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THE DISEASES − CHAPTER 4
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In order to control cutaneous leishmaniasis in the Eastern Mediterranean Region, which
has the highest burden of the disease, WHO has published a 5-year strategic framework for
action (2014–2018) and a case-management manual (10). The European Region has likewise
prepared a strategic framework for control (2014–2020). These frameworks aim to build
country capacities, enhance surveillance, case management, and vector and reservoir control,
and strengthen outbreak preparedness and response (11). The Region of the Americas has also
instituted regional surveillance for visceral and cutaneous leishmaniasis and has mapped their
distribution at subnational level. Moreover, guidelines for the treatment of the leishmaniases,
including a self-directed online learning course (12), have helped many health workers to
receive training without leaving their workplaces.
In the Syrian Arab Republic and in the neighbouring countries receiving Syrian refugees,
WHO has supported various partners to treat cases of cutaneous leishmaniasis by providing
supplies, guidance and technical assistance. In areas where the conflict is ongoing, control
has been hampered significantly. In general, controlling vectors and their reservoir hosts is
important for controlling the leishmaniases. Countries should therefore regularly monitor and
assess the effectiveness of the various strategies being deployed for vector control, including
indoor residual spraying with insecticides and the use of insecticide-treated bednets.
Research priorities
The priorities for research are to address the major gaps in the epidemiological and
transmission patterns of the disease as well as the diagnostic, treatment and prevention aspects
of all three major forms of the leishmaniases (13). A concerted effort is needed to accurately
define the population at risk and the global burden of the disease and to determine the role of
asymptomatic infections and post kala-azar dermal leishmaniasis in transmission.
Other research needs include improved rapid diagnostic tests for detecting visceral
leishmaniasis and post kala-azar dermal leishmaniasis; diagnostic tools for monitoring drug
resistance and test of cure; new therapeutics (short course, efficacious and safer) to improve
case management and prevent drug resistance for visceral leishmaniasis and post kala-azar
dermal leishmaniasis; easy to apply treatments for cutaneous leishmaniasis; better treatment
for mucocutaneous leishmaniasis as well as diffuse and other complicated forms; and vaccines
against Leishmania infection and disease as well as vaccines to prevent transmission of
Leishmania.
Studies are needed to incriminate vectors in foci where they are unknown and in new foci as
they arise. Vector population characteristics, new vector control tools and technologies are also
needed; and insecticide resistance patterns require continual monitoring.