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Leishmaniasis cases in Pakistan

18 May 2017

Background

In April 2017, the World Health Organization (WHO) organised a training workshop on the diagnosis, treatment and management of leishmaniasis in Peshawar, the capital of the province of Khyber Pakhtunkhwa. It took place following mounting concern over the rise in leishmaniasis cases in several provinces in Pakistan.

Both visceral and cutaneous forms of leishmaniasis are considered endemic in Pakistan, especially in the North-West tribal areas of the country, including Khyber Pakhtunkhwa. Cutaneous cases are far more common than the visceral form in Pakistan. Currently, there is no government leishmaniasis control programme in Pakistan so the disease remains highly endemic. Over 22,000 cases of leishmaniasis have been reported in Khyber Pakhtunkhwa since January 2014.

Pakistan

Map by kind permission of the University of Texas Map Libraries, the University of Texas at Austin

Response to the outbreak

∙    WHO has donated 50,000 doses of Glucantime to treat leishmaniasis cases in Pakistan.

∙    Training workshops are being organised in other provinces in Pakistan where leishmaniasis is present.

Leishmaniasis – a brief outline

Leishmaniasis is a Neglected Tropical Disease (NTD)* which is caused by a parasitic protozoa which is transmitted through the bite of an infected female phlebotomine sand fly. These sand flies breed in caves, mud brick houses and forested areas. They are nocturnal insects which tend to bite from dusk to dawn. There are three main forms of leishmaniasis: visceral (also known as kala-azar) which is the most serious form of the disease, cutaneous which is the most common and mucocutaneous.

The disease mainly affects poor people in Africa, Asia and Latin America and is linked to malnutrition, weakened immunity systems, large population movements, climate change and inadequate housing and resources. It is estimated there are 0.7-1.3 million new cases of the cutaneous form of leishmaniasis, worldwide each year. Over 40,000 people die of the disease every year, making it the second largest parasitic killer in the world after malaria.

The cutaneous form of the disease causes ulcers on the skin, usually on the face, arms and legs which can cause permanent scars, disfigurement and disability. There are no vaccines or medications to prevent you becoming infected with leishmaniasis.

* Neglected Tropical Diseases are chronic infections which prevail in tropical and subtropical environments in 149 countries affecting more than one billion people. Most of these people live in poverty, without adequate sanitation and in close contact with insects and animals that transmit a range of diseases.

Advice for those travelling to or working in the areas affected

Those at risk of contracting leishmaniasis include humanitarian workers, mission partners, adventure travellers, bird watchers, researchers and adventure travellers on night-time assignments. The risk is considered low, if some key precautions are followed. These include:

·    Seek advice before travelling into an area where there is a risk of becoming infected with leishmaniasis.

·    Avoid outdoor activities, particularly from dusk to dawn when sand flies are usually most active.

·    Apply an effective DEET or Icaridin-based insect repellent frequently to exposed skin, especially on your lower legs, even if you are wearing long trousers. Sandflies jump, rather than fly.

·    Wear long-sleeved clothing, long trousers and socks. Treat clothing (not the skin) with an appropriate insecticide such a Permethrin.

·    Ensure you sleep under a bed net which has been impregnated with Permethrin or another appropriate insecticide. Sandflies are very small and may be able to get through some nets but the insecticide will help to reduce the numbers which are successful in doing so.

·    Stay in well-screened or air-conditioned accommodation; otherwise ensure you sleep under a bed net which has been impregnated with insecticide.

·    Sleep on a bed which is at least one metre above the ground.

You may face additional health risks whilst working or travelling in Pakistan. Click on the link for Pakistan for information and guidance on recommended vaccinations, malaria prevention, non-vaccine preventable health risks, safety and security measures, and other relevant information.

For further advice please click on the related information topics on the right hand panel of this screen

Sources

·    Pakistan: More than 22,000 leishmaniasis cases reported in Khyber Pakhtunkhwa since 2014, Outbreak News Today, 7 May 2017

·    Pakistan General Health Risks: Leishmaniasis, accessed 12 May 2017

·    Leishmaniasis – Pakistan (02) (Khyber Pakhtunkhwa), ProMED-mail Archive number 20170508.5020142, accessed 12 May 2017

·    Leishmaniasis Fact Sheet, World Health Organization, accessed 12 May 2017

·    Leishmaniasis: Epidemiological situation, World Health Organization, accessed 12 May 2017

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