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Chad - Kala-azar 2021

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  • Chad - Kala-azar 2021


    Week 26: 21-27 June 2021
    Data as reported by: 17:00; 27 June 2021


    Visceral Leishmaniasis Chad

    122 Cases
    6 Deaths
    4.9% CFR


    Visceral leishmaniasis (VL), also known as kala-azar or black
    fever, is the most serious form of leishmaniasis. It is a disease
    caused by a parasite of the genus Leishmania. Among parasites,
    it is the second biggest killer in the world after malaria. Each
    (Plasmodium and Leishmania) is responsible for an estimated
    half a million deaths worldwide each year. Cases of VL were first
    reported in Chad in 1966, while the cutaneous and mucocutaneous
    forms were diagnosed in 1968. Similar cases have also been
    confirmed in the neighbouring countries of Western Africa.
    Visceral leishmaniasis often occurs in N’Djamena and Lake Chad
    areas, extending eastward throughout southern Chad. Cutaneous
    leishmaniasis occurs in Chari-Baguirmi Prefecture (includes
    N’Djamena), along the Chari River in south central Chad, and in
    the northern and northeastern sub-desert and desert areas. Peak
    transmission has been known to occur from April to November.

    Sporadic cases of leishmaniasis have been reported in Chad
    since 2018. In August 2020, health authorities in Chad received
    rumours of a febrile illness among young gold miners in the
    provinces of Tibesti and Borkou (desert regions of northern
    Chad). Consequently, an investigative team was deployed to the
    affected areas and identified a total of 68 suspected cases with
    two deaths in the health registers and medical files. Following
    the recommendations of this mission, and with technical support
    from key partners, 19 blood samples were sent to the Parasitology
    Reference and Research Laboratory (Carlos III Health Institute) in
    Madrid, Spain for confirmation and identification of the species.
    Analysis of these samples found 16 positive (Kr39 antigens)
    cases by rapid diagnostic tests (RDT) and 13 positive cases by
    polymerase chain reaction (PCR). Leishmania donovani was
    identified during preliminary analysis.

    Since 1 January 2018 to 31 May 2021, a total 122 cases of VL
    have been reported by three provinces of N’Djamena, Borkou and
    Tibesti. Of the 122 cases, (2, 4.0%) have died, while about (98,
    80.0%) have recovered. Case-patients identified in N’Djamena’s
    are from Miski’s and were all self-referrals. The health districts
    reporting the highest number of cases are Bardai, which
    accounted for 4 950 (50.0%) of reported cases, followed by
    Zouar (30; 25.0%), Faya with (1, 1.0%) and 20 cases (16.4%)
    from unknown areas.

    Most cases (60; 71.0%) have been reported in the age group of
    <5 years, followed by those 16 years and older (23;19.0%). More
    men have been affected (60%) than women (40%).


    The National Coordination team including the Ministry of
    Public Health National Solidarity and partners) has been
    put in place for this outbreak, and a response plan has been

    A joint mission between the Ministry of Public Health and
    National Solidarity, and partners visited Faya (Borkou) and
    Bardaï (Tibesti) from March 19 to April 2, 2021 to strengthen
    the capacity of health workers in two provinces on the
    management of VL in accordance with the WHO protocol.

    Laboratory technicians were trained on the use of Rapid
    Diagnostic Tests (Ag Kr39).

    A laboratory system was put in place to collect samples
    from all suspected cases. A total of 19 blood samples were
    collected and sent to the WHO collaborating Center in Spain
    for confirmation.

    The provincial hospitals of Faya and Bardai have been
    provided with drugs for the management of cases, and rapid
    diagnostic tests.

    Surveillance has been strengthened, all suspected cases
    are tested, active case finding is conducted in healthcare
    facilities, and a data collection system has been put in place.


    Visceral Leishmaniasis is endemic in some areas of Chad.
    However, currently, the incidence and prevalence rates of the
    disease are not known in the country. The current increase of
    cases draws much attention, and appropriate public health
    actions have been undertaken.

    The establishment of a national coordination team, a response
    plan, and the strengthening of the surveillance system will help
    to fight this infection which has been neglected for many years
    "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
    -Nelson Mandela