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Kala-Azar Outbreak in Libo Kemkem, Ethiopia: Epidemiologic and Parasitologic Assessment

In May 2005, visceral leishmaniasis (VL) was recognized for the first time in Libo Kemkem, Ethiopia. In October 2005, a rapid assessment was conducted using data from 492 patients with VL treated in the district health center and a household survey of 584 residents of four villages. One subdistrict accounted for 71% of early cases, but the incidence and number of affected subdistricts increased progressively throughout 2004–2005. In household-based data, we identified 9 treated VL cases, 12 current untreated cases, and 19 deaths attributable to VL (cumulative incidence, 7%). Thirty percent of participants were leishmanin skin test positive (men, 34%; women, 26%; P = 0.06). VL was more common in men than women (9.7% versus 4.5%, P < 0.05), possibly reflecting male outdoor sleeping habits. Molecular typing in splenic aspirates showed L. infantum (six) and L. donovani (one). Local transmission resulted from multiple introductions, is now well established, and will be difficult to eradicate.

Received September 20, 2006. Accepted for publication December 14, 2006.

Acknowledgments: The outbreak assessment would not have been possible without the help of the Ministry of Health and Regional Health Bureau authorities, the WHO representative, and the Director of Addis Zemen Health Center. We thank all the staff of MSF-Greece for collaboration and for providing information, infrastructure, and many other kinds of help. We thank the highly dedicated personnel actively involved in the assessment. Special thanks is given to the patients and villagers who participated with a generous spirit. Josseline Boisbelaud provided excellent technical support.

Financial support: The rapid outbreak assessment and further VL initiatives in the region are supported by the Cooperazione Italiana and the Agencia Española de Cooperación Internacional (AECI).

Disclaimer: The authors have no conflicts of interest.

^* Address correspondence to Jorge Alvar, Department for the Control of Neglected Tropical Diseases, World Health Organization, 20 Avenue Appia, CH-1211Geneva 27, Switzerland. E-mail: alvarj{at}who.int

Authors’ addresses: Jorge Alvar, Department for the Control of Neglected Tropical Diseases, World Health Organization, 20 Avenue Appia, CH-1211Geneva 27, Switzerland. Seife Bashaye, Malaria and Other Vector Borne Diseases, Prevention and Control Program, Ministry of Health, Addis Ababa, Ethiopia. Daniel Argaw and Olusegan Babaniyi, Disease Prevention and Control Programmes, World Health Organization. P.O. Box 3069, Menelik Avenue, UNECA Compound, Addis Ababa, Ethiopia. Israel Cruz, WHO Collaborating Center for Leishmaniasis, Servicio de Parasitología, National Center of Microbiology, Instituto de Salud Carlos III, 28220-Majadahonda, Madrid, Spain. Pilar Aparicio, Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, c/Sinesio Delgado s/n, 28029 Madrid, Spain. Askal Kassa, Health Center, Addis Zemen, Ethiopia. Giannos Orfanos, Greek Medical Council, Athens, Greece. Fernando Parreño, Centro de Salud Area 7, Cea Bermúdez núm. 10, 28015-Madrid, Spain. Nigussu Gudeta, Regional Health Bureau, Bahar-Dar, Amhara State, Ethiopia. Carmen Cañavate, WHO Collaborating Center for Leishmaniasis, Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, 28220 Majadahonda, Madrid, Spain. Caryn Bern, Division of Parasitic Diseases, National Center for Zoonotic, Vector-Borne and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30341.

Reprint requests: Jorge Alvar, Department for the Control of Neglected Tropical Diseases, World Health Organization, 20 Avenue Appia, CH-1211Geneva 27, Switzerland. E-mail: alvarj{at}who.int.

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