leishmania spm definition and control measures .pptx

Leishmaniasis definition and control measures spm

1. LEISHMANIASIS DEFINITIONS & CONTROL MEASURES Dhayanithisriram A M 22

2. 1. Case definition of kala-azar : A case of kala-azar is defined as a person from an endemic area with fever of more than 2 weeks duration and with splenomegaly , who is confirmed by an RDT or a biopsy. DEFINITIONS

3. 2.Treatment outcome definitions of kala-azar : a. Cure: a patient is considered clinically cured if he/ she has completed full treatment and there are no signs and symptoms of kala-azar . b. Non-response: Signs and symptoms persist or recur despite satisfactory treatment for more than two weeks c. Relapse: reapperence of kala-azar signs and symptoms within 6 months of peroid . d. Treatment failure: non-response or relapse e. Final cure: an symptom- free at treatment .

4. 3.Case definition of PKDL: a. Probable PKDL : a patient from kala-azar endemic area with multiple hypopigmented macules, papules or nodules, who is RDT positive . b. Confirmed PKDL : a patient from kala-azar endemic area with multiple hypopigmented macules, papules, plaques or nodules, who is parasite positive in slit­ skin smear (SSS) or biopsy.

5. TREATMENT OUTCOME IN PKDL : a. Initial cure : Clinical improvement at the end of treatment - defined as a considerable reduction in the number and size of skin lesions. b. Final cure : Clinical cure 12 months after the end of treatment - defined as a complete resolution of macules, papules, plaques and nodules

6. KEY INDICATORS IN THE KALA-AZAR ELIMINATION INITIATIVE Detection rate (%) = Number of new cases of KA detected per year in the district, UHC or subdistrict --------------------------------------------------------------- X 100 Total population in the same area

7. KEY INDICATORS IN THE KALA-AZAR ELIMINATION INITIATIVE 2. Treatment completion rate (%) = Number of patients that took a full course of first-line drug --------------------------------------------------------------X100 Total population in the same area

8. KEY INDICATORS IN THE KALA-AZAR ELIMINATION INITIATIVE 3. Coverage rate of vector control (%) = Number of households protected ---------------------------------------------- X 100 All households at risk

9. MONITORING CLINICAL OUTCOMES Final cure rate (%) = Number of patients with final cure --------------------------------------------------- X 100 Total number who started treatment

10. MONITORING CLINICAL OUTCOMES 2 . Treatment failure rate (%) = Total number of non-response + relapse + KA - related deaths ------------------------------------------------- X 100 Total number who started treatment

11. Monitoring clinical outcomes 3. Loss to follow-up rate (%) = Number of defaulters + Number of loss to follow-up --------------------------------------------------- X 100 Total number who started treatment

12. MONITORING CLINICAL OUTCOMES 4 . Mortality (%) = Number of deaths ------------------------------------------------- X 100 Total number who started treatment

13. CONTROL MEASURES : In the absence of an effective vaccine, the control measures comprise the following: CONTROL OF RESERVOIR SANDFLY CONTROL PERSONAL PROPHYLAXIS

14. CONTROL OF RESERVOIR Man is the only reservoir of kala-azar in India , active and passive case detection and treatment of those found to be infected (including PKDL) may be sufficient to abolish the human reservoir and control the disease. House-to-house visits and mass surveys may be undertaken in endemic areas for early detection of cases.

15. TREATMENT GUIDELINES (2017) Indian programme : Single dose Liposomal Amphotericin B (LAMB) injection : IV, all age groups, 10 mg/kg, including paediatric , pregnant & elderly patients Miltefosine capsules of 10 mg ( paediatric ) 50 mg (adults) in the age group between 2-65 years. Not to be given to pregnant and lactating women. Combination of Paramomycin injection intramuscular & Miltefosine Amphotericin ‘B’ deoxycholate injection 1 mg/kg over 4 months in 60-80 doses . PKDL - In order of preference: First drug of choice , miltefosine 100 mg orally per day x 12 weeks.

16. Given the high efficacy, safety, ease of use and assured compliance, Liposomal Amphotericin B (LAMB) is used as the first line of treatment. Miltefosine is relatively safe oral drug for the treatment of Kala- azar . The treatment is provided as Directly Observed Treatment (DOT) with patient coding system being followed for each patient registered at the treatment centre The drugs used in order of preference at all levels are: Liposomal Amphotericin B intra venus (LAMB) singledose 10 mg/kg bw Combination regimens (e.g. Miltefosine capsules plus Paramomycin inj IM) Amphotericin B emulsion Miltefosine capsule Amphotericin B deoxycholate inj in multiple doses Amphotericin B emulsion inj in selected districts on pilotproject .

17. Body weight Daily dosage (after meal) Number of capsules 9-11 kg 20 mg 2 capsules of Miltefosine 10 mg 12-16 kg 30 mg 3 capsules of Miltefosine 10 mg 17-20 kg 40 mg 4 capsules of Miltefosine 10 mg 21-25 kg 50 mg 1 capsule of Miltefosine 50 mg 26-31 kg 60 mg 1 capsule of Miltefosine 50 mg & 1 capsule of Miltefosine 10 mg 32-39 kg 80 mg 1 capsule of Miltefosine 50 mg & 3 capsules of Miltefosine 10 mg 40 kg and above 100 mg 2 capsules of Miltefosine 50 mg DOSAGE GUIDE FOR CHILDREN (2-11 YEARS)

18. Body weight Morning dose (after meal) Evening dose (after meal) More than 25 kg 1 capsule of Miltefosine 50 mg 1 capsule of Miltefosine 50 mg Less than 25 kg 1 capsule of Miltefosine 50 mg Drug not to be given in the evening MILTEFOSINE DOSAGE GUIDE FOR PERSONS (>12 YEARS)

19. SANDFLY CONTROL RESIDUAL INSECTICIDES: effective in the control of sandflies DDT is the first choice Sprayed in human dwellings, animal shelters and all other resting places upto a height of 6 feet (2 metres ) from floor level . two rounds per year 1-2 g per sq. metre is regular intervals. Any sign of resistance in vector should lead to an immediate change in insecticide. BHC - second line of defence . SANITATION MEASURES: Elimination of breeding places (e.g., cracks in mud or stone walls, rodent burrows, removal of firewood, bricks or rubbish around houses ) L ocation of cattle sheds and poultry at a fair distance from human dwellings Improvement of housing and general sanitation

20. PERSONAL PROPHYLAXIS the use of individual protective measures , Such as Avoid sleeping on the floor, Using the fine-mesh nets around the bed. Insect repellants (in form of lotions, cream or sticks) for temporary protection Keeping environment clean Health E ducation No drugs for personal prophylaxis

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