and accurate diagnosis/treatment and effective control measures should be conductedregularly to prevent the spread of VL in Georgia. In addition,secondary prophylaxis in HIV infected patients is also recommended.
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