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THE DISEASES − CHAPTER 4
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Burden and distribution
The leishmaniases are prevalent in 98 countries and three territories on five continents
(Fig. 4.9.1–4.9.2). Approximately 1.3 million new cases occur annually: 300 000 are visceral
(90% in Bangladesh, Brazil, Ethiopia, India, Nepal, South Sudan and Sudan); and 1 million
are cutaneous (mainly in Afghanistan, Algeria, Brazil, Colombia, the Islamic Republic of Iran,
Pakistan, Peru, Saudi Arabia, the Syrian Arab Republic and Tunisia) or mucocutaneous (mainly
in Brazil, Peru and the Plurinational State of Bolivia). The estimated number of deaths from
visceral leishmaniasis ranges from 20 000 to 50 000 annually (2,3).
The distribution of the leishmaniases has expanded during the past two decades and the
number of reported cases has increased exponentially. As reporting is mandatory in only
34% of the endemic countries, the exact burden of the disease remains unknown. Risk
factors facilitating its spread include poor socioeconomic conditions, malnutrition, climatic
and environmental changes, increased population movement, conflicts, immunosuppressive
conditions such as HIV coinfection and, in some areas, rapid urbanization or establishment of
new settlements (4,5).
In East Africa, particularly in South Sudan and Sudan, epidemics of visceral disease with
high mortality rates are frequent. The epidemic in South Sudan (2009–2012) resulted in more
than 28 000 new cases and 850 deaths (6). The rapid response from WHO, Médecins Sans
Frontières and other partners in collaboration with the Government kept the mortality rate to
below 5% compared with 35% in the epidemic of the 1990s.
Coinfection with Leishmania and HIV increases susceptibility to visceral disease and affects
its epidemiology. As of 2013, 35 countries endemic for the disease had reported cases of
coinfection with HIV. A significant, increasing trend of HIV–visceral leishmaniasis coinfection