@article{93415,
  keywords = {Epidemic, India, Indoor residual spraying, Kala-azar, Migration, Outbreak, Visceral Leishmaniasis},
  author = {Kumar A and Saurabh S and Jamil S and Kumar V},
  title = {Intensely clustered outbreak of visceral leishmaniasis (kala-azar) in a setting of seasonal migration in a village of Bihar, India.},
  abstract = {<p><b>BACKGROUND: </b>A visceral leishmaniasis outbreak was reported from a village in a low-endemic district of Bihar, India.</p><p><b>METHODS: </b>Outbreak investigation with house-to-house search and rapid test of kala-azar suspects and contacts was carried out. Sandfly collection and cone bio-assay was done as part of entomological study.</p><p><b>RESULTS: </b>A spatially and temporally clustered kala-azar outbreak was found at Kosra village in Sheikhpura district with 70 cases reported till December 2018. Delay of more than a year was found between diagnosis and treatment of the index case. The southern hamlet with socio-economically disadvantaged migrant population was several times more affected than rest of the village (attack rate of 19.0% vs 0.5% respectively, OR = 39.2, 95% CI 18.2-84.4). The median durations between onset of fever to first contact with any health services, onset to kala-azar diagnosis, diagnosis to treatment were 10 days (IQR 4-18), 30 days (IQR 17-73) and 1 day (IQR 0.5 to 3), respectively, for 50 kala-azar cases assessed till June 2017. Three-fourths of these kala-azar cases had out-of-pocket medical expenditure for their condition. Known risk factors for kala-azar such as illiteracy, poverty, belonging to socially disadvantaged community, migration, residing in kutcha houses, sleeping in rooms with unplastered walls and non-use of mosquito nets were present in majority of these cases. Only half the dwellings of the kala-azar cases were fully sprayed. Fully gravid female P. argentipes collected post indoor residual spraying (IRS) and low sandfly mortality on cone-bioassay indicated poor effectiveness of vector control.</p><p><b>CONCLUSIONS: </b>There is need to focus on low-endemic areas of kala-azar. The elimination programme should implement a routine framework for kala-azar outbreak response. Complete case-finding, use of quality-compliant insecticide and coverage of all sprayable surfaces in IRS could help interrupt transmission during outbreaks.</p>},
  year = {2020},
  journal = {BMC infectious diseases},
  volume = {20},
  pages = {10},
  month = {01/2020},
  issn = {1471-2334},
  doi = {10.1186/s12879-019-4719-3},
  language = {eng},
}