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We conducted a cross-sectional study to determine the incidence of visceral leishmaniasis (VL) and risk factors in two villages in Uttar Pradesh, India reported to have had a recent outbreak. In 245 households with 2,203 people, we detected 3 current VL cases, 32 past cases, and 8 VL deaths since 2001 (annual incidence = 6 per 1,000). Risk factors included living in the same household as a VL case (odds ratio [OR] = 76, P < 0.0005 in one village and OR = 22, P < 0.0005 in the other village), sleeping downstairs and outside in the summer (OR = 4.7, P = 0.004), and an age 
15 years old (OR = 2.9, P = 0.024). Increasing cattle density was a risk factor in one village but not the other. We were not able to determine the route by which VL entered the villages. Our data demonstrate a new spread of VL in previously unaffected areas. We recommend carefully supervised spraying with DDT, surveillance to pinpoint other affected villages, and efforts to increase availability of diagnostic and treatment facilities.
Received March 27, 2005. Accepted for publication May 25, 2005.
Acknowledgments: We are grateful to our indefatigable field workers (Shaheen Parveen, Zoheb Hasan, Shaziya Hasan, Dawar Ali, and Awadh Narayan) who endured many sweltering days in the field. We also thank Dr. Anil Kumar for dipstick testing, Dr. Aryeh Stein for epidemiologic suggestions, and Dr. Altaf Lal and Dr. Lalit Kant for their support. This study would have been impossible without the active participation and cooperation of the villagers of Tamachabad and Ramdattpur.
Financial support: This study was supported by the Anne E. and William A. Foege Global Health Fund, and the U.S. Department of Health and Human Services Fund for Emerging and Reemerging Infectious Diseases and Disease Surveillance
* Address correspondence to Caryn Bern, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mailstop F-22, Atlanta, GA 30341. E-mail: cxb9{at}cdc.gov
Authors’ addresses: Paul G. Barnett, % MSF-Holland, Plantage Middenloan 14, 1014 DD Amsterdam, The Netherlands, E-mail: chipbarnett2002{at}yahoo.com. Caryn Bern and Allen W. Hightower, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mailstop F-22, Atlanta, GA 30341, Telephone: 770-488-7654, Fax: 770-488-7761, E-mail: cxb9{at}cdc.gov and awh1{at}cdc.gov. S. P. Singh, Department of Community Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India. Shyam Sundar, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India, E-mail: shyam_vns{at}sify.com.
Reprint requests: Caryn Bern, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mailstop F-22, Atlanta, GA 30341. Phone: 770-488-7654. Fax: 770-488-7761. E-mail: CBern{at}cdc.gov
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  J. H Kolaczinski, R. Reithinger, D. T Worku, A. Ocheng, J. Kasimiro, N. Kabatereine, and S. Brooker Risk factors of visceral leishmaniasis in East Africa: a case-control study in Pokot territory of Kenya and Uganda Int. J. Epidemiol., April 1, 2008; 37(2): 344 - 352. [Abstract] [Full Text] [PDF]
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