Kala azar 'silently' kills thousands in Bihar

[Gert van der Hoek]

Kala azar 'silently' kills thousands in Bihar

From correspondents in Bihar, India, 09:01 AM IST May 08, 2007


Thousands are dying in Bihar due to kala azar, a deadly parasitic disease transmitted by the tiny sand fly. And a former minister says he knows how to battle the scourge.

According to C.P. Thakur, a former central minister and chairman of the Kala Azar Task Force in Bihar, over 100,000 people, mostly the poor, are suffering from this disease and thousands have already died this year.

'They are dying in thousands and silently. It is unlike when dozens died due to dengue in Delhi, creating a flutter,' Thakur told IANS here.

The sand fly that transmits the disease multiplies in the cow dung villagers use liberally to plaster their shanties or as cow dung cakes for fuel.

The flies survive on the sap in banana and bamboo groves and the decomposed cow dung heaps. They make their home in the straw thatches of houses.

The disease is characterised by fever, weight loss, swelling of the spleen and liver and leads to cardiovascular complications resulting in death.

'A large number of patients in flood-prone north Bihar districts hardly report to health centres and die a silent death,' said Thakur, an internationally reputed expert of kala azar.

He said the official figure of 30,000 kala azar cases is far from reality.

'Those are only the reported cases of kala azar. What about those cases that go unreported in rural areas? There was no figure available about them,' Thakur said.

Early this year, Chief Minister Nitish Kumar set up the task force on kala azar headed by Thakur to suggest measures to eradicate the disease by 2010.

Thakur said that continued spraying of insecticides for at least five years in a phased manner and supervised administration of Amphotericin B could eliminate the disease.

'There is an urgent need for at least 100,000 vials of Amphotericin-B to control the rising incidence of kala azar. For a complete elimination of the disease, over 500,000 vials are required,' Thakur said.

Currently, 31 of 38 districts in Bihar are in the grip of the disease.
'Dengue deaths in Delhi has become a national issue, but deaths due to kala azar that has been regularly reported in rural Bihar hardly makes any news,' he lamented.

Experts say poor living standards and unhygienic conditions make members of the Mushahar community of Dalits an easy prey to the disease.

The kala azar, medically known as Visceral Leishmaniasis, is also known as the poor man's disease because it affects the poorest of the poor.

According to sources in the state government, the World Bank, WHO and the Bill Gates Foundation have shown keen interest to fund the kala azar eradication programme.

Many of the worst kala azar hit areas of Bihar are the northern districts of Vaishali, Muzaffarpur, Sitamarhi, Sheohar and East and West Champaran.

Bihar last faced a kala azar epidemic in 1991 when 250,000 cases were reported. In 2000, the numbers were low but started rising from 2003.

The disease occurs in 62 countries, primarily in the developing world. Around 90 percent of world cases are found in India, Bangladesh, Nepal, Sudan and northeast Brazil.

Experts say over 60 percent of the cases in India are found in Bihar alone.

http://www.indiaenews.com/health/20070508/50669.htm

[Gert van der Hoek]

Re: Kala azar 'silently' kills thousands in Bihar

Kala-azar claims two in Jehanabad

16 May, 2007 l

JEHANABAD: Over three dozen families, mostly Dalits, are suffering from kala-azar at Sikanderpur village under Ratani block and Anantpur, Tandwan villages under Madanganj block in Jehanabad. However, the official figure of those affected by the dreaded disease has been put is at 15.

The kala-azar eradication campaign, launched by the Union health ministry, has failed to wipe out the disease particularly among the Musahars. The disease has claimed two lives at Sikanderpur village during the past one week. The victims have been identified as Kamalesh Chaudhary (34) and Rinku Kumari.

Tileshwar Kaushik, former mukhiya of Sikanderpur panchayat, said widespread illiteracy and dependence on quacks have led to the spread of kala-azar in the area. The patients are normally shifted to sadar hospital only in the eleventh hour, he said.

Dinesh Prasad a health activist said improper diet makes Musahars most vulnerable to the disease.Rama Manjhi of Sikanderpur, whose father fell victim to the disease, said most of affected families cannot afford the costly treatment.

Meanwhile, medical teams constituted by the Jehanabad civil surgeon have visited the affected villages and provided treatment to the patients. But some of the patients admitted at sadar hospital told TOI that they were not being provided the necessary medicines.

http://timesofindia.indiatimes.com/Cities/Patna/Kala-azar_claims_two_in_Jehanabad/articleshow/2051017.cms

[Gert van der Hoek]

Re: Kala azar 'silently' kills thousands in Bihar

Civic hospitals brace themselves for kala azar

BY A STAFF REPORTER | Saturday, April 28, 2007 8:14:35 IST

No reason to worry for Mumbaikars, says BMC Heath official even as deadly disease whets its fangs


The increasing number of cases of kala azar disease in the city seems to be giving sleepless nights to doctors in civic hospitals. The city has reported two cases of the disease in less than a month and the civic authorities are unprepared to deal with its outbreak.

Sources in BMC informed that the medicines had to be procured from outside for the treatment of the patients. ?There is a limited stock of Sodium Stibogluconate in the civic hospitals that is used to treat kala azar, which has worsened the situation. We have sought the help of medical experts in this issue and soon we will find some solution to giving treatment to everyone,? sources said.

Both the patients are admitted on a serious basis, at J.J Hospital in Nagpada and R.N Cooper hospital in Vile Parle.
However, when asked deans of some civic hospitals in the city, they looked prepared for fighting the disease, in case of an outbreak.

?It is caused to due to the bite of fly or a parasite called vector. It enters into the body and then it lodges in the liver, spleen and skin. The skin becomes black in colour because of which, it is named as kala azar. The drugs that can be used for this disease is Amphotericin, which is available easily; Lyposomal-amphotericin, is little expensive but safe and it is available in our hospital,? said Dr. Neelima Kshrisagar, dean of KEM Hospital in Parel.

According to Dr. M E Yealekar, Dean of Sion Hospital, ?Illness of chronic nature, abdominal mass (swelling of stomach), slate colour of one?s hue and the immunity becomes low these are the symptoms of kala azar. The insect that spreads this disease are mainly found in northern part of India like Uttar Pradesh and Bihar. So people who have been to that place or is a resident can only have this disease.? He also added that proper treatment has to needs to be given on time, otherwise it might be fatal.

However, Dr. Neelima Kshrisagar of KEM Hospital said, ?This disease is not contagious. Moreover, I do not think it would affect Mumbai anyways. There are only one or two cases in Mumbai every year. This insect basically breeds in an area with high temperature and dry hot atmosphere. But still to be on the safer side we should keep our surroundings hygienic and ensure cleanliness to avoid any such thing to happen in the near future.?

Explaining the diagnosis for kala azar, Dr. H.H Jadhav, Medical superintendent of G.T Hospital in Dhobi Talao said, ?Parasitological examination is done first to check the presence of the insect. This is done by taking out blood samples and then we detect it. If the patient is serious, he is immediately referred to the hospital. This disease can be controlled by early detection, house-to-house survey, to control sand fly by DDT or insecticide.?

When asked about the further steps taken by the BMC for kala azar, Dr. Jayaraj Thanekar, Executive Health Officer of BMC bluntly replied ?Nothing, people are just panicking. There is no need to worry. This is mainly found in northern part of India and it won?t affect Mumbai.?

What is kala azar?

Kala azar is a chronic and potentially fatal parasitic disease of the viscera (the internal organs, particularly the liver, spleen, bone marrow and lymph nodes) due to infection by the parasite called Leishmania donovani.

Leishmania donovani, the agent of kala azar, is transmitted by sandfly bites in parts of Asia (primarily India), Africa (primarily Sudan) and South America (primarily Brazil) where all together there are an estimated half million cases per year. There are also several hundred cases yearly in Europe (primarily in the Mediterranean region) and a few in North America.

Sources in the BMC?s health Department said that kala azar can cause no or few symptoms ?but typically it is associated with fever, loss of appetite (anorexia nervosa), fatigue, bleeding tendency from nose, enlargement of the liver, spleen and nodes and suppression of the bone marrow. The term ?kala azar? comes from our country, which means black fever in Hindi. The disease is also known as Indian leishmaniasis, visceral leishmaniasis, leishmania infection, dumdum fever, black sickness, and black fever,? sources said.

Dr. H.H Jadhav, Superintendent of G.T Hospital said, ?Kala azar also increases the risk of other secondary infections. The first oral drug found to be effective for treating kala-azar is miltefosine. This disease mainly affects men and it can spread through sexual transmission. People working in forest, mining and fishing are mainly affected by kala azar.?

However, when asked if there is any chance of the flied coming to the city, he said, ?No, the flies cannot come to city. However, such flies are also found in lower-social economic strata like Colaba locality.?

The name ?Leischmania donovani? honors two men: the British pathologist William Boog Leishman who in 1903 wrote about the protozoa that causes kala azar and the researcher C. Donovan, who made the same discovery independently the same year.

http://www.cybernoon.com/DisplayArticle.asp?section=fromthepress&subsection=inbombay&xfile=April2007_inbombay_standard12764

[Gert van der Hoek]

Re: Kala azar 'silently' kills thousands in Bihar

Kala Azar: Visceral leishmaniasis


Visceral leishmaniasis (VL), also known as kala-azar and black fever, is the most severe form of leishmaniasis, a disease caused by parasites of the Leishmania genus. It is the second-largest parasitic killer in the world (after malaria), responsible for an estimated half-million deaths worldwide each year.

[1] The parasite migrates to the visceral organs such as liver, spleen and bone marrow and if left untreated will almost always result in the death of the mammalian host. Symptoms include fever, weight loss, anaemia and substantial swelling of the liver and spleen. Of particular concern, according to the World Health Organization (WHO), is the emerging problem of HIV/VL co-infection[1].

From Wikipedia, the free encyclopedia



More: http://en.wikipedia.org/wiki/Kala_azar

Information from WHO: http://www.searo.who.int/en/Section10/Section2163.htm

Kala Azar is endemic in: India, Bangla Desh and Nepal, see attachment.

[Jonesie]

Re: Kala azar 'silently' kills thousands in Bihar

Kala-azar (kalajar) an infectious disease caused by an intracellular flagellate protozoan Leishmania donovani, common in rural parts of the tropical and subtropical countries of the world.

The disease, also known as visceral leishmaniasis, is characterized by lesions of the reticulo-endothelial system, especially the liver and spleen, and is often fatal. Children are more susceptible to this disease. Kala-azar is transmitted to man by the bite of the infected female Phlebotomus sandfly. The incubation period is generally 2 to 6 months.


Kala-azar has been a public health problem in the Bengal moribund delta region since the early eighteenth century. It obtained an epidemic form in the late 18th and early 19th centuries. Due to Kala-azar, Burdwan and some other districts of West Bengal were losing population. Many people deserted the Kala-azar afflicted areas and move to East Bengal. The problem became a serious threat in late 19th century due to construction of railways and consequent deterioration in the natural drainage system.

As a collateral effect of DDT spraying under the Malaria Eradication Programme (MEP), incidence of Kala-azar in Bangladesh almost disappeared at one point, because of high susceptibility of the vector sandfly to DDT. However, the disease showed resurgence in the late 70's. Following are the data on recent Kala-azar cases collected by the Directorate of Health Services:
(SEE CHART)

Most of these cases were reported from greater Mymensingh,Rangpur, Rajshahi, and Comilla districts. Cases of Kala-azar were also detected in Dhaka, Jhenaidaha, Patuakhali and Narayanganj districts.

According to a study conducted by the Institute of Epidemiology, Disease Control and Research (IEDCR), the disease is spreading at an alarming rate. Ten years ago, the disease was confined to some northern districts only. It has now spread to more than 30 districts. Compared to the number of patients identified and treated, most Kala-azar patients remain undetected and untreated.

The protozoan parasite gets multiplied in the bone marrow, spleen and liver. It attacks lymph nodes or the body defence system, crippling the production of anti-bodies. This leads to unusual enlargement of the liver and spleen. Kala-azar also causes pneumonia, diarrhoea, loss of weight and appetite, discomfort in the abdomen, and often nasal and gum bleeding that may lead to death. Although there are several methods of detecting the Kala-azar parasite, the most reliable one is the direct agglutination test (DAT). The test is very expensive and in Bangladesh only five laboratories including one each at Pabna and Dinajpur have facilities for conducting it.

Phlebotomus argentipes is the recognized vector of Kala-azar in the eastern part of this subcontinent. A WHO report indicates that Kala-azar is a serious public health problem in the state of Bihar and West Bengal in India. After its resurgence in some parts of Bihar in the early seventies, the disease spread to 36 districts in Bihar, and 10 districts in West Bengal. There were 17,806 cases with 72 deaths till 1986, which rose to 77,102 cases with 1,419 deaths in 1992 in Bihar and West Bengal; at least 17,429 people were attacked and 255 of them died of the disease in 1997.

The sandfly breeds in soil with sufficient moisture and organic debris. It is found in cracks and crevices of dwellings and floors of cattle sheds. The larva takes about 20 days to 1.5 months to reach the adult stage depending upon temperature and availability of food. The female sandfly takes the blood of mammals. It can not fly but hops, is nocturnal in habit, and rests in humid, dark areas. High humidity favours the fly. Adult longevity is about two to four weeks depending upon prevailing environmental conditions.

There are no regular Kala-azar vector control activities in Bangladesh. Areas with large number of cases and outbreaks are sometimes sprayed with DDT as the vector sandfly is still found susceptible to DDT. In some areas insecticide-treated bed nets have been tried to control Kala-azar and have been found effective. Elimination of breeding grounds of flies is helpful in reducing incidence of Kala-azar. WHO currently supports Bangladesh's programme to control the incidence of this disease. It includes: (i) indoor residual insecticidal spray twice annually to interrupt transmission of the parasite, (ii) early diagnosis and complete treatment of Kala-azar cases; and (iii) health education to create community awareness. Sodium Stiboglucona, an intra-muscular injection pushed every 20 days, has proved to be very effective in treating Kala-azar. [SM Humayun Kabir]

FOR THE COMPLETE ARTICLE GO TO:
http://banglapedia.search.com.bd/HT/K_0026.htm

[Jonesie]

Re: Kala azar 'silently' kills thousands in Bihar

Ending the scourge of black fever in India: a non-profit pharmaceutical company brings back an affordable cure

Black fever, also known as kala-azar, is the world's most deadly parasitic disease after malaria. Each year it kills about 500,000 people, who rapidly lose weight and die painfully with swollen livers and spleens. Years ago a treatment for black fever was found; however, because all those who suffered from black fever were poor, pharmaceutical companies saw no profit and shelved the drug.

Now a remarkable new kind of charity, a not-for-profit pharmaceutical company called the Institute for One World Health (IOWH), has resurrected the shelved drug, paromomyocin, proved its efficacy to the Indian government and, with funds from the Bill and Melinda Gates Foundation, is planning to make it available in the worst-affected parts of India. In tests 94.6% of patients treated with paromomyocin were cured. The drug costs $10 per patient, less than one-tenth of any available alternative.

Having proved the concept, the IOWH is moving on to tackle malaria and diarrhoea.

The institute is the brainchild of a remarkable American woman, Victoria Hale. Before attracting the funding their idea deserves, Dr Hale and her husband devoted 2? years and much of their money to building the IOWH as the first non-profit pharmaceutical company.

On June 15, 2006 Gland Pharma Limited and the Institute for One World Health submitted the dossier to the Drug-Controller General of India (DCGI). Paromomycin Intramuscular (IM) Injection was approved on August 31, 2006 for the treatment of Visceral Leishmaniasis (VL). Gland Pharma Limited, the manufacturer, will distribute the product within India, with sales initially restricted to use in the National Vector Borne Disease Control Program (NVBDCP) only.

IOWH will seek regulatory approval with either the United States Food and Drug Administration (FDA) or the European Union European Medicines Evaluation Agency (EMEA); approval in other VL-endemic countries, such as Bangladesh, Sudan, Brazil and Nepal will then follow.

The current unique public-private partnership with Gland Pharma Limited is expected to supply the needs of the worldwide Paromomycin Injection market for the treatment of VL. The ultimate goal is to use Paromomycin Injection as a key tool in the National Vector Borne Disease Control Programme to eliminate kala azar from India, and shortly thereafter, Bangladesh and Nepal.

This story is excerpted from an article by Ken Burnett, a trustee of ActionAid International, printed in the Guardian Weekly, and from information relating to Visceral Leishmaniasis on the website of the Institute for One World Health.

The Guardian article can be found at http://www.guardian.co.uk/guardianwe...ticle_continue.

Information about the disease can be found at: http://www.oneworldhealth.org/diseas...shmaniasis.php

Information about the Institute for One World Health can be found at http://www.oneworldhealth.org/

http://hopebuilding.pbwiki.com/Stories%20about%20Health

[Gert van der Hoek]

Re: Kala azar 'silently' kills thousands in Bihar

May 22, 2007

OneWorld Health?s First Approved Drug Added to WHO Essential Medicines List

Paromomycin IM Injection Treatment for Deadly Kala-Azar Approved by Expert Committee

SAN FRANCISCO & NEW DELHI, India--(BUSINESS WIRE)--The Institute for OneWorld Health, a US-based non-profit pharmaceutical company, today announced that its first approved drug product, Paromomycin IM Injection, was designated by the World Health Organization (WHO) for inclusion on its Model List for Essential Medicines.

Paromomycin IM Injection is a cost-effective treatment for visceral leishmaniasis (VL), the world?s second most deadly parasitic disease after malaria. With approximately 500,000 new cases occurring annually worldwide, visceral leishmaniasis, also known as kala-azar, primarily afflicts the rural poor in India, Nepal, Bangladesh, Sudan and Brazil.

?The inclusion of OneWorld Health?s first approved drug product on the WHO Essential Medicines List recognizes the value of Paromomycin IM Injection to combat this lethal disease. This recognition is an important step in the realization of our drug development mission: Bringing the promise of safe, effective, and affordable medicines to those most in need,? said Dr. Ahvie Herskowitz, OneWorld Health?s Co-founder and Chief Medical Officer.

The WHO List of Essential Medicines provides a model for countries to select medicines addressing public health priorities. Medicines are selected by the WHO?s Expert Committee on the Selection and Use of Essential Medicines based on its quality, safety and efficacy standards. The WHO List of Essential Medicines helps governments address problems of cost and availability and provides guidance to the pharmaceutical industry on medicine needs globally.

The decision was made at the 15th Expert Committee on the Selection and Use of Essential Medicines, which met in Geneva earlier this year. In its letter notifying OneWorld Health of its decision, the WHO noted that, ?Paromomycin appears to be the most cost-effective treatment among all available alternatives.?

Gland Pharma Limited, the Hyderabad, India-based drug manufacturer working with OneWorld Health and its collaborators, received regulatory approval from the Drug-Controller General - India (DCGI) for Paromomycin IM Injection as a treatment for VL on August 31, 2006. Gland has committed to act as the low cost global manufacturer to ensure access of Paromomycin to all those that need it.

About WHO Essential Medicines List

WHO first published the first Model List of Essential Drugs in 1977, identifying 208 individual medicines that together could provide safe, effective treatment for the majority of communicable and non-communicable diseases. Essential medicines are intended to be available within the context of functioning health systems at all times in adequate amounts, in the appropriate dosage forms, with assured quality and adequate information, and at a price the individual and the community can afford. Many international organizations, including UNICEF and the U.N. High Commission for Refugees (UNHCR), as well as other nongovernmental organizations and international non-profit supply agencies, have adopted the essential medicines concept and base their medicine supply system on WHO?s list.

About Visceral Leishmaniasis

VL is a systemic infection caused by various species of Leishmania parasites. The infection is transmitted by sandflies and causes chronic fever, weight loss, splenomegaly, hepatomegaly and anemia. Left untreated, VL is nearly always fatal. VL currently occurs in 62 countries, primarily in the developing world. Of the approximately 500,000 new cases of VL occurring annually, 90% are found in just five countries: India, Bangladesh, Nepal, Sudan and Brazil. The Indian subcontinent carries 70% of all estimated new VL cases per year worldwide, with India alone is burdened with 50% percent of all new cases. The most affected state in India is Bihar, but VL is also endemic in the states of Jharkand, West Bengal, and Uttar Pradesh.

About Paromomycin IM Injection

Paromomycin, an off-patent aminoglycoside antibiotic, is an established drug with an extensive and well-characterized safety profile. Paromomycin IM Injection is now available for the first time as a new treatment of VL as a once-a-day injection for 21 days. The cost of Paromomycin IM Injection is significantly lower than other currently approved VL therapies.

About the Institute for OneWorld Health

The Institute for OneWorld Health, the first US non-profit pharmaceutical company, develops safe, effective and affordable medicines for people with neglected diseases of the developing world. The Institute for OneWorld Health, headquartered in San Francisco, California, USA, is a tax-exempt 501 (c) (3) US corporation.

(http://www.oneworldhealth.org/).

Media resources are available at http://www.oneworldhealth.org/media/index.php/.