TY - JOUR AU - Kokaia, Nora AU - Iashvili, Nino AU - Murusidze, Manana AU - Babuadze, Giorgi PY - 2017/05/02 Y2 - 2024/03/28 TI - Epidemiology of visceral leishmaniasis in Georgia JF - Online Journal of Public Health Informatics JA - OJPHI VL - 9 IS - 1 SE - One Health DO - 10.5210/ojphi.v9i1.7742 UR - https://ojphi.org/ojs/index.php/ojphi/article/view/7742 SP - AB - <div style="left: 79.8182px; top: 271.167px; font-size: 12.564px; font-family: sans-serif; transform: scaleX(1.08117);" data-canvas-width="56.563006734006734">Objective</div><div style="left: 93.1212px; top: 284.427px; font-size: 12.564px; font-family: serif; transform: scaleX(0.963235);" data-canvas-width="337.3250872053871">The purpose of this study was to describe the epidemiology of</div><div style="left: 79.8182px; top: 299.208px; font-size: 12.564px; font-family: serif; transform: scaleX(0.989042);" data-canvas-width="345.9175883838383">visceral leishmaniasis in Georgia and to define new control measures.</div><div style="left: 79.8182px; top: 327.336px; font-size: 12.564px; font-family: sans-serif; transform: scaleX(1.11744);" data-canvas-width="73.28565488215487">Introduction</div><div style="left: 93.1212px; top: 340.595px; font-size: 12.564px; font-family: serif; transform: scaleX(1.00838);" data-canvas-width="335.92420420875413">Visceral leishmaniasis (VL) is a zoonotic, protozoal infection that</div><div style="left: 79.8182px; top: 355.376px; font-size: 12.564px; font-family: serif; transform: scaleX(0.991422);" data-canvas-width="350.7484360269358">is endemic in Georgia, which commonly affects young children.</div><div style="left: 79.8182px; top: 370.158px; font-size: 12.564px; font-family: serif; transform: scaleX(0.942658);" data-canvas-width="350.1189809764309">In recent years, the incidence of VL has increased sharply and the</div><div style="left: 79.8182px; top: 384.939px; font-size: 12.564px; font-family: serif; transform: scaleX(1.0003);" data-canvas-width="348.9216343434342">geographic distribution has increased. Recently, VL moved to highly</div><div style="left: 79.8182px; top: 399.72px; font-size: 12.564px; font-family: serif; transform: scaleX(0.992436);" data-canvas-width="348.7419695286195">populated areas as new foci appeared from 2010-2015, during which,</div><div style="left: 79.8182px; top: 414.501px; font-size: 12.564px; font-family: serif; transform: scaleX(0.959949);" data-canvas-width="350.2534154882152">610 laboratory confirmed cases of VL were registered in Georgia.</div><div style="left: 79.8182px; top: 429.282px; font-size: 12.564px; font-family: serif; transform: scaleX(1.00623);" data-canvas-width="349.17793939393914">The majority of cases were found in East Georgia (94.2%) and 5.8%</div><div style="left: 79.8182px; top: 444.063px; font-size: 12.564px; font-family: serif; transform: scaleX(1.00522);" data-canvas-width="339.1267609427608">of cases in West Georgia (representing new foci of VL in Georgia).</div><div style="left: 79.8182px; top: 472.191px; font-size: 12.564px; font-family: sans-serif; transform: scaleX(1.0727);" data-canvas-width="51.65049326599326">Methods</div><div style="left: 93.1212px; top: 485.451px; font-size: 12.564px; font-family: serif; transform: scaleX(1.00449);" data-canvas-width="335.85258956228944">Blood samples from 2,100 individuals suspected to have VL were</div><div style="left: 79.8182px; top: 500.232px; font-size: 12.564px; font-family: serif; transform: scaleX(0.969821);" data-canvas-width="348.1979494949492">tested using the rk39 based VL rapid diagnostic test, an enzyme-linked</div><div style="left: 79.8182px; top: 515.013px; font-size: 12.564px; font-family: serif; transform: scaleX(1.01161);" data-canvas-width="349.49329511784515">immunosorbent assay (ELISA). Also, 1,575 randomly selected dogs</div><div style="left: 79.8182px; top: 529.794px; font-size: 12.564px; font-family: serif; transform: scaleX(1.00101);" data-canvas-width="349.06988922558924">(stray and pet) and 77 wild canids were tested for VL using the same</div><div style="left: 79.8182px; top: 544.575px; font-size: 12.564px; font-family: serif; transform: scaleX(1.00259);" data-canvas-width="341.6144276094275">ELISA. Confirmed human cases were followed up for 9-12 months.</div><div style="left: 79.8182px; top: 572.703px; font-size: 12.564px; font-family: sans-serif; transform: scaleX(1.08437);" data-canvas-width="45.38107070707071">Results</div><div style="left: 93.1212px; top: 585.962px; font-size: 12.564px; font-family: serif; transform: scaleX(1.00865);" data-canvas-width="338.23346245791237">The most affected age group was 0-5 years (72.2%). Of the</div><div style="left: 79.8182px; top: 600.743px; font-size: 12.564px; font-family: serif; transform: scaleX(0.978075);" data-canvas-width="348.53717676767667">patients, 13.9% were HIV positive and lethal outcomes were observed</div><div style="left: 79.8182px; top: 615.525px; font-size: 12.564px; font-family: serif; transform: scaleX(1.01603);" data-canvas-width="349.6000888888889">in 2.1%of patients. Mortality was associated with delayed diagnosis</div><div style="left: 79.8182px; top: 630.306px; font-size: 12.564px; font-family: serif; transform: scaleX(1.02663);" data-canvas-width="349.635268013468">and HIV co-infection. Relapse developed in 6.4% of cases. Among</div><div style="left: 79.8182px; top: 645.087px; font-size: 12.564px; font-family: serif; transform: scaleX(0.978179);" data-canvas-width="350.2697486531985">HIV positive patients, secondary prophylaxis was conducted with</div><div style="left: 79.8182px; top: 659.868px; font-size: 12.564px; font-family: serif; transform: scaleX(0.978652);" data-canvas-width="348.2858973063973">liposomal amphotericin B, which decreased the number of relapses by</div><div style="left: 79.8182px; top: 674.649px; font-size: 12.564px; font-family: serif; transform: scaleX(1.01265);" data-canvas-width="349.34629663299654">76% in 12-24 month follow-ups. A high incidence of VL in humans</div><div style="left: 79.8182px; top: 689.43px; font-size: 12.564px; font-family: serif; transform: scaleX(1.02655);" data-canvas-width="349.62521683501683">was associated with a high prevalence of leishmaniasis in stray and</div><div style="left: 79.8182px; top: 704.211px; font-size: 12.564px; font-family: serif; transform: scaleX(1.01459);" data-canvas-width="349.51088468013467">domestic dogs. Leishmania antibodies were found in 23.7% of stray</div><div style="left: 79.8182px; top: 718.993px; font-size: 12.564px; font-family: serif; transform: scaleX(1.00074);" data-canvas-width="324.539988215488">and domestic dogs and 2.6% of wild animals screened in Tbilisi.</div><div style="left: 79.8182px; top: 747.12px; font-size: 12.564px; font-family: sans-serif; transform: scaleX(1.10256);" data-canvas-width="75.39640235690236">Conclusions</div><div style="left: 93.1212px; top: 760.38px; font-size: 12.564px; font-family: serif; transform: scaleX(0.988281);" data-canvas-width="335.307313131313">Overall, the VL situation in Georgia is concerning and new control</div><div style="left: 79.8182px; top: 775.161px; font-size: 12.564px; font-family: serif; transform: scaleX(0.949119);" data-canvas-width="349.89282946127946">measures are needed. Our study revealed a high prevalence of VL</div><div style="left: 79.8182px; top: 789.942px; font-size: 12.564px; font-family: serif; transform: scaleX(1.03269);" data-canvas-width="345.7278723905723">in humans and dogs in East Georgia. Early and accurate diagnosis/</div><div style="left: 79.8182px; top: 804.723px; font-size: 12.564px; font-family: serif; transform: scaleX(1.04027);" data-canvas-width="352.2686767676767">treatment and effective control measures should be conducted</div><div style="left: 79.8182px; top: 819.504px; font-size: 12.564px; font-family: serif; transform: scaleX(1.01889);" data-canvas-width="351.5525303030304">regularly to prevent the spread of VL in Georgia. In addition,</div><div style="left: 79.8182px; top: 834.286px; font-size: 12.564px; font-family: serif; transform: scaleX(0.989733);" data-canvas-width="345.99422861952837">secondary prophylaxis in HIV infected patients is also recommended.</div> ER -