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Natural History of a Visceral Leishmaniasis Outbreak in Highland Ethiopia

In May 2005, visceral leishmaniasis (VL) was recognized for the first time in Libo Kemken, Ethiopia, a highland region where only few cases had been reported before. We analyzed records of VL patients treated from May 25, 2005 to December 13, 2007 by the only VL treatment center in the area, maintained by Médecins Sans Frontières-Ethiopia, Operational Center Barcelona-Athens. The median age was 18 years; 77.6% were male. The overall case fatality rate was 4%, but adults 45 years or older were five times as likely to die as 5–29 year olds. Other factors associated with increased mortality included HIV infection, edema, severe malnutrition, pneumonia, tuberculosis, and vomiting. The VL epidemic expanded rapidly over a several-year period, culminating in an epidemic peak in the last third of 2005, spread over two districts, and transformed into a sustained endemic situation by 2007.

Received March 10, 2009. Accepted for publication May 12, 2009.

Acknowledgments: This assessment was made possible through the help of the Ministry of Health and Regional Health Bureau authorities, the WHO representative, and the Director of Addis Zemen Health Center. The authors thank Larry Grummer-Strawn and Jackie Roberts for advice on appropriate nutritional indicators and use of the anthropometric software. MSF-OCBA played a crucial role in identifying and managing this outbreak and the authors are indebted to its highly committed personnel. The Agencia Española de Cooperación Internacional para el Desarrollo supports the Leishmaniasis National Control Program in Ethiopia.

Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

^* Address correspondence to Caryn Bern, Division of Parasitic Diseases, National Center for Zoonotic, Vector-Borne and Enteric Diseases, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341. E-mail: cxb9{at}cdc.gov

Authors’ addresses: Mercè Herrero, Daniel Argaw, and Abate Mulugeta, Disease Prevention and Control Programmes, World Health Organization, PO Box 3069, Menelik Avenue, UNECA Compound, Addis Ababa, Ethiopia. Fernando Parreño, Oscar Bernal, Maria Angeles Lima, Laurence Flevaud, and Pedro Pablo Palma, Médecins Sans Frontières, Medical Department, Operational Centre Barcelona-Athens, Nou de la Rambla, 26, 0800 Barcelona, Spain. Pilar Aparicio, National Centre of Tropical Medicine, Instituto de Salud Carlos III, Sinesio Delgado, 6. 28029 Madrid, Spain. Daniel Rubens, Médedins Sans Frontières-Argentina, Av. Callao 531 Piso 8 Dto D, 1022, Buenos Aires, Argentina. Jaime Pedraza, Médecins Sans Frontières-Holland, C/37, 16-64, Medical Department, Bogotá, Colombia. Seife Bashaye, Malaria and Other Vector Borne Diseases, Prevention and Control Program, Ministry of Health, Ethiopia. Jorge Alvar, Control of Neglected Tropical Diseases, World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland. Caryn Bern, Division of Parasitic Diseases, 4770 Buford Highway NE (MS F-22), Centers for Disease Control and Prevention, Atlanta, GA 30341.